Longitudinal Trajectories of Food Insecurity in Childhood and Their Associations With Mental Health and Functioning in Adolescence

Vincent Paquin,Richard Tremblay,Gina Muckle,Sylvana Côté,Yohann Courtemanche,Michel Boivin,Natalie Castellanos-Ryan,Despina Bolanis,Marie-Claude Geoffroy

doi:10.1001/jamanetworkopen.2021.40085

Abstract

Household food insecurity has been associated with mental health problems in children independently of family income and other confounders. It is unclear whether food insecurity during childhood is also associated with mental health and functioning during adolescence. To evaluate longitudinal trajectories of household food insecurity during the first 13 years of life, characteristics associated with these trajectories, and the associations of the trajectories with externalizing, internalizing, substance use, and social adjustment problems at 15 years of age. This cohort study included participants from the Québec Longitudinal Study of Child Development, a cohort of 2120 children born in Québec, Canada, in 1997 and 1998 and followed up annually or biannually from 5 months to 15 years of age (1998-2013). Data were analyzed from November 2020 to October 2021. When children were aged 1.5, 4, 8, 10, 12, and 13 years, mothers reported whether a family member experienced hunger because the family had run out of food or money to buy food in the past 12 months. Group-based trajectory modeling was used to identify differential exposure to food insecurity from 1.5 to 13 years according to logit functions of age. At 15 years of age, adolescents completed validated questionnaires assessing externalizing, internalizing, substance use, and social adjustment problems. Associations between trajectories of food insecurity and outcomes were assessed using linear regressions. A total of 2032 individuals were included in the analyses of trajectories of food insecurity (1026 [50.5%] male) and 1441 in the analysis of the association with outcomes at 15 years of age (752 [52.2%] female). Two trajectories of food insecurity were identified between 1.5 and 13 years of age: high risk (73 children [3.6%]) and low risk (1959 children [96.4%]). At 5 months, the high-risk and low-risk groups differed in household characteristics including income insufficiency (58 [80.6%] vs 405 [21.0%]), single parenthood (21 [29.2%] vs 135 [6.9%]), and parental history of depression (mothers: 30 [43.5%] vs 411 [21.7%]; fathers: 12 [32.4%] vs 209 [13.5%]). The high-risk trajectory from 1.5 to 13 years of age was associated with cannabis use (β, 0.47; 95% CI, 0.12-0.81), peer bullying (β, 0.43; 95% CI, 0.08-0.77), and dropout potential (β, 0.38; 95% CI, 0.03-0.68) at 15 years of age after adjustment for sex, household income insufficiency, and parental mental health. In this cohort study, few children experienced a persistent high risk of food insecurity, which was associated with psychosocial problems later in adolescence after adjustment for confounders including low income. Early identification of risk for food insecurity may guide the delivery of tailored interventions to improve functioning in adolescence.

Highlights

From 2017 through 2018, 13% of Canadian households had food insecurity in the past year, which means they were “at times, unable to acquire adequate food for one or more household members because they had insufficient money and other resources for food.”[1,2] The prevalence of food insecurity increased during the COVID-19 pandemic in 2020.3-5 Presence of children, lower income, lower educational attainment, and migrant status were associated with household food insecurity.[5]Children are at risk for the consequences of food insecurity because they are rapidly developing.[6,7,8] Household food insecurity during childhood has been associated with negative outcomes independently of low income and other key confounders
The high-risk trajectory from 1.5 to 13 years of age was associated with cannabis use (β, 0.47; 95% CI, 0.12-0.81), peer bullying (β, 0.43; 95% CI, 0.08-0.77), and dropout potential (β, 0.38; 95% CI, 0.03-0.68) at 15 years of age after adjustment for sex, household income insufficiency, and parental mental health
In this cohort study, few children experienced a persistent high risk of food insecurity, which was associated with psychosocial problems later in adolescence after

Summary

Introduction

From 2017 through 2018, 13% of Canadian households had food insecurity in the past year (with a similar prevalence in the US), which means they were “at times, unable to acquire adequate food for one or more household members because they had insufficient money and other resources for food.”[1,2] The prevalence of food insecurity increased during the COVID-19 pandemic in 2020.3-5 Presence of children, lower income, lower educational attainment, and migrant status were associated with household food insecurity.[5]. Children are at risk for the consequences of food insecurity because they are rapidly developing.[6,7,8] Household food insecurity during childhood has been associated with negative outcomes independently of low income and other key confounders. Of the few studies examining outcomes during adolescence, most have been crosssectional (from which the temporal precedence cannot be established)[7,8] or limited to specific outcomes such as misconduct[13] or depression.[14]

Methods

Results

Discussion

Conclusion