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

Abstract

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.

Full text

The Journal of Nutrition
Community and International Nutrition
Children Are Aware of Food Insecurity and Take
Responsibility for Managing Food Resources
1,2
Maryah Stella Fram,
3
Edward A. Frongillo,
4,5
* Sonya J. Jones,
4,5
Roger C. Williams,
3
Michael P. Burke,
4,5
Kendra P. DeLoach,
6
and Christine E. Blake
4,5
3
College of Social Work,
4
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, and
5
Center for
Research in Nutrition and Health Disparities, and
6
Department of Psychology and College of Social Work, University of South Carolina,
Columbia, SC 29208
Abstract
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.
Introduction
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
hunger.
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
1
Supported in part by a grant from the Southern Rural Development Center and
the Economic Research Service through the USDA’s RIDGE program.
2
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: efrongillo@sc.edu.
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.
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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.
Method
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.
Results
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
below.
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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
explained:“...there’sbeentimesIguesswhen(mymom)
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.
Discussion
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
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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
`-vis
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.
Acknowledgments
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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