Understanding the Impact of Food Assistance Program Usage on Diet Among American Indians

Year: 2008

Research Center: American Indian Studies Program, The University of Arizona

Investigator: Gittelsohn, Joel, and Muge Qi

Institution: Johns Hopkins University

Project Contact:
Joel Gittelsohn
Center for Human Nutrition
Department of International Health
Bloomberg School of Public Health
Johns Hopkins University
615 North Wolfe Street, W2541
Baltimore, MD 21205
Phone: 510-955-3927


Food assistance programs, including the Food Distribution Program on Indian Reservations (FDPIR), aim to ensure low-income American Indian households an adequate, nutritious food supply. Many low-income American Indian households on reservations rely primarily on food assistance to meet their nutritional needs. However, limited accessibility, availability, and affordability of healthy foods on American Indian reservations may constrain food purchasing and consumption patterns of low-income American Indian households. While food assistance programs help promote food security and increase food purchasing power of low-income households, its impact on food behaviors and diet quality of low-income American Indian households is unclear.

This study examined the relationships between participation in different types of food assistance programs, psychosocial factors, and food purchasing behaviors among American Indian households on the White Mountain and San Carlos Apache Reservations. Specifically, three research questions were addressed: (1) what are the patterns of food assistance program use in American Indian households, (2) what are differences in food purchasing behaviors among households participating in different types of food assistance programs, and (3) how do psychological determinants of food purchasing behaviors mediate the relationships between food purchasing behaviors and participation in different types of food assistance programs? Finally, this information was used to develop components of the Apache Healthy Foods Program, a foodstore-based nutrition program on the White Mountain and San Carlos Apache Reservations that would be directed at improving the diets and reducing chronic disease risk for those using food assistance programs.

Analyses were based on two waves of data from the Apache Healthy Foods Program. The first wave of data was collected in 2003 as part of a baseline evaluation for the Apache Healthy Stores Program. The second wave of data was collected in 2007 as part of a followup study. Study participants were main household food preparers or food shoppers (n=270 at first wave, n=72 at second wave). A survey questionnaire was used to collect information about basic demographics, participation in different types of food assistance programs (Food Stamp Program, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and FDPIR), food-related knowledge, self-efficacy and behavioral intentions, food-getting frequency, food preparation, and prepared food purchasing. The survey was conducted on randomly selected households without overlap between the two waves of household samples.

Additive scales were developed for food knowledge (alpha=0.61), self-efficacy (alpha=0.81), intention (0.71), food-getting frequency, food preparation (alpha=0.50), prepared food purchasing (alpha=0.61), and material style of life (a proximal measure for social economic status) (alpha=0.82). The food-getting frequency score consists of three subscales: unhealthy food-getting score (an additive scale of 11 commonly consumed foods that are high in fat/sugar, low in fiber), healthy food-getting score (an additive scale of 17 healthy alternatives that are lower in fat/sugar, higher in fiber), and a fruit- and vegetable-getting score (an additive scale of 23 commonly consumed fruits and vegetables). Primary dependent variables are aforementioned food behaviors and psychosocial determinants of food behaviors. Primary independent variables are participation in different types of food assistance programs (Food Stamp Program only, FDPIR only, WIC only, and Food Stamp Program plus WIC). No food assistance program participation was used as a reference group for many of the analyses. Multivariate regression models were used, adjusting for basic demographics (age, education, household size, employment, material style of life, and data collection wave).

This research project is continuing in 2009.

Direct inquiries about this study to the Project Contact listed above.