HOUSING CHALLENGES AND CHILD HEALTH AND DEVELOPMENT

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HOUSING CHALLENGES AND CHILD HEALTH AND
DEVELOPMENT

• Patrick Casey, M.D.
• Harvey and Bernice Jones Professor of
• Developmental Pediatrics
• Department of Pediatrics
• College of Medicine
• University of Arkansas for Medical Sciences
• Arkansas Childrens Hospital

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Food Insecurity
Energy Insecurity
Housing Insecurity
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FOOD INSECURITY AND RISK FACTORS

• HOUSEHOLD RESOURCES
• (money, time, information, health)
• FOOD ACQUISITION
• HOUSEHOLD FOOD SUPPLY

NON-FOOD EXPENDITURES housing hospital
care emergencies taxes discretionary
items gasoline heating, cooling other
NORMAL FOOD SYSTEM grocery stores and food
service operations food availability (type and
quantity) food accessibility (cost and
distance) GOVERNMENT FOOD ASSISTANCE Food
Stamps WIC School Lunch and Breakfast
ALTERNATE FOOD SOURCES PRIVATE FOOD
ASSISTANCE gifts from family friends gardening,
hunting, fishing scavenging
Nutrition Program for the Elderly (Title 3c)
Modified from Campbell, CC Food Insecurity A
Nutritional Outcome or a Predictor Variable? J
Nutr. 1991.121408
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FOOD INSECURITY

• Limited or uncertain availability of
  nutritionally adequate and safe foods or limited
  or uncertain ability to acquire acceptable foods
  in socially acceptable ways.

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2011
Food Insecurity of all Households 14.9 Food
Insecurity of Households with Children 20.6
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TRENDS IN PREVALENCE OF FOOD INSECURITY2003
2011
Households
03
05
07
09
11
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FOOD SECURITY BY STATE2011

• Worst 50 Mississippi 19.2
• 50 Arkansas 19.2
• 48 Texas 18.5
• 47 Alabama 18.2
• 46 Georgia 17.4
• Best 5 Wisconsin 11.3
• 4 Minnesota 10.2
• 3 New Hampshire 9.6
• 2 Virginia 9.1
• 1 North Dakota 7.8

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FOOD HARDSHIP

• States
• 2008-2009 Arkansas 2 _at_ 24
• 2011 Arkansas 12 _at_ 21.1
• Metropolitan Area
• 2008-2009 Little Rock/Conway 18 _at_ 20
• 2011 Little Rock/Conway 47 _at_ 18.1

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CHILDREN AND FOOD INSECURITY

• Food Insecurity is associated with poorer child
• general health (and more hospitalizations)
• developmental status in pre-school years
• educational achievement
• mental health
• academic problems
• while controlling for demographic characteristics

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HOUSING SPECTRUM
Stable Poor Quality Housing Insecure Homeless
- behind on rent - crowding -
multiple moves
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HOUSING AND DISEASEASTHMA

• Increased prevalence, worse in lower SES
• Direct effect molds, dust mites,
• environmental pollutants
• Indirect effects problem affording
• medications, follow-up with doctor visits

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Childrens Health Watch

• A consortium of academic pediatricians who focus
  on infant growth (all have growth clinics), which
  collects data to influence public policy, and for
  academic publications

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WHAT WE DO
Collect data in five urban, safety-net
hospitals
Produce scientific research that is original and
timely
Inform policy decisions with state and national
partners
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STUDY METHODS

• 5 medical centers
• 3 emergency departments (ED)
• 3 hospital based clinics
• August 1998 to present
• Cross-sectional convenience sample
• Children 48 months of age

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STUDY METHODS

• Caretaker Survey
• Demographics
• Child health
• Child development concern Peds
• State federal program participation
• USDA 18-question food security scale
• Medical Record Audit
• Child weight height
• Medical diagnosis
• Admission dehydration status

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FEDERAL ASSISTANCE PROGRAMSmonitored by

• Food Stamps (SNAP)
• Temporary Assistance for Needy Families (TANF)
• Women, Infants and Children (WIC)
• Medicaid
• Federal Housing Subsidies
• Energy Assistance (LIHEAP)

• Food Insecurity
• Hospitalizations
• Child Wellbeing
• Maternal Depression
• Child Growth
• Child Development

Primary Household And Child Outcomes
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U.S. HOUSING INSECURITY AND THE HEALTH OF VERY
YOUNG CHILDREN

• American Journal of Public Health.
• 2011, June 16e1 e7

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HOUSING INSECURITY

• Crowding more than 2 people per bedroom, or
• Moved two or more times in the past year

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INSECURE HOUSING AND CHILD AND HOUSEHOLD STATUS
Secure Housing Crowding Crowding Multiple Moves Multiple Moves
Referent AOR p AOR p
Household Food Insecurity 1 1.3 lt.001 1.9 lt.001
Child Food Insecurity 1 1.5 lt.001 2.6 lt.001
Fair/Poor Child Health 1 1.07 .14 1.48 lt.001
Child Development Risk 1 1.06 .49 1.71 lt.001
Adjusted for multiple family and child
characteristics
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FOOD, HOUSING, AND ENERGY INSECURITYLITTLE ROCK
Percent
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CHILDRENS HEALTHWATCH ARKANSAS HOUSEHOLDS
Frequent Moves
Behind on Rent
Homeless
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Increased Odds of Poor Outcomes
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INSECURE HOUSING IN ARKANSASASSOCIATION WITH
CHILD AND MATERNAL HEALTH
Secure Housing (N2459) Behind on Rent (N1222) Behind on Rent (N1222) Multiple Moves (N338) Multiple Moves (N338)
Referent AOR P AOR P

Child Health Fair/Poor 1 1.41 lt.001 1.47 .01
At Risk for Under Weight 1 0.92 NS 1.34 .01
At Risk for Developmental Problems 1 1.28 .03 1.5 .01
Maternal Health Fair/Poor 1 1.62 lt.001 1.81 lt.001
Positive Maternal Depression Screen 1 2.45 lt.001 2.88 lt.001
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