Cumulative Risk Factors Associated with Food Insecurity Among Adults Who Experience Homelessness

Overview

Journal Health Behav Res

Date 2019 Jul 26

PMID 31342011

Citations 5

Authors

Daphne C Hernandez

Sajeevika S Daundasekara

Katherine R Arlinghaus

Nubia Tobar

Lorraine R Reitzel

Darla E Kendzor

Michael S Businelle

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

A Meta-analysis of the Prevalence of Food Insecurity Among People Experiencing Housing Insecurity and Homelessness in the United States.

Jackson C, Hart C, Uribe-Lacy C, Yang P, Tsai J Public Health Rep. 2025; 333549241305349.

PMID: 39760409 PMC: 11705288. DOI: 10.1177/00333549241305349.

Relationship between food insecurity and housing instability on quality of care and quality of life in adults with diabetes.

Mosley-Johnson E, Walker R, Nagavally S, Hawks L, Bhandari S, Trasser H PLoS One. 2022; 17(12):e0278650.

PMID: 36472986 PMC: 9725149. DOI: 10.1371/journal.pone.0278650.

A latent class analysis to identify socio-economic and health risk profiles among mothers of young children predicting longitudinal risk of food insecurity.

Daundasekara S, Schuler B, Hernandez D PLoS One. 2022; 17(8):e0272614.

PMID: 36001540 PMC: 9401138. DOI: 10.1371/journal.pone.0272614.

Perceived Social Support Attenuates the Association between Stress and Health-Related Quality of Life among Adults Experiencing Homelessness.

Jafry M, Martinez J, Chen T, Businelle M, Kendzor D, Reitzel L Int J Environ Res Public Health. 2021; 18(20).

PMID: 34682458 PMC: 8536194. DOI: 10.3390/ijerph182010713.

Association of Problematic Alcohol Use and Food Insecurity among Homeless Men and Women.

Reitzel L, Chinamuthevi S, Daundasekara S, Hernandez D, Chen T, Harkara Y Int J Environ Res Public Health. 2020; 17(10).

PMID: 32455769 PMC: 7277400. DOI: 10.3390/ijerph17103631.

References

Blumberg S, Bialostosky K, Hamilton W, Briefel R . The effectiveness of a short form of the Household Food Security Scale. Am J Public Health. 1999; 89(8):1231-4. PMC: 1508674. DOI: 10.2105/ajph.89.8.1231. View

Fitzpatrick K, LaGory M, Ritchey F . Dangerous places: exposure to violence and its mental health consequences for the homeless. Am J Orthopsychiatry. 1999; 69(4):438-47. DOI: 10.1037/h0080392. View

Spitzer R, Kroenke K, Williams J . 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. JAMA. 1999; 282(18):1737-44. DOI: 10.1001/jama.282.18.1737. View

Kushel M, Evans J, Perry S, Robertson M, Moss A . No door to lock: victimization among homeless and marginally housed persons. Arch Intern Med. 2003; 163(20):2492-9. DOI: 10.1001/archinte.163.20.2492. View

Richards R, Smith C . The impact of homeless shelters on food access and choice among homeless families in Minnesota. J Nutr Educ Behav. 2006; 38(2):96-105. DOI: 10.1016/j.jneb.2005.11.031. View

Wicks R, Trevena L, Quine S . Experiences of food insecurity among urban soup kitchen consumers: insights for improving nutrition and well-being. J Am Diet Assoc. 2006; 106(6):921-4. DOI: 10.1016/j.jada.2006.03.006. View

Tyler K, Johnson K . Trading sex: voluntary or coerced? The experiences of homeless youth. J Sex Res. 2007; 43(3):208-16. DOI: 10.1080/00224490609552319. View

Kroenke K, Strine T, Spitzer R, Williams J, Berry J, Mokdad A . The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2008; 114(1-3):163-73. DOI: 10.1016/j.jad.2008.06.026. View

Gundersen C, Lohman B, Garasky S, Stewart S, Eisenmann J . Food security, maternal stressors, and overweight among low-income US children: results from the National Health and Nutrition Examination Survey (1999-2002). Pediatrics. 2008; 122(3):e529-40. DOI: 10.1542/peds.2008-0556. View

10.

Weiser S, Frongillo E, Ragland K, Hogg R, Riley E, Bangsberg D . Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. J Gen Intern Med. 2008; 24(1):14-20. PMC: 2607506. DOI: 10.1007/s11606-008-0824-5. View

11.

Fowler P, Toro P, Miles B . Pathways to and from homelessness and associated psychosocial outcomes among adolescents leaving the foster care system. Am J Public Health. 2009; 99(8):1453-8. PMC: 2707485. DOI: 10.2105/AJPH.2008.142547. View

12.

Weiser S, Bangsberg D, Kegeles S, Ragland K, Kushel M, Frongillo E . Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav. 2009; 13(5):841-8. PMC: 2758196. DOI: 10.1007/s10461-009-9597-z. View

13.

Melchior M, Caspi A, Howard L, Ambler A, Bolton H, Mountain N . Mental health context of food insecurity: a representative cohort of families with young children. Pediatrics. 2009; 124(4):e564-72. PMC: 4231784. DOI: 10.1542/peds.2009-0583. View

14.

Szanton S, Thorpe R, Whitfield K . Life-course financial strain and health in African-Americans. Soc Sci Med. 2010; 71(2):259-265. PMC: 2885496. DOI: 10.1016/j.socscimed.2010.04.001. View

15.

Garasky S, Stewart S, Gundersen C, Lohman B, Eisenmann J . Family stressors and child obesity. Soc Sci Res. 2010; 38(4):755-66. DOI: 10.1016/j.ssresearch.2009.06.002. View

16.

Bassuk E . Ending child homelessness in America. Am J Orthopsychiatry. 2010; 80(4):496-504. DOI: 10.1111/j.1939-0025.2010.01052.x. View

17.

Geller A, Garfinkel I, Western B . Paternal incarceration and support for children in fragile families. Demography. 2011; 48(1):25-47. PMC: 3220952. DOI: 10.1007/s13524-010-0009-9. View

18.

Sun S, Irestig R, Burstrom B, Beijer U, Burstrom K . Health-related quality of life (EQ-5D) among homeless persons compared to a general population sample in Stockholm County, 2006. Scand J Public Health. 2012; 40(2):115-25. DOI: 10.1177/1403494811435493. View

19.

Lebrun-Harris L, Baggett T, Jenkins D, Sripipatana A, Sharma R, Hayashi A . Health status and health care experiences among homeless patients in federally supported health centers: findings from the 2009 patient survey. Health Serv Res. 2012; 48(3):992-1017. PMC: 3681240. DOI: 10.1111/1475-6773.12009. View

20.

Baggett T, Tobey M, Rigotti N . Tobacco use among homeless people--addressing the neglected addiction. N Engl J Med. 2013; 369(3):201-4. DOI: 10.1056/NEJMp1301935. View