What’s a Child Nutrition Program?

Subsidized Housing and the Low-Income Home Energy Assistance Program (LIHEAP) Are Linked to Improved Growth Outcomes for Young Children of Color

Stephanie Ettinger de Cuba, MPHChildren’s Sentinel Nutrition Assessment Program (C-SNAP)

Boston University School of Public HealthBoston Medical Center

Tuesday, November 7, 2006

Authors

• Stephanie Ettinger de Cuba, MPH• Deborah A. Frank, MD• Nicole Neault, MPH• Mariana Chilton, PhD• John Cook, PhD• Carol Berkowitz, MD• Maureen Black, PhD• Patrick Casey, MD, MPH• Diana Cutts, MD• Alan Meyers, MD, MPH• Nieves Zaldivar, MD• Suzette Levenson, MPH, EdM• Timothy Heeren, PhD• Zhaoyan Yang, MS

Children’s Sentinel Nutrition Assessment Program

(C-SNAP)

A national network of clinicians and public health

specialists for research in multiple pediatric settings on the

effect of U.S. social policy on young, low-income children’s

health and nutrition.

C-SNAP Study Sites

-Little Rock, AR -Boston, MA -Washington, D.C.*

-Baltimore, MD -Minneapolis, MN

-Philadelphia, PA -Los Angeles, CA*

C-SNAP Study Sites

Study Objective

Evaluate the importance of federal assistance programs not commonly identified with child nutrition, such as LIHEAP and Subsidized Housing, to child growth and health outcomes among young black and Latino children

Study Methods

• August 1998 – December 2004• Sentinel sample• Interview caregivers • Children 0-3 years • Emergency departments & acute care clinics• Black and Latino children - over 80%• Weight & length measurements -- outcome of

interest & accepted international indicator of wellbeing

Eligible Families

• Sample restricted to:– Low-income renters of color

with children under 3– Participate in at least one

means-tested program

• Subsidized Housing sample: (n = 13,069)

• LIHEAP sample: (n = 4,091) – additionally:

• Excludes private insurance• Only renters - heat not

included

Analytic Methods

• Multiple logistic regression

• Covariates for each program separate

- depending on correlation with program/outcome

Subsidized Housing analyses controlled for:

• Mother born in US• Receipt of TANF• Receipt of WIC• Food insecurity status

LIHEAP analyses controlled for:

• Mother born in US• Year of interview• Food insecurity status• Receipt of either TANF or Food Stamps• Receipt of WIC• Receipt of Housing Subsidy• Caregiver marital status• Caregiver employment

2004 Poverty Rates AmongHouseholds with Children

US Census Bureau, 2005

Poverty Highest among black and Latino families

2004 Food Insecurity Rates among Households with Children

Nord, Andrews, and Carlson, 2005

Food insecurity highest among black and Latino families

2004 National Eligible Household Participation in

LIHEAP

U.S. Department of Health & Human Services, 2004

Housing & LIHEAP onlyreach a fraction of eligibleC-SNAP families

Subsidized Housing Helps Black Children Grow

Outcome Subsidy

(n=3,116)

No Subsidy

(n=4,977)

P Value

≤2 SD Weight/Age below the mean

1.00 1.33 P = 0.006

Outcome Subsidy

(n=3,116)

No Subsidy (n=4,977)

P Value

Mean Z-Height/Age

Z = 0.134 Z=-0.005 P<.0001

LIHEAP Improves YoungBlack Children’s Growth

Outcome LIHEAP (n=778)

No LIHEAP (n=3,313)

P Values

At Nutritional Risk for Growth

Problems*

1.00 1.29 P = 0.05

Outcome LIHEAP (n=778)

No LIHEAP (n=3,313)

P Values

Mean Z-Weight/Age

Z = 0.061 Z=-0.051 P = .04

*Nutritional risk: < 5th percentile for weight-for-age or <10th percentile for weight-for-height

Subsidized Housing Helps Latino Children Grow

Outcome Subsidy

(n=720)

No Subsidy (n=4,256)

P Value

≤2 SD

Height/Age below the

mean

1.00 1.99 P = 0.02

LIHEAP and Latino Children

• Results for Latino children and LIHEAP not presented since did not reach statistical significance, probably due to small sample size.

• Limited program participation reflects sample characteristics

– most Latino children lived in California, where few families of any ethnicity access LIHEAP.

Overweight?

No associations between overweight and LIHEAP or

Subsidized Housing

Limitations

• Interviews in English, Spanish, and Somali (MN only)

• Only blacks and Latinos• Exclusion of the most severely ill or

injured children • Associations are not causation• Difficult to make national extrapolations

Non-food assistance programscan improve children’s growth

• Programs like LIHEAP and Subsidized Housing linked to improved growth outcomes

• “Heat or eat” phenomenon: Food budget only variable expense

• Food most easily decreased to pay for other expenses, leading to increased food insecurity, particularly during winter months.

Implications for Young Black & Latino Children

• Growth is indicator of health in young children

• Adverse child growth outcomes associated with not receiving benefits

• Safety net programs buffer young children from effects of poverty

UN Convention on the Rights of the Child

Article 271.States Parties recognize the right of

every child to a standard of living adequate for the child’s physical, mental, spiritual, moral and social development…

3. States Parties… shall take appropriate measures to assist parents…to provide material assistance and support programmes, particularly with regard to nutrition, clothing and housing.

Why does it matter?

Housing and Energy are Health Issues:

Early growth failure sets children up for long-term health & development problems.

Affordable Housing and Energy are Human Rights Issues: Black & Latino children => 35% of all children in US.

Black & Latino children higher risk for living in poor HHs

Also at greater risk for negative growth effects associated with poverty and food insecurity.

Food insecurity and its effects exacerbate achievement gaps and deepen racial/ethnic health disparities, depriving victims of other rights.

Society Has a Duty to Guarantee Children’s Basic Rights: Macro perspective: Denial of basic rights -> disastrous effects

on workforce participation and health of national economy.

Why does it matter?

What can we do aboutchanging policy?

Educate Policymakers to:• Reconsider standard view of which assistance programs

influence child nutrition.– Food + Non Food = Optimal Child Health

• Understand that safety-net programs “good medicine” but dosage and availability inadequate.

• Stop cutting or freezing funding for safety-net programs - created health crisis for poor children, especially children of color

• Give recommended “dosage”: Full package of benefits -> social investment -> reduction of racial/ethnic disparities

Acknowledgements

• Report sponsored by the Joint Center for Political and Economic Studies

• Thanks to Avi Perry, Bill Emerson National Hunger Fellow, for his assistance in preparing this presentation.

C-SNAP operations and analyses have been supported by: the Abell Foundation, the Annie E. Casey Foundation, the Anthony Spinazzola Foundation, the Candle Foundation, the Claneil Foundation, the Daniel Pitino Foundation, the EOS Foundation, the Gold Foundation, the Gryphon Fund, the Hartford Foundation for Public Giving, Jennifer Kaminsky, MAZON: A Jewish Response to Hunger, the Minneapolis Foundation, the New Hampshire Charitable Foundation, Project Bread, the Sandpiper Philanthropic Foundation, the Schaffer Foundation, Susan P. Davies and Richard W. Talkov, Susan Schiro and Peter Manus, the Thomas Wilson Sanitarium for Children of Baltimore City, the United States Department of Agriculture, Vitamin Litigation Funding, with major funding from the W. K. Kellogg Foundation.

Please visit us on the web:

www.c-snap.org

Thank you!