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. Food insecurity is an important social determinant of health, 1 a key indicator of limited resources and material hardship, 2,3 and a source of significant stress as parents and other caregivers seek to provide healthy child nutrition. The COVID-19 pandemic has had wide-reaching implications worldwide from serious health consequences to increases in food insecurity. CONCLUSIONS: Policies used to reduce household food insecurity among children may also reduce children’s chronic and acute health problems and health care needs. 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. Also consistent with other work,7 we found that food insecurity leads to an increase in ED visits of 25.9%. Pediatrics. 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. / 0 Comments /. 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. Click here for the full article. Click here to read the report. Household food insecurity (HFI) is a major global public health and pediatric concern due to its reported association with adverse child nutrition, growth, and health outcomes. We found that children in food-insecure homes face probabilities of delayed or forgone health care that are between 2 to 3 times higher (effect sizes between 105% and 180%) than they would have been had they been food secure. Food insecurity is associated with increased nutritional vulnerability in Canada. First, specifying the PS model requires no inclusion of or reference to the outcome of interest, allowing for unbiased accounting of confounding without consideration of the impact of covariates on the outcome. 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. You will be redirected to aap.org to login or to create your account. Thomas, MSW, Boston University School of Social Work, 264 Bay State Rd, Boston, MA 02215. 10 Do Food Insecurity and Hunger Matter? Results: Taking advantage of the recent inclusion of a measure of household food insecurity in the nationally representative National Health Interview Survey (NHIS), we use propensity scoring (PS) methods to investigate the effects of food insecurity on children’s health. Beyond income: what else predicts very low food security among children? Food insecurity and hunger are significant problems in Canada, with millions of Canadians experiencing some level of food insecurity. Food insecurity is an important public health problem facing children in the United States.  |  No significant differences emerged for most communicable diseases, such as ear infections or chicken pox, or conditions that may develop more gradually, including anemia and diabetes. This commentary is part of CSIS's Global Forecast 2021 essay series.. 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. In the other domains, outcomes included (0–1) indicators for children’s lifetime experience of chronic conditions such as asthma and diabetes; experience in the past 2 weeks of acute conditions such as respiratory or stomach problems; and experience in the past year of health care access issues, such as needing but being unable to afford medical care. Establishing the independent impact of food insecurity on child health serves to guide efforts to prevent food insecurity and ameliorate its consequences. 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. The household food insecurity measure is correlated with child food insecurity and the USDA recommends its use for households with children19,40; however, future research using longitudinal data and including child-specific food insecurity could address these limitations. Food insecurity during childhood is linked to poor-quality diets and impaired nutritional outcomes. 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/. Average households received Supplemental Nutrition Assistance Program (SNAP) benefits for 2 to 3 months per year. In addition, food insecurity is often experienced transiently rather than chronically,39 which may explain why we do not find impacts on some chronic or severe health outcomes. NLM food insecurity and child health is based on regression analyses with only limited control for potential confounders. Despite its strengths, this study also has limitations. 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. 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. Nutr Res Rev. Would you like email updates of new search results? In this study, we drew on a nationally representative sample of households with children from the NHIS using data harmonized by the Integrated Public Use Microdata Series.17 The NHIS collects data on an extensive set of health, health behavior, and health care topics in addition to a robust set of sociodemographic and contextual factors. Obesity and Hunger Threaten the Foundations of Child Health. 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. Food Insecurity and Health – Overcoming Food Insecurity Through Healthcare-Based Interventions ... 5 Measures to Promote Child and Family Health October 21, 2020 - 10:30 am; Tell Congress and the White House: Pass and Enact a COVID-19 Relief Deal that Supports Families! Our findings point to a unique and negative effect of household food insecurity on child health that is not due to the composition of their homes, the safety of the neighborhoods, their receipt of public assistance, or their household income (see Supplemental Table 3). Centers for Disease Control and Prevention. OBJECTIVES: Food insecurity is an important public health problem facing children in the United States. 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, 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. doi: 10.1542/peds.2019-0347. These results reveal that food insecurity predicted poorer health outcomes across all domains. Enter multiple addresses on separate lines or separate them with commas. The most recent release is based on data from 2018. Reflecting best practice in the use of IPTW, we examined measures of balance including weighted standardized differences and overlap of the distributions of continuous covariates to ensure accurate specification of the PS model before conducting main analyses.28 Examination of the IPTW-weighted standardized differences can be used to assess the success of the PS process in creating comparable treatment and comparison groups. Pediatr Obes. 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. Finally, our findings regarding chronic health outcomes (eg, higher rates of asthma, depressive symptoms, and eczema and other skin allergies) among children in food-insecure households suggest the role of stress related to material hardship and food insecurity as a factor directly affecting children’s mental health36 and reinforce previous research that suggests parental stress and depression related to food insecurity affect children’s health and development.9,37,38 Stress may also depress immune functioning11,12 and thus lead to more communicable diseases, such as the higher rates of recent (past 2 weeks) cold and stomach problems we found among children in food-insecure families. We compared probabilities of child food insecurity (CFI) across different family structures in 4 national data sets: the Early Childhood Longitudinal Study—Birth Cohort (ECLS-B), the Fragile Families and Child Wellbeing Study (FFCWS), the Early Childhood Longitudinal Study—Kindergarten Cohort (ECLS-K), and the Panel Study of Income Dynamics—Child Development Supplement (PSID-CDS). USA.gov. Further, we the associations between household food insecurity did not find significant age differences in the association and child health became insignificant (age 7–8 years). What is Food Insecurity? Food insecurity, food assistance and weight status in US youth: new evidence from NHANES 2007-08. 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. We calculated effect sizes by dividing the ATE by the expected outcome level for children in the treatment group had they not experienced food insecurity, which is derived from the IPTW model. Food insecurity means a household does not have enough money to buy food. Background: Food security (i.e., a condition in which all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life) has been noted to be lower in indigenous communities in Canada. We use propensity scoring techniques to approximate the causal effects of food insecurity on children’s health and health care use outcomes. Acad Pediatr. 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. 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. Coakley KE, Porter-Bolton S, Salvatore ML, Blair RB, Singh RH.  |  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. 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. 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. Of note, children in households with incomes <100% of the FPL make up 20% of the full sample, just 16% of the food-secure sample, and 46% of the food-insecure sample. 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%). Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 … NIH We use nationally representative data from the 2013-2016 waves of the National Health Interview Study (N = 29 341). We examined a sample of children ages 2 to 17 drawn from the 2013–2016 NHIS surveys. 3 There is concern among child advocates and child health clinicians that this trend will worsen as a result of the downswing in the US economy and changes in welfare programs. 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. Household food insecurity is strongly linked to poverty in Canada. We do not capture any email address. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. A higher risk of obesity is not found among food-insecure children except for … Agriculture is “environmentally unsustainable” too, according to the committee. “Without intervention, household food insecurity will continue to detrimentally impact children’s health.” Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. An Implementation Guide In Collaboration With Humana. This study employed inverse probability of treatment weighting (IPTW), 1 of several PS methods. 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]. 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. Archives of Pediatrics & Adolescent Medicine 2010; 164(8): 754-762. 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). "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… In turn, micronutrient deficiencies and stunting, a form of chronic malnutrition, in early childhood decreases cognitive skills and psycho-social health. Using nationally representative data and quasi-experimental analysis techniques, we find that food insecurity affects children’s health in a number of negative ways. 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). When it ultimately subsides, one of the lasting images of the pandemic in the United States will be a food bank with customers queued for blocks or cars lined up for miles. 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. This site needs JavaScript to work properly. 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). 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. Our results are also consistent with other research that finds higher rates of health care use among children in food-insecure families.13 Authors of recent research suggest SNAP participation may reduce health care costs by as much as 25% among low-income adults, which, coupled with our findings, suggests that a cost-benefit analysis of SNAP’s effects on reducing food insecurity and related reductions in ED use could be warranted.30. Impact of The Community Eligibility Provision of the Healthy, Hunger-Free Kids Act on Student Nutrition, Behavior, and Academic Outcomes: 2011-2019. Adults and adolescents in food-insecure households in Canada are more likely to experience nutrient inadequacies and have poorer diets, with lower intakes of milk products, fruits, and vegetables compared to people who are food secure. 01 INTRODUCTION 01 OBJECTIVES OF THE REPORT 01 Child Hunger is a Health Problem 02 Child Hunger is an Educational Problem 02 Child Hunger is a Workforce and Job Readiness Problem 03 BACKGROUND 06 Relationship of Food Insecurity of Poverty 09 What Are Food Security, Food Insecurity, and Hunger, and How Are They Related? 3 There is concern among child advocates and child health clinicians that this trend will worsen as a result of the downswing in the US economy and changes in welfare programs. 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. 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