Transitions between food insecurity and food security predict children's social skill development during elementary school

Translational science approaches for food insecurity research

Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.

Household food insufficiency and flourishing in a nationally representative sample of young children in the U.S

PURPOSE

This study examined the association between household food insufficiency and flourishing among young children (6 months-5 years) in the U.S. and assessed whether sleep adequacy modifies this association.

METHODS

We used data from the 2018-2020 National Surveys of Children's Health. Adjusted prevalence differences and 95% confidence intervals (CI) for the association between household food insufficiency and flourishing were modeled using average marginal predictions from logistic regression models. Sleep adequacy was assessed as an effect measure modifier on the additive scale.

RESULTS

Evidence supports additive scale effect measure modification of the food insufficiency-flourishing association by sleep adequacy (Likelihood Ratio Test statistic = 12.4, degrees of freedom = 2, P < .05). Adjusted for potential confounders, the prevalence of flourishing was 13.2 percentage points lower (95% CI: -22.6, -3.7) for children in households with insufficient food and inadequate sleep compared to those with sufficient food and adequate sleep.

CONCLUSIONS

Our findings suggest that having enough food and enough sleep are associated with greater wellbeing. These modifiable factors should be targeted by public health interventions to facilitate flourishing among young children in the U.S.

Nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details nutritional and activity recommendations for the child with normal weight, overweight, and obesity (Appendix A) with consideration of food insecurity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices in the normal range and body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA.

Methods

The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results

This OMA Clinical Practice Statement details nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity. In addition, this CPS addresses nutritional recommendations for complications related to the disease of obesity as well as providing guidance on food insecurity as it impacts children with obesity and their families.

Conclusions

This OMA Clinical Practice Statement on nutritional and activity recommendations for the child with normal weight, overweight, and obesity with consideration of food insecurity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.

Food Insecurity and Child Development: A State-of-the-Art Review

Converging research indicates that household food insecurity impedes children from reaching their full physical, cognitive, and psychosocial potential. This state-of-the-art review examines the last decade of research to: (1) describe the impact of the severity and persistence of food insecurity on child development; (2) use a socio-ecological framework to examine significant proximal and distal factors which may interplay; and (3) outline directions for future research. We conducted a systematic review of six databases of published papers from 2011 to June 2021. The search was limited to high-income countries and children aged from birth to 12 years. From 17,457 papers, 17 studies were included in the final review. Transitioning between food security and food insecurity had a significant and lasting effect on academic/cognitive function and behavior (i.e., externalizing), however less clear relationships were seen for psychosocial outcomes and other behaviors examined (i.e., internalizing). There was significant variation in the measurement and thresholds used to define both food insecurity and child development outcomes. Subsequently, comparisons across studies are difficult. Several future recommendations, including incorporation of socio-ecological factors, is provided. In conclusion, this review supports the link between food insecurity and sub-optimal child development; however, there is an imperative to improve and extend current understanding to ameliorate the causes of food insecurity.

Influence of a Pediatric Fruit and Vegetable Prescription Program on Child Dietary Patterns and Food Security

Limited access to fresh foods is a barrier to adequate consumption of fruits and vegetables among youth, particularly in low-income communities. The current study sought to examine preliminary effectiveness of a fruit and vegetable prescription program (FVPP), which provided one USD 15 prescription to pediatric patients during office visits. The central hypothesis was that exposure to this FVPP is associated with improvements in dietary patterns and food security. This non-controlled longitudinal intervention trial included a sample of caregiver–child dyads at one urban pediatric clinic who were exposed to the FVPP for 1 year. Patients received one USD 15 prescription for fresh produce during appointments. A consecutive sample of caregivers whose children were 8–18 years of age were invited to participate in the study. Dyads separately completed surveys that evaluated food security and dietary behaviors prior to receipt of their first prescription and again at 12 months. A total of 122 dyads completed surveys at baseline and 12-month follow-up. Approximately half of youth were female (52%), and most were African American (63%). Mean caregiver-reported household food security improved from baseline to 12 months (p < 0.001), as did mean child-reported food security (p = 0.01). Additionally, child-reported intake of vegetables (p = 0.001), whole grains (p = 0.001), fiber (p = 0.008), and dairy (p < 0.001) improved after 12 months of exposure to the FVPP. This study provides evidence that pediatric FVPPs may positively influence food security and the dietary patterns of children.

School absenteeism is linked to household food insecurity in school catchment areas in Southern Nevada

OBJECTIVES

Food security and school attendance are both important for health, well-being and academic performance of children and adolescents. However, their intersection remains underexamined, especially in the USA. The current study considered the association between elementary school-level absenteeism and household food insecurity.

DESIGN

The current study linked school-level absenteeism and household food insecurity rates using geographic information system mapping and applied the tobit regression model to examine their association.

SETTING

The Clark County, Nevada, public school district - the fifth largest in the USA and in a state with disproportionate food insecurity and chronic school absenteeism rates.

PARTICIPANTS

Data consisted of school-level absenteeism rates from 185 elementary schools and census tract-level household food insecurity rates.

RESULTS

Average daily attendance rates were lower for schools with catchment areas that had higher average household food insecurity (FI), decreasing by -0·0232 % per 1 % increase in FI rate (P-value = 0·022). They were also significantly associated with most absenteeism risk factors. Average daily attendance rate was negatively associated with Free and Reduced Lunch eligibility percentage (-0·010 per 1 % increase in FI, P-value < 0·001) and Individualized Education Program participation percentage (-0·039 % per 1 % increase in FI, P-value = 0·033), but positively associated with parent-teacher conference participation rate (0·006 % per 1 % increase in FI, P-value = 0·025) and white student percentage (0·011 % per 1 % increase in FI, P-value = 0·022).

CONCLUSIONS

The current study suggests a link between household food insecurity and elementary school-level absenteeism. Understanding this link is important for policy and practice because schools are frequent settings for food insecurity mitigation interventions.

The Role of Parents' Nativity in Shaping Differential Risks of Food Insecurity Among US First Graders

Objectives Food insecurity remains a problem in the US, especially for children in immigrant families. We developed a novel measure of parental nativity and incorporated school effects to advance knowledge from prior studies. Methods Using hierarchical logistic models and data from the Early Childhood Longitudinal Study-2011 Kindergarten Cohort, we examined how parental nativity and race/ethnicity, and school characteristics influence household food insecurity among a nationally representative sample of US first-graders in 2012. Results After adjusting for potential confounders, children without any US-born parents had a higher likelihood of household food insecurity than children with two US-born parents or one foreign-born/one US-born parent. Attending a Title 1 school was associated with food insecurity independent of household socioeconomic status. Conclusions for Practice Results suggest that providers should take special care to screen for food insecurity among children with only immigrant parents and that Title 1 schools have a potentially important role to play in reducing food insecurity.

Transitional Dynamics of Household Food Insecurity Impact Children's Developmental Outcomes

OBJECTIVE

To determine how transitions into and out of varying degrees of food insecurity impact children's academic competencies, executive functioning, and social skills (i.e., self-control, interpersonal skills, externalizing behaviors, and internalizing behaviors).

METHOD

Data come from the nationally representative kindergarten and first-grade waves of the Early Childhood Longitudinal Study (2010-2011); 11,958 children attending 1289 schools are included. Statistical analyses involve using a novel framework for measuring the transitional dynamics and depth of food insecurity to predict children's developmental outcomes using hierarchal linear models, which adjust for child- and school-level confounders.

RESULTS

Deepening food insecurity (DeepenFIS) was detrimental to children's self-control (-0.208, p < 0.01), math (-0.153, p < 0.01), and working memory (-5.202, p < 0.05) scores. Remitting marginal food insecurity was associated with negative effects on children's self-control (-0.082, p < 0.05) and interpersonal skills (-0.098, p < 0.01) but not on math or working memory. Persisting marginal food insecurity (PersistMFIS) negatively impacted children's self-control (-0.106, p < 0.05) and interpersonal skills (-0.115, p < 0.05). Emerging food insecurity (0.146, p < 0.01) and persisting food insecurity (0.071, p < 0.05) had detrimental effects on children's externalizing behaviors.

CONCLUSION

Based on a novel food insecurity transitions framework and examination of multiple developmental outcomes, this study highlights the importance of examining both depth and transitional dynamics of food insecurity. Findings indicate that DeepenFIS and PersistMFIS may have potentially the most harmful effects on children's developmental outcomes. Clinically, findings support the need for addressing food insecurity in early childhood, even if the food insecurity challenges are marginal and just emerging.

Child food insecurity in the UK: a rapid review

Background

Food insecurity (FI) is a multifaceted, socioeconomic problem involving difficulties accessing sufficient, safe and nutritious food to meet people’s dietary requirements and preferences for a healthy life. For children experiencing FI, there are some potentially negative developmental consequences and it is, therefore, important to understand the links between FI and children’s health and well-being as well as any strategies undertaken to address FI. The overall objective of this assessment was to determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Objective

To determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Data sources

The databases searched on 4 December 2017 included MEDLINE (including In-Process & Other Non-Indexed Citations and E-pub ahead of print files), EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Commonwealth Agricultural Bureaux (CAB) abstracts, The Cochrane Library, Education Resources Information Centre (ERIC), PsycINFO, the Social Science Citation Index and the Applied Social Sciences Index and Abstracts (ASSIA).

Methods

A rapid review of the current published and unpublished literature was conducted, including all study designs from specified high-income countries in children aged ≤ 18 years. Searches were conducted of major health-care, nutrition, education and social science databases from 1995 onwards, and websites of relevant UK and international organisations. Final searches were undertaken in December 2017.

Results

In total, 109 studies were selected. Only five studies were conducted in the UK, four of which provided qualitative data. Possible factors associated with child FI were identified, for example socioeconomic status, material deprivation, living in public housing and having unemployed or poorly educated parents. Children’s health, well-being and academic outcomes were all negatively affected by FI. The mediating effects of family stressors and parenting practices in the relationship between FI and children’s health and well-being outcomes were not clear. Food assistance programmes were generally effective in mitigating FI and improving nutritional outcomes (including hunger) in the short term, but did not eradicate FI, eliminate its effects on children’s health or have an impact on academic outcomes. No reports assessing the prevalence of child FI in the UK or the cost-effectiveness and sustainability of interventions to tackle FI were identified.

Limitations

There was a lack of consistency in how FI was defined and measured across studies. Most of the studies used indirect measurements of child FI through parental reports. The majority of studies were conducted in North America. Only five studies were conducted in the UK. Thirty potentially relevant studies were not included in the review as a result of time and resource constraints. Most studies were observational and caution is advised in interpreting their results.

Conclusions

A number of factors that were related to child FI were identified, as were negative associations between child FI and physical, mental and social outcomes. However, these findings should be interpreted with caution because of the correlational nature of the analyses and the fact that it is difficult to determine if some factors are predictors or consequences of FI.

Future research

There is an urgent requirement for the development of a reliable instrument to measure and monitor child FI in the UK and for well-designed interventions or programmes to tackle child FI.

Study registration

This study is registered as PROSPERO CRD42017084818.

Funding

The National Institute for Health Research Public Health Research programme. The Health Services Research Unit is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Food Insecurity and Family Well-Being Outcomes among Households with Young Children

OBJECTIVES

To investigate associations between household food insecurity and multiple family well-being variables in an effort to illuminate previously understudied, policy-amenable mechanisms through which food insecurity threatens healthy development.

STUDY DESIGN

Data are drawn from the nationally representative Early Childhood Longitudinal Study-Birth Cohort. The Early Childhood Longitudinal Study-Birth Cohort contains longitudinal data on household food insecurity and several family well-being factors including maternal physical and mental health, positive parenting practices and disciplinary strategies, and frequency and severity of spousal conflict. We use regression models with lagged dependent variables to estimate associations between food insecurity and family well-being outcomes, on a subsample of low-income families (N ≈ 2100-4700).

RESULTS

Household food insecurity was significantly associated with poorer maternal physical health; increased depressive symptoms and use of harsh discipline strategies; and greater frequency and negativity of conflict between parents. Associations were strongest and most consistent when children were preschool aged. Transitions into food insecurity between toddlerhood and preschool were also associated with significantly worse parental physical and mental health outcomes, and more family conflict, with similar though slightly weaker and less consistent associations for transitioning into food insecurity between infancy and toddlerhood.

CONCLUSIONS

Food insecurity is associated with significant decreases in family health and well-being. Clinicians and other public health officials play a critical role in assessing risk for children and families, and linking families with supportive services. Screening families experiencing or at risk for food insecurity and connecting them with resources is an avenue through which public health practitioners can support family health.

Association of Food Insecurity with Children's Behavioral, Emotional, and Academic Outcomes: A Systematic Review

OBJECTIVE

Food Insecurity (FI) occurs in 21% of families with children and adolescents in the United States, but the potential developmental and behavioral implications of this prevalent social determinant of health have not been comprehensively elucidated. This systematic review aims to examine the association between FI and childhood developmental and behavioral outcomes in western industrialized countries.

METHOD

This review provides a critical summary of 23 peer reviewed articles from developed countries on the associations between FI and adverse childhood developmental behavioral outcomes including early cognitive development, academic performance, inattention, externalizing behaviors, and depression in 4 groups-infants and toddlers, preschoolers, school age, and adolescents. Various approaches to measuring food insecurity are delineated. Potential confounding and mediating variables of this association are compared across studies. Alternate explanatory mechanisms of observed effects and need for further research are discussed.

RESULTS

This review demonstrates that household FI, even at marginal levels, is associated with children's behavioral, academic, and emotional problems from infancy to adolescence across western industrialized countries - even after controlling for confounders.

CONCLUSIONS

While the American Academy of Pediatrics already recommends routine screening for food insecurity during health maintenance visits, the evidence summarized here should encourage developmental behavioral health providers to screen for food insecurity in their practices and intervene when possible. Conversely, children whose families are identified as food insecure in primary care settings warrant enhanced developmental behavioral assessment and possible intervention.

Household Food Insecurity and Children's Behaviour Problems: New Evidence from a Trajectories-Based Study

This study examined the association between household food insecurity (insufficient access to adequate and nutritious food) and trajectories of externalising and internalising behaviour problems in children from kindergarten to fifth grade using longitudinal data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), a nationally representative study in the USA. Household food insecurity was assessed using the eighteen-item standard food security scale, and children's behaviour problems were reported by teachers. Latent growth curve analysis was conducted on 7,348 children in the ECLS-K, separately for boys and girls. Following adjustment for an extensive array of confounding variables, results suggest that food insecurity generally was not associated with developmental change in children's behaviour problems. The impact of food insecurity on behaviour problems may be episodic or interact with certain developmental stages.

The relationship between developmental assets and food security in adolescents from a low-income community

PURPOSE

To explore the association between developmental assets (characteristics, experiences, and relationships that shape healthy development) and food insecurity among adolescents from a low-income urban community.

METHODS

This mixed-methods study occurred in two phases. In phase 1, using a census approach, 2,350 6th to 12th graders from the public school district completed an anonymous survey that included the developmental assets profile (DAP), the youth self-report form of the Core Food Security Module, and demographic questions. Logistic and multinomial regression analyses determined independent associations between developmental assets and food security adjusting for demographics. In phase 2, 20 adult key informant interviews and four semistructured student focus groups were performed to explain findings from phase 1.

RESULTS

On average, DAP scores were consistent with national norms. Food insecurity was prevalent; 14.9% reported low food security and 8.6% very low food security (VLFS). Logistic regression revealed that higher DAP was associated with lower odds of food insecurity (odds ratio [OR], .96; 95% confidence interval [CI], .95-.97); family assets drove this association (OR, .93; 95% CI, .91-.95). In multinomial regression modeling, these associations persisted, and paradoxically, higher community assets were also associated with VLFS (ORVLFS, 1.08; 95% CI, 1.04-1.13). Qualitative analyses suggested that greater need among VLFS youth led to increased connections to community resources despite barriers to access such as stigma, home instability, and cultural differences.

CONCLUSION

Food insecurity is a pervasive problem among adolescents from low-income communities and is associated with lower developmental assets, particularly family assets. The fact that community assets were higher among VLFS youth underscores the importance of community-level resources in struggling areas.

Unwanted childbearing and household food insecurity in the United States

Household food insecurity is a population health concern disproportionately affecting families with children in the United States. Unwanted childbearing may place unanticipated strain on families to meet basic needs, heightening the risk for household food insecurity. We investigated the association between mother's and father's report of unwanted childbearing and exposure to household food insecurity among children residing in two-parent households in the United States. Data from the Early Childhood Longitudinal Study - Birth Cohort, a nationally representative cohort of US children (n ∼ 6150), were used to estimate the odds of household food insecurity when children were aged 9 months and 2 years, separately, based on parental report of unwanted childbearing. The majority of children were reported as wanted by both parents (74.4%). Of the sample, report of unwanted childbearing by father-only was 20.0%, mother-only was 3.4% and joint mother and father was 2.2%. Household food insecurity was higher when children were 9 months compared with 2 years. In adjusted models accounting for confounders, children born to mothers and fathers who jointly reported unwanted childbearing were at higher odds of exposure to household food insecurity at 9 months [adjusted odds ratio (AOR) = 3.31; 95% confidence interval (CI): 1.97, 5.57] and 2 years (AOR = 2.52; 95% CI: 1.12, 5.68). In two-parent households, we found that children raised by parents reporting unwanted childbearing were more likely to be exposed to food insecurity and potentially related stressors. Further studies that prospectively measure wantedness before the child's birth will aid in confirming the direction of this association.