High Food Insecurity Found in Sample of Rhode Island Adults
on Probation

A new cross-sectional study led by public health researchers at Tufts University School of Medicine has found significant food insecurity for adults on probation in Rhode Island. The research team found that nearly three-quarters of the 304 study participants experienced food insecurity over a 30-day period, with almost one-half having very low food security. The study is published today in PLOS ONE.

The overall prevalence of food insecurity in this study was found to be 70%. At 48%, almost one-half had very low food security. The prevalence of food insecurity and very low food security in the study are substantially higher compared with the statewide prevalence—12.8% and 6.1%, respectively—reported in 2016. In the United States generally in 2016, 12.3% of US households experienced food insecurity and 4.9% of all households had very low food security.

"Our study is among the first to assess food insecurity and food acquisition methods for adults on probation. The high levels of food insecurity we identified suggest that access to foods on a regular basis is a widespread problem for individuals on probation," says last author Aviva Must, PhD, a professor and chair of the public health department at Tufts University School of Medicine.

"More than half of participants—58%—with very low food security reported not eating for a whole day for an average of nine days in one month," says lead author Kimberly Dong, DrPH, MS, RD, a research assistant professor in public health at Tufts. Dong did this work as part of her dissertation at Tufts University School of Medicine. 

"Criminal justice reform is often focused on prisons, but this study suggests that reforms also need to target what happens after prisoners are released into the community. Given the high rates of incarceration in the US, this public health problem will only get bigger unless we address it. Identifying those who are at greatest risk for food insecurity—in our study, often relating to homelessness and depression—is a step forward," she continues.

Working with the Rhode Island Department of Corrections Probation Office, the research team used the USDA 10-Item US Adult Food Security Module to obtain food security data from 304 volunteer participants in one of Rhode Island's 11 probation offices. Based on responses, the 304 participants were categorized in one of four levels of food security: high food security, marginal food security, low food security, and very low food security. Of the 304 participants, 146 had very low food security.

The majority (86%) of very low food security participants reported hunger and not being able to eat at some point in the last 30 days. More than one-half of the total participants reported eating less than they should (52%) and skipping or cutting the size of a meal (53%).

The team obtained data for each participant on food acquisition meal patterns and meal preparation along with sociodemographics, correctional supervision history, depression, hazardous alcohol use, illicit drug use, and address or area of residence (based on GIS). Questions included "Where do you normally get food?"; "Do you usually eat breakfast, lunch, or dinner?"; and "How often do you have help preparing a meal?"

When comparing participant characteristics by the four levels of food security, participants who had very low food security were more likely to be homeless (33%) than the other levels of food security (19% for low food security, 13% for marginal food security, and 8% for high food security). There were significant differences in participants across the four levels of food security, with those in the highest level of food security most likely to always have access to a car (49%) and more often to be employed with a full-time job (35%).

Depression was more common in participants with very low food security (73%) compared with other participants.  

"The prevalence of food insecurity and very low food security among adults on probation was extremely high compared to the general population, indicating a critical need for action. We identified characteristics of probationers most at risk for food insecurity, which includes being homeless, depressed, and lacking social support for meal preparation. These findings can inform development of targeted interventions and policies to mitigate health disparities in this marginalized population," Dong says. Her upcoming related research focuses on health measures and access to care for people on probation.

Of the 304 participants, the median age was 36 years, 53% were non-Hispanic white, and 28% were female. The highest level of education attained for many participants was high school (42%). Only one-quarter of the participants had a child currently living with them, 22% had a full-time job, almost two-thirds (63%) had an individual annual income of less than $10,000, 28% always had access to a car and almost three-quarters (73%) of participants received SNAP (Supplemental Nutrition Assistance Program) benefits. Current drug use in the past 30 days was reported by 19% of the participants and 24% currently consumed alcohol at a hazardous level. Depression was identified in 56% of participants.

Limitations to the study include the inability to assess temporal relationships due to the cross-sectional study design and potential limited generalizability since the study is based on a convenience sample in one probation office in a small state.

— Source: Tufts University