Measures of Material Hardship: Final Report. Basic Needs and Food Insecurity

04/01/2004

The indexes examined here define hardship in terms of at least three aspects of basic physiological needs: food, shelter, and medical care. Additionally, several indexes include indicators of whether a household has access to basic utilities such as electricity, gas and telephone.

Food Insecurity
Exhibit 3.2 shows the measures used to construct the various food-related indicators included in the studies' material hardship indexes. All of the studies included at least one food security indicator in its material hardship index. Six of the studies include one dichotomous indicator of food security (Bauman, 1998; Beverly, 1999; Danziger et al., 2000; Federman et al., 1996; Lerman, 2002; Rector et al., 1999),while the other three studies included two such indicators (Edin & Lein, 1997; Mayer & Jencks, 1989; Short & Shea, 1995).

The six SIPP-based studies used the same indicator in their hardship index: whether or not a household "sometimes" or "often" did not have "enough" food during the past four months. Rector et al. (1999) included those households that "sometimes" did not have enough to eat in their list of moderate material problems and those that responded "often" in their list of substantial material problems; the remaining studies counted households as having a food related hardship if they respond "sometimes" or "often." The relatively consistent use of this SIPP measure allows for a comparison of the levels of food-related hardship identified by these studies. This measure is included in the analyses presented in Chapter 4.

Short and Shea (1995) included a second dichotomous food security indicator in their hardship index: whether a household had a day in the past month where they did not have food or money to buy food. Beverly (1999a) also included this measure in a secondary material hardship index, in lieu of the "enough" food question, and shows that it is correlated with low-levels of household income. The extent to which this additional food security indicator overlaps with the "enough" food indicator is unclear. To the extent it does, Short and Shea's (1995) index, which uses both questions as separate indicators in their index, may place additional weight on food-related hardships in their overall measure of material hardship. Although this measure is included in the SIPP, given that it has been used relatively infrequently in hardship indexes, it is not included in the analyses presented in Chapter 4.

Studies that used non-SIPP data sources were more likely to use different food-related indicators and combinations of indicators in their hardship indexes than studies that used SIPP data. Danziger et al. (2000) included a dichotomous indicator of food insufficiency that is based on the USDA Food Security scale, which uses 18 measures to identify households that are food secure, food insecure-with no hunger, and food insecure-with hunger.(5) Also, the 6-item scale was validated against the 18-item scale. While the USDA scale has been validated against the 18-item USDA scale and against two alternative food sufficiency measures (nutrient intake and food expenditures), none of the more limited measures used in the eight other indexes examined here have been similarly validated (Cristofar & Basiotis, 1992; Rose & Oliveira, 1997).

Edin and Lein (1997) included two food-related hardship indicators in their index. The first is based on a question similar to one included in the 1996 SIPP: whether a respondent ate less than felt s/he should. Their second dichotomous indicator identifies households as experiencing a food-related hardship if there has been a time in the last year when it could not afford to buy food or could not get out to get food. Mayer and Jencks (1989) also used this indicator in their hardship index. Additionally, Mayer and Jencks (1989) incorporated a dichotomous indicator that describes whether a household's food expenditures was below the USDA's thrifty food plan (defined as an "economy" food budget based on a basket of food items). The thrifty food plan was designed to represent the minimal cost of a nutritious diet. However, in using this indicator, Mayer and Jencks (1989) note that this might be an unreliable indicator of whether a family's diet contains what experts regard as desirable nutrients. Although, it can be expected that families that spend less than the "thrifty" food budget are less likely to eat nutritionally adequate diets.

Exhibit 3.2
Questions Used to Construct Food Insecurity Indicators
Items from the 1996 SIPP (Shaded Rows Indicate Questions Included in the 1992 SIPP) Studies Using SIPP Data Studies Using Non-SIPP Data
Bauman (1998) Beverly (1999) Federman et al. (1992) Lerman (2002a)1 Rector et al. (1999) Short & Shea (1995) Danziger et al. (2000) Edin & Lein (1997) Mayer & Jencks (1989)
Food bought didn't last and I/we didn't have money to get more             X    
Couldn't afford to eat balanced meals             X    
Respondent ate less than felt s/he should               X6  
Adult(s) cut size or skipped meals in 3 or more months             X    
Adults didn't eat for a whole day             X    
Description of food in household in last four months: Enough of the kinds of food wanted, enough but not always the kinds of food wanted, sometimes not enough to eat, often not enough to eat X X 4 (Sometimes or Often) X X X2 X      
Children were not eating enough             X    
Other Non-SIPP Questions
One day in past month household had no food or money to buy food   X5       X      
18-Item USDA Food Security Scale (Food Insufficient Households = 1 in Index)             X3    
Has there been a time in the last year when you needed food but couldn't afford to buy it or couldn't get out to get it?               X7 X
USDA Thrifty Food Budget (1 = Below Threshold; 0 = Above Threshold)                 X
1 Lerman (2002a) is the only study that used data from the 1996 SIPP. All others used data from the 1992 and 1993 SIPP panels.
2 "Sometimes" = Moderate Material Problem; "Often" = Substantial Material Problem
3 Items checked above are included in the 18-Item USDA Food Security Scale
4 Included in primary index
5 Included in secondary index
6 Have you gone hungry because you could not afford to buy food? When was the last time that this happened to you?
7 Asks if "ever" went without food and then asks when the last time this happened.

Housing Security

Housing security indicators address the stability and adequacy of a family's living conditions. Three types of these indicators were used in the examined studies: homelessness/doubling up, inability to meet essential housing expenses, and evictions. (Exhibit 3.3)

All but one of the studies included a dichotomous "eviction" indicator in its hardship index: whether the respondent or anyone in the household was evicted from their home or apartment for not paying rent or mortgage. This measure is similar to that included in the 1996 SIPP; however, researchers chose to apply different recall periods (e.g., 12 months versus 24 months). Researchers have shown that eviction is strongly correlated with low income and other factors related to material hardship (e.g., Bauman, 1998; Beverly, 1999a). (Additional descriptive analyses of this measure are included in Chapter 4.)

Lerman (2002a) combined two SIPP measures to create the eviction indictor included in his index: evicted OR home undesirable enough to move. The latter measure is intended to capture other types of involuntary moves, such as those due to inadequate or unsafe housing.

There is disagreement among researchers as to whether additional housing security indicators beyond eviction should be included in a material hardship index. Bauman (1998), Rector et al. (1999), and Short and Shea (1995) augment their use of an eviction indicator with a second indicator of housing security, a household's ability to meet its essential housing expenses. In all cases, a measure identical to that used on the 1996 SIPP is used: whether there was a time in the last 12 months when you/your household did not pay the full amount of the rent or mortgage. Mayer and Jencks (1989) and Edin and Lein (1997) similarly augment their eviction indicators: whether there was a time when the respondent could not afford a place to stay or could not afford rent. Danziger et al. (2000) and Edin and Lein (1997) also included indicators of homelessness or doubling up in their hardship indexes.

Interestingly, Mayer and Jencks (1989) eliminated their eviction indicator from their final hardship index due to the fact that it only had a small effect on respondents' assessment of their living standards, when controlling for whether the household could afford rent. They concluded that "eviction" measures are not a good measure of housing hardship.

 

Exhibit 3.3
Questions Used to Construct Housing Security Indicators
Items from the 1996 SIPP (Shaded Rows Indicate Questions Included in the 1992 SIPP) Studies Using SIPP Data Studies Using Non-SIPP Data
Bauman (1998) Beverly (1999) Federman et al. (1992) Lerman (2002a)1 Rector et al. (1999) Short & Shea (1995) Danziger et al. (2000) Edin & Lein (1997) Mayer & Jencks (1989)
Homelessness/Doubling-up  
During the last 12 months, did you or your children move in with other people even for a little while because you could not afford to pay your mortgage, rent or utility bills?               X  
Unable to Meet Essential Housing Expenses  
Was there a time in the past 12 months when you/your household did not pay the full amount of the rent or mortgage? X       X X      
Evictions/Undesirable Enough to Move  
During the last 12 months were/was you/anyone in your household evicted from your home or apartment for not paying rent or mortgage? X X X X4 X X X3 X X
Are conditions in your home undesirable enough to move?       X4          
Other Non-SIPP Questions  
Has there been a time when you couldn't afford a place to stay or when you couldn't pay the rent?               X X2
Have you been homeless since {date left welfare}?             X    
1 This is the only study that used data from the 1996 SIPP. All others used data from the 1992 and 1993 SIPPs.
2 Question used a two year recall period and was not asked of homeowners, since it was assumed that almost all homeowners should be able to make their monthly housing payments and not suffer evictions. Homeowners were coded as "no" in scale.
3 Asks whether this occurred since date left welfare.
4 Lerman (2002a) uses a combined indicator in his hardship index  "Evicted OR Home Undesirable Enough to Move."

Medical and Health Insurance Hardships

Three types of medical and health insurance hardship indicators were included in the material hardship indexes we reviewed: access to needed medical care; access to needed dental care; and health insurance coverage. All but two of the studies  Federman et al. (1992) and Lerman (2002a)  included at least one of these indicators in their hardship indexes.

All of the studies that include a medical need indicator used a measure similar to that included in the 1996 SIPP to describe whether a household has access to needed medical care: whether there was a time when anyone in the household needed to see a doctor or go to the hospital but did not go. (Exhibit 3.4) Rector et al. (1999) added a second condition to this measure when constructing their hardship indicator: lack of health insurance. That is, households were not considered to have an unmet medical need unless they also did not have health insurance. This additional condition is intended to account for the fact that the SIPP measure does not identify a cause for the unmet need. For example, someone in a household might not go to a doctor when they needed to go for reasons other than those related to material hardship. Similarly, Mayer and Jencks (1989) added an insufficient resource condition to their unmet medical and dental questions. While incorporating these types of additional conditions into unmet medical need indicators may improve their usefulness as an indicator of material hardship, it makes it difficult to compare estimates of medical need hardship across studies. Bauman (1998) and Short and Shea (1995) also included a dental need indicator in their index. Chapter 4 includes further analyses of the SIPP measures on unmet medical and dental needs.

Edin and Lein (1997) and Mayer and Jencks (1989) used a combined indicator in their index that captures households that had either an unmet medical need or unmet dental need. The dental need measure used by these studies is very similar to that included in the 1996 SIPP.

Three studies - Danziger et al., (2000), Edin and Lein (1997), and Mayer and Jencks (1989 - included non-SIPP health-insurance related indicators in their hardship indexes. Danziger et al. (2000) included two separate indicators  one for adults without health insurance and one for children in a household without health insurance. In contrast, Edin and Lein (1997) only looked at the adult respondent and Mayer and Jencks (1989) included any household member. The measures used in these studies cannot be compared to those included the 1996 SIPP analyses presented in Chapter 4.

Including health insurance-related indicators in material hardship indexes, however, may be problematic. It is unclear whether the absence of health insurance is describing a construct different from access to medical care. To the extent that these indicators describe the same construct including them both in a hardship index may be problematic. For example, while lack of health insurance coverage can certainly bring about health care-related hardships, there is a question as to whether not having coverage in and of itself constitutes a hardship; instead, this might be considered a "crude," or indirect, indicator of access to needed care (Kirby & Kennedy, 2001). However, Rector et al., (1999) note that "lacking insurance is not the same as lacking health care; in fact most uninsured persons receive medical care when needed" (p. 370). Furthermore, Mayer and Jencks (1989) found that "a family's not having a member with no health insurance correlated only 0.20 with having been able to afford medical care, but it had a strong effect on respondents' assessments of their standard of living" (p. 96). This suggests that a health insurance coverage measure may describe something other than health care-related hardship.

 

Exhibit 3.4
Questions Used to Construct Medical Care and Health Insurance Indicators
Items from the 1996 SIPP (All Questions Included in the 1992 SIPP) Studies Using SIPP Data Studies Using Non-SIPP Data
Bauman (1998) Beverly (1999) Federman et al. (1992) Lerman (2002a)1 Rector et al. (1999) Short & Shea (1995) Danziger et al. (2000) Edin & Lein (1997) Mayer & Jencks (1989)
In the past 12 months, was there a time you/anyone in your household needed to see a doctor or go to the hospital but did not go? X X     X2 X X4 X5 X3
In the past 12 months, was there a time you/anyone in your household needed to see a dentist but did not go? X         X   X5 X3
Other Non-SIPP Questions
Adult respondent did not have health insurance             X X  
Child(ren) in household did not have health insurance             X    
Is everyone in your household covered by health insurance such as Medicare, Medicaid, Veteran's benefits, Blue Cross, Prudential, an HMO, or any other program?                 X
1 This is the only study that used data from the 1996 SIPP. All others used data from the 1992 and 1993 SIPPs.
2 Only included households in index who had an unmet need and did not have health insurance.
3 Only included in index if the unmet need was because of "lack of money."
4 Includes separate measures in index for mother having unmet need and child(ren) having unmet need; reference period was "since left welfare."
5 Combines doctor and dentist into one measure in index; only includes if unmet need is due to lack of insurance or money.
6 Reported in index as "no health benefits."

Difficulty Affording Utility Bills

Absent basic utilities such as gas, electric, water and phone, families may not have necessary heat, hot water, air conditioning, lights or cooking facilities, or key means of communication (Beverly, 1999a).

All but one of the studies' hardship indexes included the following utility shut-off indicator in its hardship index: whether or not a household had experienced a gas or electricity shutoff, or an oil company had not delivered oil. (Exhibit 3.5) Beverly (1999a) constructed her indicator using two SIPP questions: the shut off question described above and a second question that determined whether a household did not pay the full amount of its gas, oil or electric bill in the last 12 months. Households that responded "yes" to either or both questions were identified as having a utility-related hardship. Bauman (1998), Rector et al. (1999), and Short and Shea (1995) included a separate indicator of whether a household did not pay the full amount of their utility bills in the last 12 months in their hardship indexes.

Both the shut-off measure and the unpaid bill measure are included in the SIPP. However, it is unclear to what extent there is overlap between these two measures. For example, it is not unlikely that those households that did not pay the full amount of their utility bills also would be those that were refused service. If this is the case, it may be that using these measures as separate indicators in a hardship index could be "double counting" the level of a households' material hardship.

Six of the studies included an indicator of whether a household had lost phone service in the past year because it did not pay the bill in their hardship index; Lerman (2002a), Edin and Lein (1997), and Mayer and Jencks (1989) did not. The telephone disconnection measure is included in the 1996 SIPP.

Chapter 4 presents additional descriptive analyses of the utility shut-off, unpaid utility bill, and telephone disconnection measures that are included in the 1996 SIPP.

 

Exhibit 3.5
Questions Used to Construct Utility-related Hardship Indicators
Items from the 1996 SIPP (All Questions Included in the 1992 SIPP) Studies Using SIPP Data Studies Using Non-SIPP Data
Bauman (1998) Beverly (1999) Federman et al. (1992) Lerman (2002a)1 Rector et al. (1999) Short & Shea (1995) Danziger et al. (2000) Edin & Lein (1997) Mayer & Jencks (1989)
Time in past 12 months when did not pay the full amount of the gas, oil, or electricity bills X X6     X4 X      
Time in past 12 months gas or electricity company turned off service or the oil company did not deliver oil X X6 X X X5 X X X X3
Time in past 12 months phone company disconnected service because of late payments X X X   X5 X X2    
1 This is the only study that used data from the 1996 SIPP. All others used data from the 1992 and 1993 SIPPs.
2 Indicator worded as, "Phone disconnected or gone without a phone because could not pay bill"; reference period of "since left welfare."
3 Uses 24 month reference period.
4 Included in analysis as "Threshold indicator."
5 Included in analysis as "Moderate Material Problem."
6 Reported as a combined measure  "household did not pay full amount AND "household's gas or electric service was disconnected."

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