HOUSING CHALLENGES AND CHILD HOUSING CHALLENGES AND CHILD

HEALTH AND DEVELOPMENTHEALTH AND DEVELOPMENT

Patrick Casey, M.D.Harvey and Bernice Jones Professor of

Developmental Pediatrics Department of Pediatrics

College of MedicineUniversity of Arkansas for Medical Sciences

Arkansas Children’s Hospital

Food Insecurity

Housing Insecurity Energy Insecurity

FOOD INSECURITY AND RISK FACTORSFOOD INSECURITY AND RISK FACTORSHOUSEHOLD RESOURCES

(money, time, information, health)

FOOD ACQUISITION

HOUSEHOLD FOOD SUPPLY

NORMAL FOOD SYSTEM

grocery stores andfood service operations

food availability(type and quantity)

food accessibility(cost and distance)

GOVERNMENT FOODASSISTANCE

Food StampsWIC

School Lunch and Breakfast

NON-FOODEXPENDITURES

housinghospital careemergencies

taxesdiscretionary items

gasolineheating, cooling

other

ALTERNATE FOOD SOURCES

PRIVATE FOOD ASSISTANCEgifts from family & friendsgardening, hunting, fishingscavenging

Nutrition Program for the Elderly (Title 3c)

Modified from Campbell, CC: Food Insecurity: A Nutritional Outcome or a Predictor Variable? J Nutr. 1991.121:408

FOOD INSECURITYFOOD INSECURITY

Limited or uncertain availability of

nutritionally adequate and safe foods or

limited or uncertain ability to acquire

acceptable foods in socially acceptable

ways.

20112011

Food Insecurity of all Households:14.9%

Food Insecurity of Households with Children:20.6%

TRENDS IN PREVALENCE OF FOOD INSECURITYTRENDS IN PREVALENCE OF FOOD INSECURITY2003 – 2011 2003 – 2011

03 05 07 09 11

FOOD SECURITY BY STATEFOOD SECURITY BY STATE

20112011

Worst 50: Mississippi 19.2%

50: Arkansas 19.2%

48: Texas 18.5%

47: Alabama 18.2%

46: Georgia 17.4%

Best 5: Wisconsin 11.3%

4: Minnesota 10.2%

3: New Hampshire 9.6%

2: Virginia 9.1%

1: North Dakota 7.8%

FOOD HARDSHIPFOOD HARDSHIP

States:

2008-2009 Arkansas #2 @ 24%

2011 Arkansas #12 @ 21.1%

Metropolitan Area:

2008-2009: Little Rock/Conway #18 @ 20%

2011: Little Rock/Conway #47 @ 18.1%

CHILDREN AND FOOD INSECURITYCHILDREN AND FOOD INSECURITY

Food Insecurity is associated with poorer child:• general health (and more hospitalizations)• developmental status in pre-school years• educational achievement• mental health• academic problems

while controlling for demographic characteristics

HOUSING SPECTRUMHOUSING SPECTRUM

Stable Poor Quality Housing Insecure: Homeless- behind on rent- crowding- multiple moves

HOUSING AND DISEASE:HOUSING AND DISEASE:

ASTHMAASTHMA

• Increased prevalence, worse in lower SES• Direct effect: molds, dust mites,

environmental pollutants• Indirect effects: problem affording

medications, follow-up with doctor visits

Children’s Health WatchChildren’s Health Watch

A consortium of academic pediatricians who focus on infant growth (all have growth clinics), which collects data to influence public policy, and for academic publications

WHAT WE DO:WHAT WE DO:

Collect data in five urban, safety-net hospitals

Produce scientific research that is original and timely

Inform policy decisions with state and national partners

STUDY METHODSSTUDY METHODS

• 5 medical centers─3 emergency departments (ED)

─3 hospital based clinics

• August 1998 to present

• Cross-sectional convenience sample

• Children ≤48 months of age

STUDY METHODSSTUDY METHODS

• Caretaker Survey:– Demographics– Child health– Child development concern: Peds– State & federal program participation– USDA 18-question food security scale

• Medical Record Audit:– Child weight & height– Medical diagnosis– Admission & dehydration status

FEDERAL ASSISTANCE PROGRAMS–FEDERAL ASSISTANCE PROGRAMS–monitored bymonitored by

• Food Stamps (SNAP)• Temporary Assistance for Needy Families (TANF)• Women, Infants and Children (WIC)• Medicaid• Federal Housing Subsidies• Energy Assistance (LIHEAP)

Primary HouseholdAnd Child Outcomes

• Food Insecurity• Hospitalizations• Child Wellbeing• Maternal Depression• Child Growth• Child Development

U.S. HOUSING INSECURITY U.S. HOUSING INSECURITY

AND THE HEALTH OF VERY AND THE HEALTH OF VERY

YOUNG CHILDRENYOUNG CHILDREN

American Journal of Public Health.

2011, June 16:e1 – e7

HOUSING INSECURITYHOUSING INSECURITY

• Crowding: more than 2 people per bedroom, or

• Moved two or more times in the past year

INSECURE HOUSING AND INSECURE HOUSING AND

CHILD AND HOUSEHOLD STATUSCHILD AND HOUSEHOLD STATUS

Secure Housing Crowding Multiple Moves

Referent AOR p AOR p

Household Food Insecurity 1 1.3 <.001 1.9 <.001

Child Food Insecurity 1 1.5 <.001 2.6 <.001

Fair/Poor Child Health 1 1.07 .14 1.48 <.001

Child Development Risk 1 1.06 .49 1.71 <.001

Adjusted for multiple family and child characteristics

FOOD, HOUSING, AND ENERGY INSECURITYFOOD, HOUSING, AND ENERGY INSECURITY

LITTLE ROCKLITTLE ROCK

Frequent Moves

Behindon Rent

Homeless

CHILDREN’S HEALTHWATCH ARKANSAS HOUSEHOLDSCHILDREN’S HEALTHWATCH ARKANSAS HOUSEHOLDS

INSECURE HOUSING IN ARKANSAS:INSECURE HOUSING IN ARKANSAS:

ASSOCIATION WITH CHILD AND MATERNAL HEALTHASSOCIATION WITH CHILD AND MATERNAL HEALTH

Secure Housing (N=2459)

Behind on Rent(N=1222)

Multiple Moves(N=338)

Referent AOR P AOR P

Child Health Fair/Poor 1 1.41 <.001 1.47 .01

At Risk for Under Weight 1 0.92 NS 1.34 .01

At Risk for Developmental Problems 1 1.28 .03 1.5 .01

Maternal Health Fair/Poor 1 1.62 <.001 1.81 <.001

Positive Maternal Depression Screen 1 2.45 <.001 2.88

<.001

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