EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To examine the effects of the eligibility restrictions from the 1996 Welform Reform Bill on older immigrants for Food Stamp Program (FSP) participation and food insecurity. Special attention was paid to household composition and eligibility as well as individual eligibility.

Inclusion Criteria:

Individual data of those age >65, living in a low-income household and having a food security variable from the 1999 Current Population Survey (CPS) Annual Social and Economic (ASEC) Supplement and the Food Security (FS) Supplement.

Exclusion Criteria:

Eight cases of of postenactment immigrants because they remained ineligible for FSP under federal rules
32 American Indians because their position in the welfare system was different from that of other populations especially if they lived on a reservation.

Description of Study Protocol:

Recruitment

Data of those meeting the inclusion criteria from the 1999 CPS ASEC Supplement and FS supplement.

Design

Cross-Sectional Study

Blinding used

Not applicable

Intervention

Not applicable

Statistical Analysis

Probit regression, tobit regression and multivariate analysis. Three analytical models were used:

Model 1 used the differences-in-differences approach with individual immigration status
Model 2 used the differences-in-differences approach with household immigration status
Model 3 used a summary variable for the percentage of FSP eligible people in the household.

Data Collection Summary:

Timing of Measurements

Review of data from FSP participation from March 1998-February 1999 and food insecurity data from April 1998-March 1999.

Dependent Variables

FSP participation defined as an older adult lived in a household that ever participated in FSP during the proceeding 12 months
Per capita food stamp benefit amount defined as the total amount of FSP benefits for the proceeding 12 months divided by the household size
Food security indicator defined as an older adult living in a household with concerns over food supply and management and/or with reduced food intake of household members for the preceding 12 months.

Independent Variables

Individual immigration status defined as native citizen, naturalized citizen or non-citizen
Household immigration status defined as all-citizen household, mixed household or all non-citizen household
Generous state defined as the state of resident provides state-funded food stamps to non-citizens ineligible for federal FSP
Percentage of household members eligible
Age
Age squared
Gender
Race/ethnicity
Education
Number of years in the United States (US)
Entered US at age 55 or older
Marital status
Household size
Number of children
Number of older people
Independent living
Homeownership
Asset income
State unemployment rate.

Control Variables

None

Description of Actual Data Sample:

Initial N: 3,175 older adults from the 1999 Current Population Survey
Attrition (final N): 3,175 older adults
Age: >65
Ethnicity: Not stated
Other relevant demographics:
- 2,886 natives
- 186 naturalized citizens
- 103 non-citizens
Anthropometrics:
Location: United States.

Summary of Results:

Variables	Model 1	Model 2	Model 3
FSP Participation	Generous states increased older non-citizen FSP participation (P=0.05)	Household immigration status was associated with older adult's likelihood of receiving food stamps (P=0.1)	The higher the percentage of eligible household members, the more likely older adult households were to receive food stamps (P=0.05)
Food Stamp Benefit Amount	No interaction terms showed association between immigration status and state generosity and the value of food stamps received	No interaction terms showed association between immigration status and state generosity and the value of food stamps received	The higher the percentage of household members eligible for FSP, the higher the per capita FSP benefit the older adults' household received (P=0.05)
Food Security Indicator	None of the interaction terms between state generosity and immigration status had a significant coefficient	None of the interaction terms between state generosity and immigration status had a significant coefficient	A high percentage of eligible household members significantly reduced an older adult's risk of food insecurity (P value not provided)

Other Findings

FSP participant benefit amounts and food insecurity are highest among non-citizens compared to native and naturalized citizens with P=0.05
Both household immigration status and older adults' individual immigration status were significantly associated with the probability of FSP participation
Living in a household with a higher percentage of eligible members significantly increased older people's FSP participation and benefit levels while significantly reducing their risk of food insecurity.

Author Conclusion:

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 imposed a barrier to immigrants' welfare program participation by restricting eligibility. When federal FSP eligibility rules were relaxed in 1998, older non-citizens did not benefit equally because older adults' FSP participation is affected by the eligibility of other household members. It is not clear why eligibility of other household members effects FSP participation by eligible older immigrants. It may be related to a low level of benefits available when only a small number of household members are eligible. Older non-citizens experience food insecurity at a significantly higher rate than older native and naturalized citizens despite their higher FSP participation rates and higher benefit levels.

There are several implications for future policy development and research from this study including:

The consideration of household composition and living arrangements of older immigrants when developing social policies as household plays an important economic role in the lives of immigrants
Experts should reconsider current restrictions on the welfare program participation of postenactment immigrants as they often help extended kin and incorporate newly immigrated family members into their homes
Future gerontology research should consider the importance of contextual factors such as household composition and living arrangements
Developing policy measures that reflect various aspects of a given policy can help researchers understand issues from various perspectives and expand knowledge of policy effects.

Funding Source:

University/Hospital:

Center for Aging and the Faculty Research Fund at Washington University

Not-for-profit

Foundation associated with industry:

Reviewer Comments:

Blinding was not used in this study.

The author notes the following limitations to this study:

A cross-sectional data was used, so there was no ability to trace changes in FSP participation and food insecurity of individual immigrants over time
Data limitations did not allow for complete resolution of the issue of unobserved covariates
The CPS may have limitations in collecting data from non-English-speaking populations
It was not possible to study postenactment immigrants who still remained ineligible for FSP and other public benefit programs in most states during the five-year ban.

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?		Yes
	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?	Yes
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	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?	N/A
	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?	N/A
	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%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	Yes
	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?		N/A
	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?	N/A
	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?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	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?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	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