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Title: FOOD INSECURITY IS ASSOCIATED WITH ADVERSE HEALTH OUTCOMES AMONG HUMAN INFANTS AND TODDLERS

Author
item COOK, JOHN - BU SCHOOL OF MEDICINE
item FRANK, DEBORAH - BU SCHOOL OF MEDICINE
item BERKOWITZ, CAROL - HARBOR-UCLA MED CTR
item BLACK, MAUREEN - BU SCHOOL OF MEDICINE
item CASEY, PATRICK - DELTA NIRI
item CUTTS, DIANA - HENNEPIN COUNTY MED CTR
item MEYERS, ALAN - BU SCHOOL OF MEDICINE
item ZALDIVAR, NIEVES - BU SCHOOL OF PUB HEALTH
item SKALICKY, ANNE - BU SCHOOL OF PUB HEALTH
item LEVENSON, SUZETTE - BU SCHOOL OF PUB HEALTH
item HEEREN, TIM - BU SCHOOL OF PUB HEALTH
item NORD, MARK - USDA, ERS

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/19/2004
Publication Date: 6/10/2004
Citation: Cook, J.T., Frank, D.A., Berkowitz, C., Black, M.M., Casey, P.H., Cutts, D.B., Meyers, A.F., Zaldivar, N., Skalicky, A., Levenson, S., Heeren, T., Nord, M. 2004. Food insecurity is associated with adverse health outcomes among human infants and toddlers. Journal of Nutrition. 134(6):1432-1438.

Interpretive Summary: Food security is defined as access at all times to enough nutritious food for an active and healthy life, whereas food insecurity is defined as limited or uncertain access to enough nutritious foods. Household food insecurity has implications for child health in several ways, such as cognitive developmental deficits, behavioral and psychosocial dysfunction, and poor general health. This study evaluates whether low-income inner-city young children in households exposed to food insecurity have a higher rate of experiencing negative health outcomes than similar children in food-secure families. Results of the current study show that food insecurity, even without evidence of hunger, is associated with adverse health outcomes in young children. This study also showed the protective effects of food stamp participation on young children's health. However, it also showed that the adverse effect of food insecurity on the health of young children is not eliminated by food stamp participation alone. More extensive support would be needed. Results of this study support the need for further research on the relations between food and cash assistance program participation and food security, and subsequent effects of food insecurity on child health. They also support the importance of effective safety-net policies in preventing health problems in low-income infants and toddlers.

Technical Abstract: The U.S. Household Food Security Scale, developed with federal support for use in national surveys, is an effective research tool. This study uses these new measures to examine associations between food insecurity and health outcomes in young children. The purpose of this study was to determine whether household food insecurity is associated with adverse health outcomes in a sentinel population ages <=36 mo. We conducted a multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington DC, August 1998-December 2001. Caregivers of 11,539 children ages <=36 mo were interviewed at hospital clinics and emergency departments (ED) in central cities. Outcome measures included child's health status, hospitalization history, whether child was admitted to hospital on day of ED visit (for subsample interviewed in EDs), and a composite growth-risk variable. In this sample, 21.4% of households were food insecure (6.8% with hunger). In a logistic regression, after adjusting for confounders, food-insecure children had odds of "fair or poor" health nearly twice as great [adjusted odds ratio (AOR)=1.90, 95% CI=1.66-2.18], and odds of being hospitalized since birth almost a third larger (AOR=1.31, 95% CI=1.16-1.48) than food-secure children. A dose-response relation appeared between fair/poor health status and severity of food insecurity. Effect modification occurred between Food Stamps and food insecurity; Food Stamps attenuated (but did not eliminate) associations between food insecurity and fair/poor health. Food insecurity is associated with health problems for young, low-income children. Ensuring food security may reduce health problems, including the need for hospitalizations.