food isecrity the southern rural development center
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INSECURITYThe Southern Rural Development Center addresses...
Report from RIDGE-funded research in the Southern Region
Food
Food insecurity and emotional well-being among single mothers in the rural SouthAndrew A. Zekeri, Tuskegee University
Introduction While we live in a wealthy nation, food insecurity continues to affect millions of American families [3, 4]. Food
insecurity means individuals and families have limited access to food or a limited or uncertain ability to obtain food
due to lack of financial resources [3, 4]. For example, the most recent data from the United States Department
of Agriculture (USDA) indicate that 11.9 percent of the United States households were food insecure in 2005 [3].
According to data published by the USDA since 1995, African American and Hispanic households are more likely than
Whites to be food insecure and hungry [4, 3]. Within that group, rural African Americans remain especially vulnerable.
Furthermore, households headed by single women, particularly African American women, tend to be at higher risk of
food insecurity. The rural South in general, and Alabama in particular, have faced significant rates of food insecurity
and hunger relative to the nation as a whole [4, 3].
Though analyses at the regional and national levels
have produced new insights into the prevalence of
food insecurity, largely missing from the literature is an
analysis examining the consequences of the resulting food
insecurity for the health and emotional well-being of rural
household residents. Little research exists that delineates
the health consequences of food insecurity as measured
by the USDA Core Food Security Survey Module (CFSM)
that was used in this study. Those analyses that do exist
have examined the impact of food insufficiency as measured
by one food sufficiency question from the National Health
and Nutrition Examination Survey III (NHANES III) on the
health status among welfare recipients in urban areas [1, 6,
8, 10]. They show that food insufficiency is associated with
individuals who self-report their health statuses as “fair” or
“poor.” However, published assessments of the association
between household food insecurity and the physical and
emotional well-being of poor single mothers in rural areas
rarely have been done. As such, the purpose of this policy
brief is to (a) estimate the prevalence of food insecurity
among single mothers living in Alabama’s Black Belt, and
(b) examine the impact of food insecurity on their physical
health and emotional well-being. In order to make informed
decisions about policies and programs designed to reduce
food insecurity, it is important to assess the link between
food insecurity and the physical and mental health of rural
single mothers.
The Study AreaAlabama’s Black Belt, the site for this study, is an ideal
setting for examining the prevalence and adverse health
consequences of food insecurity in rural areas of the United
States. Among the poorest places in the United States, this
region is characterized by its high concentration of African
American residents. Regionally, the Alabama Black Belt’s
poverty rates as of 2000 compare to that of the Appalachian
mountain region, where the poor are predominantly White,
the Rio Grande Valley/Texas Gulf Coast, where the poor are
largely Latino, and the reservations of the Southwest, where
the poor are largely Native Americans. Moreover, the Black
Belt region suffers from poor employment opportunities,
chronic unemployment, limited educational attainment,
poor health, high concentration of single parents, and
heavy dependence on public assistance programs [13, 12,
2008
11]. The five counties selected for the study are among those
categorized by the USDA as “persistent poverty” counties.
MethodologyThe sample for this study, 300 single mothers that were receiving
welfare and/or food stamp benefits, was drawn from a list of over
500 families in a five county area of Alabama Black Belt that
participated in previous studies carried out by the author [13, 12, 11].
Food insecurity was measured using a structured questionnaire
based on CFSM and the other questionnaires constructed and
used in previous studies, all investigations were approved by
the Human Subject Participants Review Committee at Tuskegee
University. The CFSM scale is based on respondents’ answers
to a series of 18 questions regarding behaviors and experiences
known to characterize households that are having difficulty
meeting food needs. Face-to-face, in-home, structured interviews
were conducted from June 2005 to September 2006. Consent to
participate in the study was obtained from all participants. The
interviews lasted approximately 90 minutes. For the present
analysis, food security status is a dichotomous variable (food
insecure and food secure).
General Health Status and Emotional Well-Being Self-rated health status provides a direct and global way of
capturing perceptions of health criteria that are as broad and
inclusive as the responding individuals choose to make them.
Single mothers were asked to rate their overall health at the time
of the interview with a standard five-category scale, with values
ranging from excellent (1) to poor (5). Self-rated health has been
shown to be a reliable, valid measure of health. It has also been
shown to be predictive of future health status in numerous studies,
independent of other physiological, behavioral, and psychological
risk factors [2].
Emotional well-being is measured by the Center for
Epidemiological Studies-Depression (CES-D) scale, a widely
used measure for assessing depression symptoms in the general
population [7]. Respondents indicated how often, over the week
preceding the interview, they had experienced each of the 20
symptoms on a four-
point scale ranging
from 0 (rarely or
none of the time) to
3 (most or all of the
time). Respondents’
scores were
totaled and an average was constructed. The 20 items cover
affective, psychological, and somatic symptoms. The CES-D
scale is a reliable predictor of depression. In the current study,
reliability was quite high, with a Chronbach’s alpha of 0.91. Key
socio-demographic characteristics of the study participants are
examined as well, such as income, education, age, race, and
employment status.
ResultsAfrican American single mothers constituted the largest portion
of the sample (65.5 percent). With respect to educational
attainment, 32.5 percent of the sample had no formal education
beyond high school, while only 9.2 percent had a four-year college
degree (Table 1). Overall personal income was low, with just
over half (50.2 percent) of the respondents earning less than
$10,000 annually. About 37 percent of the single mothers were
unemployed and looking for work (Figure 1). More than half of the
sample (54.1 percent) were receiving food stamps at the time of
interview.
Page 2
“ Food insecurity was almost three times as
common in this sample of single mothers as in the general U.S.
population.”
Category PercentRace/Ethnicity African American 65.5 White 29.0 Hispanic 2.8Educational Attainment Did not complete high school 32.5 Completed high school or equivalent 33.7 Some college of post high school training 24.5 Completed a college degree 9.2Income Under $10,000 50.2 $10,000 to $14,000 49.5Employment Status Employed(including part-time) 60.3 Unemployed 36.5Participating in Food Stamp Program Receiving food stamps 54.1 Not receiving food stamps 44.0Prevalence of Food Insecurity Food Secure 64.0 Food Insecure 36.0Health Insurance Insured 53.8 Uninsured 46.2Health Status Poor 8.3 Fair 29.0 Very Good 29.6 Excellent 7.9
a. Some percentage scores do not sum to 100% because missing data are not reported in the table.
Table 1. Description of the Sample, Prevalence of Food Insecurity and Health Status
Prevalence of Food Insecurity in the Alabama Black Belt AreaUsing the USDA’s Food Security Scale, approximately 36 percent
of the rural single mothers taking part in the study were classified
as food insecure (Figure 2). The prevalence of food insecurity
in this region contrasts sharply with the national figure, where
roughly of 12 percent suffer from food insecurity (as of 2004) [5].
The Impact of Food Insecurity on Emotional Well-BeingTable 2 presents data on depressive symptoms. The common
responses for depression in the sample involved these seven
items: “feeling bothered by little things,” “poor appetite,” “having
trouble concentrating,” “feeling sad,” “not feeling hopeful about
the future,” “having trouble sleeping,” and “having trouble getting
started” as shown in Table 2.
One of the primary goals of this study was to examine the
relationship between food insecurity and health and emotional
well-being of rural single mothers. As shown in Table 3, food
insecurity is positively related to depression (emotional well-
being). Compared with food-secure households, single mothers
from food-insecure households were more likely to be depressed.
Controlling for age, educational attainment, race and employment
status, the association between food insecurity and emotional
well-being remained statistically significant.
Page 3
Table 2. Percent of Participants Reporting Selected Depressive Symptoms
Depressive Symptoms Percent
Not feeling hopeful about the future 69.1
Feeling sad 61.2
Bothered by things that don’t usually bother 61.1
Having trouble getting started 60.4
Feeling everything I did was an effort 60.3
Having trouble sleeping 60.0
Poor appetite 59.5
Feeling lonely 57.6
Having trouble concentrating 57.5
Feeling fearful 54.4
Figure 2: Food Insecurity
0 10 20 30 40 50 60 70 80
Food Insecure
Food Secure
Not Receiving Food Stamps
Receiving Food Stamps 54.1%
44%
64%
36%
9.2%9999.9.999.999.2%2%2%2%
0 10 20 30 40 50 60 70 80
Unemployed
Employed (Including Part-Time)
Annual Income Between $10,000 to $14,000
Annual Income Under $10,000
Completed A College Degree
Some College Or Post High school Training
Completed High School Or Equivalent
Did Not Complete High School
Hispanic
White
African American 65.5%
29.0%
32.5%
33.7%
24.5%
2.8%
50.2%
49.5%
60.3%
36.5%
9.2%
Figure 1: Demographics
Page 4
The Impact of Food Insecurity on Health The separate analysis was conducted for health status. We found
that food insecurity is negatively related to health status. Single
mothers in food-insecure households were more likely to be in
poor or fair health status (Table 3). In this study, food insecurity
was a stronger predictor of health status than employment or
educational attainment. These results are consistent with other
research conducted on single women on welfare located in
Northern Michigan that found significant associations between
food insufficiency and low self-reported physical and mental health
status [8].
ConclusionsThe present research sought to examine the prevalence of
food insecurity and its relationship to self-reported health status
and emotional well-being among single mothers living in rural
Alabama’s Black Belt. The results do suggest that more than
a third of low-income single mothers from rural Alabama (35.7
percent) are food insecure. Food insecurity was almost three
times as common in this sample of single mothers as in the
general U.S. population. This shows that United States in some
regions may not be faring well in achieving its goal of reducing
food insecurity to six percent by the year 2010 (one of the Healthy
People 2010 objectives) [5].
Food insecurity had significant independent effects on the health
status and emotional well-being of this disadvantaged population
of single mothers. Single mothers in food insufficient households
were more likely to rate their health as poor or fair and to suffer
from major depressive symptoms compared to those in food
sufficient households (Figure 3).
As food insecurity responses increased, responses reflecting
depressive symptoms worsened. Being employed and educated
appear to have positive mental health benefits for rural single
mothers. These findings show the potential emotional and health
vulnerability for single mothers in the rural South who live in food
insecure households. Adding to this, some are living in social and
physical environments that are not supportive of good health,
including access to quality health care. These results mirror some
analyses using the NHANES III data that found food insufficient
households were more likely to experience major depression and
poor health status [1, 8].
Policy ImplicationsThe findings of this study are consistent with growing national
evidence that food insufficiency is associated with depression
and self-reported health status [6, 8, 10, 9]. The only difference
is that while this study used the 18-item CFSM scale to measure
food insecurity, the majority of previous studies used a single item
measure of food insufficiency [8, 1]. They highlight the need for
a concerted effort to prevent food insecurity and ensure that all
Americans are adequately fed in order to improve their physical
health and emotional well-being. Preventing food insecurity may
lower the risk of poor physical and mental health. Healthcare
providers must be sensitive to multiple barriers faced by food-
insecure single mothers. Improving access to balanced meals
and assessing for depression may promote better overall health
among food-insecure, single mothers. Also, improving local
employment contexts and job availability will be important in any
policy designed to increase the emotional well-being of single
mothers in the rural South.
Figure 3: Health Status
0 10 20 30 40 50 60
Uninsured
Insured
Excellent Health Status
Very Good Health Status
Fair Health Status
Poor Health Status
29.0%
8.3%
29.6%
7.9%
53.8%
46.2%
Depression Health Status
Food insecurity + +
Age NS NS
Employment + +
Race NS NS
Education + +
Table 3. Regression Analyses of Depression and Health Status among Single Mothers in Alabama’s Black Belt
How to interpret the table:+ means the variable has a significant impact on depression and health status NS means the variable has no significant impact on depression and health status
What Is Healthy People 2010?
“Healthy People 2010 is a set of health objectives for the Nation to achieve over the first decade of the new century. It can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health.
Healthy People 2010 builds on initiatives pursued over the past two decades. The 1979 Surgeon General’s Report, Healthy People, and Healthy People 2000: National Health Promotion and Disease Prevention Objectives both established national health objectives and served as the basis for the development of State and community plans. Like its predecessors, Healthy People 2010 was developed through a broad consultation process, built on the best scientific knowledge and designed to measure programs over time.”
-Healthy People http://www.healthypeople.gov
Page 5
The final conclusion of this study is that food insecurity may
involve physical and psychological consequences. Food
insecurity should be treated as a health issue that should concern
not only social scientists but also healthcare providers who
should recognize that low-income, single mothers may be in need
of psychological counseling in addition to increased access to
optimal food to foster overall emotional and physical health.
Limitations of the StudyLimitations to this study include a small sample size. Further,
the cross-sectional design makes it impossible to draw causal
inferences from the findings. For example, it might be possible
to contend that food insecurity predisposes individuals to poor
health; the reverse could also be true. Following a sample of
individuals over time would help determine if this study’s results
held true over time. Finally, only women were sampled; therefore,
it is unknown if the findings are applicable to men.
About the AuthorAndrew A. Zekeri is professor of Sociology at Tuskegee University.
He has been conducting research in rural Alabama for the past
15 years. He uses a multiple-method approach that involves both
qualitative and quantitative protocols. One overarching theme in
Professor Zekeri’s research is a focus on how the characteristics
of the places in which people live influence individual’s and
families opportunities, behavior and well-being. One of these
interests includes studying food insecurity in the rural south. He is
a recipient of the Southern Rural Development Center’s first Food
Assistance Research Small-Grant Program (in 1998) for his study
“Assessing the Benefits and Problems Associated with the use of
Electronic Benefits Transfer for Food Stamps in Macon County
Alabama” and in (2004) for his study “Food Insecurity in Poor,
Female-Headed Families in Five Alabama’s Black Belt Counties.”
He also received funding from the Center under the Senior Fellows
Research Initiatives program for his study, “Community Action
and Economic Development in Alabama’s Forested Black Belt
Areas.” All these projects have resulted in numerous publications
in scholarly journals. His recent ongoing research project funded
by RAND Corporation is titled “Toward Strategies for Community
Action and Economic Development in the Gulf Counties of
Alabama after Hurricane Katrina.”
REFERENCES
[1] Heflin, C. M., Siefert K., & Williams, D.R. 2005. “Food insufficiency and women’s mental health: Findings from a 3–year panel of welfare recipients.” Social Science and Medicine (61): 1971-1982.
[2] Idler, E., Russel, L. B., & Davis, D. 2000. “Survival, Functional Limitations, and Self-Rated Health in NHANES I Epidemiologic Follow-up Study, 1992.” American Journal of Epidemiology 152: 874-883.
[3] Nord, M., Andrews, M., & Carlson, S. 2005. Household Food Security in the United States, 2004. ERS11, Economic Research Service, U.S. Department of Agriculture. Retrieved April 30, 2006 from http://www.ers.usda.gov/publications/err11/
[4] Nord, M. & Andrews, M. 2003. “Putting Food on the Table: Household Food Security in the United States.” Amber Waves: 23-29.
[5] Nord, M. 2002. “Food Security in Rural Households: Rates of Food Insecurity and Hunger Unchanged in Rural Households.” Rural America, 16(4): 42-46.
[6] Olson, C. 2005. “Food insecurity in women: a recipe for unhealthy tradeoffs.” Top Clinical Nutrition 20(40): 321-328.
[7] Radloff, L.S. 1977. “The CES-D scale: a self-report depression scale for research in the general population.” Applied Psychological Measurement 1: 385-401.
[8] Siefert, K., Heflin, C.M., Corcoran, M., & Williams, D.R. 2001. “Food insufficiency and the physical and mental health of low-income women.” Women and Health 32: 159-177.
[9] Stuff, J .E., Casey, P., Szeto, K., Gossett, J., Robbins, J. M., Simpson, P., Connell, C., & Bogle, M. 2004. “Household food insecurity is associated with adult health status.” Journal of Nutrition 134: 2330-2335.
[10] Vozoris, N. T., & Tarasuk, V. 2003. “Household food insufficiency is associated with poorer health.” Journal of Nutrition 133:120-126.
[11] Zekeri, A. A. 1999. “Community-ness of a Major Economic Development Effort in a Biracial Community of Alabama.” Journal of Rural Studies 15(2): 159-169.
[12] Zekeri, A. A. 2003. Opinions of EBT Recipients and Food Retailers in the Rural South. Southern Rural Development Center, Food Assistance Policy Series (6): 1-8.
[13] Zekeri, A. A. 2004. “The Adoption of Electronic Benefit Transfer Card for Delivering Food Stamp Benefits in Alabama: Perceptions of College Students Participating in the Food Stamp Program.” College Student Journal 38(4): 602-606.
For More Information:
Contact the Southern Rural Development Center at
662-325-3207
Or visit us online at http://srdc.msstate.edu
July 2008