Food Insecurity among Latin American Recent Immigrants in Toronto Dr. Mandana Vahabi Daphne Cockwell School of Nursing Dr. Cecilia Rocha School of Nutrition Centre for Studies in Food Security Ryerson University 1 November 20, 2009
Acknowledgements Funding sources Centre of Excellence for Research on Immigration and Settlement (CERIS) - The Ontario Metropolis Centre Ryerson University- Faculty of Community Services Study participants Community centers Davenport-Perth Neighbourhood CHC COSTI Immigration Services Research Assistants Elizabeth Cristina Montoya Marcello Paolinelli Elsa Lopez Daphne Cockwell School of Nursing Peer Review Committee 2
Agenda 3 Background Latin American population in Toronto Study Purpose Methods Study design, data collection, analysis Results Socio-demographic characteristics Health related characteristics Food security status Perceived barriers to accessing food
Background Food insecurity is an important social determinant of health. Public Health Agency of Canada, 2004; Health Canada, 2007 Food security is a condition that exists when all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life 1996 World Food Summit, Rome 4
Background People s accessibility to nutritious food affects their health and management of health conditions Physical Health Decreased physical functioning Poor self- rated health Respiratory and gastrointestinal problems High blood pressure Food Insecurity Hypoglycemia in diabetics Reduced micronutrient intake Iron deficiency anemia Increased body weight Compromised health status among elderly Learning disabilities among children 5 Mental Health Anxiety Emotional distress Depression
Scope of Problem 6 According to the 2004 Canadian Community Health Survey (CCHS) cycle 2.2 9.2% of Canadian households were food insecure Higher rates of food insecurity among households receiving social assistance (60%) having low income (48%) having children less than 6 years (13%) having three or more children (15%) headed by female lone-parents (25%) formed by recent immigrants (15%). Results may underestimate true prevalence: Survey excluded the territories, on-reserve First Nations people homeless people. Regions with a greater proportion of recent immigrants
Latin American Population in Canada Latin Americans (LAs) are one of the fast growing and relatively new visible communities in Canada. In 2006, more than a quarter of a million LAs were residing in Canada, a 40% increase from 2001 for this population compared to 5.4% for the overall Canadian population. Ontario, particularly Toronto, has the largest concentration of LAs. In 2006 about half (147,135) of LAs in Canada lived in Ontario and of those about 44% (64,860) resided in Toronto Other provinces with high numbers of LAs include: British Columbia (Please check these) Quebec Alberta 7
Immigration Period for Population 15 Years and Older, Overall Immigrants and Latin Americans, Toronto CMA, 2006 % of Population 1 35% 30% 25% 20% 15% 10% 5% 0% 9% 0.2% Before 1961 11% 2% 1961-1970 17% 15% 1971-1980 19% 28% 1981-1990 32% 31% 1991-2000 20% 17% 2001-2006 Overall Immigrant population Latin Americans Source: Statistics Canada 2006 Census 8 28% had immigrated between 1981-1990 32% had immigrated between 1991-2000 20% had immigrated between 2001-2006
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Age Distribution of Total Population and Latin Americans 15 Years and Older in Toronto CMA, 2006 % of population 15+ 40% 30% 20% 10% 0% 34% 30% 31% 30% 29% 24% 15% 7% Total Population Latin Americans 15 to 29 years 30 to 44 years 45 to 64 years 65 years and over Source: Statistics Canada Census, 2006 10 Latin Americans have a younger population compared to the total population (64% vs 54% between ages of 15 44)
Median Employment Income for Total Population and Latin Americans in Toronto, 2005 Median Income 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 30,034 23,728 16,722 18,853 Immigrated 2001-2006 Total Canadian Population Latin American Visible Minorities Source: 2006 Census, Statistics Canada 11 Latin American immigrants reported to have lower median income compared to total immigrants ($23,728 $30,034). Income for new LA immigrants is below the low income cut-off point (LICO for a family with one person $20,778 (before tax)
Study Purpose To examine the extent of food insecurity and its determinants, dietary intake and perceived barriers and facilitators in accessing food among recent Latin American (LA) immigrants in Toronto This presentation focuses mainly on findings related to the extent of food insecurity and its determinants 12
Methods Design cross sectional design Sampling: A convenience sample of 70 adult LA immigrants Recruited from selected community centers across Toronto e.g. COSTI Immigration Services, Davenporth-Perth Neighbourhood Centre) and through snow ball sampling Target population/ eligibility criteria: Spanish/Portuguese speakers from Central/South and Latin America, Age 20 years or older, Primary household care givers in charge of household expenses including food purchase, Immigrated to Canada in the past 5 years 13
Data Collection June 2008-October 2008 Face-to-face interviews conducted in either Spanish or Portuguese 3 Questionnaires socio-demographic and self-reported health characteristics of participants (e.g. age, sex, marital status, education, household income, length of stay in Canada, number of people in the household, type of dwelling, knowledge of official languages, self reported health status and stress levels before and after immigration). 18 item CCHS 2004 Food Security Module classifies households as food secure, food insecure-moderate - and food insecure-severe -during the previous 12 months Self-reported dietary intake and perceived barriers and facilitators in accessing food Category Labels Food Secure Food Insecure, Moderate Food Insecure, Severe Table 1: Health Canada Food Security Category Specification Category Description 10-Item Adult Food Security Scale 0-1 affirmed responses indicating difficulty with income-related food access 2-5 affirmed responses indicating compromise in quality and/or quantity of food consumed 6 affirmed responses indicating reduced food intake and disrupted eating patterns 8-Item Child Food Security Scale 0-1 affirmed responses 2-4 affirmed responses 5 affirmed responses Household food security for Household with Children Both adults and children food secure Either adults or children (or both) food insecure, neither severely food insecure Either adults or children (or both) severely food insecure 14
Adult Food Security Scale Worried whether food would run out before getting money to buy more (in last 12 months) The food bought didn t last, and there was not enough money to get more (in last 12 months) Could not afford to eat balanced meals (in last 12 months) In past 12 months, did you or other adults in household ever cut the size of your meals or skip meals In past 12 months, how often did you cut size of meals or skip meals? In past 12 months, did you ever eat less than you felt you should because there wasn't enough money to buy food? In past 12 months, were you ever hungry but didn't eat because you couldn't afford enough food? In past 12 months, did you lose weight because you didn't have enough money for food? In past 12 months, did you or other adults in your household ever not eat for a whole day because you did not have enough money? In past 12 months, how often did you or other adults not eat for a whole day? Child Food Security Scale Relied on only a few kinds of low-cost food to feed children (<18 yrs) because money was running out Could not feed children (<18 yrs) a balanced meal, because could not afford that Children were not eating enough because could not afford enough food In past 12 months, did you ever cut the size of your children's meals because there wasn't enough money for food In past 12 months, did your children <18 ever skip meals because there wasn't enough money for food? In past 12 months, how often did your children <18 skip meals? In past 12 months, were your children <18 ever hungry but you just couldn't afford more food? In past 12 months, did your children <18 ever not eat for a whole day because there wasn't enough money for food 15 Total
Analysis Descriptive statistics to summarize participants socio-demographic/ self reported health characteristics. Bivariate statistics (chi-square, and correlation coefficient) to compare the proportion of food insecure households by participants socio-demographics and health status, and to assess the extent of the relationship between variables. 16 Backward stepwise logistic regression to determine the relationship between overall household food insecurity (dependent variable) and socio-demographic characteristics (independent variables).
Results
Socio-demographic Characteristics 18 Primary Household Care givers: Of the 70 participants 57 were female (82%) Median age was 33 years ranging from 20-56 years 43% were from Colombia; 29% each from Brazil and Mexico. 66% were married or in common law relationships 69% had a college or university degree Almost half had lived in Canada less than one year. 56% rated their communication in English as poor Household: 1 to 7 people in households 54% of the households had children less than 18 years 39% of the households had children aged less than six; only 6% had three or more children.
Socio-economic Characteristics of Households Lived in rented housing 89% Use food banks 67% Monthly hhld income >2,000 Monthly hhld income $1,000-2,000 Monthly hhld income <$1,000 30% 27% 39% 0% 20% 40% 60% 80% 100% % of households 19
Main Sources of Income for Households in Past 12 Months % of househol 60 50 40 30 20 10 51 47 26 20 14 10 0 Wages and salaries Provincial or municipal assistance Selfemployment Child tax benefit Child support Other (including Employment insurance and Retirement pensions) 20
Health Related Characteristics of Participants Some participants reported a decline in their health since arrival to Canada. in proportion rating their health as poor/fair since arrival in Canada (23% after arrival compared to 6% at arrival in Canada) Approximately two thirds had experienced some degree of stress in their lives since arrival to Canada, for 23% the stress was evaluated as unbearable. One-third of households had one person and 23% had two or more people with chronic conditions. Depression was the most commonly reported condition followed by intestinal or stomach disorders and high blood pressure. One third of the respondents reported taking medication for the health conditions. Half used government assistance 30% paid for the medicine themselves. 20% either used private insurance or did not indicate 40% had difficulty paying for the medications 21
Food Security Status Household Food Security Status of Recent Latin American Immigrants by Type of Household 60 53 % of households 50 40 30 20 10 44 37 33 22 42 23 25 21 0 Food Secure Food Insecure, Moderate Food Insecure, Severe 22 All Households % Households with no children % Households with Children %
Prevalence of Food Security by Sociodemographic Characteristics Food Insecurity by Socio-demographic Characteristics % food insecure househo 90 80 70 60 50 40 30 20 10 0 72 61 33 84 33 74 33 25 79 71 26 82 18 80 67 15 57 0 75 17 23
Predictors of Food Insecurity The three main correlates of food insecurity: being on social assistance (OR=6.7, p=0.014), use of food bank (OR= 13.01, p=0.006) limited literacy in English (OR=12.57, p=0.002). 24
Perceived barriers in accessing food (work in progress) Financial barriers Low paying jobs, seasonal jobs, welfare not sufficient Inability to get good jobs due to: poor English ability; education credentials not recognized in Canada Insufficient income affects purchase of food: quantity not enough food quality Unable to buy specific food e.g. fresh fruits, vegetables, meats too expensive, affects those who require special diets e.g. for managing chronic diseases Lack of time too busy working Lack of transportation some food stores are too far difficult to get to without a car, especially in winter 25
Perceived Barriers continued Language barriers Difficulty in reading food labels Cannot understand terms that are not familiar in their own vocabulary Difficulty communicating with store keepers- Prefer large chain stores 26 Cultural barriers Difficulty in obtaining specific foods they are used to e.g. fresh foods, fruits and vegetables such as mangoes, okra, taro. Many foods taste different compared to those from home countries Find foods too fatty, too much sugar, too much salt Not near stores that carry ethnic foods Stigma attached to receiving aids--shame in using food bank perceived as charity for destitutes. Information barriers Where to get ethnic foods Where to get cheaper foods
Study Limitations Small sample size and lack of random selection of the sample may restrict the study results from being generalized to the total population of LA recent immigrants. Use of a cross-sectional design limits our ability to infer causation. 27
Discussion & Recommendations Income plays a key role in household s food security status Need for strategies to enhance the financial power of new immigrants to purchase sufficient, nutritious and culturally acceptable food such as: strategies that enhance employability of new immigrants, a reform in the income structure for working adults that moves beyond social assistance, and provision of more subsidized English language and housing programs 28
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