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Abstract
OBJECTIVE Food insecurity (FI) is defined as uncertain access to healthy food in quantity and quality. We hypothesize that FI may be associated with greater health-care use and absenteeism because it may amplify the effect of diseases; also, FI may be associated with reduced health-care access because it reflects economic vulnerability. The present study estimates the association between FI and health-care use and access, and absenteeism. DESIGN Cross-sectional data collected in 2015-2016. Health-care use was measured as the number of consultations, taking any drug and having been hospitalized in the past year. Health-care access was measured by the suspension of medication and having fewer consultations due to financial constraints. Absenteeism was measured by the weeks of sickness leave. Binary variables were modelled as a function of FI using logistic regressions; continuous variables were modelled as a function of FI using negative binomial and zero-inflated negative binomial regressions. Covariates were included sequentially. SETTING Portugal. PARTICIPANTS Non-institutionalized adults from the EpiDoc3 cohort (n 5648). RESULTS FI was significantly associated with health-care use before controlling for socio-economic conditions and quality of life. Moderate/severe FI was positively related to the suspension of medicines (adjusted OR = 4·68; 95 % CI 3·11, 6·82) and to having fewer consultations (adjusted OR = 3·98; 95 % CI 2·42, 6·37). FI and absenteeism were not significantly associated. CONCLUSIONS Our results support the hypothesis that FI reflects precariousness, which hinders access to health care. The greater use of health care among food-insecure people is explained by their worse quality of life and lower socio-economic condition, so that the specific role of poor nutrition is unclear.
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King A, Roofeh R, Nouryan C, Zhang M, Carney MT. Developing and Piloting a Tool to Identify Food Insecurity in Older Adults. South Med J 2019; 112:433-437. [PMID: 31375840 DOI: 10.14423/smj.0000000000001007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The literature shows that food insecurity (FI) can negatively affect the trajectory of many chronic illnesses. FI can be acutely severe for older adults, but screening for FI is not regularly performed in the hospital setting. Our goal was to develop a tool to screen for FI upon hospital discharge to identify patients who may require community food resources. This is the first attempt to build such a tool for implementation in our health system. METHODS In two university hospitals and one community hospital, patients 65 years old and older were admitted to the Internal Medicine service who would approach discharge within 2 days. We screened patients meeting our criteria using an FI tool (FIT), which addressed patterns associated with FI. All of the patients screened were offered a list of community resources. RESULTS Of the patients recruited, 69 met the study criteria. The majority of patients screened displayed some FI, with 56% having ≥3 food insecurities. Statistically significant relationships were established for individual FIT questions with age, admission albumin level, body mass index, length of stay, and median household income based on ZIP code. CONCLUSIONS Use of the FIT can help identify vulnerable patients and connect them to food resources. The FIT was easy to use, well tolerated, and time-efficient, leaving it poised for use in the busy environment of inpatient services.
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Affiliation(s)
| | | | | | - Meng Zhang
- From Northwell Health, Lake Success, New York
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Men F, Gundersen C, Urquia ML, Tarasuk V. Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study. CMAJ Open 2019; 7:E590-E597. [PMID: 31551236 PMCID: PMC6759017 DOI: 10.9778/cmajo.20190075] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Food insecurity, defined as inadequate access to food owing to financial constraints, has been associated with poor disease management. Because cost-related nonadherence to prescription drugs is a possible explanation for such association, we examined the link between food insecurity and cost-related medication nonadherence in Canada. METHODS Drawing on data for adult respondents (age ≥ 18 yr) who participated in the Canadian Community Health Survey 2016 Rapid Response module on prescription medication use, we assessed the association between household food insecurity and cost-related nonadherence to prescription drugs in the previous 12 months. We further examined the self-perceived health consequences of cost-related nonadherence among nonadherents. We applied Poisson models with bootstrap weights adjusting for sociodemographic characteristics. RESULTS Of the 11 172 respondents in our sample, 930 (8.3%) reported cost-related nonadherence. Food insecurity affected 10.5% (95% confidence interval [CI] 9.1% to 11.8%) of adherents and 47.9% (95% CI 38.1% to 57.7%) of nonadherents. After adjustment for confounders, moderate and severe food insecurity were associated with 3.83 (95% CI 2.44 to 6.03) and 5.05 (95% CI 3.27 to 7.81) times higher prevalence of cost-related nonadherence, respectively, relative to food security. Despite being associated with lower probability of cost-related nonadherence, having drug insurance did not change the relation between food insecurity and cost-related nonadherence (p > 0.1 for all interactions). Severe food insecurity was correlated with higher prevalence of health deterioration and greater use of health care services as perceived consequences of cost-related nonadherence (p < 0.01 for both). INTERPRETATION Food-insecure adults in Canada have a higher likelihood of cost-related nonadherence to prescription medications than their food-secure counterparts, which may constitute a burden on their health and lead to greater use of health care services.
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Affiliation(s)
- Fei Men
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont.
| | - Craig Gundersen
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont
| | - Marcelo L Urquia
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont
| | - Valerie Tarasuk
- Department of Nutritional Sciences (Men, Tarasuk), University of Toronto, Toronto, Ont.; Department of Agricultural and Consumer Economics (Gundersen), University of Illinois, Urbana, Ill.; Department of Community Health Sciences (Urquia), University of Manitoba, Winnipeg, Man.; Dalla Lana School of Public Health (Urquia), University of Toronto, Toronto, Ont
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54
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Miranda AC, Serag-Bolos ES, Cooper JB. Cost-related medication underuse: Strategies to improve medication adherence at care transitions. Am J Health Syst Pharm 2019; 76:560-565. [PMID: 31361859 DOI: 10.1093/ajhp/zxz010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Aimon C Miranda
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, College of Pharmacy, Tampa, FL
| | - Erini S Serag-Bolos
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, College of Pharmacy, Tampa, FL
| | - Julie B Cooper
- Department of Clinical Sciences, Fred Wilson School of Pharmacy at High Point University, High Point, NC
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Seligman HK, Berkowitz SA. Aligning Programs and Policies to Support Food Security and Public Health Goals in the United States. Annu Rev Public Health 2019; 40:319-337. [PMID: 30444684 PMCID: PMC6784838 DOI: 10.1146/annurev-publhealth-040218-044132] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Food insecurity affects 1 in 8 US households and has clear implications for population health disparities. We present a person-centered, multilevel framework for understanding how individuals living in food-insecure households cope with inadequate access to food themselves and within their households, communities, and broader food system. Many of these coping strategies can have an adverse impact on health, particularly when the coping strategies are sustained over time; others may be salutary for health. There exist multiple opportunities for aligning programs and policies so that they simultaneously support food security and improved diet quality in the interest of supporting improved health outcomes. Improved access to these programs and policies may reduce the need to rely on individual- and household-level strategies that may have negative implications for health across the life course.
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Affiliation(s)
- Hilary K Seligman
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94143, USA
- The UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California 94110, USA;
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina 27599-7590, USA;
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Pooler JA, Srinivasan M. Association Between Supplemental Nutrition Assistance Program Participation and Cost-Related Medication Nonadherence Among Older Adults With Diabetes. JAMA Intern Med 2019; 179:63-70. [PMID: 30453334 PMCID: PMC6583428 DOI: 10.1001/jamainternmed.2018.5011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/31/2018] [Indexed: 12/30/2022]
Abstract
Importance Understanding if the association of social programs with health care access and utilization, especially among older adults with costly chronic medical conditions, can help in improving strategies for self-management of disease. Objective To examine whether participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with a reduced likelihood of low-income older adults with diabetes (aged ≥65 years) needing to forgo medications because of cost. Design, Setting, and Participants This repeated cross-sectional, population-based study included 1302 seniors who participated in the National Health Interview Survey from 2013 through 2016. Individuals in the study were diagnosed with diabetes or borderline diabetes, were eligible to receive SNAP benefits, were prescribed medications, and incurred more than zero US dollars in out-of-pocket medical expenses in the past year. The data analysis was performed from October 2017 to April 2018. Exposures Self-reported participation in SNAP. Main Outcomes and Measures Cost-related medication nonadherence derived from responses to whether in the past year, older adults with diabetes delayed refilling a prescription, took less medication, and skipped medication doses because of cost. To estimate the association between participation in SNAP and cost-related medication nonadherence, we used 2-stage, regression-adjusted propensity score matching, conditional on sociodemographic and health and health care-related characteristics of individuals. Estimated propensity scores were used to create matched groups of participants in SNAP and eligible nonparticipants. After matching, a fully adjusted weighted model that included all covariates plus food security status was used to estimate the association between SNAP and cost-related medication nonadherence in the matched sample. Results The final analytic sample before matching included 1385 older adults (448 [32.3%] men, 769 [55.5%] non-Hispanic white, and 628 [45.3%] aged ≥75 years), with 503 of them participating in SNAP (36.3%) and 178 reporting cost-related medication nonadherence (12.9%) in the past year. After matching, 1302 older adults were retained (434 [33.3%] men, 716 [55.0%] non-Hispanic white, and 581 [44.6%] aged ≥75 years); treatment and comparison groups were similar for all characteristics. Participants in SNAP had a moderate decrease in cost-related medication nonadherence compared with eligible nonparticipants (5.3 percentage point reduction; 95% CI, 0.5-10.0 percentage point reduction; P = .03). Similar reductions were observed for subgroups that had prescription drug coverage (5.8 percentage point reduction; 95% CI, 0.6-11.0) and less than $500 in out-of-pocket medical costs in the previous year (6.4 percentage point reduction; 95% CI, 0.8-11.9), but not for older adults lacking prescription coverage or those with higher medical costs. Results remained robust to several sensitivity analyses. Conclusions and Relevance The findings suggest that participation in SNAP may help improve adherence to treatment regimens among older adults with diabetes. Connecting these individuals with SNAP may be a feasible strategy for improving health outcomes.
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Affiliation(s)
- Jennifer A. Pooler
- Advanced Analytics Practice Area, IMPAQ International, LLC, Columbia, Maryland
| | - Mithuna Srinivasan
- Workforce Development Practice Area, IMPAQ International, LLC, Columbia, Maryland
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Afulani PA, Coleman-Jensen A, Herman D. Food insecurity, mental health, and use of mental health services among nonelderly adults in the United States. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2018.1537868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Patience A. Afulani
- Obstetrics, Gynecology and Reproductive Sciences Dept., School of Medicine, University of California, San Francisco, California, USA
| | - Alisha Coleman-Jensen
- Economic Research Service, United Stated Department of Agriculture, Washington, D.C., USA
| | - Dena Herman
- Department of Family and Consumer Sciences, California State University, Northridge, CA, USA
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Leonard T, Hughes AE, Donegan C, Santillan A, Pruitt SL. Overlapping geographic clusters of food security and health: Where do social determinants and health outcomes converge in the U.S? SSM Popul Health 2018; 5:160-170. [PMID: 29998188 PMCID: PMC6039352 DOI: 10.1016/j.ssmph.2018.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/24/2022] Open
Abstract
We identified overlapping geographic clusters of food insecurity and health across U.S. counties to identify potential shared mechanisms for geographic disparities in health and food insecurity. By analyzing health variables compiled as part of the 2014 Robert Wood Johnson Foundation County Health Rankings, we constructed four health indices and compared their spatial patterns to spatial patterns found in food insecurity data obtained from 2014 Feeding America's County Map the Meal Gap data. Clusters of low and high food security that overlapped with clusters of good or poor health were identified using Local Moran's I statistics. Next, multinomial logistic regressions were estimated to identify sociodemographic, urban/rural, and economic correlates of counties lying within overlapping clusters. In general, poor health and high food insecurity clusters, "unfavorable cluster overlaps", were present in the Mississippi Delta, Black Belt, Appalachia, and Alaska. Overlapping good health and low food insecurity clusters, "favorable cluster overlaps", were less common and located in the Corn Belt and New England. Counties with higher black populations and higher poverty were associated with an increased likelihood of lying within overlapping clusters of poor health and high food insecurity. Generally consistent patterns in spatial overlaps between food security and health indicate potential for shared causal mechanisms. Identified regions and county-level characteristics associated with being located inside of overlapping clusters may be used in future place-based intervention and policy.
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Affiliation(s)
- Tammy Leonard
- Economics Research Group, Economics Department, University of North Texas, 1155 Union Circle #310469, Denton, TX, United States
| | - Amy E. Hughes
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Connor Donegan
- Geospatial Information Systems Department, University of Texas at Dallas, Richardson, TX, United States
| | | | - Sandi L. Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
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59
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Allen NL, Becerra BJ, Becerra MB. Associations between food insecurity and the severity of psychological distress among African-Americans. ETHNICITY & HEALTH 2018; 23:511-520. [PMID: 28140616 DOI: 10.1080/13557858.2017.1280139] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Little research exists on the association between food insecurity and mild to moderate psychological distress (MPD) among Black/African-Americans. In this study, we assess the relationship between food insecurity with and without hunger to that of both MPD and serious psychological distress (SPD) among this population. METHODS 2009 and 2011/2012 adult public-use data from African-American respondents of the California Health Interview Survey were utilized for this study (n = 4003). Descriptive statistics were utilized to identify prevalence of psychological distress among sociodemographic and mental-health associated variables. Bivariate analyses were conducted between these variables and psychological distress using survey-weighted chi-square analyses. To evaluate the association between psychological distress, our primary exposure variable of food security, and other variables, we utilized survey-weighted multinomial logistic regression. RESULTS Prevalence of mild to MPD was higher among those reporting food insecurity while SPD was highest for those with food insecurity and hunger. Results of multinomial logistic regression analysis demonstrate that while MPD was significantly associated with food insecurity, Black/African-Americans with food insecurity and hunger displayed over sixfold odds of higher serious psychological distress, as compared to those living at or above 200% federal poverty level. CONCLUSION Our findings add to this growing segment of the literature on psychological distress and food insecurity. Further focus should be placed on improving the efficacy and reach of both formal and informal food support networks to improve the collective health and well-being of poor Black/African-American communities.
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Affiliation(s)
- Nickolas L Allen
- a Department of Health Science and Human Ecology , California State University, San Bernardino , San Bernardino , CA , USA
| | - Benjamin J Becerra
- b School of Allied Health Professions , Loma Linda University , Loma Linda , CA , USA
| | - Monideepa B Becerra
- c Department of Health Science and Human Ecology , California State University, San Bernardino , San Bernardino , CA , USA
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Housing and Food Insecurity, Care Access, and Health Status Among the Chronically Ill: An Analysis of the Behavioral Risk Factor Surveillance System. J Gen Intern Med 2018; 33:644-650. [PMID: 29299816 PMCID: PMC5910337 DOI: 10.1007/s11606-017-4255-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/27/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The proportion of the United States population with chronic illness continues to rise. Understanding the determinants of quality of care-particularly social determinants-is critical to the provision of care in this population. OBJECTIVE To estimate the prevalence of housing and food insecurity among persons with common chronic conditions and to assess the independent effects of chronic illness and sociodemographic characteristics on (1) housing and food insecurity, and (2) health care access hardship and health status. DESIGN Cross-sectional study. PARTICIPANTS We used data from the 11 states and one territory that completed the social context module of the 2015 Behavioral Risk Factor Surveillance System (BRFSS). MAIN MEASURES We estimated the prevalence of housing and food insecurity among patients with cancer, stroke, cardiovascular disease, and chronic lung disease. Logistic regression models were used to assess the independent effects of housing and food insecurity, chronic conditions, and demographics on health care access and health status. KEY RESULTS Among the chronically ill, 36.71% (95% CI: 35.54-37.88) experienced housing insecurity and 30.60% (95% CI: 29.49-31.71) experienced food insecurity. Cardiovascular and lung disease increased the likelihood of housing (OR 1.69, 95% CI: 1.07-2.66 and OR 1.71, 95% CI: 1.12-2.60, respectively) and food insecurity (OR 1.75, 95% CI: 1.12-2.73 and OR 1.78, 95% CI: 1.20-2.63, respectively). Housing and food insecurity significantly increased the risk of health care access hardship. Being insured or having an income level above 200% of the federal poverty level significantly reduced the likelihood of access hardship, while female gender significantly increased the likelihood. CONCLUSIONS Chronic illness independently affects housing and food insecurity. In turn, food and housing anxiety leads to reduced access to care, likely due to cost concerns, and correlates with poorer health. A more complete understanding of the pathways by which chronic illness influences social determinants and clinical outcomes is needed.
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61
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Chang Y, Hickman H. Food Insecurity and Perceived Diet Quality Among Low-Income Older Americans with Functional Limitations. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:476-484. [PMID: 29107473 DOI: 10.1016/j.jneb.2017.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 08/30/2017] [Accepted: 09/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate how functional limitations are associated with food insecurity and perceived diet quality in low-income older Americans. DESIGN Nationwide repeated cross-sectional surveys regarding health and nutritional status. SETTING The National Health and Nutrition Examination Surveys, 2007-2008, 2009-2010, and 2011-2012. PARTICIPANTS Individuals aged ≥65 years with household incomes ≤130% of the federal poverty level (n = 1,323). MAIN OUTCOME MEASURES Dependent variables included dichotomous indicators of food insecurity and poor-quality diet, measured with the household food security survey module and respondents' own ratings, respectively. Independent variable was presence of limitations in physical functioning. ANALYSIS Weighted logistic regressions with nested controls and interaction terms. RESULTS Functional limitations in low-income older adults were associated with 1.69 times higher odds of food insecurity (P < .01) and 1.65 times higher odds of poor-quality diet (P < .01) after accounting for individuals' health care needs and socioeconomic conditions. These associations were greatest among those living alone (odds ratio = 3.38 for food insecurity; 3.07 for poor-quality diet; P < .05) and smallest among those living with a partner. CONCLUSIONS AND IMPLICATIONS Low-income older adults who live alone with functional limitations are exposed to significant nutritional risk. Resources should be directed to facilitating their physical access to healthful foods.
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Affiliation(s)
- Yunhee Chang
- Department of Nutrition and Hospitality Management, University of Mississippi, University, MS.
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Srinivasan M, Pooler JA. Cost-Related Medication Nonadherence for Older Adults Participating in SNAP, 2013-2015. Am J Public Health 2017; 108:224-230. [PMID: 29267062 DOI: 10.2105/ajph.2017.304176] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To estimate the impact of Supplemental Nutrition Assistance Program (SNAP) participation on cost-related medication nonadherence (CRN) for older adults in the United States, with a particular focus on those who are food insecure and those threatened by hunger. METHODS We used propensity score matching to create matched intervention and comparison groups of SNAP-eligible US adults aged 60 years and older with data from the 2013-2015 National Health Interview Survey. Intervention group participants were identified on the basis of self-reported SNAP participation in the past year. RESULTS SNAP participants were 4.8 percentage points less likely to engage in CRN than eligible nonparticipants (P < .01). The effect of SNAP is about twice as large for older adults threatened by hunger (9.1 percentage points; P < .01), and considerable even for those who are food insecure (7.4 percentage points; P < .05). CONCLUSIONS Findings point to a spillover "income effect" as SNAP may help older adults better afford their medications, conceivably by reducing out-of-pocket food expenditures. When prescribing treatment plans, health systems and payers have a vested interest in connecting older patients to SNAP and other resources that may help address barriers to care.
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Affiliation(s)
- Mithuna Srinivasan
- At the time of this study, the authors were with IMPAQ International, Washington, DC
| | - Jennifer A Pooler
- At the time of this study, the authors were with IMPAQ International, Washington, DC
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Higashi RT, Craddock Lee SJ, Pezzia C, Quirk L, Leonard T, Pruitt SL. Family and Social Context Contributes to the Interplay of Economic Insecurity, Food Insecurity, and Health. ANNALS OF ANTHROPOLOGICAL PRACTICE 2017; 41:67-77. [PMID: 30233917 DOI: 10.1111/napa.12114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In this study, we show how household health, economic instability, and food insecurity are inextricably linked; disruptions in individual health or income create cumulative and interdependent challenges faced by multiple household members. Drawing upon semi-structured focus groups with English- and Spanish-speaking clients of an urban food pantry, we demonstrate: (1) the impact of economic scarcity on health, (2) the impact of one household member's health on the health and food security of all household members, and (3) food sharing behaviors among family and social networks, including multi-generational families and non-kin individuals. We identify the gap between household-level assessments of food insecurity and individual-level health reports, which may obscure poor health among other household members. Understanding the social and family context of health and food insecurity may inform future interventions that address the interrelated challenges of diverse and disadvantaged households and communities.
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Affiliation(s)
- Robin T Higashi
- UT Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-9066
| | - Simon J Craddock Lee
- UT Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-9066.,Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75235
| | - Carla Pezzia
- University of Dallas, 1845 East Northgate Drive, Irving, TX 75062
| | - Lisa Quirk
- UT Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-9066
| | - Tammy Leonard
- University of Dallas, 1845 East Northgate Drive, Irving, TX 75062
| | - Sandi L Pruitt
- UT Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-9066.,Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75235
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Brucker DL, Coleman-Jensen A. Food Insecurity Across the Adult Life Span for Persons With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2017. [DOI: 10.1177/1044207317710701] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Food insecurity is an inability to afford the food necessary for a healthy, active life. Using pooled data from the 2011–2014 National Health Interview Survey, this study compares food insecurity among young adults, working-age adults, and older adults with and without disabilities. Results confirm that adults with disabilities have higher odds of living in food-insecure households than adults without disabilities. For adults with and without disabilities, working-age persons face the highest levels of food insecurity compared with other age groups. Older adults face the lowest odds of living in food-insecure households. Across all age groups, persons with mental health limitations are particularly vulnerable.
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Pruitt SL, Leonard T, Xuan L, Amory R, Higashi RT, Nguyen OK, Pezzia C, Swales S. Who Is Food Insecure? Implications for Targeted Recruitment and Outreach, National Health and Nutrition Examination Survey, 2005-2010. Prev Chronic Dis 2016; 13:E143. [PMID: 27736055 PMCID: PMC5063607 DOI: 10.5888/pcd13.160103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Food insecurity is negatively associated with health; however, health needs may differ among people participating in food assistance programs. Our objectives were to characterize differences in health among people receiving different types of food assistance and summarize strategies for targeted recruitment and outreach of various food insecure populations. Methods We examined health status, behaviors, and health care access associated with food insecurity and receipt of food assistance among US adults aged 20 years or older using data from participants (N = 16,934) of the National Health and Nutrition Examination Survey from 2005 through 2010. Results Food insecurity affected 19.3% of US adults (95% confidence interval, 17.9%–20.7%). People who were food insecure reported poorer health and less health care access than those who were food secure (P < .001 for all). Among those who were food insecure, 58.0% received no assistance, 20.3% received only Supplemental Nutrition Assistance Program (SNAP) benefits, 9.7% received only food bank assistance, and 12.0% received both SNAP and food bank assistance. We observed an inverse relationship between receipt of food assistance and health and health behaviors among the food insecure. Receipt of both (SNAP and food bank assistance) was associated with the poorest health; receiving no assistance was associated with the best health. For example, functional limitations were twice as prevalent among people receiving both types of food assistance than among those receiving none. Conclusion Receipt of food assistance is an overlooked factor associated with health and has the potential to shape future chronic disease prevention efforts among the food insecure.
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Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center and Harold C. Simmons Cancer Center, 5323 Harry Hines Blvd, Dallas, TX 75390.
| | | | - Lei Xuan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Richard Amory
- The Hunger Center, North Texas Food Bank, Dallas, Texas
| | - Robin T Higashi
- University of Texas Southwestern Medical Center, Dallas, Texas
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67
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Abstract
In this longitudinal study, we applied structural equation modeling (SEM) to examine the historical, predisposing, enabling/barrier, and need factors as related to the underuse of medical services during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N = 548) followed from adolescence to early midlife. The findings supported a mediational model: A mutually affectionate parent-child relationship in early adolescence was inversely related to underuse of medical services in early midlife via the mediational roles played by later predisposing factors (i.e., depressive mood and cigarette smoking), need factor (i.e., physical health problems), barriers (i.e., financial difficulty), and enabling factors (i.e., social support for health services in early midlife). In addition, satisfaction with medical services in the neighborhood had an association with less underuse of medical services in early midlife. Family therapy focused on an increase in the affectionate relationship between the adolescents and his/her parents and cognitive-behavioral treatment of depressive mood may lead to a decrease in the underuse of medical services.
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Affiliation(s)
- Chenshu Zhang
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY, 10016, USA
| | - Judith S Brook
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY, 10016, USA.
| | - Carl G Leukefeld
- Department of Behavioral Sciences, University of Kentucky, Lexington, KY, USA
| | - David W Brook
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY, 10016, USA
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Knight CK, Probst JC, Liese AD, Sercye E, Jones SJ. Household food insecurity and medication "scrimping" among US adults with diabetes. Prev Med 2016; 83:41-5. [PMID: 26656403 DOI: 10.1016/j.ypmed.2015.11.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/27/2015] [Accepted: 11/29/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Our research examined the prevalence of food insecurity among adults with self-reported diabetes and whether food insecurity was associated with cutting back ("scrimping") on prescribed medications because of financial constraints. METHODS We conducted a cross-sectional analysis of data from the 2011 National Health Interview Survey (NHIS). Adults completing this survey were considered to have diabetes if they reported current use of insulin or "diabetic pills" (n=3,242). Food insecurity was determined with a 10-item scale; respondents were categorized as food secure (FS), marginally food secure (MFS) or food insecure (FI). RESULTS Approximately one in six adults in NHIS with diabetes reported food insecurity (17.0%), and an additional 8.8% were marginally FS. An individual was considered to be scrimping on medications if he/she gave a "yes" response to at least one of four questions pertaining to reduced, delayed or avoided medication use. Overall, 18.9% of respondents with diabetes reported one or more type of medication scrimping: 11.7% of FS individuals, 27.7% of MFS individuals and 45.6% of FI individuals. In adjusted analyses, marginal food security and food insecurity remained strongly associated with scrimping. CONCLUSIONS One-quarter of adults with diabetes may have difficulty obtaining foods appropriate for a diabetic diet; a substantial number of these individuals also fail to obtain or take medications. Practitioners may miss either problem unless targeted questions are included in clinical encounters. Clinicians should consider referring FI and MFS diabetic patients to community food resources.
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Affiliation(s)
- Chadwick K Knight
- South Carolina Department of Health and Environmental Control, United States.
| | - Janice C Probst
- Department of Health Services Policy and Management, Arnold School of Public Health, 915 Greene Street, Room 355, University of South Carolina, Columbia, SC 29208, United States
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, Room 461, University of South Carolina, Columbia, SC 29208, United States
| | - Erica Sercye
- Cancer Prevention and Control Program, Arnold School of Public Health, 915 Greene Street, Room 249, University of South Carolina, Columbia, SC 29208, United States
| | - Sonya J Jones
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, 915 Greene Street, Room 435B, University of South Carolina, Columbia, SC 29208, United States
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