Date of Award

5-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health Services

Committee Chair/Advisor

Sarah Griffin

Committee Member

Khoa Truong

Committee Member

Joel Williams

Committee Member

Ryan Gagnon

Committee Member

Rodney Joseph

Abstract

The emergency food system in the United States is a set of corresponding service programs designed to ensure that all Americans, particularly those low-income Americans, have access to an adequate quality and quantity of food. Each year from 2015 and 2019, between 31.0% and 34.4% of U.S. households would access food from the emergency food system at some point.3 In 2020, the proportion of households accessing emergency food at some point during the year reached a maximum at 42.4% (due in large part to the COVID-19 pandemic). To access emergency food system resources, one’s household income must fall within a specific range set by each U.S. state.19 In 2025 South Carolina residents must live in a household earning at or below 150% of the federal poverty level ($48,225 annually for a household of four) or 200% of federal poverty ($64,300 annually for a household of four).20 Research suggests that this income-based approach to poverty classification may be too crude, and may miss the opportunity to specifically target households based on material deprivation and resource availability.8,9

This dissertation will incorporate three separate studies to review whether: (1) food security status and the home food environment are meaningful predictors of a health outcome, as mediated by dietary intake; (2) there is a need for a more appropriate food pantry qualification criterion as compared with the current income-based criterion; (3) a composite variable that isolates a household’s food purchasing abilities and eating behaviors can be developed for practical use, specifically, as a qualification criteria for food pantry (and other emergency food system) usage. Ultimately, what is being studied are food security status and the home food environment as separate concepts that could be developed into a single score that measures household food conditions more adequately than the income-based eligibility criterion used by emergency food system services.

Study 1 examines associations among food security status, the home food environment, and cardiometabolic disease risk among a sample of 95 physically inactive Black women living in the Phoenix, AZ metropolitan area. Including dietary intake as a potential mediator in mediational analysis adjusting for perceived stress, individual findings indicate that there are no significant adjusted indirect effects of dietary intake on the relationship between food security and cardiometabolic disease risk factors (B = -0.001; 95% CI = -0.054 – 0.043), nor are there  significant adjusted indirect effects of dietary intake on the relationship between the home food environment and cardiometabolic disease risk factors (B = 0.016; 95% CI = -0.010 – 0.046). However, there are significant associations in the direct effect between food insecurity and cardiometabolic disease risk factors in the unadjusted model (B = -0.390; 95% CI = -0.771 – -0.010) and in the direct effect between the home food environment and cardiometabolic disease risk factors in the adjusted model (B = -0.081; 95% CI = -0.154 – -0.009).

Study 2 is a qualitative study exploring how income-based food pantry qualification criteria influence food attainment among rural South Carolina residents. Data were collected through ten interviews with food pantry leaders and ten interviews with food pantry clients. Thematic analysis reveals four distinct but related findings: (1) food pantries rarely have experiences with clients who earned too much income to qualify for the food pantry; (2) the current income based food pantry qualification criteria are reasonable for low-income to middle-income households; (3) the system used to verify a food pantry client’s income is not formally verified, relying solely on trust from the food pantry client; (4) regardless of whether or not a food pantry client qualifies for food pantry foods provided by the USDA, food pantries seemingly always have reserve amounts of privately donated/purchased food items they are allowed to provide to clients without USDA consent. Ultimately, findings from this study indicate that an alternative emergency food qualification criterion that isolates household food purchasing abilities and eating behaviors is not necessary for rural SC food pantries.

Study 3 empirically develops and validates a composite Household Food Poverty Measure using items from the food security status measure and the home food environment measure. This research employs efficiency reduction modeling, confirmatory factor analysis, principal component analysis, and multiple linear regression using linear mixed effects modeling. Items from both the USDA food security status measure and the home food environment measure are included to develop the composite Household Food Poverty Measure. The Household Food Poverty Measure is successfully validated as a reasonably accurate and reliable measure for rural South Carolina households, explaining 74% of the variance in food security status and the home food environment. Future research would benefit from implementing the 14-item Household Food Poverty Measure in a field test to evaluate its feasibility, reliability, and predictive validity in identifying households experiencing food poverty in real-world settings.

Author ORCID Identifier

https://orcid.org/0000-0002-0373-5251

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Available for download on Monday, May 31, 2027

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