INSECURITYThe Southern Rural Development Center addresses...

Report from RIDGE-funded research in the Southern Region

Food

Food insecurity and emotional well-being among single mothers in the rural SouthAndrew A. Zekeri, Tuskegee University

Introduction While we live in a wealthy nation, food insecurity continues to affect millions of American families [3, 4]. Food

insecurity means individuals and families have limited access to food or a limited or uncertain ability to obtain food

due to lack of financial resources [3, 4]. For example, the most recent data from the United States Department

of Agriculture (USDA) indicate that 11.9 percent of the United States households were food insecure in 2005 [3].

According to data published by the USDA since 1995, African American and Hispanic households are more likely than

Whites to be food insecure and hungry [4, 3]. Within that group, rural African Americans remain especially vulnerable.

Furthermore, households headed by single women, particularly African American women, tend to be at higher risk of

food insecurity. The rural South in general, and Alabama in particular, have faced significant rates of food insecurity

and hunger relative to the nation as a whole [4, 3].

Though analyses at the regional and national levels

have produced new insights into the prevalence of

food insecurity, largely missing from the literature is an

analysis examining the consequences of the resulting food

insecurity for the health and emotional well-being of rural

household residents. Little research exists that delineates

the health consequences of food insecurity as measured

by the USDA Core Food Security Survey Module (CFSM)

that was used in this study. Those analyses that do exist

have examined the impact of food insufficiency as measured

by one food sufficiency question from the National Health

and Nutrition Examination Survey III (NHANES III) on the

health status among welfare recipients in urban areas [1, 6,

8, 10]. They show that food insufficiency is associated with

individuals who self-report their health statuses as “fair” or

“poor.” However, published assessments of the association

between household food insecurity and the physical and

emotional well-being of poor single mothers in rural areas

rarely have been done. As such, the purpose of this policy

brief is to (a) estimate the prevalence of food insecurity

among single mothers living in Alabama’s Black Belt, and

(b) examine the impact of food insecurity on their physical

health and emotional well-being. In order to make informed

decisions about policies and programs designed to reduce

food insecurity, it is important to assess the link between

food insecurity and the physical and mental health of rural

single mothers.

The Study AreaAlabama’s Black Belt, the site for this study, is an ideal

setting for examining the prevalence and adverse health

consequences of food insecurity in rural areas of the United

States. Among the poorest places in the United States, this

region is characterized by its high concentration of African

American residents. Regionally, the Alabama Black Belt’s

poverty rates as of 2000 compare to that of the Appalachian

mountain region, where the poor are predominantly White,

the Rio Grande Valley/Texas Gulf Coast, where the poor are

largely Latino, and the reservations of the Southwest, where

the poor are largely Native Americans. Moreover, the Black

Belt region suffers from poor employment opportunities,

chronic unemployment, limited educational attainment,

poor health, high concentration of single parents, and

heavy dependence on public assistance programs [13, 12,

2008

11]. The five counties selected for the study are among those

categorized by the USDA as “persistent poverty” counties.

MethodologyThe sample for this study, 300 single mothers that were receiving

welfare and/or food stamp benefits, was drawn from a list of over

500 families in a five county area of Alabama Black Belt that

participated in previous studies carried out by the author [13, 12, 11].

Food insecurity was measured using a structured questionnaire

based on CFSM and the other questionnaires constructed and

used in previous studies, all investigations were approved by

the Human Subject Participants Review Committee at Tuskegee

University. The CFSM scale is based on respondents’ answers

to a series of 18 questions regarding behaviors and experiences

known to characterize households that are having difficulty

meeting food needs. Face-to-face, in-home, structured interviews

were conducted from June 2005 to September 2006. Consent to

participate in the study was obtained from all participants. The

interviews lasted approximately 90 minutes. For the present

analysis, food security status is a dichotomous variable (food

insecure and food secure).

General Health Status and Emotional Well-Being Self-rated health status provides a direct and global way of

capturing perceptions of health criteria that are as broad and

inclusive as the responding individuals choose to make them.

Single mothers were asked to rate their overall health at the time

of the interview with a standard five-category scale, with values

ranging from excellent (1) to poor (5). Self-rated health has been

shown to be a reliable, valid measure of health. It has also been

shown to be predictive of future health status in numerous studies,

independent of other physiological, behavioral, and psychological

risk factors [2].

Emotional well-being is measured by the Center for

Epidemiological Studies-Depression (CES-D) scale, a widely

used measure for assessing depression symptoms in the general

population [7]. Respondents indicated how often, over the week

preceding the interview, they had experienced each of the 20

symptoms on a four-

point scale ranging

from 0 (rarely or

none of the time) to

3 (most or all of the

time). Respondents’

scores were

totaled and an average was constructed. The 20 items cover

affective, psychological, and somatic symptoms. The CES-D

scale is a reliable predictor of depression. In the current study,

reliability was quite high, with a Chronbach’s alpha of 0.91. Key

socio-demographic characteristics of the study participants are

examined as well, such as income, education, age, race, and

employment status.

ResultsAfrican American single mothers constituted the largest portion

of the sample (65.5 percent). With respect to educational

attainment, 32.5 percent of the sample had no formal education

beyond high school, while only 9.2 percent had a four-year college

degree (Table 1). Overall personal income was low, with just

over half (50.2 percent) of the respondents earning less than

$10,000 annually. About 37 percent of the single mothers were

unemployed and looking for work (Figure 1). More than half of the

sample (54.1 percent) were receiving food stamps at the time of

interview.

Page 2

“ Food insecurity was almost three times as

common in this sample of single mothers as in the general U.S.

population.”

Category PercentRace/Ethnicity African American 65.5 White 29.0 Hispanic 2.8Educational Attainment Did not complete high school 32.5 Completed high school or equivalent 33.7 Some college of post high school training 24.5 Completed a college degree 9.2Income Under $10,000 50.2 $10,000 to $14,000 49.5Employment Status Employed(including part-time) 60.3 Unemployed 36.5Participating in Food Stamp Program Receiving food stamps 54.1 Not receiving food stamps 44.0Prevalence of Food Insecurity Food Secure 64.0 Food Insecure 36.0Health Insurance Insured 53.8 Uninsured 46.2Health Status Poor 8.3 Fair 29.0 Very Good 29.6 Excellent 7.9

a. Some percentage scores do not sum to 100% because missing data are not reported in the table.

Table 1. Description of the Sample, Prevalence of Food Insecurity and Health Status

Prevalence of Food Insecurity in the Alabama Black Belt AreaUsing the USDA’s Food Security Scale, approximately 36 percent

of the rural single mothers taking part in the study were classified

as food insecure (Figure 2). The prevalence of food insecurity

in this region contrasts sharply with the national figure, where

roughly of 12 percent suffer from food insecurity (as of 2004) [5].

The Impact of Food Insecurity on Emotional Well-BeingTable 2 presents data on depressive symptoms. The common

responses for depression in the sample involved these seven

items: “feeling bothered by little things,” “poor appetite,” “having

trouble concentrating,” “feeling sad,” “not feeling hopeful about

the future,” “having trouble sleeping,” and “having trouble getting

started” as shown in Table 2.

One of the primary goals of this study was to examine the

relationship between food insecurity and health and emotional

well-being of rural single mothers. As shown in Table 3, food

insecurity is positively related to depression (emotional well-

being). Compared with food-secure households, single mothers

from food-insecure households were more likely to be depressed.

Controlling for age, educational attainment, race and employment

status, the association between food insecurity and emotional

well-being remained statistically significant.

Page 3

Table 2. Percent of Participants Reporting Selected Depressive Symptoms

Depressive Symptoms Percent

Not feeling hopeful about the future 69.1

Feeling sad 61.2

Bothered by things that don’t usually bother 61.1

Having trouble getting started 60.4

Feeling everything I did was an effort 60.3

Having trouble sleeping 60.0

Poor appetite 59.5

Feeling lonely 57.6

Having trouble concentrating 57.5

Feeling fearful 54.4

Figure 2: Food Insecurity

0 10 20 30 40 50 60 70 80

Food Insecure

Food Secure

Not Receiving Food Stamps

Receiving Food Stamps 54.1%

44%

64%

36%

9.2%9999.9.999.999.2%2%2%2%

0 10 20 30 40 50 60 70 80

Unemployed

Employed (Including Part-Time)

Annual Income Between $10,000 to $14,000

Annual Income Under $10,000

Completed A College Degree

Some College Or Post High school Training

Completed High School Or Equivalent

Did Not Complete High School

Hispanic

White

African American 65.5%

29.0%

32.5%

33.7%

24.5%

2.8%

50.2%

49.5%

60.3%

36.5%

9.2%

Figure 1: Demographics

Page 4

The Impact of Food Insecurity on Health The separate analysis was conducted for health status. We found

that food insecurity is negatively related to health status. Single

mothers in food-insecure households were more likely to be in

poor or fair health status (Table 3). In this study, food insecurity

was a stronger predictor of health status than employment or

educational attainment. These results are consistent with other

research conducted on single women on welfare located in

Northern Michigan that found significant associations between

food insufficiency and low self-reported physical and mental health

status [8].

ConclusionsThe present research sought to examine the prevalence of

food insecurity and its relationship to self-reported health status

and emotional well-being among single mothers living in rural

Alabama’s Black Belt. The results do suggest that more than

a third of low-income single mothers from rural Alabama (35.7

percent) are food insecure. Food insecurity was almost three

times as common in this sample of single mothers as in the

general U.S. population. This shows that United States in some

regions may not be faring well in achieving its goal of reducing

food insecurity to six percent by the year 2010 (one of the Healthy

People 2010 objectives) [5].

Food insecurity had significant independent effects on the health

status and emotional well-being of this disadvantaged population

of single mothers. Single mothers in food insufficient households

were more likely to rate their health as poor or fair and to suffer

from major depressive symptoms compared to those in food

sufficient households (Figure 3).

As food insecurity responses increased, responses reflecting

depressive symptoms worsened. Being employed and educated

appear to have positive mental health benefits for rural single

mothers. These findings show the potential emotional and health

vulnerability for single mothers in the rural South who live in food

insecure households. Adding to this, some are living in social and

physical environments that are not supportive of good health,

including access to quality health care. These results mirror some

analyses using the NHANES III data that found food insufficient

households were more likely to experience major depression and

poor health status [1, 8].

Policy ImplicationsThe findings of this study are consistent with growing national

evidence that food insufficiency is associated with depression

and self-reported health status [6, 8, 10, 9]. The only difference

is that while this study used the 18-item CFSM scale to measure

food insecurity, the majority of previous studies used a single item

measure of food insufficiency [8, 1]. They highlight the need for

a concerted effort to prevent food insecurity and ensure that all

Americans are adequately fed in order to improve their physical

health and emotional well-being. Preventing food insecurity may

lower the risk of poor physical and mental health. Healthcare

providers must be sensitive to multiple barriers faced by food-

insecure single mothers. Improving access to balanced meals

and assessing for depression may promote better overall health

among food-insecure, single mothers. Also, improving local

employment contexts and job availability will be important in any

policy designed to increase the emotional well-being of single

mothers in the rural South.

Figure 3: Health Status

0 10 20 30 40 50 60

Uninsured

Insured

Excellent Health Status

Very Good Health Status

Fair Health Status

Poor Health Status

29.0%

8.3%

29.6%

7.9%

53.8%

46.2%

Depression Health Status

Food insecurity + +

Age NS NS

Employment + +

Race NS NS

Education + +

Table 3. Regression Analyses of Depression and Health Status among Single Mothers in Alabama’s Black Belt

How to interpret the table:+ means the variable has a significant impact on depression and health status NS means the variable has no significant impact on depression and health status

What Is Healthy People 2010?

“Healthy People 2010 is a set of health objectives for the Nation to achieve over the first decade of the new century. It can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health.

Healthy People 2010 builds on initiatives pursued over the past two decades. The 1979 Surgeon General’s Report, Healthy People, and Healthy People 2000: National Health Promotion and Disease Prevention Objectives both established national health objectives and served as the basis for the development of State and community plans. Like its predecessors, Healthy People 2010 was developed through a broad consultation process, built on the best scientific knowledge and designed to measure programs over time.”

-Healthy People http://www.healthypeople.gov

Page 5

The final conclusion of this study is that food insecurity may

involve physical and psychological consequences. Food

insecurity should be treated as a health issue that should concern

not only social scientists but also healthcare providers who

should recognize that low-income, single mothers may be in need

of psychological counseling in addition to increased access to

optimal food to foster overall emotional and physical health.

Limitations of the StudyLimitations to this study include a small sample size. Further,

the cross-sectional design makes it impossible to draw causal

inferences from the findings. For example, it might be possible

to contend that food insecurity predisposes individuals to poor

health; the reverse could also be true. Following a sample of

individuals over time would help determine if this study’s results

held true over time. Finally, only women were sampled; therefore,

it is unknown if the findings are applicable to men.

About the AuthorAndrew A. Zekeri is professor of Sociology at Tuskegee University.

He has been conducting research in rural Alabama for the past

15 years. He uses a multiple-method approach that involves both

qualitative and quantitative protocols. One overarching theme in

Professor Zekeri’s research is a focus on how the characteristics

of the places in which people live influence individual’s and

families opportunities, behavior and well-being. One of these

interests includes studying food insecurity in the rural south. He is

a recipient of the Southern Rural Development Center’s first Food

Assistance Research Small-Grant Program (in 1998) for his study

“Assessing the Benefits and Problems Associated with the use of

Electronic Benefits Transfer for Food Stamps in Macon County

Alabama” and in (2004) for his study “Food Insecurity in Poor,

Female-Headed Families in Five Alabama’s Black Belt Counties.”

He also received funding from the Center under the Senior Fellows

Research Initiatives program for his study, “Community Action

and Economic Development in Alabama’s Forested Black Belt

Areas.” All these projects have resulted in numerous publications

in scholarly journals. His recent ongoing research project funded

by RAND Corporation is titled “Toward Strategies for Community

Action and Economic Development in the Gulf Counties of

Alabama after Hurricane Katrina.”

REFERENCES

[1] Heflin, C. M., Siefert K., & Williams, D.R. 2005. “Food insufficiency and women’s mental health: Findings from a 3–year panel of welfare recipients.” Social Science and Medicine (61): 1971-1982.

[2] Idler, E., Russel, L. B., & Davis, D. 2000. “Survival, Functional Limitations, and Self-Rated Health in NHANES I Epidemiologic Follow-up Study, 1992.” American Journal of Epidemiology 152: 874-883.

[3] Nord, M., Andrews, M., & Carlson, S. 2005. Household Food Security in the United States, 2004. ERS11, Economic Research Service, U.S. Department of Agriculture. Retrieved April 30, 2006 from http://www.ers.usda.gov/publications/err11/

[4] Nord, M. & Andrews, M. 2003. “Putting Food on the Table: Household Food Security in the United States.” Amber Waves: 23-29.

[5] Nord, M. 2002. “Food Security in Rural Households: Rates of Food Insecurity and Hunger Unchanged in Rural Households.” Rural America, 16(4): 42-46.

[6] Olson, C. 2005. “Food insecurity in women: a recipe for unhealthy tradeoffs.” Top Clinical Nutrition 20(40): 321-328.

[7] Radloff, L.S. 1977. “The CES-D scale: a self-report depression scale for research in the general population.” Applied Psychological Measurement 1: 385-401.

[8] Siefert, K., Heflin, C.M., Corcoran, M., & Williams, D.R. 2001. “Food insufficiency and the physical and mental health of low-income women.” Women and Health 32: 159-177.

[9] Stuff, J .E., Casey, P., Szeto, K., Gossett, J., Robbins, J. M., Simpson, P., Connell, C., & Bogle, M. 2004. “Household food insecurity is associated with adult health status.” Journal of Nutrition 134: 2330-2335.

[10] Vozoris, N. T., & Tarasuk, V. 2003. “Household food insufficiency is associated with poorer health.” Journal of Nutrition 133:120-126.

[11] Zekeri, A. A. 1999. “Community-ness of a Major Economic Development Effort in a Biracial Community of Alabama.” Journal of Rural Studies 15(2): 159-169.

[12] Zekeri, A. A. 2003. Opinions of EBT Recipients and Food Retailers in the Rural South. Southern Rural Development Center, Food Assistance Policy Series (6): 1-8.

[13] Zekeri, A. A. 2004. “The Adoption of Electronic Benefit Transfer Card for Delivering Food Stamp Benefits in Alabama: Perceptions of College Students Participating in the Food Stamp Program.” College Student Journal 38(4): 602-606.

For More Information:

Contact the Southern Rural Development Center at

662-325-3207

Or visit us online at http://srdc.msstate.edu

July 2008