Stephanie Ettinger de Cuba

US Housing insecurity and the health of very young children.

OBJECTIVES We investigated the association between housing insecurity and the health of very young children. METHODS Between 1998 and 2007, we interviewed 22,069 low-income caregivers with children younger than 3 years who were seen in 7 US urban medical centers. We assessed food insecurity, child health status, developmental risk, weight, and housing insecurity for each childs household. Our indicators for housing insecurity were crowding (> 2 people/bedroom or>1 family/residence) and multiple moves (≥ 2 moves within the previous year). RESULTS After adjusting for covariates, crowding was associated with household food insecurity compared with the securely housed (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.18, 1.43), as were multiple moves (AOR = 1.91; 95% CI = 1.59, 2.28). Crowding was also associated with child food insecurity (AOR = 1.47; 95% CI = 1.34, 1.63), and so were multiple moves (AOR = 2.56; 95% CI = 2.13, 3.08). Multiple moves were associated with fair or poor child health (AOR = 1.48; 95% CI =1.25, 1.76), developmental risk (AOR 1.71; 95% CI = 1.33, 2.21), and lower weight-for-age z scores (-0.082 vs -0.013; P= .02). CONCLUSIONS Housing insecurity is associated with poor health, lower weight, and developmental risk among young children. Policies that decrease housing insecurity can promote the health of young children and should be a priority.

Food Insecurity and Risk of Poor Health Among US-Born Children of Immigrants

OBJECTIVES We investigated the risk of household food insecurity and reported fair or poor health among very young children who were US citizens and whose mothers were immigrants compared with those whose mothers had been born in the United States. METHODS Data were obtained from 19,275 mothers (7216 of whom were immigrants) who were interviewed in hospital-based settings between 1998 and 2005 as part of the Childrens Sentinel Nutrition Assessment Program. We examined whether food insecurity mediated the association between immigrant status and child health in relation to length of stay in the United States. RESULTS The risk of fair or poor health was higher among children of recent immigrants than among children of US-born mothers (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.02, 1.55; P < .03). Immigrant households were at higher risk of food insecurity than were households with US-born mothers. Newly arrived immigrants were at the highest risk of food insecurity (OR = 2.45; 95% CI = 2.16, 2.77; P < .001). Overall, household food insecurity increased the risk of fair or poor child health (OR = 1.74; 95% CI = 1.57, 1.93; P < .001) and mediated the association between immigrant status and poor child health. CONCLUSIONS Children of immigrant mothers are at increased risk of fair or poor health and household food insecurity. Policy interventions addressing food insecurity in immigrant households may promote child health.

“Do You Wanna Breathe or Eat?”: Parent Perspectives on Child Health Consequences of Food Insecurity, Trade-Offs, and Toxic Stress

ObjectivesThis study among 51 parents of young children under age four investigated how parents that report marginal, low and very low food security characterize how trade-offs associated with food insecurity affect parents’ mental health and child well-being.MethodsWe carried out 51 semi-structured audio-recorded interviews after participants responded to a survey regarding food security status and maternal depressive symptoms. Each interview was transcribed. Through a content analysis, we coded “meaning units” in each manuscript and organized them by themes in ATLAS.ti. Among participants reporting both food insecurity and depressive symptoms, we identified three primary areas of concern: trade-offs, mental health, and child well-being.ResultsParents described how trade-offs associated with food insecurity have a profound relationship with their mental health and home environment that strongly affects young children. Descriptions of hardships include anxiety and depression related to overdue bills and shut-off notices, strains with housing costs, and safety. Parents described how their own frustration, anxiety, and depression related to economic hardship have a negative impact on their children’s physical health, and their social and emotional development.ConclusionsParents in food insecure households recognize that trade-offs between food and other basic necessities are associated with their personal stress and poor mental health that, in turn, affects their children’s health and development. Partnerships between healthcare providers, policymakers, and parents are essential to successfully address and prevent the poor child health outcomes of toxic stress associated with food insecurity and poverty.

Health of Children Classified as Underweight by CDC Reference but Normal by WHO Standard

OBJECTIVE: To ascertain measures of health status among 6- to 24-month-old children classified as below normal weight-for-age (underweight) by the Centers for Disease Control and Prevention (CDC) 2000 growth reference but as normal weight-for-age by the World Health Organization (WHO) 2006 standard. METHODS: Data were gathered from children and primary caregivers at emergency departments and primary care clinics in 7 US cities. Outcome measures included caregiver rating of child health, parental evaluation of developmental status, history of hospitalizations, and admission to hospital at the time of visit. Children were classified as (1) not underweight by either CDC 2000 or WHO 2006 criteria, (2) underweight by CDC 2000 but not by WHO 2006 criteria, or (3) underweight by both criteria. Associations between these categories and health outcome measures were assessed by using multiple logistic regression analysis. RESULTS: Data were available for 18 420 children. For each health outcome measure, children classified as underweight by CDC 2000 but normal by WHO 2006 had higher adjusted odds ratios (aORs) of adverse health outcomes than children not classified as underweight by either; children classified as underweight by both had the highest aORs of adverse outcomes. For example, compared with children not underweight by either criteria, the aORs for fair/poor health rating were 2.54 (95% confidence interval: 2.20–2.93) among children underweight by CDC but not WHO and 3.76 (3.13–4.51) among children underweight by both. CONCLUSIONS: Children who are reclassified from underweight to normal weight in changing from CDC 2000 to WHO 2006 growth charts may still be affected by morbidities associated with underweight.

Unstable Housing and Caregiver and Child Health in Renter Families

In this study, we demonstrate associations between housing instability and the health of young children and their caregivers among low-income families in rental housing. OBJECTIVES: To evaluate how 3 forms of housing instability relate to caregiver and child health among low-income renter households. METHODS: Caregivers of children 0 to 48 months of age were interviewed in 5 urban medical centers from May 2009 to December 2015. Caregivers reported on the following: caregiver health, maternal depressive symptoms, child’s health, lifetime hospitalizations, developmental risk, and 3 housing circumstances, which were categorized as being behind on rent in the past 12 months, multiple moves (≥ 2 in past 12 months), and child’s lifetime history of homelessness. Associations with caregiver and child health outcomes were examined through multivariable logistic regression. RESULTS: Of 22 324 families, 34% had at least 1 of the following adverse housing circumstances: 27% had been behind on rent, 8% had made multiple moves, and 12% had a history of being homeless. Overlap between these was limited; 86% experienced only 1 adverse housing circumstance. Each circumstance was individually associated with increased adjusted odds of adverse health and material hardship compared with stable housing. Households behind on rent had increased adjusted odds of fair and/or poor caregiver health (adjusted odds ratio [aOR]: 1.91; 95% confidence interval [CI]: 1.77–2.05), maternal depressive symptoms (aOR: 2.71; 95% CI: 2.51–2.93), child lifetime hospitalizations (aOR: 1.19; 95% CI: 1.10–1.27), fair and/or poor child health (aOR: 1.41; 95% CI: 1.28–1.56), and household material hardships. Families with multiple moves and history of homelessness had similar adverse caregiver, child, health, and hardship outcomes. CONCLUSIONS: Three forms of housing instability were associated with adverse caregiver and child health among low-income renter households. The American Academy of Pediatrics recommends social screening within health care; providers could consider assessing for behind on rent, multiple moves, and homelessness in high-risk practices.

Timing and Duration of Pre- and Postnatal Homelessness and the Health of Young Children

In this study, we illustrate that there is no safe level of homelessness. Our findings justify interventions to stabilize families as quickly as possible in adequate, affordable housing. BrightcoveDefaultPlayer10.1542/6138655992001PEDS-VA_2017-4254 Video Abstract OBJECTIVES: Prenatal homelessness is associated with elevated risks of adverse neonatal outcomes. How the timing and duration of homelessness during pregnancy and/or a child’s early life relate to postnatal child health is unclear. METHODS: We interviewed 20 571 low-income caregivers of children <4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or <6 months. RESULTS: After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18–1.69), fair or poor child health (aOR 1.97; CI 1.58–2.47), and developmental delays (aOR 1.48; CI 1.16–1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76–1.18) or overweight status (aOR 1.07; CI 0.84–1.37). Children <1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05–4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38–2.58). CONCLUSIONS: After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.

SNAP cuts will harm children in the USA

Food insecurity, or hunger, exists in high-income countries, including the USA. Food insecurity has been associated with many adverse child health outcomes that can have long-term consequences, including fair or poor child health, history of admission to hospitals, and developmental risk. In the 1960s, the USA initiated the Food Stamp Program, now the Supplemental Nutrition Assistance Program (SNAP), to combat widespread malnutrition and provide food purchasing assistance. According to 2011 data from the US Department of Agriculture, more than 70% of benefi ts from SNAP went to households with children, and one in four American children are recipients. Evidence for the benefi cial eff ect of SNAP on childhood food insecurity is strong. In response to the global recession from December, 2007, to June, 2009, the American Recovery and Reinvestment Act (ARRA) of 2009 increased the average SNAP benefi t from US

Are Food Insecurity's Health Impacts Underestimated in the U.S. Population? Marginal Food Security Also Predicts Adverse Health Outcomes in Young U.S. Children and Mothers

1·30 to

WIC Participation and Attenuation of Stress-Related Child Health Risks of Household Food Insecurity and Caregiver Depressive Symptoms

1·60 per meal per person. Despite increases in national unemployment in 2008, after the 2009 ARRA boost to SNAP, the number of children in food-insecure households decreased from 17·2 million in 2009, to 16·2 million in 2010. Even after accounting for adverse selection bias—whereby families with the gravest health and economic burdens who are most threatened by food insecurity are more likely to access the programme than are less distressed families—SNAP participation has been associated with decreased food insecurity. Although some speculate that SNAP contributes to childhood obesity because few restrictions are placed on items that can be purchased, no data have shown that receipt of SNAP is associated with childhood obesity or other negative eff ects. By contrast, many studies have shown positive associations between receipt of SNAP and child well being beyond that of decreased risk of food insecurity, including increased intake of B vitamins, iron, and calcium, and a lower risk of anaemia, obesity, poor health, hospital admission for failure to thrive, and reports of child abuse or neglect. Children aged 5–9 years of SNAP-participating families had better academic outcomes and less obesity than had children of non-participating families. Nationally representative data suggest that SNAP-recipient school-age children and adolescents were less likely to suff er from obesity than were non-recipient peers. History provided for a natural experiment on SNAP’s eff ects on pregnancy and early life. Between 1961 and 1975, the programme was implemented county by county, thus, allowing for comparison across counties that diff ered only by SNAP availability. In SNAP-available counties, there was a 6% decrease in very low birthweight births (<1500 g) in black women and a signifi cant increase of 12–42 g in mean birthweight for both black and white Americans compared with those counties where SNAP was not available. Children of low-income women in SNAP-available counties were less likely to have metabolic syndrome in adulthood and women who had received food stamps during early childhood were more likely to be economically self-suffi cient. However, as the Institute of Medicine reported recently, the full potential of SNAP’s positive health eff ects has not been achieved because the benefi t, even with the ARRA boost, is tied to an outdated nutrition plan, providing a marginally adequate diet that is not intended for long-term use, and with no regional benefi t adjustment for diff erences in food price or availability. Despite convincing evidence of the benefi cial eff ects of SNAP on child health, American legislators have targeted SNAP as they struggle to address the federal budget and the US farm bill, the main blueprint of USA food and agriculture policy. SNAP must be reauthorised every 5 years. Yet the current political debate often ignores the evidence that SNAP improves the health and development of America’s children. SNAP is in