3.1. Quantitative Results
Participant demographics are available in
Table 1. Participants commonly originated from Asia (49%), the Middle East (28%), Africa (12%), Latin America (4%), Eastern Europe (4%) and Western Europe or United States (3%). Although 79% of all participants were in the low- or middle-income categories, a higher proportion of refugees (92%) were in these categories compared to immigrants (65%). In addition, refugees more commonly had lower levels of education.
Food security status was determined at both the household and child level. As per
Table 2, 50% of participant households experienced food insecurity, with 18% being marginally food insecure, 26% being moderately food insecure, and 6% being severely food insecure. Forty-one percent of children were food insecure with 16% being marginally food insecure, 24% being moderately food insecure, and 2% being severely food insecure.
Significant predictors of household food security included length of residence in Canada and parents’ education level (
Table 3). Recently arrived newcomer families and families that included parents that had completed high school or some years of postsecondary training were at high risk for household food insecurity compared to families that included parents that had not completed high school or had a university degree. Similarly, at the level of child food insecurity, children who were part of families who have more recently arrived or had parents that had completed high school or some years of postsecondary training were at high risk for food insecurity.
Children’s mean energy density and macronutrient composition did not significantly differ in relation to household food security status among most age groups (
Table 4). However, food-insecure children aged 4–8 years consumed a lower proportion of energy from protein, which was replaced with energy from carbohydrate, compared with the food-secure children. Children’s consumption of servings from the different food groups did not significantly differ in relation to household food security status among all age groups, except for milk products consumption among the 4–8-year-old group (
Table 5). However, in more than half of the measurements, food-insecure children consumed a lower number of average servings than food-secure children. In regards to prevalence of inadequacy for select nutrients, food-insecure children experienced a higher level of inadequate nutrient intake, such as vitamin D and calcium, than food-secure children in 75% of the measurements (
Table 6). Significantly more food-insecure children in the 4–8-year-old group consumed inadequate amounts of vitamin B
12 and calcium, while significantly more food-secure females in the 9–13-year-old group consumed an inadequate amount of iron.
3.2. Qualitative Results
All participants were either parents of children between the ages of 3 and 13 years or newcomer service providers. Interviewees included parents from 19 distinct family units, made up of 15 mothers and 7 fathers, and 13 immigrants and 9 refugees. Both the mother and father participated as a couple in 3 cases. Participants were from the Middle East (8), Asia (6), Africa (2), Latin America (1), Eastern Europe (1), Western Europe (2), and the United States (2). The vast majority reported low incomes. In contrast, families from the United States and Western Europe reported high incomes, while one Middle Eastern and one Latin American family reported middle incomes. Service providers were not asked to provide demographic information.
Although many newcomers were reluctant to comment on not having sufficient access to food, a few refugees mentioned changes in food buying habits related to decreases in income and trying to stretch food a little further. A Saskatoon refugee from Asia (R1) shared, “…they (children) do drink milk and when we used to get assistance from the government we used to buy big gallons, now we are on our own so we buy in 1 liter cartons.” Similarly, another Saskatoon refugee from Asia (R2) commented, “The family shops mostly weekly…the children eat whenever they want…and dad cannot provide the amount they want to eat. It is expensive and dad’s budget is $600 to $700 per month so dad tells kids it is OK to eat, but make it available for the next day also, so eat in a controlled way.” A Saskatoon refugee from the Middle East (R3) clarified, “Before they gave us a few hundred dollars for food so it was pretty good…we bought good things…the government gave us an allowance when we first came, but then after it is done some people have problems with having enough money for food. When we came they gave us a good amount to buy what we needed for the house, furniture. Only the first 2 months felt like we had enough money and then after that it was difficult. After that we only had a small monthly amount.” However, none of the immigrant families mentioned any difficulties with food security. A Regina healthcare provider (HC1) added further perspective, “…some families can’t afford to have red meat. They may afford to buy pasta, white bread and potatoes, things that are cheap to cook for them.”
For some newcomers, food security was balanced by the need to make prescription drug and hygiene product purchases not covered by benefit programs. The son of a Saskatoon refugee from the Middle East (R3) shared, “When the ear pain was really bad we had to buy the medicine after 2 days when the child tax credit came. My mom never ever uses our money except for food, but it was really important, she had to because it hurt a lot.” A Saskatoon immigrant service provider (SP1) further explained, “… $255 (adult) living allowance…a female she needs feminine stuff, she cannot buy anything extra…even if she needs to buy Tylenol, Advil, $9, $10, $11 from this, she wants to buy lotion, shampoo, everything comes from this $255. So they have to use at least one of the child’s tax benefit to buy those things, so they want to feed the children to fill their stomach, not vitamin C and D…they cannot.”
In some cases, insufficient prescription drug benefits impacted food security over the long-term for those with chronic health conditions. An immigrant service provider (SP1) described her client’s situation:
I have a client, mother and son with HIV. HIV medication is very expensive and she has to pay 2% and the 2% for her and her son she was paying $149 every month…so she is paying from her food allowance $74 and her son is paying from the child tax benefit $74 every month. The price of the drug is close to $1,400, very expensive medication…the doctor is always telling her healthy food and activity. She says if I pay $75 every month from my food budget, where I will get the money to eat healthy food? She is eating lentils and enjera…Also chickpeas, all vegetarian, cabbage, potato, because there is not enough money…She gets $40 extra for food, and only if the doctor writes a note for good nutrition…From $1,400 she is paying not even 2%, its 1%, but 1% according to the scale of amount is a lot for her. Why they don’t forgive 1%?
Although government-sponsored refugees can generally depend on some support through social assistance and drug benefit programs immediately upon arrival, immigrants do not have the same access to all these supports. When they arrive, they are expected to have enough money in their bank account to support themselves for at least 6 months until they can find work, so they are not eligible for social assistance and they are often not aware of health benefit programs when they first arrive. A Saskatoon immigrant service provider (SP2) commented, “With immigrants…if they are coming through the economic class they are expected to have about $12,000 to $15,000…in their bank account. This is about enough for surviving about 6 months, but the reality is there is always the fear of running out of money…a lot of parents…who sacrifice…eating healthy, because…they have a very limited bank account and they are scared of running out of money.”
In addition to prescription medicine, refugees encountered financial pressures related to repayment of transportation loans provided by the Government of Canada that impacted their food budget. A Saskatoon immigrant service provider (SP1) stated, “…they have to pay back their transportation loan…a family of 4…it costs them close to $7000…and they have to pay that out of their food, the $255 living allowance. The government starts taking that back right away, 3 or 4 months after they arrive.”
In addition to income limitations, children’s food security can be affected by the school food environment if children feel uncomfortable eating their lunch at school. The school environment can have a profound effect on a newcomer child’s daily dietary intake. A Saskatoon immigrant service provider (SP3) noted:
There was a family…the mother is always giving him (son) sandwich…and after a year…under the stairs of the apartment it was smelling bad …and then they found it under the stairs, the food was there for the whole year…he told them ‘I don’t want to eat lunch because the sandwich is not good. When I taste it from other kids it tastes so good…I don’t like your sandwich.’
When contacted to ask about food security initiatives for newcomers, the Regina Food Bank advised that 6% of their clients who collect food hampers self-identified as newcomers to the community. They described how they make efforts to lower barriers for newcomers to access their services by accepting confirmation of permanent residency documents in place of the normally required Saskatchewan Health Card as proof of residency, as well as providing ongoing services for a one year period following initial intake before having to meet with a client intake worker again. In collaboration with other immigrant serving organizations, the Regina Food Bank stated that they have branched out to providing training of interest to newcomers through their Adult Centre for Employment Readiness and Training (ACERT). They have offered English as a Second Language, Workplace Essential Skills for Newcomers, computer training, job search workshops and Nutritional Leadership Cooking training programs. The Nutritional Leadership Cooking program provides basic instruction on healthy, affordable food selection and preparation. In 2013, about 60% of ACERT clients self-identified as an immigrant or refugee. In addition, the Regina Food Bank is part of a Newcomer Food Security Group with other community partners. This group meets about four times a year to discuss newcomer food security issues and to plan activities that support newcomers.