Low-income US Research Articles

Where do US Households Shop? Understanding the Sociodemographic Characteristics that Predict Shopping Pattern Membership

ObjectivesWe examined the combination of stores where US households shop for food and sociodemographic predictors of shopping patterns.MethodsWe conducted cross‐sectional analysis of US households' shopping patterns using Nielsen Homescan. Store type was classified using 2012 information into: warehouse‐club; convenience/drug/dollar; ethnic/specialty; grocery chains (蠅10 stores); mass‐merchandisers; independent (<10 stores); and other. Cluster analysis was used to derive shopping patterns (2000, 2003, 2006, 2009 and 2012). Multinomial logistic regression was used to identify whether specific subpopulations, defined by race and income characteristics, were associated with shopping patterns in 2012.ResultsFrom 2003 onwards, we found three shopping patterns: grocery‐chain cluster, mass‐merchandise/grocery‐chain cluster and combo store cluster. The proportion of households belonging to the grocery‐chain cluster decreased from 59.6% in 2003 to 50.7% in 2012, increased from 15.6% in 2003 to 21.9% in 2012 for mass‐merchandisers/grocery‐chain cluster and remained stable for the combo store cluster. Predicted probabilities for grocery‐chain cluster membership show no race‐ethic differences amongst low‐income households; however Hispanic/low‐income households had a significantly lower probability (vs. white‐non Hispanic/low‐income) to belong to the mass‐merchandise/grocery‐chain cluster and higher probability to belong to the combo store cluster.ConclusionsContrary to research on food desserts, low income and other US households shop for food at a variety of store‐types. These complex varied patterns must be considered in policy initiatives.

Mental Health Disparities Among Low-Income US Hispanic Residents of a US-Mexico Border Colonia.

Unregulated residential settlements along the US side of the US-Mexico border, often called "colonias", are mainly populated by low-income Mexican-origin Hispanics. Colonia residents face numerous social, environmental, economic and public health challenges. Despite this, the mental health of individuals living in colonias has remained largely understudied. Drawing from a survey (N = 98) conducted through a community-based participatory research project in one colonia suffering from numerous environmental and social challenges, this study analyzes residents' mental health outcomes and access to mental health care with a focus on intra-ethnic disparities based on environmental concerns, nativity, language acculturation, comorbidity, gender, health insurance, and stressful life events. Data were analyzed using descriptive statistics, correlation, and regression. More than one third of the residents have been diagnosed with a mental health condition and over half reported stress and excess worry. In terms of mental health care, 77 % of individuals diagnosed with a mental health problem have sought additional help mainly through a primary care provider despite the high levels of uninsured individuals. Comorbidity, being female, recent negative life events, and high levels of environmental concerns were significant predictors of negative mental health outcomes. This study contributes to the understanding of the complex health dynamics of the US Hispanic population. It also highlights the need for additional research and resources devoted to the mental health of low-income minorities in isolated communities.

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community.

Community problems have been associated with higher, and community resources and social cohesion with lower, blood pressure. However, prior studies have not accounted for potential confounding by residential racial segregation. This study tested associations between community characteristics and blood pressure levels and prevalent hypertension in a racially integrated community. The Exploring Health Disparities in Integrated Communities Study measured blood pressure in residents of two contiguous racially integrated and low-income US Census Tracts. Community characteristics included a standardized community problem score and binary indicators for community social cohesion, having a community leader available, and having at least one community resource observed on the participant's block. In adjusted models, greater community problems and proximity to resources were associated with lower systolic (β = -2.020, p = 0.028; β = -4.132, p = 0.010) and diastolic (β = -1.261, p = 0.038; β = -2.290, 0.031) blood pressure, respectively, among whites (n = 548). Social cohesion was associated with higher systolic (β = 4.905, p = 0.009) and diastolic blood pressure (β = 3.379, p = 0.008) among African Americans (n = 777). In one racially integrated low-income community, community characteristics were associated with blood pressure levels, and associations differed by race. Directions of associations for two findings differed from prior studies; greater community problem was associated with lower blood pressure in whites and community social cohesion was associated with higher blood pressure in African Americans. These findings may be due to exposure to adverse environmental conditions and hypertensive risk factors in this low-income community.

The Effectiveness of Two Community-Based Weight Loss Strategies among Obese, Low-Income US Latinos

BackgroundLatino immigrants have high rates of obesity and face barriers to weight loss. ObjectiveTo evaluate the effectiveness of a case-management (CM) intervention with and without community health workers (CHWs) for weight loss. DesignThis was a 2-year, randomized controlled trial comparing two interventions with each other and with usual care (UC). Participants/settingEligible participants included Latinos with a body mass index of 30 to 60 and one or more heart disease risk factors. The 207 participants recruited during 2009-2010 had a mean age of 47 years and were mostly women (77%). At 24 months, 86% of the sample was assessed. InterventionThe CM+CHW (n=82) and CM (n=84) interventions were compared with each other and with UC (n=41). Both included an intensive 12-month phase followed by 12 months of maintenance. The CM+CHW group received home visits. Main outcome measuresWeight change at 24 months. Statistical analysesGeneralized estimating equations using intent-to-treat. ResultsAt 6 months, mean weight loss in the CM+CHW arm was −2.1 kg (95% CI −2.8 to −1.3) or −2% of baseline weight (95% CI −1% to −2%) compared with −1.6 kg (95% CI −2.4 to −0.7; % weight change, −2%, −1%, and −3%) in CM and −0.9 kg (95% CI −1.8 to 0.1; % weight change, −1%, 0%, and −2%) in UC. By 12 and 24 months, differences narrowed and CM+CHW was no longer statistically distinct. Men achieved greater weight loss than women in all groups at each time point (P<0.05). At 6 months, men in the CM+CHW arm lost more weight (−4.4 kg; 95% CI −6.0 to −2.7) compared with UC (−0.4 kg; 95% CI −2.4 to 1.5), but by 12 and 24 months differences were not significant. ConclusionsThis study demonstrated that incorporation of CHWs may help promote initial weight loss, especially among men, but not weight maintenance. Additional strategies to address social and environmental influences may be needed for Latino immigrant populations.

Chronic kidney disease (CKD) treatment burden among low-income primary care patients.

This study explored the self-management strategies and treatment burden experienced by low-income US primary care patients with chronic kidney disease. Semi-structured interviews were conducted with 34 patients from two primary care practices on Buffalo's East Side, a low-income community. Qualitative analysis was undertaken using an inductive thematic content analysis approach. We applied normalization process theory (NPT) to the concept of treatment burden to interpret and categorize our findings. The sample was predominantly African-American (79%) and female (59%). Most patients (79%) had a diagnosis of stage 3 CKD. Four major themes were identified corresponding to NPT and treatment burden: (1) coherence--making sense of CKD; (2) cognitive participation--enlisting support and organizing personal resources; (3) collective action--self-management work; and (4) reflexive monitoring--further refining chronic illness self-care in the context of CKD. For each component, we identified barriers hindering patients' ability to accomplish the necessary tasks. Our findings highlight the substantial treatment burden faced by inner-city primary care patients self-managing CKD in combination with other chronic illnesses. Health care providers' awareness of treatment burden can inform the development of person-centered care plans that can help patients to better manage their chronic illnesses.

Breastfeeding initiation and duration in coresident grandparent, mother and infant households.

In the US, the prevalence of three-generation households, where a grandparent, parent and child coreside, has increased in the last decade. Three-generation coresidence during infancy is particularly common and as many as 15 % of infants live in a three-generation household shortly after birth. Although prior research has linked family structure with breastfeeding behavior, no research has studied whether breastfeeding behavior varies by grandparent coresidence. This study is the first to investigate the association between three-generation coresidence and breastfeeding behaviors. This paper uses two data sets, the Early Childhood Longitudinal Study--Birth Cohort (n ~ 8,250), a nationally representative study of US children, and the Fragile Families and Child Wellbeing Study (n = 4,053), an urban sample of mostly low-income unmarried US mothers, to study the association between three-generation coresidence and breastfeeding initiation and duration using multivariate logistic regressions with extensive socio-demographic controls. Three-generation coresidence was associated with lower odds of breastfeeding initiation among the less advantaged mothers but not in the nationally representative sample of mothers. In comparison, three-generation coresidence was associated with lower odds of breastfeeding for 6 months or greater in both study samples. Three-generation coresidence may serve as a marker for differences in the likelihood of breastfeeding that can help inform public health strategies aimed at increasing breastfeeding rates. Research studying interventions with grandparents and the effects on breastfeeding behaviors may be a useful next step in public health promotion of breastfeeding.

New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity.

National and local policies to improve diet in low-income US populations include increasing physical access to grocery stores and supermarkets in underserved neighborhoods. In a pilot study that evaluated the impacts of opening a new supermarket in a Philadelphia community considered a "food desert"-part of the Pennsylvania Fresh Food Financing Initiative-we found that the intervention moderately improved residents' perceptions of food accessibility. However, it did not lead to changes in reported fruit and vegetable intake or body mass index. The effectiveness of interventions to improve physical access to food and reduce obesity by encouraging supermarkets to locate in underserved areas therefore remains unclear. Nevertheless, the present findings suggest that simply improving a community's retail food infrastructure may not produce desired changes in food purchasing and consumption patterns. Complementary policy changes and interventions may be needed to help consumers bridge the gap between perception and action. The replication of our findings in other settings and research into the factors that influence community residents' receptivity to improved food access are urgently required.

Food Insecurity Among Adults With Severe Mental Illness

Food Insecurity Among Adults With Severe Mental Illness

Associations of Food Stamp Participation With Dietary Quality and Obesity in Children

To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program. The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999-2008 NHANES. Diet was measured by using 24-hour recalls. Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71-1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%-89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%-91%), but 19% fewer nuts, seeds, and legumes (95% CI: -35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores. The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children's health.

Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000-2004.

Systemic lupus erythematosus (SLE) and lupus nephritis (LN) disproportionately affect individuals who are members of racial/ethnic minority groups and individuals of lower socioeconomic status (SES). This study was undertaken to investigate the epidemiology and sociodemographics of SLE and LN in the low-income US Medicaid population. We utilized Medicaid Analytic eXtract data, with billing claims from 47 states and Washington, DC, for 23.9 million individuals ages 18-65 years who were enrolled in Medicaid for >3 months in 2000-2004. Individuals with SLE (≥3 visits >30 days apart with an International Classification of Diseases, Ninth Revision [ICD-9] code of 710.0) and with LN (≥2 visits with an ICD-9 code for glomerulonephritis, proteinuria, or renal failure) were identified. We calculated SLE and LN prevalence and incidence, stratified by sociodemographic category, and adjusted for number of American College of Rheumatology (ACR) member rheumatologists in the state and SES using a validated composite of US Census variables. We identified 34,339 individuals with SLE (prevalence 143.7 per 100,000) and 7,388 (21.5%) with LN (prevalence 30.9 per 100,000). SLE prevalence was 6 times higher among women, nearly double in African American compared to white women, and highest in the US South. LN prevalence was higher among all racial/ethnic minority groups compared to whites. The areas with lowest SES had the highest prevalence; areas with the fewest ACR rheumatologists had the lowest prevalence. SLE incidence was 23.2 per 100,000 person-years and LN incidence was 6.9 per 100,000 person-years, with similar sociodemographic trends. In this nationwide Medicaid population, there was sociodemographic variation in SLE and LN prevalence and incidence. Understanding the increased burden of SLE and its complications in this low-income population has implications for resource allocation and access to subspecialty care.

Disparities in Premature Mortality Between High- and Low-Income US Counties

Several well-established determinants of health are associated with premature mortality. Using data from the 2010 County Health Rankings, we describe the association of selected determinants of health with premature mortality among counties with broadly differing levels of income. County-level data on 3,139 US counties from the 2010 County Health Rankings were linked to county mortality data from the Centers for Disease Control and Prevention Compressed Mortality database. We divided counties into 3 groups, defined by sample median household income levels: low-income (≤25th percentile, $29,631), mid-income (25th-75th percentile, $29,631-$39,401), and high-income (≥75th percentile, ≥$39,401). We analyzed group differences in geographic, sociodemographic, racial/ethnic, health care, social, and behavioral factors. Stratified multivariable linear regression explored the associations of these health determinants with premature mortality for high- and low-income groups. The association between income and premature mortality was stronger among low-income counties than high-income counties. We found differences in the pattern of risk factors between high- and low-income groups. Significant geographic, sociodemographic, racial/ethnic, health care, social, and behavioral disparities exist among income groups. Geographic location and the percentages of adult smokers and adults with a college education were associated with premature mortality rates in US counties. These relationships varied in magnitude and significance across income groups. Our findings suggest that population health policies aimed at reducing mortality disparities require an understanding of the socioeconomic context within which modifiable variables exist.

Low-income Supplemental Nutrition Assistance Program participation is related to adiposity and metabolic risk factors

The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program. In recent years, SNAP participation rates increased during times of economic hardship. We examined whether household SNAP participation was associated with adiposity and metabolic risk factors in a representative sample of low-income US adults. A cross-sectional analysis was performed with the use of data from the 2003-2006 National Health and Nutrition Examination Surveys. The study population was restricted to nonelderly adults whose household incomes fell to or <130% of the federal poverty level. Multinomial logistic and Poisson regression models were fit to examine the associations between SNAP participation and BMI, waist circumference, and metabolic risk factors among 2250 low-income adults. In the previous 12 mo, 32.8% of adults received household SNAP benefits. SNAP participation was positively associated with obesity [prevalence ratio (PR): 1.58; 95% CI: 1.08, 2.31], waist circumference in men (PR for top compared with bottom quartile: 2.04; 95% CI: 1.15, 3.62; P = 0.02), and waist circumference in women (PR: 2.95; 95% CI: 1.51, 5.77; P = 0.003; P-interaction with sex = 0.11), independent of sociodemographic characteristics. SNAP participation was also related to elevated triglycerides (PR: 1.71; 95% CI: 1.33, 2.20), lower HDL cholesterol (PR: 1.23; 95% CI: 1.08, 1.41), elevated fasting glucose (≥110 mg/dL; PR: 1.63; 95% CI: 1.05, 2.52), and metabolic syndrome (PR: 1.49; 95% CI: 1.13, 1.95). Associations with triglycerides and HDL cholesterol persisted after adjustment for BMI. Household SNAP participation was positively associated with BMI, waist circumference, and metabolic risk factors among low-income adults. These associations may be mediated by dietary intake and warrant further investigation.

The Relationship between Life Stress and Breastfeeding Outcomes among Low-Income Mothers

Stressful life events during pregnancy negatively affect maternal and infant outcomes including breastfeeding initiation. Their impact on breastfeeding duration is uncertain. Given breastfeeding's important health benefits we analyzed stressful life event types and cessation of any and exclusive breastfeeding by 4 and 13 weeks. Methods. We collected self-administered survey data at 5–7 months postpartum from over 700 primarily urban low-income US mothers. Data covered prepregnancy, prenatal, and postpartum periods including 14 stressful life events (categorized into financial, emotional, partner-associated, traumatic). Analyses included only mothers initiating breastfeeding (n = 341). Logistic regressions controlled for maternal characteristics including a breastfeeding plan. Results. All four stress categories were associated with shorter duration of any and exclusive breastfeeding. In the adjusted models, statistically significant relationships remained for financial stress (4 weeks cessation of any breastfeeding duration) and traumatic stress (13 weeks exclusive breastfeeding cessation). Controlling for stress, a longer breastfeeding plan was significantly associated with a shorter breastfeeding duration (all models) as was depression during pregnancy and current smoking (several models). Conclusions. Among low-income women, impact of stressful life events on cessation of breastfeeding may differ by stress type and interfere with achievement of breastfeeding goal. Among these stressed mothers, breastfeeding may serve as a coping mechanism.

Land use regulations and the returns to low-income homeownership

I investigate the relationship between land use regulations and the house prices of urban low-income homeowners in the United States between 1998 and 2010. Because low-income homeowners generally hold a larger fraction of their wealth as home equity and are less likely to sustain homeownership, the overall financial position of this population is especially dependent on house price movements during short holding periods and the timing of house purchase and sale. The data used for analysis include zip-code-level house price estimates provided by Fannie Mae and proprietary mortgage origination data for a representative sample of low-income US homeowners who received community reinvestment mortgages between 1998 and 2004. I estimate a series of linear mixed-effects models to predict house price appreciation and the risk premium associated with investment in housing as opposed to a risk-free asset. Controlling for a variety of related factors, including land scarcity and subprime lending activity, I find that land use regulations are associated with greater house price volatility and a greater risk premium for urban low-income households. Thus, the results suggest that the dependence of low-income homeowner wealth on the timing of house purchase and sale is weaker in less regulated markets.

Using mixed methods to examine participant utilization and satisfaction with fruit and vegetable vouchers and jarred baby foods in the new WIC food package

The WIC program underwent a major revision to the food package, representing a significant change in the resources available to improve diet quality for a large part of the low-income US population. The purpose of this study was to examine participant utilization and satisfaction with fruit and vegetable vouchers and jarred baby foods in the new food package, and to examine whether preferences vary between ethnic groups. Data were drawn from the California state-wide cross-sectional NEFPI survey of WIC participants, and qualitative interview data from a sub-set of WIC participants. Descriptive statistics, chi-square and thematic analyses were completed, which found high satisfaction with fruit and vegetable vouchers and jarred baby foods and statistically significant variation across ethnic groups. If given a choice about two-thirds of all participants reported a preference for fruit and vegetable vouchers over checks for jarred baby foods. There were significant ethnic differences: almost half of all whites (45.7%) and African-Americans (50%) preferred vouchers for fruits and vegetables over jarred baby foods, and more than two-thirds of all Latinos (69.5%) preferred vouchers for fruits and vegetables. Narratives from participants and staff reinforce the quantitative findings which suggest the need to examine cultural considerations of infant feeding practices with regards to the new WIC food package. Grant Funding Source: Supported by AHA #09PRE2390123

National School Lunch Program Participation and Sex Differences in Body Mass Index Trajectories of Children From Low-Income Families

To investigate participation patterns in the National School Lunch Program (NSLP) among low-income children from kindergarten to fifth grade and to examine the ways in which participation influences sex differences in the trajectories of body mass index (BMI) through the eighth grade. Longitudinal, secondary data analysis. Sample of low-income US children who entered kindergarten in 1998. Girls (n = 574) and boys (n = 566) from low-income families who participated in the Early Childhood Longitudinal Study, Kindergarten Cohort. Participation in the NSLP. Temporary and persistent patterns of NSLP participation, and age-specific and sex-specific BMI raw scores calculated at 5 data points. Among the low-income children who attended schools that participated in the NSLP, both the children who persistently participated in the program and those who temporarily participated in the program displayed similar socioeconomically disadvantaged factors. Nonlinear mixed models indicated a larger rate of change in BMI (ie, an increase) among low-income, participating girls than among low-income, nonparticipating girls; however, mean BMIs did not significantly differ between low-income girls who participated and those who did not participate. No significant differences were observed among low-income boys. Results suggest that participation in the NSLP is associated with rapid weight gain for low-income girls but not for low-income boys.

Discretionary calorie intake a priority for obesity prevention: results of rapid participatory approaches in low-income US communities

Since resources are limited, selecting the most promising targets for obesity interventions is critical. We examined the relative associations of physical activity, fruit and vegetable consumption and 'junk food' consumption with BMI and the prevalence of relevant policies in school, work, food outlets and health-care settings. We conducted intercept surveys in three low-income, high-minority California communities to assess fruit, vegetable, candy, cookie, salty snacks and sugar-sweetened beverage consumption and self-reported height, weight and physical activity. We also assessed relevant policies in selected worksites, schools and health-care settings through key informant interviews. Data were collected from 1826 respondents, 21 schools, 40 worksites, 14 health-care settings and 29 food outlets. The average intake of salty snacks, candy, cookies and sugar-sweetened beverages was estimated at 2226 kJ (532 kcal) daily, 88% higher than the US Department of Agriculture/Department of Health and Human Services guidelines recommend. Energy from these sources was more strongly related to BMI than reported physical activity, fruit or vegetable consumption. Policies to promote healthy eating and physical activity were limited in worksites. Fruits and vegetables were less salient than junk food in community food outlets. Targeting consumption of salty snacks, candy cookies and sugar-sweetened beverages appeared more promising than alternative approaches.

Dose-Response Associations Between Maternal Smoking During Pregnancy and Subsequent Childhood Obesity: Effect Modification by Maternal Race/Ethnicity in a Low-Income US Cohort

Studies suggest that children exposed to cigarette smoke in utero are at risk of becoming obese. Few researchers have evaluated the dose-response association between maternal smoking during pregnancy and childhood obesity or whether this association varies by maternal race/ethnicity. The authors obtained retrospective cohort data by linking records from the Pregnancy Nutrition Surveillance System and the Pediatric Nutrition Surveillance System on 155,411 low-income children born during 1995-2001 in 9 US states and 2 tribal nations. The authors examined maternal smoking status, duration of smoking, quantity of smoking, and both duration and quantity combined. Childhood obesity was based on a body mass index greater than or equal to the 95th percentile for sex and age, assessed at age 2-4 years. Maternal race/ethnicity modified the association between smoking during pregnancy and childhood obesity. Among non-Hispanic White mothers, both duration and quantity of smoking were positively associated with childhood obesity in a dose-response manner. Among non-Hispanic Black mothers, only heavy smoking was positively associated with childhood obesity. Among Hispanics, American Indians/Alaska Natives, and Asians/Pacific Islanders, smoking was not associated with childhood obesity. The inconsistent association between smoking during pregnancy and childhood obesity across race/ethnicity categories merits further investigation into potential explanations for this variation, which may include confounding, reporting bias, or unexplored biologic mechanisms.

Food Security, Maternal Stressors, and Overweight Among Low-Income US Children: Results From the National Health and Nutrition Examination Survey (1999–2002)

A high proportion of children in the United States are overweight, suffer from food insecurity, and live in households facing maternal stressors. The objective of this article was to identify the associations of food insecurity and maternal stressors with childhood overweight among low-income children. We hypothesized that maternal stressors may exacerbate the relationship between food insecurity and child obesity. The sample included 841 children (3-17 years old) and their mothers with incomes below 200% of the poverty line from the 1999-2002 National Health and Nutrition Examination Survey. Food insecurity was based on US Department of Agriculture protocol, maternal stressors were assessed from survey questions, and BMI was used to classify weight status. Probit regression models predicted the probability of a child being overweight or obese. In most specifications, there was no direct association between food insecurity or maternal stressors and overweight for children of any age. Among 3- to 10-year-olds, the interaction of food insecurity and maternal stressors was significantly linked to the probability of being overweight; more specifically, an increase in maternal stressors amplified a food secure child's probability of being overweight or obese. This result is robust to alternative specifications. However, these results were not found among 11- and 17-year-old youth. Younger children in food secure, low-income households in the United States who are experiencing higher levels of maternal stressors have a greater probability of being overweight than food insecure children. This finding was contrary to the hypothesis; 3 reasons for this are covered in the article. Those who create policies that address childhood obesity could consider the benefits to low-income children's well-being resulting from reducing their mothers' stressors. Because most children in the United States are food secure, these policies could have a profound impact on childhood overweight.

Dietary Patterns of Young, Low-Income US Children

Objective The purpose of this study was to identify dietary patterns of young, low-income US children, describe differences in diet quality between identified patterns, and make targeted food recommendations to improve diet quality. Design Dietary patterns were assessed using dietary variables from the Pyramid Servings Database within the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998. Healthy Eating Index (HEI) scores were used to validate identified dietary patterns. Subjects/Setting Two subsamples of low-income children, aged 2 to 3 years (n=1,242) and 4 to 8 years (n=1,506), were selected from the Continuing Survey of Food Intakes by Individuals data. Statistical Analysis Cluster analysis was performed to determine unique dietary patterns within the two subsamples. Linear regression analyses were used to compare energy intake, discretionary fat, added sugars, and HEI scores across cluster groups. Descriptive statistics were computed for each cluster. Results Cluster analysis identified six and seven distinct dietary patterns for the younger and older children, respectively. Four patterns were similar for both age groups. For the 2- to 3-year-old children, energy intake, overall HEI scores, and nine of the 10 HEI component scores differed among the four most prevalent dietary patterns. Among the older children, energy intake and six of the HEI component scores differed between the four most prevalent clusters but not overall HEI. Conclusions Neither age group had a cluster of children who followed a balanced/moderate diet pattern consistent with Food Guide Pyramid recommendations. Children consuming almost every pattern identified could benefit by reducing added sugars and discretionary fat and increasing low-fat, low-sugar options from the vegetables, fruits, meat, and milk groups.