Formerly Homeless but Still Food Insecure: An Examination of Food Security for Residents of Permanent Supportive Housing

Background: Food security, defined as a household having access to adequate nutritious and safe foods, is often jeopardized by homelessness. Prior studies have reported high rates of food insecurity among individuals experiencing homelessness and housing instability.  Although research supports  permanent supportive housing (PSH) as an evidence-based homelessness intervention, little research has explored the prevalence and covariates of food insecurity for formerly homeless individuals aging in PSH. The objective of this study was to address this gap by using survey research to examine food insecurity among older PSH residents in Los Angeles.   Based on prior research, we hypothesized that food insecurity would be associated with health and healthcare-related, nutrition, and socioeconomic covariates.

Methods: 237 adults aged 45+ (recruited from two PSH providers in Los Angeles) completed interviewer-administered surveys assessing self-reported health, age-related health conditions, nutrition (e.g. fruit and vegetable intake), substance use, mental health, and socioeconomic hardships (e.g. use of food aid and difficulty paying rent/utilities). Additionally, physical examinations of mobility (walk test), grip strength, vision, and cognitive ability were administered by trained interviewers. Food security, the study’s dependent variable, was assessed using the USDA’s Adult Food Security Module. We calculated descriptive statistics and bivariate analyses distinguishing between participants with high/marginal and low/very low food security in terms of the demographic, health , healthcare utilization, nutrition, and socioeconomic covariates. All covariates that were statistically significant or approached significance were entered into a multivariate logistic regression model of low/very low food security. 

Results: Participants were 63% male, 60% African American, and averaged 58 years of age, having lived an average of 5 years in PSH.. Participants reported high levels of food insecurity (67%) and on average reported 6 chronic health and mental health conditions. At the bivariate level, low/very low food insecurity was significantly associated (p<.05) with the total number of chronic health conditions, low vegetable intake, low self-rated quality of life (QOL), accessing food aid in the past 6 months, lower monthly income, and self-reported late bill payment.  In multivariate logistic regression analysis, late payment of bills, low self-rated QOL, and accessing food aid in past 6 months remained significantly associated with low/very low food insecurity.

Conclusions: Findings add to previous research on homelessness and food insecurity, suggesting that food insecurity often persists after people exit homelessness. Results show that food insecure participants are also struggling to pay bills and are relying on food aid (e.g. food pantries and soup kitchens) to meet some of their nutritional needs. As a large cohort of formerly homeless adults ages in PSH, it is critical for policies and practitioners to address food security as an important component of health and wellbeing for this vulnerable population. Efforts might include ensuring that participants are linked to SNAP and other income and food/nutritional benefits programs or implementing meal delivery programs for participants experiencing mobility challenges. Further research should build from the present Los Angeles-based study to assess food insecurity and its covariates in a national sample of PSH residents.