8. Homeless Youth, Nutritional Vulnerability, and Community Food Assistance Programs

Naomi Dachner, Valerie Tarasuk

Introduction

Nutrition is an aspect of homeless youth’s vulnerability that has received little attention in discussions of interventions. This chapter begins with a brief overview of the nutritional vulnerability of homeless youth in Canada, drawing on the results of our research with youth in Toronto. We then examine youth’s strategies for getting food, with a particular focus on their interactions with and experiences of food assistance programs in the community. Finally, we draw on data from a recent inventory of charitable food services in five Canadian cities to examine the operations of youth-focused food assistance programs. This description of current food assistance initiatives, considered together with our understanding of the food and nutrition needs of homeless youth, provides a foundation for some recommendations for policy makers and program directors.

Nutritional Vulnerability and the Health Consequences

Problems of food access and food deprivation among homeless youth in Canada have been widely documented, but our 2003 study of homeless youth in Toronto remains the only study in Canada to quantify the effects of homelessness from the perspective of nutrition (Li et al., 2009; Tarasuk et al., 2005). We recruited 261 youth (112 female, 149 male), 16 to 24 years of age, experiencing absolute homelessness. Youth were recruited from drop-in centres and various outdoor locations, and had spent 10 or more of the past 30 nights sleeping in a temporary shelter, indoor or outdoor public space, or a friend’s place, because they had no place of their own.

Participants were interviewed when recruited and invited to meet for a second interview three days later or as soon thereafter as possible. Seventy-five percent of the participants completed second interviews. At the first interview, participants were asked what they had eaten in the past 24 hours, completed a questionnaire on current living circumstances and nutrition- and health-related behaviours and had body measures taken. In the second interview participants again reported what they had eaten in the past 24 hours and answered a brief questionnaire on current living circumstances. Twenty-five youth then participated in semi-structured, open-ended interviews designed to explore the social and symbolic meanings of food and strategies for getting food.

Most of the youth we interviewed were failing to meet their basic requirements for vitamins and minerals (Tarasuk et al., 2005). Over half were not getting enough folate, vitamin A, vitamin C, zinc, and magnesium. Additionally, more than half of the young women in the sample were lacking in iron and vitamin B-12. About one-quarter of youth consumed too little protein to meet their requirements. Youth were also simply not getting enough food to provide energy. On average, the level of energy (i.e., calories) in their diets was enough to support a very inactive lifestyle, but fell well below the level of energy needed for someone engaged in more physical activity (Tarasuk et al., 2005). Although we did not measure physical activity levels in this study, most youth would likely have fallen into the middle or upper range of activity levels, given their living conditions (see Tarasuk et al., 2005).

Adolescence is an important period of nutritional vulnerability. It is associated with increased nutrient requirements for growth and development, with a lack of certain nutrients having the potential to impact health over the lifespan (e.g. calcium and the risk of bone fractures later in life) (Mesias et al., 2011). Thus, the health consequences associated with nutritional inadequacies are profound. Chronically poor nutrition is associated with impaired function and increased risk of infections. Further, poor nutrition can pose problems in pregnancy and worsen health conditions such as depression, substance abuse, hepatitis C, hepatitis B, HIV, and other sexually transmitted diseases – all of which are common among homeless youth in Canada (Boivin et al., 2005; Frankish et al., 2005; Haley et al., 2004; Kulik et al., 2011).

The extreme nutritional vulnerability of the homeless youth we interviewed was a result of two things: i) the poor nutritional quality of much of the food they consumed, and ii) the food deprivation that many homeless youth endured on a fairly regular basis. Homeless youth’s diets failed to meet the minimum recommendations outlined in Canada’s Food Guide (CFG), and their eating patterns were nutritionally inferior to those of young adults in the general population (Li et al., 2009). The youth consumed few milk products, fruit and vegetables, and their average consumption of meat and meat alternatives fell far below CFG recommendations for this food group. The youth also fell short in their consumption of whole grains, dark green and orange vegetables, fresh fruit, and leaner meat or meat alternatives; greater consumption of these foods is recommended because of their particular nutritional benefits (Health Canada, 2007; Katamay et al., 2007).

Almost all of the homeless youth that we interviewed did not have access to enough food over the past month, but for 43% of females and 28% of males, the barriers to food access were so severe as to result in chronic food deprivation over this period (Tarasuk et al., 2009). For 10 or more days in the past 30, these youth had reduced their food intake, including going completely without food, in some cases for whole days at a time, because they had no money for food. As one might expect, there were fewer overweight and obese youth among our sample of homeless youth than among youth in the general population. A few males exhibited muscle wasting, suggesting serious levels of chronic food deprivation (Tarasuk et al., 2005). Although some of the youth we interviewed had high levels of drug and alcohol use, this was not enough to explain the nutritional vulnerability we documented (Tarasuk et al., 2005). Even youth who were not using drugs or alcohol had inadequate energy and nutrient intakes.

Food Acquisition Strategies 1

The extraordinary nutritional vulnerability of homeless youth was rooted in the inadequacy and insecurity of the strategies they used to acquire food (Tarasuk et al., 2009). Purchasing food was the most common way for youth to get food. However, no one could afford to purchase all of the food they needed. Most of the youth we interviewed did not receive social assistance benefits or a regular salary. They depended instead on panhandling and other forms of ‘work’ in the informal economy (e.g. odd jobs such as snow removal and construction site cleanup); and to a lesser extent, on theft and sex and drug trade work to get cash. The money they made by these means was limited and highly challenging; 48% reported that the police had recently stopped them or tried to stop them from making money (Gaetz et al., 2006). Thus while 75% of youth bought at least some of the food they consumed in the course of a day, most also obtained food through other means, including the use of charitable meal and snack programs and receiving food from other people (friends, passers-by, etc).

On any one day, about half of the youth in the study got food from charitable meal or snack programs, and in the course of a week, 88% of youth made some use of charitable meal programs. It was the second most common strategy for getting food (Tarasuk et al., 2009). Youth were most likely to eat food in drop-in centres or get it from outreach vans, but about one-third of males and one-quarter of females also ate in soup kitchens occasionally. Almost no one reported using food banks, a finding that likely reflects homeless youths’ lack of cooking and storage facilities and resulting need for ready-to-eat food, but may also speak to the policies and practices of some food banks, such as requiring identification or proof of income or address that homeless individuals may not have.

Despite homeless youth’s frequent use of charitable meal and snack programs, we found that using these programs had minimal impact on youth’s overall nutrition (Tarasuk et al., 2009). While young men who relied more heavily on charitable programs for their food tended to have higher intakes of some nutrients, there was no evidence that greater use of meal and snack programs resulted in higher energy intakes overall. Neither the quantity nor the quality of young women’s food consumption was linked to their use of meal and snack programs.

In addition to youth’s lack of money, their homelessness limited the kinds of food they could buy, causing them to rely on fast food and pre-packaged snacks (e.g. chips, chocolate bars and pop) (Li et al., 2009). While the food obtained from charitable meal programs appeared more varied than food youth bought themselves, it was not clearly nutritionally superior to what youth purchased themselves.2 Moreover, youth’s use of charitable meal and snack programs did not affect the probability of them reporting going hungry and not being able to get enough to eat.

While it might seem counterintuitive that homeless youth who eat meals in charitable food assistance programs do not benefit nutritionally and that such programs do not prevent the youth from going hungry, the explanation for this finding lies in the accessibility and quality of charitable food assistance programs available to homeless youth. The findings from the in-depth interviews with 25 (12 females, 13 males) youth, elaborated below, offer an understanding of charitable meal programs in the context of homeless youth’s lives and highlight, from youth’s perspectives, the problematic nature of obtaining food this way.

The Experience of Obtaining Food from Charitable Meal and Snack Programs

The youth who participated in in-depth interviews pointed out problems related to program access, the quality and quantity of food served, and the atmosphere of community food programs. They expressed a certain amount of frustration about having to navigate a landscape of community food programs that operated on an unreliable, sometimes unpredictable schedule, and served food of varying quality. At the same time, they showed an understanding of the limitations of the charitable food services they received, and many even appeared resigned to these conditions.

By and large, youth preferred to purchase their food rather than get it from charitable meal programs. Purchasing gave them the choice of when, where, and what they ate, allowing them to maintain their independence and choose foods they liked. Personal choice was sacrificed in charitable programs. Getting charitable food meant “you eat what’s served or don’t eat at all” (Lisa). 3

“Well if I have money I’d rather buy food ‘cause you can just buy what you want, right. You don’t have to go wait in a line for it, or you don’t have to go ask for it. You just buy food and it’s yours and you can eat it.” (Dave)

While the frequency with which some youth used charitable meal programs suggests that it was a routine occurrence for them, most study participants used programs only when they did not have any money for food.

“I don’t like eating in the [community programs]. I like, you know, going out and buying something, even if it’s just a buck for Kraft dinner.” (Ken)

“When I have no money and I haven’t made anything panhandling, [a food program] is where I go to eat if I’m hungry.” (Mark)

Program Access

Youth’s descriptions of their use of charitable meal programs suggested that the schedules of individual meal programs were limited, irregular and sometimes changed with little warning.

“[Program A’s] usually open until 8:00. And there’s food there too. But, they’re only twice a week. And this week they were closed. They closed for like renovations or something. So, it totally screwed everybody this week because, you know to go all the way down there and then they’re not open.” (Nicole)

“…The last two times that I’ve walked there, they were closed. … It was a Tuesday and I forgot about the different hours on Tuesday. And, they closed at 1 p.m. instead of opening again at 1 p.m.” (Anita)

Access to meal programs was particularly limited on the weekends, as most youth were quick to point out.

“[On the] weekends you can’t find food anywhere. [F shelter] is closed on weekends. [D drop-in] is closed on weekends. [G drop-in] is closed on weekends. Like the community centre has food on Sundays in the winter. But like on Saturdays, it’s like they don’t want homeless people to eat or something.” (Chantal)

At times when no food programs were available, it was necessary to find ways to get money for food. As Dave explained:

“[I’ll panhandle] if I have to, if I need to eat something. Yeah, ‘cause I know the [outreach] van doesn’t come on Sunday nights. And Saturday [there’s no food programs], you sit and pan and hope, hope that somebody will give you something.”

Thus, youth used charitable programs when they lacked money to purchase food, but they also worked to raise money when they were unable to get food from programs.

Food Quality and Quantity

The quality and quantity of meals served at programs was variable and unpredictable, depending on the food supply on the given day and the staff available to prepare it.

“Some days they’ll have some really good food – Like they’ll have actual Shepherd’s pie. And I’ll be like, yeah. I’m taking three of those! And I’ll put them on my plate and eat them. But other days, I don’t eat.” (Anita)

Not all meal programs were described in negative terms. Youth also came across excellent meals.

“[At Z shelter] it was like a home cooked meal kind of thing. Like they had roast beef, potatoes, mixed vegetables, salad. … And it was well prepared, well cooked. It was good for you. It was a good healthy meal. Not like hot dogs and French fries or something like that. Actually, X drop-in is pretty good too. They’ve got some good food there. I had a well-balanced meal…hot food. Everything was cooked well. It tasted good. I had a little bit of everything. You know I felt good after eating it.” (Ken)

Unfortunately, youth were only able to obtain meals at the shelter described by Ken one day per week and only during the winter months.

Youth seemed to understand that sometimes the demand for food was greater than the food supply and the agencies’ capacity to serve.

“Some places are stingy with the food, some places aren’t. Like, you don’t always get a lot on your plate. And then they might not give you seconds. But I suppose they’re all trying to ration because there are a lot of homeless people.” (Ryan)

Beggars Can’t be Choosers

Given their constant need for food and shelter and the limited options available to them, youth regularly found themselves with no choice but to seek assistance from programs that were accessible – whether they liked the programs or not. Youth seemed used to receiving food of variable quality and quantity, in settings that were sometimes crowded and unpleasant. Interestingly, they often acknowledged that the offerings at charitable food programs were in some ways a result of the limited resources in these programs, coupled with the high demands for food assistance.

“Program J is pretty good because they give you a lot [of food], but there’s not much room to sit and eat. And sometimes you’re sitting by a person who smells. But, I’ve been smelly too with being outside all the time.” (Ryan)

The experience of getting food from charitable programs could be frustrating and time-consuming because demands for food sometimes exceeded the amount that had been prepared, and program workers were left scrambling to feed people.

“[At churches, in general] there are long lineups. And they only have a certain amount of food. And then they have to cook more. So you have to wait. Then the lineup, and then there’s no more food so you have to go sit down and get back in the lineup when they say ‘okay, food’s there’. I have enough aggravation in my life. I don’t need that on top of it.” (Scott)

Homeless youth’s desperate circumstances ultimately made them dependent on programs they disliked or were uncomfortable going to in order to meet their basic needs. Like homeless people in other studies (e.g., Evans & Dowler, 1999), several youth in this study used the phrase “beggars can’t be choosers” to express their feelings about getting food in these situations. Despite the limitations of food programs, many youth were grateful for charitable offerings since, at times, they relied on this food.

“I can’t complain about the food because it’s free. Free food is free food…beggars can’t be choosers.” (Tony)

Food, Only One of Many Unmet Needs

Although the focus of our research was homeless youth’s experiences obtaining food from community programs, the participants repeatedly expressed an appreciation for community programs that were able to offer them choices and comfort and address multiple needs with supportive, compassionate staff.

“I come here because the staff are cool and all my friends are here [not only for the food]. I come every day just to keep warm and hang out with friends.” (Anita)

While the need for food was sometimes most urgent, getting food was not always the priority; youth sometimes ate in programs where the food was considered substandard or undesirable because they could meet additional needs at these places. Youth tended to seek out and spend time at multi-service programs that allowed them to make use of facilities in a number of ways (e.g. socialize, acquire food, shower, and obtain support services).

Youth valued opportunities for choice while attending programs, and this extended to the ways in which meal programs operated. In some instances, where the meals were of high quality and the atmosphere was pleasant, youth enjoyed being served at tables (as was the case with the weekly meal served at shelter Z, mentioned previously). But, in general, youth appeared to prefer programs that offered opportunities to actively participate in the process of food selection and preparation.

“Sometimes the van will just put out the bread and all of the stuff and you make your own [sandwiches]. That’s cool.” (Lena)

The few programs that offered a self-service or buffet style of food delivery stood apart from most of the meal programs that youth frequented, where they simply ate whatever food was presented to them. Programs that allowed youth to serve themselves enabled them to choose what they ate, and how much they ate.

“[D Drop-in’s] good. They had different kinds of soups and chili. Then they had bread, mayonnaise. Everything’s all out. We can just make as many sandwiches as you want. You got like tuna, roast beef.” (Ken)

Many of the youth who frequented one particular drop-in with an open kitchen, where people could prepare and store food, appreciated the opportunity to make their own meals.

“[At C drop-in] you don’t have to wait in a line for [food]. Or you don’t have to ask for it. You just buy food and it’s yours and you can eat it. You can actually buy your food and they have a kitchen. They’ve got all the pots and pans. And they’ve got things like butter and milk. So a lot of the times I just buy Kraft dinner and go to C drop-in and cook it.” (Ken)

In summary, our research indicates that homeless youth are nutritionally vulnerable and lack adequate, secure food access. While the charitable meal and snack programs offered by community agencies provide some assistance, navigating this system is complicated by infrequent hours of service, limited and somewhat unreliable meal offerings, and youth’s desire to maintain as much choice as possible and to meet other needs in their lives. To more fully understand youth’s criticisms of community-based charitable food assistance programs and identify opportunities for improvements, it is necessary to take a closer look at these programs. In the section that follows, we draw on data from our recent study of the organization and delivery of food assistance programs in five Canadian cities to examine the nature of food assistance programs available to homeless youth and identify opportunities to strengthen this system of front-line supports.

Charitable Food Assistance Programs for Homeless Youth

In 2010-2011, we examined charitable food assistance programs in Halifax, Quebec City, Toronto, Edmonton and Victoria. Our goal was to chart the full scope of charitable food services in each city and to assess each city’s capacity to recognize and respond to local problems of unmet food needs. We began by developing comprehensive lists of agencies and organizations running charitable food assistance programs in each city, including food banks as well as agencies offering meals and snacks free or for a small charge. We then conducted a telephone survey with each consenting program director to obtain data on their operations. The survey was designed to obtain information about the nature and scope of the agency’s food program(s) and included questions about the program’s history and goals, hours/days of operation, staffing, food supply, sources of funding, and capacity to respond to need. Interviews took between 20-40 minutes to complete.

In total, we identified 617 agencies providing food assistance and conducted surveys with 517 of them (84%). The options for food assistance in youth-focused programs are very limited.

Only 19 agencies had food assistance programs specifically targeted to homeless youth – 2 each in Edmonton and Halifax, 3 in Victoria, 5 in Quebec City, and 7 in Toronto. Seventeen of these 19 agencies served meals to homeless youth, and two (both in Quebec City) provided groceries to youth through outreach programs. Three agencies operated outreach programs targeted to homeless youth, providing meals from mobile units (vans), and another was a church that provided a single hot meal to youth in Toronto through the winter months. The other 13 agencies providing meal services for homeless youth were drop-in centres that provided multiple types of services, such as employment, immigration, recreation, housing/shelter, and addiction recovery. Two were arts-based initiatives, seven were connected to larger organizations (five ran out of youth shelters, one was part of a larger LGBTQ centre, and one was part of a church), and four were independent youth drop-in centres with a general focus on supporting homeless/at-risk youth.

Below we examine the food assistance programs operated by these 19 youth-focused agencies in more detail, considering the scope of their operations, resources, and apparent capacity to respond to youth’s food needs.

Scope of Operations

Although there were some meal programs identified in our inventory that charged clients a small fee for food, all of the meals in the agencies targeting homeless youth were free. In all cases, meals were provided together with the delivery of other services and supports. All agencies provided youth with access other services, most (17) provided counseling, and 11 were engaged in advocacy. In the two multi-service agencies in Quebec City that delivered groceries to homeless youth through street outreach, workers spent time developing rapport with youth and providing referrals to other services, as well as clean needles and condoms.

Most agencies were delivering food assistance in ways that enabled youth to exert some choice over what they ate. Two of the agencies surveyed had facilities for youth to store food and prepare their own meals: one provided free access to a microwave, toaster oven, fridges and a pantry, and another allowed youth to make use of a full kitchen to prepare any food that they brought in. Five other agencies had self-service buffets. In most other agencies, food was served cafeteria style, but two agencies served food to people seated at the table. Most agencies permitted clients to have second helpings of food, if the food was available and requested.

Except for two of the meal programs that were operating within shelters, there were no agencies serving meals on a Saturday, and only four other programs serving food on Sundays. Most programs operated on weekdays, but even then, some agencies provided meals on one or two days of the week. The size of meal services also varied dramatically. At one end of the spectrum was a meal program operating in a shelter serving upwards of 2,000 meals per day, each day of the week; however most of those meals would have been consumed by shelter residents and not by the small number of youth ‘off the street’ who were allowed to eat there. At the other extreme was an agency providing 8 youth with food each weekday, but none on weekends, and a church that fed 115 youth dinner on Tuesdays during the winter. On days when they did serve meals, only two agencies routinely made food available to youth throughout the day, allowing them to eat without following a rigid schedule of meal times. Other agencies offered meals at particular times of the day, most commonly over the lunch or dinner hour; only six agencies served breakfasts.

On days when programs were not in operation, youth could have found charitable meals at other locations (e.g., meal programs that were not targeted to homeless youth but open to anyone). However, a similar, steep drop in meal services on weekends was observed among these meal programs. Moreover, in most cities, there was little evidence of coordination between service providers to ensure consistent levels of food access from one day to the next.

Agencies received funding from a variety of sources including the municipal, provincial and federal levels of government; non-governmental organizations (e.g. the United Way); and private donations from individuals, foundations and organizations. Most of the funding that the food programs received was shared across a number of programs within the agency; only seven of the agencies reported having secure (core) and dedicated funding specifically for their food program. For the most part, the sources of these dedicated funds were private (e.g., annual donations made by individuals, annual fundraising drives, and a charitable foundation), but the youth-focused agencies in Quebec City also reported dedicated public funding. In addition, 13 agencies did fundraising to get money and/or food to support their meal programs.

Although all but two agencies had paid staff working in the food programs, most agencies also relied on volunteer labour. Given their precarious funding situations, it is not surprising that agency food supplies were a mix of purchased and donated food; 11 agencies purchased half or more of the food they served, but the others relied more heavily on donations. Thirteen agencies were linked to a central collection centre in the area that gathers food from industry and public donations, and for 10 agencies, central collection centres contributed more than three-quarters of the donated food they served. In addition, 12 agencies solicited food donations from local businesses (e.g. Tim Horton’s, Starbucks). Much of the food donated by retailers and manufacturers is food they cannot sell because it is nearing expiry dates or is imperfect in some way (e.g. as a result of manufacturing errors or damage during shipping, handling, and storage). Not surprisingly then, nine agencies reported that they sometimes received donations that were inedible, and two agencies said this happened often. The reliance on donated food shaped meal planning and preparation, as the quantity, quality, and variety of food donated was often highly variable, unpredictable, and largely outside the control of the meal providers.

Eleven agencies reported that their meal services were guided by nutrition standards, but we did not assess the nature of these standards. It should be noted, however, that many agencies had difficulty consistently sticking to their meal plans because of supply constraints. Most agencies (83%) said that the people they served needed more food than they provided. About half of the agencies said they sometimes had to serve unplanned items because they were running low on food. Seven agencies sometimes had to reduce portion sizes and eight sometimes had to serve less of a variety of foods because of supply constraints. Five agencies sometimes turned people away, four sometimes shortened their hours of service, and two said they sometimes prioritized who would get to eat because they had run out of food.

It is interesting to note that most of the agencies surveyed had been providing food assistance programs for many years. Thirteen agencies had started running food programs sometime before 2000, and only one agency had started providing charitable food since 2005. This suggests that the operations we are describing are relatively well established. The potential for improvements to the charitable food services documented here is limited by agencies’ lack of resources. Three-quarters of youth-focused agencies said they would expand their food services if they could, but were prevented from doing so by a lack of resources, food supplies, and staff support.

Implications of this Research

Three key implications for policy makers and service providers emerge from our work:

1. Food needs to be an integral part of programs for homeless youth. As long as youth are unable to earn enough money to purchase the food they need, then there is a critical role for community-based agencies to provide them with food. The basic need for food is not easily separated from the multitude of physical, social and psychological needs that homeless youth have, and given their stated preference to obtain food together with other services, it is important for food to be an integral part of service delivery in youth-focused agencies. While our data would suggest this is happening now, the meal services appear, in many instances, to be scheduled around other services, rather than being the priority. This means that meals may be offered when the agency is open (e.g., during the daytime, Monday through Friday), but not timed to enable youth to meet their food and nutrition needs on a daily basis.

2. Food programs must serve nutritionally adequate food and coordinate the scheduling of meal services. Helping homeless youth to meet their nutritional needs means offering enough nutritionally adequate food, on a daily basis. Recognition of the importance of nutrition is evident in the high number of agencies that have some kind of nutrition standards. However, none of the agencies we surveyed appeared to be operating meal services that were designed to enable youth to fully meet their nutritional needs on a daily basis. For agencies to achieve this goal, the scale of food provision needs to expand considerably. This requires expanded program resources. In addition to securing adequate facilities and staffing for such programming, funding is needed for food. The unreliable nature of what programs can obtain from donors works against them ever being able to offer a consistent standard of nutritionally adequate food. To support agencies in meeting nutrition standards and developing additional policies/practices for effective meal provision, program directors/coordinators could ask the expertise and assistance of local public health units.

In order for youth to meet their food and nutrition needs, the scheduling of meal services must also be coordinated to ensure that youth can obtain enough food, each day. To achieve this, agencies serving homeless youth must network with each other to determine what food is being offered by each agency and at what times throughout the day. They also need to consult with the youth using their services to understand the gaps in food access. Agencies could then coordinate meal provision to ensure access to three square meals, every day of the week. The existing networks and associations of agencies serving homeless youth provide an ideal opportunity for this type of coordination.

3. In delivering food, programs need to consider client participation. Our interviews with homeless youth also highlight the importance of offering food in a way that respects their individual preferences and desire for choice. This can be as simple as allowing youth to make their own sandwiches, but it can also extend to providing facilities for youth to prepare their own meals. Homeless youth would likely benefit from expanded programming that provides spaces for them to store and prepare food, ideally providing cooking equipment, cutlery, and dishes, and adding to the food youth are able to acquire with some staples (e.g., cooking oil) and condiments to facilitate meal preparation. Programs that facilitate independent food preparation dramatically expand the options for homeless youth, enabling them to make less expensive and potentially more nutritious food purchases, while at the same time fostering independence. This stands in stark contrast to the passive and sometimes demeaning experience of eating in charitable meal programs.

Conclusion

This chapter offers insight into the use and nature of charitable food assistance programs by homeless youth, from their perspective and that of the agencies that serve them. Many of the shortcomings related to program access and the quality and quantity of food served expressed by homeless youth in Toronto were also reflected in the results of our study of agencies providing charitable food assistance to homeless youth in five Canadian cities. By presenting the results from the two studies, we have sought to highlight both the problematic nature of obtaining food from charitable food programs and the aspects of these programs that appear to be helpful. Our results suggest three important areas for considerations: (1) addressing food needs as an integral part of programs for homeless youth; (2) providing nutritionally adequate food and coordinating meal services across programs; and (3) delivering food programs that include client participation. Our failure to facilitate more adequate food access for homeless youth has a negative impact not only on their nutritional health, but also on their social, psychological, emotional, and physical well-being.

Acknowledgments

The two studies that are the focus of this book chapter were funded by grants from the Canadian Institutes for Health Research (MOP-57755, MOP-102591).

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Endnotes

1. Detailed findings related to homeless youth’s ways of getting food have been published elsewhere (Tarasuk et al., 2009).

2. This observation is consistent with the results of a nutritional assessment of the meals served in 18 charitable programs in Toronto (Tse & Tarasuk, 2008). Although there was wide variation in the energy and nutrient content of meals both within and between programs, the levels of nutrients provided typically fell well below requirements.

3. Pseudonyms have been used to protect the anonymity of study participants.