Tara Corbridge MCH Research Festival

June 2013

FOOD SECURITY AMONG FAMILIES WITH CHILDREN

WITH SPECIAL HEALTH CARE NEEDS

BACKGROUND AND SIGNIFICANCE

FOOD INSECURITY

Very low food security Reports of multiple indications of disrupted eating patterns & reduced food intake.

Low food security Reports of reduced quality, variety, or desirability of diet. Little or no indications of reduced food intake.

USDA Economic Research Service

FOOD INSECURITY

Calculated by ERS based on Current Populat ion Sur vey Food Secur i ty Supplement data.

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

1995 2000 2005 2010

Perc

ent o

f Hou

seho

lds

Trends in Prevalence of Food Insecurity in U.S. Households, 1995 - 2011

Food Insecurity

Very Low Food Insecurity

Food Insecurity

Very Low Food Security

CHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN)

15% of U.S. children have a special health care need

23% of U.S. households have at

least one CSHCN

CSHCN

Healthy children

Data Resource Center for Child & Adolescent Health

Families with CSHCN are at risk for:

Economic hardship

Employment

issues

Health service

difficulties

Social & psychological

issues

CSHCN & FOOD INSECURITY

Waldman, et al., 2010; Rogers & Hogan, 2010

OBJECTIVES OF THE STUDY

1. Determine prevalence of very low food security at the Center for Pediatric Dentistry (CPD)

3. Explore the impact of complexity and qualifying consequences on household food security status

2. Examine association between household food security status and presence of CSHCN

METHODS

STUDY DESIGN AND SAMPLE

•  Study Design •  Cross-sectional

•  Setting: CPD •  Participants •  150 caregivers •  Inclusion criteria: •  Age 18 years or older •  Parent or legal guardian •  Read English

MEASUREMENT: EXPOSURE

Prescription medications

Above routine service use

Functional limitation

Specialized therapies

Mental health counseling

Exposure: Presence of

CSHCN in the household

Measured by: CSHCN

screener

MEASUREMENT: OUTCOME

Outcome: household food security status

Measured by: U.S. Household Food Security

Module: 6 item short form

MEASUREMENT: COVARIATES

Caregiver data Household data

•  Age •  Race/ethnicity •  Education •  Health status •  Primary language •  Relationship to

patient

•  Number of adults & children

•  Children’s age •  Smoking •  Food and nutrition

assistance programs •  Medicaid

DATA ANALYSIS

1. Determine prevalence of very low food security at CPD

2. Examine association between household food security status and presence of CSHCN

3. Explore the impact of complexity and qualifying consequences on household food security status

Descriptive, bivariate analyses to compare food-secure & food-insecure households

Multiple logistic regression

Multiple logistic regression, bivariate analysis

RESULTS

Food-secure & food-insecure households had similar:

¡  Number of children ¡  Number of children < age 6 ¡  Primary language English ¡  Caregiver age ¡  Race/ethnicity

Food-insecure households were significantly more likely to: ¡  Have a single-parent ¡  Have smokers ¡  Be enrolled in federal food

and nutrition assistance programs

¡  Be enrolled in Medicaid ¡  Have a caregiver with lower

education ¡  Have a caregiver with

poorer health status

CHARACTERISTICS OF FOOD-SECURE & FOOD-INSECURE HOUSEHOLDS

FOOD SECURITY AT CPD

68%

23%

9%

Food Security Status at CPD High food security (n=97) Low food security (n=32) Very low food security (n=13)

63%

37%

CSHCN

Food-secure Food-insecure

CSHCN AND FOOD INSECURITY

74%

26%

No CHSCN

Food-secure Food-insecure

OR 95% CI P

CSHCN 1.67 0.8 – 3.47 0.17

COMPLEXITY OF CSHCN & FOOD INSECURITY

0

20

40

60

80

100

1 2 3 4 5

Perc

ent

Number of Qualifying Consequences

Food Secure (n=36) Food Insecure (n=21)

COMPLEXITY OF CSHCN & FOOD INSECURITY

Complexity of CSHCN OR %95% CI P

Unadjusted CSHCN (3 – 5 consequences) 2.59 1.17 – 5.72 0.019

CSHCN (1 – 2 consequences) 0.38 0.08 – 1.81 0.224

No CSHCN (reference)

Adjusted* CSHCN (3 – 5 consequences) 1.74 0.68 – 4.4 0.245

CSHCN (1 – 2 consequences) 0.41 0.067 – 2.5 0.334

No CSHCN (reference)

*Adjusted for: smoking, education, # children < 6, enrollment in Medicaid, food assistance, race/ethnicity

CSHCN QUALIFYING HEALTH CONSEQUENCES & FOOD INSECURITY

Consequence Food-secure (n=36) n (%)

Food-insecure (n=21) n (%)

P

Prescription medications 28 (78) 16 (76) 0.89

Above routine service use

26 (72) 20 (95) 0.04

Functional limitations 17 (47) 16 (76) 0.03

Specialized therapies 19 (53) 12 (57) 0.75

Mental health counseling 16 (46) 19 (90) 0.001

DISCUSSION

SUMMARY OF FINDINGS

1 CPD households have a higher prevalence of food insecurity

2 Households with CSHCN in this sample

had a higher prevalence of food insecurity, but not statistically

significant

3 Households that reported 3-5

consequences had 2.59 higher odds of reporting food insecurity

4 Among households with CSHCN, food-insecure households reported more:

•  Need or use of services •  Functional limitations

•  Mental health counseling

LIMITATIONS

Generalizability

Unable to determine causal relationship

Recall bias

Low power

Unable to distinguish one vs. multiple CSHCN

CONCLUSIONS

Families with more complex CSHCN may have a higher likelihood of food insecurity.

The AAPD recommends a dental home for all children, especially CSHCN.

Consideration of social risk factors may improve oral health care.

Thesis committee: Donna Johnson & Mollie Greves Grow

Andy Hoegh, Nick Radant, Sue Coldwell, Amy Kim, Joanna Scott, & others at the Center for Pediatric Dentistry

This study is supported by the US Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau (Title V, Social Security Act), grant #T76MC00011.

ACKNOWLEDGEMENTS

THANK YOU!