Food Insecurity and Young Child BMI Status in the U.S. Affiliated Pacific (USAP) Region: Findings from the Children's Healthy Living Program
Authors: Li Fenfang , Novotny Rachel , Wilkens Lynne R , Fialkowski Marie K , Guerrero Rachael RT , Coleman Patricia , Bersamin Andrea , Fleming Travis , Deenik Jonathan 
Published: June 2021

Food insecurity may negatively impact children's growth and weight status. The purpose of this study is to: (1) examine prevalence of food insecurity among young children in the Pacific region and by indigenous ethnic populations; (2) examine the relationship of food insecurity and child's weight status and whether there is a race modification of such relationship. Data used were from 11 USAP jurisdictions that participated in the Children's Healthy Living Program (CHL): Alaska, American Samoa, Commonwealth of Northern Mariana Islands, Guam, Hawai‘i, Republic of Marshall Islands, Republic of Palau, Pohnpei, Yap, Kosrae and Chuuk.Food insecurity was considered present if in the past 12 months, a child's household self‐reported that money for food ran out before the end of the month sometimes, most times or always. Child weight and height were measured by trained and standardized staff and child's weight status was determined according to the following CDC categories: underweight (BMI percentile<5), healthy weight (5≤BMI percentile<85), overweight (85≤BMI percentile<95) and obese (BMI percentile ≥95). Child's race was categorized according to the US Office of Management and Budget (OMB) definitions: American Indian or Alaska Native (AIAN), Asian, Black, Native Hawaiian or Other Pacific Islander (NHPI), White, and More than one race. Child's race was also examined using Pacific ethnic definitions such as Native Hawaiian, Samoan, Chamorro, Chuukese, Marshallese, Kosraean, etc. Logistic regression models were used to examine the relationship of overweight and obesity (OWOB) and underweight with food insecurity, controlling for child's age, sex, and race.Of the 4,838 children included, 68% were healthy weight, 29% were OWOB, and 3% were underweight. Slightly over half experienced food insecurity (52%). Food insecurity differed significantly by race, with highest prevalence among Chuukese (81%), Marshallese (76%), Kosraean (74%), Pohnpeian (71%) and Yapese (60%). Logistic regression found significant race/ethnicity modification on the relationship of OWOB and underweight with food insecurity. Among Pohnpeians, children with food insecurity were 69% more likely to be OWOB than those without (OR=1.69, p=0.005). Among Chuukese, Samoan, and Mixed Race, however, children with food insecurity were 60–80% less likely to be OWOB than those without (ORs 0.2–0.4, p<0.01). Among Hawaiian, Kosraean, Mixed Race, and White, food insecure children were more likely to become underweight than those with no insecurity. No significant association was observed among other race/ethnic groups.The Pacific region is experiencing the dual burden of obesity and underweight, as well as rapid dietary change. Food insecurity is an importing underlying driving force of such change. Interventions targeting food insecurity or childhood obesity should take consideration the stage of the nutrition transition and the complex ethnic composition in this region.Support or Funding InformationSupported by Agriculture and Food Research Initiative Grant no 2011‐68001‐30335 from the USDA National Institute of Food and Agriculture