THE IMPACT OF FOOD INSECURITY ON THE HEALTH AND WELL-BEING OF OLDER ADULTS: THE GROUPS MOST AT RISK

Abstract Older adults who experience food insecurity (4.6 million) often have worse health outcomes. Food insecure older adults consume less nutrients, which puts them at greater risk of developing chronic diseases. They are at increased risk of falls due the impact of poor nutrition on muscle mass, bone density, and balance. Low-income older adults are often forced to choose between buying groceries and paying other bills. The Supplemental Nutrition Assistance Program (SNAP) plays an important role in reducing food insecurity. SNAP enables older adults to buy the nutritious food they need, while freeing up resources to pay for everyday things to meet their health needs such as prescription drugs. Research shows that medication adherence increases when low-income older adults enroll in SNAP. Despite the beneficial impact of enrolling in SNAP, it’s estimated that 55% of eligible adults age 60 and older are not participating in this critical program. To understand which older adults are missing out on SNAP, the National Council on Aging engaged researchers at Leading Age LTSS Center at UMass Boston to analyze data from the 2014 Health and Retirement Study. The results show that some of the most vulnerable older adult populations are less likely to participate in SNAP even though they are eligible (i.e., Hispanic, age 75 and older, those who are not utilizing healthcare, etc.). The findings suggest that more targeted outreach to these groups is needed to ensure that the most vulnerable populations of older adults access this critical benefit.

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Food Insecurity in a Low-Income, Predominantly African American Cohort Following the COVID-19 Pandemic

American Journal of Public Health ◽

10.2105/ajph.2020.306041 ◽

2021 ◽

Vol 111 (3) ◽

pp. 494-497

Author(s):

Tamara Dubowitz ◽

Madhumita Ghosh Dastidar ◽

Wendy M. Troxel ◽

Robin Beckman ◽

Alvin Nugroho ◽

...

Keyword(s):

African American ◽

Food Insecurity ◽

Low Income ◽

The United States ◽

Supplemental Nutrition Assistance Program ◽

Food Bank ◽

Assistance Program ◽

Nutrition Assistance ◽

National Trends ◽

The Impact

Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods. Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitudinal cohort (n = 605) previously followed from 2011 to 2018. We examined longitudinal trends in food insecurity from 2011 to 2020 and compared them with national trends. We also assessed use of food assistance in our sample in 2018 versus 2020. Results. From 2018 to 2020, food insecurity increased from 20.7% to 36.9% (t = 7.63; P < .001) after steady declines since 2011. As a result of COVID-19, the United States has experienced a 60% increase in food insecurity, whereas this sample showed a nearly 80% increase, widening a preexisting disparity. Participation in the Supplemental Nutrition Assistance Program (52.2%) and food bank use (35.9%) did not change significantly during the early weeks of the pandemic. Conclusions. Longitudinal data highlight profound inequities that have been exacerbated by COVID-19. Existing policies appear inadequate to address the widening gap.

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Rapid health impact assessment of COVID-19 on families with children with disabilities living in low-income communities in Lusaka, Zambia

PLoS ONE ◽

10.1371/journal.pone.0260486 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260486

Author(s):

Mary O. Hearst ◽

Lauren Hughey ◽

Jamie Magoon ◽

Elizabeth Mubukwanu ◽

Mulemba Ndonji ◽

...

Keyword(s):

Food Insecurity ◽

Low Income ◽

Children With Disabilities ◽

Health Workers ◽

Well Being ◽

Healthcare Services ◽

Access To Health Services ◽

Adequate Food ◽

Increased Risk ◽

The Impact

Introduction Worldwide, children with disabilities are a vulnerable population and at high risk for COVID-19 morbidity and mortality. There is little information on the impact that COVID-19 had on children with disabilities and their families, particularly in low-income settings. This assessment describes the extent to which the pandemic impacted seven indicators of well-being in three low-income communities in Lusaka, Zambia. Methods Interviews were conducted with a random selection of families participating in an existing program (n = 39), community health workers (n = 6), healthcare workers (n = 7) and government officials (n = 2). Descriptive data was summarized and qualitative responses reviewed for themes. Results Most families reported a major loss of income resulting in food insecurity (79%), housing instability (67%), stress (36%), and increased risk of child separation and neglect (18%). Most families did not report receiving governmental financial assistance and reported loss of access to health services for their child such as physiotherapy (33%). Stakeholders interviewed reported that COVID-19 information was widely available although few specific interventions for children. Families were seen to have greater food insecurity, more poverty, more crowding, less healthcare services and children left alone or on the streets to beg. Discussion COVID-19 and related containment measures have impacted the lives of children with disabilities and their families to a great extent. There is an urgent need for disability-inclusive responses that deliberately address the needs of children with disabilities and their families, notably uninterrupted access to adequate food, inclusive education, rehabilitation therapy, and income-generating activities.

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“You run out of hope:” An Exploration of Low-Income Parents’ Experiences with Food Insecurity using Photovoice

Public Health Nutrition ◽

10.1017/s1368980021002743 ◽

2021 ◽

pp. 1-21

Author(s):

Payge Lindow ◽

Irene H. Yen ◽

Mingyu Xiao ◽

Cindy W. Leung

Keyword(s):

Food Insecurity ◽

San Francisco ◽

Low Income ◽

Eating Behaviors ◽

Comparative Method ◽

Well Being ◽

Structured Interviews ◽

Unhealthy Eating ◽

Low Income Families ◽

The Impact

ABSTRACT Objective: Using an adaption of the Photovoice method, this study explored how food insecurity affected parents’ ability to provide food for their family, their strategies for managing household food insecurity, and the impact of food insecurity on their well-being. Design: Parents submitted photos around their families’ experiences with food insecurity. Afterwards, they completed in-depth, semi-structured interviews about their photos. The interviews were transcribed and analyzed for thematic content using the constant comparative method. Setting: San Francisco Bay Area, California, USA. Subjects: 17 parents (14 mothers and 3 fathers) were recruited from a broader qualitative study on understanding the experiences of food insecurity in low-income families. Results: Four themes were identified from the parents’ photos and interviews. First, parents described multiple aspects of their food environment that promoted unhealthy eating behaviors. Second, parents shared strategies they employed to acquire food with limited resources. Third, parents expressed feelings of shame, guilt, and distress resulting from their experience of food insecurity. And finally, parents described treating their children to special foods to cultivate a sense of normalcy. Conclusions: Parents highlighted the external contributors and internal struggles of their experiences of food insecurity. Additional research to understand the experiences of the food-insecure families may help to improve nutrition interventions targeting this structurally vulnerable population.

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Food Insecurity in the United States: Identification, Treatment, and Implications

Innovation in Aging ◽

10.1093/geroni/igaa057.2791 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 772-773

Author(s):

Rose Ann DiMaria-Ghalili ◽

Connie Bales ◽

Julie Locher

Keyword(s):

United States ◽

Older Adults ◽

At Risk ◽

Food Insecurity ◽

Well Being ◽

The United States ◽

Health Clinic ◽

High Risk Population ◽

Geriatric Syndrome ◽

The Impact

Abstract Food insecurity is an under-recognized geriatric syndrome that has extensive implications in the overall health and well-being of older adults. Understanding the impact of food insecurity in older adults is a first step in identifying at-risk populations and provides a framework for potential interventions in both hospital and community-based settings. This symposium will provide an overview of current prevalence rates of food insecurity using large population-based datasets. We will present a summary indicator that expands measurement to include the functional and social support limitations (e.g., community disability, social isolation, frailty, and being homebound), which disproportionately impact older adults, and in turn their rate and experience of food insecurity and inadequate food access. We will illustrate using an example of at-risk seniors the association between sarcopenia, the age-related loss of muscle mass and function, with rates of food security in the United States. The translational aspect of the symposium will then focus on identification of psychosocial and environmental risk factors including food insecurity in older veterans preparing for surgery within the Veterans Affairs Perioperative Optimization of Senior Health clinic. Gaining insights into the importance of food insecurity will lay the foundation for an intervention for food insecurity in the deep south. Our discussant will provide an overview of the implications of these results from a public health standpoint. By highlighting the importance of food insecurity, such data can potentially become a framework to allow policy makers to expand nutritional programs as a line of defense against hunger in this high-risk population.

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Food Insecurity and Dietary Quality in Older Adults: Do Nutrition Assistance Programs Play a Protective Role?

Current Developments in Nutrition ◽

10.1093/cdn/nzaa061_007 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1379-1379

Author(s):

Nicholas Bishop ◽

Sarah Ullevig ◽

Krystle Zuniga ◽

Kaipeng Wang

Keyword(s):

Older Adults ◽

Food Insecurity ◽

Healthy Eating Index ◽

Dietary Quality ◽

Linear Modeling ◽

Assistance Programs ◽

Supplemental Food ◽

Nutrition Assistance ◽

Nutrition Assistance Programs ◽

The Impact

Abstract Objectives The emergence of food insecurity as a primary nutrition-related health issue among older adults suggests a need to examine how nutritional assistance programs are related to food insecurity and dietary quality in aging populations. This project examines food insecurity and dietary quality in US adults age 65 and older and the impact of nutrition assistance programs. Methods The sample was drawn from the 2012 Health and Retirement Study and 2013 Health Care and Nutrition Study and included 3779 respondents representing a population of 37,217,566 adults aged 65 and older. Food insecurity was a binary measure based on the USDA six-item US Adult Food Security Survey Module. Two forms of nutritional assistance included receipt of supplemental food from sources such as food banks and Meals-on-Wheels (1 = yes, 0 = no) and reported receipt of SNAP benefits (1 = yes, 0 = no). Dietary quality was measured using the Alternative Healthy Eating Index-2010 based on a food frequency questionnaire. General linear modeling adjusting for covariates and complex sampling design was used to test if nutritional assistance moderated the association between food insecurity and AHEI-2010. Results Around 10% of the sample was food insecure, 14% reported receipt of supplemental food, and 6.4% were SNAP benefit recipients. In covariate-adjusted models, food insecurity and receipt of SNAP benefits were not associated with AHEI-2010, but receipt of supplemental food was (b = −1.39, SE = 0.67, P = 0.038). Receipt of supplemental food moderated the association between AHEI-2010 and food insecurity (P = 0.001). Simple effect estimates suggested that among those not receiving supplemental food, the food insecure had lower AHEI-2010 scores than the food secure (b = −2.15, SE = 0.88, P = 0.014). Among those receiving supplemental food, the food insecure had greater AHEI-2010 scores than the food secure (b = 2.62, SE = 1.25, P = 0.035) and similar AHEI-2010 scores as the food secure not receiving supplemental food. Conclusions Preliminary analysis suggests that receipt of supplemental food appears to be associated with better dietary quality among food-insecure older adults and confirms the importance of food assistance programs in combating the negative effect of food insecurity on dietary quality. Funding Sources This work is supported by the Texas State University Research Enhancement Program.

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An Examination of the Adequacy of Supplemental Nutrition Assistance Program (SNAP) Benefit Levels: Impacts on Food Insecurity

Agricultural and Resource Economics Review ◽

10.1017/age.2019.30 ◽

2019 ◽

Vol 48 (3) ◽

pp. 433-447 ◽

Cited By ~ 6

Author(s):

Craig Gundersen ◽

Elaine Waxman ◽

Amy S. Crumbaugh

Keyword(s):

Food Insecurity ◽

Low Income ◽

The United States ◽

Food Prices ◽

Supplemental Nutrition Assistance Program ◽

Supplemental Nutrition ◽

Assistance Program ◽

The Difference ◽

Nutrition Assistance ◽

The Cost

The Supplemental Nutrition Assistance Program (SNAP) serves as the primary tool to alleviate food insecurity in the United States. Its effectiveness has been demonstrated in numerous studies, but the majority of SNAP recipients are still food insecure. One factor behind this is the difference in food prices across the country—SNAP benefits are not adjusted to reflect these differences. Using information from Feeding America's Map the Meal Gap (MMG) project, we compare the cost of a meal by county based on the Thrifty Food Plan (TFP)—which is used to set the maximum SNAP benefit—with the cost of the average meal for low-income food-secure households. We find that the cost of the latter meal is higher than the TFP meal for over 99 percent of the counties. We next consider the reduction in food insecurity if, by county, the maximum SNAP benefit level was set to the cost of the average meal for low-income food-secure households. We find that if this approach were implemented, there would be a decline of 50.9 percent in food insecurity among SNAP recipients at a cost of $23 billion.

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Perceptions of the Food Environment and Access among Predominantly Black Low-Income Residents of Rural Louisiana Communities

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155340 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5340

Author(s):

Denise Holston ◽

Jessica Stroope ◽

Matthew Greene ◽

Bailey Houghtaling

Keyword(s):

Food Security ◽

Focus Group ◽

Food Insecurity ◽

Low Income ◽

Food Environment ◽

Food Access ◽

The United States ◽

Grocery Store ◽

Assistance Program ◽

Nutrition Assistance

Food insecurity in rural settings is complex and not fully understood, especially from the perspective of low-income and Black residents. The goal of this study was to use qualitative methods to better understand experiences with food access and perceptions of the food environment among low-income, predominately Black rural Louisiana residents in the United States. Data were collected from focus group discussions (FGD) and focus group intake forms. Study participants were all rural residents eligible to receive at least one nutrition assistance program. FGD questions focused on perceptions of the food environment, with an emphasis on food access. Participants (n = 44) were predominately Black and female. Over half (n = 25) reported running out of food before the end of the month. Major themes included: store choice, outshopping, methods of acquiring foods other than the grocery store, and food insecurity. Concerns around price, quality, and transportation emerged as factors negatively impacting food security. Understanding residents’ perceptions and experiences is necessary to inform contextually appropriate and feasible policy and practice interventions that address the physical environment and social conditions that shape the broader physical food environment in order to achieve equitable food access and food security.

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“Now I Feel a Little Bit More Secure”: The Impact of SNAP Enrollment on Older Adult SSI Recipients

Nutrients ◽

10.3390/nu13124362 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4362

Author(s):

Katie Savin ◽

Alena Morales ◽

Ronli Levi ◽

Dora Alvarez ◽

Hilary Seligman

Keyword(s):

Older Adult ◽

Low Income ◽

Assistance Program ◽

Public Benefits ◽

Nutrition Assistance ◽

Effective Use ◽

The Impact ◽

First Time ◽

Depth Interviews ◽

Neighborhood Level

In June 2019, California expanded Supplemental Nutrition Assistance Program (SNAP) eligibility to Supplemental Security Income (SSI) beneficiaries for the first time. This research assesses the experience and impact of new SNAP enrollment among older adult SSI recipients, a population characterized by social and economic precarity. We conducted semi-structured, in-depth interviews with 20 SNAP participants to explore their experiences with new SNAP benefits. Following initial coding, member-check groups allowed for participants to provide feedback on preliminary data analysis. Findings demonstrate that SNAP enrollment improved participants’ access to nutritious foods of their choice, contributed to overall budgets, eased mental distress resulting from poverty, and reduced labor spent accessing food. For some participants, SNAP benefit amounts were too low to make any noticeable impact. For many participants, SNAP receipt was associated with stigma, which some considered to be a social “cost” of poverty. Increased benefit may be derived from pairing SNAP with other public benefits. Together, the impacts of and barriers to effective use of SNAP benefits gleaned from this study deepen our understanding of individual- and neighborhood-level factors driving health inequities among low-income, disabled people experiencing food insecurity and SNAP recipients.

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Food Insecurity and Mental Health Outcomes among Low Income, Minority Cohorts during the COVID-19 Pandemic

Proceedings of IMPRS ◽

10.18060/25947 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Sai Kodukula ◽

Amy Han

Keyword(s):

Mental Health ◽

Food Security ◽

Health Outcomes ◽

Food Insecurity ◽

Low Income ◽

Mental Health Outcomes ◽

Anecdotal Evidence ◽

Increased Risk ◽

Anxiety Depression ◽

The Impact

Objective: To examine the impact of the COVID-19 shutdowns on food insecurity and mental health outcomes among low income, minority communities in Northwest Indiana. Methods: Surveys were distributed to 160 households during the Northwest Indiana food bank distribution hours to assess food security mental health status. The survey assessed participant food security through questions adapted from the USDA food security survey module. Participant anxiety, depression, and stress scores were aggregated from questions adapted from the PHQ-4. A multiple logit regression model was utilized to estimate the risk associated with food security status and the surveyed variables. Anecdotal evidence was also collected to understand pandemic specific factors impacting participant food security. Results: Food insecurity was linked to significantly increased risk of anxiety, depression and stress. Those who identify to be food insecure have an 811 % increased risk of anxiety, 411% increased risk of depression, and 535% increased risk of stress compared to those who are food secure. In addition, a significant correlation exists between median household income and poor mental health. Anecdotal evidence identifies poor job security, food distributions, and support networks as exacerbating factors towards participant’s declining mental health. Conclusions: Our findings highlights the exacerbated impact the pandemic has had on the food security and mental health of vulnerable populations. In the light of these results and anecdotal feedback, public health measures must focus on getting increased funding towards local food banks to increase the frequency of mobile distribution markets coupled with direct subsidies to allow for food purchases, especially for those households with children. Given its impact on mental health, food insecurity status should regularly be screened by physicians access to the right resources must be provided for those screening as high risk.

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The impact of financial incentives and restrictions on cyclical food expenditures among low-income households receiving nutrition assistance: a randomized controlled trial

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-021-01223-7 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Sruthi Valluri ◽

Susan M. Mason ◽

Hikaru Hanawa Peterson ◽

Simone A. French ◽

Lisa J. Harnack

Keyword(s):

Low Income ◽

Financial Incentives ◽

Fruits And Vegetables ◽

The United States ◽

Assistance Program ◽

Added Sugar ◽

Food Expenditures ◽

Nutrition Assistance ◽

The Impact ◽

Low Income Households

Abstract Background The Supplemental Nutrition Assistance Program (SNAP) is the largest anti-hunger program in the United States. Two proposed interventions to encourage healthier food expenditures among SNAP participants have generated significant debate: financial incentives for fruits and vegetables, and restrictions on foods high in added sugar. To date, however, no study has assessed the impact of these interventions on the benefit cycle, a pattern of rapid depletion of SNAP benefits that has been linked to worsening nutrition and health outcomes over the benefit month. Methods Low-income households not currently enrolled in SNAP (n = 249) received benefits every 4 weeks for 12 weeks on a study-specific benefit card. Households were randomized to one of four study arms: 1) incentive (30% incentive for fruits and vegetables purchased with study benefits), 2) restriction (not allowed to buy sugar-sweetened beverages, sweet baked goods, or candy using study benefits), 3) incentive plus restriction, or 4) control (no incentive or restriction). Weekly household food expenditures were evaluated using generalized estimating equations. Results Compared to the control group, financial incentives increased fruit and vegetable purchases, but only in the first 2 weeks after benefit disbursement. Restrictions decreased expenditures on foods high in added sugar throughout the benefit month, but the magnitude of the impact decreased as the month progressed. Notably, restrictions mitigated cyclical expenditures. Conclusions Policies to improve nutrition outcomes among SNAP participants should consider including targeted interventions in the second half of the month to address the benefit cycle and attendant nutrition outcomes. Trial registration ClinicalTrial.gov, NCT02643576. Retrospectively registered December 22, 2014.

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