Assessing access and use of nutrition support programs, food insecurity, and health status in urban Native American families with young children in Montana: A case study.

Abstract

The purpose of this cross-sectional, mixed methods case study was to assess participation in, and use of, nutrition support programs (NSPs) and their impact on food insecurity and health status of American Indian and Alaska Native (AIAN) families with young children (ages 0-8) living in three urban areas in Montana. Convenience sampling was used to recruit urban AIANs to participate in a survey that contained closed and open-ended questions. A final sample of 177 responses were included in the analysis. Fisher exact tests, Wilcoxon rank-sum tests, and analysis of variance was used to model program participation, access, use, health scores, and food insecurity status as a function of demographic measures. Standard logistic regression was used in models with binary responses such as food insecurity. Proportional odds logistic regression was used to compare the proportion of respondents in poor, fair, good, very good, and excellent health for each of the five ordinal health measures with respect to program participation, access, use, food insecurity, and changes in the amount and variety of fruits and vegetables consumed. All logistic models used a single predictor and thus are unadjusted for additional factors. Thematic analysis was conducted on the open-ended questions. Most respondents (N = 132) identified as AIAN and 54% of respondents were categorized as food insecure. Most respondents (56-94.8%) agreed that SNAP, WIC, and DSD were helpful for improving their diets. Participants described frustrations with the SNAP application process, including long call back or wait times and difficulties getting questions answered and scheduling required certification appointments. Participants also expressed feeling discriminated against by caseworkers and community members when accessing SNAP. Respondents reporting SNAP was "very easy" to access had significantly higher general health scores (Proportional odds regression, overall p = 0.004). Higher physical functioning scores were associated with being food secure (p = 0.077). The odds of "Very Good" or "Excellent" social functioning scores were 2.26 times larger for participants identified as food secure than for participants identified as food insecure (CI: 1.21-4.28). The odds of "Very Good" or "Excellent" mental health scores were 2.10 times larger for participants identified as food secure than for participants identified as food insecure (CI: 1.13-3.96). Although further research is needed to establish causal relationships between food security, health status, dietary quality, and NSP use, our results advance understanding of the lived experiences of urban AIANs who participate in these programs. These results also emphasize the need for policy changes that reduce administrative complexity, improve program visibility, and incorporate culturally tailored approaches to better serve historically underreported communities.