EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To compare sociodemographic characteristics of food pantry clients who are food stamp recipients vs. non-recipients to provide information helpful in improving food stamp outreach and enrollment
The study was intended to test the following hypotheses:
- Single-parent families with children would be more likely to receive food stamps
- English language ability would encourage food stamp program participation
- Homeless clients would be less likely to receive food stamps.

Inclusion Criteria:

Clients that attended two different food pantries in Pomona and Ontario counties in California during 2003.

Exclusion Criteria:

No exclusion criteria were noted.

Description of Study Protocol:

Recruitment

Participants in this study were not recruited. All clients who attended two different food pantries in the LA area in 2003 were included in the study.

Design

Cross-sectional study.

Statistical Analysis

Financial eligibility and sociodemographic data were collected from attendees at two food pantries and entered into the Access software program
Regression of the binary outcome "food stamp participation" on food pantry client sociodemographic variables.

Data Collection Summary:

Timing of Measurements

Data was collected as part of the eligibility for emergency food assistance when participants presented at one of two food pantries.

Dependent Variables

Food stamp participation.

Independent Variables

Single parent families
English language ability
Homeless clients.

Description of Actual Data Sample:

Initial N: 14,317 clients seeking emergency food assistance
Attrition (final N): No attrition reported; however not all characteristics of the original N were reported. The initial N=14,317, but age data was provided for 14,011, income for 14,273, ethnicity for 14,317, language for 14,317, education for 13,135 and housing cost as a percent of income for 14,135.
Age: 30.37% of the total sample were 17 to 34 years old, 46.52% were 35 to 49 years old, 17.38% were 50 to 64 years old and 5.52% were 65 to 84 years old
Ethnicity: 14.20% of the total sample was African American, 0.30% were American Indian, 0.70% were Asian/Pacific Islander, 25.30% were Non-Hispanic White, 58.80% were Hispanic and 0.70% were classified as "other"
Other relevant demographics:
- Data was collected on income from food stamps, language, education, housing costs as percent of income and total monthly income. 86.75% of food pantry clients reported no food stamp income. 64.10% were English-speaking and 27.90% Spanish-speaking. Nearly 44% reported no monthly income, while 28.80% reported a monthly income of $501 to $1,000
- 15.2% of single parent (father) food pantry and 29.3% of single parent (mother) food pantry participants received food stamps
Location: Food pantry clients were from the greater Los Angeles, CA, area, specifically Pomona and Ontario counties.

Summary of Results:

Covariates of the Probability That Food Pantry Clients Receive Food Stamps

	Mean (SEM)	Percent Receiving Food Stamps	Bivariate Odds Ratio	Multivariate OR (95% CI)	P-value
Age (year)	42.38 (0.12)			0.971 (0.966, 0.976)	0.001
Total income per month	$584.70 ($102.07)			1.000 (1.0, 1.0)	0.358
Housing costs per month	$514.69($1.90)			0.999 (0.999, 0.999)	0.001
Education	9.85 (0.031)			0.972 (0.949, 0.995)	0.019
Single parent, father		15.2	1.18	2.672 (1.068, 6.681)	0.036
Single parent, mother		29.3	2.80	2.488 (1.670, 3.706)	0.001
English ability		13.8	0.799	1.257 (1.035, 1.527)	0.021
Homeless		5.7	0.236	0.217 (0.188, 0.251)	0.001

Other Findings

90% of food pantry users were living well below the poverty level and 44% were homeless
Only 15% of the food pantry clients received food stamps, with homelessness and limited English language skills acting as barriers to food stamp program participation
The results confirm the hypothesis that single parents (P<0.05) and clients with better English language ability were more likely to receive food stamps (P<0.021) and that being homeless made it less likely that a pantry user would also be a food stamp recipient (P<0.001)
Food pantry clients were better educated (P<0.019) and older clients (P<0.001) were less likely to receive food stamps.

Author Conclusion:

Homelessness and limited English language ability appear to act as barriers to food stamp participation. Food stamp recipients tend to be younger, less educated, single-parent households struggling with housing costs.

Funding Source:

Government:

California State Agricultural Research Initiative Grant 05-4-102-12

Reviewer Comments:

"Homeless" was not well-defined in the study. The study reports that 44% of participants were homeless but it is unclear if this includes the 20.60% of participants who had no housing costs
Food stamp participation was reported by self-reported food stamp income. This data is subject to error based on participants ability to correctly self-report.
It is unclear to the reviewer whether income and housing costs were self-reported or based on documentation provided by participants
Data was not collected for all participants.

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?	???
	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?		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.)	N/A
	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?		No
	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%.)	No
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	No
	4.4.	Were reasons for withdrawals similar across groups?	???
	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?		N/A
	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.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	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?		???
	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?	N/A
	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?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	N/A
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	???
	7.7.	Were the measurements conducted consistently across groups?	N/A
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)?	No
	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?		No
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	No
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