INSECURITY. Food. Though analyses at the regional and national levels

Size: px

Start display at page:

Download "INSECURITY. Food. Though analyses at the regional and national levels"

Easter Blake
5 years ago
Views:

Zekeri, Tuskegee University Introduction 2008 While we live in a wealthy nation, food insecurity continues to affect millions of American families [3, 4].

1 Food INSECURITY The Southern Rural Development Center addresses... Report from RIDGE-funded research in the Southern Region Food insecurity and emotional well-being among single mothers in the rural South Andrew A. Zekeri, Tuskegee University Introduction 2008 While we live in a wealthy nation, food insecurity continues to affect millions of American families [3, 4]. Food insecurity means individuals and families have limited access to food or a limited or uncertain ability to obtain food due to lack of financial resources [3, 4]. For example, the most recent data from the United States Department of Agriculture (USDA) indicate that 11.9 percent of the United States households were food insecure in 2005 [3]. According to data published by the USDA since 1995, African American and Hispanic households are more likely than Whites to be food insecure and hungry [4, 3]. Within that group, rural African Americans remain especially vulnerable. Furthermore, households headed by single women, particularly African American women, tend to be at higher risk of food insecurity. The rural South in general, and Alabama in particular, have faced significant rates of food insecurity and hunger relative to the nation as a whole [4, 3]. Though analyses at the regional and national levels have produced new insights into the prevalence of food insecurity, largely missing from the literature is an analysis examining the consequences of the resulting food insecurity for the health and emotional well-being of rural household residents. Little research exists that delineates the health consequences of food insecurity as measured by the USDA Core Food Security Survey Module (CFSM) that was used in this study. Those analyses that do exist have examined the impact of food insufficiency as measured by one food sufficiency question from the National Health and Nutrition Examination Survey III (NHANES III) on the health status among welfare recipients in urban areas [1, 6, 8, 10]. They show that food insufficiency is associated with individuals who self-report their health statuses as fair or poor. However, published assessments of the association between household food insecurity and the physical and emotional well-being of poor single mothers in rural areas rarely have been done. As such, the purpose of this policy brief is to (a) estimate the prevalence of food insecurity among single mothers living in Alabama s Black Belt, and (b) examine the impact of food insecurity on their physical health and emotional well-being. In order to make informed decisions about policies and programs designed to reduce food insecurity, it is important to assess the link between food insecurity and the physical and mental health of rural single mothers. The Study Area Alabama s Black Belt, the site for this study, is an ideal setting for examining the prevalence and adverse health consequences of food insecurity in rural areas of the United States. Among the poorest places in the United States, this region is characterized by its high concentration of African American residents. Regionally, the Alabama Black Belt s poverty rates as of 2000 compare to that of the Appalachian mountain region, where the poor are predominantly White, the Rio Grande Valley/Texas Gulf Coast, where the poor are largely Latino, and the reservations of the Southwest, where the poor are largely Native Americans. Moreover, the Black Belt region suffers from poor employment opportunities, chronic unemployment, limited educational attainment, poor health, high concentration of single parents, and heavy dependence on public assistance programs [13, 12,

2 Page 2 11]. The five counties selected for the study are among those categorized by the USDA as persistent poverty counties. Methodology The sample for this study, 300 single mothers that were receiving welfare and/or food stamp benefits, was drawn from a list of over 500 families in a five county area of Alabama Black Belt that participated in previous studies carried out by the author [13, 12, 11]. Food insecurity was measured using a structured questionnaire based on CFSM and the other questionnaires constructed and used in previous studies, all investigations were approved by the Human Subject Participants Review Committee at Tuskegee University. The CFSM scale is based on respondents answers to a series of 18 questions regarding behaviors and experiences known to characterize households that are having difficulty meeting food needs. Face-to-face, in-home, structured interviews were conducted from June 2005 to September Consent to participate in the study was obtained from all participants. The interviews lasted approximately 90 minutes. For the present analysis, food security status is a dichotomous variable (food insecure and food secure). General Health Status and Emotional Well-Being Self-rated health status provides a direct and global way of capturing perceptions of health criteria that are as broad and inclusive as the responding individuals choose to make them. Single mothers were asked to rate their overall health at the time of the interview with a standard five-category scale, with values ranging from excellent (1) to poor (5). Self-rated health has been shown to be a reliable, valid measure of health. It has also been shown to be predictive of future health status in numerous studies, independent of other physiological, behavioral, and psychological risk factors [2]. Emotional well-being is measured by the Center for Epidemiological Studies-Depression (CES-D) scale, a widely used measure for assessing depression symptoms in the general population [7]. Respondents indicated how often, over the week preceding the interview, they had experienced each of the 20 Food insecurity was almost three times as common in this sample of single mothers as in the general U.S. population. symptoms on a fourpoint scale ranging from 0 (rarely or none of the time) to 3 (most or all of the time). Respondents scores were totaled and an average was constructed. The 20 items cover affective, psychological, and somatic symptoms. The CES-D scale is a reliable predictor of depression. In the current study, reliability was quite high, with a Chronbach s alpha of Key socio-demographic characteristics of the study participants are examined as well, such as income, education, age, race, and employment status. Results African American single mothers constituted the largest portion of the sample (65.5 percent). With respect to educational attainment, 32.5 percent of the sample had no formal education beyond high school, while only 9.2 percent had a four-year college degree (Table 1). Overall personal income was low, with just over half (50.2 percent) of the respondents earning less than $10,000 annually. About 37 percent of the single mothers were unemployed and looking for work (Figure 1). More than half of the sample (54.1 percent) were receiving food stamps at the time of interview. Table 1. Description of the Sample, Prevalence of Food Insecurity and Health Status Category Percent Race/Ethnicity African American 65.5 White 29.0 Hispanic 2.8 Educational Attainment Did not complete high school 32.5 Completed high school or equivalent 33.7 Some college of post high school training 24.5 Completed a college degree 9.2 Income Under $10, $10,000 to $14, Employment Status Employed(including part-time) 60.3 Unemployed 36.5 Participating in Food Stamp Program Receiving food stamps 54.1 Not receiving food stamps 44.0 Prevalence of Food Insecurity Food Secure 64.0 Food Insecure 36.0 Health Insurance Insured 53.8 Uninsured 46.2 Health Status Poor 8.3 Fair 29.0 Very Good 29.6 Excellent 7.9 a. Some percentage scores do not sum to 100% because missing data are not reported in the table.

Page 3 Figure 1: Demographics African American 65.5% White Hispanic 29.0% 2.

2% Annual Income Under $10,000 Annual Income Between $10,000 to $14,000 50.2% 49.5% Employed (Including Part-Time) Unemployed 36.5% 60.

study were classified as food insecure (Figure 2).

Figure 2: Food Insecurity Receiving Food Stamps 54.

The common responses for depression in the sample involved these seven items: feeling bothered by little things, poor appetite, having trouble concentrating, feeling sad, not feeling hopeful about

3 Page 3 Figure 1: Demographics African American 65.5% White Hispanic 29.0% 2.8% Did Not Complete High School Completed High School Or Equivalent Some College Or Post High school Training Completed A College Degree 9.2% 32.5% 33.7% 24.5% 9.2% Annual Income Under $10,000 Annual Income Between $10,000 to $14, % 49.5% Employed (Including Part-Time) Unemployed 36.5% 60.3% Prevalence of Food Insecurity in the Alabama Black Belt Area Using the USDA s Food Security Scale, approximately 36 percent of the rural single mothers taking part in the study were classified as food insecure (Figure 2). The prevalence of food insecurity in this region contrasts sharply with the national figure, where roughly of 12 percent suffer from food insecurity (as of 2004) [5]. Figure 2: Food Insecurity Receiving Food Stamps 54.1% Not Receiving Food Stamps Food Secure Food Insecure 44% 36% 64% The Impact of Food Insecurity on Emotional Well-Being Table 2 presents data on depressive symptoms. The common responses for depression in the sample involved these seven items: feeling bothered by little things, poor appetite, having trouble concentrating, feeling sad, not feeling hopeful about the future, having trouble sleeping, and having trouble getting started as shown in Table 2. Table 2. Percent of Participants Reporting Selected Depressive Symptoms Depressive Symptoms One of the primary goals of this study was to examine the relationship between food insecurity and health and emotional well-being of rural single mothers. As shown in Table 3, food insecurity is positively related to depression (emotional wellbeing). Compared with food-secure households, single mothers from food-insecure households were more likely to be depressed. Controlling for age, educational attainment, race and employment status, the association between food insecurity and emotional well-being remained statistically significant. Percent Not feeling hopeful about the future 69.1 Feeling sad 61.2 Bothered by things that don t usually bother 61.1 Having trouble getting started 60.4 Feeling everything I did was an effort 60.3 Having trouble sleeping 60.0 Poor appetite 59.5 Feeling lonely 57.6 Having trouble concentrating 57.5 Feeling fearful 54.4

Page 4 The Impact of Food Insecurity on Health The separate analysis was conducted for health status. We found that food insecurity is negatively related to health status.

In this study, food insecurity was a stronger predictor of health status than employment or educational attainment.

physical and mental health status [8]. Table 3.

4 Page 4 The Impact of Food Insecurity on Health The separate analysis was conducted for health status. We found that food insecurity is negatively related to health status. Single mothers in food-insecure households were more likely to be in poor or fair health status (Table 3). In this study, food insecurity was a stronger predictor of health status than employment or educational attainment. These results are consistent with other research conducted on single women on welfare located in Northern Michigan that found significant associations between food insufficiency and low self-reported physical and mental health status [8]. Table 3. Regression Analyses of Depression and Health Status among Single Mothers in Alabama s Black Belt Depression Health Status Food insecurity + + Age NS NS Employment + + Race NS NS Education + + How to interpret the table: + means the variable has a significant impact on depression and health status NS means the variable has no significant impact on depression and health status Conclusions The present research sought to examine the prevalence of food insecurity and its relationship to self-reported health status and emotional well-being among single mothers living in rural Alabama s Black Belt. The results do suggest that more than a third of low-income single mothers from rural Alabama (35.7 percent) are food insecure. Food insecurity was almost three times as common in this sample of single mothers as in the general U.S. population. This shows that United States in some regions may not be faring well in achieving its goal of reducing food insecurity to six percent by the year 2010 (one of the Healthy People 2010 objectives) [5]. What Is Healthy People 2010? Healthy People 2010 is a set of health objectives for the Nation to achieve over the first decade of the new century. It can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health. Healthy People 2010 builds on initiatives pursued over the past two decades. The 1979 Surgeon General s Report, Healthy People, and Healthy People 2000: National Health Promotion and Disease Prevention Objectives both established national health objectives and served as the basis for the development of State and community plans. Like its predecessors, Healthy People 2010 was developed through a broad consultation process, built on the best scientific knowledge and designed to measure programs over time. -Healthy People Food insecurity had significant independent effects on the health status and emotional well-being of this disadvantaged population of single mothers. Single mothers in food insufficient households were more likely to rate their health as poor or fair and to suffer from major depressive symptoms compared to those in food sufficient households (Figure 3). Figure 3: Health Status Poor Health Status 8.3% Fair Health Status Very Good Health Status Excellent Health Status 7.9% Insured Uninsured As food insecurity responses increased, responses reflecting depressive symptoms worsened. Being employed and educated appear to have positive mental health benefits for rural single mothers. These findings show the potential emotional and health vulnerability for single mothers in the rural South who live in food insecure households. Adding to this, some are living in social and physical environments that are not supportive of good health, including access to quality health care. These results mirror some analyses using the NHANES III data that found food insufficient households were more likely to experience major depression and poor health status [1, 8]. Policy Implications 29.0% 29.6% 53.8% 46.2% The findings of this study are consistent with growing national evidence that food insufficiency is associated with depression and self-reported health status [6, 8, 10, 9]. The only difference is that while this study used the 18-item CFSM scale to measure food insecurity, the majority of previous studies used a single item measure of food insufficiency [8, 1]. They highlight the need for a concerted effort to prevent food insecurity and ensure that all Americans are adequately fed in order to improve their physical health and emotional well-being. Preventing food insecurity may lower the risk of poor physical and mental health. Healthcare providers must be sensitive to multiple barriers faced by foodinsecure single mothers. Improving access to balanced meals and assessing for depression may promote better overall health among food-insecure, single mothers. Also, improving local employment contexts and job availability will be important in any policy designed to increase the emotional well-being of single mothers in the rural South.

5 Page 5 The final conclusion of this study is that food insecurity may involve physical and psychological consequences. Food insecurity should be treated as a health issue that should concern not only social scientists but also healthcare providers who should recognize that low-income, single mothers may be in need of psychological counseling in addition to increased access to optimal food to foster overall emotional and physical health. Limitations of the Study Limitations to this study include a small sample size. Further, the cross-sectional design makes it impossible to draw causal inferences from the findings. For example, it might be possible to contend that food insecurity predisposes individuals to poor health; the reverse could also be true. Following a sample of individuals over time would help determine if this study s results held true over time. Finally, only women were sampled; therefore, it is unknown if the findings are applicable to men. About the Author Andrew A. Zekeri is professor of Sociology at Tuskegee University. He has been conducting research in rural Alabama for the past 15 years. He uses a multiple-method approach that involves both qualitative and quantitative protocols. One overarching theme in Professor Zekeri s research is a focus on how the characteristics of the places in which people live influence individual s and families opportunities, behavior and well-being. One of these interests includes studying food insecurity in the rural south. He is a recipient of the Southern Rural Development Center s first Food Assistance Research Small-Grant Program (in 1998) for his study Assessing the Benefits and Problems Associated with the use of Electronic Benefits Transfer for Food Stamps in Macon County Alabama and in (2004) for his study Food Insecurity in Poor, Female-Headed Families in Five Alabama s Black Belt Counties. He also received funding from the Center under the Senior Fellows Research Initiatives program for his study, Community Action and Economic Development in Alabama s Forested Black Belt Areas. All these projects have resulted in numerous publications in scholarly journals. His recent ongoing research project funded by RAND Corporation is titled Toward Strategies for Community Action and Economic Development in the Gulf Counties of Alabama after Hurricane Katrina. For More Information: Contact the Southern Rural Development Center at Or visit us online at REFERENCES [1] Heflin, C. M., Siefert K., & Williams, D.R Food insufficiency and women s mental health: Findings from a 3 year panel of welfare recipients. Social Science and Medicine (61): [2] Idler, E., Russel, L. B., & Davis, D Survival, Functional Limitations, and Self-Rated Health in NHANES I Epidemiologic Follow-up Study, American Journal of Epidemiology 152: [3] Nord, M., Andrews, M., & Carlson, S Household Food Security in the United States, ERS11, Economic Research Service, U.S. Department of Agriculture. Retrieved April 30, 2006 from publications/err11/ [4] Nord, M. & Andrews, M Putting Food on the Table: Household Food Security in the United States. Amber Waves: [5] Nord, M Food Security in Rural Households: Rates of Food Insecurity and Hunger Unchanged in Rural Households. Rural America, 16(4): [6] Olson, C Food insecurity in women: a recipe for unhealthy tradeoffs. Top Clinical Nutrition 20(40): [7] Radloff, L.S The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1: [8] Siefert, K., Heflin, C.M., Corcoran, M., & Williams, D.R Food insufficiency and the physical and mental health of low-income women. Women and Health 32: [9] Stuff, J.E., Casey, P., Szeto, K., Gossett, J., Robbins, J. M., Simpson, P., Connell, C., & Bogle, M Household food insecurity is associated with adult health status. Journal of Nutrition 134: [10] Vozoris, N. T., & Tarasuk, V Household food insufficiency is associated with poorer health. Journal of Nutrition 133: [11] Zekeri, A. A Community-ness of a Major Economic Development Effort in a Biracial Community of Alabama. Journal of Rural Studies 15(2): [12] Zekeri, A. A Opinions of EBT Recipients and Food Retailers in the Rural South. Southern Rural Development Center, Food Assistance Policy Series (6): 1-8. [13] Zekeri, A. A The Adoption of Electronic Benefit Transfer Card for Delivering Food Stamp Benefits in Alabama: Perceptions of College Students Participating in the Food Stamp Program. College Student Journal 38(4): July 2008

Workshop on Understanding the Relationship Between Food Insecurity and Obesity Sentinel Populations November 16, 2010

Workshop on Understanding the Relationship Between Food Insecurity and Obesity Sentinel Populations November 16, 2010 Rural Populations Christine M. Olson, Cornell University Definitions of Rural Rural