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Household Food Insecurity During Childhood and Subsequent Health Status: The Early Childhood Longitudinal Study—Kindergarten Cohort

机译:儿童期及其后健康状况中的家庭粮食不安全状况:儿童早期纵向研究-幼儿园队列

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Objectives. We examined long-term patterns of household food insecurity in children from kindergarten through eighth grade and the association between those patterns and children’s proxy-reported health status in eighth grade. Methods. We obtained data from the Early Childhood Longitudinal Study—Kindergarten Cohort, a study that followed a nationally representative sample of students from kindergarten entry in 1998–1999 through eighth grade. We classified food insecurity according to the number of years of reported household food insecurity over 4 observation years. We estimated logistic regression models to estimate the association between cumulative food insecurity exposure and health outcomes. Results. Food insecurity was generally a transient rather than a persistent condition. Persistent food insecurity over the 9-year period was associated with lower health status in eighth grade, whereas more transient food insecurity was not significantly associated with health outcomes in most models. Conclusions. Single-year estimates substantially underestimate the share of children whose households experienced food insecurity at some point during their childhood years. Persistent food insecurity is an important public health issue for children. Policy interventions to alleviate children’s persistent food insecurity may promote child health. During 2008, food insecurity reached its highest rate—14.7%—since formal measurement of the condition began in the mid-1990s, and this rate has persisted through 2010. 1 Among households with children, the food-insecurity rate reached 20.2% in 2010. 1 Previous research has linked food insecurity and other measures of food-related hardship to a wide array of negative health indicators in children, including lower parent-reported measures of child health status, higher incidence of health-related limitations, and higher frequency of headaches and stomachaches. 2–11 Much of this work is cross-sectional, however, making it difficult to ascertain causality. Consistent with this cross-sectional framework, existing work has generally considered food hardship during a relatively short window 2–8,11 —most commonly a 1-year period—whereas the impacts may plausibly differ with the length of exposure. Little is known about the extent to which food insecurity is transient or persistent during childhood and about the implications of differing patterns of food insecurity for child outcomes. A notable exception is a recent study in Canada, in which Kirkpatrick et al. found that experiencing 2 or more episodes of hunger over a 10-year period was associated with lower parent-reported health status among children, after controlling for initial health status and a variety of socioeconomic characteristics. 10 This is the strongest evidence to date of a causal impact of food hardships on health outcomes and the first evidence that degree of exposure plays a role. Other work has considered severity of food insecurity, with some evidence of a dose–response relationship with health outcomes, albeit in a cross-sectional context. 5 We examined cumulative exposure to household food insecurity over a 9-year period among a national sample selected when in kindergarten and the relationship between that exposure and children’s parent-reported health status in eighth grade. We were interested in the persistence of food insecurity over an extended period, and we paid particular attention to differentiating longer-term food insecurity from more recent exposure. We also focused on isolating the impact of food insecurity from the impact of income and poverty.
机译:目标。我们研究了从幼儿园到八年级的儿童的长期家庭食物不安全状况,以及这些方式与八年级的儿童代理报告的健康状况之间的关系。方法。我们从“早期儿童纵向研究-幼儿园队列”中获得了数据,该研究追踪了1998-1999年从幼儿园入学到八年级的全国代表性学生。我们根据报告的4个观察年中家庭粮食不安全的年数对粮食不安全进行了分类。我们估计了逻辑回归模型,以估计累积的粮食不安全暴露与健康结果之间的关联。结果。粮食不安全通常是暂时的而不是持久的状况。在九年期间,持续存在的粮食不安全感与八年级学生的健康状况低下有关,而在大多数模型中,暂时性的粮食不安全感与健康状况没有显着相关。结论。单年度估计数大大低估了其家庭在童年时期某个时候经历粮食不安全状况的儿童比例。持续的粮食不安全是儿童的重要公共卫生问题。减轻儿童持续性粮食不安全的政策干预措施可能会促进儿童健康。自1990年代中期开始正式测量以来,粮食不安全状况在2008年达到最高比率(14.7%),这一比率一直持续到2010年。1在有子女的家庭中,粮食不安全状况在2010年达到20.2% 1以前的研究已将粮食不安全和其他与粮食有关的困难的衡量标准与儿童中的一系列负面健康指标相关联,包括父母报告的儿童健康状况衡量指标较低,与健康相关的限制发生率较高,以及与儿童有关的频率较高。头痛和胃痛。 2-11然而,这项工作大部分是横断面的,因此很难确定因果关系。与这个横断面框架相一致,现有工作通常认为在相对较短的窗口2–8,11(最通常是1年)内出现粮食困难,而影响的程度可能会随着暴露时间的长短而有所不同。关于儿童期短暂或持续的粮食不安全程度以及粮食不安全的不同模式对儿童结局的影响知之甚少。一个明显的例外是加拿大的一项最新研究,Kirkpatrick等人在此进行了研究。研究发现,在控制了初始健康状况和各种社会经济特征之后,在10年中经历2次或更多的饥饿发作与儿童中父母报告的健康状况较低有关。 10这是迄今为止食物困难对健康结果产生因果关系的最有力证据,也是暴露程度发挥作用的第一个证据。其他工作也考虑了粮食不安全的严重性,尽管有横断面,但也有一些证据表明剂量与反应与健康结果有关。 5我们研究了在幼儿园期间选择的全国样本中9年期间累积的家庭粮食不安全状况的暴露情况,以及该暴露程度与孩子八年级报告的父母健康状况之间的关系。我们对长期存在的粮食不安全状况很感兴趣,我们特别注意将长期粮食不安全状况与最近的暴露状况区分开来。我们还专注于将粮食不安全的影响与收入和贫困的影响隔离开。

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