EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

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.

Inclusion Criteria:

Households in the United States participating in the 2003 American Community Survey
Study subsample restricted to impoverished American citizens aged 65 years and older.

Exclusion Criteria:

Non-citizens and those with gross household incomes above the poverty line were excluded.

Description of Study Protocol:

Recruitment

Secondary analysis of the 2003 American Community Survey, a nationally representative survey with a response rate of 96.7%
Study subsample restricted to 14,724 impoverished American citizens aged 65 years and older.

Design

Cross-sectional study

Blinding used

Not applicable

Intervention

Not applicable

Statistical Analysis

Bivariate and logistic regression analyses used to compare the food stamp recipients and non-recipients
To assess whether groups differed significantly in the percentage using food stamps, chi-square analyses were conducted for each of the predisposing, enabling and need characteristics
The independent contribution of each block of predictors was assessed, and odds ratios and 95% confidence intervals were generated.

Data Collection Summary:

Timing of Measurements

One-time measurements from the 2003 American Community Survey

Dependent Variables

Food stamp use

Independent Variables

Impoverished elderly

Control Variables

Ethnicity and race
Household income
Severe vision or hearing difficulty
Functional limitations
Difficulty remembering
Limitations in activities of daily living
Difficulty going out
Difficulty working.

Description of Actual Data Sample:

Initial N: 14,724 impoverished American citizens out of 838,293 households, 2,796 food stamp recipients and 11,928 non-recipients
Attrition (final N): As above:
- 4,198 males
- 10,526 females
Age: Aged 65 and older
- 6,566 were aged 65-74 years
- 5,881 were aged 75-84 years
- 2,277 were aged 85+ years
Ethnicity:
- 12,062 were not African American
- 2,622 were African American
- 13,665 were not Hispanic
- 1,059 were Hispanic
Other relevant demographics: See results
Anthropometrics:
Location: United States.

Summary of Results:

Key Findings

One in five impoverished older American citizens had received food stamps in the preceding year
Food stamp utilization rates were higher among female, Hispanic and African American respondents
In comparison with those individuals aged 85 years and older, those aged 65 to 74 had almost three times the odds of using food stamps
Individuals with less education were more likely to utilize food stamps
Older adults living below 25% of the poverty line had less than 1/3 the utilization rates as those living between 75% and 99% of the poverty line
Older adults who received welfare or SSI had much higher rates of food stamp use than those not receiving these social services
Older adults who rented their accommodation had three times the rates of food stamp use in comparison with those who owned their accommodation and did not have a mortgage
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
Those with vision or hearing difficulties, functional limitations, or disabilities that impacted their ability to work had elevated odds of using food stamps.

Author Conclusion:

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.

Funding Source:

Industry:

Royal Bank of Canada Graduate Research Fellowship in Applied Social Work

Other:

Reviewer Comments:

Nationally representative sample with large response rate. Authors note the following limitations:

Non-citizens and those with gross household incomes above the poverty line were excluded from the analysis, resulting in an exclusion of food stamp-eligible older adults
All data based on self-report.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	N/A
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	N/A

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		Yes
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	Yes
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	Yes
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	Yes
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	Yes
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		???
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	???
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	???
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		???
	7.1.	Were primary and secondary endpoints described and relevant to the question?	N/A
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	N/A
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	???
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	???
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	Yes
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes