High Level of Food Insecurity among Families with Children Seeking Routine Care at Federally Qualified Health Centers during the Coronavirus Disease 2019 Pandemic

Steven A Abrams, Ana Avalos, Megan Gray, Keli M Hawthorne, Steven A Abrams, Ana Avalos, Megan Gray, Keli M Hawthorne

Abstract

Objective: To assess food insecurity during pediatric visits to federally qualified health centers (FQHCs) during the coronavirus disease-19 pandemic.

Study design: Interviews using the validated American Academy of Pediatrics 2-question food insecurity screen were performed with 200 consecutive families presenting for pediatric care to 2 FQHC in Central Texas from April 14 to May 20, 2020, during the initial phase of the pandemic in Texas. Brief qualitative interviews were conducted to determine whether families found a worsening of food insecurity during the pandemic.

Results: Overall, 47% of families had a positive food insecurity screen. More than 90% of these were worrying about food running out and about 60% were positive for the question related to food not lasting. Among families with food insecurity, 94% indicated this had begun or worsened during the pandemic. Of the 115 families volunteering information about employment, 46% reported job loss during this time period. Both ethnicity (P < .001) and Special Supplementation Nutrition Program for Women, Infants and Children (WIC) participation (P = .03) were associated with greater levels of food insecurity. Among primarily Spanish-speaking families participating in the WIC program, 64% reported food insecurity.

Conclusions: Approximately one-half of families receiving routine pediatric care at a FQHC during the coronavirus disease-19 pandemic reported food insecurity and this was associated with loss of jobs during the pandemic. Participation in the WIC program was not protective against food insecurity. Increased frequency of food insecurity was detected in Hispanic and Spanish-speaking families. Screening of families at an FQHC should be strongly considered as a part of routine pediatric care. Knowledge of community resources is important for providers to share with patients. (J Pediatr: X 2020;4:100044).

Trial registration: ClinicalTrials.gov: NCT04378595.

Keywords: AAP, American Academy of Pediatrics; COVID-19, Coronavirus disease 2019; FQHC, Federally qualified health center; SNAP, Supplemental Nutrition Assistance Program; WIC, Special Supplementation Nutrition Program for Women, Infants and Children; infant nutrition; pediatric screening.

© 2020 The Authors.

References

    1. Ashbrook A., Hartline-Grafton H. Addressing food insecurity: a toolkit for pediatricians. Washington DC, Food Research & Action Center.
    1. Hager E.R., Quigg A.M., Black M.M., Coleman S.M., Heeren T., Rose-Jacobs R. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126:e26–e32.
    1. Peltz A., Garg A. Food Insecurity and Health Care Use. Pediatrics. 2019;144:e20190347.
    1. Council on Community Pediatrics; Committee on Nutrition Promoting food security for all children. Pediatrics. 2015;136:e1431–e1438.
    1. Coleman-Jensen A., Rabbitt M.P., Gregory C.A., Singh A. Household food security in the United States in 2018. US Department of Agriculture, Economic Research Service, Economic Research Report No. (ERR-270)
    1. Gundersen C., Ziliak J.P. Food insecurity and health outcomes. Health Aff. 2015;34:1830–1839.
    1. Clay L.A., Ross A.D. Factors associated with food insecurity following Hurricane Harvey in Texas. Int J Environ Res Public Health. 2020;17:762.
    1. Nicola M., Alsafi Z., Sohrabi C., Kerwan A., Al-Jabir A., Iosifidis C. The socio-economic implications of the coronavirus and COVID-19 pandemic: a review. Int J Surg. 2020;78:185–193.
    1. Joint Mission. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
    1. County Judge of Travis County County Judge Order No. 2020-5: Relating the Declaration Regard COVID-19 (Stay Home, Work Safe Order)
    1. Dey M.D., Loewenstein M.A. How many workers are employed in sectors directly affected by COVID-19 shutdowns, where do they work, and how much do they earn?
    1. Niles M.T., Bertmann F., Morgan E.H., Wentworth T., Biehl E., Neff R. The impact of coronavirus on Vermonters experiencing food insecurity. University of Vermont, College of Agriculture and Life Sciences Faculty Publications.
    1. Corrado K. New efforts to combat food insecurity in NYC amid COVID-19 outbreak.
    1. Food Insecurity in Travis County.
    1. USDA Food and Nutrition Service Supplemental Nutrition Assistance Program (SNAP) Eligibility.
    1. US Citizenship and Immigration Services Public Charge.
    1. Bernstein H., McTarnaghan S., Gonzalez D. Safety net access in the context of the Public Charge Rule: voices of immigrant families.
    1. Avila R.M., Bramlett M.D. Language and immigrant status effects on disparities in Hispanic children's health status and access to health care. Matern Child Health J. 2013;17:415–423.
    1. Flores G., Tomany-Korman S.C. The language spoken at home and disparities in medical and dental health, access to care, and use of services in US children. Pediatrics. 2008;121:e1703–e1714.
    1. Gattu R.K., Paik G., Wang Y., Ray P., Lichenstein R., Black M.M. The hunger vital sign identifies household food insecurity among children in emergency departments and primary care. Children (Basel) 2019;6:107.
    1. Urke H.B., Cao Z.R., Egeland G.M. Validity of a single item food security questionnaire in Arctic Canada. Pediatrics. 2014;133:e1616–e1623.
    1. Barnidge E., LaBarge G., Krupsky K., Arthur J. Screening for food insecurity in pediatric clinical settings: opportunities and barriers. J Community Health. 2017;42:51–57.
    1. Palakshappa D., Doupnik S., Vasan A., Khan S., Seifu L., Feudtner C. Suburban families' experience with food insecurity screening in primary care practices. Pediatrics. 2017;140
    1. Bovell-Ammon A., Cuba S.E., Coleman S., Ahmad N., Black M.M., Frank D.A. Trends in food insecurity and SNAP participation among immigrant families U.S.-born young children. Children (Basel) 2019;6:55.
    1. Yu S.M., Huang Z.J., Schwalberg R.H., Nyman R.M. Parental English proficiency and children's health services access. Am J Public Health. 2006;96:1449–1455.
    1. Matheson D.M., Varady J., Varady A., Killen J.D. Household food security and nutritional status of Hispanic children in the fifth grade. Am J Clin Nutr. 2002;76:210–217.
    1. Kaiser L.L., Melgar-Quiñonez H., Townsend M.S., Nicholson Y., Fujii M.L., Martin A.C. Food insecurity and food supplies in Latino households with young children. J Nutr Educ Behav. 2003;35:148–153.
    1. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to measuring household food security, revised 2000. Alexandria (VA): US Department of Agriculture, Food and Nutrition Service. 2000.
    1. Santoli J.M.L.M., DeSilva M.B., Kharbanda E.O., Daley M.F., Galloway L. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration — United States, 2020. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2020;69:591–593.
    1. Shi Q., Castillo F., Viswanathan K., Kupferman F., MacDermid J.C. Facilitators and barriers to access to pediatric medical services in a community hospital. J Prim Care Community Health. 2020;11 2150132720904518.

Source: PubMed

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