Date Published: June 8, 2018
Publisher: Public Library of Science
Author(s): Kimberly R. Dong, Alice M. Tang, Thomas J. Stopka, Curt G. Beckwith, Aviva Must, Jacobus P. van Wouwe.
Individuals under community corrections supervision may be at increased risk for food insecurity because they face challenges similar to other marginalized populations, such as people experiencing housing instability or substance users. The prevalence of food insecurity and its correlates have not been studied in the community corrections population.
We conducted a cross-sectional study in 2016, surveying 304 probationers in Rhode Island to estimate the prevalence of food insecurity, identify food acquisition methods, and determine characteristics of groups most at-risk for food insecurity. We used chi-square and Fisher’s exact tests to assess differences in sociodemographics and eating and food acquisition patterns, GIS to examine geospatial differences, and ordinal logistic regression to identify independent correlates across the four levels of food security.
Nearly three-quarters (70.4%) of the participants experienced food insecurity, with almost half (48.0%) having very low food security. This is substantially higher than the general population within the state of Rhode Island, which reported a prevalence of 12.8% food insecurity with 6.1% very low food security in 2016. Participants with very low food security most often acquired lunch foods from convenience stores (and less likely from grocery stores) compared to the other three levels of food security. Participants did not differ significantly with regards to places for food acquisition related to breakfast or dinner meals based upon food security status. In adjusted models, being homeless (AOR 2.34, 95% CI: 1.31, 4.18) and depressed (AOR 3.12, 95% CI: 1.98, 4.91) were independently associated with a greater odds of being in a food insecure group. Compared to having help with meals none of the time, participants who reported having meal help all of the time (AOR 0.28, 95% CI: 0.12, 0.64), most of the time (AOR 0.31, 95% CI: 0.15, 0.61), and some of the time (AOR 0.54, 95% CI: 0.29, 0.98) had a lower odds of being in a food insecure group. Food insecure participants resided in different neighborhoods than food secure participants. The highest density of food insecure participants resided in census tracts with the lowest median incomes for the general population. The areas of highest density for each level of food security for our participants were in the census tracts with the lowest levels of full-time employment for the general population.
The prevalence of food insecurity and very low food security were markedly higher in our probation population compared to the general RI population. These findings suggest that access to food on a regular basis is a challenge for adults on probation. Depression and being homeless were independently associated with a greater odds of being in a food insecure group. In addition to intervening directly on food insecurity, developing interventions and policies that address the contributing factors of food insecurity, such as safe housing and treatment for depression, are critical.
Food insecurity, which is defined as uncertain or limited availability of nutritionally adequate or safe food or the inability to acquire personally acceptable foods in socially acceptable ways, can result in poorer quality of dietary intake, which can lead to further health decrements. Very low food security is defined as a household with at least one individual that has reduced food intake and eating patterns that were disrupted over the year due to lack of money or other resources for food. In 2016, 12.3% of US households (or about 15.6 million households) were food insecure at some point in the year and of that, 4.9% (or about 6.1 million households) had very low food security.
A total of 304 participants were enrolled in this study. Approximately 20% refused to participate at the time of recruitment because the timing was inconvenient with transportation home or other appointments. A smaller percentage (~5%) were not enrolled because they were non-English speaking. Probation officers reported that the individuals participating in this study were, in their estimation, generally representative of the individuals reporting to this office based upon gender, race, and socioeconomic status and did not differ from those who were unable or refused to participate.
Our study is among the first to empirically assess food insecurity and food acquisition methods in adults on probation. We found that more than two-thirds of our study population were food insecure, suggesting that access to quality foods on a regular basis is a common problem for individuals on probation. The prevalence of food insecurity and very low food security in our study participants were both substantially higher compared to the general population within the state of Rhode Island (with different periods of assessment, 30 days versus 12 months, respectively). There are no data available for each of the ten food insecurity indicators for the general population of Rhode Island (as in Fig 2); however, this is reported nationally in the 2016 USDA Household Food Security report. According to this report, approximately one-third (33%) of US households with very low food security reported an adult not eating for an entire day and 26% reported that this occurred in three or more months during the year. Almost half (44%) of US households with very low food security reported weight loss because there was not enough money for food. These percentages are high nationally, but even higher in our study population. The USDA Household Food Security report provides this information over a 12-month reporting period. Given the unstable nature of our probation population and to assess current food security status, we used a 30-day reporting period. Food insecurity fluctuates throughout the year and prior studies have shown that the prevalence of food insecurity in the past 30 days is often lower compared to prevalence over the prior year[1, 37] or that the prevalence of food insecurity increases as the length of the observation period increases, which makes the findings in our study population even more striking.
The prevalence of food insecurity and very low food security among adults on probation was extremely high compared to the general population, indicating a critical need for action. We identified characteristics of probationers most at risk for food insecurity, which includes being homeless and depressed and lacking social support for meal preparation. These findings can inform development of targeted interventions and policies to mitigate health disparities in this population. The strategies to improve food insecurity need to confront the root causes of social determinants, such as improving affordable access to healthier foods, and structural determinants, such as addressing barriers to gainful employment, safe housing, and treatment for depression, in order to reduce the criminogenic risk factors for people on probation. There are many individuals on probation in the US, so this provides a window of opportunity to intervene to improve the wellbeing of a vulnerable population.