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October 19, 2017

Heather A . Eicher-Mil ler, PhD

Assistant Professor,

Nutr i t ion Science

Purdue University

REACHING FOOD INSECURE FAMILIES WITH RESOURCES IN RURAL AND URBAN ENVIRONMENTS AND FOOD SYSTEMS

FOOD INSECURE HOUSEHOLDS HAVE LOW ACCESS TO FOOD AND ALTERED DIETS IN TERMS OF QUALIT Y OR

AMOUNT

http://www.ers.usda.gov/Briefing/FoodSecurity/trends.htm

Healthy People 2020

Goal = 6%

Food Insecurity: “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable food in socially acceptable ways” Anderson et al, 1990

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Dietary: lower intake of key food groupsnutrient intake gapspoor dietary quality

Food Insecurity

FOOD INSECURITY ASSOCIATED WITH POOR DIETARY AND HEALTH OUTCOMES

Health Outcomes (children): poor health status, prevalent sickness, iron deficiency anemia,low bone mineral content, poor mental health

Health Outcomes (adults):poor health and function, prevalent risk factors & chronic disease (diabetes, obesity, heart disease, metabolic disease), poor mental health

Mabli, et al. 2014, Eicher-Miller, et al. 2009;,Kirkpatrick, et al. 2008;,Eicher-Miller, et al. 2011;,Kropf, et al. 2007, Dollahite, et al. 2014, Siefert et al. 2001, Pheley et al. 2002, Tarasuk, 2003, Stuff et al. 2004, Vozoris & Walker et al. 2007, Sharkey et al. 2011, Ramsey et al. 2012, Klesges et al. 2001, Lee & Frongillo 2001, Stuff et al. 2004, Vozoris & Tarasuk 2003, Holben & Pheley 2006, Seligman et al, 2007, Seligman et al, 2010. Gowda et al. 2012, Galesloot et al. 2012. Gucciardi et al. 2009, Seligman et al. 2012, Tayie and Zizza 2009, NCEP 2002, D ixon et al. 2001.

FOOD INSECURITY IS INCREASINGLY RELEVANT IN THE MIDWEST

15.2%

18.7%

8.7%

https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics/

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FOOD INSECURITY IS A GROWING CONCERN FOR INDIANA HOUSEHOLDS

http://www.ers.usda.gov/Briefing/FoodSecurity/trends.htm

Healthy People 2020

Goal = 6%

Food Insecurity: “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable food in socially acceptable ways” Anderson et al, 1990

FOOD INSECURIT Y HIGHER AMONG HOUSEHOLDS WITH CHILDREN COMPARED WITH ALL HOUSEHOLDS

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HOUSEHOLDS THAT QUALIFY FOR SNAP HAVE HIGH PREVALENCE OF FOOD INSECURITY

88%

35%

7%

36%

5%

29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2013-2016 USHouseholds

2013 SNAP EligibleHouseholds

Food Secure

Low Food Secure

Very Low Food

Secure

Coleman-Jensen et al, ERS Report 237, 9/2017; https://www.ers.usda.gov/publications/pub-details/?pubid=84972

12% FI 65% FI

FOOD INSECURITY MAY BE RELATED TO RURAL/URBAN

ENVIRONMENT AND FOOD SYSTEMS

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FOOD INSECURITY IS HIGHER IN RURAL COMPARED WITH ALL OTHER AREAS

FI is highest in rural areas (15%) and high in principal cities (14.2%)

FOOD INSECURIT Y ASSOCIATED WITH FOOD ENVIRONMENT & URBAN/RURAL STATUS

Food environment Quality

Accessibility

Affordability

Transportation networks

Socioeconomic status (area deprivation)

Urban/Rural Status

Community Resources

Food Deserts

Household Food

Insecurity

Food Environment7-

16

Socioeconomic Environment17-

25

Urban/Rural Status26-30

Community Assistance

Programs31-33

Transportation8,

9, 15, 34,

USDA, FNS, 2016; Dahlburg & Krug, 2002; ERS, 2009; ERS, 2015; Caspi CE, 2012; Ver Ploeg DP, et al, ERS, 2015; Ver Ploeg DP. USDA, 2013; Vandevijvere S & Tseng M2013; Olson CM, et al, 2004; Dean WR & Sharkey JR, 2011; Lee JS & Frongillo EA, Jr, 2001; Stuff JE, et al, 2004; Morton LW & Blanchard TC, 2007; Tarasuk VS & Beaton GH, 1999; Loopstra R & Tarasuk V, 2012; Caswell JA & Yaktine AL, 2013; Carney PA, et al., 2012; Stimpson JP, et al. 2007.

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SNAP AND SNAP-ED ARE RESOURCES THAT IMPROVE

FOOD SECURITY

Daviess County, Indiana SNAP-Ed client making a fruit and yogurt smoothie with her child.

Supplemental Nutrition Assistance Program (SNAP) : asset based program (<130% of poverty line) that provides additional vouchers for food based on people, ages in household

GOALS OF SNAP AND SNAP-ED ARE TO IMPROVE FOOD SECURITY AND DIET

SNAP-Ed: provides nutrition education to SNAP-qualifying households

SNAP-Ed very little rigorous evaluation

SNAP has been extensively evaluated by economists and has been generally shown to reduce food insecurity—14% improved food security among children

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What are the immediate and long-term (1 year) effects of SNAP-Ed (4 lessons) on household food security in Indiana households with children using RCT design?

This project was supported with a grant from the University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Food and Nutrition Service, contract number AG-3198-S-12-0044.

Results Household food security among SNAP-Ed participants improved by an estimated 25% from baseline to the 1 year long-term follow-up

n=328, eligible for SNAP, 37 counties

Rivera RL et al, J Nutr, 2016

DOES THE RURAL/URBAN ENVIRONMENT, AND FOOD

SYSTEM INFLUENCE EFFICACY OF SNAP AND

SNAP-ED TO IMPROVE FOOD SECURITY?

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SNAP participation was associated with a reduction in household food insecurity in both urban and rural areas, the magnitudes of the associations were not statistically significantly dif ferent in urban and rural areas.

SNAP EFFECTIVE IN RURAL AND URBAN ENVIRONMENTS

https://fns-prod.azureedge.net/sites/default/files/SNAPFS_UrbanRural.pdf

SNAP AND SNAP-ED BASED ON THE SOCIAL-ECOLOGICAL MODEL

Household Food Security

SNAP Voucher & Direct SNAP-Ed

Environmental & Food System: Rural/Urban# SNAP Authorized Stores# Food Pantries# Recreational FacilitiesNatural Amenities ScoreFair Market Rental $

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To determine environmental factor association with long-term household food security after a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) intervention—PILOT STUDY

SNAP-ED REDUCES FOOD INSECURIT Y IN URBAN & RURAL ENVIRONMENTS

URBAN n=18RURAL n=20

USDA FNS, 2016; USDA ERS Food Environment Atlas, 2015, http://ERS.uses.gov/data-products/food-environment-atlas/data-access-and-documentation-downloads.aspx ; Fair Rental Market, Obtained from U.S Department of Housing and Urban Development FY2015 Fair Market Rents Data Set. Internet:http://www.huduser.gov/portal/datasets/fmr/fmr_il_history.html, 2016.

#SNAP-Authorized Stores

#Food Pantries

#Recreational Facilities

Natural Amenities Score (USDA 1-6, 6=highest)Fair Market Rental (USDHUD, $ for 2 bedroom apt)

Methods 328 SNAP eligible adults from households with

children in Indiana Household Food Security Survey Module to

classify food security Participants recruited from n=37 IN counties in

2013-2015 Environmental factor data collected from USDA

sources from 2012-2016 were covariates Mixed multiple linear regression modeling

Rivera RL et al, In press at Public Health Nutrition

…AND MAY BE MORE EFFECTIVE WHEN MORE FOOD PANTRIES AND SNAP-AUTHORIZED STORES ARE

AVAILABLE

SNAP-Ed effective to improve food insecurity regardless of

rural/urban or other characteristics

#SNAP-Authorized Stores

#Food Pantries

Counties with more stores showed non-sig trend and could enhance SNAP-Ed efficacy

Counties with more food pantries showed non-sig trend and could enhance SNAP-Ed efficacy

Rivera RL et al, Submitted to Public Health Nutrition

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SNAP & SNAP-ED ARE EFFECTIVE AT REDUCING

FOOD INSECURITY IN BOTH URBAN AND RURAL

ENVIRONMENTS AND FOOD SYSTEMS APPEAR TO HAVE

AN IMPORTANT ROLE: IMPLICATIONS

Image taken at Gleaners Food Bank of Indianahttps://www.gleaners.org/programs/mobile/

Gaps in SNAP and SNAP-Ed use still persist

SNAP-Ed program reaches very small percentage of SNAP eligible and one of few resources to reach rural counties in IN

New interventions to close eligibility/enrollment gap are critical in all environments

Access to food pantries and SNAP authorized stores may be critical support to SNAP-Ed efficacy

IMPLICATIONS

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Funding Agencies

Eicher-Miller Lab Yibin Liu, PhD Rebecca Rivera, MPH Breanne Wright, MS Kandyce Dunlap Maryann Mundia Aaron Rafferty Stephanie Kuo Jamie Mara Leanne Horne Sucheta Kadaba McKenna Deckard Katie Cox Claire Phillips Mary Ann Kiess Ashley Burgner Kaleigh-Jo Taylor Kirby Jennifer Dunne

COLLABORATORS

Purdue University Regan Bailey, PhD Bruce Craig, PhD Melissa Maulding, MA Angie Abbott, PhD Lisa Graves, MS Richard Mattes, PhD Dennis Savaiano, PhD Shelley MacDermid

Wadsworth, PhD Martina Sternberg Andrea Wellnitz Qi Wang Yumin Zhang

Other Universities Suzanne Stluka, MS

Lacey McCormack, PhD

Dan Remley, PhD

Dawn Contreras, PhD

Donna Mehrle, MPH

Lisa Franzen-Castle, PhD

Sharon Nickols-Richardson, PhD

Becky Henne

Special Thanks: Over 75 undergrads

who collected data!

Indiana’s SNAP-Ed Paraprofessionals

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QUESTIONS…