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Health Disparities

HD: Food Security (2011)

Citation:

 Fuller-Thomson E, Redmond M. Falling through the social safety net: Food stamp use and non-use among older impoverished Americans. Gerontologist. 2008 Apr; 48 (2): 235-244.

PubMed ID: 18483435
 
Study Design:
Decision analysis
Class:
M - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:

To identify the characteristics of eligible older Americans who are not receiving food stamps and assess the validity of the Anderson behavioral model for predicting impoverished older adults food stamp use to improve targeting and outreach efforts.

Inclusion Criteria:
  • Aged 65 years and older
  • American citizens
  • Income less than 100% of the poverty level.
Exclusion Criteria:
  • Non-citizens of the United Stated including legal residents
  • Individuals with income>100% of the poverty level
  • Aged less than 65 years.
Description of Study Protocol:

Recruitment and design

A secondary analysis of a random sample of the 2003 American Community Survey available as a Public Use Microdata Set was used.

Statistical Analysis

SPSS 15.0 for Windows was used to conduct analysis. In order to validate the Andersen Behavioral Model, bivariate and multivariate tests were conducted. Chi-square analysis for each of the pre-disposing, enabling, and need characteristics were conducted to assess group differences. To avoid falsely increasing the likelihood of obtaining a significant P-value, the weight variable was re-scaled to have a mean value of 1 for the sub-sample. All variables were based on self-report. 

Data Collection Summary:

Timing of Measurements

Secondary analysis of 2003 American Community Survey completed

Dependent Variables

Food stamps

Independent Variables

  • Gender
  • Race
  • Ethnicity
  • Age
  • English-language skills
  • Education
  • Welfare
  • Supplemental security income
  • Poverty level
  • Housing tenure
  • Limitation in activities of daily living
  • Vision or hearing impairment.

Control Variables

American citizenship

 

Description of Actual Data Sample:
  • Initial N: 14,724
    • 2,796 recipients
    • 11,928 non-recipients
  • Attrition (final N): 14,724
  • Age: Aged 65 years and older
  • Ethnicity:
    • 13,665 non-Hispanic
    • 1,059 Hispanic
  • Other relevant demographics:
    • 2,662 African American
    • 4,198 male
    • 10,526 female
  • Location: Nationally representative survey.
Summary of Results:

Analysis of Predisposing, Enabling and Need Characteristics Associated with FSP Utilization Among Poor Older Americans

Variables Total (N) FSP Use (%) P

Gender
 Male
 Female


4,198
10,526 

16.4
20.4 
<0.001 

Ethnicity
 Not Hispanic
 Hispanic


13,665
1,059 

17.9
31.0 
<0.001  

Race
 Not African American
 African American


12,062
2,662 

16.5
30.1 
<0.001  
Age (years)
 65-74
 75-84
 85+

6,556
5,881
2,227 

24.0
16.8
11.1 
<0.001  

English-language Skills Speaks English at home
Speaks English as 2nd language, very well
Speaks English not well or not at all

12,699
1,180
845 
17.5
19.2
36.1 
<0.001  
Citizenship US
Citizen by birth Citizen through naturalization
13,487
1,237 
17.9
29.5 
<0.001  

No children
1 or more children

13,747
977 
17.8
37.2 
<0.001  

No welfare received
Welfare received

14,373
351 
18.3
57.5 
<0.001  

Supplemental Security Income
 No
 Yes 


12,881
1,843 

14.5
51.3 
<0.001  
Poverty Quartiles
 0% to 24%
 25% to 49%
 50% to 74%
 75% to 100% 

4,627
2,034
7,419
644 

6.5
13.2
19.9
23.1 
<0.001  
Housing Tenure
 Rented for cash rent
 Owned/mortgage
 Owned/paid off Occupied without pay
 
4,627
2,034
7,419
644 
32.4
15.7
10.4
17.3 
<0.001  
Limitation in activities of daily living
 Yes
 No 

2,156
12,568 

27.2
17.8 
<0.001  
Severe vision or hearing difficulty
 Yes
 No 

3,351
11,373 

24.3
17.8 
<0.001  

Other Findings

Logistic Analysis of FSP Utilization Among Older Americans

  • Female 1.32 P<0.001
  • Hispanic 1.23 P=0.02
  • Education, primary 1.64 P<0.001
  • Children present at home 2.51 P<0.001
  • Severe vision or hearing difficulty 1.18 P=0.003
  • Household income <25% of poverty line 1.00
  • Household income 75% to 99% of poverty line 2.79 P<0.001.
Author Conclusion:

Of older Americans living in poverty, one in five was receiving food stamps. Food stamp utilization rates were higher among female, Hispanic, and African American respondents. Prevalence rates decreased with age. Having a disability was associated with higher rates of food stamp utilization. Those who did not speak English well had twice the rates of food stamp use as those who spoke English at home.  Individuals with less education were more likely to utilize food stamps. Older adults living below 25% of the poverty line had less than one third the utilization rates as those living between 75% and 99% of the poverty line. 

Two factors may result in the exclusion of some eligible older adults from the sample. Some legal immigrants are eligible for food stamps whereas other are not. All non-citizens were excluded from the analysis. The sample was restricted to those with gross household incomes under the poverty line. 11% percent of food stamp recipients have gross incomes over 100% of the poverty line, thus a minority of eligible older adults may have been excluded. The ACS does not include information on financial or vehicle assets, therefore, some of the respondents may not be eligible for food stamps due to their assets. Findings that the younger cohort had almost three rimes the odds of food stamp utilization compared to older adults could be due to a potential negative perspective held among the older cohort towards use or dependence on social services/welfare such as food stamps. Strategies for improving food stamp use include community education, mobile and satellite food stamp offices in lower income neighborhoods, improvements in the application process, innovation outreach programs and home visits.

Funding Source:
Industry:
Royal Bank of Canada Graduste Research Fellowship in Applied Social Work
Reviewer Comments:
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? N/A
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? N/A
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? N/A
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes