Putting a Face on Hunger: A Community-Academic Research Project

Importance of the Project

One in seven U.S. households (14.5%) is currently food insecure at least some time during the year, including 5.7% with very low food security (Coleman-Jensen, Nord, & Singh, 2013). Very low food security means the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. Over half (59%) of all food insecure U.S. households participated in one or more of the three largest federal food and nutrition assistance programs during the month prior to the 2012 survey (Coleman-Jensen et al., 2013). National food insecurity data revealed that 41% of households with incomes below the official poverty line were food insecure, while about 7% of those struggling with hunger have incomes that are above 185% of the federal poverty level (Coleman-Jensen et al., 2013). These data indicate that being hungry is strongly associated with income, yet those at almost double the federal poverty level are still vulnerable to food insecurity.

Food insecurity levels are also problematic in Eau Claire County (ECC). In 2012, 10.5% of all residents in Wisconsin's 3rd Congressional District, in which ECC is located, indicated that during the past 12 months, there have been times when they did not have the money to buy the food that they or their family needed (Food Research and Action Center [FRAC], 2012). During the same period, over half (55%) of ECC Women Infants and Children (WIC) respondents reported they experienced food insecurity, and 22% indicated that their household experienced very low food security (WIC Program, 2012). These numbers are disturbing, particularly considering the growing body of evidence linking food insecurity to a variety of negative outcomes for children. Negative outcomes include lower test scores, poorer school achievement, and higher frequency of behavioral problems (Center on Hunger and Poverty, 2002).

ECC has several options available for eligible community members to access food, with a growing number of individuals participating in these programs. In 2012, one in five ECC residents participated in FoodShare [FS], nationally called Supplemental Nutrition Assistance Program (SNAP)(WI DHS, 2013). A 72% increase in ECC FS participation occurred from 2008 to 2012. Over one third (38%) of the 2012 County FS recipients were children (WI DHS). From 2008 to 2012, free and reduced lunch participation rose from 35% to 43% within the EC Area School District and from 52% to 55% at the county's rural Augusta School District (WI DPI, 2012). The Hmong population is our largest minority group. From 2012 to 2013, rice poundage distribution and clients served at the Hmong Mutual Assistance Association rice pantry increased 30% and 31%, respectively. Participation at the Community Table, a free meal site, and ECC food pantries has also risen. ECC UW-Extension SNAP-Education assists nearly 5,000 residents annually to maximize their FoodShare dollars and choose healthy food through direct education and county system interventions. Despite these available food assistance programs, many ECC families still struggle to access healthy food.

Most ECC residents are unaware of local food insecurity. The community-academic partners wanted to know why people were food insecure and how it affected their daily lives. This information would allow the researchers to identify the face of local hunger. Conveying the local face of hunger could increase ECC residents' empathy, moving systems and public policy interventions forward, resulting in increased access to adequate and appropriate healthy food. The desire to understand families' food access struggles, from the perspectives of those directly affected by food insecurity, led to the study described in the next section.

Methods and Procedures

The Hunger Prevention Coalition for Eau Claire County (HPC) has long recognized the problem of food insecurity and has been involved in efforts to reduce community hunger. However, the HPC had minimal local food security data to prioritize future efforts. To address this gap, the HPC met with faculty from the University of Wisconsin-Eau Claire (UWEC) to review available food insecurity data and request possible research project support. The meeting led to the formation of an HPC-UWEC research team, composed of representatives from Feed My People Food Bank, UW-Extension, and UWEC.

Next HPC sponsored a community round table discussion to gain perspectives from low-income individuals, media, city and rural residents. The purpose of the round table was to brainstorm what the community wanted to know about ECC food insecurity. Participants indicated that local food security quantitative data needed to be accompanied with local stories from parents describing their experiences of having inadequate food available to feed their families. In response to this community request, the HPC-UWEC research team collaborated to conduct a qualitative research study to collect the desired stories.

The focus group interview questions were developed based on key themes identified through the community round table discussion. State poverty and food security specialists from UW-Extension assisted to refine the questions. The following themes provided the framework for developing the focus group questions.

• Theme 1- Why are people hungry?
• Theme 2 - What does it mean to be hungry?
• Theme 3 - What is working with current food security systems? Suggestions to improve?

The research team hosted a meeting with service agency representatives to brainstorm participant recruitment. Strategies that facilitated recruitment included a $25 grocery gift card for gas or food, free childcare, convenient locations, and varied times during the day and evening. To obtain a representative racial and county demographic sample, an intentional effort was made to recruit participants from the Hmong population and rural regions. Recruitment was most effective when the community-academic partners collaborated with staff from local agencies that had existing relationships with the target groups, such as Head Start and Family Literacy.

A demographic questionnaire, completed prior to the focus group, included questions specific to income, household numbers, employment, and the validated, short six-item version of the USDA Food Security Survey (USDA-ERS, 2012). Additional questions specifically assessed local food resource participation. A separate demographic questionnaire was developed for staff participants, including an assessment of staff experience with the target population receiving services.

The study was approved by the UWEC Institutional Review Board. Participants completed a consent form prior to the focus group. To increase comfort among participants, an individual of limited income with previous research experience facilitated most of the focus groups. Each focus group was digitally recorded and transcribed. The Hmong focus group was facilitated by two Hmong service agency staff. Questions were asked in Hmong, and participants' responses were interpreted into English. To ensure accuracy, the recording was reviewed by two Hmong staff prior to transcription.

The research team completed seven focus groups with parents (n=43) and one focus group with agency staff (n=8) (Table 1). Almost one quarter of the parents was Hmong.

Table 1.
Summary of Focus Groups

Date	Focus Group Type	Participant Numbers	Time	Location
May 7, 2012	Pilot group-parent group	2	9-11 am	Children's Museum
July 16, 2012	Hmong HeadStart- Family Literacy parent group	10 — All Hmong	12-2 pm	EC Area Hmong Mutual Assistance Association Center
September 11, 2012	Transitional Housing & Abuse Shelter parent group	8	9-11 am	Western Dairyland
October 3, 2012	EC Area School District (ECASD) parent group	3	6-8 pm	Children's Museum
October 5, 2012	ECASD parent group	9	12-2 pm	Children's Museum
October 19, 2012	ECASD parent group	7	12-2 pm	Children's Museum
November 12, 2012	Rural parent group	4	9-11 am	Library-community room
March 15, 2013	Agency staff group	8	3-4:30 pm	EC Area Hmong Mutual Assistance Association Center
Total		51 43 parents 8 staff

Data analysis began with all team members reading transcripts and identifying quotes associated with the pre-determined theme topics. Three team members followed with an in-depth analysis, developing themes capturing the participants' experiences (Polit & Beck, 2012).

Results

Written Demographic and Food Security Results

Demographic survey data indicated 56% of parents interviewed had two children or less and 35% had children ages five or under. The majority were couples or three generational households. Over half the families had an annual income of $20,000 or less (Table 2). Although 72% of respondents' households participated in SNAP and free or reduced lunch, and 51% in WIC programs within the last 12 months (Table 2), 42% reported that they cut the size or skipped meals almost every month because of insufficient food (Table 3). Forty percent said they often could not afford balanced meals (Table 3).

Table 2.

Parent Written Demographic Survey Data — Household Occupancy *Totals more or less than number of participants. (Some totals are higher or lower than 100%due to calculation rounding.)
Number of Households with children less than 18 years	None		1 to 2		3 to 4		5 or more	# of participants
	1 (2%)		23 (53%)		13 (30%)		6 (14%)	43
Ages of children in Household	0 to 2		3 to 5		10 to 12	11 to 13	14 to 17	96*
	10 (10%)		24 (25%)		31 (32%)	19 (20%)	12 (13%)
Number of Adults per household	One			Two		Three		43
	12 (30%)			28 (65%)		3 (7%)
Description of People in Household	Single Mother/ Children	Single Father/ Children	Couple/ Children	Grand-parents/ Children	Three Generation/Children	Foster Parent/ Children	Other	43
	11 (26%)	2 (5%)	23 (53%)	2 (5%)	3 (7%)		2 (5%)
Parent Written Survey Data — Financial/Assistance Program Participation by Income
Household Annual Income	Below 10K	10,001 - 15K	15,001 - 20K	20,001 - 25K	25,001 - 30K	30,001 -35K	35,001 — and above	#Participants
	15	3	8	4	5	2	1	43
Program Assistance Participation	Below 10K	10,001 - 15K	15,001 - 20K	20,001 - 25K	25,001 - 30K	30,001 -35K	35,001 - 40K	Total # Using Program
WIC	7	2	4	4	2	2	1	22
FoodShare (SNAP)	14	2	6	4	2	1	2	31
Free or Reduced Lunch	9	3	5	4	5	1	4	31
Free Meal Site	3	2	1	2	1	0	0	9
Food Pantry	8	2	3	2	3	1	2	21
Energy Assistance	3	2	4	2	4	1	2	18
Child Care Assistance	0	0	2	2	0	0	1	5
Homeless Shelter	2	0	0	0	0	0	0	2

Table 3.

Parent Written Food Security Survey Data — Coping With Inadequate Food
Cut Size or Skipped Meals because Not Enough Food	Yes	No	If yes				# of Participants
	36 (84%)	7 (16%)	Almost every month	Some Months, Not Every Month	Only 1 or 2 Months	Unanswered	43
			18 (42%)	15 (35%)	3 (7%)	7 (16%)
Eat Less Than Felt Should because Not Enough Food	Yes			No			43
	34 (79%)			9 (21%)
Hungry because Couldn't Afford Enough Food	Yes		No		Unanswered		43
	31 (72%)		11 (26%)		1 (2%)
Parent Written Survey — Food Availability
	Often		Sometimes		Never		# of Participants
Food Purchased Didn't Last	24 (55%)		16 (36%)		4 (9%)		44*
Can't Afford to Have Balanced Meals	17 (40%)		23 (53%)		3 (7%)		43
*Sum is higher than total number of participants; one participant selected both often and sometimes

Focus Group Results

Participants indicated that being food insecure affected all aspects of life. Regardless of whether the participants were rural, urban, or Hmong, four primary themes emerged: assistance gaps, "falling through the cracks"; struggling physically and emotionally with hunger; juggling to meet life's basic needs; and desiring healthy foods without the means. Furthermore, response themes were consistent between the parent and staff participants.

Assistance Gaps, "Falling Through the Cracks"

This theme captures the struggles parents experienced as they sought to improve their family's economic situation within the context of service eligibility. Many parents spoke of the realization that their efforts to work and become self-sustaining often disqualified them from the services their families needed. As these parents shared:

• "…the day I call to say, 'Hey, I got a job. It's a temporary position, contracted 160 hours.' As of that day…she's [agency staff] like 'well, you won't get any food stamps next month then.' Meanwhile you're really hungry at work and haven't gotten paid yet. And then sometimes they hold back a check, too. Yeah, it took me four weeks to get my first check."
• "We cannot afford balanced meals because we fall into a gray area where we can't afford (not eligible) for the programs, yet we don't have enough to be comfortable."

Parent participants often perceived that caseworkers and other program assistance workers did not understand the gap problem. However, agency staff interviewed were very aware of the gap. Yet due to the enormity of these federal programs, the local staff were unable to improve these participants' situation. As these staff members stated:

• "I think there are a lot of families that are falling through the cracks, that don't qualify for programs, but still aren't able to feed their families, especially if they have children. They aren't necessarily homeless families or anything like that, but they're falling through the cracks."
• "A lot of people tell me they have enough money on their FoodShare for about three weeks of the month. If it's a long month, it's really difficult."

Although the funding gap consequence is one that local agencies have minimal, if any power to change, staff shared how they work together in the community to provide nonprofit resources and options to assist individual families.

Struggling Physically and Emotionally with Hunger

Many parent participants shared common physical and emotional impacts due to lack of food, frequently referring to low energy levels, high stress, anxiety or irritability.

• "…when there is enough [food], I can sleep, when there isn't enough, I just couldn't sleep — I can't fall asleep."
• "It's very different, because when there isn't enough [food], the stress level there is just super high. Kids will be nagging, crying. And when you do have enough it is exactly the opposite; everybody is happy."
• "The anxiety, not knowing what you're gonna do for the next week until your food stamps come in. Just that anxiety and worrying about what you're gonna do. I think that's one of the hardest parts about it. It causes a lot of stress everywhere else."

Agency staff was also cognizant of how hunger impacts physical and emotional health. Staff making home visits shared stories of how families coped with a lack of food. Below is one:

• "… she (mom) said, 'No, that's your dad's cheese. He'll be mad if you eat it.' So she decided to give him some, so she got a little cup out and gave him about this much shredded cheese to share with his one year old sister. And then he said he wanted something else to eat and she said, 'no you can't have anything more.'"

Limiting food was a strategy this mother used to ensure her working husband also had enough food. Unfortunately, the children were still hungry.

Juggling to Meet Life's Basic Needs

Faced with insufficient food, many participants spoke of making sacrifices, especially for their children. They also shared the daily demands they were juggling to meet basic needs. Food was only one of the many "balls" that these participants were juggling each day; other "balls" included transportation, medical costs, and childcare:

• "When we run short on food we go to food pantries, (Free meal site), just to…okay it's getting towards the end of the month. We're running short, we have to find ways to stretch it. But I don't have a car so getting around is another thing, so when I'm having to spend (buy food) at the gas stations it goes quick so then you have to figure out how to stretch it the rest of the month."

Staff knew that any unforeseen additional expenses, like medical bills, were detrimental to the families they served.

• "We've had people apply and one of the big obstacles for them is medical bills, and unfortunately, our applications don't take into consideration any medical bills. It's based on gross income, so that's tough for the families with medical issues."

Parent and staff participants described how access to food required more than money; transportation, child care, and nearby proximity to food are also required. All these factors further complicated parents' ability to secure sufficient food for their families and strained staff's abilities to assist.

Desiring Healthy Foods Without the Means

Parents clearly wanted to be able to provide their families with healthy, nutritious meals yet shared the difficulty of regular access:

• "…I would just love to just be able to eat healthy, you know, every single day. I, if I had the means I would eat healthy and feed my kids healthy…"
• "I think there's a big difference between eating and eating healthy. Now it's getting towards colds season and now my kids are gonna get sick because they don't get enough fruits or vegetables or vitamins of any kind because they're more expensive than candy bars [laughing]."

In addition to cost, agency staff recognized the complexity of cooking fresh food and the associated challenges with selecting, storing, and preparing food as parents work and juggle family responsibilities:

• "It has to be that we're going to teach how to choose it (other staff: uh huh), what to do with it, how to prepare it and how to store it. It's a lot of things, it's the reading level, it's the recipes. Do you have the cooking ability at home? All of those things, it's pretty complex."
• "We've gotten so used to convenience (others: yes and exactly and yeah). And women working, when you're running and working…"

The most common theme addressed in all focus groups, including agency staff, was assistance gaps. Most focus group parents had jobs, but not consistent wages or respondents would lose food assistance based on a previous temporary surge in hours. Many were resourceful in maximizing their food budgets, but it was difficult making it last the entire month. These local results are backed by national research that indicates an increase in SNAP allotments is associated with reductions in food insecurity (Nord & Prell, 2011) and the relationship between food insecurity, frequent mental distress, and insufficient sleep (Liu, Njai, Greenlund, Chapman, & Croft , 2014). Agency staff agreed that more needed to be done to address the gaps families experience in their efforts to access and prepare healthy, affordable food.

After the food security research ended, the team reconvened with media representatives and developed a hunger marketing campaign titled, Turning the Tables on Food Hardship: A community partnership to improve access to adequate, healthy food in the Chippewa Valley. The campaign used examples from the study to raise awareness about local food insecurity, including its prevalence and impact on families and communities. By including voices of residents struggling with food insecurity into this campaign, Extension is ensuring their perspectives continue to be heard. Local food security presentations by team members reached over 500 community members. One third of those members requested additional information and/or offered to assist with local hunger initiatives. In response, an Eau Claire County Hidden Hunger quarterly newsletter was initiated to help interested community members get involved in local food security efforts and learn more about the societal ramifications of hunger.

Using the focus group study results, Extension and the research team members were awarded a state grant. This grant will allow for the formation of a broad-based coalition that will develop a strategic plan to increase access to healthy food for low-income county residents. The plan will use the ecological model for health to address possible individual, environmental, and policy interventions (Fitzgerald & Spaccarotella, 2009). Extension and coalition members will then mobilize the community to implement the plan to reduce community hunger.

Limitations

Recruitment was the major study limitation. Despite multiple incentives, varied locations and times, and research team members' community connections, recruitment was a challenge. This challenge was especially evident in the rural areas, where fewer connections existed between research team members and agency staff. Stigma associated with hunger inhibited some potential respondents from approaching team members in public spaces where rural recruitment outreach was conducted. Finally, some potential participants declined due to the group format.

Conclusions and Implications for Extension

Food insecurity affects all aspects of family life, increasing stress and reducing coping abilities. From the focus group data, four major themes were identified that reflected participants' experiences: assistance gaps, struggling physically and emotionally with hunger, juggling to meet life's basic needs, and desiring healthy foods without the means. As family participants attempted to manage their struggles, they also attempted to hide food insecurity from their children. As one parent stated, "Kids should be kids. They shouldn't feel our stress to worry about what we're gonna feed them or what they're gonna eat." This face of hunger is critical for harnessing community commitment and engagement in tackling issues of food security.

Extension is an important player in supporting and strengthening the community food security infrastructure. Extension is well positioned to:

• Facilitate community discussions to identify specific research needs.
• Partner with local universities and agencies to conduct community research.
• Coordinate with the media and local organizations to disseminate research outcomes and increase community awareness.
• Mobilize community stakeholders in an inclusive, non-prescriptive process requiring leading/learning-centered approaches to create and implement a strategic plan, which aligns with the identified need (Fitzgerald & Spaccarotella, 2009).
• Ensure that the voices of those directly impacted are heard.

Extension staff, along with local partners can replicate this project. The described partnership illustrates how pressing community issues can be identified and addressed to improve community health.

References

Center on Hunger and Poverty. (2002). The consequences of hunger and food insecurity for children: Evidence from recent scientific studies. Heller School for Social Policy and Management, Brandeis University. Retrieved from: http://jubileesoupkitchen.org/Jubilee/Assets/ConsequencesofHunger.pdf

oleman-Jensen, A.,Nord, M., & Singh, A. (2013). Household food security in the United States in 2012, Economic Research Report No. (ERR-155). Retrieved from: http://www.ers.usda.gov/publications/err-economic-research-report/err155.aspx

Feeding America. (2012). Map the meal gap: Food insecurity in your county. Retrieved from: http://feedingamerica.org/hunger-in-america/hunger-studies/map-the-meal-gap.aspx

Fitzgerald, N., & Spaccarotella, K. (2009). Barriers to a healthy lifestyle: From individuals to public policy—An ecological perspective. Journal of Extension [Online], 47(1) Article 1FEA3. Available at: http://www.joe.org/joe/2009february/a3.php

Food Research and Action Center. (2013). Food hardship in America 2012: Data for the nation, states, 100MSAs, and every Congressional district. Retrieved from: http://frac.org/pdf/food_hardship_2012.pdf

Liu Y., Njai R. S., Greenlund K. J., Chapman D. P., & Croft J. B. (2014). Relationships between housing and food insecurity, frequent mental distress, and insufficient sleep among adults in 12 US states, 2009. Preventing Chronic Disease. 11:130334. Retrieved from: http://www.cdc.gov/pcd/issues/2014/13_0334.htm

Polit, D. E., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9^th ed). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

USDA-Economic Research Service. (2012). Six item short form for food security survey module. Retrieved from: http://www.ers.usda.gov/datafiles/Food_Security_in_the_United_States/Food_Security_Survey_Modules/short2012.pdf

Wisconsin Department of Health Services. (2013). FoodShare unduplicated recipients by calendar year for 2008 & 2012 for Eau Claire County. Retrieved from: http://www.dhs.wisconsin.gov/em/rsdata/

Wisconsin Department of Public Instruction. (2013). Wisconsin school district level free/reduced eligibility data, 2008 & 2012. Retrieved from: http://fns.dpi.wi.gov/fns_progstat

Women, Infants and Children Program, Wisconsin Department of Health Services (2012). Food security in Wisconsin WIC population. Retrieved from: http://www.dhs.wisconsin.gov/wic/WICPRO/data/foodsecurity.pdf