Examining Effects of Food Security and Food Choices on Health Outcomes in Households in Poverty

Background: Evidence is building on effects of food assistance programs on household food security.  Little is known about the impact of participation in such programs on health. Also, there is limited research on whether or not knowledge and use of federal nutrition guidelines moderate the relationship between experiences of hunger and negative health outcomes among low-income households. To bridge the observed gaps in knowledge, this study examines whether household hunger, SNAP participation, and use of informal food supports are associated with increased health risk among low-income households. The study also assesses whether knowledge and use of nutrition information (i.e. My Pyramid) provides protection against health risk, and if hunger moderates the relationship between nutrition knowledge and health outcomes. Implications for policy and practice are presented.

Method: Study sample and description of the data. The study uses data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) (N=10,149).  NHANES is a nationally representative study that assesses the health and nutritional status of adults and children in the United States. We focus only on respondents who are below 185% of the poverty line and who answered questions related to food security and food choices (n=2,171). 

Data analyses techniques. First-order correlations and ANOVA with post-hoc analyses were conducted to review relationships among study variables and examine disparities across racial and ethnic groups. Next, two ordered-logistic regression models and one OLS regression model was obtained to examine the relationship between socio-demographic characteristics, food security, food supports, and food choices (including both use and knowledge of nutrition knowledge) vs. diet-related and non-diet related health outcomes.  Finally, the impact of hunger on overall health risk was examined.

Results:  Older and Black adults along with respondents who reported use of the food pyramid were at greater risk for negative diet-related health outcomes. Being male and awareness of the food pyramid served as protective factors against diet-related health risk.  Further, males, Hispanics, and awareness of the food pyramid had less risk for negative non-diet health outcomes, whereas use of informal food supports predicted greater risk. Age and use of the food pyramid were associated with poor overall health outcomes. Being male, Hispanic, and awareness of the food pyramid were related to better health outcomes.  Hunger moderated the relationship between nutrition knowledge and health risk; experiencing hunger was related to poor health outcomes.

Discussion: Results highlight the health risks faced by low-income households, particularly those who experience hunger and access informal food supports. The study has important policy and program implications. With the fast-changing demographics of US, community-based programs need to provide culturally sensitive and specific, diet-related knowledge. Moreover, efforts could be devoted to measuring nutritional knowledge in a culturally sensitive manner and to incorporating these measures into nationally representative datasets. Also, nutrition knowledge has health benefits for only food-secure adults, indicating that meeting basic needs is an essential mechanism for improving health outcomes.