Course:LFS350/Projects/2014W1/T10/Report

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Executive Summary

For our research project, our team worked with the Richmond Food Security Society in an effort to examine the level of food insecurity experienced by seniors living within low-income housing in Richmond, British Columbia. Our research team focused our efforts upon creating a comprehensive survey for future students taking LFS 350 to utilize for their projects. Richmond is a community located within the Metro Vancouver region, of which roughly 20,000 household experience food insecurity, a large portion of these residents being seniors. Our research question is to examine how we can form an effective survey that would appropriately assess not only the level of food insecurity faced by seniors living within low-income housing, but also gain valuable knowledge on how seniors in this community are coping with food insecurity, and determining what changes need to be implemented to further alleviate this issue. To complete this task, research group members completed a systematic review of appropriate literature pertaining to the topic of elderly and food insecurity. This was done by using key terms and operatives to narrow our search to only literature that was pertinent to our topic. Each group member supplied information that helped us determine the structure of our survey, that it should include both quantitative and qualitative questions, and strengthened the validity of the survey that we had created. What we found was that combining both the qualitative and quantitative aspects into one comprehensive survey allowed us to create the most appropriate method to capture the degree of food insecurity experienced by elderly residents. We recommend for future students working on this research project to ensure that they respect the dignity of the seniors participating in the survey as food insecurity is a sensitive topic, and to ensure that they approach this issue from various angles; food security is not always directly affected by the amount of food a person has to eat. Finally, this study is limited in its scope as it is only focusing upon seniors within one community. There is likely to be a very low response rate and future surveyors should be aware of this.

Introduction

Our research team partnered with the Richmond Food Security Society (RFSS) for our Community-Based Experiential Learning (CBEL) project.

The RFSS is a support system that implements various programs accessible to individuals within the community of Richmond, BC to take part in to alleviate issues of food security. Their mandate is “that all people in the community, at all times, have access to nutritious, safe, personally acceptable and culturally appropriate foods, produced in ways that are environmentally sound and socially just” (Richmond Food Security Society, n.d.). With this information in mind, our group attempted to conceptualize how they fit into their community through a systems diagram, which can be accessed here

In Metro Vancouver, food insecurity was found to be significantly more prevalent in low-income households (BCNPHA & M. Thomson Consulting, 2012). Food insecurity is a growing concern for low-income housing providers since food insecurity has been strongly associated with overall health, wellbeing, and social outcomes (BCNPHA & M. Thomson Consulting, 2012). Food security, as defined by the World Health Organization, is achieved “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life” (World Health Organization, n.d). Furthermore, for food security to be satisfied, the food for a population must meet six criteria: food must be affordable, available, accessible, appropriate (nutritionally, culturally, and morally), safe, and environmentally sustainable” (Think&EatGreen@School, 2013). In 2011, BC was found to have the highest poverty rate in Canada, with 12% of the population not being able to meet their basic needs (Dietitians of Canada, 2012). We assume that for seniors, a demographic group with limited sources of income, financial strain is a major cause of food insecurity.

The population of the city of Richmond is approximately 200,000 people (City of Richmond, 2014a). Nearly 25% of households in Richmond are affected by poverty, and seniors are the third most affected group at 29% (BCNPHA & M. Thomson Consulting, 2012). Factors that contribute to food insecurity in Richmond include its geographical location and reliance on food imports (Richmond Food Security Assessment, 2006). Many of the services in Richmond are clustered in the city centre region, while many communities live in outlying neighbourhoods, creating a barrier for those to access services (Richmond Food Security Assessment, 2006). We decided to focus on seniors living in low-income housing due to the high rates of financial insecurity, which is the central factor behind food insecurity (Wolfe et al, 2003, p.2762).

The purpose of our project was to develop a survey to determine the level of food insecurity faced by the seniors living in low-income housing in Richmond, BC. To do this, we asked ourselves “What is the most effective way to design a survey to optimally determine the level of food insecurity experienced by elderly”? Another objective was to investigate possible initiatives for the Richmond community that may strengthen food security. With these research questions in mind, our research group set out to investigate how to design an effective survey that would assess proper levels of food insecurity while remaining unbiased and ethical.

Research Methods

Our team conducted our research by performing a systematic review of pertinent literature. A literature review is a report that examines literature related to the topic of interest and is compiled into a concise form. To do this, team members accessed various databases and searched specific keywords to find articles containing relevant material that could be used for our review. From those articles, team members examined the listings and determined which papers would be used for the literature review.

Searches

Our group searched for key terms using both the UBC Library search engine, Summon, and Google Scholar. Incorporating the use of Boolean operators to broaden our search to include synonyms for our search words increased the range of articles that our searches retrieved. An example of the search made is: (“food secur*” OR “food insecur*”) AND (elder* OR senior*) AND (survey OR method*)

Ultimately, all of the articles that were selected came from the UBC Library search engine, from which each member of the group found one article relating to the study. We further refined our search and focused on the following databases: Web of Science Core Collection and FAO: Food and Agriculture Organization of the United Nations. When one relevant article was found, we looked at the list of related articles provided below (Appendix 2) and went through the abstracts of all of them. In one case, one article (Wolfe & Wendy, 1998) was found in the citations of another article (Wolfe et al., 2003). We looked at the abstracts and discarded those that did not align with our inclusion and exclusion our criteria. Out of all the articles retrieved from the UBC search engine to inform our survey, three were approved according to our criteria and all three were included in our findings and results. After deciding on the articles to be used, each member of the group read through the one that they found and provided a summary of the methods, findings, and conclusions of each article (Table 1 & 2).

Exclusion and Inclusion Criteria

We initially searched for articles that related to the situation of food insecurity in Canada to give ourselves a context for our study. For articles relating to our eventual survey, our inclusion criteria were household food insecurity, how seniors experience food insecurity, and surveys measuring levels of food insecurity. Our exclusion criteria initially were studies conducted outside of the US and Canada because the two countries are similar economically, socially, and culturally. However we also added to our exclusion criteria articles outside China, because the significant immigrant population of Richmond is largely Chinese. The rationale was that research conducted in China about food security might yield unforeseen conceptions of what food security means within Richmond. As Allen states, one first has to understand the target population’s conceptualization of food security, or its definition, in order to suggest viable approaches to increasing their food security (Allen, 2012, p.135). Each member of our group was to use the aforementioned inclusion and exclusion criteria to look for relevant articles.

Findings

Our research highlighted important considerations for creating a survey that would adequately measure the level of food insecurity of Richmond seniors living in lower-income housing. We found that the survey needed to encompass the following components: an attempt to understand the individuals conceptualization of food (in)security, financial status, limits to physical mobility, psychological state, social considerations, health issues and nutritional knowledge (Wolfe et al., 2003).

Food insecurity amongst seniors is more than a poverty-linked experience. One study identified ten factors of food insecurity: a lack of money for food, not enough food due to transportation limitations, not enough food due to health or mobility limitations, not the right foods/dietary requirements for health, financial priorities (ie. medicine and other expenses over food), food compromises in quality and quantity, strategies for accessing food (e.g., borrowing money, using food programs and food trade), lack of motivation to prepare foods or eat, perception of adequate food for health (quality and quantity), and anxiety about their food situation (Wolfe et al., 2003). As well, although food insecurity affects every generation, the elderly tend to suffer more due to higher anxiety, a greater lack of mobility, and a higher likelihood to be physically or mentally limited by health issues (Wolfe et al., 2003). Food insecurity in seniors is slightly more complex because it “includes not only limited or uncertain access to food (ability to acquire), but also the inability to use food i.e. to prepare, gain access to and/or eat food that is available in the household because of functional impairments and health problems” (Wolf et al., 2003, p. 2768). Financial constraint, although emphasized in most surveys, is not the only cause of food insecurity amongst the elderly.

Wolfe et al. (2003) explained that some elders experienced food insecurity in the form of a poorer diet or eating less than they should because of lack of motivation or energy to prepare meals (fatigue, loneliness, depression, etc). It is important that nutrition is considered in an assessment of food security (Wolfe et al., 2003). Another study linked food insecurity in the senior population with poor nutrition, impaired health and risk factors including socio-demographic factors, social isolation, physical limitations, and disability (Brewer et al., 2010, p. 150). The results of the study found that weight-related disability, rather than physical limitation variables or health, were consistently related to food insecurity (Brewer et al., 2010, p. 160).

Article # Authors Article Title Year of Publication Journal
1 Wolfe, Wendy S., Frongillo, Edward A., and Valois, Pascale Understanding the Experience of Food Insecurity by Elders Suggests Ways to Improve Its Measurement 2003 The Journal of Nutrition
2 Coleman-Jensen, Nord, & Singh Household Food Security in the United States in 2012 2013 United States Department of Agriculture
3 Radimer, Olson, Campbell Development of indicators to assess hunger 1990 The Journal of Nutrition

Table 1. Journal articles chosen for systematic review

Article # Number of Subjects Subject Characteristics Sample Design Source of Instrument Conclusions
1 53 25 Latino and 28 non-Latino In-depth interviews then telephone questionnaire (48 of 53) Modified U.S. Household Food Security Survey Module (FSSM) Findings show that there are four factors that play a part in determining food insecurity faced by elderly.

Quantitative component: actual amount of food and energy available for consumption Qualitative component: quality of food in the diet Psychological component: elders knowledge, perception, and associated feelings towards their food situation Social component: 1) accessing food in socially acceptable ways and 2) socially or culturally less normative patterns of eating

2 N/A N/A N/A USDA Model 1. Survey is done under the USDA model

2. It is a national and annual research 3. The food insecurity level of seniors is better than the national average 4. No qualitative data 5. No focus on senior food insecurity

3 189 Women in Upstate New York who participated in programs for low-income households Collected statement from 32 women who had experienced hunger Author made a survey according to the 32 women interviewed No race information

Table 2. Comparison of the articles used for systematic review

Discussion and Conclusion

Discussion

Using a survey to assess food (in)security amongst seniors requires that the questions encompass as many factors as possible that relate to elderly food insecurity. Although we realize that there are some limitations to using the USDA survey. It was found that the rate of food insecurity amongst seniors was lower according to the USDA survey results than the national rate. The USDA showed that 8.8% of seniors experience food insecurity; however the country’s average was measured to be 14.5% (Coleman-Jensen, Nord, & Singh, 2013).

A generation-unspecific survey will not address specific issues faced by seniors. Scholars tend to believe that the food security of households with seniors is higher than other families (Nord, 2002). We added the qualitative component of our survey to counter the gap of knowledge that can result from solely using the USDA survey. For the analysis of the findings, the researchers can use the USDA survey rubric to determine the level of food insecurity. A mixed methods approach can be used for the answers from the qualitative component of the survey. Information yielded from the qualitative part of the survey is expected to be variable. A careful study of the answers provided will be necessary to identify any patterns and/or correlations.


Conclusion

We hope for the survey we have compiled to be used by a future LFS 350 group with the same research purpose. The survey we have designed is intended to be administered and collected door-to-door, in an anonymous fashion. Depending on how the low-income housing units are structured at the time of handing out the questionnaire, it may be best to give them to a housing director for distribution and collection or place them directly at each house unit for later collection. It is important that early contact is made with the housing complexes. In accordance to the ethics guideline for research on individuals, the interviewers should obtain initial and ongoing consent (Government of Canada, 2014). A consent form must be provided as well as a comprehensive written explanation, in lay-man’s terms, of the project and its relevance to the participants so that they are fully informed. Both the consent and the information sheet should be translated into Richmond’s major languages aside from English, which includes Mandarin, Cantonese, and Tagalog. Ideally, no reward or remuneration will be given for participating in the study to avoid participant bias. Participants should be provided an anonymous way to ask any questions they might have (i.e. the researchers might consider holding a few general information sessions at the housing complex common areas). Ultimately, the information collected from the surveys will inform future policy and programs that address food insecurity in the community.

Appendix

1a: Complete USDA Survey

Note: Only the questions would appear on the survey. The rest of the text are instructions, guidelines and additional information for the researchers. Taken directly from: http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools.aspx#adult

USDA Survey: U.S. ADULT FOOD SECURITY SURVEY MODULE: THREE-STAGE DESIGN, WITH SCREENERS Economic Research Service, USDA September 2012

Revision Notes: The food security questions in the U.S. Adult Food Security Survey Module are essentially unchanged from those in the original module first implemented in 1995. September 2012: Corrected skip specifications in AD5 Added coding specifications for “How many days” for 30-day version of AD1a and AD5a. July 2008: · Wording of resource constraint in AD2 was corrected to, “…because there wasn’t enough money for food” to be consistent with the intention of the September 2006 revision. September 2006: · Minor changes were introduced to standardize wording of the resource constraint in most questions to read, “…because there wasn't enough money for food.” · Question numbers were changed to be consistent with those in the revised Household Food Security Survey Module. · User notes following the questionnaire were revised to be consistent with current practice and with new labels for ranges of food security and food insecurity introduced by USDA in 2006.

Overview: The U.S. Adult Food Security Survey Module is the same set of questions that is administered as the U.S. Household Food Security Survey Module to households with no child present. For many measurement purposes, the adult module can be used both for households with and without children present.

The U.S. Adult Food Security Survey Module is the same set of questions that is administered as the U.S. Household Food Security Survey Module to households with no child present. For many measurement purposes, the adult module can be used both for households with and without children present. · Advantages (compared with the 18-item household module): o Less respondent burden. o Improves comparability of food security statistics between households with and without children and among households with children in different age ranges. o Avoids asking questions about children’s food security, which can be sensitive in some survey contexts. · Limitations: o Does not provide specific information on food security of children.

Transition Into Module (administered to all households): These next questions are about the food eaten in your household in the last 12 months, since (current month) of last year and whether you were able to afford the food you need. Optional USDA Food Sufficiency Question/Screener: Question HH1 (This question is optional. It is not used to calculate the Adult Food Security Scale. It may be used in conjunction with income as a preliminary screener to reduce respondent burden for high income households).

HH1.[IF ONE PERSON IN HOUSEHOLD, USE "I" IN PARENTHETICALS, OTHERWISE, USE "WE."]

Which of these statements best describes the food eaten in your household in the last 12 months: —enough of the kinds of food (I/we) want to eat; —enough, but not always the kinds of food (I/we) want; —sometimes not enough to eat; or, —often not enough to eat?

⃝ Enough of the kinds of food we want to eat
⃝ Enough but not always the kinds of food we want
⃝ Sometimes not enough to eat
⃝ Often not enough to eat
⃝ DK or Refused

Household Stage 1: Questions HH2-HH4 (asked of all households; begin scale items).

[IF SINGLE ADULT IN HOUSEHOLD, USE "I," "MY," AND “YOU” IN PARENTHETICALS; OTHERWISE, USE "WE," "OUR," AND "YOUR HOUSEHOLD."]

HH2.Now I’m going to read you several statements that people have made about their food situation. For these statements, please tell me whether the statement was often true, sometimes true, or never true for (you/your household) in the last 12 months—that is, since last (name of current month).

The first statement is “(I/We) worried whether (my/our) food would run out before (I/we) got money to buy more.” Was that often true, sometimes true, or never true for (you/your household) in the last 12 months?

⃝ Often true
⃝ Sometimes true
⃝ Never true
⃝ DK or Refused

HH3. “The food that (I/we) bought just didn’t last, and (I/we) didn’t have money to get more.” Was that often, sometimes, or never true for (you/your household) in the last 12 months?

⃝ Often true
⃝ Sometimes true
⃝ Never true
⃝ DK or Refused


HH4. “(I/we) couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true for (you/your household) in the last 12 months?

⃝ Often true
⃝ Sometimes true
⃝ Never true
⃝ DK or Refused

Screener for Stage 2 Adult-Referenced Questions: If affirmative response (i.e., "often true" or "sometimes true") to one or more of Questions HH2-HH4, OR, response [3] or [4] to question HH1 (if administered), then continue to Adult Stage 2; otherwise skip to End of Adult Food Security Module.

NOTE: In a sample similar to that of the general U.S. population, about 20 percent of households (45 percent of households with incomes less than 185 percent of poverty line) will pass this screen and continue to Adult Stage 2.

Adult Stage 2: Questions AD1-AD4 (asked of households passing the screener for Stage 2 adult-referenced questions).

AD1. In the last 12 months, since last (name of current month), did (you/you or other adults in your household) ever cut the size of your meals or skip meals because there wasn't enough money for food?

⃝ Yes
⃝ No (Skip AD1a)
⃝ DK (Skip AD1a)

AD1a.[IF YES ABOVE, ASK] How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months?

⃝ Almost every month
⃝ Some months but not every month
⃝ Only 1 or 2 months
⃝ DK

AD2. In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money for food?

⃝ Yes
⃝ No
⃝ DK

AD3. In the last 12 months, were you every hungry but didn't eat because there wasn't enough money for food?

⃝ Yes
⃝ No
⃝ DK

AD4. In the last 12 months, did you lose weight because there wasn't enough money for food?

⃝ Yes
⃝ No
⃝ DK

Screener for Stage 3 Adult-Referenced Questions: If affirmative response to one or more of questions AD1 through AD4, then continue to Adult Stage 3; otherwise, skip to End of Adult Food Security Module.

NOTE: In a sample similar to that of the general U.S. population, about 8 percent of households (20 percent of households with incomes less than 185 percent of poverty line) will pass this screen and continue to Adult Stage 3. Adult Stage 3: Questions AD5-AD5a (asked of households passing screener for Stage 3 adult-referenced questions).

AD5. In the last 12 months, did (you/you or other adults in your household) ever not eat for a whole day because there wasn't enough money for food?

⃝ Yes
⃝ No (Skip AD5a)
⃝ DK (Skip AD5a)

AD5a. [IF YES ABOVE, ASK] How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months?

⃝ Almost every month
⃝ Some months but not every month
⃝ Only 1 or 2 months
⃝ DK

END OF ADULT FOOD SECURITY MODULE User Notes

(1) Coding Responses and Assessing Household Adult Food Security Status: Following is a brief overview of how to code responses and assess household food security status based on the Adult Food Security Scale. For detailed information on these procedures, refer to the Guide to Measuring Household Food Security, Revised 2000, available through the ERS Food Security in the United States Briefing Room.

Responses of “yes,” “often,” “sometimes,” “almost every month,” and “some months but not every month” are coded as affirmative. The sum of affirmative responses to the 10 questions in the Adult Food Security Scale is the household’s raw score on the scale.

Food security status is assigned as follows: Raw score zero—High food security among adults Raw score 1-2—Marginal food security among adults Raw score 3-5—Low food security among adults Raw score 6-10—Very low food security among adults

For some reporting purposes, the food security status of the first two categories in combination is described as food secure and the latter two as food insecure.

(2) Response Options: For interviewer-administered surveys, DK (“don’t know”) and “Refused” are blind responses—that is, they are not presented as response options but marked if volunteered. For self-administered surveys, “don’t know” is presented as a response option.

(3) Screening: The two levels of screening for adult-referenced questions are provided for surveys in which it is considered important to reduce respondent burden. In pilot surveys intended to validate the module in a new cultural, linguistic, or survey context, screening should be avoided if possible and all questions should be administered to all respondents.

To further reduce burden for higher income respondents, a preliminary screener may be constructed using question HH1 along with a household income measure. Households with income above twice the poverty threshold AND who respond <1> to question HH1 may be skipped to the end of the module and classified as food secure. Using this preliminary screener reduces total burden in a survey with many higher income households, and the cost, in terms of accuracy in identifying food-insecure households, is not great. However, research has shown that a small proportion of the higher income households screened out by this procedure will register food insecurity if administered the full module. If question HH1 is not needed for research purposes, a preferred strategy is to omit HH1 and administer Adult Stage 1 of the module to all households. (4) 30-Day Reference Period: The questionnaire items may be modified to a 30-day reference period by changing the “last 12-month” references to “last 30 days.” In this case, items AD1a and AD5a must be changed to read as follows:

AD1a/AD5a. [IF YES ABOVE, ASK] In the last 30 days, how many days did this happen?

______ days

⃝ DK

Responses of 3 days or more are coded as “affirmative” responses.

1b: Demographic questions

What is your gender?

⃝ Female
⃝ Male
⃝ Other

What is your age? (check one that applies)

⃝ 65-69
⃝ 70-74
⃝ 75-79
⃝ 80-84
⃝ 85-89
⃝ 90-94
⃝ 95-99
⃝ 100+

What is your country of birth: ______________

Which languages do you consider yourself proficient in? ____________

What is your ethnicity? _____________

What’s the highest level of education you’ve completed?

⃝ Secondary or less
⃝ Associate’s Degree
⃝ College/Technical school
⃝ Bachelor’s Degree/Undergraduate
⃝ Graduate (Master’s)
⃝ Graduate (PhD)
⃝ Other (please specify): _______________________


1c: Open-ended questions

Do you cook for yourself?

⃝ Yes
⃝ No

If not, please explain why not. ____________

Do you sacrifice part of your food budget for any other needs (i.e. medical, transportation, etc.)?

⃝ Yes
⃝ No

If so, please explain briefly. ____________

Is your mobility limited in any way?

⃝ Yes
⃝ No

If so, how? ____________

Does any aspect of your health impede you from accessing the food you would like to consume?

⃝ Yes
⃝ No

If so, what? ____________

Is it easy for you to get to the store to buy food?

⃝ Yes
⃝ No

'If not, please explain. _____________

Do you have any chronic health issues?

⃝ Yes
⃝ No

If so, please explain. _______________

What does it mean to be food secure, to you? ___________________

Would you say you are food secure?

⃝ Yes
⃝ No

Why or why not? ______________________

Have you done or taken part in any of the following in the last 4 weeks (Circle all that apply):

⃝ CSA (Community Supported Agriculture) Program
⃝ Community Garden
⃝ Home Food Delivery
⃝ Community Kitchen
⃝ Farmers Market
⃝ Food Assistance Program
⃝ Food Bank
⃝ Meals on Wheels
⃝ Other (please specify): _______________________________

What would you like to see in your community that you would like to be a part of? (e.g. community garden, home movie theatre, a games room, a common lounge, more parties, etc.) ________________


2: Example of a List of Related Articles

Can be found here

References

Allen, P. (2013). Facing food security. Journal of Rural Studies, 29, 135–138.

Brewer, D. P., Catlett, C. S., Porter, K. N., Lee, J. S., Hausman, D. B., Reddy, S., & Johnson, M.A. (2010). Physical Limitations Contribute to Food Insecurity and the Food Insecurity-Obesity Paradox in Older Adults at Senior Centers in Georgia. Journal of Nutrition For the Elderly, 29(2), 150-169. doi:10.1080/01639361003772343.

City of Richmond. (2014a). Population & Demographics. Retrieved December 3rd, 2014, from http://www.richmond.ca/discover/about/demographics.htm

Coleman-Jensen, A., Nord, M., & Singh, A. (2013). Household Food Security in the United States in 2012. Retrieved from http://162.79.45.209/media/1183208/err-155.pdf

Dietitians of Canada. (2012). Cost of Eating in British Columbia 2011. Retrieved from http://www.dietitians.ca/Downloadable-Content/Public/CostofEatingBC2011_FINAL.aspx

Jonker, B. P. J., & Pennink, B. (2010). The Essence of Research Methodology - A Concise Guide for Master and PhD Students in Management Science. Springer-Verlag Berlon Heidelberg.

Government of Canada (2014). The TCPS 2 Tutorial Course on Research Ethics (CORE). www.pre.ethics.gc.ca

Nord, M. (2002). Food security rates are high for elderly households. FOOD REVIEW-WASHINGTON DC-, 25(2), 19-24.

Olson, C. M., Kendall, A., Wolfe, W. S., & Frongillo, E. A. (1996). Understanding the Measurement of Hunger and Food Insecurity in the Elderly. Institute for Research on Poverty, University of Wisconsin--Madison.

Radimer, K. L., Olson, C. M., & Campbell, C. C. (1990). Development of indicators to assess hunger. The Journal of Nutrition, 120 Suppl 11(11), 1544-1548.

Richmond Food Security Society. (2012) Introducing The New Food Security Coordinator. Retrieved from http://www.richmondfoodsecurity.org/2012/introducing-the-new-food-security-coordinator/

Statistics Canada. (2011). National Health Survey. Retrieved from http://www12.statcan.gc.ca/NHS-%20ENM/2011/ref/pdf/N1-eng.pdf Taylor, J R., Lovell, S T. (2014). Urban Home Food Gardens in the Global North: Research traditions & future directions. Agriculture and Human Values. 31(2), 285-305.

Think&EatGreen@School. (2013). Annual Activity Report 2012-2013. Retrieved from http://lfs-teg-collab.sites.olt.ubc.ca/files/2013/04/ThinkEatGreen_AnnualReport_FINAL_4Nov2013_WEB-FINAL1.pdf United States Department of Agriculture. (2014). Survey Tools. Retrieved from http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools.aspx#adult

Wolfe, W. S., Frongillo E.A., Valois, P. (2003). Understanding the experience of food insecurity by elders suggests ways to improve its measurement. The Journal of Nutrition. 113(9). 2762-2769.