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* Delta Nutrition Intervention Research Initiative, University of Southern Mississippi, Hattiesburg, MS 39406-5054;
Department of Nutrition and Food Systems, University of Southern Mississippi, Hattiesburg, MS 39406-5172; and
** School of Social Work, University of Southern Mississippi, Hattiesburg, MS 39406-5114
2To whom correspondence should be addressed. E-mail: Carol.Connell{at}usm.edu.
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ABSTRACT |
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 TOP ABSTRACT SUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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KEY WORDS: • food security • hunger • children • qualitative research
During the late 1980s and early 1990s, research focused on understanding the experience of food insecurity and hunger from the perspective of adults, particularly families with children living at home (1,2). This research resulted in a conceptualization of food insecurity and hunger that was grounded in the experience of adults and included 4 broad components at 2 levels of food insecurity, the individual level and the household level. The first component was a quantity aspect, including food depletion at the household level and insufficient food intake at the individual level. The second component was a quality component composed of unsuitable food at the household level and an inadequate diet at the individual level. The third, a psychological component, included anxiety about the household food supply and individual feelings of deprivation or lack of choice. The fourth, a social component, included acquiring food through socially unacceptable means at the household level and disrupted eating patterns at the individual level (1,3). This conceptualization was then used in the development of the current measure of household food security (4).
A number of studies have attempted to assess the effect of household food insecurity on the nutritional, physical, and mental well-being of children using household level measures of food insecurity. In short, these studies reported associations between household food insecurity and adverse emotional, behavioral, academic, and cognitive measures as well as poorer mental and physical quality of life measures among children (5–17). Studies of the associations between food insecurity and child well-being to date have used household levels of food insecurity as reported by adult respondents. Little if any research has been conducted to assess children’s own perceptions of or experience with food insecurity. An understanding of the experience of food insecurity by children is essential for better measurement and assessment of the effect of food insecurity on children’s health and quality of life. Therefore, the purpose of this research was to explore children’s perceptions of household food insecurity and use their descriptions of food insecurity to define components of the experience of food insecurity for children.
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SUBJECTS AND METHODS |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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Questions used in the semistructured interviews were developed with assistance from food security experts and an expert in qualitative marketing research with children. The questions were designed to assess children’s perception of food insecurity by asking what happened when food supplies in the house began to get low and what they thought led to that situation, as well as about anxiety over the family’s food supply. Questions and interview methods were pretested with the guidance of a child marketing research expert, with 10 children aged 10–12 y old who resided in a local apartment complex housing primarily graduate and/or married university students. The pretest resulted in a few minor changes to the qualitative questions, inclusion of more probes, addition of a nonthreatening opening question to introduce the topic of food and meals, 2 transition questions leading into the primary questions related to food insecurity, and a closing question designed to diffuse tension that might have been created from the discussion about running out of food (Table 1). The questions were used as a guide for the conversation about food insecurity with children. Probes were used if children were hesitant in answering a question or to clarify what children were expressing in the conversation about food insecurity. The food insecurity questions (Q4–Q6) are the focus of this article.
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RESULTS |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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The qualitative interviews were concluded after interviewing 32 children because similar answers were being obtained from children who had knowledge of food insecurity. Our sample of children was somewhat smaller than the average sample size reported in a review of qualitative research sample extensiveness by Sobal (22). However, purposeful sampling of children likely to have experience with food insecurity allowed us to reach data repetitiveness, informational redundancy, and thus theoretical saturation with 32 individual interviews (21,23,24). Even though 4 children were not willing/able to answer questions related to household food insecurity, there were consistent answers across the remaining children who had knowledge of food insecurity. The study sample was equally divided between boys and girls (Table 2). Similarly, Black children and White children, and rural and nonrural children were fairly equally distributed. The majority of the Black children lived in the mid-size inner city (urban), whereas all of the White children lived in the rural community. The children ranged in age from 11 to 16 y old; the majority (65%) were 13–14 y old.
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Because it became clear in the early interviews that we could not ask children whether they had direct experience with food insecurity, we asked them if they knew of a child whose family who had run out of food before there was money to buy more. Eighteen of the children stated they had known kids from other families who nearly ran out of food before the end of the month. Despite our purposeful sample and the fact that we asked about "other kids," there were still a small number of children who said they did not know other kids who had this problem. However, when probed further, 10 of these children described situations that indicated they were well aware of "others" who had problems running out of food. From this, we concluded that 28 children had some experience, either directly or indirectly, with food insecurity (data not shown). Children across all ages that we interviewed were able to describe situations in which families had "almost run out of food before the end of the month." Most used behaviors to describe how they came to know these families were running out of food. Children who appeared to be the most comfortable expressing their thoughts freely described situations of food insecurity. They talked about how families got in a food shortage situation and described what other kids said/did to let them know they were running out of food. They also reported what grown-ups said/did when food supplies were getting low
Causes of food insecurity. Resource constraints were mentioned as the cause of food insecurity in 17 of the interviews (data not shown). These are illustrated in the following quotes:
"His daddy died and his mama didn’t have a job."
"Say that we don’t have enough food stamps. If we are working on food stamps, you got that card and it runs out of money. That is bad."
"... it was the bills. They had so many bills that they had to pay and had to cut back on some stuff."
In 7 interviews, other reasons given were the parent(s)/caregiver smoking, drinking alcohol, or buying drugs or clothes rather than buying food.
Children’s behaviors and responses associated with food insecurity. Children indicated they did not routinely talk to each other about running out of food. They used behaviors to describe how they could tell when another child or family was running out of food (Table 3). We categorized the statements related to children’s behaviors and responses associated with family food insecurity into the 3 broad themes noted in the Methods. Within the theme of children’s eating behaviors, eating less was mentioned in 14 interviews, eating food that was less desirable because there was no other choice in 13 interviews, and eating larger amounts or faster than normal in 7 interviews. Eating all of the school lunch or eating the school lunch very fast were behaviors 2 children told us indicated others were running out of food at home. Over twice as many children in the rural setting mentioned eating less compared with the urban group. Children mentioned being ashamed or fearful of being labeled as "poor" 14 times in 7 interviews, primarily during the urban interviews. We categorized this under the theme of emotional responses to the family running out of food. Within the theme of social behaviors, children eating with other family, friends, or neighbors or borrowing food or money to buy food was mentioned in 12 interviews. A similar behavior, "sharing" food, was mentioned in 5 interviews. Eating with others, borrowing, or sharing was mentioned in >4 times the number of urban interviews compared with rural interviews. Statements indicative of these behaviors/responses were:
Eating less: "They will just start cutting back on what they’re eating."
View this table:
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TABLE 3 Children’s descriptions of food insecurity in terms of the number of times in which the behavior or response appeared
Eating less desirable foods: "... change to lower class meals like eatin’ a whole lot of canned food instead of fixin’ up some proper meals."
Eating with others/sharing: "... they ask if they can spend the night over to our house and I tell them yes ..."
Shame/fear: "They be like ashamed or whatever."
Children’s descriptions of adults’ behaviors and responses associated with food insecurity. Children also mentioned adult’s behaviors related to food insecurity; we categorized behaviors of adults as described by children into the same 3 broad themes of "eating behaviors," "emotional responses," and "social behaviors" (Table 3). Statements about eating behaviors related to parents’ eating less food themselves to save food for the children. Comments about adults were most often in the category of emotional responses or social behaviors. Within the theme of emotional responses, the most frequently mentioned were trying to hide the situation from children (10 interviews), telling the child about the lack of money or food only when necessary (8 interviews), and indications of family stress related to running out of food (7 interviews). We classified trying to hide the situation or telling the child only when necessary in the emotional responses category because statements made about these responses indicated that parents/caregivers were experiencing stress related to trying to protect children from experiencing hunger. Social behaviors included encouraging the child to eat with others or to borrow food or money, and limiting the child’s activities. Parents encouraging children to eat with someone else or borrow money/food was mentioned only in the urban interviews. Examples of statements associated with these behaviors were:
Hide situation: "Sometimes they just lie to protect them (the younger kids) so they don’t scare the children."
Family stress: "They (children) start looking sad and everything and their (parents’) attitudes get worse ’cause the kids get real hungry and the parents start to get madder and madder ’cause the kids’ beggin’."
Limiting activities: "My mom just tells me straight out that we don’t have the money to do [this] and we don’t have the money to do that."
Components of the food insecurity experience of children
Because the statements about adult behaviors were part of the child’s perception of family food insecurity, child and adult themes that were similar were collapsed. These groups were then categorized into 4 components of food insecurity previously described by Radimer et al. (1) that the researchers judged also captured components of the food insecurity experience of children (Table 4).
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Eating less (quantity and frequency). This component of the food insecurity experience of children included eating less, being told to "wait" to eat, losing weight due to eating less, and adults eating less so children could have food. Eating less food than desired or less frequently than usual was mentioned 24 times. Statements representing this component of the food insecurity experience of children were:
"They sort of ration the food ... say that if you have a large meal and food begins to run out, you go to a medium meal, then a small meal and they get smaller."
"They [parents] ... organize all their food or eat one time and find ways to supplement food and stuff ... the parents might eat once a day and the kids eat regular like they do everyday."
Eating more or fast when food is available. Although only 7 interviews contained this theme, it was interesting that individual children in different settings talked about it. It was mentioned in both urban and rural interviews. Children mentioned eating all of the school lunch or "eating real fast" as indications that another child was running out of food at home.
"Yeah, ’cause when they get food they try to eat it all up so that it will take a long time before they get hungry again."
"... they eat all of their food [at school] and people make fun of them, that they eat all their food."
"... eat a lot at school and then when you come home you won’t be hungry for another hour or 4 hours."
Quality component
Use of a few kinds of low-cost ("cheap") foods. It appeared that this component of the food insecurity experience overlapped considerably with the psychological aspect of the experience in that children talked about eating foods they did not necessarily like, but that were the only foods in the house. Children generally named canned foods when talking about eating only a few kinds of low-cost foods. This theme appeared 15 times in the course of 11 interviews and included children eating less desirable foods or only a few items and parents preparing less desirable or only a few foods. Statements associated with this theme were:
"They eat bologna or vegetables in the can ..." "Little small foods or like just 3 things to eat and drink ... toast, sausage, and peas."
Psychological components
Worry/anxiety/sadness about the family food supply. Two themes we placed in the psychological component of children’s food insecurity overlapped with social components of the experience as well. These overlapping components included worry/anxiety, shame/fear, attempts to shield children, and family stress. Statements that appeared to overlap were counted in each of the themes. Statements made by children in 14 interviews indicated worry, anxiety, or sadness about the family food situation either on the part of the parent or child. For parents, expressing worry was exemplified by this quote:
"... she would tell them she has to pray about it and pray that everything would get better because they are not giving her enough food stamps to supply her and her kids."
The term "look sad" was used to describe children who were running out of food. Children who talked about other children running out of food told us they knew this by the way the child looked. Two very shocking examples of children describing other children’s anxiety and sadness (or their "look") were:
"They make those sad faces."
"They will look crazy and try to borrow food."
Feeling there is "no choice." This theme overlapped with the quality component theme of use of a few kinds of low-cost foods. Children who talked about eating less desirable foods usually discussed it in the context of eating a few foods that they would not have chosen had there been another choice. The concept of lack of choice was reflected in statements such as:
"... She just cook ... something we don’t like and says this is all we have."
"... the parents would say that they were running out of food and that they had to cut back on the meals ... and that they should be grateful for the meals they had to eat; it was better than having nothing."
Shame/fear of being labeled as "poor." This theme focused on shame about the family’s situation and fear of being labeled as "poor." The children indicated that they did not routinely talk to each other about running out of food. One or two said they might tell their best friend that they were low on food at home, but most of them "just knew" when "other kids" were food insecure or hungry by their behaviors or "looks" as noted above. Several children said it would be embarrassing to tell others that food was running out in the household and that other kids would make fun of children who had this problem.
"... some of them be like ashamed or whatever."
"... well, where we stay, they will [tease them] ... push them in the head and talk about them. They will bring up something like that that they had to come to their house and eat their food."
"they don’t want their friends to think bad of them or think that they are a poor family ... yeah, a whole lot of people would take that as an advantage over you ... if he tells the truth [about not having food] in a class of boys, they will take that to their advantage."
Attempts to shield children. We labeled statements related to "sharing" food as attempts to shield children from hunger in addition to being part of the informal network for food acquisition. In addition, we included adults trying to hide the situation from children and encouraging children to eat with others or borrow money in this theme. Several children indicated that adults and even older siblings would try to hide food insecurity from younger children.
"... I go in my house and I do everything that I can for my little brother, my little sister, and my friends so I just bring them something to eat."
Inability to shield children. Statements made by children indicated that parents tell them about the food situation at home only when the situation has reached a critical point and there is not enough food for them. We chose to separate this theme from attempts to shield children and labeled it "inability to shield children." It included parents telling the child to "wait until I get paid" or telling him/her to "go play" when the child asked for something to eat.
Social components
Use of informal social networks for food acquisition. Sharing, borrowing food or money to buy food, and eating with other families were mentioned most frequently by children in the 2 after school programs. Parents encouraging these behaviors were mentioned directly in 4 urban interviews but not rural ones. We labeled these behaviors "use of informal social networks for food acquisition." Only 1 child in the rural interviews mentioned being "loaned" some money that he then used for food. Statements related to this were:
"They send you to borrow some flour. Our neighbor do that all the time. She borrow flour and eggs all the time so that she can finish cooking. We borrow flour all the time. We always run out."
"... she gets food stamps but they like run out like in the middle of the month so my mama gives her some chicken or something."
"... they go ask my mama because they know that she gonna feed them and they can just stay and get fed."
Limited participation in social activities. Parents limiting children’s social activities due to limited resources was categorized as a social component of the experience of food insecurity because children in the interviews indicated this was a way they knew families were running out of money.
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DISCUSSION |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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Children’s responses spanned the severity range of food insecurity from the psychological aspect of worry to the quantitative aspect of eating less (1). The most frequent responses were related to using informal social networks for food acquisition, having no choice in the foods eaten, and eating less. Only 2 children indicated they or "other kids" had gone hungry and no child talked about going a whole day without eating. This supports earlier work indicating that most children are spared from hunger by adults except at the most severe level of household food insecurity (1,2,14). It also may reflect the important role of the school breakfast and lunch programs in providing nourishment for children because a few children talked about eating all of the school lunch to keep from being hungry later. One child said other food insecure kids would eat the school lunch to keep from being hungry even if it was something they did not want.
We expected the interviews to be somewhat sensitive. We discovered in the pretest that children would not answer questions that were directed toward them personally; we had to ask about "kids from a family ..." Somewhat surprising was the magnitude of the psychological responses, emotional strain, and social ramifications created for the children "running out of food." A growing body of literature suggests an association between household food insecurity and children’s adverse outcomes related to emotional and mental health (8,12,13,17) as well as cognitive, academic, and psychosocial development (10). The remainder of the discussion will focus on the emotional responses and social ramifications that may add to the current knowledge related to food insecurity and child well-being. Additionally, there were some obvious differences in the responses of urban vs. rural children that will be discussed.
Bandura’s work in social learning and, later, social cognitive theory, suggests that children not only are affected by their parents’ stressors, but in fact mirror and replicate their parents’ responses to the same stressors (25,28,29). Thus, children capable of cognition can understand issues such as inadequate food supplies within their households even if the gravity of the situation was not directly explained to them. Responses from children in this study indicated they were well aware of parental attempts to manage the food supply as well as the parental anxiety created by diminishing food supplies and constrained financial resources to acquire more food. Adult behaviors such as "praying about it," getting madder "cause the kids’ beggin," and "they stop talking (at meals)" related to food insecurity as reported by the children in this study mirror the Hamelin et al. (30) report of sociofamilial perturbations in reaction to food insecurity as reported by adults. In the present study, even attempts to hide the food situation from children were noticed as indicated by statements such as "they [parents] lie to protect the children" and "they [try to hide it] because they don’t want their kids to think they cannot trust their parents."
The anxiety and frustration of the parents/caregivers were mirrored in the children as indicated by statements about other children such as "they make those sad faces" and "they look crazy and will try to borrow food." This also suggests that children in this situation have learned to recognize behaviors exhibited by other children related to food insecurity and use these behaviors to make judgments about the child. This observation can then lead to fear on the part of the food-insecure child of being labeled as "poor" by other children. This was a theme that was vocalized among the urban children with statements about being teased for having to eat with another family in the neighborhood or being made fun of for eating all the school lunch. Further it suggests that behaviors indicate to other children that there is something "different" about the food-insecure child that prevents him/her from participating fully in social activities. This exclusion, termed "alienation" by Hamelin et al. (30) was also reported among food-insecure adults and again fits within Bandura’s framework of modeling and observational learning on the part of children (28,29). One rural child noted that kids would not want their friends to think "bad" of them or think they were a "poor" family, implying that a person who is poor is somehow "bad" and that poverty was a situation of that person’s making. An indication that the stigma associated with poverty was a constant, albeit perhaps subconscious, concern to these children was embodied in statements made by one child related to the best way to administer a similar survey to other children.
Child: "Like you wouldn’t go in their house or nothin’ you would just ask them if you run out of food we can help you?"
Interviewer: "No, we wouldn’t go in their house ..."
Child: "We can ask their parents if they want to come to a place with their children where you be healthier and never be poor again."
Adults and elders reported feelings of shame and embarrassment related to their inability to adequately provide the necessary food for their families or themselves (30,31). Similarly, shame and embarrassment about the family’s food situation were expressed verbally and nonverbally by the children in this study. However, their shame and embarrassment appeared to be relative to others "discovering" that their family was poor rather than their own inability to provide food for themselves. Statements such as "they be like ashamed or whatever" and "some [kids] won’t tell anybody [they are hungry]" are indicative of the shame, embarrassment, and need for secrecy that food-insecure children feel. Six urban children verbally expressed these feelings but only 1 rural child mentioned this. Rural interviews became more tense once Q4 was asked compared with urban interviews. Rural children took on a more defensive posture and were more guarded in responding to questions about families running out of food than urban children, nonverbal indications that these children also felt shame about their family’s food situation and its social implications if discovered by their peers.
Research with low-income food-insecure adults revealed several strategies used to manage the household food supply and feed families such as sending children to eat with relatives or friends, borrowing food or money, or buying food on credit (1,30). Our findings add to this by revealing that children adopt similar strategies, often at the behest of parents, to cope with food insecurity themselves. In some cases, the coping strategies assisted in acquisition of food and at the same time alleviated the fear of being labeled as poor. Urban children most frequently mentioned strategies such as eating with other relatives or friends and borrowing food or money. Statements such as "They (parents) send you to borrow some flour" and "... our neighbor do that all the time. She borrow flour and eggs all the time so she can finish cookin’ " reveal that mothers have developed a "code" of how to ask for food (borrowing to finish cooking) that can both garner needed supplies and spare the child the embarrassment of admitting the family ran out of food. It also means that adults avoid being labeled as "poor parents" or being accused of child neglect if they ask for food or money themselves. This was exemplified in one child’s story of a neighbor who lost 2 of her "babies" to the "welfare people" because she "ran out of food." Therefore, sending children to borrow flour and eggs "to finish cooking" may deflect accusations of child neglect.
Social learning theory suggests that modeling and observational learning influence children’s behavior. One way children are influenced is when they are placed in parental roles in which they supervise their younger siblings and are likely to engage in the same type of "protective" behaviors that they have seen their parents/caregivers model for them relative to the family’s food situation (25–29). Some of the statements made by children indicate they adopt similar strategies of coping behaviors to those of their parents. Statements such as "I go in my house ... and I just bring them some food" and "I gave him 3 pieces of chicken and he fried it ..." embody the construct of borrowing from neighbors. However, these actions were independent of encouragement from parents and we labeled them "sharing" food among children. Additionally, both of the above statements were in reference to what 2 children were doing for younger children, indicating that as children age, they begin to model their parents’ attempts to shield younger children from hunger.
There were 2 apparent differences between the urban and the rural interviews. More rural children reported the behavior of eating less and more urban children reported using informal social networks for food acquisition. Several possible explanations for these differences exist. Relative to "eating less," rural children may be modeling the rural pride in self-sufficiency they see in their parents, which may include resistance to asking for assistance from others outside the family and reluctance to use government food assistance programs other than the school lunch program. Therefore, they are more likely to "go without" or eat less rather than admit that they need assistance. Others have reported food insecure rural elders to exhibit this characteristic and to be more resistant to asking for assistance from outsiders and less likely to participate in food assistance programs because of an unfavorable view of food assistance as "welfare" (31–33). Only 2 rural children made statements indicating their parents used food stamps; 3 rural children made statements indicating they thought parents should "get a second job" or the "wife might have to go to work" to provide more income to get enough food for the family. This is perhaps further evidence for the self-sufficiency modeling of children in the rural setting.
Relative to using informal social networks, urban children in this study lived primarily in subsidized housing apartments and therefore were likely in closer proximity to friends and neighbors than rural children. This would make it easier to ask others outside the family to "borrow flour." Similarly, extended families lived in the same apartment complex, which made it easier to "go to your uncle’s or grandma’s to eat." Urban children were also together for longer periods of time after school during participation in the after school programs as well as playing together in the neighborhood on weekends. Therefore, they were likely better able to observe each other and offer to "share" food with their friends. However, the sense of shame and embarrassment about the family food situation and the implications it had relative to poverty were still apparent among urban children as they verbalized in their descriptions of "running out of food." Without further research, we cannot say whether these differences were truly urban vs. rural or whether they were ethnically or culturally based because we did not interview any urban White children and only 2 rural Black children.
The detailed probes for Q4 and Q5, listed in Table 1 as "may probe for ...," had the potential to lead children to answer in a particular way. Therefore we avoided using these probes except when children hesitated or had difficulty verbalizing their thoughts or to clarify an answer. We used these probes in only 10 of the interviews, indicating that for the most part, children were telling us their own direct or indirect experience with food insecurity. Similarly, the transition questions related to the last time the child was hungry had the potential to impress upon the child that the interviews were only about being physically hungry rather than about food insecurity, which may or may not include hunger as an outcome. However, the change in the children’s demeanor and the atmosphere of the interviews from relaxed to tense and strained when we introduced the first food insecurity question indicated that the children understood the intent of the interviews.
Our research was limited in its purpose, which was to understand children’s perceptions of food insecurity and the language they use to describe it, allowing us to develop a direct measure of child food insecurity. This goal was accomplished (18). However, this central purpose limited our inquiry into the emotional responses and social ramifications of child food insecurity, and therefore our ability to more fully illuminate emotional and social facets of a child’s experience of food insecurity. Nonetheless, we found that children’s experiences of food insecurity bear a strong resemblance to those of adults, and that children do in fact experience physical, psychological, and social dimensions of food insecurity that could in turn contribute to adverse outcomes in children in each of these dimensions. Our work thus provides a foundation for the further exploration of the relation between food insecurity and children’s emotional and mental well-being.
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ACKNOWLEDGMENTS |
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FOOTNOTES |
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Manuscript received 29 October 2004. Initial review completed 13 December 2004. Revision accepted 19 April 2005.
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LITERATURE CITED |
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TOPABSTRACTSUBJECTS AND METHODSRESULTSDISCUSSIONLITERATURE CITED |
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