Peer-reviewed Publications
Based on the research that Children's HealthWatch and Witnesses to Hunger conducts, we have published a number of peer-reviewed articles in scholarly journals such as the American Journal of Public Health and Pediatrics, the official journal of the American Academy of Pediatrics.
The causes and contexts of food insecurity among children in the U.S. are poorly understood because the prevalence of food insecurity at the child level is low compared to the prevalence of household food insecurity. In addition, caregivers may be reluctant to admit their children may not be getting enough food due to shame or fear they might lose custody of their children.
Based on our ongoing qualitative research with mothers of young children, we suggest that food security among children is related to adverse childhood experiences of caregivers. This translates into poor mental and physical health in adolescence and adulthood, which can lead to inability to secure and maintain meaningful employment that pays a living wage.
In this paper we propose that researchers shift the framework for understanding food insecurity in the United States to adopt a life course approach. This demands we pay greater attention to the lifelong consequences of exposure to trauma or toxic stress—exposure to violence, rape, abuse and neglect, and housing, food, and other forms of deprivation—during childhood. We then describe three case studies of women from our ongoing study to describe a variety of toxic stress exposures and how they have an impact on a woman’s earning potential, her mental health, and attitudes toward raising children. Each woman describes her exposure to violence and deprivation as a child and adolescent, describes experiences with child hunger, and explains how her experiences have shaped her ability to nourish her children. We describe ways in which we can shift the nature of research investigations on food insecurity, and provide recommendations for policy-oriented solutions regarding income support programs, early intervention programs, child and adult mental health services, and violence prevention programs.
America’s low-income families struggle to protect their children from multiple threats to their health and growth. Many research and advocacy groups explore the health and educational effects of food insecurity, but less is known about these effects on very young children. Children’s HealthWatch, a group of pediatric clinicians and public health researchers, has continuously collected data on the effects of food insecurity alone and in conjunction with other household hardships since 1998. The group’s peer reviewed research has shown that a number of economic risks at the household level, including food, housing and energy insecurity, tend to be correlated. These insecurities alone or in conjunction increase the risk that a young child will suffer various negative health consequences, including increases in lifetime hospitalizations, parental report of fair or poor health,1 or risk for developmental delays.2 Child food insecurity is an incremental risk indicator above and beyond the risk imposed by household-level food insecurity. The Children’s Healthwatch research also suggests public benefits programs modify some of these effects for families experiencing hardships. This empirical evidence is presented in a variety of public venues outside the usual scientific settings, such as congressional hearings, to support the needs of America’s most vulnerable population through policy change. Children’s HealthWatch research supports legislative solutions to food insecurity, including sustained funding for public programs and re-evaluation of the use of the Thrifty Food Plan as the basis of SNAP benefits calculations. Children’s HealthWatch is one of many models to support the American Academy of Pediatrics’ call to “stand up, speak up, and step up for children.”3 No isolated group or single intervention will solve child poverty or multiple hardships. However, working collaboratively each group has a role to play in supporting the health and well-being of young children and their families.
1. Cook JT, Frank DA, Berkowitz C, et al. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr. 2004;134:1432-1438.
2. Rose-Jacobs R, Black MM, Casey PH, et al. Household food insecurity: associations with at-risk infant and toddler development. Pediatrics. 2008;121:65-72.
3. AAP leader says to stand up, speak up, and step up for child health [news release]. Boston, MA: American Academy of Pediatrics; October 11, 2008. http://www2.aap.org/pressroom/nce/nce08childhealth.htm. Accessed January 1, 2012.
Objectives. We investigated the association between housing insecurity and the health of very young children.
Methods. Between 1998 and 2007, we interviewed 22069 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 child’s 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.
(Am J Public Health. 2011;101:1508–1514. doi:10.2105/AJPH.2011.300139)
The goal of this publication is to develop a brief screen to identify families at risk for food insecurity and to evaluate the sensitivity, specificity, and convergent validity of the screen.
The goals of this publication were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance.
When female-headed households and households with children have the highest prevalence of food insecurity and hunger in the US, the participation of low-income mothers in the development and administration of policies is fundamental to the process of ending hunger and improving child wellbeing.
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.
Food insecurity is a serious public health problem associated with poorcognitive and emotional development in children and with depression and poor health in adults.
The objectives of this study were to develop a clinical indicator of household energy security and assess associations with food security, health, and developmental risk in children less than 36 months of age.
In this study, we evaluated the relationship between household food security status and developmental risk in young children, after controlling for potential confounding variables.
This qualitative study examined the relationship between health, hunger, and food insecurity among African American women in Philadelphia.
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Drexel University Public School of Health 
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