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The purpose of this study is to explore the associations between diet quality, body mass index, and smoking status of adult women who are clients of a food pantry in Lee County, Alabama.

Adult women, age 19 to 50, who were not pregnant or breast feeding and who are food pantry clients. Participants completed informed consent forms; data from participants were included if the 24-hour food recall was complete and plausible.

Women not in the age range of 19 to 50 years old, were breast feeding or pregnant, did not complete an informed consent form, or had incomplete or implausible dietary recalls.

Recruitment

Participants were clients at the Lee County food pantry, solicited to volunteer in the study during its regular business hours.

Design

Participants completed a food security survey instrument and 24-hour food recall, both administered by trained interviewers. Participants were asked orally if they had smoked at least 100 cigarettes in their lifetime and whether they currently smoked every day, some days, or not at all. They were also verbally asked basic demographic information about age, education, ethnicity and household income. The trained interviewers also completed anthropometric measurements of the participants. All interviews were conducted in English, in a private room at the food pantry, and questions on the survey instrument were read to participants.

Blinding used

No blinding was used

Intervention 

No intervention, as this was an epidemiological study

Statistical Analysis

One-way analysis of variance was used to examine differences in Healthy Eating Index-2005 [HEI-2005] and smoking, food security status, education level and participation in WIC or food stamps. ANOVA was also done to test differences in adult food security scale score and body mass index among smokers and non-smokers. Regression techniques were used to assess the relationship of food security, education, age, ethnicity, participation in government food programs and smoking to the overall HEI-2005 score as well as its components. Standard ordinary test squares regression was used for HEI-2005. Significance is reported at the 10 percent level due to the small sample size and exploratory nature of the study.

Timing of Measurements

Data were collected from participants during a one-time interview, conducted in March and April of 2006.

Dependent Variables

• Diet quality, measured using the USDA Healthy Eating Index 2005 
• Adult obesity, measured using body mass index
• Household food security, measured using 10 selected questions from the USDA Food Security Module.

Independent Variables

• 24-hour dietary recall
• Anthropometric measurements (weight and height)
• 10 selected questions from the USDA Food Security Module.

Control Variables

• Initial N: 55 women were recruited
• Attrition (final N): Usable 24-hour food recalls were collected from 48 participants. For the food security survey and anthropometric measures, 55 participants provided data.
• Age: Mean age of the participants was 34.4 years
• Ethnicity: Of the 55 participants:
  • 34.5 percent were white
  • 60.0 percent were black
  • 5.5 percent other ethnicities
• Other relevant demographics: All participants had incomes below the federal poverty threshold.
  • About 45 percent of participants were single parents and 24 percent reported having less than a high school education/GED
  • About 65 percent of participants reported some level of food insecurity
  • 27.3 percent reported low food security, while 38.2 reported very low food security
  • In addition, 38.2 percent of participants were classified as current smokers, 41.8 percent reported they have no health insurance, 50.9 percent  use food stamps, and 25.4 percent use benefits from WIC 
• Anthropometrics: Participants' weight according to body mass index [BMI]:
  • 10.9 percent classified as normal weight (BMI 18.5-24.9)
  • 21.8 percent classified as overweight (BMI 24-29.9)
  • 45.5 percent classified as obese (BMI 30-39.9)
  • 21.8 percent classified as severely obese (BMI over 40)
• Location: Lee County, Alabama.

 

Key Findings

• According to the Healthy Eating Index-2005 [HEI-2005], diet quality of participants was generally poor. No participant scored above 80 on the HEI-2005, and only 29 percent scored above 50.
• Most of the participants reported no consumption of: fruit; whole fruit; whole grain; or dark green or orange vegetables or legumes
• Significant differences were found between body mass index and current smoking (P<0.05) and food security and current smoking (P<0.02)
• No significant differences were found between HEI- 2005 and: food security status; current smoking; low education; and participation in food stamps and/or WIC
• Food stamps and WIC participation were positively related to specific subcomponents of the HEI-2005 but were not positively associated with higher diet quality.

Variables	Mean marginal effects of explanatory variables on components of HEI-2005	Statistical Significance of Group Difference
WIC Marginal effect on whole fruit Marginal effect on whole grain	1.31 1.53	P<0.09 P<0.04
Food Stamps Marginal effect on sodium	1.94	P<0.05
Low Education Marginal effect on whole fruit Marginal effect on whole grain Marginal effect on milk Marginal effect on sodium	-1.99 -2.38 -3.10 -2.15	P<0.07 P<0.02 P<0.03 P<0.06
Smoking Marginal effect on total grain Marginal effect on whole grain Marginal effect on meat	-1.10 -1.33 -2.65	P<0.08 P<0.03 P<0.02
African American Marginal effect on total grain	-1.06	P<0.05
Age (per year) Marginal effect on whole grain	0.07	P<0.08

 

Food pantry clients in Lee County, Alabama reported high rates of obesity and food insecurity, and poor diet quality. Smoking was associated with increased probability of food insecurity and with lower diet quality. Food stamps and WIC participation were not positively associated with higher diet quality but were positively related to specific components of the Healthy Eating Index-2005. Results should be interpreted with caution, as a relative increase in one area could be associated with a relative decrease in other areas. Alabama food pantry clients may be likely to experience health problems due to the high prevalence of obesity, smoking, and poor diet quality; the lack of health insurance among many of the clients is especially concerning. More specific knowledge about the diet quality of food pantry clients will help food pantry directors and nutritionists target nutrition outreach programs more effectively. Also, smoking cessation programs may be of special benefit to pantry clients.

There are many limitations to the study discussed by the authors. The study size is small and may not be a representative sample. The 24-hour food recalls provided by participants may not represent usual intake, as the 24-hour period was immediately before clients came to the food pantry; also, the data used for analysis were from only one 24-hour recall. The investigators did not capture participants' food intakes on different days of the week, seasons of the year, or the time period before and after receiving food from the food pantry. A greater sample of pantry clients over a broader geographic area is needed to determine whether food pantry clients in general have high levels of obesity and smoking and poor diet quality. Because there was no control group or comparison group, no conclusions can be made as to whether food pantry clients had worse diets or higher rates of obesity than other low-income women in the study area.