Justicia de Ventanilla

According to Feeding America, the nation’s largest hunger relief organization, older adults age 60 and older “are particularly vulnerable to the negative health and nutrition implications of food insecurity.”⁴⁸ Several nutritional and non-nutritional factors have been associated with food security levels in households with older adults in the United States.³ Notable risk factors for hunger and food insecurity include low socio-economic status and geographic-environmental limitations. According to the ERS (2014), “Rates of food insecurity were substantially higher than the national average for households with incomes near or below the Federal poverty line, households with children headed by single women or single men, and Black- and Hispanic-headed households.”⁷¹ System-level barriers such as: food environment resource deficiencies; consumer barriers to acquisition, preparation and consumption; and multiple resource inadequacies can negatively affect health outcomes in presently disparate populations.⁹⁸

Findings from a recent wave of the NHANES were instrumental in helping investigators identify multi-level approaches to hunger and food insecurity (i.e.

communities, state and local policy) as priority areas.⁴⁵ The Food and Agriculture Organization of the United Nations (FAO) World Summit report (1996) identified four pillars of global food security and its determinant factors: availability, access, utilization,

and stability.⁹⁹ Perhaps the most significant nutrition-related factor used to assess food security is food access—or the availability and accessibility of affordable, nutritious, and safe food sources. Food access is a dichotomous variable separated by distinctions between physical access and economic access to food and potable water supplies.

Adequate market infrastructure and ample population incomes per capita lend to ease of food access. However, physical access can be negatively impacted by one’s geographic location; in addition, the lack of reliable transportation, unpredictable regional food supply, proximity to food deserts, rural or urban area of residence, and food environment quality can negatively impact access.²⁷ Issues with physical access are further

exacerbated where issues of economic access are involved. Food utilization—the use of food which is accessed and one’s biological ability to process and absorb nutrients—

depends upon household storage and processing resources, knowledge of food

preparation, food sharing within a household, and the state of health of each individual within a household. Concerns regarding household food adequacy are compounded when food that is accessed is not adequately or appropriately utilized—further exacerbating food insecurity within a household.

Social and health disparities are even more prominent among MH seniors who live along the U.S.-Mexico border.²⁵ Research suggests that seniors of Mexican descent, both U.S. and foreign-born, may be more at risk for diet-related chronic disease due to acculturation and dietary patterns in the U.S.¹⁰⁰ For older adults, both poverty and food insecurity are predictive of poor nutrition and negative health outcomes.³ When

culturally appropriate food sources become less affordable and involuntary reductions in

dietary intake occur, access to convenience foods that are not desirable can encourage poor dietary intake and patterns.⁵⁶ Convenience food items are attractive to individuals with limited incomes due to accessibility and affordability of those items. Nonetheless, these foods have widely become staple items in an average American diet, regardless of socio-economic status. Research suggests that household composition (children in the home) and individual or family characteristics (age, employment status, education, household resources) were also associated with unhealthy eating behaviors.¹⁰⁰

Convenience food items generally contain high amounts of saturated fat, cholesterol, added sugar, and sodium and are energy dense; meaning, they contain a large caloric load and energy density per volume. High energy (calorie) consumption promotes increased body weight which leads way to overweight and obesity and associated co-morbidities. Affordability and accessibility of energy dense foods and beverages versus healthful, nutrient dense foods are areas of increasing concern, especially in regard to older adults on limited incomes. Though older individuals who acquired food and nutrition assistance through available programs such as SNAP reported lower incidence of food insecurity, food selection and dietary patterns were not improved overall.⁷⁶

In addition to food access and the availability of a healthful and nutritious food and water supply, social determinants of health can affect the ability of older adults to achieve and maintain food security. Financial and economic barriers to food access remain the most frequently measured non-nutritional food security indicators due to the positive association between poverty and food insecurity. Adequate housing,

transportation, social support systems, and access to healthcare and social services have

an incredible impact on food security. As it stands, minority populations tend to use healthcare less often and tend to be in poorer health than individuals from non-minority populations.¹⁰¹ Other non-nutritional factors include socio-demographic indicators of food insecurity. The ERS found that education level, race, gender, marital status, citizenship status, disability, and employment status of the head of the household relate to the prevalence of food insecurity.¹⁰² These results are substantiated by a study by Bartfield and Duniform (2006) which examined the individual factors and state level predictors that influence food insecurity in households using data from the USDA’s Current Population Survey Food Security Supplements (CPS-FSS).¹⁰³

One indicator that may mask the effects of low and very low food security are coping mechanisms or strategies. Coping strategies can be defined as the physical responses to crises on livelihood systems in the face of unwelcome incidences; they are considered short-term reactions.¹⁰⁴ In addition, the adaptive capacity of an individual is their level of ability to respond to these life changes through autonomous and organized adaptation over time. Referring to the work of Frankenberger (1992), Watts (1983), Corbet (1988), de Waal (1989), Davies (1996), and Maxwell (1999), use of coping strategies as indicators of food security are advocated due to the set of patterns and contexts in which they frame short and long-term food security status.¹⁰ Self-reported measures of food security, including the ERS 18-question Core module, allude to coping behaviors and subjective perceptions within households but do not offer full disclosure of strategies. Examples of coping strategies include: a) altering the diet by means of purchasing less expensive, more affordable foods; b) engaging in food-seeking strategies

that will increase the amount of food available within the home (short-term); c)

activating strategies to restructure the household, i.e. decrease the number of individuals within a household; d) engaging in rationing strategies to manage food insufficiency;

and e) activating social networks to maximize resources and encourage food sharing or food seeking strategies. Other coping strategies may include the reliance upon strength from, and faith in, a religious deity. With MH individuals, social networks and support systems primarily have a great impact on coping strategies as indicated by cultural normative behaviors and expectations.¹⁰⁵