Household Food Insecurity Among Urban, Low-Income Families: Cumulative Risk and Equitable Access to Stores

Background and Purpose

Low-income families experience disproportionate risk of household food insecurity (HFI) and rely heavily on small stores that are close by, but have higher prices and fewer healthy food options.  Little is known about how the food environment and accumulation of risk relates to HFI.  The current study expands this research by examining the relationship between cumulative risk (education, employment, head of household, smoking, depression, anxiety), food environment, and HFI among households with adolescent girls. 

Methods

The study used baseline data from a randomized control trial of an obesity prevention/health promotion intervention with adolescent girls in urban schools.  Risk, HFI, and home address data were collected from 450 predominantly African American, low-income caregivers. For each risk factor present, caregivers received a score of one, which were summed to form a final cumulative risk index (CRI). 

Data were connected with secondary data from the Maryland Food Systems Map, a compilation of food store data.   ArcGIS^® was used to: (1) map home and store addresses, (2) calculate accessibility, the distance between home addresses and nearest supermarket, cornerstore, and convenience store, and (3) calculate availability, the number of supermarkets, cornerstores, and convenience stores within a ¼-mile of households.  Data were merged with CRI and HFI data.   Logistic regression models were run with HFI as the outcome variable. In model one, CRI and distance to nearest supermarket, cornerstore, and convenience store were added in step one; the interaction between CRI and distance to each store type was added in step two.  In model two, CRI and number of supermarkets and cornerstores within a ¼-mile of households was added in the first step; the interaction between CRI and number of each store type was added in step two.  All models controlled for caregiver race and poverty ratio. 

Results

Each additional CRI factor was related to a 59% (p<.001) increase in odds of HFI.  Availability of three or more cornerstores within ¼ mile was associated with an 88% (p value) increase in odds of HFI.  CRI moderated the relationship between accessibility (distance) of cornerstones and HFI.  Higher CRI and greater distance to cornerstores related to higher odds of being food insecure.  For each one-unit increase on the CRI, a ¼-mile increase in distance to the nearest cornerstore raised odds of HFI by 22% (p=.038), indicating being closer to cornerstores reduced risk of HFI for high CRI families. There was no association between HFI and availability or distance to nearest supermarket and convenience store.

Conclusion

Cumulative risk is associated with risk of HFI.  The relationship between the food environment and HFI is mixed, varying with CRI.  High-risk families may experience greater reliance on cornerstores to protect them from HFI due to barriers in accessing other stores, such as transportation.   More research is needed on the barriers for high-risk families and the protective factors for low risk families to inform micro efforts to reduce food insecurity.  Macro efforts should focus on policies that increase access to affordable food stores and purchasing power for low-income families.