Federal Nutrition Programs and Childhood Obesity: Inside the Black Box

In response to the dramatic rise in childhood obesity, particularly among low income individuals, federal nutrition assistance programs have come under scrutiny. However, the vast majority of this research focuses on the direct relationship between these programs and child health, while little is known about the mechanisms by which such relationships arise. Using the 2007 American Time Use Survey and the Eating and Health Module, we explore differences in time use across families that participate in the Supplemental Nutriation Assistance Program (SNAP), the School Breakfast Program (SBP), and the National School Lunch Program (NSLP) to better understand behavioral differences across participants and non-participants. These differences have important implications for future research and policy.School Breakfast Program, National School Lunch Program, Supplemental Nutrition Assistance Program, time use, program evaluation

Partial Identification of the Long-Run Causal Effect of Food Security on Child Health

Food security and obesity represent two of the most significant public health issues. However, little is known about how these issues are intertwined. Here, we assess the causal relationship between food security during early childhood and relatively long-run measures of child health. Identifying this causal relationship is complicated due to endogenous selection and misclassification errors. To overcome these difficulties, we utilize a nonparametric bounds approach along with data from the ECLS-K and ECLS-B. The analysis reveals a positive association between food insecurity and future child obesity in the absence of misclassification. However, under relatively innocuous assumptions concerning the selection process, we often obtain bounds that indicate a negative causal effect of food insecurity on future child obesity. All results are extremely sensitive to misclassification

Identifying the Effect of WIC on Very Low Food Security among Infants and Children

The Women, Infants, and Children Program (WIC) is considered a crucial component of the social safety net in the United States, yet there is limited supporting evidence on the effects of WIC on the nutritional well-being and food security of infants and young children. Two key identification problems have been especially difficult to address. First, the decision to take up WIC is endogenous as households are not randomly assigned to the program; recipients are likely to differ from nonrecipients in unobserved ways (e.g., prior health) that are related to associated outcomes. Second, survey respondents often fail to report receiving public assistance, and the existing literature has uncovered substantial degrees of systematic misclassification of WIC participation. Using data from the National Health and Nutrition Examination Survey (NHANES), we apply recently developed partial identification methodologies to jointly account for these two identification problems in a single framework. Under relatively weak assumptions, we find that WIC reduces the prevalence of child food insecurity by at least 5.5 percentage points and very low food security by at least 1.5 percentage points

Federal Nutrition Programs and Childhood Obesity: Inside the Black Box

In response to the dramatic rise in childhood obesity, particularly among low income individuals, federal nutrition assistance programs have come under scrutiny. However, the vast majority of this research focuses on the direct relationship between these programs and child health, while little is known about the mechanisms by which such relationships arise. Using the 2007 American Time Use Survey and the Eating and Health Module, we explore differences in time use across families that participate in the Supplemental Nutriation Assistance Program (SNAP), the School Breakfast Program (SBP), and the National School Lunch Program (NSLP) to better understand behavioral differences across participants and non-participants. These differences have important implications for future research and policy

Association between low health literacy and adverse health behaviors in North Carolina, 2016

Introduction: Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health. Purpose: This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health. Methods: Researchers used North Carolina’s 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and sleep, and irregular medical and dental check-ups. The sample was divided into four age categories (18–49, 50–64, and 65–75, and 76 and older) for statistical comparisons. Stata 15 and a user-written Stata command, -psacalc-, were used to examine the relationships by addressing omitted variable bias in OLS regressions. Results: Findings indicate that LHL has a direct robust relationship with not exercising, inadequate sleep, irregular health and dental checkup, and health screenings across different age groups. Among women, LHL is associated with getting a Pap test in 3 years as opposed to more than 3 years. Implications: The adverse behaviors can explain the mechanisms underlying the link between LHL and adverse health outcomes. Further research on the causal relationship between LHL and adverse health behaviors using longitudinal data on a broader geographic region is warranted

Does the Women, Infants, and Children Program (WIC) Improve Infant Health Outcomes?

We evaluate causal impacts of prenatal WIC participation on healthy birth outcomes, simultaneously accounting for self-selection of expectant mothers into WIC and systematic underreporting of program participation. In doing so, we extend existing partial identification methods to reflect the institutional details of the program. In particular, we allow for a richer measurement error model and apply a modified regression discontinuity design. Combining survey data from the Early Childhood Longitudinal Study Birth Cohort (ECLS-B) with administrative data from the USDA, our reduces the prevalence of unhealthy birth weight by at least 21 percent and unhealthy gestation duration by at least 9.9 percent

Adult food security and the relationship with Adverse Childhood Experiences among residents of Appalachian North Carolina

Introduction: The Appalachian region has worse health outcomes than the remainder of the United States. These disparities are often linked to the underlying social and environmental determinants of health. Adverse childhood experiences (ACEs) are associated with poor health outcomes across the lifespan and have a significant impact on future social determinants as an adult, including food security status. Purpose: To explore the relationships between ACEs and food security among adults in the Appalachian counties of North Carolina and make comparisons with the rest of the state. Methods: Researchers used North Carolina’s 2012 Behavioral Risk Factor Surveillance System data; namely, the ACEs optional module which includes 11 items related to experiences respondents had before the age of 18 and a single item from the Social Context optional module to classify food security status. The sample was divided into three age categories (18-44, 45-64, and 65 and older) for statistical comparisons as well as by the indicator for Appalachian county. Using Stata 15, weighted logistic regression was utilized for examining relationships between variables. Results: ACEs were a statistically significant predictor of food insecurity across all respondents; each additional ACE was associated with a 13-21% increase in the odds of food insecurity, depending on age group. However, living in an Appalachian county was only a predictor for those age 45-64. Implications: These findings highlight the long-term effects of childhood experiences on food security generally, and in Appalachia particularly for middle-aged adults. Reducing ACEs could reduce food insecurity and improve health in the region

Exploring the dynamics of racial food security gaps in the United States

Household-level food insecurity is one of the largest public health concerns facing millions of people in the United States today. Although recent work has highlighted gaps in food security rates between minority and non-Hispanic white households, little is known about how these households evolve through the overall distribution of food security over time. As such, we employ nonparametric estimators of distributional mobility to household-level data on food security from the Early Childhood Longitudinal Survey, Kindergarten Class of 1998-1999 study. Results suggest that Hispanic and non-Hispanic white households with children are equally mobile in the long run whereas non-Hispanic black households with children tend to be less upwardly mobile and more downwardly mobile in food security status over time

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (>= 65 years; estimated glomerular filtration rate <= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off <= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men