Food security and nutritional outcomes of preschool-age Mexican-American children. (Research).(Statistical Data Included)

Food insecurity has been defined 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" (1). In underdeveloped countries, limited access to food stunts growth in a large proportion of the children. In contrast, the effects of food insecurity in developed countries are often much less obvious. Some researchers have even suggested that periodic food deprivation may promote overeating and obesity later (2). In adult women, mild levels of food insecurity have been associated with higher body mass index (BMI) (3).

Based on in-depth interviews with low-income white and African-American women, the 12-item Radimer/Cornell scale was designed to detect food insecurity experienced at the household, adult, and child levels (4). The conceptual framework holds that food insecurity is a "managed process" with a sequence of responses as food supplies become more limited. At the first level, the household level, which is of mild severity-anxiety and concern about the household food supply exists. Consequently, the household makes budget adjustments that may affect the diet quality. At the adult level, which is of moderate severity, adults limit the quantity and quality of food consumed. At the last stage--the most severe stage, the child level--children feel the effects of limited food supplies and experience hunger. Trends are seen between deepening food insecurity and a decline in household food supplies, less-frequent fruit and vegetable consumption, and increased participation in food assistance programs and unemployment (5). Eating behaviors also become more disordered as food insecurity increases (6).

Although this conceptual framework maintains that children are spared until levels of food insecurity become severe, very little is known about the relationship of food insecurity to the well being of children. Data from the Continuing Survey of Food Intakes by Individuals (CSFII) indicate that percentage of energy from total and saturated fat increases in children's diets as households experience greater food insufficiency (7). Food insecurity has also been linked to emotional and psychological problems in children (8).

National data suggest that prevalence of food insufficiency is relatively high among Mexican Americans (9). Federal data using the 18-item Core Food Security Module similarly indicate that Hispanic Americans report relatively high levels of food insecurity (10). Yet, little is known about the cultural relevance of food security instruments in diverse ethnic groups (11).

The purpose of this paper is to examine the relationship of food security to dietary patterns and nutritional status of Mexican-American children of preschool age (aged 3 to 6 years). This information is needed to be able to tailor nutrition education and other services more effectively to food-insecure Mexican-American families.

METHODS

Subjects

University of California Cooperative Extension staff in Kern, Monterey, Fresno, and Tulare counties contacted local coordinators of Head Start; Healthy Start; the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); county day care centers; and Migrant Education for help in recruiting subjects. A convenience sample of 239 Mexican-Americans parents with preschool-aged children was reached through meetings, personal contact, and fliers. Attempts were made to recruit equal numbers of Spanish- and English-speaking Mexican-American families. Subjects were eligible for this study if they met the following criteria: the target child's age was between 36 and 72 months, at least one of the child's parents claimed to be of Mexican-American origin, and the child was not developmentally delayed or handicapped (per parental report). If the family had more than 1 preschool-aged child, the youngest child within our age range parameters was selected. Because this study was part of a larger i nvestigation examining the child-parent feeding relationship, twins and children living in homeless shelters were excluded from the study. All subjects signed consent forms approved by the Human Subjects Review Committee of the University of California at Davis. After the interviews, subjects received gift certificates from local stores, equivalent to $15 in value. Bilingual staff completed the interviews between February and May of 1998.

Instrument Development and Interview Procedures

The instrument included items related to food security, acculturation, household size, income, education, occupation, participation in food assistance and nutrition education programs, child feeding strategies, and the target child's health and early feeding history. The Spanish and English versions of the 12-item Radimer/Cornell food security scale, identical to the instruments used in a Puerto Rican population, were used to estimate levels of household, adult, and child food insecurity during the past month (12). This tool was chosen to enable comparisons with work carried out in other Mexican-American populations and to minimize respondent burden in using the 18-item Gore Food Security Module. Maternal acculturation level was …