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Childhood Food Insecurity and Hunger: A Threat to Children s Health, and to our Future Prosperity John T. Cook, PhD, MAEd Children s HealthWatch – PowerPoint PPT presentation

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Title: John T. Cook, PhD, MAEd


1
Childhood Food Insecurity and Hunger A Threat to
Childrens Health, and to our Future Prosperity
John T. Cook, PhD, MAEd Childrens HealthWatch
Department of Pediatrics Boston University
School of Medicine New York Hunger
Solutions Spring Conference, May 7, 2015 Albany,
NY Workshop on Food Security and its Connections
to Health and Well-being
2
Childrens HealthWatch
  • Non-partisan network of pediatric public health
    researchers ? research policy center based at
    Boston Medical Center, BU School of Medicine
  • MISSION Improve health development of young
    children? public policies ? alleviate family
    economic hardships
  • Food insecurity
  • Housing insecurity
  • Energy insecurity
  • Provide policy makers with evidence to develop
    policies that protect young childrens health and
    development

3
Where our data come from
Emergency Departments and Primary Care Clinics in
Boston, Baltimore, Philadelphia, Little Rock and
Minneapolis.
  • A household survey (about 30 mins)
  • Interviews - caregivers with children 0 to 4
    years old
  • invisible group
  • critical growth and development window

4
  • Conduct empirical research,
  • Publish it in peer-reviewed journals,
  • Translate findings into policy oriented and
    relevant materials,
  • Communicate research results to academics,
    advocates, policy makers, the public.

5
The future of any society depends on its ability
to foster the healthy development of the next
generation. Center On The Developing Child,
Harvard University

6
Overview
  1. How does food insecurity affect child health?
  2. Prevalence of food insecurity US NY


7
Background/Motivation
8
Pathways Through Which Food Insecurity Influences
Child Health Development
  • Food Insecurity Influences Childrens Health and
    Development Through
  • ? Nutritional and
  • ? Non-nutritional Pathways

9
Examples of Nutritional Pathways
  • Perinatal nutrition of mother and child,
    including internatal period
  • Brain and cognitive development in the child
    (sensitive and vulnerable periods)
  • Growth impacts (stunting, wasting, structural and
    system anomalies, endocrine system, obesity, oral
    health issues)
  • Compromise of immune system functions (risks for
    infection-malnutrition cycle)
  • Energy deficits
  • Compromised body temperature regulation
  • Reduced environmental exploration learning

10
Examples of Non-nutritional Pathways
  • Adverse impacts on the childs and mothers
    mental health (depression) and adult-child
    interactions (impaired responsiveness, serve and
    return),
  • Impoverished home environment and lack of
    appropriate stimulation and nurturing support,
  • Toxic stress (repetitive, persistent or
    inescapable acute or chronic stress e.g., child
    abuse, domestic violence, recurrent or persistent
    hunger, poverty food insecurity(?)),
  • Delays in and/or foregoing needed medical care,
  • Non-compliance with treatment, including Rx due
    to trading-off health care against other
    necessities.

11
Stress can damage a childs health and development
  • Stress is a natural response to changes and
    challenges in our environment ? stress response,
    return to homeostasis
  • Stress can be mild, and lead to important
    learning we can learn a lot from stress
  • Moderate stress can go either way, may be good
    or it may not, can learn from it, or it can be
    harmful
  • Toxic stress chronic un-ameliorated
    mild-to-moderate stress, or acute or repeated
    short-term intense stress
  • Toxic stress can damage the brain architecture
    and immune systems of young, developing children!
  • Allostasis/allostatic load cumulative wear
    tear on body systems resulting form toxic stress

12
Toxic Stress and Immune Function
  • The hypothalamic-pituitary-adrenal (HPA) axis is
    activated in response to stress - increases level
    of stress hormones (e.g., cortisol, adrenaline,
    ACTH) ? help the body mobilize resources to
    respond to stress.
  • HPA axis activation for example, by stress
    also increases susceptibility to infectious
    disease.
  • Toxic stress also affects development and
    calibration of the neuroendocrine-immune (NEI)
    network in the prenatal and early childhood
    periods.

13
Food Insecurity and Hunger are Linked to Many
Adverse Child Health Outcomes
  • Children in food-insecure families are more
    likely to
  • Have been hospitalized since birth,
  • Have their health status reported as fair/poor
    versus excellent/good,
  • Have parents report concerns indicating risk of
    developmental problems,
  • Have iron deficiency anemia,
  • Have anemia without iron deficiency.
  • Cook JT, Frank DA, Berkowitz C, Black MM, Casey
    PH, Cutts DB, Meyers AF, Zaldivar N, Skalicky A,
    Levenson SM, Heeren T, Nord M. Food Insecurity is
    Associated with Adverse Health Outcomes Among
    Human Infants and Toddlers. J Nutr, June 2004
    1341432-1438.
  • Skalicky A, Meyers A, Adams W, Yang Z, Cook J,
    Frank DA. Child Food Insecurity and Iron
    Deficiency Anemia in Low-Income Infants and
    Toddlers in the United States. Maternal and Child
    Health Nov 2005, 191-9.

14
Food Insecurity and Hunger Also are Linked to
Adverse Maternal Health Outcomes
  • Children in households with child food
    insecurity are also more likely to
  • Have mothers who report having depressive
    symptoms,
  • Have mothers who report their own health as
    fair/poor,
  • Have mothers with unhealthy weight status,
  • Have mothers with chronic diseases, e.g.,
    diabetes.
  • Casey P, Goolsby S, Berkowitz C, Frank D, Cook J,
    Cutts D, Black MM, Zaldivar N, Levenson S, Heeren
    T, Meyers A, and the C-SNAP Study Group. Maternal
    Depression, Changing Public Assistance, Food
    Security, and Child Health Status. Pediatrics,
    2004 113(2) 298-304.
  • Laraia BA. Food Insecurity and Chronic Disease.
    Adv. Nutr. 4 203212, 2013.

15
NOTE Meaning of Self-rated Health Status
  • In the US, according to Census Bureau data
  • Of all children (ages lt18 years) with fair or
    poor health status in 2010
  • 61.6 had 3 or more medical care provider visits,
  • 26.2 spent at least one night in the hospital.
  • Of all children with excellent, very good, good
    health status in 2010
  • Only 28.0 had 3 or more medical care provider
    visits,
  • Only 4.2 spent at least one night in the
    hospital.
  • In 2012, the average cost for non-birth related
    pediatric hospital stays was 11,143 (AHRQ,
    H-CUPnet Kids Inpatient Database).
  • Source OHara B, Caswell K. Health Status,
    Health Insurance, and Medical Services
    Utilization 2010. Household Economic Studies,
    Current Population Reports, P70-133RV, July 2013.

16
Prevalence of Food Insecurity in New York State
and in the Five Boroughs, 2013
Total Food Insecure Total Food Insecure Children Food Insecure Children Food Insecure
Number Percent Number Percent
New York State 2,740,000 13.9 938,610 21.9
Bronx 262,580 18.8 102,210 27.8
Kings 502,240 19.8 151,280 25.2
New York 246,120 15.3 49,480 20.9
Queens 300,190 13.3 95,890 20.6
Richmond 49,610 10.6 20,720 19.2
New York City 1,360,740 16.5 419,750 23.6
Feeding America, Map the Meal Gap 2015. http//map.feedingamerica.org/county/2013/overall Feeding America, Map the Meal Gap 2015. http//map.feedingamerica.org/county/2013/overall Feeding America, Map the Meal Gap 2015. http//map.feedingamerica.org/county/2013/overall
16
17
Prevalence of Food Insecurity by Race/Ethnicity,
All Adults and Children in the US, 2013
Total Food Insecure Total Food Insecure Total in Hhlds with VLFS Total in Hhlds with VLFS
Number Percent Number Percent
Adults 33,306,000 13.9 12,191,000 5.1
Latino 8,124,000 23.3
Non-Latino Black 7,166,000 26.5
Non-Latino White 16,151,000 10.3
All Children lt 18 Yrs 15,772,000 21.4 4,913,000 6.7
Latino 4,711,000 29.5
Non-Latino Black 3,738,000 36.1
Non-Latino White 6,385,000 15.4
All People 49,078,000 15.8 17,104,000 5.5
Coleman-Jensen, Alisha, Christian Gregory, and Anita Singh. Household Food Security in the United States in 2013, ERR-173, U.S. Department of Agriculture, Economic Research Service, September 2014. Coleman-Jensen, Alisha, Christian Gregory, and Anita Singh. Household Food Security in the United States in 2013, ERR-173, U.S. Department of Agriculture, Economic Research Service, September 2014. Coleman-Jensen, Alisha, Christian Gregory, and Anita Singh. Household Food Security in the United States in 2013, ERR-173, U.S. Department of Agriculture, Economic Research Service, September 2014.
17
18
What Have we Learned in over 15 Years About Food
Insecuritys Impacts on Child Health
Development?
  • Recommended reviews
  • Gunderson C, Kreider B, Pepper J. The Economics
    of Food Insecurity in the United States. Applied
    Economic Perspectives and Policy (2011) volume
    33, number 3, pp. 281303. doi10.1093/aepp/ppr022
    .
  • Nord M. Food Insecurity in Households with
    Children Prevalence, Severity, and Household
    Characteristics. EIB-56. U.S. Dept. of
    Agriculture, Econ. Res. Serv. September 2009.
    http//www.ers.usda.gov/Publications/EIB56/
  • Cook JT, Frank DA. Food Security, Poverty and
    Development in the United States. Ann. N.Y. Acad.
    Sci. xxxx 116 (2008). 2008 New York Academy of
    Sciences. doi 10.1196/annals.1425.001
    http//www.childrenshealthwatch.org/page/Publicati
    ons

19
  • Reviews (Contd.)
  • Reviews from ASN EB Symposium 2012 (Food Security
    and Health Across the Lifespan)
  • Laraia BA. Food Insecurity and Chronic Disease.
    Adv. Nutr. 4 203212, 2013. http//advances.nutri
    tion.org/content/4/2/203.full.pdfhtml
  • Cook, JT, et al. Are Food Insecuritys Health
    Impacts Underestimated in the U.S. Population?
    Marginal Food Security Also Predicts Adverse
    Health Outcomes in Young U.S. Children and
    Mothers. Adv. Nutr. 4 5161, 2013.
    http//advances.nutrition.org/content/4/2/51.full.
    pdfhtml
  • Gundersen C. Food Insecurity Is an Ongoing
    National Concern. Adv. Nutr. 4 3641, 2013.
    http//advances.nutrition.org/content/4/2/36.full.
    pdfhtml
  • In addition, all Childrens HealthWatch
    publications can be found at http//www.childrensh
    ealthwatch.org/page/Publications

20
Human Brain Development Most Vulnerable Period
Birth Age 4 Yrs Synapse formation, neural
networks brain architecture
Age
Source Thompson Nelson, 2000
21
Brain architecture is laid down during the first
three years of life
22
Brain architecture is physical structure, intercon
nections, neural networks
  • Brain architecture is physical structure, and
    interconnections.
  • There are about 100 billion cells in the brain.
  • Brain architecture is influenced by many factors,
    including those associated with stress related to
    poverty, and food insecurity.
  • The first 3 years of life largely set the
    trajectory of cognitive development, school
    readiness, academic achievement, educational
    attainment, and other human capital accumulation.

22
23
  • Source Wikimedia Commons, by Mariana Ruiz
    Villarreal (LadyofHats), Hamburg, Germany, used
    with gratitude.

24
Animal research indicates that brain architecture
is harmed by toxic stress
24
25
Why Impacts of Food Insecurity on Child Health
and Development and Health Matter
Source U.S. Bureau of Labor Statistics, CPS
unemployment data.
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33
How Does Living in Households Where Adults, but
Not Children, Have VLFS Affect Children?
  • In 2013, there were 6.845 million households with
    very low food security on the household scale
  • 17.104 million people lived in those households
  • 12.191 million adults 4.913 million children
  • There were 3.814 million households with 8.585
    million children with low food security on the
    child scale
  • 765,000 children had VLFS on the child scale
  • This implies that 4.148 million children lived in
    households where adults had VLFS, but the
    children did not. What does that mean for those
    children? How do they experience the adults
    hunger? How does it affect them? Is it stressful?
    Toxic Stress?

34
Childrens Awareness and Experience of Food
Insecurity? (School Age)
  • Connel, et al. (2005) found that children (ages
    11-16 Yrs) described food insecurity in terms of
    quantity (eating less than usual, or eating more
    or fast when food is available), quality (having
    only a few, low-cost foods), affective states
    (worry/anxiety/sadness about the familys food,
    shame/fear of being labeled poor, feelings of
    having no choice, adults trying to shield
    children from food insecurity), and social
    dynamics (using social networks to get food, or
    being socially excluded).
  • Fram, et al. (2011) found that children (9-16
    Yrs) experience food insecurity distinct from
    parents experience and reports of the condition,
    and have cognitive, emotional and physical
    awareness of food insecurity adults are not
    always aware of childrens experience of food
    insecurity.

35
The Hunger Vital Sign A Brief and Effective
Clinical Screener for Food Insecurity
  • Hager ER, et al. Development and Validity of a
    2-Item Screen to Identify Families at Risk for
    Food Insecurity. Pediatrics, Volume 126, Number
    1, July 2010.
  • Develops and validates a 2-item clinical screen
    for food insecurity using the first 2 items in
    the 18-item household scale.
  • Using the 18-item HFSS as a gold standard,
  • Endorsement of either of the first two HFSS items
    provided
  • Q1 only Sensitivity of 93 and specificity of
    85
  • Q2 only Sensitivity of 82 and specificity of
    95
  • Endorsement of both questions 1 and 2 provided
  • Sensitivity of 78 and specificity of 96.
  • Endorsement of question 1 and/or question 2
    provided
  • Sensitivity of 97 and specificity of 83.

36
The Elusive Obviousness of Hunger
  • Hunger is an inescapable part of our
    creatureliness we are living systems
  • We all have it, and it is both personal and
    social we are inter-related, social systems
  • It is problematic when out of control, or it
    cannot be fulfilled the system is threatened
  • It is socially problematic because humans are
    social beings, and inter-dependent
  • Our health, well-being and prosperity depend on
    the public well-being and prosperity

37
We Know When We are Hungry, and We Know, and Can
Say How Hungry We Are
  • Humans can self-report hunger both its existence
    and its severity
  • Hunger sensations are eccentric, but universal
    painful or uneasy sensations caused by a lack
    of food
  • Social harmony and prosperity require that we not
    allow our fellow human beings to go hungry,
  • We all have a right to enough healthy food to
    lead an active, healthy life.
  • We have very effective social infrastructures to
    enable all of us to be healthy and prosperous.

38
Housing, food and energy insecurity are results
of systemic failures, not individuals failures

39
Housing, food and energy insecurity are results
of systemic failures, not individuals failures
  • Myth that increasing taxes is taboo, politically
    economically
  • Myth that the safety net leads to dependence
  • Myth that government cant work, and is the
    peoples enemy


40
Housing, food and energy insecurity are results
of systemic failures, not individuals failures
  • Banks financial industry
  • Workers rights
  • Consumer protections
  • Environment


41
Housing, food and energy insecurity are results
of systemic failures, not individuals failures
  • Citizens United
  • Vote suppression disenfranchisement
  • Campaign finance
  • Wealth dominates in campaigns
  • Revolving doors


42
Housing, food and energy insecurity are results
of systemic failures, not individuals failures
  • Myth that the free market exists at all,
  • Myth that the market will allocate resources
    most effectively,
  • Myth that we must not intervene in the market,
  • Myth that we cant change the rules of the
    market,
  • Markets are human creations!


43
Food, housing, and energy insecurity are results
of systemic failures, not individuals failures
  • Myth that increasing taxes is taboo, politically
    economically
  • Myth that the safety net leads to dependence
  • Myth that government cant work, and is the enemy
  • Myth that the free market exists at all,
  • Myth that the market will allocate resources
    most effectively,
  • Myth that we must not intervene in the market
  • Myth that we cant change the rules of the
    market
  • Markets are human creations!
  • Banks financial industry
  • Workers rights
  • Consumer protections
  • Environment
  • Citizens United
  • Vote suppression disenfranchisement
  • Campaign finance
  • Wealth dominates campaigns


44
Thank You! www.childrenshealthwatch.org john.coo
k_at_bmc.org Tel. 617-414-5129
88 E. Newton Street Vose Hall 4th Floor
Boston, MA 02118 tel 617.414.6366
info_at_childrenshealthwatch.org
45
Food Insecuritys Impacts on Child Health
Development (Perinatal Period)
  • Borders et al. (2007) Chronic stress and low
    birth weight neonates in a low-income population
    of women.
  • FI is positively associated with low-birthweight
    births.
  • Laraia et al. (2006) Psychosocial factors and
    socioeconomic indicators are associated with HFI
    among pregnant women.
  • FI positively associated with psychosocial
    indicators of perceived stress, trait anxiety,
    and depressive symptoms in pregnant women
    indication of doseresponse relationship with
    greater effects at more severe levels of FI.
  • Zubieta et al. (2006) Breastfeeding practices in
    U.S. households by food security status.
  • FI is negatively associated with initiation of
    breastfeeding and with duration if initiated.

46
Food Insecuritys Impacts on Child Health
Development (Early Childhood)
  • Kaiser et al. (2002) Food Security and
    Nutritional Outcomes of Preschool-Age
    Mexican-American Children.
  • Using data from the Radimer/Cornell food security
    scale, found limited education, lack of English
    proficiency, and low income negatively correlated
    with food security. Controlling for
    acculturation, children in severely food-insecure
    households were less likely to meet Food Guide
    Pyramid guidelines than other children, and
    percent overweight tended to peak among children
    from household level food insecure families no
    significant differences were found in weight or
    height status of children by level of food
    insecurity.
  • Cook et al. (2004) FI is associated with adverse
    health outcomes among human infants and toddlers.
  • FI is positively associated with fair/poor
    health and having been hospitalized since birth.
    A doseresponse relationship was found between
    severity of FI and likelihood of fair/poor
    health. Food stamps attenuated effect of FI on
    health status but did not eliminate it.

47
Food Insecuritys Impacts on Child Health
Development (Early Childhood)
  • Casey et al. (2004) Maternal depression,
    changing public assistance, food security, and
    child health status.
  • Maternal PDS are positively associated with HFI,
    fair/poor child health status, and child
    hospitalization. PDS also positively associated
    with reductions or loss of welfare and FSP
    benefits.
  • Black et al. (2004) WIC participation and
    infants growth and health a multisite
    surveillance study.
  • Infants (aged 12 months) that did not receive
    WIC benefits because of access problems were more
    likely to be underweight, short, and perceived as
    having fair/poor health than were WIC recipients.
    Both infants receiving WIC and those eligible but
    not receiving benefits because of access problems
    were more likely to be FI than infants whose
    caregiver perceived no need for WIC.

48
Food Insecuritys Impacts on Child Health
Development (Early Childhood)
  • Skalicky et al. (2006) CFI and IDA in low-income
    infants and toddlers in the United States.
  • CFI positively associated with IDA in children
    aged 636 months.
  • Neault et al. (2007) Breastfeeding and health
    outcomes among citizen children of immigrant
    mothers.
  • Although families of US-born breastfed infants of
    immigrant mothers had greater odds of being food
    insecure than those of nonbreastfed infants of
    immigrant mothers, breastfed infants had lower
    odds of having fair/poor health (versus
    excellent/good), of having a chronic health
    condition, and of having previously been
    hospitalized than nonbreastfed infants of
    immigrant mothers.

49
Food Insecuritys Impacts on Child Health
Development (Early Childhood)
  • Whitaker et al. (2006). Food Insecurity and the
    Risks of Depression and Anxiety in Mothers and
    Behavioral Problems in the Preschool-Aged
    Children. Pediatrics,118(3)859-68.
  • Significant behavioral problems (aggressive,
    anxious/depressed, inattention/hyperactivity) 1.6
    times more likely in hh with marginal food
    security among adults and 2.1 times more likely
    in hh with food-insecure adults. Similar and
    statistically significant associations with each
    problem domain individually.
  • Rose-Jacobs et al. (2007) HFI associations with
    at-risk infant and toddler development.
  • FI positively associated with parental reports of
    developmental issues on the PEDS after
    controlling for confounders.

50
Food Insecuritys Impacts on Child Health
Development (School Age)
  • Kleinman et al. (1998) Hunger in children in the
    United States potential behavioral and emotional
    correlates.
  • Children categorized as hungry by the CCHIP scale
    more likely to have clinical levels of
    psychosocial dysfunction on the PSC than either
    at-risk or non-hungry children. Analysis of
    individual PSC items found that most behavioral,
    emotional, and academic problems were more
    prevalent in hungry children, that aggression
    and anxiety had the strongest degree of
    association with hunger.
  • Murphy et al. (1998) Relationship between hunger
    and psychosocial functioning in low-income
    American children.
  • Found children aged lt 12 years categorized as
    hungry or at risk of hunger twice as likely as
    non-hungry children to be reported as having
    impaired functioning by either a parent or the
    child her/himself. Teachers reported
    statistically significantly higher levels of
    hyperactivity, absenteeism, and tardiness among
    hungry/at-risk children.

51
Food Insecuritys Impacts on Child Health
Development (School Age)
  • Weinreb et al. (2002) Hunger its impact on
    childrens health and mental health.
  • Severe hunger was a statistically significant
    predictor of chronic illness among both
    preschool-aged and school-aged children and was
    statistically significantly associated with
    internalizing behavior problems, whereas moderate
    hunger was a statistically significant predictor
    of health conditions in preschool-aged children.
    Severe hunger was also associated with higher
    reported anxiety/depression among school-aged
    children.
  • Alaimo et al. (2001a) Food insufficiency, family
    income, and health in U.S. preschool and
    school-aged children.
  • Food insufficiency associated with higher
    prevalence of fair/poor health and iron
    deficiency, and with greater likelihood of
    experiencing stomachaches, headaches, and colds
    in children aged 15 years.

52
Food Insecuritys Impacts on Child Health
Development (School Age)
  • Alaimo et al. (2001b) Food insufficiency and
    American school-aged childrens cognitive,
    academic, and psychosocial development.
  • Children aged 611 years in food-insufficient
    families had lower arithmetic scores, were more
    likely to have repeated a grade, to have seen a
    psychologist, and to have had difficulty getting
    along with other children, than similar children
    whose families were food sufficient. Teenagers
    from food insufficient families more likely than
    food-sufficient peers to have seen a
    psychologist, to have been suspended from school,
    and to have had difficulty getting along with
    other children.
  • Alaimo et al. (2002) Family food insufficiency,
    but not low family income, is positively
    associated with dysthymia and suicide symptoms in
    adolescents.
  • Children aged 1516 years from food-insufficient
    households were statistically significantly more
    likely to have had dysthymia, to have had
    thoughts of death, to have had a desire to die,
    and to have attempted suicide than
    food-sufficient peers.

53
Food Insecuritys Impacts on Child Health
Development (School Age)
  • Jyoti et al. (2005) FI affects school childrens
    academic performance, weight gain, and social
    skills.
  • In lagged models, found FI in kindergarten
    associated with lower math scores, increased BMI
    and weight gain, and lower social skills in girls
    at third grade, but not for boys, after
    controlling for time-varying and time-invariant
    covariates.
  • Using difference scores and dynamic models based
    on changes in predictors and outcomes from
    kindergarten to third grade, found that children
    from persistently FI households (FI at both
    kindergarten and third grade years) had greater
    gains in BMI and weight than those of children in
    persistently food-secure households, though
    effects were statistically significant only for
    girls. Also among girls, but not boys, persistent
    FI was associated with smaller increases in
    reading scores over the period than for
    persistently food-secure girls.

54
Food Insecuritys Impacts on Child Health
Development (School Age)
  • Jyoti et al. (2005)
  • In dynamic models, for households that
    transitioned from food security to FI over
    kindergarten to third grade (i.e., became FI),
    the transition was associated with statistically
    significantly smaller increases in reading scores
    for girls and boys than for children in
    households remaining food secure. For children
    transitioning from FI to food security (i.e.,
    becoming food secure), the transition was
    associated with larger increases in social skills
    scores for girls but not for boys. Becoming FI
    was associated with statistically significantly
    greater weight and BMI gains for boys but not for
    girls and with greater declines in social skills
    scores for girls but not boys.

55
Childrens Awareness and Experience of Food
Insecurity? (School Age)
  • Connel, et al. (2005) found that children (ages
    11-16 Yrs) described food insecurity in terms of
    quantity (eating less than usual, or eating more
    or fast when food is available), quality (having
    only a few, low-cost foods), affective states
    (worry/anxiety/sadness about the familys food,
    shame/fear of being labeled poor, feelings of
    having no choice, adults trying to shield
    children from food insecurity), and social
    dynamics (using social networks to get food, or
    being socially excluded).
  • Fram, et al. (2011) found that children (9-16
    Yrs) experience food insecurity distinct from
    parents experience and reports of the condition,
    and have cognitive, emotional and physical
    awareness of food insecurity adults are not
    always aware of childrens experience of food
    insecurity.

56
Childrens Awareness and Experience of Food
Insecurity? (School Age)
  • Bernal, et al. (2012) found children (10-17 Yrs)
    in peri-urban areas of Miranda State, Venezuela
    were cognitively aware (of food insecurity, their
    parents worries about it, and causes both
    internal and external to their households),
    emotionally aware (feelings of concern, anguish,
    sadness episodes of crying), physically aware
    (of hunger, reduced quantity and quality of
    intake, eating smaller meals, and thinness and
    fainting as consequences).
  • Childrens responses included reducing quantity
    and quality of intake, child labor, food from
    waste, sacrifice in food consumption, seeking
    food from extended family, strategies for
    obtaining, preparing and cooking food
  • Children were not always protected from hunger by
    adults

57
Childrens Awareness and Experience of Food
Insecurity (School Age)
  • Fairbrother, et al. (2012) explored childrens
    (9-10 Yrs) understanding of family finances and
    how they related to eating healthily in two
    contrasting SES schools in the North of England.
    The authors found
  • Children incorporated a variety of media
    information into their understanding, and sought
    explanations from personal experience.
  • Children had sophisticated ideas about
    interrelationships between diet, cost and health,
    and were keenly aware of how family finances
    influenced food purchases.
  • Children proposed a variety of strategies for
    eating healthily on a budget, but prioritized
    state and corporate responsibility in ensuring
    that eating healthily is affordable.
  • Children consistently conflated eating fruits and
    vegetables with eating healthily.

58
Levels of Severity of Food Insecurity
  • Most Childrens Healthwatch studies have used a
    dichotomous household food security status
    variable as predictor.
  • We have found that variable to be a strong
    predictor of adverse health outcomes in children
    and caregivers in our sentinel sample of over
    40,000 mother-child dyads.
  • In one study we found that including child food
    insecurity as another category led to greater
    odds of adverse health outcomes in children, but
    their magnitude (odds ratios) were only
    marginally statistically significantly different.
  • We recently completed a study (funded by the
    UKCPR/USDA) testing how mothers foreign-born
    status, together with risk and protective
    factors, are related to very low food security
    (VLFS) in children. (Results presented at ASN/EB
    2013)
  • 1.4 of children in Childrens HealthWatch data
    have VLFS compared to 1.1 (845,000) of children
    in the CPS living in households with VLFS in at
    least one child in 2011.

59
Levels of Severity of Food Insecurity
  • Marginal Food Security
  • Cook, JT, et al. Are Food Insecuritys Health
    Impacts Underestimated in the U.S. Population?
    Marginal Food Security Also Predicts Adverse
    Health Outcomes in Young U.S. Children and
    Mothers. Adv. Nutr. 4 5161, 2013.
    http//advances.nutrition.org/content/4/2/51.full.
    pdfhtml
  • Reviews several studies presenting evidence that
    marginal food security is more like food
    insecurity than food security.
  • All studies find that marginal food security is a
    significant predictor of adverse health outcomes
    in children or their mothers, compared to food
    security.
  • Present results of new research showing that
    marginal food security is associated with the
    same negative health outcomes as food insecurity,
    but magnitude of associations are intermediate
    between food security and food insecurity (dose
    response).
  • Conclude that marginal food security should be a
    separate adverse category and not combined with
    either food security or food insecurity marginal
    food insecurity.
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