Low-income workers' perceptions of wages, food acquisition, and well-being

Early results of a natural experiment evaluating the effects of a local minimum wage policy on the diet-related health of low-wage workers, 2018-2020

OBJECTIVE

The current study presents results of a midpoint analysis of an ongoing natural experiment evaluating the diet-related effects of the Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/h.

DESIGN

A difference-in-difference (DiD) analysis of measures collected among low-wage workers in two U.S. cities (one city with a wage increase policy and one comparison city). Measures included employment-related variables (hourly wage, hours worked and non-employment assessed by survey questions with wages verified by paystubs), BMI measured by study scales and stadiometers and diet-related mediators (food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation and daily servings of fruits and vegetables, whole-grain rich foods and foods high in added sugars measured by survey questions).

SETTING

Minneapolis, Minnesota and Raleigh, North Carolina.

PARTICIPANTS

A cohort of 580 low-wage workers (268 in Minneapolis and 312 in Raleigh) who completed three annual study visits between 2018 and 2020.

RESULTS

In DiD models adjusted for time-varying and non-time-varying confounders, there were no statistically significant differences in variables of interest in Minneapolis compared with Raleigh. Trends across both cities were evident, showing a steady increase in hourly wage, stable BMI, an overall decrease in food insecurity and non-linear trends in employment, hours worked, SNAP participation and dietary outcomes.

CONCLUSION

There was no evidence of a beneficial or adverse effect of the Minimum Wage Ordinance on health-related variables during a period of economic and social change. The COVID-19 pandemic and other contextual factors likely contributed to the observed trends in both cities.

Association Between Adherence to the MIND Diet and Cognitive Performance is Affected by Income: The ELSA-Brasil Study

BACKGROUND

The relationship between the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) diet and cognition has not been widely investigated in low- to middle-income countries. We investigated the relationship between MIND diet and cognition in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data.

METHODS

We included 11,788 participants. MIND diet adherence was based on the intake of 15 components according to a food frequency questionnaire. We analyzed the association between MIND diet adherence and global cognition, memory, and executive function using adjusted linear regression. We examined the interaction between income and MIND diet adherence on cognition and presented income stratified analyses.

RESULTS

MIND diet adherence was not associated with cognition in the whole sample. Income was an effect modifier of MIND adherence on global cognition (P=0.03) and executive function (P<0.001). For participants with high income, greater adherence was associated with better executive function [β=0.015, 95% confidence interval (CI)=0.002; 0.028, P=0.025]; while for participants with low income, greater adherence was associated with lower global cognition (β=-0.020, 95% CI=-0.036; -0.005, P=0.010) and executive function (β=-0.023, 95% CI=-0.039; -0.007, P=0.004). Adherence to the MIND diet was higher among participants with high income (P<0.001).

CONCLUSION

For high-income participants, greater adherence was associated with better cognitive performance; for low-income participants, greater adherence was associated with lower cognitive performance.

Associations Among Select State Policies and the Nutritional Quality of Household Packaged Food Purchases in the United States from 2008 Through 2017

BACKGROUND

Policy interventions are important public health tools because they can reach large numbers of people. State context has been associated with health outcomes, yet few studies have examined the extent to which state-level policies are associated with dietary quality.

OBJECTIVES

The objective of this study was to evaluate whether state policies are associated with the nutritional quality of household packaged food purchases.

DESIGN

This observational study used data from Nielsen Homescan, an open-cohort household panel where participants track purchases, and a combination of state-level food and social safety net policy variables from 2008 through 2017.

PARTICIPANTS AND SETTING

This study included 615,634 household-year observations in the United States from 2008 through 2017. Household-year observations were excluded in the case that a household did not make a minimum number of purchases and in the case that they had incorrect geographic information. The final analytic sample was 611,719 household-years.

MAIN OUTCOME MEASURES

Study outcomes included a set of nutrition-related measures of public health interest, including nutrients of concern (eg, sugar, saturated fat, and sodium) and calories from specific food groups (eg, fruits, nonstarchy vegetables, processed meats, mixed dishes, sugar-sweetened beverages, and desserts and snacks).

STATISTICAL ANALYSIS

This study used multilevel generalized linear models with state fixed effects on three samples: all households, only households with low income, and only households with low educational attainment.

RESULTS

Few significant associations were found between healthy food retail policies and the nutritional quality of purchases, and mixed associations were found between social safety net policies and lower or higher quality packaged food purchases.

CONCLUSIONS

Little evidence was found that state policy context in 2008 through 2017 was associated with the quality of packaged food purchases. However, variation in state policies is increasing over time, warranting future research into the relationship between these policies, the quality of packaged food purchases, and the rest of the diet.

Parental perceptions of the food environment and their influence on food decisions among low-income families: a rapid review of qualitative evidence

Background

The food environment within and surrounding homes influences family dietary habits with socio-economic areas at a nutritional disadvantage. Families’ perception of the food environment and how it influences their food decisions is less clear. This rapid review aimed to synthesise qualitative evidence of parental perspectives of the food environment and their influence on food decisions among disadvantaged families.

Method

Qualitative and mixed-methods peer-reviewed journal articles published after 2000, that explored the perspectives of low-income parents in relation to their food environment and how this impacted food decisions for families with children aged 2-17 years, were included in this review. Embase, Scopus and PsycINFO were the databases chosen for this review. Search strategies included seven concepts related to family, food, perceptions, influences, environment, socio-economic status and study type. Two independent reviewers screened sixty-four studies. Thematic synthesis was employed.

Results

Two thousand one hundred and forty five results were identified through database searching and 1,650 were screened. Fourteen articles that originated from the US, Australia and the UK were included in this review. No articles were excluded following quality appraisal. Child preferences, financial and time constraints, and location and access to food outlets were barriers to accessing healthy food. Parental nutrition education and feeding approaches varied but positive outcomes from interventions to address these behaviours will be short-lived if inequities in health caused by poverty and access to affordable and healthy food are not addressed. The reliance on social support from families or government sources played an important role for families but are likely to be short-term solutions to health and nutritional inequities.

Conclusions

This qualitative evidence synthesis provides an insight into the perceptions of low-income parents on the factors influencing food decisions. Findings have implications for public health and the development of effective strategies to improve the dietary habits of children of disadvantaged families. Sustainable changes to dietary habits for families on low-income requires policy responses to low income, food access and to the high cost of healthy foods.

A qualitative analysis of SNAP and minimum wage policies as experienced by workers with lower incomes

Work-related policies, including minimum wage and food assistance work requirements, can affect food security for people with lower incomes. This study conducted 112 qualitative interviews to understand participant policy experiences in two contexts (Raleigh, North Carolina and Minneapolis, Minnesota). Participants experienced frequent, destabilizing changes to their United States Department of Agriculture Supplemental Nutrition Assistance Program benefits, which they identified as part of a broader safety net. Raleigh workers described an unsupportive policy environment; Minneapolis workers reaped few benefits from an ongoing wage increase. Many workers face complex financial tradeoffs; more sophisticated evaluations should consider broader policy contexts and long-range effects.

Food security and alternative food acquisition among US low-income households: results from the National Food Acquisition and Purchasing Survey (FoodAPS)

OBJECTIVE

To determine the characteristics of US low-income households that use alternative food acquisition strategies and to examine the association between food security and alternative food acquisition.

DESIGN

Cross-sectional analysis. The ten-item Adult Food Security Survey Module was used to determine food security status. Self-reported data were used to determine food acquisition from community food sources, social networks and household food production.

SETTING

The National Food Acquisition and Purchasing Survey (FoodAPS), 2012.

PARTICIPANTS

The sample consisted of 2534 low-income households (≤185 % of the federal poverty line) in the USA.

RESULTS

Households using alternative food acquisition strategies were more likely to have a primary respondent who was non-Hispanic White, born in the USA, and female, and more likely to live in a rural area, have higher income and own a home than households not using alternative acquisition strategies. Very low food security was positively associated with the use of community food sources (aOR = 2·26 (95 % CI 1·15, 4·46)). There was no association between food security and food acquisition from social networks or household food production.

CONCLUSIONS

Use of alternative food acquisition strategies varied by specific demographic characteristics among low-income households, suggesting opportunities for outreach and promotion of alternative acquisition strategies in specific subpopulations in the USA. Future research should examine whether quantity and quality of food received from these sources are associated with food security.

Addressing food insecurity in the United States: the role of policy, systems changes, and environmental supports

This commentary provides a brief overview of the historical, contemporary, and potential future approaches for using policy, systems changes, and environmental supports (PSE) to address food insecurity in the United States. We reflect on and integrate where possible the findings put forth in the other 16 papers included in the Translational Behavioral Medicine Special Issue entitled: Food Access Among Low-Income Populations: Understanding the Potential Intersect of Diet, Obesity, Food Insecurity, and Hunger.