Food Insecurity Assessment
MONITORING FOOD SECURITY -_____ responsible for continuously monitoring food insecurity status in U.S. -think of monitoring as a form of _____
*USDA -assessment (collecting data to ID problems, to see if problem exists, if problem increasing/decreasing...) -
ASSESSING FOOD INSECURITY Once data is collected, USDA publishes reports, usually every September for the previous year.
*chart shows how households were categorized based on response to questions -small % of food secure households answered affirmatively, but over 80% of low FS and very low FS answer affirmatively to specific question
HOW DO WE DETERMINE IF SOMEONE IS LIVING IN POVERTY in the US?
*compare household income (money income, before taxes, household size) to Poverty Threshold (PT), which is based on the Consumer Price Index (CPI) -CPI used to create poverty threshold (updated yearly for inflation) and once established, household income compared to that poverty line
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Health: adults - greater chronic disease, for example...
*cross sectional study of 5000 low income NHANES adult participants found -positive association of FI with CV risk factors, hypertension, and DM -poorer disease management (esp. DM) -higher rates of depression
RISK FACTORS FOR FOOD INSECURITY - POVERTY -What is the poverty line? -Calculation based on the _____ _____ _____ -determines eligibility for most... -refers to...
*estimated minimum level of income needed to secure the necessities of life -consumer price index (CPI) -income-based assistance programs in US (not just food assistance, but also Medicaid, TANF, est.) *inflation-adjusted measure of the average price of a market basket of goods and services
WHAT IS FOOD SECURITY? definitions we discussed?
-WHO definition (food security) -USDA's Economic Research Services definition (food insecurity?
RISK FACTORS FOR FOOD INSECURITY - POVERTY LINE Fancy algorithm results in ____ ____ to which we can then compare someone's _____
-poverty line -income ex: if poverty line was $10,000 & household income of 1 who earned $10,000 = 100% of federal poverty line; if earn $8000, would be at 80% of federal poverty line
HEALTHY PEOPLE 2020 -national agenda initiative related to food security? -target? -baseline? -target setting method? -how are we doing? in 2003? in 2016?
-reduce household food insecurity and reduce hunger -6% (by 2020, no more than 6% of households would be categorized as FI/low FS and very low FS) -14.6% of all US households were considered FI -50% decrease in food insecurity in 10 years -11% FI in 2003, 12.3% FI in 2016 *down from 2016, but still a long way to go
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Nutrition: Adults -reduced diet quality verified by...? -for example...?
-serum nutrient values -self-reported F&V consumption validated by biomarkers of dietary carotenoids
FOOD INSECURITY IS CONCENTRATED IN LOW INCOME HOUSEHOLDS income as % of poverty line with high % of FI households? drops at what %?
<100% <130% <185% >185%
WHAT IS FOOD SECURITY? Who is responsible for monitoring food insecurity in the US?
USDA
POVERTY RATE BY OCCUPATION FOR PERSONS IN THE LABOR FORCE FOR AT LEAST 27 WEEKS, 2014 Jobs are also often seasonal in nature and poverty rate can be based on occupation - for example...
agricultural industry where parts of the country does not have 12 month growing seasons, so individuals have to move - migrant workers; retail settings hiring for holidays highest rates: -farming, fishing: harvesting crops -service -production, transportation, material moving -natural resources, construction, maintenance
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Health: adults -health consequences?
higher rates of chronic disease (whether DM, COPD, CV disease...)
FOOD INSECURITY & OVERWEIGHT/OBESITY Highest obesity rates with...
least income/education among women
"FOOD DESERTS" defined by USDA ERS?
"LOW INCOME census tract where a substantial number or share of residents has low access to a supermarket or large grocery stores" -not just any food source, but supermarket or large grocery store; low income emphasis
WHAT IS FOOD INSECURITY? USDA's Economic Research Services defines food insecurity as...
"limited or uncertain ability to acquire or consume an adequate quantity of food in socially acceptable ways
MONITORING FOOD SECURITY 4 different levels of food security based on...
# of questions answered in the affirmative or the negative
DHHS POVERTY GUIDELINES, 2018 Household size - Poverty guideline/annual income -1? -2? -3? -4?
$12,140 (= 100% of poverty line and below would be categorized as living under poverty line) $16,460 $20,780 $25,100 ...
MONITORING FOOD SECURITY Methods of monitoring food insecurity status in U.S.?
*Food and Nutrition Service agency of USDA uses supplement of Current Population Survey -US Census Bureau administers monthly Current Population Survey to 50-60,000 households randomly each month -in survey is a Food Security Supplement with list of questions intended to categorize households as level of food secure or food insecure
WHAT IS FOOD SECURITY? Other factors that influence food security aside from quantity?
-QUALITY --> both nutritionally and related to food safety -VARIATION -PREFERENCE -meets PHYSIOLOGICAL NEED (familiar foods can provide comfort/alleviate anxiety in uncertain/stressful times) -KNOWLEDGE/SKILLS of preparation -ability to ACCESS in SOCIALLY ACCEPTABLE ways (not dumpster diving, roadkill...) -CULTURALLY RELEVANT
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Nutrition: Children - What might be some explanations for why no significant difference was found in dietary variety and energy or macronutrient intake in FS and FI children?
-VARIETY ALREADY LACKING in child diets: neophobia, biological component that makes skeptical of new foods, need to introduce 10-15+ times before even trying it -ENERGY DENSE FOODS consumed, cheaper -PARENT BUFFER: parent sacrifices intake for child -FOOD & NUTRITION ASSISTANCE PROGRAMS, like free lunch -BREAKFAST CEREAL fortified with so many vitamins, can appear similar micronutrients
FOOD INSECURITY IN TEXAS SNAP (aka Food Stamp) participation: -in July 2017? -age distribution of those recipients?
-about 3.8 million recipients per month -over half (~54%) are children less than/equal to 17 years old in July 2017
FOOD INSECURITY (FI) We know different household characteristics are related to greater risk for food insecurity, including households with...
-children -one parent (female more so than male)
RISK FACTORS FOR FOOD INSECURITY (FI): CONTINUED -high school drop-outs -sudden economic changes -the young/the old -ethnic minorities -inner city and rural locale
-lower education --> lower income earning potential, increasing risk for FI (pretty linear relationship) -catastrophic illness, pregnancy, job loss... -households with children at higher risk -certain racial/ethnic minorities at risk -where you live: often inner city locations impact access with food swamps or rural location impact access with food desserts
energy dense vs nutrient dense
ENERGY DENSITY: amount of calories per gram of food NUTRIENT DENSITY: amount of nutrients per calorie of food *can be energy dense & nutrient dense (e.g. avocado w potassium, fiber, MUFA...) OR energy dense & nutrient poor (processed snack foods)
____ ____ (national anti-hunger association) does survey where recipients of emergency food assistance are asked was there every a time where you had to chose to pay utility bill or go to dr. and therefore could not but food
Feeding America
MONITORING FOOD SECURITY 4 classifications of food security?
HIGH food security MARGINAL food security LOW food security VERY LOW food security
MONITORING FOOD SECURITY What classification(s) of food security are considered to be food insecure households?
LOW food security VERY LOW food security
FOOD INSECURITY & OVERWEIGHT/OBESITY Previous research indicates...?
OBESITY PARADOX IN US increased overweight in SOME food insecure populations - highest obesity rates with least income/education among women
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Health: children -increased risk in children in FI households for...?
POORER HEALTH -increased hunger, visits to school nurse (not starvation, but hunger symptoms like headache, stomachache...) -poorer DEVELOPMENTAL OUTCOMES (perhaps delayed developmental milestones) -higher rates of IRON-DEFICIENCY ANEMIA -more HOSPITALIZATIONS
RISK FACTORS FOR FOOD INSECURITY Primary risk factor?
POVERTY - limited financial resources that place you below poverty line
HOUSEHOLD FOOD INSECURITY: ASSOCIATIONS WITH AT-RISK INFANT AND TODDLER DEVELOPMENT study related to developmental delays?
The Children's Sentinel Nutritional Assessment Program: -caregivers of children <37 months interviewed -caregiver of children in FI households: lower education and experience more clinical depression -children living in FI households: 2/3 higher risk for developmental problems (language, motor skills, behavioral/social/emotional, self help, and school readiness) *not limited to very low FI, but across categories of FI (low and very low FS)
FOOD INSECURITY IS CONCENTRATED IN LOW INCOME HOUSEHOLDS Households whose income <130% poverty line often have to make tough decisions regarding...
allocation of money - not just food, but housing, utilities, healthcare
risk factor
anything that increases the likelihood of injury, disease, or other health problems -risk factor x increases probability of y, but not cause and effect
MONITORING FOOD SECURITY Households that classify as VERY LOW food security differ from LOW food secure households in that...
coping strategies are not successful --> reduced dietary intake *more extreme financial limitations
Trends in rates of the working poor - pretty much reflects...?
economy - steep increase with 2008 recession, starting to decline now with slight improvements
FI IN HOUSEHOLDS (2016) Interestingly, elderly FI rates are lower than the national average, which can be explained at least partially by...
elderly nutrition programs
Is it only those who meet definition of "working poor" who are at risk for FI?
example of hypothetical single mom of 2 in CStat working as an administrative associate at TAMU, making $13.01/hour (excess of federal minimum wage) -after calculating expenses other than food (housing, health insurance, transportation, other maintenance/utilities...$200/month of $6.66/person/day... but then add in child care and that is $600/child per month and now have only $25 for food *not just unemployed or minumum wage jobs at risk for FI
-talked about defining, monitoring, prevalence of risk factors for FI as one of the variables in assessment -will talk more about consequences and programs like SNAP, WIC, National School Lunch Program whose target market is...
food insecure populations in effort to eliminate
FI IN HOUSEHOLDS (2016) Differences based on household characteristics
households more vulnerable to food insecurity: -with children -marital status: single households, differing based on sex
FOOD INSECURITY & OVERWEIGHT/OBESITY *curve on graph of BMI (y-axis) vs level of food security (food secure, low FS, very low FS on x-axis) is really a u-shaped (upside down U) curve -low in FS and very low FS, and high in low FS, which makes sense bc...
in low FS, using coping strategies that may lead to altered metabolism and weight gain, while very low FS have altered food intake
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Nutrition: Adults -in men?
not much of a difference observed in food group intake, energy intake, micronutrient intake... pretty much same between FI and FS
RISK FACTORS FOR FOOD INSECURITY - POVERTY LINE Government defines a market based of good and services by identifying things that...
people would need to purchase for basic existence - housing costs, food costs, education costs, healthcare, transportation costs, recreation costs
What determines eligibility for most income-based assistance programs in the US?
poverty line
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Health: children -body weight/BMI associations?
*inconsistent data for body weight, BMI associations, especially in young children -in children, not a clear consensus for impact on overweight -in developing nations, ppl in poverty more likely to be underweight -in developed nations, FI populations have been found to be o/o
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Nutrition: Children -most research in US finds...?
*no significant differences in DIETARY VARIETY or ENERGY OR MACRONUTRIENT INTAKE between food secure and food insecure children
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Nutrition: Children -however, research has suggested...
*reduced consumption of certain food groups in food insecure children -fruits, vegetables, dairy, and some studies suggest animal protein *increased consumption of energy-dense foods compared to FS childnre *but caution bc goal in science is statistical significance, which may not have physiological significance
QUESTIONS USED TO ASSESS THE FOOD SECURITY OF HOUSEHOLDS IN THE CPS FOOD SECURITY SURVEY
*set of 10 ? for every household, plus another subset of ? if have children
CONSEQUENCES OF FOOD INSECURITY In addition to nutritional and health consequences, also ______ consequences, including...
*social -poorer cognitive development -lower productivity (school, job) -more behavior problems (anxiety, aggression, social withdrawal and isolation) -less social interaction
CONSEQUENCES OF FOOD INSECURITY: SUMMARY OF RESEARCH EVIDENCE Nutrition: Adults -research indicates...? -rationale? -one food group consistently cited in literature?
*women at higher risk of nutritional compromise due to FI -role as traditional gatekeeper of food coming in and out of house in most cultures, so assures family is fed even at expense of own nutritional adequacy -reduced F&V intake
WHAT IS FOOD SECURITY? -WHO definition? -focuses on...? -flaw?
-"access at all times to sufficient food for an active and healthy life" -quantity of food -food security is about more than just quantity
FOOD INSECURITY (FI): How common is food insecurity in U.S.? Households with children more vulnerable: -in households with children <18 yo, ___% of households were food insecure (2016) -in about _____ of these households, adults were food insecure, but children were not (...?) -in the other half... -HP 2020? current %? target %?
-16.5% -half; (parent gives up food to ensure child has food) -both adults and children were food insecure -eliminate very low food security among children; current 0.8% (2016), target 0.2%
THE WORKING POOR -____% of population in the labor force in 2014 -more likely to work ___ ____ -other characteristics about jobs?
-6.3% -part time (4.1% full time tripled to 13.5% part time) -minimum wage ($7.25) or a little more; typical jobs provide no benefits (heath insurance, retirement plan, etc.)
RISK FACTORS FOR FOOD INSECURITY - POVERTY LINE Once market basket of goods and services defined, then go to ___ different ____ areas in the US to determine...
-8 different urban areas -how must does it cost on average to purchase each item
FOOD INSECURITY (FI) How common is food insecurity in U.S.? In 2016... -____% of households were food secure -____% of households were food insecure, ___% of which were low food security households and ___% very low food security households
-87.7% -12.3%, 7.4%, 4.9%
FOOD INSECURITY IS CONCENTRATED IN LOW INCOME HOUSEHOLDS In households whose incomes <130% poverty line... - - -
-FI prevalence 3x national average -diet quality may be reduced -increased participation in food assistance programs (food pantry, SNAP, WIC, school lunch program...)
FOOD INSECURITY IN TEXAS -compared to national average? -in the past year? -___% of population food insecure (2014-2016), with ___% very low food insecure
-consistently higher -declined -14.3%; 5.6%
FI BY HOUSEHOLD RACE/ETHNICITY BACKGROUND (2016) Can also see differing rates based on ____ characteristics like race/ethnicity (for example in...), but primary concentration of FI is in _____ _____households
-demographic -higher % of FI households of black, non-hispanic, then hispanic -low income
-who is responsible for calculating and publishing poverty line? -while partially used for determining eligibility for food and nutrition assistance programs, the poverty line is NOT used as the ultimate cutoff with an understanding that...
-department of health and human services agency -there's an area of margin above poverty threshold that people can still have difficulty meeting needs; household income compared to 130% of federal poverty line and less than that is eligible for SNAP benefits *never just 100% of poverty line, but a margin
HOW DO WE DETERMINE IF SOMEONE IS LIVING IN POVERTY? What's counted in money income, before taxes, and household size to determine household income?
-earnings/monetary income/wage -unemployment compensation -social security -public assistance, diasbility benefits
HOW DO WE DETERMINE IF SOMEONE IS LIVING IN POVERTY? What is NOT counted?
-food assistance -housing subsidies
Terms that are used to define access to food depending on where an individual lives?
-food desert -food swamp
HP2020 (nation's health agenda) initiatives include several benchmarks for things like CV disease, obesity, and physical activity... but there is also a benchmark related to ____ ____, so as a nation and at state and local levels, we continuously collect data to identify ____ of ____ ____, understand why it exists, the ___ ___, and the _____
-food security -prevalence of food insecurity -risk factors -consequences
FOOD INSECURITY AND GLYCEMIC CONTROL AMONG LOW-INCOME PATIENTS WITH TYPE 2 DIABETES Contributing factors to why FI participants were 50% more likely to have poor glycemic control based on A1c?
-greater difficulty affording recommended diet -more emotional distress related to diagnosis (less social support, etc.)
RISK FACTORS FOR FOOD INSECURITY (FI): CONTINUED Other risk factors (which are all tied to each other and related to income/earning potential)?
-high school drop-outs -sudden economic changes -the young/the old -ethnic minorities -inner city and rural locale
FOOD INSECURITY & OVERWEIGHT/OBESITY possible reasons for relationship?
-increased consumption of low cost, high kcal, highly palatable foods -time, knowledge, resources for healthy eating/physical activity behaviors -possible mechanisms; social status and metabolic efficiency, excess intake, physiological differences
RISK FACTORS FOR FOOD INSECURITY (FI): CONTINUED How can where you live increase risk for FI?
-inner city locations impact access with food swamps -rural location impact access with food desserts
FOOD INSECURITY AND GLYCEMIC CONTROL AMONG LOW-INCOME PATIENTS WITH TYPE 2 DIABETES research example?
*Immigration, Culture, and Healthcare Study: cross sectional methodology (n=700) -FI T2DM participants were 50% more likely to have poor glycemic control based on A1c
"FOOD DESERTS" tool used to assess?
ERS Food Desert Locator
THE WORKING POOR Who are they (as defined by federal government)?
individuals who worked at least 27 weeks of the year (at least 27 weeks of the year in labor force), and income still falls below poverty threshold
Top risk factor for FI?
limited financial resources or living in poverty
"FOOD SWAMPS" What is it?
location where healthy foods are less available than unhealthy foods (usually defined as being high in calories, added sugars, added fats, and sodium) -not an absence of places to get food, by types of places available are overwhelmingly high in added sugars, fats... energy dense, fast foods...
Hemoglobin A1c
long term measure of blood glc - average levels over 3 months
Food insecurity is concentrated in...
low-income households
LOW AND VERY LOW FOOD SECURITY/FOOD INSECURITY Households that classify as having LOW food security responded in a manner that indicated...
over the past 2 months, had to use coping strategies in order to meet food needs primarily due to financial limitations and in doing so, was able to maintain energy needs (did not have reduced food intake) *coping strategies could vary - food pantry, food assistance program like SNAP, reduce dietary variety, ate lower quality/cheaper foods