Cumulative Risk Factors Associated with Food Insecurity among Adults who Experience Homelessness.

Introduction There is a dearth of research on the determinants of food insecurity among adults who experience homelessness. According to cumulative risk theory, it is the accumulation of risk factors that places individuals in jeopardy for negative health consequences. Building on the cumulative risk theory, domain specific indices were created to examine the relationship between four cumulative risk factors and food insecurity among adults who experience homelessness. Methods Adult participants were recruited from six-area shelters in Oklahoma City (N = 565) during July - August 2016. Participants who affirmatively responded to two-six items of the six-item USDA Food Security Scale-Short form were categorized as food insecure. Four indices of cumulative risk were created based on affirmative survey responses: poor health & risky health behaviors index, personal and sexual victimization index, household disruption, and financial strain. Covariate-adjusted logistic regression models predicted the odds of adults experiencing food insecurity. Results Seventy-eight percent of the sample experienced food insecurity. Higher scores for the poor health and risky health behaviors index predicted higher odds of experiencing food insecurity (OR = 1.80, CI: 1.51 - 2.14). Higher scores for the personal and sexual victimization index predicted higher odds of experiencing food insecurity (OR = 1.57, CI: 1.20 - 2.04). Conclusion To facilitate food security among adults experiencing homelessness, shelters and community-based programs need to consider homelessness and food insecurity to be multi-faceted public health problems that are inter-related.

[1]  L. Tieu,et al.  Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study. , 2019, Journal of public health.

[2]  Kristin Turney,et al.  Parental Incarceration and Children's Wellbeing , 2018 .

[3]  Dylan B. Jackson,et al.  Food Insecurity and Violence in the Home: Investigating Exposure to Violence and Victimization Among Preschool-Aged Children , 2018, Health education & behavior : the official publication of the Society for Public Health Education.

[4]  D. Hernandez,et al.  Food insecurity and adult overweight/obesity: Gender and race/ethnic disparities , 2017, Appetite.

[5]  J. Tsoh,et al.  Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity , 2017, Journal of Urban Health.

[6]  D. Wetter,et al.  Smoking, Financial Strain, and Food Insecurity , 2017 .

[7]  A. Russolillo,et al.  Food Insecurity among Homeless Adults with Mental Illness , 2016, PloS one.

[8]  A. Marques,et al.  Unemployment, Parental Distress and Youth Emotional Well-Being: The Moderation Roles of Parent–Youth Relationship and Financial Deprivation , 2015, Child Psychiatry & Human Development.

[9]  S. Narendorf,et al.  Exploring Contextual Factors of Youth Homelessness And Sexual Risk Behaviors: A Qualitative Study. , 2015, Perspectives on sexual and reproductive health.

[10]  C. Christian,et al.  Permanency and the Foster Care System. , 2015, Current problems in pediatric and adolescent health care.

[11]  L. Whitbeck,et al.  Homelessness-Related Traumatic Events and PTSD Among Women Experiencing Episodes of Homelessness in Three U.S. Cities. , 2015, Journal of traumatic stress.

[12]  Jin Huang,et al.  Unemployment and household food hardship in the economic recession , 2015, Public Health Nutrition.

[13]  D. Singer,et al.  Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston. , 2015, American journal of public health.

[14]  L. Fiellin,et al.  Food Insecurity and Health: Data from the Veterans Aging Cohort Study , 2015, Public health reports.

[15]  D. Hernandez,et al.  Gender disparities among the association between cumulative family-level stress & adolescent weight status. , 2015, Preventive medicine.

[16]  D. Hernandez.  The impact of cumulative family risks on various levels of food insecurity. , 2015, Social science research.

[17]  M. Haskett,et al.  Developmental Status and Social–Emotional Functioning of Young Children Experiencing Homelessness , 2015 .

[18]  Mariana Chilton,et al.  The relationship between childhood adversity and food insecurity: ‘It’s like a bird nesting in your head’ , 2015, Public Health Nutrition.

[19]  J. Geddes,et al.  The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations , 2014, The Lancet.

[20]  C. Hall,et al.  Exploring the Experiences of Violence Among Individuals Who Are Homeless Using a Consumer-Led Approach , 2014, Violence and Victims.

[21]  D. Hernandez,et al.  Maternal depression mediates the association between intimate partner violence and food insecurity. , 2014, Journal of women's health.

[22]  N. Rigotti,et al.  Tobacco use among homeless people--addressing the neglected addiction. , 2013, The New England journal of medicine.

[23]  Q. Ngo-Metzger,et al.  Health status and health care experiences among homeless patients in federally supported health centers: findings from the 2009 patient survey. , 2013, Health services research.

[24]  Sohyun Park,et al.  Functional limitation and chronic diseases are associated with food insecurity among U.S. adults , 2013, Annals of epidemiology.

[25]  S. Wallace,et al.  The Impact of Incarceration on Food Insecurity Among Households with Children , 2013 .

[26]  B. Burström,et al.  Health-related quality of life (EQ-5D) among homeless persons compared to a general population sample in Stockholm County, 2006 , 2012, Scandinavian journal of public health.

[27]  L. Wigfall,et al.  HIV testing among midlife women in the deep south: an analysis of the 2008 Behavioral Risk Factor Surveillance System survey data. , 2011, Journal of women's health.

[28]  B. Western,et al.  Paternal Incarceration and Support for Children in Fragile Families , 2011, Demography.

[29]  E. Bassuk.  Ending child homelessness in America. , 2010, The American journal of orthopsychiatry.

[30]  S. Szanton,et al.  Life-course financial strain and health in African-Americans. , 2010, Social science & medicine.

[31]  J. Eisenmann,et al.  Family stressors and child obesity. , 2009, Social science research.

[32]  A. Caspi,et al.  Mental Health Context of Food Insecurity: a Representative Cohort of Families With Young Children , 2009, Pediatrics.

[33]  Bart W. Miles,et al.  Pathways to and from homelessness and associated psychosocial outcomes among adolescents leaving the foster care system. , 2009, American journal of public health.

[34]  S. Kegeles,et al.  Food Insecurity Among Homeless and Marginally Housed Individuals Living with HIV/AIDS in San Francisco , 2009, AIDS and Behavior.

[35]  T. Strine,et al.  The PHQ-8 as a measure of current depression in the general population. , 2009, Journal of affective disorders.

[36]  Christy A. Visher.  Employment after Prison: A Longitudinal Study of Releasees in Three States , 2008 .

[37]  J. Eisenmann,et al.  Food Security, Maternal Stressors, and Overweight Among Low-Income US Children: Results From the National Health and Nutrition Examination Survey (1999–2002) , 2008, Pediatrics.

[38]  J. Belcher,et al.  Personal Resources and Homelessness in Early Life: Predictors of Depression in Consumers of Homeless MultiService Centers , 2008 .

[39]  J. Buckner.  Understanding the Impact of Homelessness on Children , 2008 .

[40]  Kimberly A. Tyler,et al.  Trading sex: Voluntary or coerced? The experiences of homeless youth , 2006, Journal of sex research.

[41]  M. Courtney,et al.  Early outcomes for young adults transitioning from out-of-home care in the USA , 2006 .

[42]  L. Trevena,et al.  Experiences of food insecurity among urban soup kitchen consumers: insights for improving nutrition and well-being. , 2006, Journal of the American Dietetic Association.

[43]  Chery Smith,et al.  The impact of homeless shelters on food access and choice among homeless families in Minnesota. , 2006, Journal of nutrition education and behavior.

[44]  A. Moss,et al.  No door to lock: victimization among homeless and marginally housed persons. , 2003, Archives of internal medicine.

[45]  D. Hosmer,et al.  Homelessness and food insecurity , 2003 .

[46]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[47]  M. Lagory,et al.  Dangerous places: exposure to violence and its mental health consequences for the homeless. , 1999, The American journal of orthopsychiatry.

[48]  R. Briefel,et al.  The effectiveness of a short form of the Household Food Security Scale. , 1999, American journal of public health.

[49]  A. Sameroff,et al.  Environmental risk factors in infancy. , 1998, Pediatrics.

[50]  S. Raudenbush,et al.  Neighborhoods and violent crime: a multilevel study of collective efficacy. , 1997, Science.

[51]  A. Browne,et al.  Homelessness in female-headed families: childhood and adult risk and protective factors. , 1997, American journal of public health.

[52]  A. J. MacFadyen,et al.  Economic stress and psychological well-being: An economic psychology framework , 1996 .

[53]  E. J. Mayeaux,et al.  Rapid estimate of adult literacy in medicine: a shortened screening instrument. , 1993, Family medicine.

[54]  A. Sameroff,et al.  Stability of intelligence from preschool to adolescence: the influence of social and family risk factors. , 1993, Child development.

[55]  M. Rutter.  Protective factors in children's responses to stress and disadvantage. , 1979, Annals of the Academy of Medicine, Singapore.

[56]  Christian A. Gregory,et al.  Household Food Security in the United States in 2017 , 2018 .

[57]  G. Aarons,et al.  The impact of changing neighborhoods, switching schools, and experiencing relationship disruption on children's adjustment to a new placement in foster care. , 2017, Child abuse & neglect.

[58]  E. Ahmann.  Supporting Youth Aging Out of Foster Care. , 2017, Pediatric nursing.

[59]  Jennifer M. Reingle,et al.  Smoking policy change at a homeless shelter: attitudes and effects. , 2015, Addictive behaviors.

[60]  Jill Khadduri,et al.  The 2013 Annual Homelessness Assessment Report (AHAR) to Congress: Part 1, Point-in-Time Estimates of Homelessness , 2013 .

[61]  R. Hogg,et al.  Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco , 2008, Journal of General Internal Medicine.

[62]  J. Sheikh,et al.  The primary care PTSD screen (PC-PTSD): development and operating characteristics , 2004 .

[63]  Peggy W. Murphy,et al.  Rapid Estimate of Adult Literacy in Medicine (REALM): A Quick Reading Test for Patients. , 1993 .