Using nationally representative data and quasi-experimental analysis techniques, we find that food insecurity affects children’s health in a number of negative ways. Food insecurity. For the tenth consecutive year, Feeding America conducted our annual Map the Meal Gap study to improve our understanding of food insecurity and food costs at the local level. by Children's HealthWatch. Another limitation of this study stems from the cross-sectional nature of the data. Food insecurity is an important public health problem facing children in the United States. Nonetheless, in drawing on a sample that was balanced to address confounding from an extensive set of factors, the current study is a major improvement over a great deal of previous research. For example, the authors of a majority of studies in this area use convenience samples of children or primary caregivers and control for a handful of child and caregiver characteristics including demographics, education and employment, and receipt of benefits from public assistance and nutrition assistance programs.2,3,5,7,13 However, for regression analyses to generate causal estimates of the effects of food insecurity on health, one must assume that the regression controls for all potential confounding factors15; yet, food insecurity is a complex social phenomenon whose causes are not fully understood. Analysis showed that food insecurity is associated with a significantly higher risk of poor health and developmental delay, with the odds tending to increase as children get older till age four. Pediatrics. In 2017, 11.8% of US households (∼15 million) were food insecure, meaning that members lacked “enough food for an active, healthy life.”1 Although food insecurity rates have dropped since 2011, current levels are still as high or higher than at any point in the 10 years before the Great Recession.1 Food insecurity is especially prevalent among low-income families with children. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. Establishing the independent impact of food insecurity on child health serves to guide efforts to prevent food insecurity and ameliorate its consequences. Would you like email updates of new search results? To study the association between food insecurity and children’s mental health outcomes, we combined exposure to food insecurity when children were 1½ and 4½ years of age (ever food-insecure vs. never food-insecure) and tested associations with children’s probability of being on a ‘high’ behavioural trajectory group at ages 4½ to 8 years. Click here for the full article. Findings support American Academy of Pediatrics recommendations for food insecurity screening. Additionally, the food insecurity measure captures household food insecurity in the past 30 days, whereas the child health outcomes are primarily measured over the past year. According to a report issued by the Rhode Island Community Food Bank last fall, one in four Rhode Island households lacks adequate food, up from one in ten just a few years ago. 2020 Sep;110(9):1405-1410. doi: 10.2105/AJPH.2020.305743. In turn, results from simple regressions are likely biased, and the nature and degree of this bias are not immediately clear.15 Understanding the degree to which food insecurity affects the health of children or other household members is key both to making the case for its elimination and also to the design of effective social programs. In non-pandemic times, households with children were nearly 1.5 times more likely to experience food insecurity than households without children, according to … Environmental influences on food security in high-income countries, The economics of food insecurity in the United States, Childhood food insecurity in the U.S.: trends, causes, and policy options, The central role of the propensity score in observational studies for causal effects, Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies, Bounding the effects of food insecurity on children’s health outcomes, SNAP Is Linked With Improved Nutritional Outcomes and Lower Health Care Costs, Food Insecurity and Overweight Among Infants and Toddlers: New Insights Into a Troubling Linkage, Child hunger and long-term adverse consequences for health, “Do you wanna breathe or eat?”: parent perspectives on child health consequences of food insecurity, trade-offs, and toxic stress, Poverty, food insecurity, and nutritional outcomes in children and adults, Material hardship and child socioemotional behaviors: differences by types of hardship, timing, and duration, Food insecurity works through depression, parenting, and infant feeding to influence overweight and health in toddlers, Food Insecurity in Households With Children: Prevalence, Severity, and Household Characteristics, US Department of Agriculture Economic Research Service, Household food insecurity during childhood and subsequent health status: the early childhood longitudinal study--kindergarten cohort, Recent advances provide improved tools for measuring children’s food security, Short screening scales to monitor population prevalences and trends in non-specific psychological distress, The strengths and difficulties questionnaire: a research note, The Revised WIC Food Package and Child Development: A Quasi-Experimental Study, Nurse Home Visiting and Maternal Mental Health: 3-Year Follow-Up of a Randomized Trial, Neighborhood Child Opportunity Index and Adolescent Cardiometabolic Risk, Follow American Academy of Pediatrics on Instagram, Visit American Academy of Pediatrics on Facebook, Follow American Academy of Pediatrics on Twitter, Follow American Academy of Pediatrics on Youtube, Racism and Its Effects on Pediatric Health, www.pediatrics.org/cgi/content/full/110/4/e41, https://www.cdc.gov/nchs/nhis/about_nhis.htm, https://www.who.int/social_determinants/sdh_definition/en/. Methods: USA.gov. 2 This represents 15.2% of all children. Using inverse probability of treatment weighting, a propensity scoring method, we examine a broad range of child health outcomes and account for a comprehensive set of controls, focusing on a sample of children 2 to 17 years old. Most children were of white non-Latinx ethnicity, just over 25% were of Latinx ethnicity, and children were ∼10 years old, on average. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. The purpose of the present article is to review what is currently known about the effects of food insecurity and hunger on children. In addition, children in food-insecure households were far more likely to delay medical care because of cost (146.5%) and to need but be unable to afford medical (179.8%), dental (105.5%), and mental health care (114.3%). This site needs JavaScript to work properly. Because of the highly detailed nature of the information available in the NHIS, we are able to use this method to create a sample that is balanced with respect to many of the known predictors of food insecurity, an important improvement over previous work. Objectives: E-mail: Copyright © 2019 by the American Academy of Pediatrics. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. Backpack Buddies employee Michelle Vanderzon packs a bag full of food for the weekend for a food-insecure child somewhere in B.C at the organization’s North Vancouver facility. Nutr Res Rev. Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. What is Food Insecurity? The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Food insecurity is associated with increased nutritional vulnerability in Canada. Table 1 presents sample descriptive statistics for the full sample and unweighted food-secure and food-insecure subsamples, including prevalence of all child health outcomes. Acad Pediatr. Request PDF | Food Insecurity and Child Health | Objectives: Food insecurity is an important public health problem facing children in the United States. Children in food-insecure households had worse general health (a difference of 2.5%) and were less likely to be in very good or excellent health (3.1%) compared with peers in food-secure households. Associations between housing instability and food insecurity with health care access in low-income children. Food insecurity, food assistance and weight status in US youth: new evidence from NHANES 2007-08. The resulting variable, called the propensity score, is a single-number summary of the probability of treatment conditional on the values of the covariates. Using a rich, nationally representative data set of US children and PS techniques, we were better able to assess the causal impact of food insecurity on key domains of child health and health care use. The World Bank’s recent brief “Food Security and COVID-19” estimates that 265 million people worldwide could face acute food insecurity by the end of 2020, up from 135 million people before the COVID-19 crisis, because of income and remittance losses. In particular, researchers frequently cite early work finding food insecurity to be associated with a slew of negative outcomes for children, including worse general health, increased use of emergency department (ED) services, worse academic performance, poorer social outcomes, and anxiety and depression.2–5 Food insecurity may negatively affect children’s acute and chronic health in both direct and indirect ways. Results: Chan School of Public Health. KINGSTON, R.I. – Jan. 25, 2021 – During the past year, food insecurity in the United States has reached record levels. Enter multiple addresses on separate lines or separate them with commas. Click here to read the report. In an October 28, 2020 USA Today op-ed, four Harvard Chan School faculty members noted that the percent of U.S. households with children who are food insecure has doubled, from 14% to 28%, with communities of color most affected. Nutrients. Fifty-eight percent of households reported having at least one member with high blood pressure and 33 percent had at least one member with diabetes. The high percentage of food-insecure households is a public health issue that must be addressed. Child food insecurity increases risks posed by household food insecurity to young children’s health. The Hunger in America 2014 study found that many households served by the Feeding America® network of food banks include people coping with a diet-related chronic disease. Although there is no definitive cutoff for determining successful balance, previous research suggests that standardized differences less than an absolute value of 0.10 indicate good balance.28 After assessing balance, we examined IPTW estimates of the impact of food insecurity on children’s health and health care access. Supplemental Table 3 is used to present unweighted and IPTW weighted standardized differences in means, which quantify differences between the food-secure and food-insecure samples before and after propensity score weighting, respectively. COVID-19 is an emerging, rapidly evolving situation. The NHIS also includes a rich set of background information about families, including demographic characteristics, economic information, public program participation, and adult physical and mental health outcomes. Whereas there were sizeable discrepancies in standardized differences in means between the unweighted food-secure and food-insecure subsamples, the weighted samples were balanced on all of these covariates, with no standardized difference measures >0.10. To do so, such methods model the probability of treatment (food insecurity) as a function of a set of salient covariates,20,27 which are listed in Supplemental Table 3. But it also greatly affects a significant portion of the Canadian workforce. The successful application of PS balances treatment and control groups in observational data such that, conditional on the PS, treatment assignment is independent of all measured covariates.20 Because PS approximates random assignment, the literature on PS methods uses causal language,20,27 referring to model estimates as average treatment effects (ATEs), a convention we adopt in this study. “There are clear and consistent harmful impacts of food insecurity on children’s general health, chronic health, acute health, and access to health care,” Thomas says. Or Sign In to Email Alerts with your Email Address, Impact of COVID-19-related School Closures on the Drivers of Child Health, Social Determinants of Health and the Hospitalized Child, DOI: https://doi.org/10.1542/peds.2019-0397, Household Food Security in the United States in 2017, US Department of Agriculture, Economic Research Service, Food insecurity is associated with adverse health outcomes among human infants and toddlers, Food insecurity affects school children’s academic performance, weight gain, and social skills, Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development, Hunger: its impact on children’s health and mental health, The food insecurity-obesity paradox: a review of the literature and the role food stamps may play, Child food insecurity increases risks posed by household food insecurity to young children’s health, The cost of US foods as related to their nutritive value, Children’s Sentinel Nutritional Assessment Program Study Group, Maternal depression, changing public assistance, food security, and child health status, Poverty, material hardship, and depression, Psychological stress in children may alter the immune response, Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry, Impact of Food Insecurity and SNAP Participation on Healthcare Utilization and Expenditure, Food insecurity and poor sleep: another consequence of food insecurity in the United States, Food insecurity research in the United States: where we have been and where we need to go, IPUMS Health Surveys: National Health Interview Survey, Version 6.3 [Dataset]. Child health and food insecurity in households with children ages 3–11 years, León, Nicaragua. Food insecurity during pregnancy may be especially risky for the health of the developing fetus and the well-being of the postnatal child,8, 9, 10 and programs to respond to food insecurity, such as Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC), have been known to benefit maternal and child health. The use of IPTW creates a synthetic sample, such that treatment assignment in the weighted sample is independent of measured covariates.28 This simulation of random treatment assignment affords the opportunity to examine directly the effects of treatment on outcomes of interest. Jomaa L, Na M, Eagleton SG, Diab-El-Harake M, Savage JS. Household food insecurity has insidious effects on the health and development of young children, including increased hospitalizations, poor health, iron deficiency, developmental risk and behavior problems, primarily aggression, anxiety, depression, and attention deficit disorder (Cook & Frank, 2008; Whitaker, Phillips, & Orzol, 2006). The eradication of poverty and hunger are the top sustainable development goals, adopted by UN Member States in 2015. Examining an “Experimental” Food-Security-Status Classification Method for Households With Children, An introduction to propensity score methods for reducing the effects of confounding in observational studies, A primer on inverse probability of treatment weighting and marginal structural models. Ambul Pediatr. Child Food Insecurity is a Health Problem Children ages 0 to 3 who face food insecurity often cannot learn as much, as fast or as well, because chronic under-nutrition and toxic stress harm their cognitive development during this critical period of development. We use nationally representative data from the 2013-2016 waves of the National Health Interview Study (N = 29 341). In terms of health care use, food insecurity predicted more ED visits among children (25.9%). Of this eligible sample, we omitted observations missing information on food insecurity (n = 8), health outcomes (n = 819), or covariates (n = 5483) (primarily household income). 2008 Jan-Feb;8(1):50-7. doi: 10.1016/j.ambp.2007.08.004. CONCLUSIONS: Policies used to reduce household food insecurity among children may also reduce children’s chronic and acute health problems and health care needs. PS, a quasi-experimental family of methods, seeks to mimic the context of an experimental design by comparing outcomes among children who differ with respect to the household’s food insecurity but who are alike in all other observable ways. 4 As such, food insecurity would be expected to adversely affect child growth 5,6 and health and development more broadly. 70% of households who rely on social assistance in Canada are food insecure. JIMD Rep. 2020 Mar 20;53(1):103-110. doi: 10.1002/jmd2.12115. between mild food insecurity and illness, indicating sim- Both biological and socio-cultural factors may ilar risk of illness among younger and older children in explain the stronger effects of food insecurity on child food insecure … Although a number of previous studies suggest that food insecurity has negative impacts on health, these studies have not dealt thoroughly with issues of selection bias. If this proves true, it would indicate the highest number of food-insecure individuals, and the greatest annual increase in food insecurity, in over twenty years—including the Great Recession. Address correspondence to Margaret M.C. Food insecurity is closely linked to child malnutrition and is associated with deleterious biopsychosocial outcomes such as decreased academic performance, increased juvenile delinquency, and increased problem behaviors (Cook et al., 2004). Core data are available about all household members, and more detailed information is gathered about 1 randomly selected sample adult and, if present, 1 randomly selected sample child.18 Questions on household food insecurity were added to the NHIS in 2011. Food insecurity may have lasting consequences on child development Based on food security status over three years, households were classified into three groups: (i) never food-insecure; (ii) transitory food insecurity, if the household was food-insecure only in one year; and (iii) persistent food insecurity, if the household was food-insecure in two or all years. Health-care costs in Ontario are 49 per cent higher for adults in moderately food-insecure households and 121 per cent higher for adults in severely food-insecure … POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. "COVID has just wreaked havoc on so many things: on public health, on economic stability and obviously on food insecurity," said Luis Guardia, the president of the Food… Although we also found no differences in rates of anemia and diabetes, these health outcomes are both relatively rare in children and may develop gradually over time, which likely explains the limited effects of a cross-sectional measure of food insecurity on these outcomes. As a result, food-insecure and food-secure households are likely to be different in both observable and unobservable ways. Family socioeconomic status and maternal depressive symptoms: Mediation through household food insecurity across five years. Compared to rates had they not been food insecure, children in food-insecure household had rates of lifetime asthma diagnosis and depressive symptoms that were 19.1% and 27.9% higher, rates of foregone medical care that were 179.8% higher, and rates of emergency department use that were 25.9% higher. After adjusting for food insecurity status, parents' and adolescents' fruit, vegetable, and sugar-sweetened beverage consumption was not associated. We … Children in food-insecure households were more likely to experience some chronic health conditions, including a lifetime diagnosis of asthma (16.3%), current diagnosis of asthma (19.1%), experience of eczema or other skin allergies (49.3%), and experience of depressive symptoms (27.9%). Copyright © 2019 by the American Academy of Pediatrics. View. Caregiver's Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families. Policy and program responses to the immediate consequences of food insecurity might include increasing SNAP benefits broadly for families with very low food security and introducing supplementary benefits for SNAP recipients to make nutrient-dense but more expensive food available to all food-insecure families. Responses to food insecurity in Canada over the past 15 to 20 years have been community-based, ad hoc and largely focused on the provision of free or subsidized food (e.g., food banks, targeted meal programs). February 1, 2020. “Without intervention, household food insecurity will continue to detrimentally impact children’s health.” 2018 Oct;215:1-6. doi: 10.1016/j.socscimed.2018.08.043. Results Food insecurity was prevalent with 65.4% of parents and 43.6% of adolescents reporting food insecurity; 34.5% of parents and 14.5% of adolescents reported very low food security. Despite its strengths, this study also has limitations. OBJECTIVES: Food insecurity is an important public health problem facing children in the United States. Our findings point to pervasive negative impacts of household food insecurity on children’s health. Nearly 35% of households with children and incomes below 185% of the federal poverty level (FPL) were food insecure in 2017 compared to <6% among more affluent households.1, Eradicating food insecurity is important for many reasons. In doing so, our study joins the small number of previous studies in which authors have used rigorous methods such as bounding or instrumental variables29 to demonstrate that food insecurity causes poor health. Raising Canada 2020 finds the harsh realities facing young Canadians during the pandemic has exacerbated threats to mental illness, food insecurity, child abuse, physical inactivity and poverty. Thank you for your interest in spreading the word on American Academy of Pediatrics. We find there are clear and consistent harmful impacts of food insecurity on children’s general health, chronic health, acute health, and access to health care, suggesting the urgent need for action. While food insecurity has direct and indirect impacts on physical and mental health for people of all ages, food insecurity is especially detrimental to the health, development, and well-being of children in the short and long terms.73 74,, 75, 76 “After multiple risk factors are considered, children who live in households that are food insecure, The results of this study reveal the deleterious effects of household food insecurity on children’s health. eCollection 2020 May. Evidence for the age-specific relationship of food insecurity and key dietary outcomes among US children and adolescents. Childhood poverty and food insecurity remains … Results from this analysis reveal that the application of IPTW created balance between the 2 samples. In turn, micronutrient deficiencies and stunting, a form of chronic malnutrition, in early childhood decreases cognitive skills and psycho-social health. A higher risk of obesity is not found among food-insecure children except for … Results: Household food insecurity was related to significantly worse general health, some acute and chronic health problems, and worse health care access, including forgone care and heightened emergency department use, for children. In 2018, approximately 11.2 million children lived in food-insecure households. [Free Full Text] Prevalence and associations of food insecurity in children with diabetes mellitus Marjerrison S, Cummings E, Glanville NT, Kirk S, Ledwell M. Journal of Pediatrics 2010; 158(4): 607-611. Please enable it to take advantage of the complete set of features! Drawing on household-level responses to the 10-item version of the US Department of Agriculture (USDA) 30-day food security measure, which captures food insecurity among household adults, we constructed a binary variable indicating that children lived in food-insecure households.1 The USDA recommends the 10-item scale to measure food insecurity in household with and without children.19 In line with the USDA measure, we categorized households as food insecure if they affirmed ≥3 of the 10 food insecurity items.1,19 Over the study period, 4080 children (13.9%) lived in a food-insecure household. Soc Sci Med. Health & Fitness Arizona Among Worst States For Malnourished Children: Report A new report ranked every state based on "childhood enders" — such as food insecurity … January 26, 2021. Since the pandemic started last year, childhood poverty and food insecurity has increased for many throughout the province, according to the non-profit. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Researchers often point to deleterious consequences of food insecurity among children to justify attention to the problem. USDA will increase the current daily benefit amount by approximately 15% to tackle the serious problem of child food insecurity during this school year when need is greatest. By the end of the year, it said the socio-economic impact of the pandemic had caused the actual number of persons suffering from food insecurity to exceed pre-pandemic estimates by 100 per cent, primarily affecting female-headed households and homes with at least one child. The prevalence of food insecurity in the United States increased from 10.1% in 1999 to 11.1% in 2002, an increase of more than 1.5 million households. We estimated the effects of food insecurity on children’s health outcomes using PS methods. Also consistent with other work,7 we found that food insecurity leads to an increase in ED visits of 25.9%. Data were pooled to ensure a sufficient sample size, and 2013 was selected as the starting point of the study period because valuable data on respondents’ neighborhoods were introduced to the survey in that year and because food insecurity was at historically high levels after the Great Recession.1 During this period, 35 651 sample children ages 2 to 17 were surveyed in households with sample adults. Our results also lend support to previous correlational findings that identify the negative impact of food insecurity in childhood on short- and long-term health outcomes.3,5,9,29,31–35 For instance, our results are consistent with previous findings that children in food-insecure households are less likely to be in good or excellent health and are at higher risk for asthma and for internalizing behavior issues, such as depressive symptoms, compared with children in food-secure households.5,7,29,31 Our IPTW results point to rates of ever having been diagnosed with asthma, current asthma diagnosis, and of depressive symptoms that are, respectively, 19.1%, 16.3%, and 27.9% higher than if children had not experienced food insecurity. 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