Food- and Health-Related Correlates of Self-Reported Body Mass Index Among Low-Income Mothers of Young Children

Objective: To examine how income-related challenges regarding food and health are associated with variation in self-reported maternal body weight among low-income mothers. Design: Cross-sectional design. Setting: Two Northeastern cities. Seven day care centers and a Supplemental Nutrition Assistance Program outreach project. Participants: Sample of 166 mothers; 67% were overweight or obese, 55% were Hispanic, and 42% reported household food insecurity (HFI). Main Outcome Measures: Maternal self-reported height and weight to calculate body mass index (BMI). Independent variables were food program participation, supermarket use, 8-item food shopping practices scale, HFI, maternal depressive symptoms, and self-rated health. Analysis: Hierarchical multiple regression analysis tested relationships between maternal BMI with the independent variables of interest, adjusting for demographic confounds. Results: Shopping practices to stretch food dollars (P = .04), using community food assistance programs (P \u3c .05), and HFI (P \u3c .04) correlated with heavier maternal BMIs; higher self-rated health corresponded to lower BMIs (P = .004). Conclusions and Implications: Some strategies low-income mothers use to manage food resources are associated with heavier BMIs. Nutrition educators, public health practitioners, and researchers need to collaboratively address the associations between these strategies, food insecurity, poor health, and unhealthy weight

Associations between family food behaviors, maternal depression, and child weight among low-income children

Although low-income children are at greater risk for overweight and obesity than their higher income counterparts, the majority of poor children are not overweight. The current study examined why such variation exists among diverse young children in poor families. Cross-sectional data were collected on 164 low-income, preschool aged children and their mothers living in two Rhode Island cities. Over half of the sample was Hispanic (55%). Mothers completed measures of family food behaviors and depression while trained assistants collected anthropometric data from children at seven day care centers and a Supplemental Nutrition Assistance Program outreach project. Multivariate analysis of covariance revealed that higher maternal depression scores were associated with lower scores on maternal presence when child eats (P \u3c .05), maternal control of child\u27s eating routines (P \u3c .03), and food resource management skills (P \u3c .01), and with higher scores on child control of snacking (P \u3c .03) and negative mealtime practices (P \u3c .05). Multiple regression results revealed that greater maternal presence whenever the child ate was significantly associated with lower child BMI z scores (β = .166, P \u3c .05). Logistic regression analyses indicated that higher scores on food resource management skills reduced the odds of child overweight (odds ratios = .72–.95, P \u3c .01). Maternal depression did not modify the relationship between family food behaviors and child weight. Overall, caregiver presence whenever a child eats, not just at meals, and better parental food resource management skills may promote healthier weights in low-income preschoolers. Further research is needed to identify the mechanisms that connect caregiver presence and food resource management skills to healthier weights for this age group

Sociodemographic determinants of food security status among first-time WIC participants

This longitudinal study examines determinants of change in household food insecurity among 18 064 first-time, low-income Massachusetts mothers participating in the Special Supplemental Nutrition Assistance for Women, Infants, and Children (WIC) program. Minority status and initial food security status explained likelihood to remain or become food insecure over time. At the final WIC visit, risk for food insecurity remained 1.6 times higher for blacks and 1.2 times higher for Hispanics and 47% lower for households that were food secure at baseline. Sociodemographic factors interacted with baseline food security status and with race/ethnicity to explain final food security status, suggesting that the mechanisms leading to household food insecurity vary within low-income populations. Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited

A Longitudinal Study of Food Insecurity on Obesity in Preschool Children

Background: Obesity and its co-occurrence with household food insecurity among low-income families is a public health concern, particularly because both are associated with later adverse health consequences. Objective: Our aim was to examine the relationship between household food insecurity with and without hunger in infancy and later childhood with weight status at 2 to 5 years. Design: This longitudinal study uses household food-security status, weight, and height data collected at the first infancy and last child (2 to 5 years) Special Supplemental Nutrition Program for Women, Infants, and Children visits. Household food security was based on parent/caretaker responses to a four-question subscale of the 18-item Core Food Security Module. Obesity was defined as sex-specific body mass index for age ≥95th percentile. Participants/setting: A diverse (58.6% non-white) low-income sample of 28,353 children participating in the Massachusetts Special Supplemental Nutrition Program for Women, Infants, and Children (2001-2006); 24.9% of infants and 23.1% of children lived in food-insecure households and 17.1% were obese at their last child visit. Statistical analysis: Multivariate logistic regression analyses assessed the association between household food-security status during the infant and child visits, and risk of preschool obesity, while controlling for child race/Hispanic ethnicity, sex, child and household size, maternal age, education, and prepregnancy weight. Interactions between these covariates and household food-security status were also examined. In cases of multiple comparisons, a Bonferroni correction was applied. Results: Persistent household food insecurity without hunger was associated with 22% greater odds of child obesity (odds ratio=1.22; 95% CI 1.06 to 1.41) compared with those persistently food secure (P\u3c0.05). Maternal prepregnancy weight status modified this association with children of underweight (adjusted odds ratio=3.22; 95% CI 1.70 to 6.11; P=0.003) or overweight/obese (adjusted odds ratio=1.34; 95% CI 1.11 to 1.62; P=0.03) mothers experiencing greater odds of child obesity with persistent household food insecurity without hunger compared with those with persistent household food security. Conclusions: These results suggest that persistent household food insecurity without hunger is prospectively related to child obesity, but that these associations depend on maternal weight status. Vulnerable groups should be targeted for early interventions to prevent overweight and obesity later in life. © 2012 Academy of Nutrition and Dietetics

From poverty to food insecurity and child overweight: A family stress approach

Food insecurity and child overweight represent major public health problems in the United States, especially for children living in poverty. Recent research has greatly expanded our knowledge regarding the antecedents of these health concerns, yet the causal mechanisms connecting poverty to food insecurity and to child overweight remain unclear. This article reviews the research through the perspective of family stress theory and proposes a developmental model to explain how poverty and its related economic stress affect specific parental resources and behaviors that, in turn, may account for food insecurity and overweight in young children. It proposes maternal depression and family food behaviors-such as the acquisition, provision, and distribution of food in the household-as key mediators linking poverty to food insecurity and child overweight. © 2010, Copyright the Author(s). Journal Compilation © 2010, Society for Research in Child Development

A longitudinal study of WIC participation on household food insecurity

We examined the association between women\u27s/ children\u27s duration of WIC participation and household food security status. For mothers (n = 21,863) and their children (n = 57,377) participating in WIC (2001-2006), longitudinal measures of household food security status were collected using a subscale of the USDA Food Security Module. Using logistic regression, household food security status at the last WIC visit was associated with measures of WIC duration (number of trimesters on WIC for pregnant women, and number of WIC visits for children). Among women with prenatal household food insecurity with hunger, odds of any post-partum household food insecurity was reduced with first (AOR = 0.67, 95% CI = 0.48-0.94) or second trimester of entry (AOR = 0.64, 95% CI = 0.45-0.90) versus third. Among children with initial household food insecurity without hunger, an additional WIC visit reduced the odds of any household food insecurity (AOR = 0.92, 95% CI = 0.90-0.94) and of household food insecurity with hunger (AOR = 0.94, 95% CI = 0.89-0.98) at the last visit. Among those with initial household food insecurity with hunger, an additional WIC visit reduced the odds of any household food insecurity (AOR = 0.96, 95% CI = 0.92-0.99) and of household food insecurity with hunger (AOR = 0.88, 95%CI = 0.83-0.94) at the last visit. Earlier and longer WIC participation may improve household food security status, particularly of vulnerable groups. © Springer Science+Business Media, LLC 2011

Maternal Strategies to Access Food Differ by Food Security Status

Background Household food insecurity is associated with health and behavior risk. Much less is known about how food insecurity is related to strategies that adults use in accessing food: how and where they shop, use of alternative food sources, and their ability to manage resources. Objective To examine how maternal behaviors, including shopping, accessing alternative sources of food, and managing resources, are related to household food security status (HHFSS). Design Cross-sectional study collecting survey data on HHFSS, shopping behaviors, use of alternative food sources, and managing resources obtained from low-income mothers of preschool-aged children. Participants One hundred sixty-four low-income mothers of young children (55% Hispanic) from two communities in Rhode Island. Measures HHFSS was measured using 10 items from the 18-item Core Food Security Module to assess adult food security. Mothers were surveyed about where, when, and how often they shopped; the strategies they use when shopping; their use of alternative sources of food, including federal, state, and local assistance; and their ability to manage their resources. Statistical analysis Analysis of variance and χ2 analyses assessed the associations between demographic variables, shopping, accessing alternative food sources, and managing resources, and HHFSS. Multivariate logistic regression assessed the associations between HHFSS and maternal demographic variables, food shopping, strategies, alternative sources of food, and ability to manage resources. Results Maternal age and language spoken at home were significantly associated with HHFSS; food insecurity was 10% more likely among older mothers (adjusted odds ratio [aOR] 1.10, 95% CI 1.03 to 1.17) and 2.5 times more likely among Spanish-speaking households (compared with non–Spanish speaking [aOR 3.57, 95% CI 1.25 to 10.18]). Food insecurity was more likely among mothers reporting more informal strategies (aOR 1.98, 95% CI 1.28 to 3.01; P\u3c0.05) and perceiving greater inability to manage resources (aOR 1.60, 95% CI 1.30 to 1.98; P\u3c0.05). Conclusions The results suggest that low-income mothers use a variety of strategies to feed their families and that the strategies they use vary by HHFSS. Community nutrition programs and providers will need to consider these strategies when counseling families at risk for food insecurity and provide guidance to minimize the influence on healthy food choices

Maternal Mental Health and Child Health and Nutrition

In this chapter, the family stress model provides a framework for exploring the relationships between maternal mental health and child health and nutrition, in the context of poverty. Specifically, we examine what is known about the links between maternal depression and anxiety with the increased rates of overweight, nutritional deficiencies, food insecurity, and overall poorer health observed among low-income children. We then explore how maternal psychological distress may impact three parenting practices linked to these child health domains: (1) health-related parenting behaviors, such as monitoring the child\u27s access to television; (2) parental feeding strategies, such as how long the mother breast-feeds; and (3) food-related coping strategies, such as the need to shop in a variety of stores for the best food bargains. We conclude with three key directions to advance our understanding of the pathway from maternal mental health to child outcomes