Public versus private food assistance: barriers to participation differ by age and ethnicity

Food Insufficiency and Coping Resources among Women: Postpandemic Racial, Ethnic, and Household Disparities

Background: Empirical evidence shows women are more likely to report food hardship (e.g., food insufficiency and food insecurity) compared with men. Coronavirus disease-19 exacerbated these gender disparities; however, the impact of postpandemic social/economic/regulatory changes on women's food sufficiency and coping strategies has not been examined. This study evaluates factors associated with food insufficiency among women postpandemic. Methods: This study used a cross-sectional study design and analyzed data from the U.S. Census Bureau's Household Pulse Survey. Variations in the likelihood of food insufficiency by age, income, household composition, race/ethnicity, region, metropolitan status, and employment status among women were evaluated using logistic regression with state-level response clustering. Among women reporting food insufficiency, associations between these characteristics and likelihood of utilizing food assistance programs and/or donated foods were assessed. Interaction terms accounted for the intersectional nature of these characteristics. Results: Compared with White women, Black (odds ratio [OR] = 1.66, confidence interval [CI] = 1.47, 1.88) and Hispanic (OR = 1.77, CI = 1.52, 2.07) women were more likely to report food insufficiency. These likelihoods were higher in households earning <$100,000 (Black OR = 13.17, CI = 10.82, 16.02; Hispanic OR = 9.32, CI = 7.72, 11.25) and <$35,000 (Black OR = 8.65, CI = 15.31, 22.71; Hispanic OR = 17.86, CI = 3.64, 23.40). Racial/ethnic differences were observed among households with children; no effects appeared in multi-adult households. Food-insufficient Black (OR = 3.74, CI = 2.23, 6.28) and Hispanic (OR = 1.36, CI = 0.79, 2.36) women were more likely to use food assistance programs than Whites. Food-insufficient Hispanic women were more likely to use donated foods (OR = 2.71, CI = 1.84, 3.99). Conclusion: Food insufficiency among low-income Black and Hispanic women, particularly those with children, is likely to have persisted postpandemic, suggesting a high likelihood of dietary deficits in these households. Additional resources should be dedicated to meet the dietary needs of women and children in vulnerable households.

Food insecurity among Asian Americans: A scoping review protocol

INTRODUCTION

Food insecurity is prevalent in the U.S. and is associated with deleterious health, behavioral, and social consequences. Food insecurity is currently addressed largely through public and private food assistance programs (e.g., the Supplementary Nutrition Assistance Program, and food pantries). A body of research has explored racial and ethnic disparities and differences in food insecurity and coping strategies. However, limited literature has explored these experiences among Asian Americans and Asian origin groups in the United States.

OBJECTIVE

The aim of this review is to establish what is known about the experience of food insecurity and nutrition program participation in the Asian American population and among Asian origin groups and to suggest further research and policy action to better address food insecurity in this population.

METHODS

Our review is guided by the methodological framework proposed by Arksey and O'Malley and refined and outlined by Levac and colleagues and the Joanna Briggs Institute. We will search key terms related to food insecurity and Asian Americans in Medline (Ovid), the Cochrane Library (Wiley), CINAHL Plus with Full Text (Ebsco), PsycINFO (Ebsco), and Scopus (Elsevier). An article will be included if it was published in the English language; is a peer reviewed research manuscript and reports primary research findings from analyses; and describes food insecurity or strategies to cope with food insecurity among individuals of Asian origins living in the U.S. An article will be excluded if it is a book, conference proceedings, or grey literature (e.g., thesis or dissertation); is a commentary, editorial, or opinion piece without primary research data; contains only research conducted outside of the U.S.; includes Asians in the sample but does not provide separate data on food insecurity or strategies to cope with food insecurity among Asians; and describes only dietary changes or patterns but not food insecurity. Two or more reviewers will participate in the study screening and selection process. We will record information from the final articles chosen to be included in the review in a data table template and will also prepare a summary narrative with key findings.

EXPECTED OUTPUTS

Results will be disseminated through peer-reviewed publications and conference presentations. The findings from this review will be of interest to researchers and practitioners and inform further research and policy to better address food insecurity among this population.

An Investigation of Social Ecological Barriers to and Facilitators of WIC Farmers Market Nutrition Program Voucher Redemption

In the United States, many communities lack sufficient access to fresh produce. To improve access to fresh fruits and vegetables, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides eligible participants vouchers through the Farmers Market Nutrition Program (FMNP) that can be redeemed directly from farmers at markets or farm stands. However, FMNP voucher redemption rates in New Jersey remain lower than those in neighboring states. This article used the social ecological model to examine differences between FMNP participants who redeem vouchers (Redeemers) and those who do not (non-Redeemers) in the areas of: produce procurement practices and consumption frequency, and barriers to and facilitators of FMNP voucher redemption. This cross-sectional study included WIC FMNP participants (N = 329) in northern New Jersey, USA. Analyses were conducted using descriptive statistics, independent sample t-tests, and one-way ANOVA. Compared to Redeemers, non-Redeemers consumed fewer average daily vegetable servings, were more likely to shop at small grocery/corner stores, and encountered significant barriers to FMNP redemption, e.g., difficulty finding time to redeem vouchers.

Strengthening the Public Health Impacts of the Supplemental Nutrition Assistance Program Through Policy

The US Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) is the cornerstone of the US nutrition safety net. Each month, SNAP provides assistance to 40 million low-income Americans-nearly half of them children. A number of changes could strengthen the public health impacts of SNAP. This review first presents a framework describing the mechanisms through which SNAP policy can influence public health, particularly by affecting the food security, the diet quality, and, subsequently, the health of SNAP participants. We then discusspolicy opportunities with the greatest potential to strengthen the public health impacts of SNAP, organized into three areas: (a) food production and distribution, (b) benefit allocation, and (c) eligibility and enrollment. For each section, we describe current policy and limitations of the status quo, suggest evidence-based opportunities for policy change to improve public health, and identify important areas for future research.

Supplemental Nutrition Assistance Program Participation Improves Children's Health Care Use: An Analysis of the American Recovery and Reinvestment Act's Natural Experiment

OBJECTIVE

To examine the impact of increased Supplemental Nutrition Assistance Program (SNAP) benefit levels as provided by the American Recovery and Reinvestment Act (ARRA) beginning in April 2009 on the health care use and health care needs of participating children.

METHODS

Difference-in-differences analysis compared changes in health care use and needs between children in SNAP-eligible households and those in low-income but SNAP-ineligible households before and after ARRA's implementation, using data from the nationally representative National Health Interview Survey (NHIS). Survey respondents reported on children's health care use and outstanding health care needs. Our sample included approximately 38,500 children in low-income households who completed the core NHIS, and a subsample of 15,000 sample children who reported additional information.

RESULTS

Approximately 6% of low-income children had delayed care due to cost. Three percent and 4% of children in low-income households and low-income single-parent households, respectively, reported needing health care but not being able to afford it. The increase in SNAP benefits was associated with a 65% reduction in outstanding medication needs due to affordability among SNAP-eligible children, relative to low-income, ineligible children. There was also a reduction in the likelihood that children had seen a general doctor in the last year. Among children in single-parent households, SNAP benefit expansion was associated with a 3.2 percentage point decrease in needing but not being able to afford health care.

CONCLUSIONS

Findings suggest that even a small increase in household resources leads to reductions in outstanding health care needs due to affordability, particularly among children.

Addressing Food Insecurity: An Evaluation of Factors Associated with Reach of a School-Based Summer Meals Program

BACKGROUND

One in six US households with children experiences food insecurity, with higher rates in the summer. Approximately 3 million children receive free meals each summer weekday through the US Department of Agriculture's Summer Nutrition Programs. However, participation in these programs has been declining in recent years and is lower than participation in programs that serve free or reduced-price meals during the school year.

OBJECTIVE

To identify school and site characteristics associated with greater reach by school-based free summer meals program sites.

DESIGN

This observational study combined program data, public school data, and Google Maps data to determine factors associated with site reach.

PARTICIPANTS/SETTING

LunchStop Summer Meals Program sites (N=100) and schools at which they were based during summer 2018 in Chicago, IL.

MAIN OUTCOME MEASURES

Reach of sites was measured by the mean daily meals served at each site throughout summer 2018.

STATISTICAL ANALYSES PERFORMED

Associations between site reach and each independent variable were evaluated using Mann-Whitney tests and simple linear regressions. Variables significantly associated with site reach in bivariate analyses (P<0.05) were included in a multivariate linear regression.

RESULTS

In bivariate analyses, sites with greater reach were significantly more likely to be based at schools with higher attendance percentages, higher percentages of Hispanic/Latino students, larger student populations, and locations in a network of southwest Chicago schools. Those with greater reach were also significantly more likely to have continuity in program staff and more years of site operation (all P values ≤0.01). The last four factors remained significant in multivariate analysis.

CONCLUSIONS

School-based summer meals programs may be able to reach more vulnerable children by taking into account continuity among sites and staff. Further research is needed to clarify whether the relationships between these variables and increased reach is causal.

Patient experiences and provider perspectives on a hospital-based food pantry: a mixed methods evaluation study

Objective:

The purpose of this evaluation study was to identify strengths and opportunities for improvement in programme functioning and common aspects of patients’ experiences at a hospital-based food pantry.

Design:

Semi-structured, in-depth interviews with patients and a cross-sectional survey for providers were used. Interview transcripts were coded using both inductive and deductive approaches and assessed for inter-rater reliability. Descriptive statistics were produced from quantitative data.

Setting:

An academic urban safety-net hospital in the Northeastern US offering inpatient and outpatient services.

Participants:

Thirty patients and 89 providers.

Results:

Patients expressed feeling comfortable, trusting the food, high satisfaction with food quality, convenience, and lack of stigma at the hospital-based pantry. Patients mentioned the pantry helped them eat more fruits and vegetables, but expressed concerns about the healthfulness of other foods distributed. Providers believed they should discuss food insecurity (FI) with patients (99 %) and that the pantry improves the health of patients (97 %), but faced barriers to consistently screening for FI and referring patients to the pantry, such as insufficient training on FI (53 %) and time constraints (35 %).

Conclusions:

Findings suggest hospital-based food pantries may have several advantages. Hospitals with onsite food pantries must work to eliminate barriers to FI screening and pantry referral. To optimize their impact, such pantries should develop nutritional guidelines for food donations and connect patients with nutrition education resources. Future research should examine health outcomes for patients using hospital-based food pantries.

Food Insecurity and Food Resource Utilization in an Urban Immigrant Community

Risk and prevalence of food insecurity and use of food security resources are important but incompletely understood factors in immigrant health. Key informant interviews and a survey (N = 809) of housing units were conducted in a San Diego, California neighborhood with a high proportion of immigrant and low income families. The difference in food insecurity between immigrant and non-immigrant households was non-significant (20.1 vs. 15.7 %, p = n.s.), though immigrant families were more likely to use food security resources such as SNAP (32.7 vs. 22.9 %, p < .01) and food pantries (28.2 vs. 19.7 %, p < .001). Among immigrants, neither national origin nor years in the United States predicted food insecurity or use of most food security resources. In immigrant families, food insecurity often remains a challenge long after immigration, suggesting a potentially increasing need for food security resources as immigration into the United States continues.

The Nutritional Quality of Food Provided from Food Pantries: A Systematic Review of Existing Literature

BACKGROUND

In many affluent countries, food-insecure households use food pantries to keep their family fed. The long-term dependence of many users on these programs calls for a systematic review of studies on the nutritional quality of food provided by food pantries.

OBJECTIVE

The purpose of this systematic review was to summarize the current scientific evidence about the nutritional quality of food bags distributed by food pantries.

METHODS

A systematic literature search was conducted in the electronic databases PubMed, PsycINFO, PsycARTICLES, and Psychology Behavioral Sciences Collection to identify cross-sectional, cohort, and intervention studies reporting baseline data conducted in high-income countries and published between 1980 and 2015, which reported the nutritional quality of food bags distributed by food pantries. Identified citations were screened in two stages and data were independently extracted by two authors using a predefined data sheet. The quality of included studies was evaluated using criteria of an adapted Ottawa Scale. The systematic review was reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

Applying the two-stage screening, 9 of 1,546 articles were identified for inclusion. Nutritional quality of food bags varied widely between and within studies. Milk products, vitamins A and C, and calcium were provided in particularly low amounts. None of the studies were nationally representative and only a few studies controlled for the household composition of the recipients of food bags.

CONCLUSION

Food pantries likely have a strong influence on users' diets, but the food pantries examined in the selected studies were largely unable to support healthy diets. The distribution of more perishable foods would increase users' diet quality and may have an immense potential to address malnutrition in vulnerable population groups.

Investigation of the Food Choice, Promoters and Barriers to Food Access Issues, and Food Insecurity Among Low-Income, Free-Living Minnesotan Seniors

OBJECTIVE

Investigate food choice, food access, and food insecurity among seniors.

METHODS

Eight focus groups were conducted in 2 counties with high and low Supplemental Nutrition Assistance Program (SNAP) participation rates. A total of 62 seniors (aged ≥ 60 years) were recruited and each attended 1 focus group at a community center. The sample was 79% female and most were Caucasian (91%), similar to state demographics. The focus group themes of how seniors make food choices and access food, and food insecurity perceptions among this population were identified based on discussion commonalities. For quantitative data, P < .05 was significant.

RESULTS

Five themes emerged: (1) former experiences affecting eating behaviors; (2) financial and food security driving use of food assistance programs; (3) food access strategies: restaurants, retail markets, and alternative sources; (4) physical changes associated with aging influencing food access and intake; and (5) social influences that play a role in decision making.

CONCLUSIONS AND IMPLICATIONS

Both SNAP and congregate dining offer food assistance to seniors, but SNAP use was considered unacceptable by some seniors living in county 1 because of the negative stigma attached to the program or because they lacked program knowledge about income criteria. More effort needs to be made to educate seniors about SNAP. It is important to gain insight into how food insecurity affects their food choices.

Unemployment and household food hardship in the economic recession

OBJECTIVE

The present study examined the association between unemployment and household food insecurity during the 2007-2009 economic recession in the USA.

DESIGN

Longitudinal survey of the Survey of Income and Program Participation (SIPP; 2008-2011). Food insecurity was measured by five questions excerpted from an eighteen-item Food Security Scale. Unemployment was measured by a dichotomous indicator, the number of job losses and the total duration of all episodes in the observation period.

SETTING

As nationally representative data, the SIPP interviewed respondents in multiple waves with a time interval of four months.

SUBJECTS

The study created two analytic samples including working-age household heads employed at the beginning of the observation period. The size of the two samples was 14,417 and 13,080.

RESULTS

Unemployment was positively associated with food insecurity (OR=1.55; 95% CI 1.32, 1.83; P<0.001). Similar results were obtained when the analysis controlled for food insecurity status measured before unemployment (OR=1.54; 95% CI 1.27, 1.88; P<0.001). For households with the same duration of unemployment, one more episode of unemployment increased the odds of food insecurity by 8% (OR=1.08; 95% CI 1.00, 1.18; P<0.001).

CONCLUSIONS

More in-depth understanding of the relationship between unemployment and food insecurity is useful to better identify and serve the at-risk population. Connecting unemployment assistance closely to nutrition assistance could lower the prevalence of food insecurity among unemployed households. Public policy should better account for both episodes and duration of unemployment to reduce food insecurity.

Should Canadian health promoters support a food stamp-style program to address food insecurity?

Food insecurity is an urgent public health problem in Canada, affecting 4 million Canadians in 2012, including 1.15 million children, and associated with significant health concerns. With little political will to address this significant policy issue, it has been suggested that perhaps it is time for Canada to try a food stamp-style program. Such a program could reduce rates of food insecurity and improve the nutritional health of low-income Canadians. In this article, we explore the history of the US food stamp program; the key impetus of which was to support farmers and agricultural interests, not to look after the needs of people living in poverty. Though the US program has moved away from its roots, its history has had a lasting legacy, cementing an understanding of the problem as one of lack of food, not lack of income. While the contemporary food stamp program, now called Supplemental Nutrition Assistance Program (SNAP), reduces rates of poverty and food insecurity, food insecurity rates in the USA are significantly higher than those in Canada, suggesting a food stamp-style program per se will not eliminate the problem of food insecurity. Moreover, a food stamp-style program is inherently paternalistic and would create harm by reducing the autonomy of participants and generating stigma, which in itself has adverse health effects. Consequently, it is ethically problematic for health promoters to advocate for such a program, even if it could improve diet quality.

Factors contributing to participation in food assistance programs in the elderly population

BACKGROUND/OBJECTIVES

The study objectives were to examine the participation rate in food assistance programs and explore the factors that contribute to such participation among the Korean elderly population.

SUBJECTS/METHODS

The study sample comprised 3,932 respondents aged 65 years or older who were selected from a secondary data set, the fourth Korean Welfare Panel Study (KoWePS). The factors, related to participation in programs were examined based on the predisposing, enabling and need factors of the help-seeking behavior model. Multiple logistic regression analysis was used to select the best contributors among the factors related to program participation.

RESULTS

The predisposing rate in food assistance programs was 8.5% (7.1% for men and 10.4% for women). When all variables were included in the model, living without spouse, no formal education, low income, having social security benefits and food insecurity in elderly men, and age, low income, having social security benefits and feeling poor in elderly women were significantly related to a higher tendency to program participation.

CONCLUSIONS

The predisposing and need factors, such as living without spouse, low education level, food insecurity and feeling poor were important for program participation, as well as enabling factors, such as household income and social security benefits. A comprehensive approach considering these factors to identify the target population for food assistance programs is needed to increase the effectiveness and target population penetration of these programs.

Low Income Families' Utilization of the Federal "Safety Net": Individual and State-Level Predictors of TANF and Food Stamp Receipt

Two of the primary programs through which the federal government provides benefits to low income families are the Temporary Assistance for Needy Families (TANF) program and the Food Stamp program. However, many eligible low income families do not actually receive these benefits. We combined state-level policy data with rich data on a national sample of low income families to investigate family and state-level predictors of TANF and Food Stamp receipt. Our findings indicate: 1) families experiencing more economic hardship and health challenges are more likely to receive benefits, and 2) states' coverage is associated with families' receipt of TANF, but not Food Stamps. Implications for policy and research are discussed.

Prices of unhealthy foods, Food Stamp Program participation, and body weight status among U.S. low-income women

This paper examines the interactive effect between the price of unhealthy foods and Food Stamp Program participation on body weight status among low-income women in the United States. We merged the panel data of the National Longitudinal Survey of Youth 1979 cohort in 1985-2002 and the Cost of Living Index data compiled by the American Chamber of Commerce Researchers Association by using geographic identifiers. Using the merged data, we used panel econometric models to examine the impact of unhealthy food prices on the food stamp-eligible U.S. population. Our results indicate that higher prices for unhealthy food can partially offset the positive association between Food Stamp Program participation and bodyweight among low-income women.

Food security in older australians from different cultural backgrounds

OBJECTIVE

To investigate the experiences and barriers to food security of community-dwelling older people.

DESIGN

Quantitative questionnaire and 5 focus group discussions using purposive sampling.

SETTING

Shire of Melton, Victoria, Australia.

PARTICIPANTS

Thirty-seven people (13 male and 24 female), between 58 and 85 years of age, from Anglo-Celtic (15), Macedonian (6), Serbian (8), and Maltese (8) backgrounds.

PHENOMENA OF INTEREST

Food security perceptions and barriers.

ANALYSES

Quantitative data were analyzed using descriptive statistics and chi-square. The focus group data (transcripts) were subjected to a systematic thematic analysis to identify major themes and subthemes.

RESULTS

Cost and financial considerations, health and physical capacity, transport, intrapersonal factors, and lack of availability of preferred food all emerged as potential barriers to participants accessing nutritious food of their choice.

CONCLUSIONS AND IMPLICATIONS

Overall, the quantitative and qualitative data indicated that the changing circumstances that accompany growing older influenced this group's ability to independently shop for, prepare, and eat affordable and nutritious food. Nutrition educators, in conjunction with local government service providers, have the opportunity to play a key role in building upon existing safety nets and innovative initiatives to ensure older people have access to adequate and appropriate food of their choice.

Patterns of food insecurity and participation in food assistance programmes over time in the elderly

OBJECTIVE

The present study aimed to understand the relationship between need and help-seeking behaviour in older adults by examining the patterns of food insecurity and participation in food assistance programmes (FAP), i.e. the Food Stamp Program and home-delivered meals.

DESIGN

Data from two longitudinal studies were used. The studies were designed to obtain nationally representative information on health, insurance coverage, financial status, family support systems, labour market status and retirement planning, every two years: the Health and Retirement Study (HRS, 1996-2002) and Asset and Health Dynamics Among the Oldest Old (AHEAD, 1995-2002).

SETTING

USA.

SUBJECTS

There were 7623 participants for HRS and 3378 for AHEAD.

RESULTS

The older adults appeared to have persistent patterns between food insecurity and participation in FAP, especially in the Food Stamp Program. More persistently food-insecure older adults had higher participation in FAP (P < 0.001). Food-insecure older adults at one time were more likely to shift from non-participation to participation in FAP the next time than food-secure older adults (P < 0.001). Regardless of previous food insecurity status, previous participants in FAP were more likely to participate subsequently.

CONCLUSIONS

The relationship between need and help-seeking behaviour in older adults was found to follow a persistent positive pattern, determined by looking at the patterns of food insecurity and participation in FAP. Although food insecurity as a need is a good predictor of participation in FAP, it is not enough to fully predict participation in FAP. Help-seeking behaviour (i.e. previous programme participation) is also important in predicting participation in FAP.

Preadolescent female development through sport and physical activity: a case study of an urban after-school program

Youth development research has found that children become more engaged and benefit more from being incorporated as decision makers. Thus participation helps promote development and encourages engagement. Based in theories of engagement and free-choice learning, the current research focused on a program combining sport/physical activity, life skills, and mentoring while promoting healthy life choices for preadolescent girls of color The co-investigators, all women, conducted two 2-hr visits per week for two 12-week periods with a group of 8 girls at a community recreation center in Hartford, Connecticut, including lessons in nutrition and life skills and participation in a sport/physical activity. Five of the girls completed every stage of data collection, including participant journals and four individual interviews with each participant and her parents, over the course of the 24 weeks. The co-investigators also kept journals throughout the program. The results reflected the following themes: self-esteem/self-worth, accountability/responsibility for self connections to community and a sense of belonging, knowledge and acquisition of health/life skills, application of those skills, and planning and recognizing one's own influence on self and others.

Falling through the social safety net: food stamp use and nonuse among older impoverished americans

PURPOSE

Older adults are less likely than any other age group to use the federal Food Stamp Program. The personal and social costs of elderly diet insufficiency include disease exacerbation, depression, and increased hospitalization. In order to improve targeting and outreach efforts, this study identifies the characteristics of eligible older Americans who are not receiving food stamps and assesses the validity of the Andersen behavioral model for predicting impoverished older adults food stamp use.

DESIGN AND METHODS

We conducted a secondary analysis of the 2003 American Community Survey, which is a nationally representative survey with a response rate of 96.7%. We restricted our study subsample to the 14,724 impoverished American citizens who were aged 65 years and older. We used bivariate and logistic regression analyses to compare the 2,796 food stamp recipients with the 11,928 nonrecipients.

RESULTS

One in five impoverished older American citizens had received foods stamps in the preceding year. Female respondents, renters, younger respondents, disabled individuals, and those who received Supplemental Security Income or welfare were more likely to receive food stamps. The pseudo-R-square value indicated that the Andersen Behavioral Model explained 28% of the model's variability.

IMPLICATIONS

Improved targeting is needed to enhance older adults' participation rates. Mobile and satellite food stamp offices in lower income neighborhoods and other innovative outreach programs that collaborate with community partners could also improve access. With the vast majority of impoverished older adults not receiving food stamps, strategies such as these are extremely important to rectify this situation among the most vulnerable group of older Americans.

Why do low-income women not use food stamps? Findings from the California Women's Health Survey

OBJECTIVE

To determine factors associated with Food Stamp Program (FSP) participation in a potentially eligible California population.

DESIGN

The California Women's Health Survey is an on-going annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Statistical procedures included chi2 and logistic regression.

SETTING

California, USA, from 2002 to 2004.

SUBJECTS

A total of 527 FSP female participants and 1405 potentially eligible non-participant females, aged 18 years and older.

RESULTS

The following characteristics remained independently and positively related to FSP participation: single mother with children; unemployed; on welfare; on WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children); and US-born. Women under 25 years and those over 54 years were less likely to participate than women aged 25-54 years. Hispanic/Latino ethnicity was also negatively related to participation. Over 42 % of potentially eligible non-participants cited 'don't need them' as the reason for not applying for FSP, but 34.9 % either do not think they are eligible or do not know how to apply. Potentially eligible non-participants who cite 'don't need them' as a reason for not applying are less likely to be food insecure, to have inadequate income and to use alternative emergency aid, compared to women citing all other reasons. The highest level of need is among those who cite worry about citizenship or stigma as reasons for not applying.

CONCLUSION

Strategies to increase participation in FSP should incorporate messages that change the public's perception of the programme, in addition to simplifying the application process, raising awareness of eligibility criteria and improving customer service.