EAL

HD: Food Security (2011)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To explore the role that social support from family, friends, and the community (faith communities and public and private assistance) plays in the relationship between income and food insecurity, and to assess other contributing factors from the perspective of those at risk for food insecurity
The objectives of the present study were to
- Explore the experiences of people around food security, food insecurity, and the role of social support
- Examine whether the experiences and perceptions of food insecurity and social support differ based on rural or urban residence.

Inclusion Criteria:

Respondents to a mail survey who indicated on the survey that they were willing to participate in an in-depth interview about their responses
Capable of providing information pertinent to the study objectives
Low income (≤185% of the federal poverty guideline for a given household size), food insecure (measured as three or more affirmative responses to the 10 questions from the United States Department of Agriculture Food Security Core Module) or both.

Exclusion Criteria:

Respondents to a mail survey who did not indicate on the survey that they were willing to participate in an in-depth interview about their responses
Respondents who were not capable of providing information pertinent to the study objectives
Respondents who were not low income (≤185% of the federal poverty guideline for a given household size), food insecure (measured as three or more affirmative responses to the 10 questions from the United States Department of Agriculture Food Security Core Module) or both.

Description of Study Protocol:

Recruitment

Participants were recruited from the respondents to a mail survey conducted as part of a larger project.

Design

Interviews were conducted by the first author in private rooms at convenient locations.

Blinding used

No blinding was used

Intervention

No intervention was used

Statistical Analysis

The study objectives were revisited to confirm the explanations that were sought
Study authors developed potential themes and sub-themes based on the review of the literature, study objectives, and interview questions
Study authors conducted an initial thorough review of the transcripts to ascertain whether the themes and sub-themes were still relevant and to see whether any new themes or sub-themes emerged
Study authors created a list of the themes, sub-themes and rules for coding text
Data from each transcript were coded into corresponding themes or sub-themes using MAXqda2 software version (MAXqda, 2007)
Two authors coded 1/2 of the survey transcripts and then reviewed the coding done by the other researcher
Coding was compared and any discrepancies were reconciled
The number of data items in each theme and sub-theme were reviewed to ascertain the relative magnitude and to look for patterns, with the rule that patterns must be supported by at least three occurrences of the same idea
Conclusions were drawn by considering the patterns found in light of previous research and the study objectives for this study.

Data Collection Summary:

Timing of Measurements

Interviews conducted between December 2006 and February 2007
Each interview lasted 45-75 minutes.

Dependent Variables

Study authors developed potential themes and sub-themes based on the review of the literature, study objectives and interview questions
Study authors conducted an initial thorough review of the transcripts to ascertain whether the themes and sub-themes were still relevant and to see whether any new themes or sub-themes emerged
Study authors created a list of the themes, sub-themes and rules for coding text
The number of data items in each theme and sub-theme were reviewed to ascertain the relative magnitude and to look for patterns, with the rule that patterns must be supported by at least three occurrences of the same idea.

Independent Variables

33 questions that were primarily open-ended and included follow-up probes
- Questions came from the Rural Families Speak Multi-State Longitudinal Research Project and an ethnography of hunger in rural Benton County, Oregon
- Questions about employment, income, expenses, food insecurity, social support, transportation and community were included from the two instruments listed above
- Study authors developed questions about food procurement, ease of getting to a grocery store, prices at that store, and whether the store carried fresh fruit and vegetables.

Control Variables

None listed

Description of Actual Data Sample:

Initial N: 38 participants were willing to be interviewed and met inclusion criteria
- 10 failed to respond to queries to set up an interview
- Three missed their scheduled interview and could not be rescheduled
Attrition (final N): 25 participants
- 18 female
- Seven male
Age:
- Mean=47.75 years
- Range=21-64 years
Ethnicity:
- 20 White/Non-Hispanic
- Three Native American/Non-Hispanic
- Two Hispanic
Other relevant demographics:
- 14 rural; 11 urban
  - 12 rural participants were food insecure; two were food secure
  - Eight urban participants were food insecure; three were food secure
- Eight participants had incomes>185% of the federal poverty guideline because they had the potential to provide a unique perspective on the causes of food insecurity and their coping strategies
- Six participants had children in the home
Anthropometrics: None provided
Location: Oregon.

Summary of Results:

Key Findings

There were three main themes, each with sub-themes
- Contributors to food insecurity
  - Illness and injury
  - Unemployment and underemployment
  - Family changes
    - Divorce
    - Birth of a child
  - Prior choices
  - Other bills
  - Social isolation
  - Geographic isolation
- Coping strategies
  - Food stretching
  - Alternate food sources
    - Gardening
    - Hunting
    - Fishing
    - Crabbing
    - Cattle
  - Use of nutrition assistance
  - Creative bill paying
  - Social support
- Mechanisms for improving conditions
  - Education
  - Employment
  - Home-ownership.

Other Findings

Urban and rural participants gave many of the same explanations for their experience with food insecurity
Most of those interviewed described using similar strategies to cope with food insecurity
During the interviews with rural participants, some differences were noted, including social isolation, geographic isolation, and the use of alternate sources of food.

Author Conclusion:

Some Oregonians are still confronted with challenges to maintaining food security
This study provides insight into the causes of food insecurity from the perspective of those struggling with it, as well as the strategies they use to cope with this ongoing problem
- Participants who were food insecure, low income or both suggested common contributors to food insecurity such as ill health and un- or underemployment
- Many food insecure participants found themselves in that situation because of illnesses and injuries, resulting in high health care costs exacerbated by lack of health insurance
- Participants felt that home ownership, more education and more stable employment contributed to food security
This study highlights the differences in experiences between rural and urban Oregonians, revealing that the nature of rural living can be both a barrier and a facilitator to food security
- Food-insecure participants from rural Oregon reported problems with isolation that their urban counterparts did not
- Several rural Oregonians facing food insecurity noted that transportation was a barrier for them
- Rural interviewees mentioned that food prices were higher in their areas
- With the exception of one urban participant who reported some comparable sources, only rural participants cited hunting, fishing, crabbing and cattle ranching as sources of food.

Funding Source:

Other:

No financial support information provided.

Reviewer Comments:

No comments.

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?		Yes
	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?		N/A
	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?	N/A
	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?		No
	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.)	No
	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?		Yes
	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?	Yes
	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?	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?	N/A
	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)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	N/A
	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?		???
	10.1.	Were sources of funding and investigators' affiliations described?	No
	10.2.	Was the study free from apparent conflict of interest?	Yes