368 - Prevalence and predictors of food and nutrition security among low-income hospitalized families

Publication Number: 4361.368

Michael Lugo, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Meghan Fanta, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Melinda C. MacDougall, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Shelley Ehrlich, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Kerry Tepe, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Olivia Haines, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Amanda Schondelmeyer, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Katherine Auger, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Nutrition security (NS) extends beyond food security (FS) to emphasize food quality along with quantity. The relationship between factors influencing FS and NS among families with children remains unclear, with some studies showing discordance between NS and traditional FS measures.

Objective: 1) Describe the prevalence and related factors of FS/NS status among families of hospitalized children with Medicaid insurance, and 2) examine the association of FS/NS with Healthfulness and Dietary Choice, receipt of nutrition assistance benefits (e.g., WIC, SNAP), and neighborhood-based Child Opportunity Index (COI).

Design/Methods: We conducted a prospective study of families with children with Medicaid insurance who were hospitalized at a standalone children's hospital. We obtained demographics, household characteristics (including current receipt of WIC/SNAP), and results from the U.S. Department of Agriculture 6-item (USDA-6) FS survey, and the Center for Nutrition and Health Impact (CNHI) Household NS, Dietary Choice, and Healthfulness Choice surveys from caregivers. FS status was defined using USDA-6 (score < 2: FS; ≥2: food insecurity [FI]). NS status was assessed via the CNHI NS survey (score >2: NS; ≤2: nutrition insecurity [NI]). Our outcome was the ordinal determination of FS/NS status, grouped into 1) FS/NS, 2) FI/NS and FS/NI, or 3) FI/NI. Due to uncertainty in their relative ranking, discordant groups were combined for analysis. Bivariate analyses explored associations between outcomes and multiple exposures; for ordinal logistic regression analyses, WIC, SNAP, and COI were used as predictors. A priori defined covariates included child age and language.

Results: Of 405 families enrolled, 43% were FI and 17% were NI. Most families were FS/NS (55%; Table 1). Among those eligible for nutrition assistance benefits, most received WIC (68%) and SNAP (78%), with notable gaps in benefit utilization despite eligibility. Both Dietary Choice (the ability to choose preferred foods) and Healthfulness Choice (choosing foods for health and well-being) were significantly associated with FS/NS status (p < 0.001). Unadjusted and adjusted ordinal logistic regression models showed no relationship between FS/NS and either the receipt of nutrition benefits or COI (p>0.05 for all models; Table 2).

Conclusion(s): Rates of FI among a vulnerable population are high and exceed NI rates. Since FS/NS aligns with dietary and healthfulness choice, exploring structural access, affordability, and perceived autonomy could help better understand the factors influencing FS and NS status.

Table 1: Summary of participant demographics and comparison of Food Security (FS) and Nutrition Security (NS) outcome groups using bivariate analyses (a: Fisher's exact test, b: ANOVA, c: Kruskal-Wallis).
WIC is a state-administered program that provides benefits to all children under 5 years old who are enrolled in Medicaid. Accordingly, we considered any child <5 years old in our cohort to be "eligible" for WIC. SNAP eligibility is based on USDA criteria, including household size and income. We used these to determine eligibility in our cohort. Receipt of WIC and SNAP benefits were determined based on caregiver report. Dietary choice refers to a household's perceived ability to select foods that meet their preferences, free from external constraints such as affordability, availability, or cultural appropriateness. Healthfulness choice refers to a household's perceived ability to choose foods that are good for their health and well-being, without being limited by external factors. Abbreviations: CNHI: Center for Nutrition and Health Impact, COI: Child Opportunity Index, SNAP: Supplemental Nutrition Assistance Program, WIC: Special Supplemental Nutrition Program for Women, Infants, and Children.

Table 2: Ordinal logistic regression analyses evaluating exposures, including receipt of WIC and SNAP benefits and neighborhood opportunity, with FS/NS outcomes, adjusting for patient age and language.