housing challenges and child health and development
DESCRIPTION
HOUSING CHALLENGES AND CHILD HEALTH AND DEVELOPMENT. Patrick Casey, M.D. Harvey and Bernice Jones Professor of Developmental Pediatrics Department of Pediatrics College of Medicine University of Arkansas for Medical Sciences Arkansas Children’s Hospital. Food Insecurity. - PowerPoint PPT PresentationTRANSCRIPT
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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