Food security among young adults with disabilities in the United States: Findings from the National Health Interview Survey

The Impacts of the COVID-19 Pandemic on Receipt of Needed Medical Care and At-Home Support among U.S. Households Receiving Supplemental Security Income and Social Security Disability Insurance on the Basis of Disability

More than 8.1 million Americans with disabilities qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Individuals with disabilities were particularly vulnerable to COVID-19, which may have altered individual and household behavior. Research on the impact of COVID-19 on individuals with disabilities and their families remains limited. Authors analyzed 2020 National Health Interview Survey data. Logistic regression models were applied, controlling for the effects of age, race, sex, income, education, employment, and health status. Households with SSI/SSDI beneficiaries with disabilities were associated with significantly greater odds of delaying or forgoing medical care and receiving needed personal and household care at home due to COVID-19 compared with households without beneficiaries. The health and well-being of households with individuals with disabilities may require more robust and inclusive social work initiatives that aim to reduce adverse pandemic impacts.

College students with disabilities report higher rates of food insecurity

BACKGROUND

Increased risk of food insecurity has been reported among both college students and persons with disabilities; however, food insecurity among college students with disabilities has not been explored.

OBJECTIVE

This article aims to characterize the prevalence of food insecurity among college students with and without disabilities at a northeastern university.

METHODS

Cross-sectional data were collected between 2018 and 2020at a public northeastern university as part of the ongoing College Health and Nutrition Assessment Survey. An online survey collected self-reported data, including food security and disability status. Chi-square and logistic regression analyses examined the differences in food insecurity among college students with and without disabilities.

RESULTS

The sample (n = 880) was 61.6% female, predominately white (94.5%), and had a mean age of 19 ± 1.2 years. One out of eight participants (13.3%) reported a disability. Low or very low food security (13.3% and 5.5% respectively) was reported in one out of five participants, while 81.4% reported high or marginal food security (67.6% and 13.8%, respectively). Participants with a disability were more than twice as likely to report food insecurity than those without a disability (35.9% vs. 16.0%, p < 0.001). Among participants with a disability, 12.8% reported very low food security and 23.1% reported low food security, compared to 4.3% and 11.7%, respectively, among those students without disabilities (p < 0.001).

CONCLUSIONS

College students with disabilities experienced disproportionally higher rates of food insecurity than students without disabilities. Further research in diverse institutions can help to better understand and develop targeted supports for this vulnerable segment of the college population.

Food security for survivors of intimate partner violence: Understanding the role of food in survivor well-being

Intimate partner violence (IPV) and food security are two leading public health issues that disproportionately impact women in the United States. Despite this connection, the relationship between IPV and food security has been relatively unexplored. While food security is a known factor in increased well-being, it is not often explicitly included in care for survivors. As part of a larger study on survivors of domestic violence who are receiving services from a domestic violence and sexual assault agency in the Southern United States, we analysed participant responses (n = 26) to various scales (i.e. depression, anxiety, PTSD, disability, well-being, hope, food security) to determine the relationships between mental health and food-related variables. Importantly, findings from our study show that survivors experience low food security at higher rates (53.8%) than the U.S. national average (11.5%). Additionally, the proportion of survivors in our sample who are receiving some form of food aid and remain food insecure is high (26.9%), leading to questions about the adequacy of food aid. Finally, our results underpin the relationship between food security and mental health for survivors, as low food security is positively correlated with depression, PTSD, disability, trouble concentrating, lack of hope and decreased well-being. These findings have implications for how we evaluate food security and the role it plays in well-being for survivors.

Access to food and health care during the COVID-19 pandemic by disability status in the United States

BACKGROUND

The COVID-19 pandemic has impacted people's access to food and health care. People with disabilities may be disproportionately affected by these outcomes due to structural and social barriers.

OBJECTIVE/HYPOTHESIS

To examine the relative prevalence of food insufficiency and unmet health care needs among the U.S. residents by vision, hearing, cognition, and mobility disability.

METHODS

We used data from the Household Pulse Survey wave conducted from April 14 to April 26, 2021, when questions about functional disability were first included. Participants were asked about difficulty seeing, hearing, remembering or concentrating, and walking or climbing stairs. The outcomes of interest were food insufficiency, delaying needed medical care and not getting needed medical care. Poisson regression models with robust variance adjusted for potential confounders were used to examine the prevalence ratio of each of these outcomes by disability status in separate models for each type of disability.

RESULTS

During April 14-26, 2021, 39.5% adults in the U.S. reported cognitive disability, 30.8% reported vision disability, 23.2% reported mobility disability, and 14.9% reported hearing disability. Adults with any type of disability were more likely than those without to experience food insufficiency (range of prevalence rate ratios [PRR]: 1.67-1.96), and delay (range of PRR: 1.48-1.87) or not get (range of PRR: 1.60-2.07) needed medical care.

CONCLUSIONS

These disparities suggest there is an urgent need to address the negative impact of the COVID-19 pandemic on people with disabilities. The prioritization of disability data collection is key in achieving that goal.

Food sufficiency and the utilization of free food resources for working-age Americans with disabilities during the COVID-19 pandemic

BACKGROUND

Working-age people with disabilities are an economically disadvantaged population more likely than those without disabilities to live in food insecure households.

OBJECTIVE/HYPOTHESIS

Compare rates of food sufficiency and utilization of free food sources between working-age persons with and without disabilities in the US during the COVID-19 pandemic.

METHODS

In September 2020, an online survey was conducted with n = 13,270 working-age individuals with and without disabilities to gather information about food sufficiency prior to COVID-19 (i.e., in March 2020) and within the last seven days as well as receipt of free groceries or meals, use of food programs or pantries, and concerns with using free food sources over the past week. Descriptive and multivariate statistics were used to compare these measures for persons with and without disabilities.

RESULTS

Controlling for sociodemographic characteristics, the proportion of working-age persons who were food sufficient decreased from March 2020 to September 2020 for persons with disabilities (59%-53%, a six-percentage point decrease) and for persons without disabilities (77%-73%, a four-percentage point decrease). The rates of change were not significantly different between groups. In September 2020, higher proportions of persons with disabilities (57%) used free food resources in the past week than persons without disabilities (41%).

CONCLUSIONS

The low rate of food sufficiency, the high rate of free food resource utilization, and the concerns noted by working-age persons with disabilities in using these sources suggest a need for continuing nutrition assistance policy and program development targeted towards the needs of persons with disabilities.

The impact of disability on employment and financial security following the outbreak of the 2020 COVID-19 pandemic in the UK

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic may have a greater impact on people with disabilities than non-disabled people. Our aim was to compare the short-term impact of the 2020 COVID-19 pandemic and first lockdown on the employment and financial security of working age adults with and without disabilities in the UK.

METHODS

Secondary analysis of data collected in Wave 9 and the special April, May and June COVID-19 monthly surveys of 'Understanding Society', the UK's main annual household panel study.

RESULTS

During the first 3 months of the introduction of the COVID-19 lockdown in the UK, respondents with disability were more likely than their peers to be working reduced hours and experience higher levels of financial stress. These differences were attenuated, but not eliminated, when estimates were adjusted to take account of pre-lockdown financial status.

CONCLUSIONS

Working age adults with disability were particularly disadvantaged by the financial impact of the COVID-19 lockdown in the UK. The UN Secretary-General António Guterres has stated the need for a disability-inclusive COVID-19 government response. The results of our analysis suggest that these pleas have either not been heeded, or if measures have been implemented, they have so far been ineffectual in the UK.

Food sufficiency and the utilization of free food resources for working-age Americans with disabilities during the COVID-19 pandemic

BACKGROUND

Working-age people with disabilities are an economically disadvantaged population more likely than those without disabilities to live in food insecure households.

OBJECTIVE/HYPOTHESIS

Compare rates of food sufficiency and utilization of free food sources between working-age persons with and without disabilities in the US during the COVID-19 pandemic.

METHODS

In September 2020, an online survey was conducted with n = 13,277 working-age individuals with and without disabilities to gather information about food sufficiency prior to COVID-19 (i.e., in March 2020) and within the last seven days as well as receipt of free groceries or meals, use of food programs or pantries, and concerns with using free food sources over the past week. Descriptive and multivariate statistics were used to compare these measures for persons with and without disabilities.

RESULTS

Controlling for sociodemographic characteristics, the proportion of working-age persons who were food sufficient decreased from March 2020 to September 2020 for persons with disabilities (65%-57%, an eight-percentage point decrease) and for persons without disabilities (78%-73%, a five-percentage point decrease). The rates of change were not significantly different between groups. In September 2020, higher proportions of persons with disabilities (58%) used free food resources in the past week than persons without disabilities (41%).

CONCLUSIONS

The low rate of food sufficiency, the high rate of free food resource utilization, and the concerns noted by working-age persons with disabilities in using these sources suggest a need for continuing nutrition assistance policy and program development targeted towards the needs of persons with disabilities.

Food security and health in transition to adulthood for individuals with disabilities

BACKGROUND

Due to a more stringent disability definition used for eligibility redetermination at age 18, individuals with disabilities may lose eligibility for the Supplement and Nutrition Assistance Program (SNAP).

OBJECTIVE

This study examines how the transition to adulthood may affect the association between food security and self-rated health and healthcare needs for individuals with disabilities.

METHODS

The study uses five years of data (2011-2015) from the National Health Interview Survey (NHIS). One health indicator, self-rated health status, and two indicators of unmet healthcare needs, delayed medical care and not receiving medical care due to cost, are analyzed as dependent variables. The effects of food security status on health and health-related outcomes are closely examined for the four groups: youth without disabilities, youth with disabilities, young adults without disabilities and young adults with disabilities.

RESULTS

Results indicate a statistically significant association between food security status and self-rated health and unmet healthcare needs in late childhood and young adulthood. Such association is stronger for young adults than for youth. The association between low food security and self-rated health and health-related outcomes does not significantly differ between the two youth groups or the two young adult groups by disability status.

CONCLUSIONS

Suggestions for improving accessibility of public food and nutrition programs are discussed. The study also suggests the importance of creating a healthcare system that benefits every member of the society.

Multiple financial stressors and serious psychological distress among adults in the USA

OBJECTIVES

Financial stress has adverse consequences for health. However, the association between individual and cumulative associations of multiple financial stressors and serious psychological distress (SPD) is unclear.

METHODS

Using data from the 2017 National Health Interview Survey, we examined cross-sectional associations between perceived financial worries, healthcare insecurity, food insecurity, and SPD among 23,317 US adults. Associations were examined using logistic regression.

RESULTS

Among US adults in 2017, the overall prevalence of SPD was 3.6%. Among those with SPD, 85.5% were financially worried, 50.3% were food insecure, and 51.2% were healthcare insecure. Financial worries (OR 4.27; CI 3.31, 5.52), food insecurity (OR 2.34; CI 1.92, 2.85), and healthcare insecurity (OR 2.26; CI 1.85, 2.76) were each associated with higher odds of SPD. A dose-response association was found between the number of stressors and SPD.

CONCLUSIONS

Each financial stressor was adversely associated with SPD both individually and cumulatively, indicating the adverse effects of the accumulation of these stressors. Additional studies are needed to understand the longitudinal effects of multiple financial stressors on mental health outcomes.

Disability, food insecurity by nativity, citizenship, and duration

Prior research examines the prevalence of either disability or food insecurity among immigrants. We examine whether the presence of a disability operates as a stronger predictor of food insecurity among prime-aged immigrants relative to the US-born. Probit models estimate the relationship of disability with food insecurity among immigrants and distinguish by duration of US residence and citizenship status using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2014. Descriptively, food insecurity was highest among non-citizen immigrants with longer durations of US residence, compared to non-citizen immigrants with shorter durations and naturalized immigrants. Multivariate results suggest that among Hispanics, the association between disability and food insecurity was stronger among immigrants compared to US-born adults; the disability-food insecurity association varied by an immigrant's duration of US residence and citizenship status. The results emphasize the importance of disaggregating by citizenship status and duration of US residence.

A Systematic Review and Meta-analysis of Depression, Anxiety, and Sleep Disorders in US Adults with Food Insecurity

INTRODUCTION

A large number of peer-reviewed studies, with various methodologies and populations, have addressed the effects of food insecurity (FIS) on mental health conditions such as depression, anxiety, and sleep disorders. There are currently, however, no published systematic assessments or meta-analyses of this literature.

METHODS

A systematic search of the literature was conducted in PubMed, PsycInfo, Embase, Scopus, and Web of Science. Cross-sectional studies assessing the association between food insecurity and depression, anxiety, or sleep disorders were identified. For each of the three health outcomes, we extracted (or calculated when possible) the following effect sizes: odds ratio (OR), Hedges' g, Pearson correlation coefficients r, or bivariate coefficients. Then, for each mental health-outcome/effect-size pair, the available studies were combined using the random effect model. Heterogeneity, publication bias, and subgroup dependence, for each meta-analysis, were also assessed.

RESULTS

Fifty-seven studies provided cross-sectional data on the relationship between FIS and depression (n = 169,433), 13 on anxiety and psychological distress (n = 91,957), and 8 studies provided data on sleep disorders (n = 85,788). Meta-analysis showed that FIS is associated with an increased risk of testing positive for depression OR = 2.74 [95% CI 2.52-2.97, n = 135,500, Q(df = 41) = 69, I² = 40%], anxiety OR = 2.41 [95% CI 1.81-3.22, n = 51,541, Q(df = 3) = 8, I² = 63%], and sleep disorders OR = 1.80 [95% CI 1.51-2.15, n = 84,800, Q(df = 5) = 13, I² = 62%]. The highest risks were found for depression and anxiety which had statistically similar values. The results were robust to covariates and population groups.

DISCUSSION

This systematic review and meta-analysis demonstrates a strong association between FIS and depression, anxiety, and sleep disorders, for which more longitudinal studies addressing effect sizes are warranted to further study causation.

Are You Getting Enough to Eat? Addressing Food Insecurity in Rehabilitation Clients

Food insecurity is a well-known risk factor for poor health and quality-of-life outcomes. Recent explorations of census data have concluded that it is experienced disproportionately by individuals with disabilities, making it an important area of focus for rehabilitation counseling and research. The purpose of this study is to explore the relationship between food insecurity and work barriers and intrapersonal characteristics that are often the focus of rehabilitation counseling. Findings from a national sample of adults with disabilities ( N = 435) reveal that individuals with less than a bachelor’s degree or in a household earning less than $40,000 per year were more likely to report high food insecurity. In addition, food insecurity correlated with unfavorable outcomes in measures of self-reported health, depression, social support, acceptance of chronic illness and disability (CID), and vocational self-efficacy. Implications are presented for increasing attention to the issue of food insecurity within the context of rehabilitation counseling practice and research, including strategies for augmenting services to include food assistance in a way that is sensitive to the experience of individuals with significant resource gaps.

Freshmen at a University in Appalachia Experience a Higher Rate of Campus than Family Food Insecurity

Food insecurity means having limited or uncertain access, in socially acceptable ways, to an adequate and safe food supply. Ample evidence has identified college students as vulnerable to this problem, but little research has focused on freshmen. This cross-sectional study examined family and campus food insecurity among freshmen at a university in Appalachia. An online questionnaire contained sociodemographic items and scales that measured food security status, academic progress, coping strategies for accessing food, and social support. T-tests and Chi square analyses compared food insecure and food secure students. Statistical significance was p < .05. Participants were 456 freshmen, 118 males (26%) and 331 females (73%). Family and campus food insecurity were experienced by 32 (7.1%) and 98 (21.5%) of the freshmen, respectively, and 42.5% of those who experienced campus food insecurity believed their food access had worsened since starting college. Family and campus coping strategies, respectively, included stretching food (72.9 vs. 18.4%) and purchasing cheap, processed food (68.8 vs. 16.3%). Food secure students scored significantly higher on self-rated measures of academic progress (p < .01), and greater proportions of food secure students (60.7 vs. 43.9%, p < .01) perceived their eating habits since starting college as "healthy/very healthy," and perceived their health status as "good/excellent" (86.0 vs. 71.4%, p < .01). Students requested assistance with job opportunities (19.4%), affordable meal plans (18.4%), money management (13.3%), and eating healthy (11.2%). Findings suggest that college student food insecurity begins during the freshmen year, and that there is a need for campus and community-based interventions to increase food access among these freshmen and their families.

Transition to adulthood: Dynamics of disability, food security, and SNAP participation

INTRODUCTION

This study examines how the transition to adulthood may affect food security for individuals with disabilities and estimates the effects of SNAP participation on their food security during the transition.

METHODS

The study uses a repeated cross-sectional design with five years of data (2011-2015) from the National Health Interview Survey (NHIS) in the US. The difference-in-difference approach is applied to compare individuals with and without disabilities regarding their food security status in adolescence and young adulthood. Instrumental Variable analyses are conducted using state SNAP policy rules as exogenous instruments to estimate the effects of SNAP participation on food security status for youth and young adults with disabilities.

RESULTS

Results indicate that transition into adulthood results in greater food security for individuals without disabilities but an increased risk of low food security for individuals with disabilities. The increased risk for young adults with disabilities may well put them at very low food security, the most severe category on the food security scale. SNAP participation appears to have greater impacts for youth than for young adults.

CONCLUSIONS

Since food security likely has a profound impact on the long-term development, economic independence, and self-sufficiency, we discuss a few policy strategies that may help individuals with disabilities in their transition to adulthood.

Disability and food access and insecurity: A scoping review of the literature

A scoping review was conducted, using a social ecological model approach, of 106 articles examining the effect of disability on food access and (in)security. Results of the review show a consistently increased risk of food insecurity among people with disabilities with a higher risk for mental health disabilities, and among disabled younger adults. Mediators of this relationship were underexplored. Disability was mainly conceptualized as a problematic category preventing food access while ignoring disabling social and environmental barriers. A social model of disability can inform future research by acknowledging the role of socio-environmental influences on the production and experience(s) of disability.

Reaching rural veterans: a new mechanism to connect rural, low-income US Veterans with resources and improve food security

Background

Rural, low-income US veterans face additional barriers to accessing food and resources compared to urban veterans. Based on both social-ecological and cultural competence approaches, the Reaching Rural Veterans (RRV) pilot intervention built on the existing infrastructure of food pantries to improve food security and connect rural, low-income veterans with resources. This article describes the process of implementing and evaluating RRV.

Methods

Five rural food pantries within each of two states, Indiana and Kentucky, received training in cultural competence and held monthly outreach events where food and services were offered to veterans. Veteran adult participants completed an assessment at baseline and 3-month follow-up that measured food security using the US Household Food Security Survey Module and self-reported resource enrollment. Repeated measures logistic regression models evaluated the odds of improving food security and resource enrollment from baseline to follow-up (significance P &lt; 0.05).

Results

RRV recruited 234 participants; 53% completed the follow-up assessment. At follow-up, the odds of household (P = 0.009) and adult (P = 0.01) food security increased, as did enrollment in one or more of the following resources: Temporary Assistance for Needy Families, Supplemental Security Income, General Assistance or Assistance from the Township Trustee (P = 0.005).

Conclusions

RRV yielded promising preliminary results of improved food security and resource use.

Food insecurity and healthcare decision making among mobile food pantry clients in Tampa Bay

This article examines the relationship between food insecurity and health-care decision-making among mobile food pantry clients in Tampa Bay, Florida. Results show a high rate of food insecurity, high stress levels, and chronic health conditions among mobile pantry clients, many of whom are long-term users of food pantry services. The fruits and vegetables supplied by the pantry allow clients to manage chronic health conditions and mitigate some of the financial burden of health-care costs. Research was conducted in cooperation with the Anthropology Department at the University of South Florida, Feeding Tampa Bay, and WellCare .

Food Insecurity Across the Adult Life Span for Persons With Disabilities

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.

Food Insecurity Among Young Adults With Intellectual and Developmental Disabilities in the United States: Evidence From the National Health Interview Survey

People with intellectual or developmental disabilities (IDD) face higher levels of poverty than others, which can lead to concerns regarding areas of well-being, such as food security. Young adults with IDD who are, in many cases, transitioning from the system of educational, health care, and income supports of their youth into the adult world may be particularly vulnerable. Using pooled data from the 2011-2014 National Health Interview Survey, we find that young adults with IDD have significantly higher levels of food insecurity than young adults without disabilities, even when controlling for poverty. Young adults with IDD who are living in low-income households are not significantly more likely to participate in the Supplemental Nutrition Assistance Program (SNAP) than young adults without disabilities who are also living in low-income households. Although our results suggest that SNAP is effectively reaching many young adults with IDD in need of nutrition assistance, further research is needed to determine the specific effects of food insecurity and SNAP participation on overall economic and health outcomes for this population.

Beyond Income Poverty: Measuring Disadvantage in Terms of Material Hardship and Health

The New York City (NYC) Longitudinal Study of Wellbeing, or "Poverty Tracker," is a survey of approximately 2300 NYC residents. Its purpose is to provide a multidimensional and dynamic understanding of economic disadvantage in NYC. Measures of disadvantage were collected at baseline and a 12-month follow-up, and include 3 types of disadvantage: 1) income poverty, using a measure on the basis of the new Supplemental Poverty Measure; 2) material hardship, including indicators of food insecurity, housing hardship, unmet medical needs, utility cutoffs, and financial insecurity; and 3) adult health problems, which can drain family time and resources. In this article initial results for NYC families with children younger than the age of 18 years are presented. At baseline, 56% of families with children had 1 or more type of disadvantage, including 28% with income poverty, 39% with material hardship, and 17% with an adult health problem. Even among nonpoor families, 33% experienced material hardship and 14% reported an adult health problem. Two-thirds of all families faced disadvantage at either baseline or follow-up, with 46% experiencing some kind of disadvantage at both time points. Respondents with a college education were much less likely to face disadvantage. Even after adjusting for educational attainment and family characteristics, the families of black and Hispanic respondents had increased rates of disadvantage. Considering income poverty alone the extent of disadvantage among families with children in NYC is greatly understated. These results suggest that in addition to addressing income poverty, policymakers should give priority to efforts to reduce material hardship and help families cope with chronic physical or mental illness. The need for these resources extends far above the poverty line.