Household Food Insufficiency Research Articles

Household job insecurity, food insufficiency, and children’s mental health needs: Household Pulse Survey in June 2023

BackgroundEconomic hardships have far-reaching implications for families with children, impacting their well-being and development during the COVID-19 pandemic. The pandemic has led to household financial problems following job loss and reduced income. As parents or caregivers face financial difficulties, children may experience emotional distress through heightened anxiety and a sense of helplessness. This study examined the effects of household job insecurity and food insufficiency due to the pandemic's aftermath on the mental well-being of children in the United States.MethodThis study utilized data from the Household Pulse Survey (HPS) during June 7–19, 2023 (Phase 3.9). The prevalence and effect of job insecurity, delineated by recent household job loss and employment status, and food insufficiency, measured through levels of food insufficiency, were analyzed across households with different age groups of children: under 5 years, 5–11 years, and 12–17 years, with an overall perspective on children under 18. We calculated unweighted observations, survey-weighted proportions, and survey-weighted 95% confidence intervals to analyze the impact of job insecurity and food insufficiency on children’s mental health treatment needs.ResultsThis study highlighted differences in economic hardships due to household job insecurity and food insufficiency across households with children in multiple age groups. There were almost twice as many respondents with no work in the last 7 days (33.68%) compared to those who experienced job loss within the last 4 weeks (14.82%). Additionally, 51.68% of respondents reported food insufficiency over the last 7 days, with more than half of the households experiencing food insufficiency due to the inability to afford more food. Mental health treatment needs among children were significantly higher in households experiencing job loss and food insufficiency. The need for mental health support for children increased with age in households facing job loss or no employment.ConclusionsThis study enhances our understanding of post-pandemic economic hardships and their influence on children’s mental health needs across different age groups. By identifying disparities and patterns, policymakers and practitioners can design targeted interventions to address employment opportunities and food access in the aftermath of the COVID-19 pandemic. Providing mental health treatments is crucial, especially for children aged 5–11 and 12–17, who are at higher risk of experiencing emotional distress due to household economic hardships.

Gas extraction and community outcomes: The case of Mtwara rural district, Tanzania

This study examines the effects of gas extraction operations (GEOs) on livelihood outcomes among rural communities in the Mtwara Rural District of Tanzania. This study employed a cross-sectional research methodology with a proportionately stratified sample of 260 participants. A questionnaire and interview guide were used to collect both quantitative and qualitative data during focus group discussions, key informant interviews, and household surveys. It examines net annual income in Tanzanian shillings (TAS), the monetary value of a household's assets in TAS, and food security using the Household Food Insufficiency Access Scale (HFIAS). The study revealed that nearby households (treated group) had much stronger food security than distant (control) households by 9.528 to 8.189 across near neighbor matching (NNM) and by 9.444 to 7.619 across radius caliper matching, with these differences being statistically significant at t = 2.0 and t = 2.5, respectively. The results suggest that the government should pursue measures that increase rural households' chances for off-farm jobs in order to improve their well-being.

Association of emergency allotment discontinuation with household food insufficiency in Supplemental Nutrition Assistance Program participants: A quasi-experimental study

ObjectiveThe Supplemental Nutrition Assistance Program (SNAP) was modified to mitigate food insecurity faced by low-income families during the pandemic. These changes included enhancement of SNAP benefits via 2020 emergency allotments (EA). Despite the high food price inflation in 2022, 17 states ceased providing EA benefits by end of 2022. The objective of this research is to examine the impact of EA discontinuation on food insufficiency. MethodsUsing Household Pulse Survey data from December 2021–January 2023, SNAP participants (n = 57,556) from states that discontinued EA at some point during the study period and those from states that did not discontinue EA were included. The main analyses examined the impact of EA discontinuation on food insufficiency via staggered difference-in-difference models using two-way fixed effects (TWFE) regression. Additional analyses examined this association using Callaway-Sant'Anna approach for difference-in-difference analyses. ResultsUsing TWFE, EA discontinuation was significantly associated with increased food insufficiency in the overall sample, as well as in individuals who were non-Hispanic White and Hispanic, and who had annual family incomes of less than $25,000. Investigation of time-varying association of EA termination with food insufficiency suggested that EA discontinuation was significantly associated with greater food insufficiency in the second week following rollback. DiD analyses using Callaway-Sant'Anna approach suggested that states' rollback of EA was significantly associated with higher food insufficiency in non-Hispanic White individuals. ConclusionFindings imply that EA discontinuation, amidst the corresponding surge in inflation, could have contributed to increased rates of household food insufficiency.

Household Food Insufficiency and Chronic Pain among Children in the US: A National Study.

This study aimed to determine the prevalence of pediatric chronic pain by household food sufficiency status and examine whether food insufficiency would be associated with greater risk for chronic pain. We analyzed data from the 2019-2020 National Survey of Children's Health of 48,410 children (6-17 years) in the United States. Across the sample, 26.1% (95% CI: 25.2-27.0) experienced mild food insufficiency and 5.1% (95% CI: 4.6-5.7) moderate/severe food insufficiency. The prevalence of chronic pain was higher among children with mild (13.7%) and moderate/severe food insufficiency (20.6%) relative to children in food-sufficient households (6.7%, p < 0.001). After adjusting for a priori covariates (individual: age, sex, race/ethnicity, anxiety, depression, other health conditions, adverse childhood events; household: poverty, parent education, physical and mental health; community: region of residence), multivariable logistic regression revealed that children with mild food insufficiency had 1.6 times greater odds of having chronic pain (95% CI: 1.4-1.9, p < 0.0001) and those with moderate/severe food insufficiency, 1.9 higher odds (95% CI: 1.4-2.7, p < 0.0001) relative to food-sufficient children. The dose-response relationship between food insufficiency and childhood chronic pain highlights the importance of further research to identify underlying mechanisms and evaluate the impact of food insufficiency on the onset and persistence of chronic pain across the lifespan.

The effect of state Earned Income Tax Credit (EITC) eligibility on food insufficiency during the COVID-19 pandemic.

This paper uses data from the Household Pulse Survey to examine whether and for how long the eligibility to receive state Earned Income Tax Credit (EITC) benefits reduced self-reported household food insufficiency among lower-income households with dependent children during the COVID-19 pandemic. The results of models estimated using difference-in-differences (DD) and difference-in-difference-in-differences (DDD) methods suggest that state EITC eligibility, on average, reduced food insufficiency by about 3 percentage points between March 2021 and early October 2021. However, the results of models estimated using an event study method show that the effect was not visible in all the post-March bimonthly periods. Overall, this paper finds some evidence to suggest that state EITC eligibility reduced food insufficiency over a short period.

Food Insufficiency Following Discontinuation of Monthly Child Tax Credit Payments Among Lower-Income US Households

The 2021 expanded Child Tax Credit provided advance monthly payments to many US families with children from July through December 2021 and was associated with a reduction in food insufficiency. Less is known about the effect of the discontinuation of monthly payments. To assess whether the discontinuation of monthly Child Tax Credit payments was associated with subsequent changes in food insufficiency among lower-income US households with children. This population-based cross-sectional study used data from the Household Pulse Survey, a recurring online survey of US households conducted by the US Census Bureau, from January 2021 to March 2022. This study estimated difference-in-differences regression models for households making less than $50 000, less than $35 000, and less than $25 000 annually, adjusting for demographic characteristics and state of residence. The estimation sample of households making less than $50 000/y included 114 705 responses, representing a weighted population size of 27 342 296 households. Receipt of monthly Child Tax Credit payments, as measured by living in a household with children during the period of monthly payments from July through December 2021. Household food insufficiency, as measured by a respondent indicating that there was sometimes or often not enough food to eat in the household in the previous 7 days. Among 114 705 households making less than $50 000/y, respondents were predominantly female (57%); White (71%); not of Hispanic, Latino, or Spanish origin (79%); had high school or equivalent education (38%); and were unmarried (70%). Following the discontinuation of monthly Child Tax Credit payments, food insufficiency in US households with children increased by 3.5 percentage points (95% CI, 1.4-5.7 percentage points) among households making less than $50 000/y, 4.9 percentage points (95% CI, 2.6-7.3 percentage points) among households making less than $35 000/y, and 6.2 percentage points (95% CI, 3.3-9.3 percentage points) among households making less than $25 000/y. These estimates represent a relative increase in food insufficiency of approximately 16.7% among households making less than $50 000/y, 20.8% among households making less than $35 000/y, and 23.2% among households making less than $25 000/y. In this population-based cross-sectional study, discontinuation of monthly Child Tax Credit payments in December 2021 was associated with a statistically significant increase in household food insufficiency among lower-income households, with the greatest increase occurring in the lowest-income households.

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

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. 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. 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. 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.

Association of the Expiration of Child Tax Credit Advance Payments With Food Insufficiency in US Households

Advance Child Tax Credit (CTC) monthly payments administered to more than 35 million households with children in the US between July and December 2021 were associated with a substantial decrease in food insufficiency. These monthly payments expired in January 2022 after Congress failed to extend the policy, and the subsequent impact on food insufficiency is currently unknown. To assess whether the expiration of monthly CTC payments in January 2022 was associated with changes in food insufficiency in US households with children. This study used repeated cross-sectional, nationally representative data from multiple waves of the Household Pulse Survey, conducted by the US Census Bureau. Online data collection occurred from July 21, 2021, to July 11, 2022, and data analysis was performed in July 2022. The first missed advance CTC payment on January 15, 2022. The main outcome was unadjusted prevalence of household food insufficiency. Event study specification was used to estimate the association between the expiration of the CTC payments and household food insufficiency with the exposure of being in a household with children present. The sample (592 044 respondents, representing households with and without children, for a weighted population size of 123 350 770 individuals) was majority female (362 286 individuals [51.3%]) and non-Hispanic White (425 497 individuals [62.2%]), and a plurality of respondents (248 828 [48.3%]) were aged 25 to 44 years at the time of the survey. During the survey wave just before CTC expiration (reference wave, December 29, 2021, to January 10, 2022), unadjusted household food insufficiency was 12.7% among households with children. In late January and early February 2022, following the first missed CTC monthly payment, 13.6% of households with children reported food insufficiency, increasing to 16.0% by late June and early July 2022. The event study specification estimated a 3.2 percentage point increase (95% CI, 1.4-5.0 percentage points; P < .001) in food insufficiency by the most recent wave available after the first missed CTC payment (June 29 to July 11, 2022) among households with children compared with the reference wave, a 25% increase. The findings of this study suggest that there was an increase in food insufficiency among households with children after they stopped receiving monthly CTC payments. Given the well-documented associations between inability to afford food and poor health outcomes across the life span, Congress should consider swift action to reinstate this policy.

Impacts of climate-smart crop varieties and livestock breeds on the food security of smallholder farmers in Kenya

This paper analyses the impact of climate-smart agriculture (CSA) technologies on household dietary diversity and food insufficiency as indicators of food and nutrition security in Kenya. Using a combination of Propensity Score Matching and endogenous treatment effect approaches, we found that adoption of stress-tolerant varieties of several crops (such as bean, pigeon pea, cowpea, maize and sorghum) improved household dietary diversity score by 40% and reduced food insufficiency by 75%. Adoption of improved and resilient livestock breeds (including Red Maasai sheep and Galla goats) improved household dietary diversity by 38% while reducing household food insufficiency by 90%. We also found that stress-tolerant crop varieties were more effective in improving food security outcomes among households with large landholdings and with more educated and younger to middle-age heads. Effects of resilient livestock breeds on household food security were much stronger for households with large landholdings and with young and/or much older heads that have low levels of education. Given the large, demonstrated benefits from the use of the CSA technologies, policies and programs aimed at their promotion should apply appropriate targeting to ensure wider uptake of the technologies and maximum returns on investment.

Economic Impact Payments and Household Food Insufficiency during COVID-19: The Case of Late Recipients.

During the COVID-19 pandemic, the U.S. government distributed Economic Impact Payments (EIPs) to ease the economic hardships of American households. Using the Household Pulse Survey, we study the association of first-round EIPs with household-level food insufficiency in a sample of late recipients of EIPs. Studying the late recipients is important for two reasons, first, about 12 million eligible individuals did not automatically receive EIPs, and second, the late receipt of EIPs and the low-income status of late recipients allow us to tease out the relationship between EIPs and food insufficiency. We find that EIPs were associated with a 9.2 percentage points decrease in the likelihood of food insufficiency. However, households kept relying on free food acquisition to fight food hardship. Our results suggest that government efforts to provide more timely stimulus payments could be very impactful and significantly impact household food insufficiency.

Association of the Implementation of Child Tax Credit Advance Payments With Food Insufficiency in US Households

A key component of the American Rescue Plan Act of 2021 included an expansion of the Child Tax Credit with advance payments beginning in July 2021, a "child allowance" that was projected to dramatically reduce child poverty. Food insufficiency has increased markedly during the economic crisis spurred by the COVID-19 pandemic, with disparities among marginalized populations, and may be associated with substantial health care and social costs. To assess whether the introduction of advance payments for the Child Tax Credit in mid-July 2021 was associated with changes in food insufficiency in US households with children. This cross-sectional study used data from several phases of the Household Pulse Survey, conducted by the US Census Bureau from January 6 to August 2, 2021. The survey had 585 170 responses, representing a weighted population size of 77 165 153 households. The first advance Child Tax Credit payment, received on July 15, 2021. Household food insufficiency. The weighted sample of 585 170 respondents was mostly female (51.5%) and non-Hispanic White (62.5%), with a plurality aged 25 to 44 years (48.1%), having a 4-year degree or more (34.7%) and a 2019 household income of $75 000 to $149 999 (23.1%). In the weeks after the first advance payment of the Child Tax Credit was made (July 21 to August 2, 2021), 62.4% of households with children reported receiving it compared with 1.1% of households without children present (P < .001). There was a 3.7-percentage point reduction (95% CI, -0.055 to -0.019 percentage points; P < .001) in household food insufficiency for households with children present in the survey wave after the first advance payment of the Child Tax Credit, corresponding to a 25.9% reduction, using an event study specification. Difference-in-differences (-16.4%) and modified Poisson (-20.8%) models also yielded large estimates for reductions in household food insufficiency associated with the first advance payment of the expanded Child Tax Credit. This study suggests that the Child Tax Credit advance payment increased household income and may have acted as a buffer against food insufficiency. However, its expansion and advance payment are only a temporary measure for 2021. Congress must consider whether to extend these changes or make them permanent and improve implementation to reduce barriers to receipt for low-income families.

Mediated Relationships between Supplemental Nutrition Assistance Program Benefits, Food Hardships, Health Status, and Emergency Department Use Among Low‐Income Children with and without Special Health Care Needs

Research ObjectiveThe Supplemental Nutrition Assistance Program (SNAP) has been found to reduce food hardships, which are associated with poor health and health care outcomes among children. Evidence that SNAP improves adult health and healthcare outcomes is growing, but studies including children have been limited. The need to assess these potential relationships among children with special health care needs (SHCN) is particularly pronounced, given their heightened social and health care complexity. We therefore aimed to (i) examine relationships between SNAP, food hardships, health status, and health care use among children, and (ii) examine whether SHCN status modified any of these relationships.Study DesignTo estimate the relationship between SNAP and food hardships, we followed prior studies in using a bivariate probit model with state‐level SNAP administrative policies as instruments (to account for disproportionate self‐selection into SNAP among households with high food hardships). We estimated this model within a structural equation modeling framework to simultaneously estimate downstream associations with health status and health care use. Household food insufficiency (FI) and excellent health status (versus very good, good, fair, or poor; a robust dichotomization among children) were modeled as mediators of the relationship between any SNAP receipt and any emergency department (ED) use over the prior year. We interacted SHCN status with SNAP to assess modification, and we adjusted for sociodemographic and environmental variables (e.g., exposure to smoking). Associations were estimated as the combination of direct and indirect effects. Predicted probabilities were calculated for interpretability.Population StudiedUsing pooled 2016, 2017, and 2018 National Survey of Children's Health data (nationally representative), we examined 17,791 children in households with income below 150% of the federal poverty level (a cutoff used in prior studies), 4710 of whom had SHCN based on a validated instrument.Principal FindingsSNAP was associated with: decreased FI likelihood, increased excellent health status likelihood, and decreased ED use likelihood; SHCN status was associated with an increase in the magnitude of each of these relationships. All associations had p‐values ≤0.001. See table: FI Excellent Health Status ED Use Total No SHCN SHCN Total No SHCN SHCN Total No SHCN SHCN No SNAP 65% 63% 73% 46% 54% 22% 35% 29% 53% SNAP 32% 31% 35% 66% 74% 45% 21% 16% 33% Δ −33 −32 −37 +20 +20 +22 −14 −13 −19 ΔΔ −5 +3 −7 Δ: difference in percentage points (pp), SNAP vs. no SNAP ΔΔ: difference‐in‐difference in pp; (SNAP vs. no SNAP if SHCN) vs. (SNAP vs. no SNAP if no SHCN) ConclusionsSNAP was associated with significant beneficial effects regarding a child's likelihood of experiencing FI, excellent health status, and ED use, with even more beneficial effects found for children with SHCN.Implications for Policy or PracticeThough an incomplete solution, SNAP may improve child health and healthcare outcomes, particularly for children with elevated vulnerabilities. Greater investments in food hardship relief by healthcare systems (e.g., SNAP enrollment assistance, food Rx programs) and policymakers (e.g., increased SNAP benefits, reduced enrollment barriers) may pay substantial dividends in improved outcomes for these populations and the health systems providing them care.Primary Funding SourceNational Institutes of Health.

Associations of household food insufficiency with childhood depression and anxiety: a nationwide cross-sectional study in the USA

ObjectiveHousehold food insufficiency (HFIS) is a major public health threat to children. Children may be particularly vulnerable to HFIS as a psychological stressor due to their rapid growth and accelerated...

Regional differences in the impact of the COVID-19 pandemic on food sufficiency in California, April-July 2020: implications for food programmes and policies.

To evaluate regional differences in factors associated with food insufficiency during the initial months of the COVID-19 pandemic among three major metropolitan regions in California, a state with historically low participation rates in the Supplementation Nutrition Assistance Program, the nation's largest food assistance programme. Analysis of cross-sectional data from phase 1 (23 April-21 July 2020) of the US Census Household Pulse Survey, a weekly national online survey. California, and three Californian metropolitan statistical areas (MSA), including San Francisco-Oakland-Berkeley, Los Angeles-Long Beach-Anaheim and Riverside-San Bernardino-Ontario MSA. Adults aged 18 years and older living in households. Among the three metropolitan areas, food insufficiency rates were lowest in the San Francisco-Oakland-Berkeley MSA. Measures of disadvantage (e.g., having low-income, being unemployed, recent loss of employment income and pre-pandemic food insufficiency) were widely associated with household food insufficiency. However, disadvantaged households in the San Francisco Bay Area, the area with the lowest poverty and unemployment rates, were more likely to be food insufficient compared with those in the Los Angeles-Long Beach-Anaheim and Riverside-San Bernardino-Ontario MSA. Food insufficiency risk among disadvantaged households differed by region. To be effective, governmental response to food insufficiency must address the varied local circumstances that contribute to these disparities.

Maternal Stress Moderates the Relationship of Food Insufficiency with Body Mass Index Trajectories from Childhood to Early Adulthood among U.S. Rural Youth.

Background: Findings on the relationships between household food insufficiency (HFI), maternal stress, and youth body mass index (BMI) are mixed, possibly due to cross-sectional study designs and measurement issues. Furthermore, little is known about how childhood exposure to HFI and maternal stress influences BMI into young adulthood among rural youth. We aimed to determine the independent and moderating relationships of HFI and maternal perceived stress on youth BMI trajectories from age 9 to 24 years. Methods: We used longitudinal data from rural New York youth (n = 341). At youth age 9 years, parents reported HFI using a reliable one-item measure, and mothers responded to the 10-item Perceived Stress Scale (PSS; range: 0-40). BMI was calculated (kg/m2) from objective measures of height and weight at 9, 13, 17, and 24 years. Multivariate random-intercept trajectory models estimated the relationships of HFI and PSS on BMI trajectories (p < 0.05 for main effects, p < 0.10 for interactions). Results: At age 9 years, 16.4% experienced HFI and mean (standard deviation) BMI and PSS were 18.4 (3.6) kg/m2 and 7.7 (2.9), respectively. HFI and PSS were not associated with BMI trajectories (p = 0.18, p = 0.64, respectively), but their interaction was significant (p < 0.01). Each one-unit increase in PSS was associated with 0.6 (0.2) kg/m2 higher mean change in BMI trajectories for youth in food-insufficient, compared with food-sufficient, households. Conclusions: Higher levels of maternal stress in food-insufficient households may lead to greater increases in BMI from childhood to young adulthood. Public health interventions should simultaneously address parental stress and quality food access among low-income rural households.

Economic Impact Payments and Household Food Insufficiency during COVID-19: The Case of Late Recipients

Economic Impact Payments and Household Food Insufficiency during COVID-19: The Case of Late Recipients

Investigating the Association between English Proficiency and General Health among Marshallese Adults in the United States.

Prior studies have not examined the association between English proficiency and health among Marshallese adults. Cross-sectional data from 378 Marshallese adults enrolled in a Diabetes Prevention Program study in Arkansas and Oklahoma were used to document English proficiency, assess the relationship between sociodemographic health-related characteristics and English proficiency, and examine the association between English proficiency and general health. Approximately one-fifth of participants reported limited English proficiency (LEP). One-fifth of participants reported being in fair or poor health. General health, age group, education, household food insufficiency, inability to afford necessities, and comorbidities were significantly associated with LEP. Participants with LEP were 78% less likely to report better general health compared with those who reported speaking English very well. Limited English proficiency was high among this sample of Marshallese adults. Findings highlight the need for additional Marshallese clinical interpretation and translation services.

Frequency of Intimate Partner Violence among an Urban Emergency Department Sample: A Multilevel Analysis.

Intimate partner violence (IPV) is a pervasive public health problem. Within the U.S., urban emergency department (ED) patients have elevated prevalence of IPV, substance use, and other social problems compared to those in the general household population. Using a social-ecological framework, this cross-sectional study analyzes the extent to which individual, household, and neighborhood factors are associated with the frequency of IPV among a socially disadvantaged sample of urban ED patients. Confidential survey interviews were conducted with 1037 married/partnered study participants (46% male; 50% Hispanic; 29% African American) at a public safety-net hospital. Gender-stratified multilevel Tobit regression models were estimated for frequency of past-year physical IPV (perpetration and victimization) and frequency of severe IPV. Approximately 23% of participants reported IPV. Among men and women, impulsivity, adverse childhood experiences, substance use, and their spouse/partner’s hazardous drinking were associated with IPV frequency. Additionally, household food insufficiency, being fired or laid off from their job, perceived neighborhood disorder, and neighborhood demographic characteristics were associated with IPV frequency among women. Similar patterns were observed in models of severe IPV frequency. IPV prevention strategies implemented in urban ED settings should address the individual, household, and neighborhood risk factors that are linked with partner aggression among socially disadvantaged couples.

Household food insufficiency, health status and emergency healthcare utilisation among children with and without special healthcare needs.

To compare exposure to household food insufficiency and the relationship between household food insufficiency and both health status and emergency healthcare utilisation among children with and without special healthcare needs (SHCN). Analysing pooled data from the 2016-2017 iterations of the National Survey of Children's Health, we conducted multivariate logistic regressions on household food insufficiency, health status and emergency healthcare utilisation. We assessed interactions between household food insufficiency and children's SHCN status in our models of health status and utilisation. United States. Parents of a nationally representative sample of non-institutionalised children (aged 0-17 years). Children with SHCN were more likely to experience household food insufficiency (70 v. 56 %), non-excellent health status (67 v. 28 %) and emergency healthcare utilisation (32 v. 18 %) than other children. Household food insufficiency was associated with 37 % (children with SHCN) and 19 % (children without SHCN) reductions in the likelihood of having excellent health. Household food insufficiency was associated with a roughly equal (16-19 %) increase in the likelihood of emergency department utilisation across groups. Compared with other children, children with SHCN have an elevated risk of exposure to household food insufficiency and experiencing greater reductions in health status when exposed.

The Relationship Between Household Food Insufficiency and Development of Type 2 Diabetes over 10 Years in a Sample of U.S. Black and White Adults

Abstract Objectives Household food insufficiency (HFI) is associated with type 2 diabetes (T2D) but longitudinal studies are scarce. Our objectives were to test the relationship of 1) HFI during young-to-middle adulthood with risk of T2D 10 years (y) later; and 2) transient (1 time) or persistent (2 times) HFI with odds of T2D. Methods We used data from 3672 black and white adults (32–49y) from Year 15, 20, and 25 follow-up exams of the Coronary Artery Risk Development in Young Adults (CARDIA) Study (2000–2011). Participants with missing HFI or T2D data, prevalent T2D at Year 15 (and Year 20 for objective 2), or reported pregnancy were excluded (n = 720), for a total of n = 2952. At each exam, a screener question captured HFI over the past 12 months. Participants reporting that the food they had to eat was not always what they wanted, sometimes not enough, or often not enough were categorized with HFI. Participants with enough of the kinds of food they wanted were categorized with household food sufficiency. T2D was defined as fasting serum glucose ≥126 mg/dL or hemoglobin A1c ≥6.5%. Multivariable-adjusted repeated-measures and logistic regression models tested the relationships between HFI at Year 15 with risk of T2D at Year 25, and between transient or persistent HFI from Years 15 to 20 with odds of T2D at Year 25, respectively. Results T2D prevalence was 4.7% at Year 20 and 9.7% at Year 25. At Year 15, 13.2% reported HFI, and 14.6% and 5.2% were categorized with transient or persistent HFI, respectively. Adjusted for age, sex, and race, HFI at Year 15 was associated with 36% higher risk of T2D by Year 25 (Risk Ratio (95% Confidence Interval (RR (95% CI)): 1.36 (1.02, 1.80); P &amp;lt; 0.05), though the relationship was attenuated after adjustment for education (1.28 (0.96, 1.71)). Compared to no HFI at Years 15 and 20, participants with persistent, but not transient, HFI had higher odds of T2D at Year 25 in fully-adjusted models (Odds Ratio (OR (95% CI)): persistent HFI: 2.06 (1.09, 3.67), P &amp;lt; 0.05; transient HFI: 1.26 (0.76, 2.01)). Conclusions Transient or persistent exposure to HFI in young-to-middle adulthood may be a risk factor for developing T2D among black and white adults. Preventing and reducing HFI may be a strategy to reduce socioeconomic and racial disparities in T2D prevalence in the U.S. Funding Sources SDSU University Grants Program; NIH NHLBI K01.