UKCPR awards new research projects examining senior hunger

The University of Kentucky Center for Poverty Research awarded nine new projects that will examine a variety of questions related to food hardships facing older persons in the United States. The program -- made possible with funding from the Food and Nutrition Service in the U.S. Department of Agriculture -- will provide about $1.2 million for research into the impact of factors such as medical expenses, food production activities, and chronic disease on food insecurity and related health and material hardships among seniors.

Following are our newest awardees and descriptions of their projects:

Irma Arteaga, University of Missouri-Columbia (PI), Leslie Hodges, University of Wisconsin-Madison (co-I), Colleen Heflin, Syracuse University (co-I), Chinedum Ojinnaka, Arizona State University (co-I).  Food insecurity and chronic diseases in low-income older Americans: The role of SNAP receipt in medication underuse. This project will investigate how SNAP benefits affect medication and health care use for seniors with chronic conditions. Using a unique linked state administrative dataset from Missouri that contains both the universe of Medicaid claims and SNAP data among adults ages 60 and older from 2006 to 2014, the authors propose four inter-related questions. First, are Medicaid claims for diabetic and hypertensive emergencies that result in emergency department (ED) visits and hospitalizations less likely among SNAP recipients? Second, do SNAP recipients have lower rates of medication non-adherence for these conditions than non-SNAP recipients? Third, is medication non-adherence for these conditions more likely to result in ED visits and hospitalizations among SNAP recipients compared to non-SNAP recipients, and what is the relation to the amount of SNAP benefits? Fourth, is medication non-adherence related to the timing of SNAP benefit disbursement? For these conditions, is the rate of claims for ED visits and hospitalizations related to the timing of SNAP benefit disbursement? The findings of this analysis will inform policymakers about the extent to which SNAP produces health benefits among older Americans by promoting disease control and reducing diabetic and hypertensive emergencies.

Joshua Berning, (PI), Jude Bayham (co-I), Alessandro Bonnano (co-I), Rebecca Cleary (co-I), Colorado State University. How older households manage food insecurity with food production activities. The investigators will conduct an analysis of how food insecurity and food production activities change for elderly households as they age. They hypothesize that elderly households may spend more time on food production activities to maintain food security into retirement, while the intensity of activities is likely to decline. Using the CPS American Time Use Survey linked to the CPS Household Food Security Supplement, the researchers will look at meal preparation, grocery shopping, non-grocery food acquisition, and eating time. They will examine how food production activities are related to food insecurity across different household types and explore differences between age cohorts for single and couple households. Researchers will analyze the causal effect of food production activities on household food insecurity. The results of this analysis will provide greater insight into understanding which behaviors are more effective for minimizing food insecurity and which activities may need to be supported to help improve food security for elderly households.

Barbara Butrica (PI), Stipica Mudrazija (co-I), Urban Institute. The relationship between food insecurity and poverty among older adults. The project will examine the determinants and dynamics of food insecurity over time using the Health and Retirement Study. The aim is to better understand what drives the gap between food insecurity and poverty rates, and how to better align the two measures of economic hardship using alternative measures of poverty, namely, the official poverty measure (OPM) and the supplemental poverty measure (SPM). They hypothesize that factors not captured by the OPM such as food assistance and out-of-pocket medical spending are important determinants of senior food insecurity and the discrepancy between food insecurity and existing measures of poverty among older adults has increased. The research will examine how the risk of experiencing food insecurity and remaining food insecure increase as seniors age. The implication is that an increasing number of older adults, even those not deemed poor, may be at risk of food insecurity. The researchers hope these findings will inform policymakers about how to improve the criteria for determining SNAP eligibility among older adults by determining a set of key predictors that define food insecurity.

Heather Eicher-Miller (PI), Regan Bailey (co-I), Purdue University. Total nutrient intake, dietary nutrient intake, and dietary quality of U.S. seniors using federal and non-federal food assistance. This project will use data from the National Heath and Nutrition Examination Survey to determine and compare the national estimates of mean usual intake of nutrients from food, total nutrients (from food and supplements) and dietary quality of U.S. seniors age 60 and older who use food assistance from public and private food networks. The proportion of seniors meeting the Dietary Reference Intake (DRI) recommendations by program will also be provided to inform policy. About 66 percent of seniors 71 and older and at or below 130 percent of the poverty threshold use dietary supplements. Determining nutrient and dietary gaps/excesses and comparisons by food assistance program use is critical to inform nutrition planning for food assistance programs (some specifically directed to seniors) and senior ability to achieve DRI recommendations. Recent suggested provisions in the farm bill would allow SNAP benefits to be used to purchase dietary supplements such as multivitamins, and the results of this study should inform policy on the potential implications for diet quality of seniors.


Colleen Heflin, Syracuse University (PI). Changing patterns of eligibility and take up in SNAP and the role of out-of-pocket medical expenses. While national SNAP caseloads peaked in fiscal year 2013 and have declined since then, participation among older adults has continued to rise. With increased health care expenditures and out-of-pocket costs, medical expenses have become a major contributor to the household financial instability of older adults. The impact of out of pocket medical expenses has not been the subject of previous research in relation to SNAP participation, especially among seniors. Using a long panel of seniors from the Health and Retirement Study, the first objective of this project is to explore the temporal dimension of SNAP eligibility and take-up for older adults and their policy implications. Researchers will focus on the age pattern of SNAP eligibility and take-up, the period pattern of individuals’ SNAP eligibility and take-up within economic and policy contexts, and the demographic pattern of how the age and period patterns differ by demographic characteristics. The second objective is to examine the role of out-of-pocket medical expenditures on SNAP participation. Given the increase in out of pocket medical expenses for older adults, the authors will ask whether these expenses increase eligibility but not participation, or whether participation also increases. Results will provide policymakers with information on seniors families burdened by out-of-pocket health care expenditures and the eligibility guidelines for food assistance programs.


Carla Pezzia, University of Dallas (PI); Tammy Leonard, University of Dallas (Co-I). Food security status in seniors over their life course. Despite multiple social safety net systems, seniors over 60 are at risk for food, economic, and material hardship, complicating health challenges. Little is known about the ways early and mid-life experiences moderate and mediate senior experiences of food-related hardship and health. The project will utilize mixed qualitative and quantitative methods to evaluate the impact of household dynamics on food insecurity, economic and material hardship, and household health over the life course. The project will describe current and past hardships and health characteristics of food insecure households with older adults to determine if food insecurity is more likely associated with some individual/household characteristics, particularly related to health outcomes. The project will also determine what individual/household characteristics and life circumstances affect the likelihood of senior food insecurity. Researchers will also use interviews to examine the relationships between household characteristics, food insecurity (alone or in combination with other material hardships), and quality of life among seniors over a 12-month period. Study results will inform programming and outreach to relieve food insecurity and other hardship among seniors, as well as potentially formulate preventive approaches to address earlier life course events found to exacerbate senior hardships.


Perry Singleton, Syracuse University (PI). The effect of Social Security retirement benefits on food-related hardship among older Americans. This project examines the effect of Social Security retirement benefits on food-related hardship, particularly at the early retirement age of 62, when Social Security claims spike. One study links this spike to individuals with limited wealth and private pensions who are unable to retire before age 62. This implies that individuals who claim Social Security benefits at the early retirement age are more likely to face food-related hardship and that Social Security benefits may reduce food-related hardship at age 62 and beyond. This project uses data from the CPS Food Security Supplement and Health and Retirement Study to first examine whether the prevalence of food-related hardship decreases precipitously at age 62. Next, it examines whether the persistence of food-related hardship decreases at age 62, since income from Social Security is more stable across periods. Finally, the author plans to test whether the effect of Social Security benefits on food-related hardship was larger during the Great Recession, which sharply increased food insecurity among the population. The policy implications of the results reach to the wider safety net of seniors, especially potential unintended food insecurity consequences of changing age eligibility for Social Security.


Geetha Waehrer, Pacific Institute for Research and Evaluation (PI). Effects of higher SNAP benefits on low-income seniors. This project will use data from the Current Population Survey and the Consumer Expenditure Survey to investigate whether higher SNAP benefits can increase participation among eligible seniors, along with the effects of changes in SNAP benefits on the food and non-food expenditures of elderly SNAP participants. To estimate the effects of benefit changes, the project will use the natural experiments provided by the increase in SNAP benefits as a result of the 2009 American Recovery and Reinvestment Act and the decrease in 2013 following the sunset of this benefit expansion. By estimating the effect of benefit changes on participation and spending, findings will add to information about the adequacy of SNAP benefits. Results will inform policy by revealing the spillover effects, if any, on other types of expenditures to show the full impact of SNAP on the health and well-being of older Americans, beyond its support of food spending. The research will also inform policy on whether SNAP’s emphasis on home preparation discourages participation.

Tara Watson (PI), Lara Shore-Sheppard (co-I), Lucie Schmidt (co-I), Williams College. Living arrangements and food hardship among seniors. Researchers will investigate how senior living arrangements – particularly living with grandchildren or in an institution - affect food insecurity and SNAP participation. The project will investigate how living arrangements of seniors have been changing over the past two decades and how patterns of food insecurity and SNAP participation among seniors vary based on living arrangements. The project, using data from the American Community Survey, Current Population Survey, and Health and Retirement Study, will estimate the effect of co-resident grandchildren on food insecurity and program participation, by examining transitions for seniors who experience an entry or exit of a grandchild from their household. Researchers will analyze state welfare policies, county opioid rates, and county female incarceration, which predict grandparents serving as caregivers. Understanding how caregiving responsibilities impact food insecurity and SNAP can help guide policymakers as they develop safety net guidelines for increasingly complex family structures and can highlight spillovers from other policy decisions onto the SNAP program. The project will also examine how aging in place rather in institutions, affects food insecurity and SNAP participation.