1999 Executive Summary

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A Comparison of Demographic Variables, Food/Nutrient Intakes, Level of Food Security, and Food/Nutrient Changes with Intervention Among Food Stamp and Non-Food Stamp Recipients in South Carolina, Tennessee, and Virginia

Katherine L. Cason
Pennsylvania State University

Janie Burney
Wayne Moore
Richard Poling
Sandra Shivers
University of Tennessee

Ruby Cox
Kathleen Poole
Judy Midkiff
Virginia Tech University

December 1, 2000

Introduction

This study examined the role of food assistance, nutrition education, and mother's workforce participation on the dietary patterns of rural households in South Carolina, Tennessee, and Virginia. The researchers utilized data collected from participants in the Expanded Food and Nutrition Education Program (EFNEP) and the Food Stamp Nutrition Education Program (FSNEP) in the three states during the 1999 reporting year. Data on intake of foods and nutrients and food-related behaviors were used to compare Food Stamp recipients with non-Food Stamp recipients on relative dietary adequacy, recommended food-related behaviors, and other factors.

Purpose

The nutritional status and food security level of low income individuals and the relationships of individual, dietary, and environmental factors are not well understood. Providing information on the relationship of socio-economic and other factors to nutrient intake and food security is basic to improving the health and well-being of low income individuals and families. Information obtained from this study may provide direction to EFNEP, FSNEP, and other nutrition education programs for more effective educational programming.

The purpose of the study was to determine if relationships exist between participation in the Food Stamp Program and food security, food purchasing patterns, and dietary practices. This study examined the relationships of participation in the Food Stamp Program, level of food security, and dietary patterns in low income populations.

Methods

Subjects in this study were participants in the Expanded Food and Nutrition Education Program (EFNEP) or the Food Stamp Nutrition Education Program (FSNEP) at Clemson University in South Carolina, The University of Tennessee, and Virginia Polytechnic Institute & State University. EFNEP and FSNEP are nutrition education programs targeted to low income families and youth that teach families how to make healthy food choices, prepare food safely and manage their resources to reduce food insecurity. EFNEP focuses on nutrition education for families with children; FSNEP focuses on education for families receiving food stamps. EFNEP and FSNEP programs are administered by the Extension Service at each university. To be included in the study, participants must have received education targeted to adult learners.

The EFNEP study included 6,969 participants and the FSNEP study involved 3,552 participants who were enrolled in these respective programs during the 1999 reporting period.

Results

Demographic Comparisons:

The racial distribution of the EFNEP subjects was 3947 (56.6%) White, 2771 (39.8%) African American, 173 (2.5%) Hispanic, and 78 (1.1%) other. The majority of the subjects (78%) were 19-50 years of age, with the next highest percentage (18.4%) in the £ 18 years age group. The mean monthly income was $378, with the ³ 65 years age group reporting the highest monthly income ($437) and the £ 18 years age group reporting the lowest monthly income ($126). Food Stamp recipients reported lower monthly incomes ($349) as compared to those not receiving Food Stamps ($649). The subjects' participation in Food Stamps varied by age group, with the 19-50 age group reporting the highest participation (56.9%) and the £ 18 years age group reporting the lowest participation (22.0%).

The racial distribution of the FSNEP subjects was 1538 (43.3%) White, 1865 (52.5%) African American, 90 (2.5%) Hispanic, and 59 (1.7%) other. The age distribution revealed that the largest age category of subjects was ³ 65 years of age (48.0%) and19-50 years of age was the second largest (33.9%). The reported mean monthly income of the group was $394, with the ³ 65 years age group reporting the highest monthly income ($400) and the £ 18 years age group reporting the lowest monthly income ($293). Food Stamp recipients reported lower monthly incomes ($379) as compared to those not receiving Food Stamps ($524). Participation in the Food Stamp Program varied by age group, with the 19-50 age group reporting the highest participation (56.3%) and the £ 18 years age group reporting the lowest participation (35.0%).

Diets and Food-Related Behaviors at Pre-Intervention:

EFNEP Participants: A comparison of food group and selected nutrient intake of Food Stamp households and non-Food Stamp households revealed no significant differences with regard to the majority of food groups and nutrients. Significant differences were noted for two food groups and one nutrient. Food Stamp recipients consumed more meat, 2.3 servings (SD ± 2.5), compared to non-Food Stamp recipients, 2.0 servings (SD ± 1.8). Food Stamp recipients consumed less milk, 1.2 servings (SD ± 1.4) than non-Food Stamp recipients, 1.4 servings (SD ± 1.5). Food Stamp recipients consumed more fat (71.7 grams, SD ± 54.4) than non-Food Stamp recipients (67.9 grams, SD ± 49.6).

Food Stamp Nutrition Education Program Participants: When comparing food group and selected nutrient intake of Food Stamp households and non-Food Stamp households, no significant differences were noted for the majority of food groups and nutrients. Significant differences were noted for fat and energy. Food Stamp recipients consumed more fat (62.4 grams, SD ± 49.4) than non-Food Stamp recipients (56.3 grams, SD ± 39.4). Energy intake was also higher for Food Stamp recipients, 1565.7 (SD ± 892.3) versus 1490.0 (SD ± 837.7) for non-Food Stamp recipients.

EFNEP Participants. A comparison of desirable responses on the 10 question food behavior checklist between Food Stamp and non-Food Stamp recipients enrolled in EFNEP prior to educational intervention revealed no significant differences for six of the 10 food behaviors. For four questions, significant differences were noted between responses of Food Stamp household and non-Food Stamp households. Food Stamp recipients more often reported planning meals ahead of time (20.3%) than non-Food Stamp recipients (18.7%). Food Stamp recipients reported that they ran out of food before the end of the month (10.3%) more often than non-Food Stamp recipients (8.2%). For the two questions dealing with food safety behavior, a lower percentage of Food Stamp recipients (45.7% for item five and 34.0% for item six) reported practicing the desirable behavior as compared to non-Food Stamp recipients (47.9% for item five and 37.5% for item six).

Food Stamp Nutrition Education Program Participants. Significant differences were noted between responses of Food Stamp and non-Food Stamp households for two questions only. A lower percentage of Food Stamp recipients (33.7%) reported practicing the desirable food safety behavior of proper thawing as compared to non-Food Stamp recipients (44.8%). A lower percentage of Food Stamp recipients (9.9%) reported using the Nutrition Facts on food labels to make food choices as compared to non-Food Stamp recipients (14.9%).

Diets and Food-Related Behaviors at Pre- and Post-Intervention:

EFNEP Participants. Within the Food Stamp Group, significant increases were found from entry to exit in all food groups and nutrients measured (P£ .001). Within the Non-Food Stamp Group, there were also significant increases at P£ .001 for all dietary components. However, it is important to note that the significant increase in servings of the Fats/Sweets Group and in the total amount of fat may represent undesirable changes. When comparing the two groups on the amount of change made as a result of nutrition intervention, there were only two significant differences. The Food Stamp Group significantly increased their intake of the fruit and vitamin C above that of the Non-Food Stamp Group (P£ .01).

Food Stamp Nutrition Education Program Participants. Within the Food Stamp Group, there were significant increases from entry into FSNEP to exit in all food groups and nutrients measured (P£ .001), except for the Fats/Sweets Group and total fat intake, which did not show significant change. Within the Non-Food Stamp Group, there were also significant increases at P£ .001 for all dietary components, except for fat intake. Unlike the EFNEP participants, FSNEP clients did not appear to make the undesirable increases in fats and sweets, while they increased other dietary components. In comparing the two groups on amount of change made as a result of nutrition intervention, there were only two significant differences. The Food Stamp Group significantly increased their intakes of the vitamin A and B6 above levels of the Non-Food Stamp Group (P£ . 01).

EFNEP Participants. When pre-test scores on the EFNEP Survey were compared to post-test scores, participants in South Carolina and Virginia made improvements in several food and nutrition-related behaviors. A greater percentage (P £ .001) of EFNEP graduates planned meals ahead of time, compared prices when buying food, reported running out of food less often before the end of the month, shopped with a grocery list, refrigerated meat and dairy foods within two hours of serving, thawed frozen food correctly, thought of healthy food choices when deciding what to feed their families, prepared foods without adding salt, and ate something in the morning within 2 hours of waking at exit compared to entry. This was true for food stamp recipients and those not receiving food stamps. When the percentages of graduates from EFNEP who received food stamps were compared to those who did not receive food stamps, significantly more food stamp recipients (P £ .001) thawed frozen food correctly.

Food Stamp Nutrition Education Program (FSNEP). Participants in the FSNEP also made improvements in food and nutrition-related practices when pre- and post-test scores were compared. A greater percentage (P £ .001) of FSNEP participates at program exit planned meals ahead of time, compared prices when buying food, reported running out of food less often before the end of the month, shopped with a grocery list, refrigerated meat and dairy foods within two hours of serving, thawed foods correctly, thought of healthy food choices when deciding what to feed their families, prepared foods without adding salt, used "Nutrition Facts" on food labels to make food choices, and ate something in the morning within 2 hours of waking. This was true for food stamp recipients and those not receiving food stamps. When the percentages of graduates from FSNEP who received food stamps were compared to those who did not receive food stamps, significantly more non-food stamp recipients (P £ .001) ate something in the morning within 2 hours of waking than those who received food stamps.

Food Security:

South Carolina. Seventy-one percent of all South Carolina EFNEP and FSNEP households were food secure during the 12 months ending in August 2000. The remaining 29 percent were food insecure, meaning that at some time during the previous year they were uncertain of having, or unable to acquire, adequate food sufficient to meet basic needs at all times due to inadequate household resources for food. Of these, 11.6% were food insecure to the extent that one or more household members were hungry due to inadequate resources at least some of the time during the year.

Tennessee. A random sample of 200 individuals receiving food stamps and 155 individuals not receiving food stamps were obtained from the population of EFNEP and TNCEP participants in Tennessee in 1990-2000. Because of missing data, only 142 of the surveys from individuals not receiving food stamps could be analyzed. Analyses showed significant differences between individuals who received food stamps and those who did not receive food stamps in how they responded to five food security questions. Chi-square tests showed a significant, but weak, association (P £ .000) between whether a family received food stamps and if they had to cut the size of their children's meals because there was not enough money to buy food. Similarly, there was a significant, but weak, association (P £ .000) between whether a family received food stamps and if they reported any adults in their household cutting or skipping meals because there was not enough money. Proportionately more individuals who did not receive food stamps reported cutting or skipping meals compared to those who received food stamps. T-tests showed families on food stamps reported more often (P £ .000) worrying that food would run out before they could buy more, the inability to afford balanced meals, and running out of food with no money to buy more compared to those not receiving food stamps.

Summary

This study was designed to compare the dietary adequacy, food related behaviors, and purchasing patterns of families receiving food stamps and those not receiving food stamps. It examined the effects of nutrition education on both groups. It also looked at food security among low-income families to help identify who was more likely to be food insecure.

Overall, there were few differences between the groups in the kinds of foods they consumed and their behaviors related to food selection, preparation, and food safety. The Food Stamp Program is designed to safeguard the health and well-being of low income Americans by providing them with access to a healthy, nutritious diet. Participation in the Food Stamp Program generally increases access to food, and therefore, nutrients, to low income individuals through increased purchasing power (DeVaney et al, 1991). A study reported by Butler and Raymond (1996) suggested that Food Stamps have beneficial effects on the adequacy of diets for certain populations. Findings from this present study, however, do not support substantial differences between diets of Food Stamp and non-Food Stamp recipients at the time they enroll in EFNEP and FSNEP.

There also were few differences between the groups after nutrition education. However, both groups consumed more nutritious diets and improved their food-related practices when they received nutrition education. Although Food Stamp benefits may have increased food purchasing power, Food Stamps do not appear to ensure consumption of nutritionally adequate diets. One goal of the Food and Nutrition Services is to help Food Stamp recipients bring their food choices and food preparation practices more in line with broadly accepted recommendations for healthful eating. Butler and Raymond (1996) indicated that adequate income was no guarantee of adequate nutrition, and reported that "even rudimentary knowledge of nutrition can increase nutrition intake considerably. Results of the present study suggest that low income individuals benefit from nutrition education provided through EFNEP and FSNEP. For all participants in the EFNEP and FSNEP education, significant increases from entry to exit were made in all food groups, nutrients, and food behaviors measured. This study also provided information, which can help direct the focus of the educational intervention.

All Food Stamp recipients would benefit from a long-term, sustained nutrition education program, which would complement the income subsidies. Without such a program, access to supplemental food through Food Stamps may not promote healthier dietary intakes or reduce disease risks. Food Stamp recipients should be able to make informed choices based upon nutrition knowledge and an awareness of increased health risk due to inadequate or excess food intakes.

Study findings also indicate that hunger and food insecurity exist among the EFNEP and FSNEP audiences. The risk factors of households experiencing food insecurity and hunger in South Carolina include: being African American, not receiving Food Stamps, and having children in the household. In Tennessee, families receiving food stamps report more food insecurity than families not receiving food stamps.

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