Food Hardships and Child Behavior Problems among Low-income Children Food Hardships and Child Behavior Problems among Low-income Children

Using data from two waves of a panel study of families who currently or recently received cash welfare benefits, we test hypotheses about the relationship between food hardships and behavior problems among two different age groups (458 children ages 3–5-and 747 children ages 6–12). Results show that food hardships are positively associated with externalizing behavior problems for older children, even after controlling for potential mediators such as parental stress, warmth, and depression. Food hardships are positively associated with internalizing behavior problems for older children, and with both externalizing and internalizing behavior problems for younger children, but these effects are mediated by parental characteristics. The implications of these findings for child and family interventions and food assistance programs are discussed. Food Hardships and Child Behavior Problems among Low-Income Children INTRODUCTION In the wake of the 1996 federal welfare reforms, several large-scale, longitudinal studies of welfare recipients and low-income families were launched with the intent of assessing direct benchmarks, such as work and welfare activity, over time, as well as indirect and unintended outcomes related to material hardship and mental health. One area of special concern to many researchers and policymakers alike is child well-being in the context of welfare reforms. As family welfare use and parental work activities change under new welfare policies, family income and material resources may also fluctuate. To the extent that family resources are compromised by changes in welfare assistance and earnings, children may experience direct hardships, such as instability in food consumption, which in turn may affect other areas of functioning. It is also possible that changes in parental work and family welfare receipt influence children indirectly through their caregivers. As parents themselves experience hardships or new stresses, their mental health and interactions with their children may change, which in turn could affect their children’s functioning. This research assesses whether one particular form of hardship, food hardship, is associated with adverse behaviors among low-income children. Specifically, analyses assess whether food hardships have relationships with externalizing (e.g., aggressive or hyperactive) and internalizing (e.g., anxietyand depression-related) child behavior problems, and whether associations between food hardships and behavior problems are mediated by parental stress, warmth, and depression. The study involves a panel survey of individuals in one state who were receiving Temporary Assistance for Needy Families (TANF) in 1998 and were caring for minor-aged children. Externalizing and internalizing behavior problems associated with a randomly selected child from each household are assessed in relation to key predictors, taking advantage of the prospective study design. 2 BACKGROUND Food hardships have been conceptualized by researchers in various ways. For example, food insecurity is defined by the U.S. Department of Agriculture (USDA) as the “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways” (Bickel, Nord, Price, Hamilton, and Cook, 2000, p. 6). An 18-item scale was developed by the USDA to assess household food insecurity with and without hunger, where hunger represents a potential result of more severe forms of food insecurity, but not a necessary condition for food insecurity to exist (Price, Hamilton, and Cook, 1997). Other researchers have used selected items from the USDA Food Security Module to assess food hardships (Nelson, 2004; Bickel et al., 2000) The USDA also developed the following single-item question to identify food insufficiency: “Which of the following describes the amount of food your household has to eat....enough to eat, sometimes not enough to eat, or often not enough to eat?” This measure addresses the amount of food available to a household, not assessments about the quality of the food consumed or worries about food (Alaimo, Olson and Frongillo, 1999; Dunifon and Kowaleski-Jones, 2003). The Community Childhood Hunger Identification Project (CCHIP) assesses food hardships using an 8-item measure to determine whether the household as a whole, adults as individuals, or children are affected by food shortages, perceived food insufficiency, or altered food intake due to resource constraints (Wehler, Scott, and Anderson, 1992). Depending on the number of affirmative answers, respondents are categorized as either “hungry,” “at-risk for hunger,” or “not hungry” (Wehler et al., 1992; Kleinman et al., 1998). Other measures, such as the Radimer/Cornell measures of hunger and food insecurity, have also been created to measure food hardships (Kendall, Olson, and Frongillo, 1996). In recent years, food hardships in the United States have been on the rise. After declining from 1995 to 1999, the prevalence of household food insecurity in households with children rose from 14.8 percent in 1999 to 16.5 percent in 2002, and the prevalence of household food insecurity with hunger in households with children rose from 0.6 percent in 1999 to 0.7 percent in 2002 (Nord, Andrews, and 3 Carlson, 2003). A similar trend was also observed using a subset of questions from the USDA Food Security Module (Nelson, 2004). Although children are more likely than adults to be buffered from household food insecurity (Hamilton et al., 1997) and inadequate nutrition (McIntyre et al., 2003), a concerning number of children are reported to skip meals or have reduced food intake due to insufficient household resources. Nationally, children in 219,000 U.S. households were hungry at times during the 12 months preceding May 1999 (Nord and Bickel, 2002). Food Hardships and Child Behavior Problems Very little research has been conducted on the effects of food hardship on children’s behaviors, although the existing research suggests that it is associated with adverse behavioral and mental health outcomes for children. Using data from the National Health and Nutrition Examination Survey (NHANES), Alaimo and colleagues (2001a) found that family food insufficiency is positively associated with visits to a psychologist among 6to 11year-olds. Using the USDA Food Security Module, Reid (2002) found that greater severity and longer periods of children’s food insecurity were associated with greater levels of child behavior problems. Dunifon and Kowaleski-Jones (2003) found, using the same measure, that food insecurity is associated with fewer positive behaviors among school-age children. Children from households with incomes at or below 185 percent of the poverty level who are identified as hungry are also more likely to have a past or current history of mental health counseling and to have more psychosocial dysfunctions than children who are not identified as hungry (Kleinman et al., 1998; Murphy et al., 1998). Additionally, severe child hunger in both pre-school-age and school-age children is associated with internalizing behavior problems (Weinreb et al., 2002), although Reid (2002) found a stronger association between food insecurity and externalizing behaviors than between food insecurity and internalizing behaviors among children 12 and younger. Other research on hunger has identified several adverse behavioral consequences for children (See Wachs, 1995 for a review; Martorell, 1996; Pollitt, 1994), including poor play behaviors, poor preschool achievement, and poor scores on 4 developmental indices (e.g., Bayley Scores). These studies have largely taken place in developing countries, where the prevalence of hunger and malnutrition is much greater than in the U.S. population (Reid, 2002), so it is not known whether similar associations would emerge for children in the United States. Furthermore, while existing studies point to a relationship between food hardships and adverse child behavioral outcomes, limitations in design stemming from cross-sectional data, reliance on singleitem measures of food difficulties, or failure to adequately control for factors that may confound the observed relationships make it difficult to assess the robustness of the findings. For current and recent recipients of welfare and their families, increased food hardships are a potential problem, given the fluctuations in benefits and resources that families are likely to experience as a result of legislative reforms. To the extent that food hardships are tied to economic factors, we may expect levels of food hardships to increase for families who experience periods of insufficient material resources, and to decrease for families whose economic situations improve. If levels of food hardship are associated with the availability of parents and other caregivers, we may find that the provision of food to children changes as parents work more hours, or as children spend more time in alternative caregiving arrangements. Poverty and Child Behavior Problems When exploring the relationship between food hardships and child well-being, it is crucial to ensure that factors associated with economic hardship and poverty are adequately controlled, particularly since poverty has been linked to some of the same outcomes as food hardships. Extensive research has shown a higher prevalence of behavior problems among children from families of lower socioeconomic status (McLoyd, 1998; Duncan, Brooks-Gunn, and Klebanov, 1994), and from families receiving welfare (Hofferth, Smith, McLoyd, and Finkelstein, 2000). This relationship has been shown to be stronger among children in single-parent households than among those in two-parent households (Hanson, McLanahan, and Thompson, 1996), and among younger children (Bradley and Corwyn, 2002; McLoyd, 5 1998), with less consistent findings for adolescents (Conger, Conger, and Elder, 1997; Elder, N