Food Insecurity, Health, and Healthcare Utilization among the Working Poor in the U.S

Abstract

BackgroundFood insecurity has detrimental effects on individuals’ health and well‐being. The prevalence of food insecurity is substantially higher among individuals with incomes near or below the Federal Poverty Level (FPL) compared to those of higher incomes and persists among working adults with nonstandard work arrangements, such as individuals working multiple jobs, part‐time, or varied hours, compared to full‐time workers. However, little is known about food insecurity, health, and healthcare utilization among the working poor.ObjectiveThe objective of this study was to describe food insecurity, health, and healthcare utilization characteristics of working poor Americans.MethodsWe performed cross‐sectional analysis on 8,273 adults aged 20–64 years (mean age 43.8 ± 10.1 years, 51.2% female, 70.1% Non‐Hispanic White) using data from the National Health and Nutrition Examination Survey 2007–2012. Food insecurity was measured using the validated 18‐item U.S. Household Food Security Survey Module. The working poor were defined as individuals who were working at the time of the interview while having annual incomes < the FPL. Using descriptive and bivariate analysis, we compared demographics, food insecurity status, health status, and healthcare utilization of the working poor to those of non‐working poor, working near‐poor, non‐working near‐poor, working non‐poor, and non‐working non‐poor. Sub‐group analysis was performed among the working poor only (n=648) to compare these characteristics by food security status.ResultsA total of 5.7% adults were classified as working poor and 13.3% were food insecure. In comparison to the working non‐poor, the working poor were significantly more likely to be younger (aged 20–34 years), Mexican American (15.4% vs. 4.6%) or non‐Hispanic Black (15.1% vs. 8.7%) and to have less than high school education (27.0% vs. 6.9%); the working poor were also less likely to be married (31.7% vs. 66.6%) and to have any kind of health insurance (55.9% vs. 90.9%). Health status and rates of hospitalizations did not differ among groups. Only 47.3% of the working poor received Supplemental Nutrition Assistance Program (SNAP) benefits. Over one third of working poor adults (35.6%) was food insecure. In comparison to food secure working poor, food insecure working poor were significantly less likely to have any type of health insurance (38.4% vs. 54.5%). Although the health status was comparable among food secure and insecure individuals, prevalence of arthritis was higher among food insecure than food secure working poor (17.16% vs. 10.7%).ConclusionsFood insecurity is prevalent among working poor adults and seems to be associated with reduced access to health insurance. Working poor may be at risk of cumulative adverse effects of food insecurity, poverty, and reduced health care access. Education and outreach efforts should focus on increasing SNAP participation in this population. More research is needed to understand changes in access to insurance due to health exchanges on food insecure working poor and patterns of healthcare utilization in this population.