Household food insecurity is associated with threats to children’s intellectual, behavioral, and psycho-emotional development.  In addition to poor food quality and quantity, the stress associated with food insecurity can undermine caregiver mental health and family functioning. Evidence demonstrates that national assistance programs and policies are needed to ensure that families and children have access to adequate sources of healthy food and to stress-alleviating resources

Black, Maureen M

DigitalCommons@The Texas Medical Center

Journal of Applied Research on Children: Informing Policy forChildren at RiskVolume 3Issue 1 Food Insecurity Article 182012Protect Children From Household FoodInsecurity: Promote Access To Food and Stress-Alleviating ResourcesMaureen M. BlackUniversity of Maryland School of Medicine, mblack@peds.umaryland.eduFollow this and additional works at: http://digitalcommons.library.tmc.edu/childrenatriskThe Journal of Applied Research on Children is brought to you for free andopen access by CHILDREN AT RISK at DigitalCommons@The TexasMedical Center. It has a "cc by-nc-nd" Creative Commons license"(Attribution Non-Commercial No Derivatives) For more information,please contact digitalcommons@exch.library.tmc.eduRecommended CitationBlack, Maureen M. (2012) "Protect Children From Household Food Insecurity: Promote Access To Food and Stress-AlleviatingResources," Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 3: Iss. 1, Article 18.Available at: http://digitalcommons.library.tmc.edu/childrenatrisk/vol3/iss1/18  The recent economic downturn has resulted in record-breaking rates of national poverty, particularly among households with children.  As families struggle to meet their children’s basic needs, household food insecurity (uncertain access to enough food for all household members to sustain an active and healthy life) has become a major public health problem, affecting an estimated 21.8% of US households with children under age 6 years, with rates as high as 49.9% for low-income, female-headed households with children.1-3   In a systematic review published in this issue, Rafael Perez-Escamilla and Rodrigo Pinheiro de Toledo Vianna report consistent evidence that children in food insecure households experience higher vulnerability to intellectual, behavioral, and psycho-emotional developmental problems than children in food secure households, even after adjusting for socioeconomic indicators. Their review also provides evidence that the negative associations between food insecurity and caregivers’ mental health may not only mediate the relationship between household food insecurity and children’s development, but may also lead to family dysfunction, adding additional stress and potentially interfering with families’ ability to transition out of food insecurity.  These findings are consistent with a recent report from Children’s HealthWatch that, as the number of family stressors (household food insecurity and maternal depressive symptoms) increases, the odds of children’s fair/poor health, hospitalizations, and developmental risk increase and the odds of children achieving a “well-child” status (weight and length within normal, good/excellent health, no hospitalizations, and no developmental risk) decrease.4    The family stress and cumulative stress models5-7 suggest that families with limited resources who must make difficult choices to meet their children’s needs often experience frustration and emotional distress.8 In turn, emotional distress increases the number of family stressors, further disrupting the family’s functioning and care giving practices, and potentially undermining children’s development and sense of security. Thus, strategies to alleviate household food insecurity may need to extend beyond meeting families’ nutritional needs to address the increases in family stress and dysfunction that often accompany household food insecurity.   The studies comparing persistent versus episodic household food insecurity illustrate that food insecurity extends beyond the presence or absence of food. For example, in one study toddlers in persistently food- insecure households fared better than toddlers in households that experienced episodic food insecurity.9 In another study, children in 1Black: Protect Children From Household Food InsecurityPublished by DigitalCommons@The Texas Medical Center, 2012  households that transitioned from food insecure to food secure had lower scores on measures of social skills than children in persistently food insecure households.10 There are several possible explanations for why exposure to episodic household food insecurity or the transition out of food insecurity may be so challenging to children and families. One possibility is that persistently food insecure caregivers develop adaptive coping skills for handling food insecurity that are less accessible or acceptable to families in transition. Another possibility is that transitioning to a food- secure status is associated with a loss of public assistance services, thereby introducing other stressors. With few longitudinal studies, our ability to understand how families cope with fluctuating resources related to the varying availability of adequate and healthy food is limited.   Providing food assistance is a critical intervention for alleviating food insecurity, particularly because food insecure families often resort to low-cost, low nutrient-dense food,11,12 with limited consumption of fruits, dark green vegetables, grains, yogurt, nuts, seeds, and dried beans and peas.13  As a result, children in food-insecure households are at risk for iron deficiency14,15 and high cholesterol values.14  Evidence suggests that national nutritional programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), are effective in reducing household food insecurity by providing children and families with healthy food, nutritional counseling, and referrals when necessary.4,16  WIC participation has also been associated with lower rates of caregiver depressive symptoms, compared to WIC-eligible non-participants.4 Other investigators have also reported that poverty alleviation and family-oriented programs that are not specifically designed to address mental health problems have been associated with lower rates of maternal depressive symptoms.17-19 These findings, consistent with the family stress model,1 suggest that maternal depressive symptoms are sensitive to the availability of household and family resources.  Although WIC participation attenuates the negative association in families experiencing both household food insecurity and depressive symptoms with indicators of child health and development, a significant association remains,4 suggesting that families and children may benefit from additional assistance to address the stress-associated impact of household food insecurity.  Recent research, including the review by Perez-Escamilla and Pinheiro de Toledo Vianna, has shown that not only is household food insecurity associated with children’s intellectual, behavioral, and psycho-emotional developmental problems, but the stress associated with food insecurity can undermine caregiver mental health and family functioning. 2Journal of Applied Research on Children:  Informing Policy for Children at Risk, Vol. 3 [2012], Iss. 1, Art. 18http://digitalcommons.library.tmc.edu/childrenatrisk/vol3/iss1/18  Longitudinal research is needed to clarify the mechanisms linking household food insecurity, caregiver and family stress, and children’s intellectual, behavioral, and psycho-emotional development, along with effective strategies to prevent and alleviate food insecurity.  However, there is enough current evidence to demonstrate that national assistance programs and policies are needed to ensure that families and children have access to adequate sources of healthy food and to stress-alleviating resources.    3Black: Protect Children From Household Food InsecurityPublished by DigitalCommons@The Texas Medical Center, 2012  References  1. Nord M, Coleman-Jensen A, Andrews M, Carlson S. Household Food security in the United States, 2009 (Economic Research Report No. 108). http://www.ers.usda.gov/Publications/ERR108/. Accessed February 23, 2012.  2. DeNavas-Walt C, Proctor BD, Smith JC. Income, poverty, and health insurance coverage in the United States: 2010. U.S. Census Bureau, Current Population Reports, P60-239. http://www.census.gov/prod/2011pubs/p60-239.pdf. Accessed February 23, 2012. 3. Coleman-Jensen A, Nord M, Andrews M, Carlson S. Household food security in the United States in 2010. U.S. Dept. of Agriculture. http://www.ers.usda.gov/Publications/err125/. Published September 2011. Accessed February 23, 2012. 4. Black M, Quigg A, Cook J, et al. WIC participation and attenuation of child health risks associated with household food insecurity and caregiver depressive symptoms. Arch Pediatr Adol Med. In Press. 5. Conger RD, Wallace LE, Sun Y, Simons RL, McLoyd VC, Brody GH. Economic pressure in African American families: a replication and extension of the family stress model. Dev Psychol 2002;38:179-93. 6. Conroy K, Sandel M, Zuckerman B. Poverty grown up: how childhood socioeconomic status impacts adult health. J Dev Behav Pediatr. 2010;31:154-60. 7. Sameroff, A. The Transactional Model of Development: How Children and Contexts Shape Each Other. Washington, DC: American Psychological Association; 2009. 8. Wickrama KA, Conger RD, Lorenz FO, Jung T. Family antecedents and consequences of trajectories of depressive symptoms from adolescence to young adulthood: a life course investigation. J Health Soc Behav. 2008;49:468-83. 9. Hernandez DC, Jacknowitz A. Transient, but not persistent, adult food insecurity influences toddler development. J Nutr 2009;139(8):1517-24. 10. Howard L. Transitions between food insecurity and food security predict children's social skill development during elementary school. Brit J Nutr. 2011;105:1852-1860. 11. Cole N, Fox M (ed). Diet quality of american young children by WIC participation statue: data from the National Health and Nutrition Examination Survey. Special Nutrition Programs Report No. WIC-4Journal of Applied Research on Children:  Informing Policy for Children at Risk, Vol. 3 [2012], Iss. 1, Art. 18http://digitalcommons.library.tmc.edu/childrenatrisk/vol3/iss1/18  08-NH. Published July 2008. US Department of Agriculture, Food and Nutrition Web site. http://www.fns.usda.gov/ora/menu/Published/WIC/FILES/NHANES-WIC.pdf. Accessed February 23, 2012. 12. Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Amer J Clin Nutr. 2004;79(1):6-16. 13. Casey P, Szeto K, Lensing S, Bogle M, Weber J. Children in food-insufficient, low-income families: prevalence, health and nutrition status. Arch Pediatr Adolesc Med. 2001;155(4):508-14. 14. Alaimo K, Olson C, Frongillo E. Food insufficiency and American school-aged children's cognitive academic, and psychosocial development. Pediatrics. 2001;108(1):44-53. 15. Skalicky A, Meyers A, Adams W, Yang Z, Cook J, Frank D. Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States. Matern Child Health J. 2006;10(2):177-85. 16. Metallinos-Katsaras E, Gorman KS, Wilde P, Kallio J. A longitudinal study of WIC participation on household food insecurity. Matern Child Health J. 2011;15:627-33. 17. Baker-Henningham H, Powell C, Walker S, Grantham-McGregor S. The effect of early stimulation on maternal depression: a cluster randomised controlled trial. Arch Dis Child. 2005;90:1230-4. 18. Ozer EJ, Fernald LC, Weber A, Flynn EP, Vanderweele TJ. Does alleviating poverty affect mothers' depressive symptoms? A quasi-experimental investigation of Mexico's Oportunidades programme. Int J Epidemiol 2011;40(6):1565-76 19. Surkan PJ, Gottlieb BR, McCormick MC, Hunt A, Peterson KE. Impact of a health promotion intervention on maternal depressive symptoms at 15 months postpartum. Matern Child Health J. January 2012;16(1):139-48.    5Black: Protect Children From Household Food InsecurityPublished by DigitalCommons@The Texas Medical Center, 2012

Protect Children From Household Food Insecurity: Promote Access To Food and Stress-Alleviating Resources

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