Ninety percent of Canadian food aid donations were tied to domestic procurement sources until 2005. Procurement restrictions were reduced to 50% in 2005 and were eliminated in 2008. Implementing agencies are now free to procure commodities of their choice in locations of their choice. This study investigates whether the untying of Canadian food aid procurement in 2008 has made procurement decisions more responsive to changes in the relative prices of wheat, maize, and rice in Canadian cereal food aid baskets. It applies a pooled empirical model with regional fixed effects to regional price data and data on Canadian government-funded food aid shipments to five recipient regions. The results are mainly counterintuitive, which is partly attributable to a number of data and model limitations. Consequently, this study does not provide empirical evidence of cereal commodity substitution after the untying of Canadian food aid in 2008. However, there is still reason to believe that donor agencies substitute between cereal food aid commodities, especially after the elimination formal procurement restrictions. Further research is however needed to generate empirical evidence for this. / May 2017

The first part of this dissertation evaluates the effectiveness of food assistance by gathering evidence from developing countries and the United States. The first essay applies a multi-market model to three developing countries and simulate recent spikes in staple prices and food aid impacts. Results indicate that higher food prices would result in reduction in household real income and deterioration of household welfare. Food aid in the form of cash transfers targeted at low-income groups could improve household real income of the target group after world price shocks and, partially or completely, offset the negative impacts of higher food prices. The impact of cash transfer on untargeted groups is ambiguous. It is likely to be positive for households that are net producers of the commodities that have increased production and prices under cash transfer and the production surplus is sufficiently large. The second essay focuses on the Food Stamp Program (FSP), a cornerstone of food assistance safety net efforts in the U.S. to reduce household food insecurity, particularly among children. The essay examines the dynamic relationship between FSP participation and child food security using monthly measures. Empirical estimates using the Panel Study of Income Dynamics demonstrate that child food security declines in the months immediately prior to FSP entrance, but then partially recovers following program entrance. These dynamic FSP effects are masked when annual measures are employed. The third paper of this dissertation studies the potential impacts of patient's widespread use of online health information. In particular, the essay employs a principal agent model and focuses on the quality of online health information. The model shows that when the quality of health information improves, since medical consultations become more efficient and less costly, a higher effort will be induced or contracted from the physician. Diagnosis becomes more accurate, because physicians will try exert more effort in diagnosing patients and patients will suffer less loss from their illnesses. / Ph. D.

OBJECTIVES: The aim of this study is to examine the association between food insecurity and untreated dental caries among U.S. children and adults and to investigate the effect of participating in the Supplemental Nutrition Assistance Program (SNAP) on dental caries among U.S. adults. METHODS: Our sample was derived from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low, and very low). SNAP participation in the past 12 months was self-reported (yes/ no). The main outcome variable was untreated dental caries (none vs. one or more). Descriptive, Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship among food insecurity, SNAP participation, and untreated caries. RESULTS: Our results suggest that food insecure children were more likely to have untreated caries compared to full food secure counterparts, after controlling for potential confounders (OR: 1.38; 95% CI: 1.11-1.72). On household-level food security, children from marginal and very low food secure households had significantly higher odds of untreated caries compared to children from fully food secure households (OR: 1.48; 95% CI: 1.10-2.01 and OR: 1.59; 95% CI: 1.12-2.26 respectively). Moreover, our findings suggest significant association between overall food security status and dental caries among U.S. adults (OR: 1.35, 95% CI: 1.05-1.74). We also observed a significant association between the severity of household food insecurity and untreated caries among adults after adjusting for confounders (P=0.04). SNAP participants were more likely to have untreated caries compared to non-SNAP participants (OR: 1.5; 95% CI: 1.19-1.87). The interaction of food insecurity and SNAP participation was not significant. However, SNAP participants from all levels of food security had higher prevalence ratio of dental caries compared to non-SNAP participants, regardless of food security status. CONCLUSION: Food insecurity was negatively associated with dental caries among U.S. children and adults. In addition, SNAP participation had adverse association with dental caries among U.S. adults. Further research is needed to more comprehensively understand the impact of food insecurity and food assistance programs on oral health. / 2021-06-16T00:00:00Z

Purpose: To assess whether the participation in food assistance programs (Community Kitchens and Glass of Milk) was associated with lipid profile patterns in the Peruvian population. We conducted a secondary data analysis using data from the National Survey of Nutritional, Biochemical, Socioeconomic, and Cultural Indicators related to Chronic Degenerative Diseases. The sample included individuals aged ≥20 years, selected from five geographic strata in Peru. From each stratum a random sample of clusters was chosen. Different Poisson regression models with robust variance were built to determine the association between food assistance programs and participant lipid profile (total cholesterol (TC), HDL-cholesterol (HDL-c), LDL-cholesterol and triglycerides (TG)). Data from 4028 participants was analyzed, 123 (3.1%) reported being beneficiaries of the Community Kitchens program and 827 (20.5%) were beneficiaries of the Glass of Milk program. An association between being a beneficiary of Community Kitchens and increased LDL-c (Prevalence ratio (PR)= 2.33; 95% CI: 1.18–4.59) was found. Being a beneficiary of the Glass of Milk program increased the probability of having low HDL-c levels (PR= 1.08; 95% CI: 1.02–1.14), but reduced the probability of hypertriglyceridemia (PR= 0.70; 95% CI: 0.56–0.88). Being a beneficiary of the Community Kitchen program was associated with increased LDL-c levels; while, being a beneficiary of the Glass of Milk increased the probability of low HDL-c, but reduced the probability of developing hypertriglyceridemia. / Revisión por pares

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This dissertation is composed of three essays that measure the impact of social programs and policies on the well being of their target populations. The first essay entitled "The Wage Impact of Historically Black College and University Attendance" examines the impact of attending a Historically Black College or University on the wages of Blacks attending HBCUs versus other four year colleges or universities using a sample of Blacks from the National Longitudinal Survey of Youth (1979). The study finds no initial advantage to HBCU attendance for black men, but a 1.4 to 1.6 percentage point higher growth rate in subsequent wages is associated with the attendance of an HBCU as opposed to other four year colleges. This faster growth rate translates in a net discounted HBCU earnings gain of 8.9 to 9.6 percent over a 16 year period following college attendance. The study finds no advantage or disadvantage to HBCU attendance for Black females. The second essay entitled "Transient and Chronic Poverty in the US: The Role of the Food Stamp Program" examines the unique and common determinants of short-term intra-annual transient poverty and chronic poverty, as well as the differential response of each state of poverty to Food Stamp Program (FSP) use. The study employs dynamic expenditure-based poverty measures using quarterly data from the Consumer Expenditure Survey (2001-2004). The major finding is that FSP use reduces transient poverty, but the study finds no significant impact of FSP use on chronic poverty. The common causes of both states of poverty are low human capital, minority status and involuntary unemployment of the household head. Changes in family composition during the year is only associated with higher transient poverty. The third essay entitled "Food Insecurity and the Food Stamp Program" examines the determinants of food insecurity in the US, as well as its response to Food Stamp Program use with data from the Panel Study of Income Dynamics (1995-1999). The study finds that FSP use reduces household food insecurity, and that the program impact is greater for households that experience more severe insecurity. In addition the study finds that higher risk tolerance as well as a preference for smoking cigarettes increase household food insecurity. / Ph. D.

U.S. food banks emerged thirty years ago as part of a temporary, charitable food assistance safety net to address government welfare shortfalls. Over time their size and scope expanded significantly alongside growing food insecurity. As government entitlement programs continue to erode, the ensuing institutionalization of food banks secured their future. Yet scholars such as sociologist Janet Poppendieck argued over twenty years ago that these charitable programs inadvertently prevent the government from reassuming responsibility by providing the public the illusion of a solution despite their inability to adequately meet the need. This research argues that food bank advocacy can be used to reduce hunger and address its root cause—poverty. A case study analysis of the advocacy programs of the San Francisco-Marin and Alameda County Community Food Banks describes how their advocacy work, in practice, addresses both Poppendieck’s and contemporary food bank critiques. This analysis illustrates how both case study organizations built their advocacy programs on a foundation of public food program outreach—redirecting their clients to government programs—but now affect change through divergent approaches. San Francisco employs a top-down government system reform and technical assistance model. Alameda’s bottom-up social justice model reaches past food programs to broader anti-poverty advocacy. In the process, both food banks have positioned themselves as models for their peers and as bridges connecting food assistance scholarship to public policy and practice.

Research has demonstrated the crucial role fresh fruit and vegetable consumption plays in maintaining good health. However, most Americans do not consume adequate amounts, and low-income Americans consume the lowest quantities of fresh fruits and vegetables. The Farmers’ Market Nutrition Program (FMNP) and Senior Farmers’ Market Nutrition Program (SFMNP) attempts to rectify this situation by providing vouchers to low-income women, children, and elders that can be used only at farmers’ markets for the purchase of locally grown, fresh fruits and vegetables. Unfortunately, FMNP and SFMNP exhibit variable and often low benefit utilization. This variable and often low benefit utilization is unique among all other federal food assistance programs. Given the importance of fresh fruit and vegetable consumption to health and the incomplete understanding of low-income food-related behaviors, this research endeavored to understand the unique benefit utilization patterns exhibited by FMNP. Utilizing the theoretical framework of Pierre Bourdieu, benefit utilization was conceptualized as an inherently social activity occurring within the field of food acquisition. Through the use of extensive interviews with FMNP and SFMNP officials, field observations, and secondary data analysis, data was collected to determine the relevant capitals and features of the field contributing to benefit utilization. Cultural capital was deemed to be particularly important to benefit utilization vis-à-vis the requirement to enter the subfield of the farmers’ market to redeem their vouchers. Compared to SFMNP participants, FMNP participants exhibited lower and often multiple deficits of the types of cultural capital needed to successfully use the vouchers at farmers’ markets. However, the local fields in which the farmers’ markets operated also had a significant impact on benefit utilization. For example, Appalachian counties exhibited higher rates of benefit utilization that were statistically significant compared to non-Appalachian counties. This resulted in several policy recommendations including the distribution of recipes, interagency collaboration, and repeated opportunities to enter the subfield of the farmers’ market to encourage higher benefit utilization in FMNP and SFMNP.

Many families that experience hunger in the United States rely on Food Assistance Programs to meet their daily nutrition needs. However, these programs do not always meet the needs of these individuals, as has been the case for individuals living under higher than expected levels of poverty in the Great Lakes region of the United States. Using policy feedback theory (PFT), the purpose of this case study was to explore the experiences of individuals from a county in the Great Lakes region of the United States, who depend on the federal Food Assistance Program, with particular attention given to evaluate the effectiveness of distribution mechanisms in helping these individuals meet their food needs. Data were collected through interviews with 11 program clients, 3 program administrators, as well as publicly available agency data. These data were inductively coded and then analyzed using Braun and Clarke's thematic analysis procedure. Key findings revealed that clients perceived the Food Assistance Program as ineffective in preventing food insecurity without additional programs and resources. The findings also revealed that distribution mechanisms negatively impacted food recipients with limited income, resulting in increased food shortages, requiring recipients to seek additional food programs and resources. These findings also exposed barriers to employment opportunities for recipients, adding to the stress and anxiety experienced from food shortages. Positive social change implications from the findings include providing information to program administrators that can be used to improve the Food Assistance Program, which may in turn improve the lives of those who rely on food assistance programs.

Since 1999, there has been a significant increase in the number of food insecure individuals in the United States. The Great Recession (2007-2009) and slow economic recovery has led to additional increases in rates of food insecurity and the usage of emergency food assistance programs. Thirty qualitative interviews with individuals seeking emergency food assistance at a Tampa Bay food pantry were conducted. Interviews focused on collecting the life experiences of participants, the barriers they face in having food security, their strategies to cope with limited food budgets, and how food insecurity impacts their household's overall health and wellbeing. Recommendations for fulfilling the immediate need for food as well as addressing the larger issues that lead to and perpetuate food insecurity and hunger are presented in this paper. In collaboration with the food pantry, a booklet presenting personal experiences of hunger alongside broad institutional forces affecting food insecurity was disseminated in the community in hopes of increasing awareness of and support for combating this important social issue.