Hunger in young children of Mexican immigrant families
Margaret Kersey*, Joni Geppert and Diana B Cutts
Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN 55415, USA
Submitted 16 November 2005: Accepted 11 October 2006
Objective: To measure rates of hunger and food insecurity among young US-born
Latino children with Mexican immigrant parents (Latinos) compared with a non-
immigrant non-Latino population (non-Latinos) in a low-income clinic population.
Design, setting and subjects: A repeated cross-sectional survey of 4278 caregivers of
children ,3 years of age in the paediatric clinic of an urban county hospital for a
5-year period from 1998 to 2003. A total of 1310 respondents had a US-born child with
at least one parent born in Mexico. They were compared with a reference group
comprised of non-Latino US-born participants (n ¼ 1805). Child hunger and
household food insecurity were determined with the US Household Food Security
Results: Young Latino children had much higher rates of child hunger than non-
Latinos, 6.8 versus 0.5%. Latino families also had higher rates of household food
insecurity than non-Latinos, 53.1 versus 15.6%. Latino children remained much more
likely to be hungry (odds ratio (OR) ¼ 13.0, 95% confidence interval (CI) ¼ 5.9–28.7,
P , 0.01) and in household food-insecure households (OR ¼ 6.6, 95% CI ¼ 5.2–8.3,
P ,0.01) than non-Latinos after controlling for the following variables in multivariate
analysis: child’s age, sex, maternal education level, single-headed household status,
family size, young maternal age (,21 years), food stamp programme participation,
TANF (Temporary Assistance to Needy Families, or ‘welfare’) programme
participation and WIC (Women, Infants, and Children) usage, and reason for clinic
visit (sick visit versus well-child).
Conclusion: Young children in Mexican immigrant families are at especially high risk
for hunger and household food insecurity compared with non-immigrant, non-Latino
patients in a low-income paediatric clinic.
Latino child health
Poor children in America have high levels of hunger and
household food insecurity1,2. While hunger is a poor
outcome in itself, it is also a risk factor for poor health and
impaired development. Hungry children have more colds,
headaches and stomach aches3,4. Children experiencing
hunger have decreased school performance and increased
behavioural problems5,6. Household food insecurity, or
limited or uncertain availability of nutritionally adequate
and safe foods7, is also associated with poor health
outcomes among young children8.
Previous studies suggest that Latino children in
immigrant families may be at greater risk for hunger and
food insecurity than other children. Kasper et al. demon-
strated a very high prevalence of hunger among Latino
immigrant adults9. Analysis of National Health and
Nutrition Examination Survey III (NHANES III) data found
that Mexican-American children are at greater risk for food
insufficiency than children of most other ethnicities3. Two
other studies have found high rates of hunger and food
insecurity among low-income Latino children10,11.
Latino children in general are also at high risk for other
poor health outcomes. Latino children have increased
rates of asthma, obesity, diabetes and exposure to
environmental hazards compared with the general
population12. They also have decreased access to health
care12. Latino children in families who have recently
immigrated may be ateven higher risk for poor health than
other Latino children13.
US-born children in immigrant families are typically
considered immigrants for the purposes of health services
research since their health and well-being is so closely
linked to their immigrant parents’ health and socio-
economic status13,14. Health issues facing Latino children
in immigrant families are important in part because of their
rapidly increasing numbers. In 2000, 20% of all children in
the USA had at least one foreign-born parent, with over
half of these parents born in Latin America15. There are
.5.1 million children in the USA who are the children of
immigrants from Mexico16. Furthermore, children of
Latino immigrants are now found throughout the USA,
as immigrant populations are increasing much faster in
‘non-traditional’ immigrant states than in the six states
in which immigrants traditionally settled (California,
New York, Florida, Texas, Illinois and New Jersey)17.
*Corresponding author: Email firstname.lastname@example.org
q The Authors 2007
Public Health Nutrition: 10(4), 390–395
For example, in Hennepin County, Minnesota, the site of
the present study, the Latino foreign-born population
increased from about 3500 in 1990 to 27000 in 2000,
representing a 770% increase in just a decade18.
Analysis of the 2000 Census indicates that the poverty
rate for children in immigrant families is much higher than
for children in native-born families, at 21 versus 14%,
although the data are not presented for specific ethnic
groups or country of origin19. Thus, the present study
aimed to measure rates of hunger and food insecurity
among US-born Latino children with Mexican immigrant
parents compared with the native-born non-Latinos in a
low-income paediatric clinic population.
Caregivers gave permission for chart reviews as part of the
informed written consent process. The study was
approved by the Institutional Review Boards at Hennepin
County Medical Center and the University of Minnesota.
Setting and participants
A total of 4278 caregivers of children ,3 years of age were
surveyed in interviews from 1998 to 2003 in the paediatric
clinic and the paediatric emergency department (ED) at
Hennepin County Medical Center. The clinic and ED serve
a primarily low-income, urban, diverse population. Data
were collected at both well-child and acute visits.
Approximately one-third of subjects were US-born
children who had at least one parent born in Latin
America, with 88% of those born in Mexico. Because of the
heterogeneity of Latinos from different countries of origin
with respect to cultural differences, socio-economic status,
health status and patterns of immigration, we elected to
restrict our analysis to immigrant families of Mexican
origin. This group of US-born Latino children in Mexican
immigrant families (called ‘Latinos’ in the present study)
non-Latino children (called ‘non-Latinos’). Foreign-born
Latino children and Latino children of US-born parents,
both of whom comprised a very small proportion of the
sample, were also excluded. The non-Latino children with
foreign-born parents were also excluded, since most were
refugees from Somalia, a group with its own unique health
issues and benefits usage patterns due to their refugee
status. All questions were read aloud to study participants
by bilingual interviewers in English or Spanish according
to caregiver preference. Although caregivers were eligible
to be interviewed every 6 months, only one interview was
randomly selected per caregiver. After exclusion of cases
with multiple interviews and missing data, the final study
groups were as follows: Latinos of Mexican origin,
n ¼ 1310; non-Latinos, n ¼ 1805; other, n ¼ 1078
(excluded from analysis). The study participation rate
Instruments and measures
The study consisted of repeated cross-sectional surveys
collected for the Minneapolis sample of the Children’s
Sentinel Nutrition Assessment Program, a multisite survey
which includes questions on household characteristics,
child hunger and food security, and federal assistance
programme participation20. Household food security and
food insecurity with hunger among children (hereafter
referred to as child hunger) were determined using the US
Household Food Security Scale, which includes the
Children’s Food Security Scale21,22. The scale was chosen
because it has been generally adopted as the ‘gold
standard’ instrument in the USA and because its use
permits comparisons with nationwide prevalence data.
It has also been used in other studies with Spanish-
speaking immigrant populations9,23.
Hunger is defined by the United States Department of
Agriculture (USDA) as ‘the uneasy or painful sensation
caused by a lack of food; the recurrent and involuntary
lack of access to food’7. Food insecurity is a more subtle
concept defined as ‘limited or uncertain availability of
nutritionally adequate and safe foods or limited or
uncertain ability to acquire acceptable foods in socially
acceptable ways’7. Hunger occurs at the individual level,
while food insecurity is measured at the household level.
In accordance with the US Household Food Security Scale
guidelines, participants had to affirm at least five of the
eight child-specific food insecurity items to meet the
criteria for ‘child hunger’ (Table 1). The children’s food
insecurity items were specifically referenced to the child
presenting in the clinic.
8.0. Since caregivers were eligible for re-interview after 6
months, a random number generator from Epi-Info was
used to select a single interview date for participants who
had been interviewed more than once to avoid bias from
Table 1 Child hunger questions
All questions refer to the last 12 months.
1. Did you ever cut the size of your child’s meals because there
wasn’t enough money for food?
2. Did your child ever skip meals because there wasn’t enough
money for food?
3. How often did this happen?
4. Was your child ever hungry but you just couldn’t afford more
5. Did your child ever not eat for a whole day because there
wasn’t money for food?
Child hunger statements (answered as often, sometimes or never
true in the last 12 months)
6. We relied on only a few kinds of low-cost food to feed our child
because we were running out of money to buy food.
7. We couldn’t feed our child a balanced meal because we
couldn’t afford that.
8. Our child was not eating enough because we just couldn’t
afford enough food.
Hunger in young children of Mexican immigrant families 391
any possible temporal trend. Thus, each data point
represents a single and unique child.
Bivariate analyses were calculated using the x2statistic.
Comparisons of medians were performed with the Mann–
Whitney test. Multiple logistic regression models were
constructed to control for likely confounding factors for all
Ninety-four per cent of respondents were mothers, 5%
fathers, with grandmothers and foster parents comprising
the remainder. The Latino respondents were generally
recent immigrants, with a median length of time in the USA
of 4 years (data presented as medians due to right skew).
Sample demographics of the Latino versus non-Latino
sample are shown in Table 2. Maternal education level
was significantly lower among Latinosthan non-Latinos, as
only about one-third of Latina mothers had 12 years or
more of formal education, versus two-thirds of non-
Latinos. Latino families had much lower rates of single
parent households than non-Latinos, at 38 versus 70%.
Because the survey asked about household composition
rather than nuclear family size per se, we constructed a
‘family size’ variable by measuring the ratio of dependent
children per adult in each household to reflect the number
of children supported by each adult. By this measure,
family size was smaller for Latinos than for non-Latinos,
with a median of 0.75 children per adult in the Latino
household versus 1.33 children per adult in non-Latino
families (data presented as medians due to right skew).
Nearly all households in both groups contained at
least one employed adult, at 98% for both Latinos and
The median age of the Latino children in the sample was
statistically significantly lower than that of the non-Latino
children, at 8 versus 9 months (data presented as medians
due to right skew), although this difference is not likely to
be of clinical relevance.
Latino families participated in the Women, Infants, and
Children (WIC) programme at higher rates than
non-Latinos, at 86 versus 76%, but were much less likely
to receive food stamps, at 22 versus 64%. Similarly, Latinos
were much less likely than non-Latinos to receive
Temporary Assistance to Needy Families (TANF, or
‘welfare’), at 33 versus 74%. This is despite the fact that
all the Latino children were US citizens by study definition
and therefore eligible for participation in the food stamp
programme and TANF, regardless of the parents’
immigration status, as long as their families met income
Latino children (n ¼ 1310) had much higher rates of
child hunger than non-Latinos (n ¼ 1805), at 6.8 versus
0.5% (P , 0.01). Latino families also had much higher
rates of household food insecurity than non-Latinos, at
53.1 versus 15.6% (P , 0.01).
socio-economicand demographic variables inmultivariate
analysis: child’s age, sex, maternal education level (three-
level variable: less than high school, high school graduate
and any post-secondary education), single-headed house-
hold status, family size, young maternal age (,21 years),
food stamp programme participation, TANF programme
participation, WIC usage and visit type (well-child versus
sick visit). Latino children were much more likely to be
hungry (odds ratio (OR) ¼ 13.0, 95% confidence interval
(CI) ¼ 5.9–28.7, P , 0.01) and in food-insecure house-
holds (OR ¼ 6.6, 95% CI ¼ 5.2–8.3, P , 0.01) than non-
Latino children. None of the other covariates in our model
wereindependentpredictorsofchildhunger(allP . 0.05)
(results not shown). In the household food insecurity
model, increased maternal education level was negatively
associated with food insecurity (OR ¼ 0.85, 95%
CI ¼ 0.75–0.96, P ¼ 0.01), as would be expected. Young
maternal age (,21 years) was also negatively associated
with food insecurity (OR ¼ 0.66, 95% CI ¼ 0.52–0.83,
P , 0.01).
The present study has several limitations. First, there has
been some question about the validity of the US
Household Food Security Scale in Spanish. Although
Table 2 Selected demographics and benefits use, Latinos versus non-Latinos
(n ¼ 1310)
(n ¼ 1805)
% of mothers with 12 years or more of formal education
% of single parent households
Ratio of children to adults in household (‘family size’), median
% with maternal age ,21 years
Age of child in months, median
% participating in WIC programme
% participating in food stamp programme
% participating in TANF
% of households with at least one employed adult
WIC – Women, Infants, and Children; TANF – Temporary Assistance to Needy Families.
M Kersey et al. 392
a standard translation instrument now exists24, it was not
available at the time of the study’s inception, so a
translated instrument was developed and extensively pre-
tested by bilingual translators. Furthermore, the original
validation of the USDA scale did not include large
numbers of Latinos, and questions have arisen regarding
the instrument’s validity in this population24. However, the
scale has recently been validated in at least one low-
income Latino population, as families reporting food
insufficiency and/or hunger were found to have decreased
amount and quality of foods in their households25. If
anything, case studies and ethnographic research suggest
that the currently used instrument is more likely to
underestimate than overestimate the prevalence of child
hunger, since parents may be reluctant to admit the extent
of the problem out of pride, shame or fear of government
Secondly, the sample was clinic-, rather than popu-
lation-based, and there may be a selection bias for Latinos
compared with non-Latinos seeking care in the county
hospital system overall, independent of visit type.
Furthermore, since the data only come from one site,
with a sample restricted to immigrants of Mexican origin,
these results cannot be generalised to the general
immigrant Latino population or even the Mexican
immigrant population in the USA.
Thirdly, although we did have substantial demographic
information about our study participants, there almost
certainly remain a large number of unmeasured con-
founders which may mediate the relationship between
immigration status and hunger and food insecurity.
Finally, since our data are cross-sectional and observa-
tional, causality cannot be determined between the
exposure (ethnicity and immigration status) and outcome
of interest (hunger and food security status), although
the temporal relationship is consistent with causality since
the exposure by definition preceded the outcome.
The prevalence of child hunger in our Latino sample was
.10 times the national average in 2003 according the 2003
Current Population Survey, which uses the identical
instrument and is representative of the general US
population across all income levels26. They report a
national prevalence of child hunger of 0.5%, compared
with 6.8% of our Latino sample. Using the same data
source, 11.2% of households were food insecure in 2003,
compared with 53% of our Latino sample26.
The disparity between the Latinos and non-Latinos in
our study is all the more striking because our reference
group of low-income non-Latinos had rates of food
insecurity only moderately higher than the nationwide
average of all households in 2003, at 15.6 versus 11.2%.
Minnesota has among the lowest rates of food insecurity in
the nation: analysis of the 1998–2000 Current Population
Survey indicates that the rate of food insecurity in
Minnesota during this period was only 7.8%, versus
10.8% nationwide27. Despite the relatively favourable food
security status of most Minnesotans during this time
period, it is apparent that this did not extend equally to all
In our study population, Latino immigrant children are
far more likely to be hungry than non-Latino, non-
immigrant children. This is despite Latino families’ higher
proportions of dual-parent households and smaller family
sizes (measured as the ratio of children to adults per
household) than non-Latino families.
The causal pathway between food security status and
benefits usage is impossible to determine in a cross-
sectional survey such as this one. According to our
multivariate analysis, none of the food assistance
programmes (WIC, food stamps and TANF) was either
positively or negatively associated with either child
hunger or household food insecurity.
It is probably the case that families elect to participate in
benefit programmes precisely because they are experien-
cing household food insecurity or child hunger. This self-
selection of the neediest families makes the true effect of
food assistance programmes very difficult to determine.
Many studies which examine the effects of WIC, TANF and
food stamps are limited by their inability to account for this
important potential bias. Nonetheless, at least one study
which attempted to control for this self-selection effect
using proxy measures from other databases found positive
effects of WIC on pregnancy and birth outcomes28.
Most of the Latino families in our sample were
presumably eligible for child-only benefits, since all the
Latino children in our sample were by definition US-born,
with at least one foreign-born parent (most of whom were
recent immigrants and therefore ineligible for benefits
themselves). We hypothesise that the monetary benefit
may not be sufficient to motivate participation in
programmes designed to protect against household food
insecurity or child hunger. These immigrant families’ low
rate of participation in the food stamp programme for their
citizen children despite very high levels of family food
insecurity and child hunger is very similar to that of a
children in immigrant families received the food stamp
has found that immigrant families are often reluctant to
receive public benefits such as food stamps even for their
US-born citizen children for fear of being named a ‘public
charge’, which may affect parents’ later chances of
obtaining citizenship or even result in deportation30. This
belief persists despite the fact that the Immigration and
Naturalization Service (now the US Citizen and Naturaliz-
such as food stamps is not considered in the determination
of public charge, particularly when the benefits are for
US-born citizen children31. Thus, many of the families in
Hunger in young children of Mexican immigrant families 393
our study were not accessing much-needed benefits (by
their own admission of very high rates of food insecurity
and child hunger) despite their presumed eligibility and
despite reassurances from the US government that
accessing these benefits will not affect family members’
current or future immigration status. Further research is
needed to determine ways to ‘reach out’ effectively to
immigrant communities to dispel any fear or myths
regarding government assistance for citizen children in
It is striking that Mexican immigrant children in this
study were at a 13-fold increased risk of experiencing
hunger compared with our non-immigrant, non-Latino
clinic population even after controlling for many of the
socio-economic and demographic variables that might
cause children to be at high risk for poverty.
Young children of low-income Mexican immigrants are at
especially high risk for hunger and food insecurity
compared with other low-income children in one urban,
diverse paediatric clinic population. Public health officials
and policy makers should be particularly attentive to the
issues of hunger and food insecurity and its effects on
child health in this growing high-risk population. While
underutilised by low-income immigrant families, present
government food assistance programmes may be
inadequate to prevent child hunger and family food
insecurity even when accessed. Nevertheless, it is critical
that any modifiable limitations to enrolment, such as
language or literacy barriers, cumbersome bureaucracy,
and confusion or misinformation, be minimised in order to
moderate the severity of child hunger. Efforts directed
towards achieving health equity for US citizen children in
immigrant families are unlikely to be successful if the issue
of food insecurity and hunger is ignored.
Sources of funding:
were collected as part of the multisite Children’s Sentinel
Nutrition Assessment Program. CSNAP is supported by
W.K. Kellogg Foundation, Eos Foundation, Claneil
Foundation, Anthony Spinazzola Foundation, US Depart-
ment of Agriculture/Economic Research Service, MAZON:
a Jewish Response to Hunger, Annie E. Casey Foundation,
Gold Foundation, Daniel Pitino Foundation, Thomas
Wilson Foundation, Sandpipers Foundation, Candle
Foundation, Minneapolis Foundation, Project Bread: The
Walk for Hunger, Hartford Foundation, Sue Schiro and
was provided by the Robert Wood Johnson Foundation.
Conflict of interest declaration:
potential conflicts of interest or corporate sponsorship to
Data presented in this manuscript
The authors have no
study design and conception, collaborated in data
analysis, and wrote and edited the manuscript. J. G.
collaborated in study design and conception, and assisted
in writing the manuscript.
Acknowledgements: We thank the families who par-
ticipated in this study as well as all the research assistants
for their dedication and advocacy. We also thank John
Lantos and the CSNAP study group including the CSNAP
Data Coordinating Center, Deborah Frank and Anne
Skalicky for their manuscript reviews and other valuable
Preliminary results of this study were presented at
the Pediatric Academic Society Annual Meeting, Seattle,
WA, 5 May, 2003, and at the Robert Wood Johnson
Clinical Scholar National Meeting, Fort Lauderdale, FL,
22 November, 2003.
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