Joan Costanzo, 63, clutched a ticket numbered 192 and a library book as she waited in the crowd gathered at a food pantry run by Feeding Hawaii Together.org in Kakaako.

She has been coming here to pick up free groceries for more than a year because she can’t afford to cover the bills although she works part time at Walmart and lives on her own boat in Kewalo Basin.

"A loaf of bread is $5, same as a gallon of milk," she said Tuesday, shaking her head, as her number was called and she filed in with another 100 people behind her.

Across the islands, 1 out of every 5 Hawaii residents depends on food aid from the Hawaii Foodbank and its network of agencies, a new report reveals. That’s well above the national average of 1 in 7 people relying on food banks and feeding programs.

The sobering figures are contained in "Hunger in America 2014," billed as the most comprehensive study to date of domestic hunger relief programs. It was conducted by Westat, a social science research company, and published Monday by Feeding America, a network of 200 food banks in all 50 states that is the nation’s biggest provider of charitable food aid to the poor.

"The results from this historic study are truly alarming," said Bob Aiken, CEO of Feeding America, based in Chicago. "Many of the people we serve struggle not only to get enough to eat, but also to keep a roof over their heads, the lights on in their homes, and to cover their health care and medicine costs."

In Hawaii, 123,000 households, made up of 287,000 residents, receive food assistance annually from the Hawaii Foodbank and its affiliates, according to the report. They include nearly 48,000 children and 46,000 senior citizens. The elderly made up much of the throng at the Kakaako pantry this week.

"We are helping the underemployed, the disabled, our elderly, that’s our biggest clientele," said Diana Lorenz, assistant director of Feeding Hawaii Together.org. "People that are living from paycheck to paycheck and having to make a decision on whether to pay rent or buy food."

The report showed that three-fourths of the households seeking food aid in the state had incomes at or below the federal poverty level, which was $27,000 a year for a family of four in Hawaii in 2013.

In most of the households, nearly 60 percent, no one had a job. Seven out of 10 of those households said that was because the breadwinner was either disabled or retired.

"I’ve worked all my life," said Elizabeth Faucett, a 53-year-old Kalihi Valley resident who suffers from arthritis and is now disabled. "It’s been a struggle for me. I use this program as a supplement to my food stamps that I receive, and I’m on Social Security."

She has been patronizing the food pantry in Kakaako for about four months, and appreciates the variety it brings to a diet that tends to be heavy on starches because they are cheaper.

"The produce really helps," she said. "They have potatoes, carrots, lettuce and some form of fruit. I’m really, really grateful to be able to come here."

About 30 percent of households surveyed for the report said they chose between paying for food and paying for utilities every month. Roughly the same ratio made the same tough trade-off between food and housing, or food and transportation each month.

The survey found that 73 percent of households receiving food aid in Hawaii bought the cheapest food available, even if they knew it wasn’t the healthiest option.

To meet the growing need, the Hawaii Foodbank has changed the way it operates over the years. It stretches dollars by buying food that isn’t retail grade in bulk at deep discounts and shipping it to the islands.

"We used to purchase maybe 1 to 2 percent of the food we needed," said Polly Kauahi, the foodbank’s vice president and chief operating officer. Last year, the charity bought 21 percent of the 12 million pounds of food it distributed, she said.

"We bring in a lot of produce that would not be able to be sold," she said. "We’ll get a container of potatoes or apples, onions or cabbage. We have our operations team scouting what’s available every single day."

Along with canned food drives, cash donations to the Foodbank go a long way.

"A $10 donation to the Foodbank helps distribute food for 25 meals," Kauahi said. "That $10 plate lunch can mean 25 meals for other people."

Close to half of the Hawaii Foodbank’s 200 member agencies are operated solely by volunteers. Many are affiliated with religious institutions.

"This is a huge community undertaking," Kauahi said. "We’re so glad that the people of Hawaii are there to give and make sure these people are OK."

"Hunger in America 2014" was based on interviews with more than 60,000 clients and 32,000 partner agencies. In Hawaii, 649 clients were surveyed and 201 surveys were completed by food banks and their partner agencies.

Feeding America has done previous studies on hunger in America, but the report’s authors said the new one used different methodology, so comparisons with previous reports are not valid.

A 2010 "Hunger in Hawaii" study found that 183,500 people statewide, or roughly 1 in 7 residents, received food from the Hawaii Foodbank.

On the sidewalk outside the Kakaako food pantry on Tuesday, a cheerful woman who gave her name as Paula rested next to a cardboard box holding packaged food, eggs, lettuce and bruised bananas. Just one member of her family has been able to land a job, she said.

"If we don’t have Foodbank," she said simply, "we don’t have food."

The Hawaii Foodbank’s phone number is 836-3600.

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On the Net:

To learn more, visit:

» feedingamerica.org

» www.hawaiifoodbank.org