Abstract
Food insecurity (FI) has been recognized as a public challenge not only for developing countries but also for the U.S. population. The present study was designed to identify the prevalence of FI and the association of household FI with the health status of pediatric patients seen at a Federally Qualified Health Center in New Jersey which provides health care mainly for Latino patients. Patients were included if they were screened for FI at their well visits during a 4-month period following implementation of the 2-item screening tool recommended by American Academy of Pediatrics. We compared demographic and morbidity data of children with FI to those living in food-secure households. The results are presented as the distribution of frequency (%) and odds ratios (OR) with 95% confidence interval (95% CI). FI was detected in 15.8% (95% CI 14.2–17.5%) of 486 studied children. We recorded higher rates of anemia (10.4 vs. 3.2%, p < 0.005), hypercholesterolemia (10.4 vs. 3.4%, p < 0.01), and any morbidity (24.7 vs. 9.3%, p < 0.02) in children living in FI households. Multivariate logistic regression analysis revealed an association of household FI with at least one recorded morbidity independent of the patient’s age, gender, and body mass index (OR 1.79, 95% CI 1.31–2.43). No one was diagnosed with diabetes, and only a few with asthma and hypertension. We have concluded that living in households with FI increased the risk for unfavorable health outcomes in a predominantly economically disadvantage community of children within the U.S. population.
Similar content being viewed by others
References
Coleman-Jensen, A., Rabbitt, M. P., Gregory, C. A., & Singh, A. (2017). Household Food Security in the United States in 2016. ERR-237, U.S. Department of Agriculture, Economic Research Service.
Schanzenbach, D. W., & Baurer, L. (2017). Food Insecurity Among Children in 2015. Retrieved November 28, 2017 from https://www.brookings.edu/blog/up-front/2017/06/19/food-insecurity-among-children-in-2015/.
Gundersen, C., & Gundersen, C. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839.
Schwarzenberg, S. J., Kuo, A. A., Linton, J. M., & Flanagan, P. (2015). Promoting food security for all children. Pediatrics, 136(5), e1431–e1438. https://doi.org/10.1542/peds.2015-3301.
Department of Agriculture, Economic Research Service and Food and Nutrition Service. (2017). Percentage of children ages 0–17 in food insecure households by selected characteristics and severity of food insecurity, selected years 1995–2015. Retrieved November 28, 2017 from https://www.childstats.gov/americaschildren/tables/econ3.asp.
Gundersen, C., Dewey, A., Crumbaugh, A. S., Kato, M., & Engelhard, E. (2017). Map the Meal Gap 2017: Food Insecurity and child food insecurity estimates at the county level. Feeding America. Retrieved November 17, 2017 from http://www.feedingamerica.org/research/map-the-meal-gap/2015/2015/-mapthemealgap-exec-summary.pdf.
Quandt, S. A., Shoaf, J. I., Tapia, J., Hernandez-Pelletier, M., Clark, H. M., & Arcury, T. A. (2006). Experiences of Latino immigrant families in North Carolina help explain elevated levels of food insecurity and hunger. Journal of Nutrition, 136(10), 2638–2644.
Gundersen, C., Garasky, S., & Lohman, B. J. (2009). Food insecurity is not associated with childhood obesity as assessed using multiple measures of obesity. Journal of Nutrition, 139(6), 1173–1178.
Banach, L. P. (2016). Hospitalization: Are we missing an opportunity to identify food insecurity in children? Academic Pediatrics, 16(5), 438–445.
Cook, J. T., Frank, D. A., Berkowitz, C., Black, M. M., Casey, P. H., Cutts, D. B., … Nord, M. (2004). Food insecurity is associated with adverse health outcomes among human infants and toddlers. Journal of Nutrition, 134(6), 1432–1438.
Bright, M. A., Thompson, L., Esernio-Jenssen, D., Alford, S., & Shenkman, E. (2015). Primary care pediatricians’ perceived prevalence and surveillance of adverse childhood experiences in low-income children. Journal of Health Care for the Poor and Underserved, 26(3), 686–700.
McLoyd, V. C. (1998). Socioeconomic disadvantage and child development. American Psychologist, 53(2), 185–204.
Hager, E., Quigg, A., Black, M., Coleman, S., Heeren, T., Rose-Jacobs, R., … Frank, D. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), E26–E32.
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. (2015). About child and teen BMI. Retrieved November 5, 2017 from https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.
Carbarski, D. (2014). Comparing self and maternal reports of adolescents’ general health in a nationally representative survey: Do self and proxy reports differ in their relationships with covariates? Quality of Life Research, 23(7), 1953–1965.
Alaimo, K., Olson, C., Frongillo, E., & Briefel, R. (2001). Food insufficiency, family income, and health in US preschool and school-aged children. The American Journal of Public Health, 91(5), 781–786.
Garg, A., Toy, S., Tripodis, Y., Silverstein, M., & Freeman, E. (2015). Addressing social determinants of health at well child care visits: A cluster RCT. Pediatrics, 135(2), 296–304.
Park, K., Kersey, M., Geppert, J., Story, M., Cutts, D., & Himes, J. H. (2009). Household food insecurity is a risk factor for iron-deficiency anaemia in a multi-ethnic, low-income sample of infants and toddlers. Public Health Nutrition, 12(11), 2120–2129.
Trapp, C. M., Burke, G., & Gorin, A. A. (2015). The relationship between dietary patterns, body mass index percentile, and household food security in young urban children. Child Obesity, 11(2), 148–155.
Metallinos-Katsaras, E., Must, A., & Gorman, K. (2012). A longitudinal study of food insecurity on obesity in preschool children. Journal of the Academy of Nutrition and Dietetics, 112(12), 1949–1958.
Skalicky, A., Meyers, A. F., Adams, W. G., Yang, Z., Cook, J. T., & Frank, D. A. (2006). Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States. Maternal and Child Health Journal, 10(2), 177–185.
Gundersen, G., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839.
Marjerrison, S., Cummings, E. A., Glanville, N. T., Kirk, S. F., & Ledwell, M. (2011). Prevalence and associations of food insecurity in children with diabetes mellitus. Journal of Pediatrics, 158(4), 607–611.
To, Q. G., Frongillo, E. A., Gallegos, D., & Moore, J. B. (2014). Household food insecurity is associated with less physical activity among children and adults in the U.S. Journal of Nutrition, 144(11), 1797–1802.
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents. American Academy of Pediatrics. Retrieved November 28, 2017 from https://pediatriccare.solutions.aap.org/book.aspx?bookid=990.
Bolton, P., Holt, E., Ross, A., Hughart, N., & Guyer, B. (1998). Estimating vaccination coverage using parental recall, vaccination cards, and medical records. Public Health Reports, 113(6), 521–526.
Anderson, S. A. (1990). Core indicators of nutritional state for difficult-to-sample populations. Journal of Nutrition, 120(suppl 11), 1557S–1600S.
Bickel, G., Nord, M., Price, C., Hamilton, W., & Cook, J. T. (2000). Measuring Food Security in the United States: Guide to Measuring Household Food Security. USDA. Retrieved November 28, 2017 from http://www.fns.usda.gov/guidmeasuring-household food security.
Lee, J. S., Gundersen, C., Cook, J., Laria, B., & Johnson, M. A. (2012). Food insecurity and health across the lifespan. Advances in Nutrition, 3(5), 744–745.
Nord, M. (2009). Food spending declined and food insecurity increased for middle-income and low-income households from 2000 to 2007. Economic Information Bulletin (EIB), 61, 1–16.
Fram, M. S., Frongillo, E. A., Draper, C. L., & Fishbein, E. (2012). Development and validation of a child report assessment of child food insecurity and comparison to parent report assessment. Journal of Hunger and Environment Nutrition, 8(2), 128–145.
Casey, P. H., Szeto, K., Lenzing, S., Bogle, M., & Weber, J. (2001). Children in food-insufficient, low-income families: Prevalence, health, and nutrition status. Archives of Pediatrics & Adolescent Medicine, 155(4), 508–514.
Acknowledgements
The authors wish to acknowledge the physicians, pediatric residents, and nurses who all contributed to the implementation of food insecurity screening of pediatric patients at the Eric B. Chandler Health Center in New Brunswick, NJ. We are indebted to the parents and children whose medical records were used in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. The corresponding author wrote the first draft of the manuscript and it has been edited and approved by all authors.
Disclosure
There are no prior publications or submissions with any overlapping information, including studies and patients. The authors have no financial relationships relevant to this article to disclose.
Rights and permissions
About this article
Cite this article
Bahadur, K., Pai, S., Thoby, E. et al. Frequency of Food Insecurity and Associated Health Outcomes in Pediatric Patients at a Federally Qualified Health Center. J Community Health 43, 896–900 (2018). https://doi.org/10.1007/s10900-018-0499-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-018-0499-8