Food insecurity and participation in community food programs among low-income Toronto families.
Kirkpatrick, Sharon I. ; Tarasuk, Valerie
Almost 1 in 10 Canadian households experienced food insecurity in
2004. (1) In addition to compromising nutrition, (2-4) household food
insecurity is associated with poorer physical, mental, and social
health. (5-7) While the existing research suggests that problems of
household food insecurity are primarily rooted in inadequate incomes,
(1,5-8) few policy directions have been proposed to address factors that
constrain food purchasing. Instead, responses have generally been
community-based initiatives focused on food and food-related behaviours,
including food banks, meal and snack programs for children, and
community kitchens and gardens. We undertook a study of low-income
families residing in high-poverty Toronto neighbourhoods, employing
survey methods, mapping of neighbourhood food access, and qualitative
interviewing, to gain an understanding of factors that influence
household food security. In this paper, we draw upon the survey and
mapping data to examine household food security, participation in
community food programs, and resource augmentation strategies employed
when running out of food or money for food. A comprehensive examination
of the relation between housing affordability, housing subsidies, social
assistance, and household food insecurity will be published elsewhere.
METHODS
Sample and data collection
Data collection was completed between November 2005 and January
2007 in 12 census tracts randomly chosen from 23 high-poverty tracts in
Toronto. (9) Families with children and who were tenants were studied
because of the association between these household characteristics and
food insecurity. (1,5,6) Potential respondents residing in rental units
in each census tract were approached at the door and screened for
inclusion by trained interviewers with personal experience of low
income. Tenant families were deemed eligible if their gross household
income was at or below the mid-level of Statistics Canada's
five-category income adequacy scale. (10) These thresholds, which are
slightly higher than Statistics Canada's Low Income Cut-Offs (11)
and considerably higher than social assistance rates in Ontario, (12)
were selected to ensure that the sample encompassed both the
'working poor' and social assistance recipients. Participation
was voluntary and confidential, and the study protocol was approved by
the Human Subjects Research Ethics Board at the University of Toronto.
Respondents from 501 families were surveyed, reflecting a
participation rate of 62%. Seventeen families had incomes exceeding the
eligibility threshold based on the detailed data collected in the survey
and were excluded, resulting in an analytic sample of 484 families.
Household food security over the previous 12 months was assessed using
the Household Food Security Survey Module (13) and a three-level
categorical variable was constructed using thresholds developed by
Health Canada. (1) Moderately food-insecure families are characterized
by compromises in the quality and/or quantity of food consumed by adults
and/or children, whereas severely food-insecure families are
characterized by reduced food intake and disrupted eating patterns among
adults and/or children. Families in which neither adults nor children
were characterized as moderately or severely food insecure are
categorized as food secure. Questions were posed on the use of food
banks and community kitchens and gardens over the previous 12 months and
on children's participation in meal or snack programs at schools or
community agencies over the previous 30 days. Resource augmentation
strategies employed in the previous 12 months in response to threats of
food shortages were captured through questions on delaying the payment
of rent or bills, terminating services, pawning or selling possessions,
and sending children to a friend's or relative's home for a
meal. (3,14) Data on the location of community food programs were
obtained from program providers and mapped using Geographic Information
Systems software. Variables were then derived to indicate the distance
from the dwelling of each family surveyed to the nearest food bank,
community kitchen, and community garden.
Statistical methods
Analyses were performed using SAS, version 9.1.3 (SAS Institute,
Cary, NC), utilizing SURVEY procedures to account for the clustering in
the sampling design. Multivariate logistic regression was used to assess
associations between socio-demographic characteristics and household
food security status, utilizing severe food insecurity as the predicted
outcome because of the highly vulnerable nature of the sample. Logistic
regression was also used to examine predictors of program participation
and use of resource augmentation strategies. Frequency of food bank use
was examined to explore the hypothesis that regular use of charitable
food assistance may be a means by which some families maintain food
security. The examination of children's participation in food
programs over the previous 30 days was restricted to a subsample (n=345)
of families that included school-aged children (ages 5-18 years) and
excluded those for whom the 30-day recall period corresponded to the
summer months.
RESULTS
The sample characteristics in relation to household food security
status are outlined in Table 1. Over one third of families (37.6%) were
moderately food insecure and over one quarter (27.7%) were severely food
insecure over the previous 12 months. Severe food insecurity was
negatively associated with household income whereas households reliant
on social assistance, those headed by a lone mother, and those in which
the respondent had not completed high school had greater odds of severe
food insecurity (Table 2).
About one in five families used food banks in the previous 12
months (Table 3). Moderately food-insecure families had two times higher
odds (OR = 2.18, 95% CI = 1.17-4.07) and severely food-insecure families
had six times higher odds (OR = 6.41, 95% CI = 3.75-10.97) of using a
food bank at least one time in the previous year compared to food-secure
families. Food bank use was positively associated with reliance on
social assistance or other government transfers and the respondent
having less than a high school education; lower odds of food bank use
were observed with increasing income and among immigrants (data not
shown). Among families that used food banks, use was relatively
infrequent with over half (56.7%) reporting use in 3 or fewer of the
previous 12 months and less than one fifth (19.2%) reporting use in 10
or more months. Only 4.1% of all families used a food bank in 10 or more
of the previous 12 months (1.2% of food-secure families, 5.0% of
moderately food-insecure families, and 6.7% of severely food-insecure
families). Regular food bank use was positively associated with reliance
on social assistance (data not shown). The distance from each
family's dwelling to the nearest food bank was not associated with
whether a family used a food bank at all nor with regular food bank use
(data not shown). Rates of participation in community kitchens and
gardens were very low (Table 3), precluding an examination of predictors
of participation.
One third (33.6%) of families with school-aged children reported
participation in children's food programs at schools or community
agencies in the previous 30 days, with snack programs being most
frequently used (Table 3). The majority of children (68.1%) who
participated in programs attended regularly (at least 20 of the previous
30 days). Families paid a program fee for most children (76.2%) who
participated regularly: the median cost per child per program over the
previous 30 days was $4 (range $0-100). There were no significant
associations between regular participation in children's food
programs and household food security status nor household
socio-demographic characteristics (data not shown); using a less
stringent threshold of 15 days to denote regular participation did not
change these findings. Associations between participation and geographic
proximity of programs were not assessed since our data did not permit us
to identify the schools that children attended.
Among the resource augmentation strategies examined, delaying
payment of bills in response to threats of food shortages was most
commonly used (Table 4). Moderately and severely food-insecure families
were significantly more likely than food-secure families to delay
payments of bills or rent, sell or pawn personal possessions, and
terminate services (Table 5). The low rates of usage of some strategies
among food-secure families resulted in wide confidence intervals for
some odds ratios, but the pattern appears to be towards increasing use
of strategies with worsening food insecurity. The odds of sending
children to a friend's or relative's home for a meal according
to food security status were not computed since this strategy was used
exclusively by food-insecure families (Table 4).
DISCUSSION
Among this sample, the prevalence of food insecurity was more than
double the observed prevalence among households in the lowest three
income adequacy categories nationally in 2004, (1) highlighting the
clustering of problems of food insecurity in high-poverty
neighbourhoods. Even among this highly vulnerable subgroup though,
severe food insecurity was associated with the same risk factors
repeatedly identified in national surveys--i.e., declining income,
reliance on social assistance, and living in a lone-mother household.
(1,5-8)
To date, the primary responses to household food insecurity have
been local-level food-based initiatives, predominantly food banks,
(15,16) but also school- and community-based meal and snack programs for
children (17-22) and programs such as community kitchens and gardens
aimed at enhancing food skills and food access. (23-26) While it has
long been recognized that such initiatives do not address the economic
issues that underlie food insecurity, (15,16,27-29) the perception that
these programs play a valuable role in addressing the unmet food needs
of food-insecure children and/or households persists.30 Our data
challenge this perception. Not only were rates of program participation
surprisingly low--never exceeding one third of our sample--but we found
no indications that the use of food banks or children's food
programs had any bearing on household food security status. The patterns
of food bank use among this sample suggest that it is a strategy of
desperation, not a means of routine food acquisition. Participation
rates were so low that we could not even analyze the relationship
between community garden or kitchen participation and household food
insecurity. These low participation rates were documented among a
predominantly food-insecure sample of families living in neighbourhoods
with ample access to such programs. Our results highlight the need for
systematic evaluations of community food initiatives to determine their
relevance and accessibility for food-insecure households.
We are unable to assess whether the program participation rates
observed in this study differ from those of food-insecure households in
other jurisdictions. However, the relationships observed between usage
of community food programs and household food insecurity are consistent
with previous research. Data from the 1996-97 and 1998-99 cycles of the
National Population Health Survey indicated that only 20-35% of
households characterized as food insufficient or food insecure reported
receiving food charity over the previous year. (5,6) Food bank
statistics also show numbers that are far lower than those captured in
national food insecurity prevalence estimates. (31) The apparent lack of
a protective effect of food bank use observed in the current study has
also been previously documented, with our research on food bank users in
Toronto revealing no association between frequency of food bank use and
severity of household food insecurity. (32) Studies of children's
food programs and community kitchens have also raised questions about
their capacity to address problems of food insecurity due to factors
such as limited scope and inability to address the food needs of those
living in severe poverty. (15,18,19,22,24,33-37)
While rates of program participation were low, the use of other
resource augmentation strategies such as delaying payments of bills or
rent and the termination of telephone and other services was relatively
common. This is worrisome given that such strategies can only compound
the vulnerability of food-insecure families by causing them to incur
debts, risk eviction, exhaust social support networks and become more
socially isolated.
The high prevalence of food problems among this sample coupled with
low levels of participation in community-based programs and the common
use of other resource augmentation strategies highlight the need for
more effective responses to household food insecurity in Canada. While
community-based programs currently form the mainstay of responses, our
research provides evidence that these initiatives are reaching only a
small proportion of those in need and are unable to compensate for the
inadequacy of their household incomes. Our findings point to the need
for a critical examination of these programs to ensure that they are
structured to provide the maximum benefit possible to the most
vulnerable members of our communities. There is also a need for advocacy
for policy reforms to ensure that low-income households have adequate
resources for food.
Received: July 12, 2008
Accepted: September 29, 2008
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Sharon I. Kirkpatrick, PhD, RD, [1] Valerie Tarasuk, PhD [2]
Author Affiliations
[1.] Department of Community Health Sciences, Faculty of Medicine,
University of Calgary, Calgary, AB
[2.] Department of Nutritional Sciences, Faculty of Medicine,
University of Toronto, Toronto, ON
Correspondence and reprint requests: Sharon Kirkpatrick, Department
of Community Health Sciences, Faculty of Medicine, University of
Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, E-mail:
sharon.kirkpatrick@ucalgary.ca
Acknowledgements: This study was funded by grants from the Canadian
Institutes for Health Research (IGP-74207, MOP-77766). Sharon
Kirkpatrick was a doctoral student at the time that this study was
conducted and received financial support from an Ontario Graduate
Scholarship and a Social Sciences and Humanities Research Council of
Canada Doctoral Scholarship. The authors are grateful to Richard
Maaranen (Centre for Urban and Community Studies, University of Toronto)
for his GIS work on this study. We also gratefully acknowledge our
collaborators at the City of Toronto Shelter, Housing and Support
Division and Toronto Public Health.
Table 1. Household Food Security Status in Relation to Household
Socio-demographic Characteristics (n=484)
Food Secure Moderately Food
Insecure
(n=168) (n=182)
Mean (SE)
Income ($) * 24,506 [+ or -] 576 23,639 [+ or -] 551
n (%) n (%)
Household type
Two-parent (n=206) 85 (41.3) 91 (44.2)
Lone mother (n=260) 74 (28.5) 84 (32.3)
Lone father (n=18) 9 (50.0) 7 (38.9)
Main source of income
Employment (n=254) 107 (42.1) 106 (41.7)
Social assistance (n=131) 25 (19.1) 44 (33.6)
Other government 22 (28.6) 29 (37.7)
transfers [dagger]
(n=77)
Other sources 14 (63.6) 3 (13.6)
[double dagger] (n=22)
Immigrant status [section]
Born in Canada (n=85) 19 (22.4) 32 (37.7)
Immigrated <10 yrs ago 90 (43.1) 79 (37.8)
(n=209)
Immigrated [greater than 59 (31.1) 71 (37.4)
or equal to] 10 yrs ago
(n=190)
Respondent education
Did not complete high 30 (27.5) 31 (28.4)
school (n=109)
Completed high school 53 (32.7) 66 (40.7)
(n=162)
Some or completed post- 85 (39.9) 85 (39.9)
secondary education
(n=213)
Severely Food
Insecure
(n=134)
Income ($) * 20,362 [+ or -] 652
n (%)
Household type
Two-parent (n=206) 30 (14.6)
Lone mother (n=260) 102 (39.2)
Lone father (n=18) 2 (11.1)
Main source of income
Employment (n=254) 41 (16.1)
Social assistance (n=131) 62 (47.3)
Other government 26 (33.8)
transfers [dagger]
(n=77)
Other sources 5 (22.7)
[double dagger] (n=22)
Immigrant status [section]
Born in Canada (n=85) 34 (40.0)
Immigrated <10 yrs ago 40 (19.1)
(n=209)
Immigrated [greater than 60 (31.6)
or equal to] 10 yrs ago
(n=190)
Respondent education
Did not complete high 48 (44.0)
school (n=109)
Completed high school 43 (26.5)
(n=162)
Some or completed post- 43 (20.2)
secondary education
(n=213)
* Means for income are adjusted for household composition.
([dagger]) Other government transfers include Employment Insurance,
Worker's Compensation, Child Tax Benefits, and seniors' benefits.
([double dagger]) Other sources of income include child support and rent
paid by tenant(s) living in the dwelling.
([section]) Immigrant status is based on the household respondent and/
or his/her partner if applicable. In households in which both the
respondent and partner were born outside of Canada, immigrant status
is based on the individual who immigrated most recently.
Table 2. Odds of Severe Household Food Insecurity in Relation
to Household Socio-demographic Characteristics
(n=484)
Odds Ratio (95%
CI) * of Severe
Food Insecurity
0.94 (0.91-
Income (in $1000 units) 0.97)
Household type
Two-parent or lone father ([dagger]) 1.0
([double dagger]) Lone mother 2.30 (1.37-3.86)
Main source of income
Employment or other sources ([dagger]) 1.0
([double dagger]) ([section])
Social assistance 2.18 (1.21-3.92)
Other government transfers ([parallel]) 1.31 (0.81-2.11)
Immigrant status ([paragraph])
Born in Canada ([dagger]) 1.0
Immigrated <10 yrs ago 0.81 (0.42-1.60)
Immigrated [greater than or equal to] 1.18 (0.67-2.07)
10 yrs ago
Respondent education
Did not complete high school 1.70 (1.07-2.70)
Completed high school 0.82 (0.52-1.29)
Some or completed post-secondary education 1.0
([dagger])
* Odds ratios were derived from multivariate logistic regression,
adjusted for household composition and all other variables in the
table.
([dagger]) Reference category.
([double dagger]) Categories presented in Table 1 have been grouped
together.
([section]) Other sources of income include child support and rent paid
by tenant(s) living in the dwelling.
([parallel]) Other government transfers include Employment Insurance,
Worker's Compensation, Child Tax Benefits, and seniors' benefits.
([paragraph]) Immigrant status is based on the household respondent and/
or his/her partner if applicable. In households in which both the
respondent and partner were born outside of Canada, immigrant status
is based on the individual who immigrated most recently.
Table 3. Use of Community Food Programs over Previous 12 Months
(n=484) and Children's Food Programs over Previous 30 Days (n=345) in
Relation to Household Food Security Status
Number (%) of Families Using Program
Community Food Programs Total Food Secure
(n=484) (n=168)
Food banks 104 (21.5) 16 (9.5)
Community kitchens 24 (5.0) 6 (3.6)
Community gardens 10 (2.1) 1 (0.6)
Children's Food Programs Total Food Secure
(n=345*) (n=117)
Breakfast programs 24 (7.0) 6 (5.1)
Lunch programs 23 (6.7) 3 (2.6)
Snack programs 68 (19.7) 22 (18.8)
After-school programs 11 (3.2) 6 (5.1)
Number (%) of Families Using Program
Community Food Programs Moderately Food Severely Food
Insecure Insecure
(n=182) (n=134)
Food banks 34 (18.7) 54 (40.3)
Community kitchens 9 (5.0) 9 (6.7)
Community gardens 5 (2.8) 4 (3.0)
Children's Food Programs Moderately Food Severely Food
Insecure Insecure
(n=130) (n=98)
Breakfast programs 13 (10.0) 5 (5.1)
Lunch programs 12 (9.2) 8 (8.2)
Snack programs 28 (21.5) 18 (18.4)
After-school programs 3 (2.3) 2 (2.0)
* The examination of children's participation in food programs over
the previous 30 days was conducted among a subsample (n=345) of
families that included school-aged children (ages 5-18 years) and
excluded those for whom the 30-day recall period corresponded to the
summer months.
Table 4. Use of Resource Augmentation Strategies in Relation to
Household Food Security Status (n=484)
Number (%) of Families Using Strategy
Total Food Moderately Severely
Secure Food Food
Insecure Insecure
(n=484) (n=168) (n=182) (n=134)
Delayed paying 244 (50.4) 35 (20.8) 105 (57.7) 104 (77.6)
a bill
Delayed paying rent 111 (22.9) 11 (6.6) 48 (26.4) 52 (38.8)
Sold or pawned 62 (12.8) 3 (1.8) 19 (10.4) 40 (29.9)
personal
possessions
Gave up television 77 (15.9) 10 (6.0) 34 (18.7) 33 (24.6)
cable service
Gave up telephone 60 (12.4) 3 (1.8) 19 (10.4) 38 (28.4)
service
Gave up internet 72 (14.9) 8 (4.8) 31 (17.0) 33 (24.6)
service
Sent child/ 38 (7.9) 0 (0) 8 (4.4) 30 (22.4)
children to homes
of friends or
relatives for a
meal
Table 5. Odds of Using Each Resource Augmentation Strategy in
Relation to Household Food Security Status (n=484)
Delayed Bill Delayed Sold or
Payment Payment of Pawned
Rent Personal
Possessions
Odds Ratio
(95% Cl) *
Food secure ([dagger]) 1.0 1.0 1.0
Moderately food insecure 5.18 5.11 6.41
(3.24-8.29) (2.57-10.17) (1.41-29.15)
Severely food insecure 13.17 9.05 23.4
(9.50-18.26) (3.89-21.08) (5.63-97.32)
Gave Up TV Gave Up Gave Up
Cable Telephone Internet
Service Service Service
Odds Ratio
(95% Cl) *
Food secure ([dagger]) 1.0 1.0 1.0
Moderately food insecure 3.63 6.41 4.11
(2.02-6.53) (2.59-15.85) (1.62-10.40)
Severely food insecure 5.16 21.77 6.54
(2.96-8.99) (7.32-64.79) (3.34-12.78)
* Odds ratios for each strategy were derived from a logistic
regression model which included dummy variables to indicate household
food security status.
([dagger]) Reference category.
