HOUSING CHALLENGES AND CHILD HEALTH AND DEVELOPMENT Patrick Casey, M.D. Harvey and Bernice Jones Professor of Developmental Pediatrics Department of Pediatrics.

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Presentation transcript:

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 Children’s Hospital

Food Insecurity Housing Insecurity Energy Insecurity

FOOD INSECURITY AND RISK FACTORS HOUSEHOLD RESOURCES (money, time, information, health) FOOD ACQUISITION HOUSEHOLD FOOD SUPPLY 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 NON-FOOD EXPENDITURES housing hospital care emergencies taxes discretionary items gasoline heating, cooling other 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 :408

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.

2011 Food Insecurity of all Households: 14.9% Food Insecurity of Households with Children: 20.6%

TRENDS IN PREVALENCE OF FOOD INSECURITY 2003 – 2011 % Households

FOOD SECURITY BY STATE 2011 Worst50: Mississippi19.2% 50: Arkansas19.2% 48: Texas18.5% 47: Alabama18.2% 46:Georgia17.4% Best5:Wisconsin11.3% 4:Minnesota10.2% 3:New Hampshire9.6% 2:Virginia9.1% 1:North Dakota7.8%

FOOD HARDSHIP States: Arkansas 24% 2011 Arkansas 21.1% Metropolitan Area: : Little Rock/Conway 20% 2011: Little Rock/Conway 18.1%

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

HOUSING SPECTRUM Stable Poor QualityHousing Insecure:Homeless - behind on rent - crowding - multiple moves

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

Children’s 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

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

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

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

FEDERAL ASSISTANCE PROGRAMS– monitored by Food Stamps (SNAP) Temporary Assistance for Needy Families (TANF) Women, Infants and Children (WIC) Medicaid Federal Housing Subsidies Energy Assistance (LIHEAP) Primary Household And Child Outcomes Food Insecurity Hospitalizations Child Wellbeing Maternal Depression Child Growth Child Development

U.S. HOUSING INSECURITY AND THE HEALTH OF VERY YOUNG CHILDREN American Journal of Public Health. 2011, June 16:e1 – e7

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

INSECURE HOUSING AND CHILD AND HOUSEHOLD STATUS Secure HousingCrowdingMultiple Moves ReferentAORp p Household Food Insecurity11.3< <.001 Child Food Insecurity11.5< <.001 Fair/Poor Child Health <.001 Child Development Risk <.001 Adjusted for multiple family and child characteristics

FOOD, HOUSING, AND ENERGY INSECURITY LITTLE ROCK Percent

Frequent Moves Behind on Rent Homeless CHILDREN’S HEALTHWATCH ARKANSAS HOUSEHOLDS

Increased Odds of Poor Outcomes

INSECURE HOUSING IN ARKANSAS: ASSOCIATION WITH CHILD AND MATERNAL HEALTH Secure Housing (N=2459) Behind on Rent (N=1222) Multiple Moves (N=338) ReferentAORP P Child Health Fair/Poor11.41< At Risk for Under Weight10.92NS At Risk for Developmental Problems Maternal Health Fair/Poor11.62< <.001 Positive Maternal Depression Screen12.45< <.001