Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children

A surge in food insecurity during the COVID-19 pandemic in a cohort in Mexico City

BACKGROUND

The COVID-19 pandemic has not only caused tremendous loss of life and health but has also greatly disrupted the world economy. The impact of this disruption has been especially harsh in urban settings of developing countries. We estimated the impact of the pandemic on the occurrence of food insecurity in a cohort of women living in Mexico City, and the socioeconomic characteristics associated with food insecurity severity.

METHODS

We analyzed data longitudinally from 685 women in the Mexico City-based ELEMENT cohort. Food insecurity at the household level was gathered using the Latin American and Caribbean Food Security Scale and measured in-person during 2015 to 2019 before the pandemic and by telephone during 2020-2021, in the midst of the pandemic. Fluctuations in the average of food insecurity as a function of calendar time were modeled using kernel-weighted local polynomial regression. Fixed and random-effects ordinal logistic regression models of food insecurity were fitted, with timing of data collection (pre-pandemic vs. during pandemic) as the main predictor.

RESULTS

Food insecurity (at any level) increased from 41.6% during the pre-pandemic period to 53.8% in the pandemic stage. This increase was higher in the combined severe-moderate food insecurity levels: from 1.6% pre-pandemic to 16.8% during the pandemic. The odds of severe food insecurity were 3.4 times higher during the pandemic relative to pre-pandemic levels (p<0.01). Socioeconomic status quintile (Q) was significantly related to food insecurity (Q2 OR = 0.35 p<0.1, Q3 OR = 0.48 p = 0.014, Q4 OR = 0.24 p<0.01, and Q5 OR = 0.17 p<0.01), as well as lack of access to social security (OR = 1.69, p = 0.01), and schooling (OR = 0.37, p<0.01).

CONCLUSIONS

Food insecurity increased in Mexico City households in the ELEMENT cohort as a result of the COVID-19 pandemic. These results contribute to the body of evidence suggesting that governments should implement well-designed, focalized programs in the context of economic crisis such as the one caused by COVID-19 to prevent families from the expected adverse health and well-being consequences associated to food insecurity, especially for the most vulnerable.

Association between Child Tax Credit advance payments and food insufficiency in households experiencing economic shocks

The COVID-19 pandemic brought increases in economic shocks due to poor health and lost employment, which reduced economic well-being, especially in households with children. The American Rescue Plan Act of 2021 expanded Child Tax Credit (CTC) payments to include eligibility for the lowest income households, boosted benefit levels, and provided monthly advance payments to households with children. Using Census Household Pulse Survey respondent data from January 2021 to July 2022, we evaluated the association between these advance CTC monthly payments and food insufficiency among households with children experiencing health- or employment-related economic shocks (defined as missed work due to COVID-19/other illness or COVID-19-related employer closure/layoff/furlough). Using a triple difference design, we found that the advance CTC was associated with greater reductions in food insufficiency among households with children experiencing economic shocks both compared with households without children and with households with children not experiencing economic shocks. Permanently expanding the advance CTC could create resilience to economic shocks during disease outbreaks, climate disasters, and recessions.

How food insecurity affects children's behavior problems in early childhood: The nutrition and family stress pathways

This study examines how household food insecurity shapes young children's behavior problems in Singapore. The analysis is based on two waves of data collected before and during COVID-19 from a nationally representative sample of 2,601 children in the Singapore Longitudinal Early Development Study (SG-LEADS, Mage = 4.5 at wave 1, Mage = 6 at wave 2). Results based on propensity score matching, fixed effects analysis and lagged-variable models show a positive association between household food insecurity and children's behavior problems both concurrently and over a two-year period. Two mediating pathways of this association are identified-children's dietary intake and family stress. Children in food-insecure households tend to consume fewer vegetables and more sugar-sweetened beverages and carbohydrates, which is associated with elevated behavior problems. Parents in food-insecure households exhibit greater emotional distress, diminished parental warmth, and increased punitive parenting practices, also contributing to their children's behavior problems. The family stress pathway has a stronger explanatory power than the nutrition pathway on children's behavior problems. This study reveals that food insecurity is a risk factor for children's behavior problems in early childhood which can lead to later developmental vulnerabilities for children in financially deprived families.

Patterns and predictors of material hardship among poor families with children

Experiences of material hardship vary across poor families, but little is understood about this variability. The present study aimed to distinguish subtypes of material hardship as well as which characteristics predict subtypes. Latent class analysis with data from a large, longitudinal study of families with youth children investigated subtypes of material hardship as well as predictors of subtypes. Multinomial logistic regression then predicted class membership used on known housing risk factors maternal IPV victimization, depression, and substance use. Analyses identified three distinct subtypes of material hardship: "Housing Insecure," "Food Insecure," and "Cost-Burdened but Managing." Maternal IPV victimization and depression reduced likelihood of membership in the "Managing" class, but no predictors distinguished families who become food versus housing insecure. Findings suggest widespread financial stress and complex tradeoffs for low-income families, who struggle to afford basic needs. Maternal safety and mental health prove crucial to families' coping abilities. Increased systemic supports targeting specific circumstances may promote stability and prevent more severe hardship.

Food Insecurity Transitions and Changes in Employment and Earnings

INTRODUCTION

Many low-income U.S. households experience food security changes over time, but little is known about how labor market transitions contribute to these changes. This paper uses longitudinal survey data collected from 2017 to 2020 to explore how changes in employment and earnings are associated with changes in food security status.

METHODS

Analyses were conducted in the spring of 2022 and include nearly 3,500 individuals who participated in the Supplemental Nutrition Assistance Program Employment and Training program. Individuals responded to surveys at 2 points in time-12 months and 36 months after study enrollment-which asked for employment, earnings, and food security information. Logistic regression models were used to estimate the associations between food security transitions and employment and earnings changes. Analyses also were conducted to assess whether these associations differed on the basis of individuals' previous employment and earnings volatility.

RESULTS

Individuals who experienced a job loss 2 months before the second survey interview had higher odds of becoming food insecure (OR=2.67; 95% CI=1.24, 5.75); those who experienced an earnings reduction in the month before the interview also had higher odds of becoming food insecure (OR=1.89; 95% CI=1.03, 3.47). The association between experiencing a job loss and becoming food insecure was greater among those who had experienced past earnings changes. There were no statistically significant associations between changes in earnings and employment and the likelihood of becoming food secure.

CONCLUSIONS

Employment losses and earnings reductions are associated with becoming food insecure among Supplemental Nutrition Assistance Program Employment and Training participants. Providing additional support to individuals who experience these losses and reductions may reduce their risk of becoming food insecure.

Promoting Temporal Investigations of Development in Context: a Systematic Review of Longitudinal Research Linking Childhood Circumstances and Learning-related Outcomes

Children’s learning and cognitive development have a distinct receptivity to the circumstances of childhood. However, not all children have equal opportunities and learning inequities continue to be influenced by the social and economic circumstances of childhood. Examining factors within the environments that children are growing up in, and the associations of these factors with learning, can help to identify leverage points for change, enabling more children to be supported to reach their potential. Specifically, turning attention to the timing and duration of exposure to specific social and economic factors across childhood can provide essential details to determine who is most susceptible to contextual effects and at what ages. This paper presents a systematic review of 75 longitudinal studies of families and children carried out between 2000 and 2021. These studies tracked social and economic circumstances between pregnancy and early adolescence in relation to educational and cognitive outcomes across the lifespan. The results of the included studies were examined and grouped into themes using reflexive thematic analysis. The findings largely suggest that the degree to which educational and cognitive outcomes are affected by specific social and economic circumstances depends on the duration, timing, and mobility across childhood. In particular, findings relating to the developmental timing of exposure, as well as persistent exposure, revealed distinct evidence of the effects of temporality. These findings provide detail into how much and in what instances temporality should be considered—results which can be used to inform avenues for reducing learning disparities.

Depressive symptoms mediate the relationship between sustained food insecurity and cognition: a causal mediation analysis

PURPOSE

This study aimed to investigate the association of change in food insecurity over time with cognitive function in midlife, and whether depressive symptoms mediated that relationship.

METHODS

We used longitudinal data from the Coronary Artery Risk Development in Young Adults study. Change in food insecurity in 2000-2005 was coded as "persistently food-secure," "persistently food-insecure," "became food-insecure," and "became food-secure." Depressive symptoms were measured in 2010, and cognitive function was measured in 2015. Multivariable linear regression controlled for sociodemographic and cardiovascular health factors was used. We also conducted causal mediation analysis.

RESULTS

Our study population included 2448 participants (57.23% female and 43.18% Black, mean age = 40.31 in 2000). Compared with persistent food security, persistently and became food-insecure were associated with worse cognition, particularly with processing speed (β_persistent = -0.20 standard unit, 95% CI = -0.36, -0.04; β_became = -0.17, 95% CI = -0.31, -0.03), and these associations appeared mediated by depressive symptoms (proportion-mediated = 14% for persistently food-insecure and 18% for became food-insecure).

CONCLUSIONS

Persistent and transition to food insecurity were associated with worse cognition, both directly and indirectly through increasing depressive symptoms. Targeting food insecurity or depressive symptoms among persistently or became food-insecure individuals may have the potential to slow premature cognitive aging.

Transient food insecurity during the juvenile-adolescent period affects adult weight, cognitive flexibility, and dopamine neurobiology

A major challenge for neuroscience, public health, and evolutionary biology is to understand the effects of scarcity and uncertainty on the developing brain. Currently, a significant fraction of children and adolescents worldwide experience insecure access to food. The goal of our work was to test in mice whether the transient experience of insecure versus secure access to food during the juvenile-adolescent period produced lasting differences in learning, decision-making, and the dopamine system in adulthood. We manipulated feeding schedules in mice from postnatal day (P)21 to P40 as food insecure or ad libitum and found that when tested in adulthood (after P60), males with different developmental feeding history showed significant differences in multiple metrics of cognitive flexibility in learning and decision-making. Adult females with different developmental feeding history showed no differences in cognitive flexibility but did show significant differences in adult weight. We next applied reinforcement learning models to these behavioral data. The best fit models suggested that in males, developmental feeding history altered how mice updated their behavior after negative outcomes. This effect was sensitive to task context and reward contingencies. Consistent with these results, in males, we found that the two feeding history groups showed significant differences in the AMPAR/NMDAR ratio of excitatory synapses on nucleus-accumbens-projecting midbrain dopamine neurons and evoked dopamine release in dorsal striatal targets. Together, these data show in a rodent model that transient differences in feeding history in the juvenile-adolescent period can have significant impacts on adult weight, learning, decision-making, and dopamine neurobiology.

Association of Food Insecurity with Mental Health Outcomes in Parents and Children

BACKGROUND

Food insecurity affects 13.7 million US households and is linked to poor mental health. Families shield children from food insecurity by sacrificing their nutritional needs, suggesting parents and children experience food insecurity differentially.

OBJECTIVE

To identify the associations of food insecurity and mental health outcomes in parents and children DATA SOURCES: PubMed, Embase, Web of Science, and PsycInfo STUDY ELIGIBILITY CRITERIA: We included original research published in English from January 1990 to June 2020 that examined associations between food insecurity and mental health in children or parents/guardians in the United States.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two reviewers screened studies for inclusion. Data extraction was completed by one reviewer and checked by a second. Bias and confounding were assessed using the Agency for Healthcare Research and Quality RTI Item Bank. Studies were synthesized qualitatively, grouped by mental health outcome, and patterns were assessed. Meta-analyses were not performed due to high variability between studies.

RESULTS

We included 108 studies, assessing 250,553 parents and 203,822 children in total. Most studies showed a significant association between food insecurity and parental depression, anxiety, and stress, and between food insecurity and child depression, externalizing/internalizing behaviors, and hyperactivity.

LIMITATIONS

Most studies were cross-sectional and many were medium- or high-risk for bias or confounding.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Food insecurity is significantly associated with various mental health outcomes in both parents and children. The rising prevalence of food insecurity and mental health problems make it imperative that effective public health and policy interventions address both problems.

Assessing the Relationship Between Emergency Food Assistance and Social Vulnerability During the COVID-19 Pandemic

Food insecurity is a major public health challenge that is associated with negative health outcomes in wealthy countries. In US urban areas, food banks and pantries played an expanded role in providing emergency food assistance and addressing food insecurity during the COVID-19 pandemic. This study seeks to determine if socially vulnerable neighborhoods are more likely to receive emergency food assistance during this pandemic, after controlling for distance to emergency food distribution sites and spatial clustering. The study area is El Paso County, Texas-an urban area on the US-Mexico border. Dependent variables represent both coverage and intensity of emergency food transfers (EFTs) from local food banks and pantries during November 2020, at the census tract level. Independent variables are derived from the widely used Social Vulnerability Index (SVI) developed by the Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry. Our statistical analyses are based on multivariable generalized estimating equations that account for spatial clustering and proximity to emergency food distribution sites. Results indicate that both coverage and intensity of EFTs are significantly greater in neighborhoods with higher social vulnerability and proximity to emergency food distribution sites, but lower in neighborhoods that are more vulnerable in terms of housing and transportation. Our findings highlight the significance of neighborhood-level social factors in influencing access to the emergency food network during a public health crisis and have important implications for government agencies and nonprofit organizations associated with public health and emergency preparedness in US urban areas.

Risk of Food Insecurity in Young Adulthood and Longitudinal Changes in Cardiometabolic Health: Evidence from the National Longitudinal Study of Adolescent to Adult Health

BACKGROUND

Studies have demonstrated relations between food insecurity, the lack of access to enough nutritious food, and greater risk of diet-sensitive chronic diseases. However, most prior evidence relies on cross-sectional studies and self-reported disease.

OBJECTIVES

The objective was to assess the longitudinal relation between risk of food insecurity in young adulthood and changes in diet-sensitive cardiometabolic health outcomes across 10 y among non-Hispanic white, non-Hispanic black, American Indian or Alaska Native, and Hispanic adults.

METHODS

Data from the fourth and fifth waves (n = 3992) of the National Longitudinal Study of Adolescent to Adult Health were used. Measures included risk of food insecurity, body weight, diabetes, and sociodemographic characteristics. Body weight and diabetes were assessed with direct measures. Mixed-effects models assessed the association of risk of food insecurity with BMI, obesity, and diabetes while accounting for sociodemographic characteristics and the complex survey design.

RESULTS

Risk of food insecurity was associated with increases in BMI as well as incidence of obesity and diabetes from young to middle adulthood in unadjusted and adjusted models (all P < 0.01). In models stratified by race and ethnicity, the relations of risk of food insecurity with body weight outcomes and diabetes varied.

CONCLUSIONS

Risk of food insecurity in young adulthood was related to BMI and obesity during young and middle adulthood but not in changes over time. Risk of food insecurity in young adulthood related to an increased incidence of diabetes in middle adulthood. However, the relations among specific racial and ethnic groups were unclear. Estimates of the relation between food insecurity and cardiometabolic health outcomes within racial and ethnic groups experiencing the highest prevalence of these conditions should be refined.

Are free school meals failing families? Exploring the relationship between child food insecurity, child mental health and free school meal status during COVID-19: national cross-sectional surveys

OBJECTIVE

Food insecurity is linked to poor health and well-being in children and rising prevalence rates have been exacerbated by COVID-19. Free school meals (FSM) are considered a critical tool for reducing the adverse effects of poverty but apply a highly restrictive eligibility criteria. This study examined levels of food security and FSM status to support decision-making regarding increasing the current eligibility criteria.

DESIGN

Two cross-sectional national surveys administered in August-September 2020 and January-February 2021 were used to examine the impact of COVID-19 on the food experiences of children and young people.

SETTING

UK.

PARTICIPANTS

2166 children (aged 7-17 years) and parents/guardians.

MAIN OUTCOME MEASURES

Participant characteristics were described by food security and FSM status; estimated marginal means were calculated to obtain the probability of poor mental health, expressed as children reporting feeling stressed or worried in the past month, by food security status and FSM status.

RESULTS

We observed food insecurity among both children who did and did not receive of FSM: 23% of children not receiving FSM were food insecure. Children who were food insecure had a higher probability of poor mental health (31%, 95% CI: 23%, 40%) than children who were food secure (10%, 95% CI: 7%, 14%). Food insecure children receiving FSM had a higher probability of poor mental health (51%, 95% CI: 37%, 65%) than those who were food insecure and not receiving FSM (29%, 95% CI: 19%, 42%).

CONCLUSION

Many children experienced food insecurity regardless of whether they received FSM, suggesting the eligibility criteria needs to be widened to prevent overlooking those in need.

Food Security Impacts of the COVID-19 Pandemic: Longitudinal Evidence from a Cohort of Adults in Vermont during the First Year

This study assessed changes in household food insecurity throughout the first year of the COVID-19 pandemic in a cohort of adults in the state of Vermont, USA, and examined the socio-demographic characteristics associated with increased odds of experiencing food insecurity during the pandemic. We conducted three online surveys between March 2020 and March 2021 to collect longitudinal data on food security, use of food assistance programs, and job disruptions during the COVID-19 pandemic. Food security was measured using the USDA six-item module. Among the 441 respondents, food insecurity rates increased significantly during the pandemic and remained above pre-pandemic levels a year after the start of the pandemic. Nearly a third (31.6%) of respondents experienced food insecurity at some point during the first year of the pandemic, with 53.1% of food-insecure households being classified as newly food-insecure. The odds of experiencing food insecurity during the pandemic varied based on socio-demographic factors. Households with children (OR 5.5, 95% CI 1.782−16.936, p < 0.01), women (OR 8.1, 95% CI 1.777−36.647, p < 0.05), BIPOC/Hispanic respondents (OR 11.8, 95% CI 1.615−85.805, p < 0.05), and households experiencing a job disruption (OR 5.0, 95% CI 1.583−16.005, p <0.01) had significantly higher odds of experiencing food insecurity during the first year of the COVID-19 pandemic, while respondents with a college degree (OR 0.08; 95% CI 0.025−0.246; p < 0.001) and household income of ≥USD 50,000 (OR 0.01; 95% CI 0.003−0.038; p < 0.001) had lower odds of experiencing food insecurity. These findings indicate that food insecurity continued to be a significant challenge one year after the start of the pandemic, which is important, given the adverse health impacts associated with food insecurity and health disparities among certain socio-demographic groups.

Both sides of the screen: Predictors of parents' and teachers' depression and food insecurity during COVID-19-related distance learning

The COVID-19 pandemic has placed unprecedented strains on both parents and teachers, both of whose mental and financial hardships have serious implications for young children's wellbeing. We drew on an existing cohort study of families with low incomes in Tulsa, OK when children were in their Spring of first grade in 2020. We surveyed parents and teachers - children's caregivers on both sides of the screen during distance learning - before and after the COVID-19 pandemic hit and schools were closed. We first compared the proportion of parents and teachers who were depressed and food-insecure before and after the pandemic struck. We then used pre-pandemic characteristics of parents and teachers in separate models to predict their depression and food insecurity during the pandemic. Results showed that rates of depression among both parents and teachers spiked after COVID-19, and food insecurity rates also increased among parents. For both parents and teachers, the strongest predictor of depression during COVID-19 was having experienced depression before the pandemic. Similarly, the strongest predictor of food insecurity during COVID-19 was having experienced food insecurity beforehand. These results point intervention efforts towards identifying the caregivers of children in low-income contexts whose mental and financial wellbeing are likely to be most compromised during this and perhaps future disasters.

The association between insecurity and subjective well-being among youth during the COVID-19 outbreak: A moderated mediation model

BACKGROUND

Sudden and unpredictable changes caused by the COVID-19 pandemic have profoundly threatened the psychological well-being and increased insecurity among adolescents worldwide. At a critical developmental stage, the well-being of the youth is more vulnerable to adverse environments. This study constructed a moderated mediation model to explore the buffering factors between insecurity and subjective well-being of the youth during the pandemic.

METHODS

During the COVID-19 outbreak in June 2020, data of 5,503 Chinese youth (15-29 years old) were collected via an online questionnaire. Subjective well-being, insecurity, self-control, and hope were measured, and the moderated mediation model was analyzed.

RESULTS

Findings from this study showed that with the mediating effect of self-control, insecurity negatively predicted subjective well-being, and hope moderated the association between insecurity and self-control. Specifically, the link between insecurity and self-control was stronger when hope was low but weaker when hope was high.

LIMITATIONS

Since this study was mainly conducted in China, and considering the continuous change of the pandemic on a global scale, it is of great significance to conduct cross-cultural and cross-time studies in the future.

CONCLUSIONS

The results demonstrate that self-control and hope play important roles in buffering the negative effects of insecurity on the subjective well-being of adolescents and young adults. The findings provide implications for reducing the negative impact of insecurity from a positive psychology perspective and for youth mental health interventions during public health crises.

Trends in food insecurity rates at an academic primary care clinic: a retrospective cohort study

BACKGROUND

Healthcare organizations are increasingly screening and addressing food insecurity (FI); yet, limited data exists from clinic-based settings on how FI rates change over time. The objective of this study was to evaluate household FI trends over a two-year period at a clinic that implemented a FI screening and referral program.

METHODS

In this retrospective cohort study, data were extracted for all visits at one academic primary care clinic for all children aged 0-18 years whose parents/guardians had been screened for FI at least once between February 1, 2018 to February 28, 2019 (Year 1) and screened at least once between March 1, 2019 to February 28, 2020 (Year 2). Bivariate analyses tested for differences in FI and demographics using chi-square tests. Mixed effects logistic regression was used to assess change in FI between Years 1 and 2 with random intercept for participants controlling for covariates. The interaction between year and all covariates was evaluated to determine differences in FI change by demographics.

RESULTS

Of 6182 patients seen in Year 1, 3691 (59.7%) were seen at least once in Year 2 and included in this study. In Year 1, 19.6% of participants reported household FI, compared to 14.1% in Year 2. Of those with FI in Year 1, 40% had FI in Year 2. Of those with food security in Year 1, 92.3% continued with food security in Year 2. Compared to Hispanic/Latinx participants, African American/Black (OR: 3.53, 95% CI: 2.33, 5.34; p < 0.001) and White (OR: 1.88, 95% CI: 1.06, 3.36; p = 0.03) participants had higher odds of reporting FI. African American/Black participants had the largest decrease in FI between Years 1 and 2 (- 7.9, 95% CI: - 11.7, - 4.1%; p < 0.0001).

CONCLUSIONS

Because FI is transitional, particularly for racial/ethnic minorities, screening repeatedly can identify families situationally experiencing FI.

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.

Beyond Groceries: An Analysis of Referral Needs to Address Underlying Causes of Child Hunger among Households Accessing Food Pantries

Very low food security among children (VLFS-C), often referred to as child hunger, can profoundly hinder child development, family well-being, and community health. Food pantries are important community resources that routinely serve at-risk families. This study investigated the influence of various candidate risk factors for VLFS-C within a food pantry population to inform the development of the "Pantry Assessment Tool against Child Hunger (PATCH)." We collected standardized surveys among a representative sample of households with children accessing food pantry services in Oklahoma (n = 188). Weighted analyses revealed a large majority of households experienced child-level food insecurity (70.6%), with nearly half reporting low food security and nearly one-quarter reporting VLFS-C. We then used logistic regression to identify factors associated with VLFS-C, followed by chi-square automatic interaction detection (CHAID) to assess if, and in what progression, significant risk factors predicted VLFS-C. In unadjusted models, annual household income <$15,000, non-urban residence, lack of health insurance, unstable housing, heavier food pantry reliance, fair or poor adult health, adult anxiety, and adult smoking to reduce hunger pangs were all positively associated with VLFS-C. Receipt of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and higher social support were protective against VLFS-C. However, in adjusted models, only receipt of WIC remained significant. CHAID analysis revealed that access to insurance best differentiated groups with and without VLFS-C. Informed by these analyses, the PATCH tool may be useful for the development of screening programs to identify and address potential root causes of VLFS-C in pantry settings.

Household food insecurity and children's physical activity and sedentary behaviour in the United States: the Healthy Communities Study

Objective:

To examine associations between household food insecurity and children’s physical activity and sedentary behaviours.

Design:

Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling.

Setting:

A total of 130 communities in the USA.

Participants:

In sum, 5138 US children aged 4–15 years.

Results:

No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03).

Conclusions:

Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

Association Between Receipt of Unemployment Insurance and Food Insecurity Among People Who Lost Employment During the COVID-19 Pandemic in the United States

Importance

More than 50 million US residents have lost work during the coronavirus disease 2019 (COVID-19) pandemic, and food insecurity has increased.

Objective

To evaluate the association between receipt of unemployment insurance, including a $600/wk federal supplement between April and July, and food insecurity among people who lost their jobs during the COVID-19 pandemic.

Design, Setting, and Participants

This cohort study used difference-in-differences analysis of longitudinal data from a nationally representative sample of US adults residing in low- and middle-income households (ie, <$75 000 annual income) who lost work during the COVID-19 pandemic. Data were from 15 waves of the Understanding Coronavirus in America study (conducted April 1 to November 11, 2020).

Exposure

Receipt of unemployment insurance benefits.

Main Outcomes and Measures

Food insecurity and eating less due to financial constraints, assessed every 2 weeks by self-report.

Results

Of 2319 adults living in households earning less than $75 000 annually and employed in February 2020, 1119 (48.3%) experienced unemployment during the COVID-19 pandemic and made up our main sample (588 [53.6%] White individuals; mean [SD] age 45 [15] years; 732 [65.4%] women). Of those who lost employment, 415 (37.1%) reported food insecurity and 437 (39.1%) reported eating less due to financial constraints in 1 or more waves of the study. Among people who lost work, receipt of unemployment insurance was associated with a 4.3 (95% CI, 1.8-6.9) percentage point decrease in food insecurity (a 35.0% relative reduction) and a 5.7 (95% CI, 3.0-8.4) percentage point decrease in eating less due to financial constraints (a 47.8% relative reduction). Decreases in food insecurity were larger with the $600/wk supplement and for individuals who were receiving larger amounts of unemployment insurance.

Conclusions and Relevance

In this US national cohort study, receiving unemployment insurance was associated with large reductions in food insecurity among people who lost employment during the COVID-19 pandemic. The $600/wk federal supplement and larger amounts of unemployment insurance were associated with larger reductions in food insecurity.

A systematic review examining the relationship between food insecurity and early childhood physiological health outcomes

Food insecurity, or limited access to nutritious foods, is a significant public health concern especially among vulnerable populations including infants and young children in low-income households. While literature to date has thoroughly examined the psychological and behavioral impacts of food insecurity on children, no known study to date has specifically synthesized the literature exploring the relationship between food insecurity and physiological health outcomes during early childhood. The purpose of this study was to review the literature on physiological health outcomes associated with food insecurity during early childhood among children aged 0-5 years in developed countries. Our literature search sources included PubMed, PsycInfo, CINAHL, and Embase databases. A total of 657 articles published up to September 2019 were reviewed for eligibility by two coders, with a third reviewer in cases of disagreement. Eighty-three articles remained after screening by abstract, with a final 27 studies ultimately included in the final synthesis. This review is registered with PROSPERO and adhered to PRISMA guidelines. In total, 20 articles (74%) noted significant relationships between food insecurity and physiological health outcomes in young children. Findings included an association with overweight or obesity (n = 9), anemia (n = 3), poor child health (n = 3), low birth weight (n = 3), chronic illness (n = 1), special health care needs (n = 1), and increased cortisol (n = 1), in young children who experience food insecurity. Identifying relationships between food insecurity and health outcomes during early childhood has the potential to inform future prevention interventions to reduce health disparities in these vulnerable populations.

Maternal mental health modifies the association of food insecurity and early child development

We examined the association between household food insecurity and early child development and whether or not maternal depression and anxiety modifies this association. The cross-sectional study included 468 mother-infant pairs recruited at primary health centers of the Federal District, Brazil. Mothers answered a questionnaire that evaluated early child development (outcome), household food insecurity (independent variable), maternal depression and trait anxiety (effect modifiers). Variables were collected with validated questionnaires for the Brazilian population. Pearson's χ2 test and logistic regression analyses were conducted. Infants who lived in a moderate or severe food insecure household had 2.52 times (95% confidence interval [CI] [1.13, 5.65]) the odds of having early child development delays compared with infants in secure households. Maternal depression and anxiety modified the strength of association between household food insecurity and early child development, which is an innovative finding. Among infants with depressed mothers, those experiencing mild (adjusted odds ratio [aOR] 3.33, 95% CI [1.17, 9.46]) and moderate/severe household food insecurity (aOR 10.13, 95% CI [2.18, 47.10]) had higher odds of having early child development delays, compared with infants in food secure households. Among infants with both anxious and depressed mothers, these associations were even stronger for mild (aOR 4.69, 95% CI [1.41, 15.59]) and moderate/severe household food insecurity (aOR 16.07, 95% CI [2.70, 95.66]). In conclusion, household food insecurity is a risk factor for early child development delays, and this association is modified by maternal depression and anxiety. Future studies should evaluate the impact of intervention packages that address maternal depression and anxiety and household food insecurity on preventing early child development delays.

Stability of food insecurity status in paediatric primary care

OBJECTIVE

The American Academy of Pediatrics recommends screening for food insecurity (FI) at all well-child visits due to well-documented negative effects of experiencing FI in childhood. Before age 3, children have twelve recommended primary care visits at which screening could occur. Little is known regarding the stability of FI status at this frequency of screening.

DESIGN

Data derived from electronic health records were used to retrospectively examine the stability of household FI status. Age-stratified (infant v. toddler) analyses accounted for age-based differences in visit frequency. Regression models with time since last screening as the predictor of FI transitions were estimated via generalised estimating equations adjusting for age and race/ethnicity.

SETTING

A paediatric primary care practice in Philadelphia.

PARTICIPANTS

3451 distinct patients were identified whose health record documented two or more household FI screens between April 1, 2012 and July 31, 2018 and were aged 0-3 years at first screen.

RESULTS

Overall, 9·5 % of patients had a transition in household FI status, with a similar frequency of transitioning from food insecure to secure (5·0 %) and from food secure to insecure (4·5 %). Families of toddlers whose last screen was more than a year ago were more likely to experience a transition to FI compared with those screened 0-6 months prior (OR 1·91 (95 % CI 1·05, 3·47)).

CONCLUSIONS

Screening more than annually may not contribute substantially to the identification of transitions to FI.

Unemployment insurance and food insecurity among people who lost employment in the wake of COVID-19

Forty million U.S. residents lost their jobs in the first two months of the coronavirus disease 2019 (COVID-19) pandemic. In response, the Federal Government expanded unemployment insurance benefits in both size ($600/week supplement) and scope (to include caregivers and self-employed workers). We assessed the relationship between unemployment insurance and food insecurity among people who lost their jobs during the COVID-19 pandemic in the period when the federal unemployment insurance supplement was in place. We analyzed data from the Understanding Coronavirus in America (UAC) cohort, a longitudinal survey collected by the University of Southern California Center for Economic and Social Research (CESR) every two weeks between April 1 and July 8, 2020. We limited the sample to individuals living in households earning less than $75,000 in February 2020 who lost their jobs during COVID-19. Using difference-in-differences and event study regression models, we evaluated the association between receipt of unemployment insurance and self-reported food insecurity and eating less due to financial constraints. We found that 40.5% of those living in households earning less than $75,000 and employed in February 2020 experienced unemployment during the COVID-19 pandemic. Of those who lost their jobs, 31% reported food insecurity and 33% reported eating less due to financial constraints. Food insecurity peaked in April 2020 and declined over time, but began to increase again among people receiving unemployment insurance during the final wave of the survey ahead of the federal supplement to unemployment insurance ending. Food insecurity and eating less were more common among people who were non-White, lived in lower-income households, younger, and who were sexual or gender minorities. Receipt of unemployment insurance was associated with a 4.4 percentage point (95% CI: −7.8 to −0.9 percentage points) decline in food insecurity (a 30.3% relative decline compared to the average level of food insecurity during the study period). Receipt of unemployment insurance was also associated with a 6.1 percentage point (95% CI: −9.6 to −2.7 percentage point) decline in eating less due to financial constraints (a 42% relative decline). Estimates from event study specifications revealed that reductions in food insecurity and eating less were greatest in the four-week period immediately following receipt of unemployment insurance, with no evidence of differential pre-existing trends in either outcome. We conclude that receiving unemployment insurance benefits during the period when the $600/week federal supplement was in place was associated with large reductions in food insecurity.

Community-Level Social Determinants and Children's School Readiness

The current study examined links between social determinants across communities and school readiness of children attending kindergarten in each community, in literacy, math, self-regulation, and social skills. Four types of social determinants were explored: socioeconomic, crime/violence, health and well-being, and access to resources. Data came from the Oregon Kindergarten Assessment, with 40,652 entering kindergarteners attending 706 schools in the fall of 2014. The 706 schools were nested within 36 counties. Variables representing social determinants were drawn from a variety of publicly available data sources from the year(s) most recently prior to the 2014-2015 school year. Bayesian multilevel modeling was conducted with children nested within schools, within counties. Children's school readiness in all four domains was negatively predicted by economic disadvantage at the school-level (indicated by other children with whom they attend Kindergarten), accounting for economic disadvantage in their own household. Moreover, school-level economic disadvantage amplified the negative effects of children's economic disadvantage on their school readiness. Four county-level social determinants also predicted one or more of the four school readiness outcomes, accounting for child- and school-level factors: child care supply, behavioral crime, maternal smoking, and adult health. County-level findings should be interpreted with caution due to a small sample and exploratory approach. However, this study is a first step to helping leaders address critical questions about how community risk factors like crime, and resources like child care, relate to school readiness among children in their communities.

Food Insecurity Is Associated with Lower Cognitive Functioning in a National Sample of Older Adults

BACKGROUND

Food insecurity, a social and economic condition of inadequate food resources, is known to affect cognitive development in children. However, research is sparse among adult populations, particularly older adults who may be more susceptible to accelerated cognitive decline.

OBJECTIVE

The aim of this study was to examine the associations between food insecurity and cognitive functioning among older adults.

METHODS

Data came from 1823 older adults (≥60 y) with incomes ≤300% of the federal poverty level (FPL) from the 2011-2014 NHANES. Food security was measured using the 10-item Adult Food Security Survey Module. Cognitive function was measured using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning subtest and delayed word recall, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). The cognitive assessments were then standardized and an overall cognitive function z score was created by averaging across all cognitive assessments. Associations with food insecurity were examined using multivariate linear regression models, adjusting for sociodemographic and health characteristics.

RESULTS

In the analytic population, the prevalence of food insecurity was 23.7%. Across all cognitive assessments, the mean scores among food-insecure adults was significantly lower than the mean scores among food-secure adults. After adjusting for sociodemographic and health characteristics, food insecurity was associated with lower scores on the CERAD word learning subtest (β = -0.14, 95% CI: -0.26, -0.01), the AFT (β = -0.13, 95% CI: -0.25, -0.002), and the DSST (β = -0.24, 95% CI: -0.33, -0.15). Food insecurity was also associated with a lower score on the overall cognitive function z score (β = -0.15, 95% CI: -0.26, -0.05).

CONCLUSIONS

In this national sample of 1823 adults aged ≥60 y, food insecurity was inversely associated with cognitive function, which may translate into higher risk of cognitive impairment over time.

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.

Household Food Insecurity is Associated with Higher Adiposity among US Schoolchildren Ages 10-15 Years: The Healthy Communities Study

BACKGROUND

Limited research exists on the relationship between food insecurity and children's adiposity and diet and how it varies by demographic characteristics in the United States.

OBJECTIVE

The aim of this study was to assess the relationship between household food insecurity and child adiposity-related outcomes, measured as BMI (kg/m2) z score (BMI-z), weight status, and waist circumference, and diet outcomes, and examined if the associations differ by age, sex, and race/ethnicity.

METHODS

Data collected in 2013-2015 from 5138 US schoolchildren ages 4-15 y from 130 communities in the cross-sectional Healthy Communities Study were analyzed. Household food insecurity was self-reported using a validated 2-item screener. Dietary intake was assessed using the 26-item National Cancer Institute's Dietary Screener Questionnaire, and dietary behaviors were assessed using a household survey. Data were analyzed using multilevel statistical models, including tests for interaction by age, sex, and race/ethnicity.

RESULTS

Children from food-insecure households had higher BMI-z (β: 0.14; 95% CI: 0.06, 0.21), waist circumference (β: 0.91 cm; 95% CI: 0.18, 1.63), odds of being overweight or obese (OR: 1.17; 95% CI: 1.02, 1.34), consumed more sugar from sugar-sweetened beverages (β: 1.44 g/d; 95% CI: 0.35, 2.54), and less frequently ate breakfast (β: -0.28 d/wk; 95% CI: -0.39, -0.17) and dinner with family (β: -0.22 d/wk; 95% CI: -0.37, -0.06) compared to children from food-secure households. When examined by age groups (4-9 and 10-15 y), significant relationships were observed only for older children. There were no significant interactions by sex or race/ethnicity.

CONCLUSIONS

Household food insecurity was associated with higher child adiposity-related outcomes and several nutrition behaviors, particularly among older children, 10-15 y old.

The Academic, Behavioral, and Health Influence of Summer Child Nutrition Programs: A Narrative Review and Proposed Research and Policy Agenda

Since 1975, the US Department of Agriculture has sponsored the Summer Food Service Program as a nationwide strategy for providing nutritious meals to children and youth (aged 18 years or younger) in low-income communities during the summer months. Many programs are sponsored by community organizations as well as school districts that may offer the program through the Summer Food Service Program or a seamless waiver, allowing them to extend school meals programs into the summer. These summer nutrition programs are designed to decrease food insecurity and improve health outcomes among at-risk populations. However, the characteristics of these programs, including the types of participants reached, and the programs' influence on outcomes such as academics, behavior, and physical and mental health, have not been summarized. The aims of this narrative review are to present existing knowledge about the characteristics of summer nutrition programs and their influence on students, to identify knowledge gaps, and to identify future research needs. An extensive search identified eight peer-reviewed articles and 10 reports, briefs, or other documents reporting research on the Summer Food Service Program. A variety of additional literature was reviewed to provide relevant information about summer nutrition programs. The review revealed a dearth of research regarding current Summer Food Service Program implementation. Summer nutrition programs alleviated food insecurity among at-risk populations; however, little research was found about the influence of summer programs on students' dietary intake or weight outcomes. More rigorous and mixed-methods studies examining the characteristics and influence of summer nutrition programs are needed.

The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature

Food insecurity is a major public health concern characterized by an individual or household lacking access to adequate food to support a healthy lifestyle. Food insecurity has been associated with predisposing or exacerbating mental health symptoms in children. However, the evidence is scarce with regards to Attention-Deficit Hyperactivity Disorder (ADHD) symptoms in children. The purpose of this review is to summarize and identify gaps in the existing literature, as well as to explore associations between food insecurity and symptoms of childhood ADHD. Literature for this review was pulled from Ovid MEDLINE and PubMed library databases, with a focus on food insecurity, food insufficiency, hunger, and ADHD symptoms such as inattention, hyperactivity, and impulsivity in children. The limited evidence to date shows a predictive and inverse relationship between childhood experience of food insecurity and symptoms of ADHD, with lasting impacts into adulthood. Evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children, yet the literature needed to confirm this relationship is scarce and utilizes inconsistent methodology. Future research is needed to further characterize this complex relationship and inspire community or public health interventions addressing food insecurity in children with ADHD. Additionally, it may be clinically useful to routinely screen for food insecurity when assessing pediatric ADHD symptoms.

Household Food Insufficiency and Children Witnessing Physical Violence in the Home: Do Family Mental Illness and Substance Misuse Moderate the Association?

Objectives Research to date indicates that parents and children residing in food insufficient homes incur a host of negative health outcomes. Recently, studies have suggested that these homes are also at risk of violence between family members. Our objective is to examine the link between household food insufficiency and physical violence in the home using a recent, nationally representative sample, and to determine whether family mental illness and/or substance misuse inform this association. Methods A sample of nearly 50,000 children and families from the 2016 National Survey of Children's Health were employed in the study. Information concerning household access to food, experiences of violence between parents/adults, and associated mental health and substance use risk factors were available in the data. Logistic regression, employed in a hierarchical fashion, was utilized to analyze the data. Results Household food insufficiency was associated with an increased risk of children witnessing physical violence in the home, and this was especially pronounced in the case of moderate-to-severe food insufficiency. Findings also indicated that family mental illness and substance misuse partly attenuated this association and that household food insufficiency was more strongly associated with violence in the home in the absence of mental health and substance use risk factors. Conclusions for Practice Polices aimed at diminishing food insufficiency may have important collateral benefits in the form of reductions in family violence, and these benefits appear to extend to families that are otherwise at low risk of family violence.

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.

Household Food Insecurity and Psychosocial Dysfunction in Ecuadorian Elementary Schoolchildren

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. Psychosocial dysfunction is a major cause of childhood disability. US and Canadian studies have linked HFI to poorer overall psychosocial dysfunction and specific dysfunction types in school-aged children, i.e., internalizing, externalizing, and attention behaviors. However, it is uncertain whether prior findings are generalizable to low- and middle-income country (LMIC) settings. We conducted a cross-sectional study to explore the association of HFI with psychosocial dysfunction in 6-12-year-old public elementary schoolchildren (n=279) residing in low-income neighborhoods in Quito, Ecuador. Maternal caregivers were interviewed to obtain data on child psychosocial dysfunction (Pediatric Symptom Checklist, PSC), food security (Household Food Security Survey Module), and maternal mental health (SF-36 Mental Composite Summary). Capillary blood samples were obtained from child participants to measure hemoglobin levels. The data were analyzed using general linear models with adjustment for covariates. The results revealed that HFI was associated with significantly higher overall average PSC scores (p=0.002) and with internalizing (p=0.001) and externalizing (p=0.03) but not attention subscale scores. However, anemia was independently associated with PSC attention subscale scores (p=0.015). This is the first study to report on the relationship between HFI and psychosocial dysfunction in school-aged children in a LMIC setting. It highlights the importance of improving policies and programs protecting vulnerable households from HFI. In addition to improving health and nutrition, such improvements could potentially reduce the burden of child psychosocial dysfunction.

Application of the Human Well-Being Index to Sensitive Population Divisions: A Children's Well-Being Index Development

The assessment of community well-being is critical as an end-point measure that will facilitate decision support and assist in the identification of sustainable solutions to address persistent problems. While the overall measure is important, it is equally vital to distinguish variations among groups within the population who may be impacted in a different manner. The U.S. Environmental Protection Agency (US EPA) developed the Human Well-Being Index (HWBI), as a way of measuring these outcomes and assessing community characteristics. The HWBI approach produces a suite of indicators, domains and a final composite index appropriate for characterizing well-being of a population. While generalized approaches are needed, it is important to also recognize variations in well-being across community enclaves. This paper presents an adaption of the HWBI for child populations to test the applicability of the index framework to specific community enclaves. First, an extensive literature review was completed to ensure the theoretical integrity of metric and indicator substitutions from the original HWBI framework. Metric data were then collected, refined, imputed where necessary and evaluated to confirm temporal and spatial availability. A Children's Well-Being Index (CWBI) value, representing the same indicators and domains of well-being as the original HWBI, was calculated for the population under age 18 across all US counties for 2011. Implications of this research point to an effective, holistic end-point measure that can be tracked over time. Similarly, there is great potential for the application of the original HWBI method to other statistical population segments within the greater US population. These adaptations could help identify and close gaps in equity of resource distribution among these groups.

Brain Activity, Low Self-Control, and Delinquency: An fMRI Study of At-Risk Adolescents

PURPOSE

A vast literature finds that low self-control is associated with a myriad of antisocial behaviors. Consequently, increasing attention has focused on the causes of low self-control. While criminologists have directed significant attention to studying its social causes, fewer studies have considered its neural bases.

METHODS

We add to this nascent body of research by using data collected on an at-risk sample of adolescents participating in the ongoing Michigan Longitudinal Study. We examine the functioning of prefrontal and limbic regions of the brain during failed inhibitory control, assessed using the go/no-go task and functional magnetic resonance imaging, in relation to low self-control and self-reported delinquency.

RESULTS

Results indicate that greater activation localized in the anterior cingulate cortex (ACC) during failed inhibitory control is negatively associated with low self-control. Moreover, the association between ACC activity and later delinquency is mediated through low self-control.

CONCLUSIONS

Findings of this study demonstrate the utility of integrating neuroscientific and criminological perspectives on the causes of antisocial behavior. Concluding remarks address the theoretical and policy implications of the findings, as well as directions for future research.

Food insecurity and child behavior problems in fragile families

Food insecurity remains a persistent problem in the United States. Several studies have shown that food insecurity is associated with child externalizing and internalizing behavior problems. However, some potential methodological limitations remain. For example, most studies use a household measure of food insecurity while there is evidence that children, especially younger ones, tend to be shielded by their parents from experiencing food insecurity. In addition, the mechanisms through which food insecurity affects children are not well understood. This study uses longitudinal data from the Fragile Families and Child Wellbeing Study to address these limitations. Fixed-effects models show that the association is even larger using a measure of child food insecurity instead of a household one. Correlated-random effects models show a large difference in child behavior problems between food secure and food insecure children due to unobserved heterogeneity. In addition, the association between child food insecurity and child externalizing behaviors remains largely unexplained while food insecurity among adults explains almost all the variation in the association with child internalizing behaviors. Food insecure children and parents are at risk of micronutrient deficiencies, which may lead to behavior problems in young children. These findings underscore the need for greater focus on reducing the risk of food insecurity, especially for children in fragile families, in order to reduce behavior problems and improve their educational attainment.

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.

The association between food insecurity and academic achievement in Canadian school-aged children

OBJECTIVE

Education is a crucial social determinant of health. Food insecurity can be detrimental to children's academic achievement, potentially perpetuating a cycle of poverty and food insecurity. We aimed to assess the relationship between food insecurity and academic achievement in Canadian school-aged children.

DESIGN

Cross-sectional study of children and parents. Parents completed the short-form Household Food Security Survey Module and questions about income and education level (socio-economic status). Children completed FFQ. Data were prospectively linked to children's performance on standardized exams written one year later. Mixed-effect logistic regression was employed to assess the relationship between food insecurity and likelihood of meeting academic expectations adjusting for socio-economic status, diet quality and potential confounders.

SETTING

Nova Scotia, Canada in 2011-2012.

SUBJECTS

Students (n 4105) in grade 5 (10-11 years; 2167 girls) and their parents.

RESULTS

Low food security was reported by 9·8 % of households; very low food security by 7·1 % of households. Students from low-income households and reporting poor diet quality were less likely to do well in school. Children who lived in households reporting very low food security had 0·65 times the odds (OR=0·65; 95 % CI 0·44, 0·96) of meeting expectations for reading and 0·62 times the odds (OR=0·62; 95 % CI 0·45, 0·86) of meeting expectations for mathematics.

CONCLUSIONS

Very low household insecurity is associated with poor academic achievement among children in Nova Scotia.

Soft drinks consumption and child behaviour problems: the role of food insecurity and sleep patterns

Objective

To examine whether the association between soft drinks consumption and child behaviour problems differs by food security status and sleep patterns in young children.

Design

Cross-sectional observational data from the Fragile Families and Child Wellbeing Study (FFCWS), which collected information on food insecurity, soft drinks consumption, sleep patterns and child behaviour problems. Bivariate and multivariate ordinary least-squares regression analyses predicting child behaviour problems and accounting for socio-economic factors and household characteristics were performed.

Setting

Twenty urban cities in the USA with a population of 200 000 or more.

Subjects

Parental interviews of 2829 children who were about 5 years old.

Results

Soft drinks consumption was associated with aggressive behaviours, withdrawn and attention problems for children aged 5 years. However, the association differed by food security status. The association was mostly statistically insignificant among food-secure children after accounting for socio-economic and demographic characteristics. On the other hand, soft drinks consumption was associated with behaviour problems for food-insecure children even after accounting for these factors. However, after accounting for child sleep patterns, the association between soft drinks consumption and child behaviour problems became statistically insignificant for food-insecure children.

Conclusions

The negative association between soft drinks consumption and child behaviour problems could be explained by sleep problems for food-insecure children. Since about 21 % of households with children are food insecure, targeted efforts to reduce food insecurity would help improve dietary (reduce soft drinks consumption) and health behaviours (improve sleep) and reduce child behaviour problems.