There is a high prevalence of chronic diseases and conditions among older, low-income individuals in the United States. It is well recognized that diet plays an important role in the management and prevention of chronic diseases. Despite this, primary-care physicians often do not provide adequate dietary counseling or appropriate nutrition referrals to this patient population. Two surveys were conducted in Southwest and the western part of Central Virginia, one with 209 family practitioners and internists and the other with 57 low-income participants in the Food Stamp Nutrition Education Program (FSNEP). The FSNEP clients were aged 40 years or older, had been enrolled in FSNEP for four months or less, and had a diet-related chronic disease or condition. Eighty-one percent of physicians reported that they provide nutrition advice to their chronic disease patients on a regular basis. Most physicians further stated that they make a limited number of referrals to registered dietitians and very few referrals to community nutrition education programs. FSNEP clients were generally dissatisfied with their primary-care physician's provision of nutrition information and indicated a desire for more dietary guidance. Results indicate a need for primary-care physician referrals to free community nutrition education services that tailor their programs to the patient's socioeconomic situation. These referrals may improve the nutrition health of older, low-income patients and help manage their chronic diseases. Informational brochures need to be developed and distributed to primary-care physicians informing them of the positive attributes of free community nutrition education programs, such as FSNEP. / Master of Science

Dissertation (Ph.D.)--Auburn University, 2006. / Abstract. Includes bibliographic references.

This dissertation is composed of three essays that analyze the significance of the Food Stamp Program (FSP) for low-income households. The first essay entitled “Intensity of Food Stamp Use and Transient and Chronic Poverty: Evidence from the Panel Study of Income Dynamics” examines the impact of intensity of use of FSP benefits on household exposure to transient and chronic poverty with respect to food and housing expenditures. The study finds that FSP is used for both long-term expenditure support and as a smoothing mechanism before the welfare reform, and only for smoothing expenditures after the welfare reform. Factors that influence both components of poverty are number of children, human capital, minority status and local economic conditions. Another finding is that shorter recertification periods reduce the length of FSP use, and indirectly result in higher poverty. The second essay entitled “The End of the Paper Era in the Food Stamp Program: The Impact of Electronic Benefits on Program Participation” documents the impact of the implementation of the statewide Electronic Benefits Transfer (EBT) system on household participation behavior in the entire period of nationwide implementation. The major finding is that the switch from paper coupons to EBT cards induces participation among eligible households, most likely by reducing the stigma associated with FSP participation. The effect of the EBT system on participation probabilities is the largest among households residing in the rural South, those not headed by a single mother or those with a White household head. The third essay entitled “The Dynamics of Food Stamp Program Participation: A Lagged Dependent Variable Approach” investigates the existence of state dependence and its sources by analyzing the dynamics of participation in the FSP using a lagged dependent variable approach. Results show that FSP receipt in the previous period is an important determinant of current FSP receipt. Estimated persistence rates declined significantly after 1996, suggesting that long-term welfare dependency was reduced after the welfare reform, at least with respect to the FSP. The source of state dependence in FSP participation among low-income households is mostly structural implying that a welfare trap does exist for these households. / Ph. D.

The purpose of the present study was to gain insight on the real and perceived needs of food stamp recipients for use in developing nutrition education programs. Six focus group interviews with 26 food stamp recipients were conducted in six Virginia counties. Transcripts of the meetings were analyzed to identify themes prevalent in all of the focus group interviews. Ninety-two 24-hour food recalls from a different sub-group of food stamp recipients were also analyzed for food consumption frequencies, trends in food preparation, and common food purchasing locations. A key finding was that most focus group participants made food-related decisions while in the grocery store. Explanations for incidences of food resource scarcities included beliefs that the amount of food stamps was insufficient and that poor food purchasing decisions were made. Predominant food behavior changes that had been previously attempted were decreasing consumption of fat and fried foods and reducing portion sizes. Most of the reasons for attempting those behavior changes involved a desire for weight loss. Prevalent nutrition education interests were low-fat cooking and child nutrition. Results of the 24-hour food recall analysis indicated an inadequate consumption of fruits, vegetables, whole grain cereals, and dairy products. Seventy-five percent of the subjects purchased food in a grocery store and prepared meals at home. / Master of Science

A paradox exists between food insecurity and obesity. Childhood obesity has tripled in the past three decades. This study aimed to understand the relationships between food insecurity, poverty income ratio, food stamps usage, perceived diet quality, and weight status in children. A child’s weight status is determined by many different factors and this study investigated several of these aspects. It was found that the family’s poverty index ratio had the greatest effect on a child’s BMI, but household food security status, ethnicity, and the perceived inability to serve balanced meals were all found to be statistically significant when considering a child’s BMI.

The Supplemental Nutrition Assistance Program (SNAP) is the United States' largest government assistance program that aims to alleviate food insecurity. The SNAP program allows low-income individuals and families the ability to purchase nutritious foods through a monthly benefit. However, the current body of literature presents evidence of the program's counterproductive effect. The purpose of this study was to determine whether incentivizing SNAP recipients to purchase additional fruits and vegetables was beneficial in increasing such purchases. Social cognitive theory was used as a theoretical framework to address research questions associated with shopping patterns and attitudes and beliefs. This quantitative study used a randomized controlled trial to study differences between incentivized and control groups. The Healthy Incentives Pilot Program (HIP) used a stratified sampling of 55,095 SNAP households receiving benefits between July, 2011, and December, 2012. Statistical analyses (t test, Pearson correlation, and multiple regression analysis) were conducted to identify changes in food shopping patterns and eating behaviors associated with the HIP intervention. Results indicated that (a) incentivizing SNAP recipients leads to an increase in fruit and vegetable purchase, and (b) a correlation exists between fruit and vegetable purchase and attitudes and beliefs. No correlation was found between the intervention and changes in food shopping patterns. Positive social change implications include the improvement of health outcomes in over 43 million people currently enrolled in the SNAP program on a national level.

The caseloads of food stamp program and welfare program experienced sharp drops among non-metropolitan single female-headed families with children (SFHFwC) after welfare reform in 1996. There is concern that leaving welfare program has led to nonparticipation in food stamp program due to multiple reasons. This study conducts an empirical analysis of non-metropolitan SFHFwC's participation in food stamp program and welfare program, using the 1993 and 1999 CPS data. Results from using reduced-form probit model, bivariate probit model and structural probit model are compared. The reduced-form probit model considers participation in both programs as functions of all exogenous variables. The bivariate probit model allows correlation between the participation in the two programs. The structural probit model considers participation in welfare as an endogenous variable of FSP participation. Empirical analysis is also conducted through the comparison across years and between southern and the remaining U.S. states. We found that welfare participation has a significant and positive impact on FSP participation. Households leaving welfare are more likely not to participate in FSP. Further, welfare participation is more important in determining FSP participation in 1999 than in 1993. Residence in South has a significant and negative impact in welfare participation in 1999, but has no significant impact on FSP participation in either year. Incomes and number of young children are the other major determinants of participation in both programs. Policy suggestions include improving economic situation to reduce FSP caseloads on one side, and providing more information about FSP eligibility to welfare leavers to ensure their food safety on the other side. / Master of Science

This study explores and assesses the attitudes of the personnel of welfare-oriented governmental bureaucracies toward the poor. To fulfill these goals, a treatment and a control group were selected to compare their attitudes toward this group. They were measured by a disguised-structured instrument using the survey approach. It was found that the majority of respondents in both groups have a pro-poor attitude but it is more prevalent among the bureaucrats than among the students. In light of the knowledge we have of the effect of attitudes on the execution of policies, these results suggest that the policies governing the different programs studied are being executed to the advantage of the client.

No description available.

The "work first" philosophy of the Personal Responsibility and Work Opportunity Reconciliation Act sent millions of people into the labor force, many for the first time. The result was a dramatic increase in the number of workers whose earnings failed to pull them and their families out of poverty. Assistance in the form of childcare, transportation, medical coverage, and the Earned Income Tax Credit is beginning to receive attention as support mechanisms for people who do not earn adequate wages and receive little benefits from their employers. This study examines the effectiveness of Georgia's approach to providing work support programs to its working poor citizens. No single entity is responsible for making work supports accessible. Thus, services often go underutilized because those who might qualify are not aware of their potential eligibility. Further, there is no state level strategy for ensuring that wage advancement is considered by agencies providing work support services. Using client administrative wage data from the Georgia Department of Labor and qualitative interviews from program staff, the state's structure for assisting the working poor is examined.