Food Intake, Obesity, and Nutritional Risk Among the Homeless in Rhode Island

1. Food Intake, Obesity, and Nutritional Risk Among the Homeless in Rhode Island Leah Murphy, BA Sekboppa Sor, BSN Jonah Martins Mercy Otieno Jennifer De la Cruz Maria Mendez Melissa Kirton, BS

2. Homeless in Rhode Island. Tent City, July ‘09

3. Overview… • I. Introduction • II. Key concepts • III. The issue at hand • IV. What we did • V. What we learned & why it matters

4. INTRODUCTION…WHO WE ARE • An interdisciplinary team representing the following disciplines: - Nursing - Pharmacy - Nutrition - Social Work - Statistics • Working under a grant from Area Health Education Center for Central Rhode Island

5. With funding from Central RI AHEC…. We teamed with community agencies to better understand the challenges facing Providence’s homeless population. The agencies we worked with included: Crossroads Rhode Island Rhode Island Coalition for the Homeless The RI Family Shelter WARM Shelter McAuley House Providence In-town Churches Association Providence Community Health Center The SNAP Outreach Program (Food Stamp outreach)

6. Our group…(not pictured: Maria and Jonah)

7. Our group in action…Outreach @ Grace Church

8. Key Concepts • Homelessness “…a person is considered homeless when he/she lacks a fixed, regular, and adequate night-time residence; and... has a primary night time residency that is: (A) a supervised publicly or privately operated shelter designed to provide temporary living accommodations... (B) An institution that provides a temporary residence for individuals intended to be institutionalized, or (C) a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings (Stewart B. McKinney Act, 42 U.S.C. § 11301, et seq. , 1994). The term “homeless individual” does not include any individual imprisoned or otherwise detained pursuant to an Act of Congress or a state law." National Coalition for the Homeless. (2009). Who Is Homeless, NCH Fact Sheet #3. Washington, DC.

9. Key Concepts • Food Security: access at all times, to enough food for an active healthy life for all household members. • Food Insecurity: At times in the year, there exists uncertainty of having, or inability to acquire, enough food to meet the needs of all household members because of insufficient money or other resources for food. • Source: Nord, M. (2008). Food Security in the United States: Key Statistics and Graphics. Retrieved from http://www.ers.usda.gov/Briefing/Food Security/stats_graphs.htm

10. U.S. Food Insecurity, 2007 • In 2007, 11.1% of U.S. households were food insecure (13.0 million households)

11. Food insecurity is measured per household in the United States by the US Bureau of the Census. • Therefore, the homeless population’s food security status is not captured in the national measure. source: Alaimo, K. (2005). Food Insecurity in the United States: An Overview. The Journal of Topics in Clinical Nutrition. Vol. 20, No. 4, 281-298.

12. The Issue • There is a need for more knowledge about the nutrition status and ability to access food within the homeless population.

13. Questions about: • How do homeless people eat if they don’t have access to a place to prepare and store food? • What does a homeless person’s diet consist of? • Do homeless people in Providence experience hunger? • Are there any patterns or trends in the health parameters of Providence’s homeless population?

14. Tent City, Providence- July 2009

16. Our Assessment… • Homeless individuals and families were recruited at Rhode Island’s largest service agency for the homeless (Crossroads RI). • A healthy snack was offered as an incentive

17. Voluntary, informed consent was required by participants. • Trained research assistants collected the following data: • Height • Weight • Waist circumference • Blood pressure • Body Mass Index (BMI) calculated by height & weight

18. The participant would then engage in a face-to-face interview with the research assistant. • The interview featured: • Questions regarding demographics and living situation • A detailed 24 hour dietary recall • Six-item Subset of the USDA Food Security Survey.

19. What We Learned about Providence’s Homeless Population, Phase I…

20. Regarding the population… • The study’s population featured diverse cultural backgrounds, including people who are Puerto Rican, Dominican, Colombian, Cape Verdean, Caucasian, African American, Asian, and Native American. • The study’s population ranged in age from young adult to older adult (65 y.o. +). • Many did not have access to a kitchen to prepare food, therefore, food of their ethnic background was not eaten unless they used the little money they had to purchase the food from ethnic restaurants.

21. Regarding the population… • As a result, many of the individuals who participated in the study were not satisfied after eating in soup kitchens. • Older adults who are homeless often have no choice but to eat foods from soup kitchens. They have little or no access to foods from their ethnic backgrounds.

22. Regarding health… • From Phase I of the study, it was established that in a group of 115 homeless adults in Providence: - 77% of the sample was overweight or obese - 34% overweight - 43% obese

23. Regarding disease risk… • Disease risk was calculated by comparing the participant’s BMI and waist circumference to norms for these two measures as defined by The National Heart Lung and Blood Institute. • 77% of the participants are at increased risk for disease • 56% fell into the range of high-to-extremely high risk for disease

25. Regarding food insecurity… • Of the 115 participants, only 15.5% were food secure. • Sixty-seven percent were food insecure with hunger, while 17.5% were food insecure without hunger. • This means a total of 84.5% of the participants were found to be food insecure.

26. Regarding diet quality… The participants’ intake does not meet the USDA recommendations, with far fewer servings of vegetables, fruit, dairy and meats/beans than recommended, and excessive servings of fats.

27. Regarding methods used to access food… • 42% of the participants visited a soup kitchen daily in the past month • 18% visited a soup kitchen more that once daily in the past month. • Food pantries were used by only 11.8% of the participants in the past month, while 65.5% had not been to a food pantry in the past month.

28. Regarding use of governmental nutrition assistance programs… • Supplemental Nutrition Assistance Program (SNAP) {formerly known as the Food Stamp Program} • Of the 115 participants, 79% had been on the SNAP at one time and 69% had been on the SNAP in the last 12 months. Fifty-five percent of the participants were currently on SNAP.

29. How can we empower the homeless to better access food, improve their nutritional status, and thus their overall health? To address an issue as complex as homelessness and hunger in the USA, successful solutions must informed by numerous disciplines: - nutrition - nursing - social work - medicine - pharmacology - economics - agriculture - political science and government - philosophy and ethics

30. References Alaimo, K. (2005). Food Insecurity in the United States: An Overview. The Journal of Topics in Clinical Nutrition. Vol. 20, No. 4, 281-298. Bengiveno, N. (2009). “Seeking a Home With No Certain Address.” New York Times 07-30- 2007. National Coalition for the Homeless. (2009). Who Is Homeless, NCH Fact Sheet #3. Washington, DC. National Institutes for Health. (1998). First Federal Obesity Clinical Guidelines Released. Retrived from http://www.nhlbi.nih.gov/new/press/oberel4f.htm. Nord, M. (2008). Food Security in the United States: Key Statistics and Graphics. Retrieved from http://www.ers.usda.gov/Briefing/Food Security/stats_graphs.htm