Date

September 2009

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

BACKGROUND Food insecurity, the limited or uncertain availability of nutritionally adequate and safe food, is known to disproportionately affect households with members with disabilities. A subset of these households experience hunger, the more extreme form of food insecurity characterized by reduced intake of food, disrupted eating patterns, and the inability to afford to buy more food. Food insecurity is known to negatively affect the health of adults. Adults with disabilities experience greater threats to their health, in terms of optimization and maintenance, often as a result of chronic conditions and/or difficulties they experience accessing health care, including transportation and communication barriers. Food insecurity is perceived as an additional barrier to achieving wellness in people with disabilities. This study examines differences in food insecurity and hunger between people with and without disabilities in the context of other demographic variables. Additionally, the study analyzes experiences of food insecurity and hunger among subgroups of people with disabilities. METHODS In order to elaborate upon characteristics of disability within the household in relation to food insecurity and hunger, a cross-sectional analysis of data from 2005-2006 Oregon Behavioral Risk Factor Surveillance System (BRFSS) was carried out. BRFSS, a population-based telephone survey, provides self-reported information on health behaviors, health risks, and health status. The BRFSS includes disability identifiers. In 2005 and 2006, the Oregon BRFSS asked for the nature of the disability: physical, sensory, cognitive, or psychiatric/emotional health-related. A total of 2,016 respondents identified themselves as persons with disabilities; physical type was cited as the predominant single disability type. In 2005 and 2006, a hunger module was also included in the BRFSS for the purposes of identifying food insecurity in the state. Both the outcomes of food insecurity and hunger were generated from the six-item hunger module. Univariate analysis preceded multiple logistic regression to provide adequate descriptive statistics and facilitate effective model building. Multivariate logistic regression analysis determined whether the experience of food insecurity and hunger differed by presence of disability, disability type, and number of disabilities while accounting for race/ethnicity, income, employment status, age, gender, education, and other extenuating factors relating to the household. The principal expectation was that food insecurity and hunger would be higher amongst individuals with disabilities compared to individuals without disabilities. Additionally, it was expected that individuals living with multiple disability types would have experienced greater food insecurity and hunger compared to individuals with a single disability. RESULTS In univariate analysis, people with disabilities were twice as likely to have experienced food insecurity (p=0.000) and four times as likely to experience hunger (p=0.000) compared to people without disabilities. Among people with disabilities, cognitive type and psychiatric type had greater odds of experiencing food insecurity (OR 2.61 and 3.50, respectively) and hunger (OR 4.56 and 4.38, respectively) compared to physical type. Individuals with multiple disabilities were also more likely to have experienced food insecurity and hunger compared to individuals with a single disability type (OR 1.83 and 2.61, respectively). Multivariate analysis revealed important correlates of food insecurity and hunger including income, employment, age, county of residence, gender, race, and self-reported health status, though these associations varied between outcomes and disability correlates assessed. Several interactions were identified affecting age, gender, and health status. CONCLUSION This study describes a range of factors associated with food insecurity and hunger and elaborates on the relationship between these outcomes and disability. Programs focused on addressing food insecurity may benefit from including strategies that alert individuals with disabilities of such services. Disability is a complex issue involving many factors; additional studies are needed to investigate social and environmental elements to enhance accessibility of paths to health and well-being. Future projects may assess food-stamp programs, food bank services, and other food service programs and facilities for accessibility by people with disabilities.

Identifier

doi:10.6083/M42B8W0P

School

School of Medicine

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