Food insecurity and health outcomes in U.S. school-aged children
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In the U.S. in 2015, 16.6% of households with children experienced food insecurity, which is associated with adverse health outcomes. Yet, little to no research has examined the relationship between food insecurity and asthma, the most common chronic childhood disease. Furthermore, studies of the association between food insecurity and overweight/obesity, an ongoing pediatric health crisis, have yielded mixed findings. Thus, the three aims of this research are: 1) to determine the association between household food security status and asthma in a cross-section of U.S. 3rd graders; 2) to examine the association between repeated exposures to food insecurity in early to mid-childhood and the risk of asthma; and 3) to determine the association between repeated exposures to food insecurity in early to mid-childhood and the risk of overweight/obesity. Data from the Early Childhood Longitudinal Study- Kindergarten cohort (ECLS-K), a diverse cohort of school-aged children followed from kindergarten to 8th grade, were analyzed. Household food insecurity was assessed using the validated 18-item Household Food Security Survey Module. Child asthma was assessed by parent report of a clinical diagnosis. Direct anthropometric assessments yielded age- and sex-specific BMI z-scores, categorized as normal or overweight/obese. Multivariate logistic regression models were computed in Aims 1 and 2 to test the association between food insecurity and asthma. In Aim 3, sex-specific multivariable Poisson regression models were used to calculate relative risk for overweight/obesity by exposure to food insecurity. Odds of asthma doubled in children that lived in households that were food-insecure and poor (OR 2.00 [95% CI 1.97 to 2.03]). Any exposure to food insecurity between kindergarten and 8th grade was associated with increased odds of asthma; the highest odds were among those with 2 years of exposure (OR 1.82 [95% CI 1.80 to 1.85]). Two years of exposure (but not fewer or more) also were associated with a 39% higher risk of overweight/obesity in 8th grade (RR 1.39 [95% CI 1.15 to 1.69]). Repeated exposures to household food insecurity increased the risk of both asthma and overweight/obesity in 8th grade. These findings are important for public health policy as well as asthma and obesity prevention efforts.
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