628 - Inpatient and Household Food Insecurities Impact Financial and Psychological Stress of Caregivers of Hospitalized Children

Publication Number: 3609.628

Laura Plencner, Children's Mercy Kansas City, Prairie Village, KS, United States; Jessica Bettenhausen, Children’s Mercy, Prairie Village, KS, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Molly Krager, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; S. Margaret Wright, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Emily J. Goodwin, University of Missouri Kansas City, Children's Mercy Kansas City, Kansas City, MO, United States; Isabella Zaniletti, IZ Statistics LLC, Tampa, FL, United States; Jacqueline Kitchen, Children's Mercy Hospitals and Clinics, Overland Park, KS, United States; Jeffrey D. Colvin, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Background: Inpatient food insecurity (IFI) is caregivers experiencing inadequate food access or skipping meals due to cost during a child's hospitalization. Prior research demonstrates that IFI is common, incompletely overlaps with household food insecurity (HFI), and has been associated with caregiver distress and longer length of stay and readmissions. The relationship with IFI and caregiver stress is not well described.

Objective: We aimed to assess HFI, IFI, and caregiver psychological and financial stress during the hospitalization.

Design/Methods: This prospective cross-sectional study surveyed caregivers of hospitalized children on a general inpatient unit from 8/2021-12/2022. The main predictor was food insecurity, categorized into: no food insecurity, HFI only, IFI only, and both HFI and IFI. The main outcomes were financial stress (e.g., job loss, ability to take paid leave), caregiver stress during the hospitalization time period (Cohen's Perceived Stress Scale [PSS]), emotional support (PROMIS Emotional Support scale), and resilience (Brief Resilience Scale). Multivariable logistic and linear regressions estimated associations between each outcome by food security status.

Results: The characteristics of the 170 participants were similar across food security statuses (Table 1). Over 30% endorsed IFI and 25% caregivers experienced HFI in the past 12 months. No participants with both HFI/IFI could take paid leave (Table2). In adjusted analyses, participants with IFI only and both HFI/IFI had 11.5 (95% CI: 3.6, 36.9) and 32.3 (95% CI: 8.8, 117.8) adjusted odds of concerns about job loss, respectively, compared with those with no food insecurity (Table 3). Compared to those with no food insecurity, the IFI only group had 13% higher and the HFI/IFI group had 20% higher adjusted PSS. Additionally, IFI only had 4% lower and both IFI/HFI had 7% lower emotional support scores. Participants with both HFI/IFI also had 10% lower adjusted resilience.

Conclusion(s): Caregivers with both HFI/IFI had higher odds of being concerned about job loss, higher perceived stress, lower emotional support, and lower resilience compared to participants with neither HFI/IFI. These results suggest that, while HFI and IFI are distinct issues, their effects are compounding. The most effective interventions to reduce caregiver stress during a child's hospitalization would address both the more immediate needs of IFI (i.e., inpatient meal trays or food vouchers) as well as the longer-term needs of HFI (i.e., referral to federal nutrition or community programs).

Table 1
*Percentages do not total 100% because participants could select more than one health-related social need

Table 2


Table 3
*Dichotomous outcomes of "yes" or "no" responses analyzed by logistic regression
^Continuous outcome with a range of a total Perceived Stress Scale of 0-40 analyzed by linear regression
~Continuous outcome with a range of Emotional Support Scale 0-100 analyzed by linear regression
±Continuous outcome with a range of Brief Resilience Scale of 1-5 analyzed by linear regression
All models adjusted for participant age, gender, race/ethnicity, income, and distance from hospital.