The Effects of Food Insecurity on Child Health: Updated Estimates from Nationally Representative Data

Background and Purpose: The United States Department of Agriculture’s (USDA) food and nutrition assistance programs reach one out of every four American households each year at a total cost of over $100 billion (Oliveria, 2017). Yet, at some time during 2016, 12.3% of American households – 41.2 million people – experienced food insecurity, meaning that they did not have enough money or other resources to provide sufficient food for everyone in the home (Coleman-Jensen et al., 2017). The continued prevalence of food insecurity, even in light of the sizeable commitment by the USDA, is of critical concern, posing a threat to health and a challenge to effective programming. Renewed efforts to combat food insecurity will require expansions of existing policies as well as new policies to creatively combat this persistent problem. One way to encourage such efforts is to clearly articulate the costs of food insecurity. While a number of previous studies have pointed to the negative impacts of food insecurity on health, these studies have not dealt carefully with issues of selection bias, prompting a recent review (Gundersen & Ziliak, 2018) to call for researchers to more clearly identify the causal effects of food insecurity. Accordingly, this study uses propensity score weighting to investigate the effects of household food insecurity on the health of children.

Methods: The study uses nationally representative data from the National Health Interview Study (NHIS). We restrict our sample to households with children. Pooling data from 2013-2016, we examine a broad range of child health outcomes and account for a comprehensive set of controls. These data strengths are central to our effective use of inverse probability of treatment weighting (IPTW) to address selection bias. We use IPTW to create a weighted sample in which selection into food insecurity is independent of an extensive list of covariates, weighting observations based on their propensity for experiencing food insecurity. Diagnostics indicate that our IPTW model created balanced treatment and control groups with respect to key covariates (Austin & Stuart, 2015).

Results: Consistent with previous work, our results indicate that food insecurity affects children’s health in a number of negative ways. Broadly, food insecurity causes worse health among children, with food insecure children significantly less likely to be in very good or excellent health compared to food secure children. Food insecurity also leads to higher rates of: emergency department use; delayed necessary medical care; and needing but being unable to afford medical, dental, and mental health care. Further, food insecure children are more likely to experience some chronic and acute health problems, including common cold; stomach problems; depression; asthma; and food, respiratory, and seasonal allergies. However, no significant differences emerged in areas including general mental health, ADHD, diabetes, or ear infections. Children in food insecure households did not fare better on any outcome.

Conclusions: These findings directly address the need for rigorous research investigating causal impacts of food insecurity and highlight the continued urgency of effective policies to combat food insecurity among children and promote child health.