Currently, 10 million individuals in the world meet the United Nation’s
definition of a refugee—that is, an individual who is unable to return to
his or her country of birth because of a well-founded fear of persecution.
Refugees are typically individuals forced to flee their homes because
of civil wars and are, therefore, exposed to violence, torture, and loss of
family and assets. Each year, approximately 70,000 refugees are eligible to
be resettled in the United States through the U.S. Department of State’s
refugee resettlement program.
Most research on refugees who have resettled in western countries has focused
on physical or mental health status at the time of entry. Studies focusing on
other dimensions of health and well-being in the post-resettlement period are,
however, lacking, which is unfortunate because many believe that resettled
refugees may face barriers to entry into the health care system, quality
housing, and quality dietary intake.
This study investigated several dimensions of health and well-being
among a sample of West African refugees living in a medium-sized city
in the Northeastern United States. The study focused on the social and
economic determinants of household food insecurity.
Food insecurity occurs whenever adequate and safe foods are not available or
the ability to acquire such foods is limited or uncertain. Conceptually, food
insecurity is a more direct measure of inadequate or unreliable dietary supply
than is low income because food insecurity more closely taps into the
phenomena of interest. Food insecurity represents a public health concern
and is a useful index of health and well-being because it is associated with
poverty, ill health, poor dietary intake (e.g., low intake of fruits and vegetables),
limited social capital, depressive disorders, and, paradoxically, overweight
and obesity among females. Refugees resettled from developing
countries are hypothesized to be at elevated risk of food insecurity because
they initially face high levels of underemployment or unemployment, language
barriers, shopping difficulties, and a tremendous shift in the budget and
management of household resources. The study’s objective was to test for
associations between measures of food insecurity and indicators of economic
standing, knowledge, and practice of budget management strategies and
measures of acculturation, including language ability and time since arrival.
A variety of ethnographic and survey methods were employed in this
study. For the survey, a nonprobability sample was used and 101 West
African caretaker-child pairs were enrolled (there were no refusals). At
baseline, mean household size was five individuals, one to two of whom
were under the age of 5. Caretakers were on average 30 years of age, with a
range of ages 18-74. The women had been in the United States for an
average of 22 months. Just over one-half of the women (59 percent) interviewed
had a high school education or higher, and 57 percent were currently
employed. One-half of caretakers reported the mean household income as
less than $1,000 per month, and 64 percent reported their own income as
less than $1,000 per month. Nearly all caretakers had participated in the
Food Stamp Program (FSP) at some point since their arrival (98 percent),
and about 48 percent were currently participants.
About 53 percent of caretakers’ responses indicated that they and members
of their households had experienced periods of food insecurity during the 6
months before the interview. The 53 percent was comprised of 37 percent who
experienced food insecurity with no indication of hunger and 16 percent
whose responses to the USDA food insecurity scale indicated food insecurity
with hunger. The mean food insecurity score on the continuous scale,
indicating severity, was 3.6. The modified USDA scale showed acceptable
internal consistency. A majority of caretakers (90 percent) responded that
they had experienced food insecurity before arriving in the United States.
In bivariate statistical tests, the occurrence and severity of food insecurity
was associated with both economic and sociocultural factors. Households
that scored lower on several measures of financial security scored
significantly higher on the food insecurity scale. Similarly, respondents who
were currently participating in the FSP experienced greater food insecurity.
Informal social support appeared to be protective against food insecurity,
although the effect was weak. Two measures of acculturation, language use
and shopping difficulty, were also associated with greater food insecurity.
Respondents who reported difficulty with understanding people and who
reported more difficulty shopping scored higher on the food insecurity
scale. These bivariate relationships disappeared in a multivariate regression
model when the time since arrival in the United States was entered as a
factor. This commonly used measure of acculturation was the most important
explanatory variable in this study and explained approximately 13
percent of the variation in food insecurity.
Other noteworthy results include:
- The prevalence of overweight and obesity among caretakers approached
65 percent, which appears to be considerably higher than found in the
- Participation in the FSP declined sharply with amount of time lived in the
- The share of the sample that reported being employed increased sharply
with time in the United States.
Although based on a nonprobability sample, findings suggest that food
insecurity is an important public health problem in this vulnerable
population, particularly during the first year in the United States. The
distribution of food insecurity is consistent with theoretically derived predictions
and ethnographic reports from caseworkers and refugees. The results
also highlight the important role that economics and acculturation appear to
play in protecting against food insecurity. Confidence in the results is
further enhanced by the concordance between these findings and the limited
data from other groups resettled in other industrial countries. From a
programmatic standpoint, the results suggest that traditional measures of
self-sufficiency, such as employment, may not be reliable indicators alone.
Rather, measures of income, coupled with measures of food insecurity, may
provide a more accurate picture of the health and well-being of a family.
Despite agency objectives of achieving self-sufficiency within the first 6
months, these data suggest that families may still be struggling 2 or 3 years
The prevalence and existence of food insecurity, as identified through
qualitative and quantitative methodologies, also suggest that nutrition
education programs should be further integrated into the resettlement
orientation that all refugees are expected to undergo upon arrival in
their new home. The Expanded Food and Nutrition Education Program
(EFNEP), through its hands-on didactic approach, may be a useful program
to promote money management strategies to ensure that food stamps reach
through the whole month. The EFNEP, along with education geared towards
dietary change, may improve food insecurity as well as intake of key
micronutrients; the latter may be particularly important given high levels of
iron deficiency anemia in sending countries. The data on overweight and
obesity from this refugee sample also suggest worrisome trends that may be
combated through behavioral change programs in the area of physical
activity and dietary intake.