In November 1997, researchers at California Food Policy Advocates designed a study to measure the impact of the food stamp cuts on legal immigrant households. The survey tool selected was the Core Food Security Module, designed by the United States Department of Agriculture. The Food Security Module is an 18-item questionnaire that is based on a longer set of questions, the Food Security Supplement, used yearly since 1995 by the U.S. Census Bureau as part of the ongoing Current Population Survey (CPS) of 65,000 households. Both of these survey tools are the result of 10 years of extensive research and validation studies by government, research and university groups. The Food Security Module has been further adapted for use in national surveys such as the National Health and Nutrition Examination Survey (NHANES), and research conducted by Centers for Disease Control (CDC).

The questions used in the Core Food Security Module reflect the findings of previous research that households facing economic hardship go through a continuum of coping strategies as food insecurity due to lack of money becomes more severe, finally resulting in stark hunger. First, heads of households feel anxiety about the insufficiency of food to meet their basic needs, and begin to adjust to limited food budgets by changing the quality or variety of the food they eat or serve their children. As the situation becomes more severe or prolonged, adults in the household reduce their food intake and begin to experience hunger. In the most severe conditions, children, as well as adults, suffer from hunger due to reduced food intake.

Each of the 18 questions in the survey verifies that the reported behavior or condition occurred due to financial limitations placed on the household by phrasing the questions in this context. For example, one question asks, "In the last 12 months, did you ever cut the size of your meals or skip meals because there wasn’t enough money for food?" Another question asks, "In the last 12 months, did you ever not eat for a whole day because there wasn’t enough money for food?" Participants respond by answering that this statement is "Always true", "Sometimes true", or "Never true".

Based on the statistically scaled responses to the 18 questions in the Food Security Module, a Food Security Measure was derived, which assigns a score of 0 — 4 to each household surveyed. The Measure uses the definitions adopted in 1990 by the Life Sciences Research Office (LSRO) of the Federation of American Societies for Experimental Biology (FASEB).

0 Food Secure: Households show no or minimal evidence of food insecurity.

1 Food Insecure without Hunger: Food insecurity is evident in households’ concerns and in adjustments to household food management, including reduced quality of diets. Little or no reduction in household members’ food intake is reported.

2 Food Insecure with Moderate Hunger Evident: Food intake for adults in the households has been reduced to an extent that implies that adults have repeatedly experienced the physical sensation of hunger. Such reductions are not observed at this stage for children in the household.

3 Food Insecure with Severe Hunger Evident: Households with children have reduced the children’s food intake to an extent that implies that the children have experienced the physical sensation of hunger. Adults in the households with and without children have repeatedly experienced more extensive reductions in food intake.

In September 1997, California Food Policy Advocates approached several county welfare departments and requested their cooperation in using the USDA Food Security Measure to study the impact of the legal immigrant food stamp reductions. Given the nature and timing of the cuts, the legal immigrant caseload was undergoing a "natural experiment," i.e. certain households retained benefits due to federal rules or age levels, while others were to become ineligible. This allowed the design of a case-control study. Los Angeles and San Francisco County agreed to participate in the study.

From a total population of food stamp households having at least one non-citizen member, a random sample was drawn from those scheduled to come in for recertification or verification interviews during the months of November 1997 (Los Angeles only), January 1998 (San Francisco) and March 1998 (Los Angeles). The sampled population was divided into impacted cases (i.e., those with at least one member who had lost food stamp benefits due to the legal immigrant provision), and controls (i.e., those where no household member lost food stamps.)

The survey instrument used the verbatim sequence and language of the 18 questions in the USDA Food Security Module, with the addition of follow-up questions which focused specifically on the period of time since September 1, 1997 (the date food stamps were cut). For example, respondents were asked, "Since September, did you ever cut the size of your meals or skip meals because there wasn’t enough money for food?" The Appendix contains more detailed information about the survey design, sampling and analysis.

County eligibility workers administered the survey questionnaire in face-to-face interviews with heads of households who voluntarily agreed to participate. Translated surveys in six languages and translation services were available. Surveys were then forwarded to California Food Policy Advocates for data entry and analysis. In compliance with the procedure outlined in federal guidelines for implementing the food security measure, all surveys having more than three missing responses were not included in the final analysis.

The Los Angeles data provide an opportunity to examine the impact of the food stamp cuts over time, because two separate surveys were done. Interviews were done in November 1997, only two months after the federally mandated reductions were implemented, and another survey was conducted in March, after households had experienced six months of reduced food benefits. In November, 403 valid, randomly sampled surveys were completed (186 cases, 217 controls), and in March, 376 surveys were completed (210 cases, 166 controls).

The Los Angeles samples consisted primarily of families with children. The profile of a typical respondent in November was a 41 year old female with 3 children and a monthly rent and utilities expense of $555 (the March profile was nearly identical.). Nearly half (49%) of the respondents reported that they were born in Mexico, 21% were born in Central or South America, and 12% were from East and Southeast Asian countries. About one quarter of the sample was current or former refugees, and 21% reported using emergency food sites to supplement food stamps.

• Children living in immigrant households where food stamps have been cut are suffering from worsening rates of severe hunger.

According to the USDA Food Security Measure used in this study the term "food insecure with moderate hunger" means that the adults in the household have reduced their food intake to the extent that they have repeatedly experienced the physical sensation of hunger. Children, however, are not directly experiencing hunger at this stage. The term "food insecurity with severe hunger" means that children are being directly affected by the lack of food and money in the household, and there is evidence that they are experiencing the physical sensation of hunger. In this most serious level of food insecurity, adults are already severely restricting their own intake, but now report having to skimp on portions or cut food variety for their children, skip serving meals or snacks, or send their children to bed hungry.

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By March, impacted immigrant households with children in Los Angeles were one third more likely to experience the most serious food problems — food insecurity with severe hunger — than similar immigrant households not impacted by the food stamp cuts; and one third more likely to experience moderate hunger as well.

By March, 21% of impacted households with at least one child under 18 present experienced the most serious food problems — food insecurity with severe hunger — a 7 percentage point increase over the November rate.

• By March, legal immigrant households in Los Angeles whose benefits had been cut were experiencing significantly more hunger than non-impacted households.

In November, 40% of the impacted group experienced moderate or severe hunger, compared to 33% of the control group — a difference which sharpened slightly when the groups were asked if their food security problems had worsened "in the last three months" (i.e., since the September 1 cutoff).

By March, however, 50% of the all households in the impacted group experienced moderate or severe hunger, compared to 38% of the control group. These differences were statistically significant.

By March, immigrant households that were cut off food stamps were 30% more likely to experience the most serious food problems — food insecurity with severe hunger -- than those who were not; and 29% more likely to experience food insecurity with moderate hunger.

• All legal immigrant households were experiencing high levels of food insecurity and hunger, which worsened between November and March.

By March, half (50%) of the impacted (i.e., benefits cut) group experienced household food insecurity with moderate or severe hunger, an increase of 8 percentage points since the survey was done in November. In the control group (i.e., benefits not cut), 39% experienced moderate or severe hunger in March, an increase of 3 percentage points since the survey was done in November.

By March, the hunger rate in the impacted households was four times higher than that found by the Current Population Survey (CPS) in a low-income sample of the U.S. population, and ten times higher than the CPS found prevalent in the general California population in 1995. The CPS low-income subsample included households with incomes up to 130% of poverty level, while all of the households in this study had incomes well below the poverty line, since they were public assistance households (a CalWORKS household of three lives at 72% of poverty even when food stamps are included).

The hunger prevalence found in the Los Angeles study is substantially higher than that found in a recently released study, carried out by the Physicians for Human Rights (PHR), an international medical organization based in Boston. Researchers in the PHR study interviewed immigrants in community clinics and centers in California, Texas and Illinois during March 1998, also using the USDA Food Security Instrument. Of the 682 households represented in the PHR study, 34% were found to be food insecure with moderate (25%) or severe (9%) hunger. The PHR sample, while largely low-income, did not consist wholly of very low-income immigrants receiving food stamps, as in this study. (See comparative chart on Page 12.)

High rates of hunger among these households were detected despite concerted public and private efforts in Los Angeles County to mitigate the potential (and expected) harm caused by the termination of over 90,000 persons from food stamps. Los Angeles County officials aggressively promoted naturalization, provided detailed information to all terminated persons about emergency food sites in their neighborhoods, and coordinated referrals via the county’s "800" information phone line. The County also worked actively with the county emergency food networks to encourage increased food donations from corporate giving programs and food companies in order to serve the increased need.

Nonetheless, the alarmingly high hunger prevalence among all households in the sample suggests that immigrant households represented in this survey are especially vulnerable to both short and long-term economic hardship and its negative consequences, including food insufficiency.

San Francisco County interviews were conducted in January 1998, after immigrant households had experienced four months of reduced food benefits. 241 valid, randomly sampled surveys were completed, consisting of 111 cases and 131 controls.

The San Francisco sample was evenly divided between households with and without children. The profile of a typical respondent in households with children was a 41 year-old woman with two children, paying an average rent/utilities of $458, with 16% reporting using emergency food sites on a daily or weekly basis. In adult-only households the average age was 59 years old, 70% were female, 30% were male, rent/utilities expenses averaged $297, and reliance on emergency food sites was 12%.

Unlike Los Angeles, the majority of respondents in this sample came to the U.S. from an East or Southeast Asian country (48%), or from a former Soviet Union nation (30%), while 11% of respondents were born in Mexico or other Central or South American nations.

• Children living in immigrant households where food stamps have been cut are suffering from very high rates of hunger.

In San Francisco, one third (33%) of the impacted households with children were experiencing moderate or severe hunger in January. Children living in households where at least one adult had lost food stamps were 35% more likely to experience moderate to severe hunger than those living in non-impacted households.

(See Page 7 for definitions of moderate and severe hunger.)

• By January, legal immigrant households whose benefits had been cut were experiencing significantly more hunger than non-impacted households.

In the impacted group (i.e., benefits cut), almost one third (32%) of immigrant food stamp households were experiencing food insecurity with moderate or severe hunger, compared to 19% in the control group. This difference was highly statistically significant.

Moreover, immigrant households that were cut off food stamps were almost twice as likely (173%) to experience the most serious food problems — food insecurity with severe hunger -- than those who were not; and over half as likely (56%) to experience food insecurity with moderate hunger.

• Adult food stamp households in San Francisco have fared very badly since the cuts.

The San Francisco sample contained more households composed of adults without children (47 cases and 75 controls) than the Los Angeles sample (7 and 12, respectively, in March), due to the differences in how these counties process their cases. This subsample, which is large enough to provide meaningful data, yielded alarming findings:

In the impacted group of adult-only households (both single adults and couples), almost one third (30%) of immigrant food stamp households were experiencing food insecurity with moderate or severe hunger, compared to 15% in the control group. This difference was highly statistically significant.

Moreover, adult households that were cut off food stamps experienced the most serious food problems — food insecurity with severe hunger — at a rate that was over five times higher (538%) than was found in households that were not cut. In adult households without children, food insecurity with severe hunger is defined as repeatedly experiencing more extensive reductions in food intake. These impacted households were almost two-thirds as likely (60%) to experience food insecurity with moderate hunger.

• All legal immigrant households were experiencing high levels of food insecurity and hunger.

In January, almost one third (32%) of the impacted group experienced household food insecurity with moderate or severe hunger, compared with 19% in the control group.

This hunger rate is two and half times higher than that found by the Census bureau in a low-income sample of the U.S. population, and almost seven times higher than the Census found prevalent in the general California population in 1995. (See comparative chart on the next page.)

These high hunger rates were found in San Francisco despite aggressive efforts to directly mitigate the harm. The Board of Supervisors allocated $297,000 to the county food bank, which was used to bulk-purchase and distribute food to emergency food sites located in immigrant communities. All persons terminated from food stamps received referrals to these sites, where emergency food was made available on a monthly basis.

This study documents alarmingly high rates of food insecurity and hunger among legal immigrants who have lost food stamp benefits, and provides clear evidence that the immigrant food stamp cuts contained in the federal welfare reform bill are actually generating hunger and harming children and adults alike. Since this study design included a validated and widely used survey instrument, a randomly selected, case-control sample of a distinct population, and careful quality control of all aspects of data collection, the findings are particularly powerful and compelling.

It is important to note that these conditions have been created despite the California Legislature’s partial restoration of food stamp benefits to children and seniors, a step that has now been replicated by Congress. Clearly, a partial legal immigrant restoration, such as that contained in the current California Food Assistance Program and the recently passed Agricultural Research Conference Report bill (S. 1150) will not go far enough. Full restoration of food stamps to all impacted immigrant households is needed to more adequately protect vulnerable populations from needless and unjust hunger.

These findings can be placed in the context of other recent medical studies that demonstrate that hunger and food insecurity can cause serious short and long-term health consequences, in both children and adults. These studies have found that children suffering form hunger are more likely to have psychosocial dysfunction, such as aggression and anxiety. Episodes of food insufficiency and hunger are also associated with poor academic performance. Young hungry children may exhibit long-term nutrition-related health problems such as delayed growth, iron-deficiency anemia and increased uptake of lead. A recently published study of an adult patients in a Minneapolis county hospital used the USDA Food Security Measure, and found that hunger was closely correlated with reduction in food stamps, and that inadequate food was severely compromising the health of low-income diabetic patients treated in the emergency room.

Other studies have demonstrated the protective effect of the Food Stamp Program against food insecurity and nutritional problems. Studies have indicated that food stamp use during pregnancy is associated with a decrease in the incidence of low birth weight infants. Poor children in households receiving food stamps are better nourished than poor children in non-food stamp households. Food stamp households receive more nutrients for every dollar’s worth of food than those living in similar non-food stamp households.