Findings

Food Insecurity and Child Health | SNAP | WIC | CACFP | Energy Insecurity and Child Health | LIHEAP | Housing Insecurity | Subsidized Housing | Cumulative Hardship | TANF | Maternal Depression and Child Well-Being | Breastfeeding | Child Development | Children of Immigrants | Children of Color

 

Children’s HealthWatch works to improve child health by bringing evidence and analysis from the front lines of pediatric care to policy makers and the public.  Through our network of pediatricians and public health researchers, we collect data on children up to the age of four in emergency rooms and clinics at Boston Medical Center; the University of Maryland School of Medicine in Baltimore; the University of Arkansas for Medical Sciences in Little Rock; Hennepin County Medical Center in Minneapolis; and St. Christopher’s Hospital in Philadelphia.  The Children’s HealthWatch dataset currently includes over 41,000 caregiver interviews. 

Below are a few of the many findings that have been drawn from Children’s HealthWatch data, all of which have been published in peer reviewed journals or presented at national scientific meetings.  Many of these findings have also been highlighted in Congressional testimony, policy reports, and media coverage. 

To read more on our methodology, click here.

To read our peer-reviewed articles, click here.

Food Insecurity and Child Health (1-3)

Through 2009, in Children's HealthWatch's five-city sample of low-income families with children, 20.8% were food insecure.

Compared to young children in food secure households, infants and toddlers in food insecure households are:
  • 30% more likely to have a history of hospitalization.
  • 90% more likely to be reported in fair or poor health.
  • Nearly twice as likely to have iron deficiency anemia.
  • Two-thirds more likely to be at risk for developmental delays.

Child Food Insecurity Intensifies the Harmful Effects of Household Food Insecurity

Compared to infants and toddlers in food insecure households, infants and toddlers in households with both household and child food insecurity had significantly higher odds of having a history of hospitalization and of being reported in fair or poor health.

Household and Child Food Insecurity Are Not the Whole Picture

At very low levels of food insecurity, children suffer negative health and developmental effects. Children under age three in marginally food-secure households were found to have health outcomes that are significantly worse than children in fully food-secure households. They are more likely to:

  • Be in fair/poor health.
  • Be at risk for developmental delays.
  • Have been hospitalized since birth.
  • Lack stable housing.
  • Live in households with inadequate heating and cooling.
  • Have caregivers experiencing symptoms of depression.
  • Have caregivers in fair/poor health.

To read our Policy Action Brief, "Even Very Low Levels of Food Insecurity Found to Harm Children's Health," click here.

To read the NYAS article, click here.

To read our publications on food insecurity, click here.

SNAP (Supplemental Nutritional Assistance Program, formerly the Food Stamp Program) (3, 4)

Compared to children in families receiving SNAP whose benefit was not decreased, children in families with terminated or reduced SNAP assistance are:
  • 90% more likely to live in food insecure households.
  • More than two times as likely to experience child food insecurity.
Compared to children in food insecure households who participate in the SNAP, children in food insecure households whose families do not participate are:
  • Significantly more likely to be reported in fair or poor health.

To read our report, "Food Stamps as Medicine: A New Perspective on Children's Health," click here.

To read our publications on food insecurity and SNAP, click here.

  

  

WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) (5)

Research on WIC has demonstrated repeatedly that WIC is a very effective program for protecting the health of infants and young children. Children's HealthWatch research has shown that:

  • Children under age three who receive WIC are more likely to be in excellent of good health than eligible children who do not receive WIC due to access problems.
  • WIC's most protective effect is on children younger than 12 months of age.
  • Receipt of WIC is linked to a decrease in the risk of developmental delays in young children .
  • WIC has a positive effect on children's health in both working and non-working families who receive WIC.

To read our report, "Feeding our Future: Growing up Healthy with WIC," click here.

To read our policy action brief, "Even Very Low Levels of Food Insecurity Found to Harm Children's Health," click here.

To read our publications on food insecurity and WIC, click here.

CACFP (Child and Adult Care Food Programs)

Because CACFP is administered at the child care provider level and parents cannot apply individually, many do not know whether their child participates. This has complicated collecting data that could connect child health to program participation. Children's HealthWatch identified a subset of children in its database who are highly likely to be participating in CACFP. Of these children in child care centers between 13 months and three years of age, whose parents receive a child care subsidy, Children's HealthWatch compared children whose meals were supplied from home and children whose meals were supplied by the child care provider. Children whose meals were supplied by the child care provider were:

  • 28% less likely to be in fair or poor health.
  • 26% less likely to be hospitalized.
  • More likely to have a healthy weight and height for their age.

To read our policy action brief, "Child Care Feeding Programs Support Young Children's Health Development," click here.

To read our publications on food insecurity and CACFP, click here.

Energy Insecurity and Child Health (6)

Through 2009, in Children's HealthWatch's five-city sample of low-income families with children, 26.8% were energy insecure.

Compared with infants and toddlers in households that were energy secure, those in households with moderate energy insecurity were:
  • More than twice as likely to live in a food-insecure household
  • 79% more likely to be child food insecure (a more severe form of food insecurity)
  • 34% more likely to be in fair or poor health
  • 22% more likely to have been hospitalized since birth
Compared with infants and toddlers in households that were energy secure, those in households with severe energy insecurity were:
  • More than three times as likely to live in a food-insecure household
  • More than three times as likely to be child food insecure (a more severe form of food insecurity)
  • 36% more likely to be in fair or poor health
  • 82% more likely to be at risk for developmental delays
To read our policy action brief, "Energy Insecurity is a Major Threat to Child Health," click here.


To read our publications on energy insecurity, click here.

  

LIHEAP (Low-Income Home Energy Assistance Program) (7)

Among low-income Children’s HealthWatch families eligible for LIHEAP, only 16% of families received energy assistance. Compared to infants and toddlers in families who receive LIHEAP, infants and toddlers who do not receive the benefit are:
  • Significantly more likely to be underweight.
  • 23% more likely to be at nutritional risk for growth problems.
  • 32% more likely to be admitted to the hospital on the day of the Children’s HealthWatch interview.

To read our article published in Pediatrics, "Heat or Eat: The Low Income Home Energy Assistance Program and Nutritional Risks Among Children Less Than 3 Years of Age," click here.

To read our publications of energy insecurity and LIHEAP, click here.

Housing Insecurity (8-10)

Compared to children in housing secure families, children in housing-insecure families are more likely to be:
  • Food insecure
  • Child food insecure (a more severe form of food insecurity)
  • In fair or poor health
  • At risk for developmental delays
  • Gaining weight too slowly
Among low-income Children's HealthWatch families in all five cities:
  • 36.6% are moderately housing insecure
  • 4.7% are severely housing insecure
In Metro-Boston, Children's HealthWatch found:
  • 38% of the families are moderately or severely housing insecure
  • 15.6% of children living in severely housing insecure families suffer from poor health versus 8.6% in families with stable housing
To read our report, "Bringing Children in from the Cold: Solutions for Boston's Hidden Homeless," click here. 

 

To read our publications on housing insecurity, click here.  

    

  

Subsidized Housing (11) 

Among low-income Children’s HealthWatch families eligible for housing subsidies:
  • Housing assistance was received by only 27% of the families
  • Children in subsidized housing have better growth outcomes than children in families who do not receive the benefit.

In Boston, when children living in subsidized housing are compared to those whose families are on the wait list, those in subsidized housing are:

  • More likely to be food secure
  • Less likely to be seriously underweight
  • More likely to be classified as "well" on a composite indicator of child health

To read our published article in Archives of Pediatric and Adolescent Medicine, "Subsidized Housing and Children's Nutritional Status, Data from a Multisite Surveillance Study," click here.

To read our report, "Rx for Hunger: Affordable Housing," click here.

To read our publications on subsidized housing, click here.

  

Cumulative Hardship

Children’s HealthWatch research shows the very young children in families that experience multiple hardships—in this case, not enough nutritious food, inadequate or inconsistent and access to utility service, and unstable housing, suffer negative health effects, many of which have life-long consequences.
Cumulative hardship is assessed using a numerical scale to measure severity of food, energy and housing insecurity. The scores are summed across the three components to arrive at a total hardship score.
Children’s HealthWatch found that compared to those with no hardship, children with moderate hardship were:

  • 11% less likely to be classified as well
  • 21% more likely to be at risk for developmental delay

Compared to those with no hardship, children with severe hardship were:

  • 35% less likely to be classified as well
  • 120% more likely to be at risk of developmental delay

In Boston, Children’s HealthWatch found:

  • 30% of all families suffer from energy insecurity
  • Moderately housing insecure families are more likely to be food insecure
  • Moderately housing insecure families are more likely to be energy insecure

To read our report, "Healthy Families in Hard Times: Solutions for Multiple Hardships," click here.

  

TANF (Temporary Assistance for Needy Families) (12)

Compared to TANF families whose benefit was not decreased, infants and toddlers with terminated or reduced TANF assistance are:
  • 30% more likely to have a history of hospitalization.
  • 50% more likely to be in food insecure households.
  • 90% more likely to be admitted to a hospital at an ED visit.


To read our article published in Pediatrics, “Maternal Depression, Changing Public Assistance, Food Security and Child Health Status," click here.

To read our reports on TANF, click here.

 

Maternal Depression and Child Well-Being (13)

Compared to mothers who do not report symptoms of depression, mothers who do report depression are:
  • 60% more likely to describe their child's health as fair or poor.
  • More than twice as likely to experience household food insecurity.
  • 50% more likely to report decreased welfare support and/or lost SNAP.

To read our report, "Healthy Families in Hard Times: Solutions for Multiple Hardships," click here.

To read our article published in Pediatrics, “Maternal Depression, Changing Public Assistance, Food Security and Child Health Status," click here.

Breastfeeding (14)

Among citizen infants of immigrant mothers, those who are breastfed are:
  • 35% less likely to be in fair or poor health 
  • 28% less likely to have a history of hospitalizations.
  • Significantly higher in weight-for-age and length-for-age z scores than those who are not breastfed. 

The positive impact of breastfeeding is largest in food insecure households, suggesting that breastfeeding is an important strategy for protecting infants from the negative health effects of food insecurity.

To read our article published in Journal of the American Dietetic Association, "Breastfeeding and Health Outcomes among Citizens Infants of Immigrant Mothers," click here. 

  

  

Child Development (15)

Compared to caregivers in food secure households, caregivers in food insecure households are:
  • Two-thirds more likely to report their children as being at developmental risk.

The increase in developmental risk is similar in magnitude between households that are food insecure, and households that experience the more severe condition of food insecurity with hunger, suggesting a low threshold for food insecurity affecting young children’s development.

To read article published in Pediatrics, "Household Food Insecurity: Associations with At-Risk Infant and Toddler Development," click here.

  

  

Children of Immigrants (16)

Compared to children of US-born mothers, children of immigrants are:
  • 26% more likely to be at risk for fair or poor health.
  • More than twice as likely to be at risk for food insecurity among newly arrived immigrants.

The disparities existing between children of US-born parents and children of immigrants are harmful to the health and well-being of children of immigrants.  As a large part of America’s future population and workforce, this raises concerns as to the future development and productivity of tomorrow’s workforce.

To read our article published in American Journal of Public Health, "Food Insecurity and Risk of Poor Health Among US-born Children of Immigrants," click here.


To read our publications on children of immigrants, click here.

 

Children of Color (17, 18)

Black Children

Compared to Black children who live in low-income but food-secure households, Black children living in low-income, food-insecure households experience 57% higher odds of their parents identifying significant developmental concerns.

TANF

Compared with Black infants and toddlers whose TANF family benefit was not reduced in the past year:
  • Black infants and toddlers whose TANF family benefit was reduced were 56 percent more likely to be food insecure.
  • Black infants and toddlers whose TANF family benefit was sanctioned were 78 percent more likely to be food insecure.

SNAP 

Compared with Black infants and toddlers whose SNAP/food stamp family benefit was not reduced in the past year:
  • Black infants and toddlers whose SNAP/food stamp family benefit was reduced were 33 percent more likely to be food insecure.
  • Black infants and toddlers whose SNAP/food stamp family benefit was sanctioned were 84 percent more likely to be food insecure.
  • Black infants and toddlers whose SNAP/food stamp family benefit was reduced were 38 percent more likely to be reported as being in fair or poor health.

WIC

Compared with Black infants who received WIC, those who were potentially eligible but did not receive WIC were:
  • 56% more likely to be at nutritional risk for growth problems.
  • More than twice as likely to be underweight (as measured by being less than or equal to two standard deviations below the mean for weight-for-age).
  • More likely to be shorter in height (as measured by height-for-age z-score).

Housing Subsidy

Compared with Black infants and toddlers in families who received a housing subsidy, those in potentially eligible families who did not receive a housing subsidy were:
  • 33% more likely to be underweight (as measured by being less than or equal to two standard deviations below the mean for weight-for-age).
  • More likely to be shorter in height (as measured by height for- age z-score).

Fuel Assistance

Compared with Black infants and toddlers in families who received fuel assistance, those who were in potentially eligible families but did not receive fuel assistance were:
  • 29% more likely to be at nutritional risk for growth problems (less than the fifth percentile for weight-for-age, or less than the tenth percentile for weight-for-height).
  • More likely to have a lower weight (as measured by weight for- age z-score).
 Latino Children

Compared to Latino children who live in low-income but food-secure households, Latino children living in low-income, food-insecure households experience more than twice the odds of their parents identifying significant developmental concerns.

TANF 

Compared with Latino infants and toddlers whose TANF family benefit was not reduced in the past year:
  • Latino infants and toddlers whose TANF family benefit was reduced were more than twice as likely to be food insecure.
  • Latino infants and toddlers whose TANF family benefit was sanctioned were 63% more likely to be food insecure.

SNAP

Compared with Latino infants and toddlers whose SNAP/family benefit was not reduced in the past year:
  • Latino infants and toddlers whose SNAP/food stamp family benefit was sanctioned were more than twice as likely to be food insecure.

WIC

Compared with Latino infants who received WIC, those who were potentially eligible but did not receive WIC were:
  • More likely to have a lower weight and be shorter in height (as measured, respectively, by weight-for-age and height-for-age z-scores).

Housing Subsidy

Compared with Latino infants and toddlers in families who received a housing subsidy, those who were potentially eligible but did not receive a housing subsidy were:
  • 99% more likely to be short in height (less than or equal to two standard deviations below the mean for height-for-age).

Fuel Assistance

No significant findings for Latino children.

To read our report, "Balancing Acts: Energy Insecurity among Low-Income Babies and Toddlers of Color Increases Food Insecurity and harmful Health Effects," click here.

To read our reports on children of color, click here.

 

(1) Cook JT, Frank DA, Berkowitz  C, et al. Food Insecurity is associated with adverse health outcomes among human infants and toddlers. Journal of Nutrition. 2004; 134:1432-1438.
(2) Skalicky A, Meyers AF, Adams W et al. Child Food Insecurity and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the United States. Maternal and Child Health Journal. 2006; 10(2): 177-185.
(3) Cook JT, Frank DA, Levenson SM et. al. Child Food Insecurity Increases Risks Posed by Household Food Insecurity to Young Children’s Health. American Society for Nutrition Symposium: Food Assistance and the Well-Being of Low-Income Families. 2006; 1073-1076.
(4) Frank DA, Cook JT, Meyers AF, et al. Reduction/loss of Welfare and Food Stamp benefits: Impact on family food security and children’s hospitalizations. Abstract No. 85 Presented at Pediatric Academic Societies Annual Conference, Baltimore, MD. May 2001.
(5) Black M, Cutts D, Frank DA, et al. WIC Impact on Infant Growth, Health, and Food Security: Results of a Multisite, Multiyear Surveillance Study.  Pediatrics. 2004; 114(1):169-176.
 (6) Cook JT, Frank DA, Casey PH, et. al. A Brief Indicator of Household Energy Security: Associations with Food Security, Child Health, and Child Development in US Infants and Toddlers. Pediatrics. 2008; 122;867-875.
(7) Frank DA, Neault N, Skalicky A et. al. Heat or Eat: The Low Income Home Energy Assistance Program and Nutritional and Health Risks Among Children Less Than 3 Years of Age. Pediatrics. 2006; 118:1293-1302.
(8) Rice, D. Center on Budget and Policy Priorities. September 14, 2009.
(9) Becker Cutts D, Meyers A, Black M, et al. Housing Insecurity and the Health of Very Young Children. American Journal of Public Health (under review).
(10) Bringing Children in from the Cold: Solutions for Boston’s Hidden Homeless. Children’s HealthWatch. October 2008.
(11) Meyers A, Cutts D, Frank DA, et al. Subsidized housing and child nutritional status: Data from a multisite surveillance study. Arch Pediatr Adolesc Med. 2005;159:551-556.
(12) Cook JT, Frank DA, Berkowitz C, et al. Welfare reform and the health of young children: A sentinel survey in 6 US Cities. Arch Pediatr Adolesc Med.
(13) Casey P, Goolsby S, Berkowitz C, et al. Maternal depression, changing public assistance, food security, and child health status. Pediatrics 2004;113:298-3042002;156:678-684.
(14) Neault N , Frank DA, Merewood A, et. al. Breastfeeding and health outcomes among citizen infants of immigrant mothers. Journal of the American Dietetic Association 2007; 107:2077-2086.
(15) Rose-Jacobs R, Black M, Casey P, et. al. Household food insecurity: Associations with at-risk infant and toddler development. Pediatrics 2008; 121:65-72.
(16) Chilton M, Black M, Berkowitz C, et. Al. Food Insecurity and the Risk of Poor Health among US-Born Children of Immigrants. American Journal of Public Health 2009; 99 (3);556-562.
(17) The Impact of Food Insecurity on the Development of Young Low-Income Black and Latino Children. C-SNAP. May 2006.
(18) Protecting the Health and Nutrition of Young Children of Color: The Impact of Nutrition Assistance and Income Support Programs. C-SNAP. May 2006.