1. 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

2. Food Insecurity Housing Insecurity Energy Insecurity

3. 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. 1991.121:408

4. 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.

5. 2011 Food Insecurity of all Households: 14.9% Food Insecurity of Households with Children: 20.6%

6. TRENDS IN PREVALENCE OF FOOD INSECURITY 2003 – 2011 % Households 0305070911

7. 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%

8. FOOD HARDSHIP States: 2008-2009 Arkansas #2 @ 24% 2011 Arkansas #12 @ 21.1% Metropolitan Area: 2008-2009: Little Rock/Conway #18 @ 20% 2011: Little Rock/Conway #47 @ 18.1%

9. 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

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

11. 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

13. 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

14. 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

15. 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

16. 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

17. 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

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

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

20. INSECURE HOUSING AND CHILD AND HOUSEHOLD STATUS Secure HousingCrowdingMultiple Moves ReferentAORp p Household Food Insecurity11.3<.0011.9<.001 Child Food Insecurity11.5<.0012.6<.001 Fair/Poor Child Health11.07.141.48<.001 Child Development Risk11.06.491.71<.001 Adjusted for multiple family and child characteristics

21. FOOD, HOUSING, AND ENERGY INSECURITY LITTLE ROCK Percent

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

23. Increased Odds of Poor Outcomes

24. 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<.0011.47.01 At Risk for Under Weight10.92NS1.34.01 At Risk for Developmental Problems11.28.031.5.01 Maternal Health Fair/Poor11.62<.0011.81<.001 Positive Maternal Depression Screen12.45<.0012.88 <.001

25. www.ChildrensHealthWatch.org