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Children Are Aware of Food Insecurity and Take Responsibility for Managing Food Resources



Child food insecurity is measured using parental reports of children's experiences based on an adult-generated conceptualization. Research on other child experiences (e.g. pain, exposure to domestic violence) cautions that children generally best report their own experiences, and parents' reports of children's experiences may lack adequate validity and impede effective intervention. Because this may be true of child food insecurity, we conducted semistructured interviews with mothers, children (age 9-16 y), and other household adults in 26 South Carolina families at risk for food insecurity. Interview transcripts were analyzed using a constant comparative process combining a priori with inductive coding. Child interviews revealed experiences of food insecurity distinct from parent experiences and from parent reports of children's experiences. Children experienced cognitive, emotional, and physical awareness of food insecurity. Children took responsibility for managing food resources through participation in parental strategies, initiation of their own strategies, and generation of resources to provide food for the family. Adults were not always aware of children's experiences. Where adult experiences of food insecurity are conditioned on inadequate money for food, child experiences were grounded in the immediate household social and food environment: quality of child/parent interactions, parent affect and behavior, and types and quantities of foods made available for children to eat. The new, child-derived understanding of what children experience that results from this study provides a critical basis from which to build effective approaches to identify, assess, and respond to children suffering from food insecurity.
The Journal of Nutrition
Community and International Nutrition
Children Are Aware of Food Insecurity and Take
Responsibility for Managing Food Resources
Maryah Stella Fram,
Edward A. Frongillo,
* Sonya J. Jones,
Roger C. Williams,
Michael P. Burke,
Kendra P. DeLoach,
and Christine E. Blake
College of Social Work,
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, and
Center for
Research in Nutrition and Health Disparities, and
Department of Psychology and College of Social Work, University of South Carolina,
Columbia, SC 29208
Child food insecurity is measured using parental reports of children’s experiences based on an adult-generated
conceptualization. Research on other child experiences (e.g. pain, exposure to domestic violence) cautions that children
generally best report their own experiences, and parents’ reports of children’s experiences may lack adequate validity and
impede effective intervention. Because this may be true of child food insecurity, we conducted semistructured interviews
with mothers, children (age 9–16 y), and other household adults in 26 South Carolina families at risk for food insecurity.
Interview transcripts were analyzed using a constant comparative process combining a priori with inductive coding. Child
interviews revealed experiences of food insecurity distinct from parent experiences and from parent reports of children’s
experiences. Children experienced cognitive, emotional, and physical awareness of food insecurity. Children took
responsibility for managing food resources through participation in parental strategies, initiation of their own strategies,
and generation of resources to provide food for the family. Adults were not always aware of children’s experiences. Where
adult experiences of food insecurity are conditioned on inadequate money for food, child experiences were grounded in
the immediate household social and food environment: quality of child/parent interactions, parent affect and behavior, and
types and quantities of foods made available for children to eat. The new, child-derived understanding of what children
experience that results from this study provides a critical basis from which to build effective approaches to identify,
assess, and respond to children suffering from food insecurity. J. Nutr. 141: 1114–1119, 2011.
Childhood food insecurity and hunger is a persistent problem in
the food-rich United States. Household food insecurity in the US
is at its highest level since national measurement began in 1995
(1) and over one-fifth of all U.S. children live in food-insecure
households (2). The problem is serious enough that President
Obama has pledged to end child hunger by 2015 (3). Meeting
this goal depends on developing and resourcing effective preven-
tion and intervention strategies but even more foundationally on
an accurate understanding of the nature, extent, and severity of
the problem of childhood hunger itself.
Existing research on food insecurity in the US has relied on
parental (and particularly maternal) reports of the household
food environment, including parental reports of children’s ex-
periences. This approach has been accepted as a valid basis for
establishing national prevalence estimates of childhood food in-
security, even though research on other topics such as childhood
exposure to domestic violence and children’s experiences of pain
cautions that children are generally the best reporters of their
own experiences and parental reports of children’s experiences
may lack adequate validity and impede effective intervention.
The use of parental reports rather than child reports in
food insecurity research is undergirded by 2 assumptions that
emerged in early interviews with mothers in food-insecure
households. The first assumption is that mothers manage the
household food environment and the ways that food insecurity is
experienced by other family members. According to mothers’
narratives, when food becomes scarce, the mother employs a
sequence of strategies to manage increasingly severe situations
with an overall function of protecting children from hunger ex-
cept in the most extreme situations (4–6). The second assump-
tion is that all household members experience food hardships
in terms of the components that mothers have identified: quality
of food, quantity of food, social acceptability of methods of
acquiring food, uncertainty, and limiting of choices. Taken
together, these 2 assumptions support a research perspective that
minimizes potential problems with parent reporting of child
This research perspective has become a powerful filter for
understanding, measuring, and ultimately responding to child
hunger in the US. National estimates based on parental reports
of children’s experiences indicate that, although many children
Supported in part by a grant from the Southern Rural Development Center and
the Economic Research Service through the USDA’s RIDGE program.
Author disclosures: M. S. Fram, E. A. Frongillo, S. J. Jones, R. C. Williams,
M. P. Burke, K. P. DeLoach, and C. E. Blake, no conflicts of interest.
* To whom correspondence should be addressed. E-mail:
ã2011 American Society for Nutrition.
1114 Manuscript received November 23, 2010. Initial review completed December 21, 2010. Revision accepted March 21, 2011.
First published online April 27, 2011; doi:10.3945/jn.110.135988.
at CAPES Consortium on August 15, 2011jn.nutrition.orgDownloaded from
live in food-insecure households, few children actually experi-
ence reduced food intake or disrupted eating patterns. For
instance, in 2008, parents reported that children cut back how
much or how often they ate because there was not enough
money for food in only 1.3% of U.S. households with children.
In contrast, 6.6% of those same households reported adult food
cutbacks and 21% of households were categorized as food
insecure (7).
There is a disjuncture between the perspective that most U.S.
children are protected from food insecurity and substantial
research showing that children experience negative developmental
outcomes when they live in food-insecure households (8,9).
School-age children in food-insecure households demonstrate
diminished academic, behavioral, and social functioning (10–13).
Infants and toddlers in food-insecure households are at increased
developmental risk (14–18). Household food insecurity is asso-
ciated with poor developmental trajectories from kindergarten
through 3rd grade (19). If mothers protect children from food
insecurity in all but the rarest of circumstances, why do children in
food-insecure households generally fare so poorly?
Additional research is needed to clarify the nature, preva-
lence, and severity of child hunger and the pathways through
which household food insecurity affects children’s development.
This research can and should be grounded in children’s own
perspectives. Some foundation already exists for child reports of
food insecurity. Hadley et al. (20) surveyed Ethiopian adoles-
cents about their experiences of food insecurity; they found that
adolescents were able to report on their own experiences and
that their self-reports were significantly associated with their
health outcomes. Connell et al. (21) developed a child-report
food insecurity module for the US, adapting items from the
Adult Food Security Module to more child-appropriate word-
ing. While supporting child self-report, this approach assumes
that the adult-generated conceptualization of food insecurity is
valid for children. In other work, Connell et al. (22) took a more
grounded approach, beginning with children’s general under-
standings of and feelings about food insecurity. Thirty-two
children, aged 11–16 y, were asked to talk about “kids they
know” whose families have “almost run out of food.” Children
identified aspects of food insecurity that would not be captured
in an adaption of the adult measure: eating fast, feeling shame,
and contextualizing food insecurity in terms of almost running
out of food rather than not having enough money. A limitation
of the Connell et al. (22) study is that children were asked to
report on other people’s experiences rather than their own.
Consequently, although the study’s findings provide new insights
into children’s general awareness of food insecurity, they do not
give a complete picture of what children experience in their own
lives and in the context of their own family situations.
These prior studies provide a strong practical and conceptual
rationale for the current study, which aimed to investigate
childhood food insecurity and hunger from the child’s own
perspective. Because parents were also interviewed (separately),
child reports can be considered in the context of household food
resources and stressors, parental efforts to manage food insecu-
rity, and other salient aspects of family functioning.
Twenty-six families were interviewed, including children, mothers,
fathers, and other household adults. Family members were interviewed
separately and interviews took place primarily in families’ homes in rural
and nonrural South Carolina. Adult interviews lasted 45–90 min and
child interviews lasted 15–60 min. All interviews were audio-taped and
de-identified transcripts and field notes became the data for analysis. The
study protocol was approved by the University of South Carolina
Institutional Review Board.
Families were recruited from food pantries, soup kitchens, social-
service agencies, and through fliers posted at groceries, laundromats, and
churches. Potential participants were given informational fliers and/or a
brief oral presentation explaining that the purpose of the study was to
learn about how different families meet their food needs during difficult
economic times. Interested parents contacted a member of the research
team, either in person or by phone, and were asked about: 1) the
presence of a child in the household; 2) parental race/ethnicity; and 3)
place of residence (city, town, suburb, rural area). Families were eligible
to participate if at least 1 child aged 9–16 y was living in the home. Race/
ethnicity and residence information was used only to direct subsequent
recruitment efforts to ensure a diverse sample. Sampling continued until
a theoretical saturation was reached, as indicated by the repeated
stability of the core coding framework when applied to new interview
data (23).
The final sample included families who, based on mother’s report,
were rural (n= 14) and nonrural (n= 12) and in which mothers were
white (n= 8) and African-American (n= 18). Thirteen boys and 13 girls
were interviewed. Fourteen children were in elementary school, 10 in
middle school, and 2 in high school. In addition to interviews with
children and mothers, 7 fathers, 1 grandmother, 2 aunts, and 1 family
friend were interviewed.
Semistructured interview guides were developed by the research
team. Some interview questions were based on the work of Connell et al.
(22); additional questions were developed to address food decision-
making and eating norms. Most questions were asked of both children
and adults, but only adults were asked about household finances and
completed the USDA 6-question Household Food Security Module (24).
This paper reports primarily on child-interview results, with parent
interviews providing context as necessary.
Data analysis involved a constant comparative process (25), com-
bining a priori coding based on key concepts from the interview guide
with an inductive process of identifying new codes and refining existing
codes based on the data. Codes were clustered into themes, which were
confirmed through team discussion and in light of existing research.
NVivo software (26) was used for coding.
Based on mothers’ responses to the Household Food Security
Module, 16 families experienced low or very low food security
in the previous 12 mo. In the interview process, 8 of the 10 food-
secure families described experiences that were suggestive of
some level of food insecurity, including worry about running out
of food, reliance on cheap foods such as rice and pasta, skipping
meals, and making problematic compromises (e.g. canceling
health insurance, not paying the power bill) to pay for food. In
one family where the mother’s response to the Household Food
Security Module indicated that the household was food secure,
the father’s response classified the family as “very low food
security.” Ten families were receiving food stamps, 6 were
struggling with barriers in the application or recertification
process, and 1 reported being eligible but too embarrassed to
apply. The relatively low use of food stamps may be related to
our sampling process, which relied heavily on soup kitchens and
food pantries to find families experiencing food hardships;
households tend to use either food stamps or food pantries, but
not both (27,28). Twenty-two of the children received free or
reduced-cost school meals.
Study children experienced household food insecurity in 2
components: awareness of food insecurity and taking responsi-
bility for managing food resources (Table 1). These components,
and the family contexts associated with them, are discussed
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Awareness of food insecurity
Awareness means that the child had an experience of or an
encounter with the household’s food insecurity and understood
that experience as being related to not having enough food to
meet everyone’s needs. Awareness was further differentiated into
3 subcategories: cognitive, emotional, and physical awareness.
Cognitive awareness refers to children’s knowledge that food
is scarce and their knowledge of ways that their family manages
food problems. This included awareness of the resources and
strategies used to meet household food needs. As a teenage boy
reported, “. . . we get (food stamps). . . between the 1st and the
3rd, maybe the 4th . . . when we do get it then, I’m telling you the
food is coming in the house . . . you come home after school and
you got food.” Cognitive awareness also included awareness of
inadequate quality of food. When asked if her family had ever
almost run out of food before the end of the month, a middle-
school girl replied, “Yeah, but like we always have hot dogs or
French fries or something.” Children were aware of the use of
cheap foods and also of being limited to eating the same foods
repeatedly. One boy described, “I guess chicken is like the eas-
iest affordable thing to (my mother) . . . all she buys is
chicken.”Awareness of inadequate quantity was also evidenced
and could extend to knowing that there is no food at all. A
middle-schooler explained that there was no food in his house
twice in the last month; the interviewer asked, “What do your
brothers say (to your mother)?” The student replied, “If we’re
gonna eat and how we’re gonna eat.” “And then what is your
mom’s response?” “Sometimes, ‘no’.”
Emotional awareness refers to feelings such as worry,
sadness, or anger that are related to household food insecurity.
For instance, an elementary-school girl talked about times when
food was running low: “I felt kind of sad too because I was really
starving and then there was nothing else to eat. Except for
maybe some chips or a soda . . .” “How did that make you feel?”
“Kind of sad, kind of happy . . . because we had a little bit of
food left, but we didn’t have like as much as anyone else.” In
addition to worries about getting enough food, some children
expressed unhappiness about the strategies used to make it
through a food shortage. One child said, “I just hated it eating
like hot dogs or the French fries or the Oodles of Noodles.”
Another commented, “ . . . we had to keep going over to my
friend’s house back and forth asking if she had butter and milk
and eggs ....Ireally didn’t feel good about it because I’m not
comfortable asking people that.”
There were also children who reported a lack of worry; despite
food resources sometimes being low, they were confident that
food problems would be handled. As one girl commented: “I
know that I’m not gonna like starve ‘cause my mom won’t let that
happen.” Another child offered a religious explanation: “. . . if
we’re at the last resort and we still don’t have (food) and then,
I don’t know, somebody just comes and it’s exactly what we
needed . . . so I guess it’s God.”
Physical awareness refers to physical feelings such as hunger,
pain, tiredness, and weakness that are related to lack of sufficient
food. Eight children reported physical awareness of hunger;
some experienced hunger only occasionally, whereas others
experienced it quite frequently. A high-school boy ate no more
than 1 meal at home each day. He was often hungry and
described that he felt: “angry, mad, go to sleep basically, that’s
the only thing you can probably do and after you wake up, you
feel like you’ve got a bunch of cramps in your stomach and you’ll
be light-headed.” An elementary-school girl explained, “Some-
times on Sundays before we figured out there was a soup kitchen,
we would skip breakfast because there’s no cereal and then we
would have an early lunch and I would get really hungry because
we get a late dinner.” Child hunger was also related to poor
quality of available food. A boy said he was hungry during the
interview, because he had not eaten all the food served at school
that day: “. . . cause the beef jerky looks like beef – the fruit jerky
looks like beef jerky and it tastes nasty. And the orange chips
normally don’t taste like oranges to me.”
Responsibility for managing food resources
The children reported a range of behaviors that reflected taking
responsibility for managing household food insecurity. Sometimes
this involved participation with adult strategies for stretching
resources. One boy commented that: “We would try and save
most of our food so we won’t have to buy anymore, ‘cause usually
we wouldn’t have as much food as anyone else.” An elementary-
school girl described that her parents “. . . say, ‘We’re running low
on food. You guys can’t have an apple or something because we
need those for snacks for later when we need them.’”
Some children went beyond participation to initiate strategies
without being asked. For instance, the girl quoted above not
only complied with her parents’ request to not eat a snack when
resources were low, she also initiated similar requests in her
interactions with her younger sister: “(My sister) would some-
times ask me to ask for a fruit snack or a banana and I would say,
no, we’re running low, we could use those for tomorrow for
lunch.” Other types of initiation included not asking for foods
at the grocery store, eating less at meals, and asking only for
healthy foods rather than treats.
Occasionally, children reported that they took responsibility
for managing food insecurity by generating more resources
TABLE 1 Components of household food insecurity experienced by children
Components Description
Awareness of food insecurity
Cognitive awareness Children's knowledge that food is scarce, and their knowledge of ways
that their family manages food problems
Emotional awareness Feelings such as worry, sadness, or anger that are related to
household food insecurity
Physical awareness Physical feelings such as hunger, pain, tiredness, and weakness that
are related to lack of sufficient food
Taking responsibility for managing food resources
Participation with adult strategies Going along with adult strategies for managing scarce food resources
Initiation of strategies Initiating strategies to make existing food resources stretch
Generation of resources Taking action to attain additional food or money for buying food
1116 Fram et al.
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themselves. These strategies included asking neighbors and family
members to borrow food, bringing food home from a relative’s
house, and working part-time and giving the money to parents for
food. In one particularly poignant example, a high-school boy
hesitantly described how he and other youth in his community
helped their families when food was running out: “. . . we’ll like
get together and we’ll find a way to get money up, not, we ain’t
got to sell no drugs though, not like that, but we’ll find a way to
get money up. We might all get together and cut the grass or
something. We’ll find some way . . .people will be putting money
up on fights and stuff, too. And they might do dog fights every
now and to get money like that.”
Family context of children’s experiences
Children’s awareness and responsibility occurred in the context
of family life more generally. Although the study data are rich
with respect to family interactions and food decision-making in
general, we focus here on the 2 themes most directly linked to
child experiences of food insecurity: communication and com-
plex family problems.
Communication. Families differed in their communication
about food insecurity. Some parents spoke with children openly.
As one elementary-school boy said, “. . . my grandma tells me we
can’t be buying a lot of food with the EBT ‘cause we ain’t got
much on it.” In other situations of open communication, parents
asked children to stretch snack foods, choose fewer foods or only
healthy foods in the store, and to wait on food shopping needs.
One girl explained: “ ...wedidn’t have as much money to buy
enough food for everyone in the house to eat . . . (my parents)
would say that we would just have to wait . . . cause usually the
only way (my dad) go to the grocery store is if his check in the
mail and then we can . . . buy some more food.”
Other parents did not discuss food problems with children.
Sometimes children were not aware of issues at all, protected
from awareness and thus from taking responsibility for resolving
problems. This does not mean children were not affected;
children may have received inadequate food quality or quantity
or experienced strained and suboptimal parenting without
becoming cognizant that food resources were low. Other
children became aware of food insecurity despite parental
efforts to keep them from knowing. Thinking about whether her
family had ever come close to running out of food, one girl
couldn’t find (money for food), but I just never probably knew
about it because she’s always trying to hide it.” Another girl
described how she could tell when food was low without her
family telling her: “They don’t really say anything, but you can
read it in their face . . . when they’re out of money and then you
ask why don’t you go to the store and they don’t answer or
something or, and they just try to find other ways, like they just
forget . . . I can tell by people’s expressions . . . (they) wouldn’t be
frowning, but like it wouldn’t be a happy face, it wouldn’t be sad,
it wouldn’t be any face at all, it would be just like–an empty face.”
Children sometimes kept secrets from parents as well. For
example, a single mother who reported very low food security
based on the USDA Module described how she nonetheless
protected her young son from food hardships: “I always let (my
son) eat first. If I think I don’t have enough I will give him as
much as he wants and I can always drink water and tea is cheap.
But I don’t talk to him about it because it’s none of his business.”
Her son, when interviewed separately, described his own role in
making food last: Interviewer: “Have you ever done anything to
help your family have enough food or to make food last a long
time?” Child: “Yes.” “What do you do?” “I normallydon’t eat it
that much.
In another parent-child interview dyad, a mother explained
that she sometimes ate less than she should because there was
not enough money for food, but clarified: “I didn’t make (my
son) eat less.” Despite her efforts, her son experienced worry
about having enough food: “It’s like certain times I go, when I
can’t find anything to really eat then I worry about (food running
out) . . . we’ll be low on food for about a while, for about, I’ll say
about four days, and then like after that she gets some money or
her paycheck come in ....
Complex problems. Most of the children in this study were
affected by household food insecurity to some degree. Some-
times children’s experiences were difficult, but not dire. Food
quality was less than desirable and children had to be aware of
and responsive to food needs in ways that children from more
affluent homes generally do not, but they had enough to eat and
trusted their parents to manage food problems. Other children
experienced more severe aspects of food insecurity. Consistent
with findings in other research (29), these children lived in
families with additional, complex problems including: parent
mental and physical health challenges, domestic violence, recent
relocation, job loss, and geographic and social isolation. One
mother’s untreated schizophrenia and the ensuing fear-inducing
hallucinations kept her from driving or cooking on the stove; her
ability to access and maximize food resources was thus con-
strained. In another family, parents were coping with recent
economic crisis. One parent had recently lost a job, the other
parent in the household had work hours cut back, and the
informal income production strategies on which they had relied
(collecting and selling scrap metal and items from yard sales)
were failing in the recession. Lack of knowledge about available
services exacerbated food shortages. A mother in a rural area
had neither a car nor a refrigerator and spent hours each day
walking to the nearest grocery and bringing home one day’s
worth of food to cook for dinner. An urban mother had left a
violent marriage, and her stress, fear, and sudden poverty
overwhelmed her; she did not notice her child’s awareness of
food problems or efforts to solve them.
This study demonstrates that children are able and willing to
report on their own experiences of food insecurity and that child
food insecurity differs from adult food insecurity in both its
content and its context. Content differences are reflected in the
distinct components of food insecurity that emerge when
children are asked about their own experiences. For instance,
prior research with parents led to a conceptualization of food
insecurity that involves struggles to afford adequate food quality
and quantity in socially desirable ways. Analysis of child
interviews in this study leads to a different conceptualization,
involving components of awareness and responsibility. These
components are grounded in children’s unique experiences, such
as worries about parental stress and hardships, feelings of anger
and helplessness when food is not available, and cognitive vig-
ilance to monitor the household food situation when parents are
trying to hide what is happening. Children also take on res-
ponsibilities to preserve and provide food resources for the
household. These responsibilities may mean very different things
when performed by a child as opposed to an adult. Skipping a
meal has different developmental consequences at different
developmental moments. A responsibility such as earning money
Understanding food insecurity in children 1117
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for household groceries is appropriate and healthy for an adult
but may impede a child’s development by taking time away from
other more age-appropriate tasks (e.g. school work). Moreover,
because children have more restricted options in the formal
labor market, the need to earn grocery money can expose a child
to risky choices, for instance, setting up dog fights.
The context of child compared with adult food insecurity
differs in important ways as well. Prior research with adults has
indicated that the money/economic context in which food
experiences take place is key to distinguishing food insecurity
from other phenomena that may manifest in similar ways (e.g.
cutting back portions because of money constraints vs. a desire
to lose weight). This is evident in the USDA measurement
approach in which each question is conditioned on not having
enough money to buy food (e.g. “. . . did you ever eat less than
you felt you should because there wasn’t enough money to buy
food?”). Children, however, talk about food insecurity in terms
of their direct experiences of the household food environment.
Rather than worrying about not having money to buy food,
children worry when they see less food (or less desirable food) in
the home, when they are given or allowed different or less food
to eat, and when they see parents behaving differently vis-a
mealtimes and food management. This makes sense. Because
children generally do not earn the money for household food or
do the family’s grocery shopping, their experiences of food
insecurity flow not from the economic context of family life but
from the relational and resource contexts that they actually
encounter day to day: what they get to eat and how they interact
with their parents, relatives, neighbors, teachers, and friends.
In addition to differences in the content and context of parent
compared with child food insecurity, this study suggests that
there may be differences in parent compared with child perspec-
tive on what children experience. Specifically, there were instan-
ces when a parent said that their child was protected from
hunger and worries about food, but the child reported substan-
tial worry and/or cutting back on food. This is consistent with
existing research showing that children are better reporters of
their own experiences of internal state than are their parents
(30,31). Because parents were not asked explicitly about their
children’s experiences, however, we cannot systematically com-
pare and contrast parent/child reports using the current data and
thus do not know the extent of discordance in child/parent
perspectives on childhood food insecurity. More systematic
comparison of child vs. parent reports is a critical next step for
research on childhood hunger; if the discordance we observed
anecdotally in this study is common, current estimates on the
prevalence and distribution of childhood food insecurity and
hunger may be inaccurate.
A successful effort to end child hunger must be grounded in a
comprehensive understanding of children’s experiences of food
insecurity. By investigating childhood food insecurity from the
child’s perspective, we find that children’s experiences are unique
in terms of content and context. The resulting new, child-derived
understanding of what children experience provides a critical
basis from which to build effective approaches to identify, assess,
and respond to children suffering from food insecurity.
M.S.F., E.A.F., and S.J.J. designed the study; M.S.F., R.C.W.,
M.P.B., and K.P.D. conducted the data collection; M.S.F., R.C.
E., M.P.B., and K.P.D. analyzed the data; M.S.F., E.A.F., S.J.J.,
and C.E.B. wrote the paper; and M.S.F. and E.A.F. had primary
responsibility for final content. All authors read and approved
the final manuscript.
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... Research suggests that the daily requirement to negotiate basic needs and trade-offs for food insecure individuals leads to toxic stress for both children and adults [48][49][50][51][52]. In this research, parents tried to buffer their children from these impacts, but studies show that children are often aware of food insecurity and adopt their own strategies to mitigate hunger for themselves and other family members, compounding family stress [53]. ...
... Families with a low-income often do not have the time or resources to cook specific meals for children, to experiment with different types of food, try foods multiple times, and have the added worry that if a child does not like a meal, it could be a waste of resources [54][55][56]. Participants in this study demonstrated additional obstacles for feeding children that are unique to food insecurity, along with the struggle of picky eaters [48,51,53,[57][58][59][60]. ...
... Additionally, parents were eager to protect children from the negative physical and mental health outcomes of food insecurity and often prioritized children's needs over their own. These coping mechanisms of exceptional desperation and accommodation reflect previous research, about how caregivers, despite utilizing all their resources, manage extraordinarily difficult circumstances and continue to struggle mightily to keep their families fed [48,53]. ...
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Households with a low-income in rural places experience disproportionate levels of food insecurity. Further research is needed about the nuances in strategies that households with a low-income in rural areas apply to support food security nationally. This study aimed to understand the barriers and strategies that households with a low-income in rural areas experience to obtain a meal and support food security in the United States. We conducted a qualitative study with semi-structured interviews among 153 primary grocery shoppers with a low-income residing in rural counties. A majority of family’s ideal meals included animal-based protein, grains, and vegetables. Main themes included struggles to secure food and coping mechanisms. Ten categories included affordability, adequacy, accommodation, appetite, time, food source coordinating, food resource management, reduced quality, rationing for food, and exceptional desperation. These results can inform public health professionals’ efforts when partnering to alleviate food insecurity in rural areas.
... Linking food insecurity to clinical mental health outcomes, studies have found that food insufficiency was significantly associated with poor or fair self-rated health and physical limitations with respondents meeting the criteria for recent major depressive episode or generalized anxiety (Siefert et al., 2001;Whitaker et al., 2006). Coping with food insecurity is also associated with complex familiallevel processes that impact parent-child relationships; parents try to protect children and children try to protect parents from the physical and emotional effects of food insecurity-motivations that arise from deep seated beliefs about the gendered role of family members (Hamelin et al., 1999;Fram et al., 2011). ...
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Introduction The feminization of hunger plays out in communities across the globe where poverty exists, including the United States, the world's wealthiest nation. The feminization of hunger and poverty can be traced to the “gender system”—deep seated gender inequities resulting in job segregation, discrimination in pay, unpaid caring work, and gender-based violence. Methods Exploratory qualitative research study with two focus groups comprising low-income women ( n = 20). Results The analysis identified three key themes: toxic stress related to food work, welfare stigma and racism, and the invisible loads of care work and communicative labor. Discussion The analysis shows how women's experience of hunger and food insecurity in the US is linked to forces of economic deprivation and symbolic violence. Consistent with Allen's (2007) theorization of “motherwork”, for women and mothers the experience of food insecurity is distinct because of its gendered link to the care work, food work, and communicative labor necessary for the survival and wellbeing of children.
... High internal consistency was found using Cronbach α (0.88-0.94 across countries) and a confirmatory factor analysis, and acceptable criterion validity relative to other markers of food insecurity and cross-context equivalence was demonstrated. A youth-reported measure of food insecurity was included because previous research suggests youth are aware of and can report experiences of food insecurity, with their reports diverging from those of their caregivers [52][53][54]. Response options for each item include never (scored value of zero), 1 or 2 times (scored value of 1), and many times (scored value of 2). Based on the resulting continuous score, youth were categorized as having no (zero affirmations), few (1-6 affirmations), several (7-10 affirmations), or many (11-20 affirmations) experiences of food insecurity over the past year [51]. ...
Background: Disruptions from the coronavirus disease 2019 (COVID-19) pandemic potentially exacerbated food insecurity among adults and youth. Objectives: The objective was to examine changes in the prevalence and severity of food insecurity among adults and youth from before (2019) to during (2020) the pandemic in multiple countries. Methods: Repeated cross-sectional data were collected among adults aged 18-100 y (n = 63,278) in 5 countries in November to December in 2018-2020 and among youth aged 10-17 y (n = 23,107) in 6 countries in November to December in 2019 and 2020. Food insecurity in the past year was captured using the Household Food Security Survey Module and the Child Food Insecurity Experiences Scale. Changes in the prevalence and severity of food insecurity were examined using logistic and generalized logit regression models, respectively. Models included age, gender, racial-ethnic identity, and other sociodemographic characteristics associated with food insecurity to adjust for possible sample differences across waves. Models were weighted to reflect each country's population. Results: Adults [adjusted OR (AOR): 1.15; 95% CI: 1.02, 1.31] and youth (AOR: 1.43; 95% CI: 1.19, 1.71) in Mexico were more likely to live in food-insecure households in 2020 compared to 2019. Adults in Australia (AOR: 0.81; 95% CI: 0.72, 0.92) and Canada (AOR: 0.87; 95% CI: 0.77, 0.99) were less likely to live in food-insecure households in 2020. Trends in severity aligned with changes in prevalence, with some exceptions. Youth in Australia (AOR: 2.24; 95% CI: 1.65, 3.02) and the United States (AOR: 1.39; 95% CI: 1.04, 1.86) were more likely to have many compared with no experiences of food insecurity in 2020 compared to 2019. There was no evidence of change among adults and youth in the remaining countries. Conclusions: Except for Mexico, few changes in food insecurity among adults and youth were observed from before to during the COVID-19 pandemic. Action is needed to support households at risk of food insecurity. J Nutr 20XX;xx:xx-xx.
... This is likely a result of parents attempting to shield their children from the impact of HFI. 12,16,38 However, as we have shown, these efforts do not entirely combat the negative effects children experience. Children may identify instability and stress within the household, ultimately resulting in worsening mental health. ...
Background: Household food insecurity (HFI) is associated with poor general and mental health. Prior studies assessed parent and child mental health separately and did not assess other social risks. Objective: To assess the relationship between HFI and both parental and child mental health. Methods: Parents of 3-5-year-old children completed validated measures of food insecurity and mental health. Separate linear regression models were used for unadjusted analysis for each mental health outcome (parent depression, anxiety, and stress, and child mental health). Multivariable analysis was performed using hierarchical regression to adjust for relevant covariates. Results: Children (n = 335) were racially and socioeconomically diverse. HFI was reported in 10% of participants. HFI was associated with worse parent depression and stress in unadjusted analyses; however, after adjusting for covariates, the associations became insignificant. HFI was significantly associated with worse child mental health in unadjusted and multivariable analysis (aβ 2.24, 95% CI 0.59-3.88) compared to those without HFI. Conclusion: HFI was not associated with parental mental health outcomes when other social risks were included in the analyses; however, HFI was significantly associated with worse childhood mental health in all analyses. Pediatric providers should screen for and develop interventions to target both HFI and mental health. Impact: Household food insecurity was associated with worse parent depression and stress in unadjusted analyses; however, after adjusting for other social risks, the associations became insignificant. Household food insecurity was significantly associated with worse child mental health, even after adjusting for demographics, other social risks, and parent mental health. Social risks are differentially associated with parent and child mental health. Understanding the complexities of family stressors can help better support parents and children struggling with mental health problems and social risks.
... Food insecurity is detrimental to children's physical and psycho-social health, with potential long-term consequences [3,4]. Although parents may shield younger children from food insecurity, adolescents are typically more aware of the household's economic environment and may take action to ensure that themselves and other members of the household have food, putting themselves at a higher risk of food insecurity [5,6]. Over 6.7 million or 16% of US adolescents live in households experiencing food insecurity [7]. ...
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This study explored strategies to improve adolescent food security using semi-structured in-depth interviews with 9 policy advocates, 12 parents and 15 adolescents aged between 17 and 20 years, living in households who were eligible for the Supplemental Nutrition Assistance Program in 2020. This study was part of a larger evaluation of adolescent food insecurity conducted in Baltimore, Maryland, USA during the COVID-19 pandemic. Three key strategies arose during analysis—improving federal nutrition assistance programs for households, federal nutrition assistance programs for individual adolescents, and leveraging school programs and resources. Respondents described concordant views regarding the role of the Supplemental Nutrition Assistance Program in supporting households but held discordant views about the role of other federal programs, such as the school nutrition programs and Pandemic Electronic Benefit Transfer program. The results of this study provide important insights about policy and programmatic supports that may assist adolescents to acquire food for themselves and their families. Future research should test how federal programs and policies specifically impact food security and nutrition for adolescents.
... One explanation is that parents may shield their children from the effects of food insecurity, which may improve the types of foods accessible to and consumed by children. Younger children may be shielded more than adolescents, resulting in greater risk of poor diet quality for adolescents experiencing food insecurity [12,13]. Additionally, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides benefits which support better diet quality for young children in low-income households, but no such federal program specifically targets older children or adolescents. ...
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This study evaluated differences in overall diet quality, diet quality components, and food-related contextual factors between adolescents with food security and those with food insecurity. Mixed methods analysis was conducted on data from three 24-h dietary recalls from 61 adolescents ages 14–19 years old living in Baltimore, Maryland, USA in 2020–2021. All adolescents were sampled from households eligible for the Supplemental Nutrition Assistance Program in 2020. There were no significant differences in overall diet quality or components between adolescents with food security and those with food insecurity in this sample, except for seafood and plant proteins, which was higher for adolescents with food insecurity. Qualitative analysis found that adolescents were largely influenced by their parents and the home food environment, and that workplace environments enabled adolescents to eat foods high in refined grains, sugar, and saturated fat. These findings provide insight about the experiences of low-income adolescents during times when they are home for prolonged periods (i.e., emergency school closures, summer, and winter breaks). Programs and policies that aim to improve healthy food access may positively impact adolescent food security and diet quality, and it is important to ensure that healthy foods are available and accessible to adolescents in the places where they spend the most time. Multilevel interventions in the home, school, and workplace may be most effective in encouraging healthy eating behaviors among adolescents.
Adolescence is a period of development in which youth have new opportunities for decision-making, often in situations where they may have little information or experience to guide their choices. Thus, learning to make decisions under uncertainty is a key challenge during adolescence. To date, researchers have applied economics formalisms to understand the processes that support adolescents in making decisions under two distinct forms of uncertainty: economic risk and economic ambiguity. Economic risk is when the probabilities of outcomes are known. Economic ambiguity is when the probabilities of outcomes are unknown or unknowable. This research has led to foundational knowledge about the basic processes involved in adolescent decision-making, but many experimental paradigms that dissociate economic risk and ambiguity rely on monetary or point-based choices. Given that adolescence is a period of development characterized by a changing social environment, it remains unclear whether the processes that adolescents engage during decision-making on monetary or point-based experimental tasks generalize to their day-to-day experiences in the real world. In this brief piece, we explore how developmental research applying economics formalisms can be bolstered by research on youth’s social environments to advance our understanding of decision-making in adolescence. First, we review developmental research by using economic uncertainty paradigms. Next, we highlight research on adolescents’ social environments to provide examples of the day-to-day choices that adolescents face among their peers and in their broader communities. Finally, we propose directions for future research integrating these separate approaches to create a more nuanced, ecologically informed understanding of adolescent decision-making.
Background: Adults with low incomes have lower diet quality than their higher income counterparts. In Canada, the British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods in farmers' markets. Objective: The objective of this study was to examine the impact of the FMNCP on the diet quality of adults with low incomes. Method: In a pragmatic randomized controlled trial conducted in 2019, adults with low incomes (≥18 y) were randomly assigned either to an FMNCP intervention (n = 143) or a no-intervention control group (n = 142). The FMNCP group received 16 coupon sheets valued at $21 per sheet over 10-15 wk to purchase healthy foods from farmers' markets. Participants completed a questionnaire and 2 24-h dietary recalls at baseline (0 wk), immediately postintervention (10-15 wk), and 16-wk postintervention (26-31 wk). Diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015). Linear mixed-effects regression assessed differences in HEI-2015 total (primary outcome) and component scores (secondary outcomes) between the FMNCP and control groups at postintervention and 16-wk postintervention. Subgroup analyses examined program impacts by sex and age group (18-59 y, ≥60 y). Results: There were no significant differences in HEI-2015 total scores between the FMNCP and control groups at postintervention (-0.07; 95% CI: -4.07, 3.93) or 16-wk postintervention (1.22; 95% CI: -3.00, 5.44) overall or between subgroups. There were no significant between-group differences in HEI-2015 component scores at postintervention, although there were significant differences in component scores for dairy and fatty acids at 16-wk postintervention. Conclusion: The FMNCP did not significantly improve diet quality among adults with low incomes over the study period. Further research is needed to explore whether higher subsidy amounts or a longer intervention period is needed to meaningfully improve diet quality among adults with low incomes. This trial was registered at [] as [NCT03952338].
Food insecurity is a significant social and health issue for children in high-income countries and contributes to sub-optimal child outcomes. This scoping review examines how food insecurity intersects with the moral experiences of those involved in providing and receiving paediatric health care. Multiple databases were searched using a priori inclusion criteria, papers were screened by multiple reviewers. Searches yielded nine papers. Descriptive data was summarised and qualitative results extracted from included papers were analysed using inductive and deductive thematic analysis. Four main themes emerged: Food insecurity threatens caregiver and healthcare provider identity; is food insecurity the business of health? is screening for food insecurity surveillance or facilitating assistance? and the lived experience of navigating the tension of managing food insecurity and a child’s health condition. The moral experiences lens has magnified the countless everyday encounters in which values and beliefs about what is ‘right’ or ‘just’ can be realised or thwarted in the context of the intersection between healthcare and food insecurity. Review findings have implications relating to the inclusion of children’s voices in healthcare settings, healthcare practice and policy design, and the development and use of FI screening tools.
Sixteen million US children (21%) live in households without consistent access to adequate food. After multiple risk factors are considered, children who live in households that are food insecure, even at the lowest levels, are likely to be sick more often, recover from illness more slowly, and be hospitalized more frequently. Lack of adequate healthy food can impair a child’s ability to concentrate and perform well in school and is linked to higher levels of behavioral and emotional problems from preschool through adolescence. Food insecurity can affect children in any community, not only traditionally underserved ones. Pediatricians can play a central role in screening and identifying children at risk for food insecurity and in connecting families with needed community resources. Pediatricians should also advocate for federal and local policies that support access to adequate healthy food for an active and healthy life for all children and their families.
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In this study, we examined characteristics associated with experiencing persistent and transitional adult food insecurity and how persistent and transitional adult food insecurity influences toddler cognitive and motor development, along with toddler's weight and health status. Using the first 2 waves of the Early Childhood Longitudinal Study-Birth Cohort, 4 mutually exclusive variables capturing persistent and transitional adult food insecurity were created to capture those adults that experience adult food insecurity in the following: both waves, in 1 wave (at 9 or 24 mo after birth), and never experience food insecurity. We used logistic regression models to estimate characteristics associated with the likelihood of experiencing persistent and transitional adult food insecurity. Ordinary least squares regression models were used to estimate how persistent and transitional adult food insecurity influences toddler development. Similar factors influenced one's likelihood of experiencing adult transitional and persistent food insecurity; individuals who experienced any food insecurity were more economically disadvantaged. Thus, outreach efforts do not need to vary by duration of food insecurity. Whereas negative effects of food insecurity on school-aged children are found in the literature, it appears toddlers are buffered from the effects of persistent adult food insecurity. Our findings suggest that toddlers residing with a temporarily food-insecure adult compared with a never food-insecure adult experienced immediate, but small, negative effects on their development. Hence, outreach and assistance may lessen immediate impacts of food insecurity on toddler development.
Qualitative Data is meant for the novice researcher who needs guidance on what specifically to do when faced with a sea of information. It takes readers through the qualitative research process, beginning with an examination of the basic philosophy of qualitative research, and ending with planning and carrying out a qualitative research study. It provides an explicit, step-by-step procedure that will take the researcher from the raw text of interview data through data analysis and theory construction to the creation of a publishable work. The volume provides actual examples based on the authors' own work, including two published pieces in the appendix, so that readers can follow examples for each step of the process, from the project's inception to its finished product. The volume also includes an appendix explaining how to implement these data analysis procedures using NVIVO, a qualitative data analysis program.
Using data from two waves of a panel study of families that currently receive or recently received cash welfare benefits, this article examines the relationship between food hardship and behavior problems for two different age groups (3-5 years and 6-12 years). Results show that food hardship is positively associated with externalizing behavior problems for the older children even after controlling for parental stress, warmth, and depression. Food hardship is positively associated with internalizing behavior problems for the older group of children, and with both externalizing and internalizing behavior problems for the younger group of children. These effects are mediated by parental characteristics. Results suggest that practitioners who work with children should screen for food hardship as a potential source of behavior problems.
The lack of an operational definition for hunger has been frequently cited as a barrier to progress in addressing the problem. The purposes of this research were to develop an understanding of hunger from the perspective of women who had experienced it and to construct and evaluate indicators to measure hunger directly in similar populations. In-depth interviews were conducted with 32 women of childbearing age from rural and urban areas of Upstate New York. Qualitative analysis of the responses yielded a conceptualization of hunger that included two levels: the individual and household. Hunger at each of these levels had quantitative, qualitative, psychological and social components. These women also viewed hunger as a managed process. Based on this conceptualization of hunger, survey items were developed and evaluated, using data from a questionnaire administered to 189 women from the same geographical area. Three scales, one each for household, women's, and children's hunger, emerged and were found to be valid and reliable indicators for measuring hunger directly in this population.
give an overview of the origins, purposes, uses, and contributions of grounded theory methodology / grounded theory is a general methodology for developing theory that is grounded in data systematically gathered and analyzed (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The research presented examines the role of Food Stamps versus food pantries in alleviating food shortages among poor households. First, multinomial logit models are used to examine which factors affect four alternate food assistance choices poor households make: (a) to use Food Stamps, (b) to use a food pantry, (c) to use both programs, or (d) to use neither program. Second, the efficacy of food pantries and Food Stamps in alleviating food shortages is investigated by using binomial probit models, which estimate whether using Food Stamps and/or food pantries have an effect on (a) whether the household perceives food shortages and (b) whether a child's physical well-being is being compromised by a lack of food.The research uses data collected by the Food Distribution Research Project, which in 1993 surveyed 405 households below 185% of the poverty level in Allegheny County, PA. The research shows a preference among the nonelderly for the Food Stamp program over food pantries. Conversely, elderly households tend to use the food pantry system over the Food Stamp program.
Eighty-four percent of U.S. households with children were food secure throughout 2007, meaning that they had consistent access to adequate food for active, healthy lives for all household members. Nearly 16 percent of households with children were food insecure sometime during the year, including 8.3 percent in which children were food insecure and 0.8 percent in which one or more children experienced very low food security—the most severe food-insecure condition measured by the U.S. Department of Agriculture. Numerous studies suggest that children in food-insecure households have higher risks of health and development problems than children in otherwise similar food-secure households. This study found that about 85 percent of households with food-insecure children had a working adult, including 70 percent with a full-time worker. Fewer than half of households with food-insecure children included an adult educated past high school. Thus, job opportunities and wage rates for less educated workers are important factors affecting the food security of children. In 2007, Federal food and nutrition assistance programs provided benefits to four out of five low-income, food-insecure households with children.
Previous research has estimated that food insecure children are more likely to suffer from a wide array of negative health outcomes than food secure children, leading many to claim that alleviating food insecurity would lead to better health outcomes. Identifying the causal impacts is problematic, however, given endogenous selection into food security status and potential mismeasurement of true food security status. Using recently developed nonparametric bounding methods and data from the 2001-2006 National Health and Nutritional Examination Survey (NHANES), we assess what can be identified about the effects of food insecurity on child health outcomes in the presence of nonrandom selection and nonclassical measurement error. Under relatively weak monotonicity assumptions, we can identify that food security has a statistically significant positive impact on favorable general health and being a healthy weight. Our work suggests that previous research has more likely underestimated than overestimated the causal impacts of food insecurity on health.
Eighty-nine percent of American households were food secure throughout the entire year 2001. The rest were food insecure at least some time during the year, meaning they did not always have access to enough food for active, healthy lives for all household members because they lacked sufficient money or other resources for food. The prevalence of food insecurity rose from 10.1 percent in 1999 to 10.7 percent in 2001, and the prevalence of food insecurity with hunger rose from 3.0 percent to 3.3 percent during the same period. This report, based on data from the December 2001 food security survey, provides the most recent statistics on the food security of U.S. households, as well as on how much they spent for food and the extent to which food-insecure households participated in Federal and community food assistance programs. Survey responses indicate that the typical food-secure household in the United States spent 32 percent more than the typical food-insecure household of the same size and household composition. About one-half of all food-insecure households participated in one or more of the three largest Federal food assistance programs during the month prior to the survey. About 19 percent of food-insecure households—2.8 percent of all U.S. households—obtained emergency food from a food pantry at some time during the year.