EAL

FNOA: Aging Programs (2012)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To examine participation in the Food Stamp Program (FSP), food pantries and soup kitchens and to identify reasons food insecure households choose not to participate.

Inclusion Criteria:

Households with income below 185% of the federal poverty level in Hartford, Connecticut.

Exclusion Criteria:

Income above 185% of the poverty level.

Description of Study Protocol:

Recruitment

1,050 randomly selected households out of 45,521 households in Hartford, CT.

Design

Cross-sectional analysis of a retrospective cohort

Blinding used

Not applicable

Intervention

Not applicable

Statistical Analysis

Chi-square tests of association between program participation and sociodemographic characteristics
Logistic regression tested for associations between program participation and ethnicity and between food security status and household composition while controlling for potential confounding.

Data Collection Summary:

Timing of Measurements

Surveys were completed in participants' homes from May to October 1999.

Dependent Variables

Yes or no for participation within the previous 12 months in the:

Food Stamp Program
Food pantry
Soup kitchen.

The survey instrument was pre-tested on 19 low-income households to assess face validity of items and internal consistency of the overall instrument.

Independent Variables

Food security status defined as food secure or food insecure
Household composition defined as having a child under age five, having a school-aged child ages five to 18 and having a household member over age 65
Ethnicity defined as black, white or Hispanic.

Control Variables

Car ownership
Income above 100% poverty
Adult member with a high school degree
Adult member with full-time employment.

Description of Actual Data Sample:

Initial N: 1,050 households
Attrition (final N):
- 73 had income above 185% of the poverty level
- 377 households could not be contacted
- 270 households refused to participate, leaving 330 responses
Age: Not provided
Ethnicity:
- 153 Hispanic
- 146 Black
- 20 White
Other relevant demographics:
Anthropometrics:
Location: Hartford, Connecticut USA.

Summary of Results:

Program participation:

36% of respondents did not participate in any of the three programs
33% participated in food stamps alone
13% received assistance from food stamps and food pantries
7% received assistance only from food pantries
4% received assistance from food stamps and food soup kitchens
4% received assistance from all three programs.

After logistic regression:

Black households are half as likely as Hispanic households to receive food stamps.	Adjusted odds ratio=0.49	P=0.02
Elderly households are less than half as likely to receive food stamps	Adjusted odds ratio=0.44	P=0.04
Households with a school-aged child are less than half as likely to go to a soup kitchen as households without school aged children	Adjusted odds ratio=0.39	P=0.02

Other Findings

Reasons for not participating in FSP, food pantries and soup kitchens included:

We do not need the food
We do not feel comfortable using the program
No transportation, difficult to get to program
We belive our family is not eligible
We do not know where the program is located
Hard to carry the food home
Paperwork is difficult/difficult to apply
Applied but were found ineligible
Other
Do not know.

Author Conclusion:

This study's findings show that many food-insecure people feel uncomfortable using assistance programs. Additional research is needed to examine what types of interventions can be used to increase participation, particularly among the elderly and Hispanic households.

Many households classified as food secure based on the US Household Food Security Module have received food from food pantries or soup kitchens in the 12 months prior to the survey. This suggests that these people many actually be food insecure or receiving food from food pantries or soup kitchens is socially acceptable. The definition of food insecurity may have to be changed.

Welfare reform was successful in getting many people off of public assistance; however, many of these people now receive private assistance. The FSP is considered the first line of defense against hunger by the US Department of Agriculture (USDA). The USDA and individual states need to make the FSP more accessible to food insecure households. Some ways this can be accomplished include:

Using on-line pre-screeners
Using nutrition educators to provide practical information
Reducing the length of the application
Developing mobile food stamp offices within low income communities
Accepting applications on-line.

Funding Source:

Not-for-profit

Foundation associated with industry:

Reviewer Comments:

The authors note the following limitations:

Data is limited to one medium-sized city and may not be representative of other cities of different sizes, rural areas, or the nation
The bivariate analyses reported do not control for ther covariates which may influence the relationships identified
Data was cross-sectional and appropriate control groups were not included, so casual relationships cannot be identified
Surveys were translated into Spanish and different interpretatons across ethnic groups could affect reliability and validity of the questions.

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?	N/A
	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?		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?		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?		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?	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?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	No
	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)?	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?		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