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 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 percent. At 48 percent, almost half had very low food security. The prevalence of food insecurity and very low food security in the study are substantially higher compared to the statewide prevalence—12.8 percent and 6.1 percent, respectively—reported in 2016. In the U.S. generally in 2016, 12.3 percent of U.S. households experienced food insecurity and 4.9 percent 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," said last author Aviva Must, Ph.D., professor and chair of the public health department at Tufts University School of Medicine.

"More than half of participants—58 percent—with very low food security reported not eating for a whole day for an average of nine days in one month," said lead author Kimberly Dong, Dr.P.H., M.S., R.D., 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 U.S., 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 continued.

Working with the Rhode Island Department of Corrections Probation Office, the research team used the USDA 10-Item U.S. 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 percent) of very low food security participants reported hunger and not being able to eat at some point in the last 30 days. More than half of the total participants reported eating less than they should (52 percent) and skipping or cutting the size of a meal (53 percent).

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 (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 percent) than the other levels of food security (19 percent for low food security, 13 percent for marginal food security, and 8 percent 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 percent) and more often to be employed with a full-time job (35 percent).

Depression was more common in participants with very low food security (73 percent) compared to 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," said Dong. 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 percent were non-Hispanic white, and 28 percent were female. The highest level of education attained for many participants was high school (42 percent). Only one-quarter of the participants had a child currently living with them, 22 percent had a full-time job, almost two-thirds (63 percent) had an individual annual income of less than $10,000, 28 percent always had access to a car and almost three-quarters (73 percent) of participants received SNAP benefits. Current drug use in the past 30 days was reported by 19 percent of the participants and 24 percent currently consumed alcohol at a hazardous level. Depression was identified in 56 percent 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.

Rhode Island has the second highest rate of community corrections supervision in the nation with 23,823 adults on probation (or about 2.8 percent of the state population). There are 11 probation offices across the state and this study took place in an office that supervises 12 percent of the people under community corrections in RI. The study enrolled English-speaking adults that were under probation supervision at this office between July and October 2016.

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More information: Dong, K.R., Tang, A.M., Stopka, T.J., Beckwith, C.G., Must, A. (2018). Food acquisition methods and correlates of food insecurity in adults on probation in Rhode Island. PLoS ONE 13(6): e0198598. Journal information: PLoS ONE Dong, K.R., Tang, A.M., Stopka, T.J., Beckwith, C.G., Must, A. (2018). Food acquisition methods and correlates of food insecurity in adults on probation in Rhode Island.13(6): e0198598. doi.org/10.1371/journal.pone.0198598