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What’s a Child Nutrition Program?
Subsidized Housing and the Low-Income Home Energy Assistance Program (LIHEAP) Are Linked to Improved Growth Outcomes for Young Children of Color
Stephanie Ettinger de Cuba, MPHChildren’s Sentinel Nutrition Assessment Program (C-SNAP)
Boston University School of Public HealthBoston Medical Center
Tuesday, November 7, 2006
Authors
• Stephanie Ettinger de Cuba, MPH• Deborah A. Frank, MD• Nicole Neault, MPH• Mariana Chilton, PhD• John Cook, PhD• Carol Berkowitz, MD• Maureen Black, PhD• Patrick Casey, MD, MPH• Diana Cutts, MD• Alan Meyers, MD, MPH• Nieves Zaldivar, MD• Suzette Levenson, MPH, EdM• Timothy Heeren, PhD• Zhaoyan Yang, MS
Children’s Sentinel Nutrition Assessment Program
(C-SNAP)
A national network of clinicians and public health
specialists for research in multiple pediatric settings on the
effect of U.S. social policy on young, low-income children’s
health and nutrition.
C-SNAP Study Sites
-Little Rock, AR -Boston, MA -Washington, D.C.*
-Baltimore, MD -Minneapolis, MN
-Philadelphia, PA -Los Angeles, CA*
C-SNAP Study Sites
Study Objective
Evaluate the importance of federal assistance programs not commonly identified with child nutrition, such as LIHEAP and Subsidized Housing, to child growth and health outcomes among young black and Latino children
Study Methods
• August 1998 – December 2004• Sentinel sample• Interview caregivers • Children 0-3 years • Emergency departments & acute care clinics• Black and Latino children - over 80%• Weight & length measurements -- outcome of
interest & accepted international indicator of wellbeing
Eligible Families
• Sample restricted to:– Low-income renters of color
with children under 3– Participate in at least one
means-tested program
• Subsidized Housing sample: (n = 13,069)
• LIHEAP sample: (n = 4,091) – additionally:
• Excludes private insurance• Only renters - heat not
included
Analytic Methods
• Multiple logistic regression
• Covariates for each program separate
- depending on correlation with program/outcome
Subsidized Housing analyses controlled for:
• Mother born in US• Receipt of TANF• Receipt of WIC• Food insecurity status
LIHEAP analyses controlled for:
• Mother born in US• Year of interview• Food insecurity status• Receipt of either TANF or Food Stamps• Receipt of WIC• Receipt of Housing Subsidy• Caregiver marital status• Caregiver employment
2004 Poverty Rates AmongHouseholds with Children
US Census Bureau, 2005
Poverty Highest among black and Latino families
2004 Food Insecurity Rates among Households with Children
Nord, Andrews, and Carlson, 2005
Food insecurity highest among black and Latino families
2004 National Eligible Household Participation in
LIHEAP
U.S. Department of Health & Human Services, 2004
Housing & LIHEAP onlyreach a fraction of eligibleC-SNAP families
Subsidized Housing Helps Black Children Grow
Outcome Subsidy
(n=3,116)
No Subsidy
(n=4,977)
P Value
≤2 SD Weight/Age below the mean
1.00 1.33 P = 0.006
Outcome Subsidy
(n=3,116)
No Subsidy (n=4,977)
P Value
Mean Z-Height/Age
Z = 0.134 Z=-0.005 P<.0001
LIHEAP Improves YoungBlack Children’s Growth
Outcome LIHEAP (n=778)
No LIHEAP (n=3,313)
P Values
At Nutritional Risk for Growth
Problems*
1.00 1.29 P = 0.05
Outcome LIHEAP (n=778)
No LIHEAP (n=3,313)
P Values
Mean Z-Weight/Age
Z = 0.061 Z=-0.051 P = .04
*Nutritional risk: < 5th percentile for weight-for-age or <10th percentile for weight-for-height
Subsidized Housing Helps Latino Children Grow
Outcome Subsidy
(n=720)
No Subsidy (n=4,256)
P Value
≤2 SD
Height/Age below the
mean
1.00 1.99 P = 0.02
LIHEAP and Latino Children
• Results for Latino children and LIHEAP not presented since did not reach statistical significance, probably due to small sample size.
• Limited program participation reflects sample characteristics
– most Latino children lived in California, where few families of any ethnicity access LIHEAP.
Overweight?
No associations between overweight and LIHEAP or
Subsidized Housing
Limitations
• Interviews in English, Spanish, and Somali (MN only)
• Only blacks and Latinos• Exclusion of the most severely ill or
injured children • Associations are not causation• Difficult to make national extrapolations
Non-food assistance programscan improve children’s growth
• Programs like LIHEAP and Subsidized Housing linked to improved growth outcomes
• “Heat or eat” phenomenon: Food budget only variable expense
• Food most easily decreased to pay for other expenses, leading to increased food insecurity, particularly during winter months.
Implications for Young Black & Latino Children
• Growth is indicator of health in young children
• Adverse child growth outcomes associated with not receiving benefits
• Safety net programs buffer young children from effects of poverty
UN Convention on the Rights of the Child
Article 271.States Parties recognize the right of
every child to a standard of living adequate for the child’s physical, mental, spiritual, moral and social development…
3. States Parties… shall take appropriate measures to assist parents…to provide material assistance and support programmes, particularly with regard to nutrition, clothing and housing.
Why does it matter?
Housing and Energy are Health Issues:
Early growth failure sets children up for long-term health & development problems.
Affordable Housing and Energy are Human Rights Issues: Black & Latino children => 35% of all children in US.
Black & Latino children higher risk for living in poor HHs
Also at greater risk for negative growth effects associated with poverty and food insecurity.
Food insecurity and its effects exacerbate achievement gaps and deepen racial/ethnic health disparities, depriving victims of other rights.
Society Has a Duty to Guarantee Children’s Basic Rights: Macro perspective: Denial of basic rights -> disastrous effects
on workforce participation and health of national economy.
Why does it matter?
What can we do aboutchanging policy?
Educate Policymakers to:• Reconsider standard view of which assistance programs
influence child nutrition.– Food + Non Food = Optimal Child Health
• Understand that safety-net programs “good medicine” but dosage and availability inadequate.
• Stop cutting or freezing funding for safety-net programs - created health crisis for poor children, especially children of color
• Give recommended “dosage”: Full package of benefits -> social investment -> reduction of racial/ethnic disparities
Acknowledgements
• Report sponsored by the Joint Center for Political and Economic Studies
• Thanks to Avi Perry, Bill Emerson National Hunger Fellow, for his assistance in preparing this presentation.
C-SNAP operations and analyses have been supported by: the Abell Foundation, the Annie E. Casey Foundation, the Anthony Spinazzola Foundation, the Candle Foundation, the Claneil Foundation, the Daniel Pitino Foundation, the EOS Foundation, the Gold Foundation, the Gryphon Fund, the Hartford Foundation for Public Giving, Jennifer Kaminsky, MAZON: A Jewish Response to Hunger, the Minneapolis Foundation, the New Hampshire Charitable Foundation, Project Bread, the Sandpiper Philanthropic Foundation, the Schaffer Foundation, Susan P. Davies and Richard W. Talkov, Susan Schiro and Peter Manus, the Thomas Wilson Sanitarium for Children of Baltimore City, the United States Department of Agriculture, Vitamin Litigation Funding, with major funding from the W. K. Kellogg Foundation.
Please visit us on the web:
www.c-snap.org
Thank you!