![[Feedback]](/icons/banner/feedbackACT.gif){kind=icon}
![[For Subscribers]](/icons/banner/subscriberACT.gif){kind=icon}
![[Archive]](/icons/banner/archiveACT.gif){kind=icon}
![[Search]](/icons/banner/searchACT.gif){kind=icon}
![[Contents]](/icons/banner/tocACT.gif){kind=icon}
|
|
|
|
|
||
3 Department of Human Development and Family Studies and 5 Department of Sociology, Iowa State University, Ames, IA 50011; and 4 Department of Kinesiology, Michigan State University, East Lansing, MI 48824
* To whom correspondence should be addressed. E-mail: cggunder{at}iastate.edu.
 |
ABSTRACT |
|---|
 TOP ABSTRACT IntroductionMethodsResultsDiscussionLITERATURE CITED |
|---|
25% of the food insecure children were overweight. Additional research is needed to explore the potential relationships between food insecurity and overweight and to better inform policy that attempts to address these issues among low-income households with children.
|
Introduction |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionLITERATURE CITED |
|---|
Another public health concern related to diet and nutritional status in the US is food insecurity. A person is considered food insecure if he or she does not have the financial means to access enough food to sustain active, healthy living (5). Approximately 1 in 5 children in the US lives in a food insecure household as measured using the USDA Core Food Security Module (CFSM)6 (5). For households below the poverty line (i.e. an income level, adjusted for household size and composition, below which household members are said to not be able to achieve a minimum standard of living), the prevalence of food insecurity is 35% (5). As with obesity, food insecurity has been shown to lead to a plethora of medical problems for children, including diminished psychosocial functioning (6), frequent stomachaches and headaches (7), worse health outcomes (8), increased odds of being hospitalized (8), higher levels of hyperactivity (9), greater propensities to have seen a psychologist (10), behavior problems (11,12), and higher levels of iron deficiency with anemia (13).
Early studies of poverty and child growth clearly show compromised growth and underweight (14); hence, it is somewhat counterintuitive that food insecure children would be overweight. Consistent with this notion, some studies have found either no relationship (15–17) or an inverse relationship (18–20) between food insecurity and child obesity. However, recent studies (21–24) have provided some evidence for a positive link between food insecurity and overweight among children.
One important methodological issue of these previous studies is that food insecurity was measured at the household level, either defined for all household members or for all children in the household. Except in cases where there is only 1 child in a household, the structure of the CFSM food insecurity questions does not allow for the identification of the food insecurity status of an individual child in the household. As a consequence, studies using the CFSM have not directly connected the food insecurity status of an individual child in the household with his or her own weight status.
In contrast, in this article, the relationship between food insecurity and overweight were measured directly. Instead of defining food insecurity at the household level (15–23) or for all children in the household (24), we examined the association between food insecurity and overweight status when food insecurity and BMI were measured for the same child. We did so with data from the first wave of Welfare, Children, and Families: A Three-City Study (commonly referred to as the Three-City Study) (25), which focused on the well-being of low-income children and families. These data provide in-depth information for focal children in these families, including food insecurity and weight status. We chose to focus on children between the ages of 10 and 15 y because of findings from developmental theory. Whereas understanding the causes of obesity is important for all age groups of children, developmental research has demonstrated that this age group is different from other age groups with respect to the causes of obesity. In particular, multiple biological, cognitive, and social developmental tasks differ from other age groups.
|
Methods |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionLITERATURE CITED |
|---|
The Three-City Study is a 6-y longitudinal, multi-method investigation designed to understand the effects of the Personal Responsibilities and Work Opportunities Reconciliation Act of 1996 on the well-being of low-income children and families. The Three-City Study includes, among other components, a household-based stratified random sample survey with over 2400 low-income children and their mothers in low-income neighborhoods in Boston, Chicago, and San Antonio. Data from the first wave of interviews conducted in 1999 were used for these analyses.
In 1999, over 40,000 households in randomly selected low-income neighborhoods (93% of block groups selected for sampling had a 20% or higher poverty rate) were screened, with a screening response rate of 90%. In selected families with household incomes 200% or less than the poverty line, interviewers randomly selected 1 focal child per family and invited the focal child (aged birth to 5 y or between the ages of 10 to 15 y) and his or her primary female caregiver to participate. For reasons discussed above, we only analyzed focal children between the ages of 10 and 15 y but other children could also be present in the household. Of the selected families, 83% agreed to participate in the study, resulting in an overall response rate of 74%. For further sampling details, see Winston et al. (25).
In each family, focal children and mothers participated in separate in-home interviews led by trained field investigators. Interviews were conducted primarily in English but also in Spanish with the 12% of mothers who reported their primary language was Spanish (protocols were translated into Spanish and verified with back-translations). All respondents were paid for their participation in the study. Children and mothers were compensated separately for their time. Parental consent and child assent were obtained prior to data collection. The study protocol was approved by the human subjects review boards of the Research Triangle Institute and the 11 universities involved in the Three-City Study data collection effort (25).
For reasons noted in the Introduction, this article focuses on children aged 10 to 15 y who had valid data on the central variables of interests including height, weight, and food insecurity status. Children who were classified as underweight (BMI < 5th percentile) were excluded from our analyses (n = 60), because underweight children should not be included in the referent group (e.g. normal weight) and we were not interested in examining the association between underweight and food insecurity given the focus of the study is overweight. The final analytic sample included 1031 children.
Measures
Classification of weight status.
Height and weight were measured by personnel in the child's home. The persons conducting these measurements were extensively trained in how to measure height and weight. To further ensure the accuracy of the measurements, children were asked to remove their shoes and any bulky clothes for these measurements. Height was taken with the child standing against the wall with his or her head level using an electronic distance measuring tool. Weight was taken using a scale that was recalibrated to 0 pounds prior to each measurement. Prior to inclusion in this analysis, height and weight values were examined for biologically implausible values by an experienced auxologist (J.C.E.) using the SAS program for the CDC growth charts (26). In brief, biologically implausible values are based on the WHO-defined limits of acceptable data (i.e. height-for-age 
–5.0 Z-score and 
+3.0 Z-score or weight-for-age –5.0 Z-score and +5.0 Z-score). For cases identified as biologically implausible (n = 36), height, weight, and age were taken from the focal child's measurement during wave 2 of the study. These measurements occurred a mean 16 mo later. The analyses presented here include these substituted cases to maintain sample size. Analyses were tested with and without these 36 cases and the results of the analyses were similar.
To facilitate comparisons with other studies and potential studies, both the CDC and the International Obesity Task Force (IOTF) weight categorizations were used. For the former, BMI was used to classify children into 1 of 4 weight status categories according to the age- and sex-specific reference values of the CDC growth charts (27) as follows: 1) underweight (BMI < 5th percentile); 2) normal weight (BMI > 5th and < 85th percentiles); 3) at risk for overweight (BMI 85th and < 95th percentiles); and 4) overweight (BMI 95th percentile). For the latter, BMI was used to determine overweight and obesity based on age- and sex-specific reference values developed by the IOTF (28). These cut points are anchored to adult values for overweight and obesity at the age of 18 y and back-extrapolated. The reader should also be aware of the difference in terminology used by the CDC and IOTF; that is, the CDC uses the terms at risk of overweight and overweight, whereas the IOTF uses the terms overweight and obese. The respective terms are theoretically equivalent. For clarity, we will use the terms at risk of overweight and overweight herein. As noted above, underweight children were excluded from the analyses.
Child food security status. The Three-City Study includes 3 questions about the child's food insecurity status taken from the 18-item CFSM used by the USDA in the calculation of official food insecurity rates in the US (5). Consistent with methods used in the CFSM, these questions were answered by the mother, not the child. The Three-City Study questions are: 1) "At any time in the past 12 mo, did you cut the size of any of [focal child's name] meals because there wasn't enough money for food?"; 2) "At any time in the past 12 mo, was [focal child's name] hungry but you just couldn't afford more food?"; and 3) "At any time in the past 12 mo, did [focal child's name] skip a meal because there wasn't enough money for food?" The other 5 child-specific questions in the CFSM are not included in the Three-City Study. As conducted in Coley et al. (29), children were classified as being food insecure if the child's mother responded affirmatively to any of the 3 questions.
Comparing the 3 food insecurity questions in the Three-City Study to items in other studies is not straightforward. Questions that address food insecurity in other surveys do so with respect to all the children in the household. In the Three-City Study, only 1 child, the focal child or the child chosen to participate in the survey, is questioned. With this important caveat (and other caveats discussed below), we compare answers to the 3 questions in the Three-City Study with answers to the same 3 questions drawn from a comparable sample of Current Population Survey (CPS) households. More specifically, we combine CPS survey years 2001–2004 and limit our analyses to households with a child between the ages of 10 and 15 y residing in a metropolitan area and with household income below 200% of the poverty line.
When comparing the 3 questions from the Three-City study assessed in 1999 with the 3 questions from the 2001–2004 CPS, we find similar response patterns. The comparisons are as follows. For question 1 above, 5.2% of the children in our sample from the Three-City Study had mothers who responded affirmatively that they cut the size of meals vs. 3.7% of households within the CPS. For questions 2 and 3, the comparisons are 4.1 vs. 3.0% and 2.9 vs. 1.8%, respectively. In the CFSM, the questions are ordered with respect to increasing severity and the expectation is that more severe questions will be answered affirmatively by fewer households than the less severe questions. In both the CFSM and the Three-City Study, this pattern emerges: question 1, the least severe question of these 3, has the highest number of affirmative responses. Similarly, question 2 has more affirmative responses than question 3. In addition to consistent patterns of responses, the number of affirmative responses is very close with the widest gap, only 1.5 percentage points. The slightly higher proportion of affirmative responses in the Three-City Study could be a function of the caveat noted above (i.e. the questioning regards a specific child), in addition to other factors including, in particular, that the mother responded to the food insecurity questions in the Three-City study, whereas the respondent is the household head in the CPS. In the sample taken from the CPS, 36.5% of households were headed by a man (viz. the definition of household head in the CPS). Insofar as mothers may be more aware of the food intake of children than the household head as defined in the CPS, especially if he was a male respondent, responses in the Three-City Study may be more accurate.
Confounders. Because numerous demographic characteristics are often related to children's overweight status and food insecurity, we include numerous covariates in the multivariate analyses. Our choice of covariates was guided by previous research (15–24). The covariates are as follows: age of the child, the race/ethnicity of the child (Hispanic of any race, non-Hispanic black, and non-Hispanic white), household income:needs ratio (household income including food stamps divided by the poverty line), whether the caregiver is a high school graduate, whether the caregiver is an immigrant, whether the family eats breakfast together, whether the family eats dinner together, whether the household owns its residence, whether the caregiver is married, the age of the caregiver, and household size.
Statistical analyses
Descriptive statistics were calculated for the total sample by normal weight/at-risk of overweight/overweight under the CDC standards, by normal weight/at-risk of overweight/overweight under the IOTF standards, and by food insecure/food secure. To test for significance within the various overweight and food insecurity categories with respect to the variables of interest, we used t tests for continuous variables and 
2 tests for categorical variables. Logistic regression models were then used to assess the effect of food insecurity on childhood obesity, controlling for other factors (i.e. the list of confounders above). The 2 dependent variables in the logistic regression models were overweight vs. at-risk-of-overweight or normal weight and at-risk-of-overweight or overweight vs. normal weight. These comparisons were made using both the CDC and IOTF weight status categories. In light of previous work showing gender differences in the relationship between food insecurity and obesity (17), along with making these comparisons for the full analysis sample, the estimations were determined by gender. All analyses were conducted using Stata Version 10 for Windows (30). Differences were considered significant at P 0.05.
|
Results |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionLITERATURE CITED |
|---|
|
The percentage of subjects by race/ethnicity was 9% non-Hispanic white, 43% non-Hispanic black, and 49% Hispanic. White children did not differ in terms of weight category; black children were more likely to be in the normal weight category in comparison to the overweight category using CDC cutoffs and more likely to be in the normal weight category compared with the at-risk-of-overweight category using IOTF cutoffs; Hispanic children were more likely to be in the at-risk-of-overweight category compared with the normal weight category; and Hispanic children were more likely to be in the overweight than the normal weight category. (The power to detect these and all the other significant bivariate comparisons was above 0.90 for each of the comparisons.) Males were more likely to be normal weight than at-risk-of-overweight using the IOTF cutoffs. The mean age of the children in the study was 12.5 y. Overweight children were taller than children at risk of overweight.
Mean age for caregivers was 38 y (see Table 2 for descriptive characteristics). The majority (62%) of caregivers were high school graduates. One-in-5 of the caregivers were immigrants. Approximately 16% of the caregivers were married and 13% were homeowners. The mean household size was 4 members. The mean household income:needs ratio was 0.9, with 39% of children in households that were above the poverty line (ratio > 1.0) and 61% in households with incomes that were at or below the poverty line (ratio 1.0) (data not shown). Families were almost twice as likely to eat dinner together (60%) as they were to eat breakfast together (35%). Comparing subgroups, significant differences were found only for comparisons of children in food secure and food insecure households. Children in food secure households were more likely to have a caregiver who was an immigrant, married, and a homeowner. In addition, children in food secure households were more likely to eat dinner together as a family.
|
|
|
|
Discussion |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionLITERATURE CITED |
|---|
Based on this methodology, our results show that food insecure children were no more likely than food secure children to be overweight or at risk of overweight. This is consistent with the work of Alaimo et al. (15), Kaiser et al. (16), and Martin and Ferris (17). We consider 3 possible reasons for our findings. First, previous studies that used household measures of food insecurity may have masked differences between individuals within a household. By examining just a single child, one can isolate the more direct impact of food insecurity on obesity. Second, along with masking differences between individuals, the standard household-based food insecurity module used in previous research is designed to portray both worries about reductions in food intakes and actual intake reductions. In contrast, the measures of individual (i.e. focal child) food insecurity used in this article consider reductions in food intake without reference to worries. As a result, standard household food security measures may be capturing something distinct from food security assessments at the individual level (31). For example, worries about reductions in food intake may be associated with stress, and stress has been associated with obesity (32). It is plausible that the stress evident within the household is responsible for the positive relation between food insecurity and obesity found in previous studies. Third, as noted above, the questions in this study are drawn from the child-specific questions in the CFSM and assess relatively more severe levels of food insecurity (33). Thus, it may be that the less severe levels of food insecurity examined in earlier studies are associated with obesity, while the more severe levels portrayed in this article are not associated with obesity.
Although food insecure children were no more likely than food secure children to be overweight or at risk of overweight in this study, an important point (and paradox) still remains; that is, food insecurity and overweight coexist in low-income children. In our sample, one-fourth of food insecure children were overweight and almost one-half were at risk of overweight or overweight. The possible reasons for this paradox may include overconsumption of cheaper, energy-dense foods (34,35), overeating when food is more plentiful (36), metabolic changes to ensure a more efficient use of energy (15), different standards of what constitutes an adequate diet (37), parents overprotecting their children by giving them more food than needed when food is available (38), and the mother being food insecure during pregnancy (39). Clearly, additional research is warranted to explore the differences in normal weight and overweight food insecure children.
Four limitations of this study warrant mention. First, this study included only youths between the ages of 10 and 15 y from 3 large cities. Children in other age ranges may show different associations between food insecurity and obesity. This may be especially the case for younger children who are more likely to be protected from hunger than older children (40). Children from different locations (e.g. other large cities, suburbs, or rural areas) may also show different associations if, for example, access to food stores and recreational activities differ in other locations. Second, the sample size in this study is relatively small compared with larger epidemiological studies such as the NHANES. Thus, examining if food insecurity is related to overweight in certain subgroups that may be at an increased risk was limited. This was particularly true for non-Hispanic whites. Third, this article investigated a subset of the child-specific food insecurity questions from the CFSM (41–45). Future work should examine the relationship between food insecurity and childhood obesity when all 8 CFSM child-specific questions are asked of the child whose BMI is calculated. A data set with the full set of child-specific food insecurity questions asked of a specific child, to the best of our knowledge, does not exist. Fourth, the data used in this article were obtained from interviews with the mother regarding the food insecurity status of the child between the ages of 10 and 15 y rather than responses from the child. Children in this older age group may be able to access food that the mother does not consider in her responses to the food insecurity questions. Previous work in other countries (C. Gundersen and Y. Kuku, unpublished material) has demonstrated differences in reports of food intakes depending on whether or not the child or the caregiver is the respondent. If consistent with our study, this may impart an upward bias in the mother's reports of food insecurity. Future data sets may include food insecurity reports by children and by mothers.
In conclusion, we emphasize that more research is needed to further explore the potential relationships between childhood food insecurity and overweight and obesity. Additional research will better inform policy that attempts to address these issues in low-income households. A significant portion (26.5%) of food insecure youths in this study was overweight demonstrating that these 2 conditions paradoxically coexist. From a policy perspective, programs that focus on food intake adequacy and nutrition for youths must work together to achieve common outcomes. For example, administrators of school food programs must work with school administrators and students to ensure that the entire school food environment addresses food intake needs and supports youths' nutrition. School breakfasts and lunches must be nutritionally sound. Opportunities for students to purchase separate food items via cafeteria à la carte options and vending machines must be provided so that selections are both healthy and popular with youths. Input from students is vital in this latter regard. Coordinated efforts offer not only efficiency opportunities, but may also provide better outcomes for youths.
Along with approaches aimed toward children in a school setting, policymakers may consider ways to modify programs that address the economic constraints that low-income households face in securing enough food and maintaining a healthy diet. States have the ability to design their Temporary Assistance to Needy Families programs to meet the economic needs of low-income families. The Earned Income Tax Credit has been expanded in recent years to aid low-income working families in meeting their basic needs. The Food Stamp Program is uniquely positioned to help Americans acquire enough food. It is the largest food assistance and the largest near-cash entitlement program in the United States. It can therefore play a role in addressing these economic constraints. In terms of food insecurity, the central goal of the Food Stamp Program is to alleviate food insecurity and hunger in the United States (46). The Food Stamp Program has been successful in this area, as research has demonstrated that food stamps can be associated with reductions in food insecurity (47–49). Although food stamps are designed to alleviate food insecurity, they are not designed to reduce obesity. Nevertheless, food stamps can play a role in helping reduce obesity by, for example, allowing families to purchase healthier foods and helping to alleviate the stress associated with not having enough money. The research on the connection between food stamps and obesity (among both children and adults) has been mixed: some research has found a positive correlation between food stamps and obesity (50,51), whereas other research has found either negative correlations or no correlations (52–55).
Along with government efforts to enable coordination between different providers of food and other forms of assistance and to ensure that families have enough healthy food to eat, efforts at the household level should also be emphasized to help ensure reductions in both food insecurity and childhood obesity. Within any given financial situations, families have some scope to choose healthy and nutritious foods while avoiding other types of foods (e.g. soda, salty snacks). These efforts should be encouraged within our society. One method of encouragement is through nutrition education programs, because these programs and other nutrition interventions have demonstrated some success in addressing poor nutrition habits (56–60).
|
ACKNOWLEDGMENTS |
|---|
|
FOOTNOTES |
|---|
2 Author disclosures: C. Gundersen, B. J. Lohman, J. C. Eisenmann, S. Garasky, and S. D. Stewart, no conflicts of interest.
6 Abbreviations used: CFSM, Core Food Security Module; CPS, Current Population Survey; IOTF, International Obesity Task Force.
Manuscript received 20 August 2007. Initial review completed 12 September 2007. Revision accepted 29 October 2007.
|
LITERATURE CITED |
|---|
|
TOPABSTRACTIntroductionMethodsResultsDiscussionLITERATURE CITED |
|---|
1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.
2. Koplan J, Liverman C, Kraak V, editors. Preventing childhood obesity: health in the balance. Washington, DC: National Academies Press; 2005.
3. Daniels SR. The consequences of childhood overweight and obesity. Future Child. 2006;16:47–67.[Medline]
4. Anderson PM, Butcher KE. Childhood obesity: trends and potential causes. Future Child. 2006;16:19–45.[Medline]
5. Nord M, Andrews M, Carlson S. Household food security in the United States, 2005. Washington, DC: USDA; 2006. Economic Research Report No. 29.
6. Kleinman R, Murphy J, Little M, Pagano M, Wehler C, Regal K, Jellinek M. Hunger in children in the United States: potential behavioral and emotional correlates. Pediatrics. 1998;101:e3.
7. Alaimo K, Olson C, Frongillo E, Briefel R. Food insufficiency, family income, and health in US preschool and school-aged children. Am J Public Health. 2001;91:781–6.[Abstract]
8. Cook J, Frank C, Berkowitz M, Cook J, Frank D, Berkowitz C, Black M, Casey P, Cutts D, et al. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr. 2004;134:1432–48.
9. Murphy J, Wehler M, Pagano M, Little R, Kleinman R, Jellinek M. Relationship between hunger and psychosocial functioning in low-income American children. J Am Acad Child Adolesc Psychiatry. 1998;37:163–70.[Medline]
10. Alaimo K, Olson C, Frongillo E. Food insufficiency and American school-aged children's cognitive, academic, and psychosocial development. Pediatrics. 2001;108:44–53.
11. Slack K, Yoo J. Food hardship and child behavior problems among low-income children. Soc Serv Rev. 2005;79:511–36.
12. Whitaker R, Phillips S, Orzol S. Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children. Pediatrics. 2006;118:e859–68.
13. Skalicky A, Meyers A, Adams W, Yang Z, Cook J, Frank D. Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States. Matern Child Health J. 2006;10:177–85.[Medline]
14. Tanner JM. Growth at adolescence. 2nd ed. Oxford: Blackwell Press; 1962. p. 340.
15. Alaimo K, Olson CM, Frongillo EA. Low family income and food insufficiency in relation to overweight in US children: is there a paradox? Arch Pediatr Adolesc Med. 2001;155:1161–7.
16. Kaiser L, Melgar-Quiñonez H, Lamp C, Johns M, Sutherlin J, Harwood J. Food security and nutritional outcomes of preschool-age Mexican-American children. J Am Diet Assoc. 2002;102:924–9.[Medline]
17. Martin KS, Ferris AM. Food insecurity and gender are risk factors for obesity. J Nutr Educ Behav. 2007;39:31–6.[Medline]
18. Jimenez-Cruz A, Bacardi-Gascon M, Spindler A. Obesity and hunger among Mexican-Indian migrant children on the US-Mexico border. Int J Obes. 2003;27:740–7.[Medline]
19. Rose D, Bodor J. Household food insecurity and overweight status in young school children: results from the early childhood longitudinal study. Pediatrics. 2006;117:464–73.
20. Matheson D, Varady J, Varady A, Killen J. Household food security and nutritional status of Hispanic children in the fifth grade. Am J Clin Nutr. 2002;76:210–7.
21. Dubois L, Farmer A, Girard M, Porcherie M. Family food insufficiency is related to overweight among preschoolers. Soc Sci Med. 2006;63:1503–16.[Medline]
22. Casey P, Szeto K, Lensing S, Bogle M, Weber J. Children in food-insufficient, low-income families: prevalence, health and nutrition status. Arch Pediatr Adolesc Med. 2001;155:508–14.
23. Jyoti DF, Frongillo EA, Jones SJ. Food insecurity affects school children's academic performance, weight gain, and social skills. J Nutr. 2005;135:2831–9.
24. Casey P, Simpson P, Gossett J, Bogle M, Champagne C, Connell C, Harsha D, McCabe-Sellers B, Robbins J, et al. The association of child and household food insecurity with childhood overweight status. Pediatrics. 2006;118:e1406–13.
25. Winston P, Angel R, Burton L, Chase-Lansdale P, Cherlin A, Moffitt R, Wilson W. Welfare, children, and families: a three-city study -overview and design report. Baltimore (MD): Johns Hopkins University; 1999. Study No.: QN-021–001–2-1-United States-SOCIO-1999. Available from: http://web.jhu.edu/threecitystudy/images/overviewanddesign.pdf.
26. Centers for Disease Control and Prevention. SAS program for the CDC growth charts 2007. Available from: www.cdc.gov/nccdphp/dnpa/growthcharts/sas.htm.
27. Ogden C, Kuczmarski R, Flegal K, Mei Z, Guo S, Wei R, Grummer-Strawn L, Curtin L, Roche A, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109:45–60.
28. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–3.
29. Coley RL, Lohman B J, Votruba-Drzal E, Pittman LD, Chase-Lansdale PL. Maternal functioning, time, and money: the world of work and welfare. Child Youth Serv Rev. 2007;29:721–41.[Medline]
30. StataCorp. StataCorp statistical software. Release 9. College Station (TX): StataCorp LP; 2007.
31. Hamilton W, Cook J, Thompson W, Burn L, Frongillo E, Olson C, Wehler C. Household food security in the United States in 1995: technical report of the Food Security Measurement Project. Washington, DC: USDA, Food and Consumer Service, Office of Analysis and Evaluation; 1997.
32. Bjorntorp P. Do stress reactions cause abdominal obesity and comorbidities? Obes Rev. 2001;2:73–86.[Medline]
33. Gundersen C. Measuring the extent, depth, and severity of food insecurity: an application to American Indians in the United States. J Popul Econ. In press.
34. Dietz WH. Does hunger cause obesity? Pediatrics. 1995;95:766–7.
35. Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004;79:6–16.
36. Scheier LM. What is the hunger-obesity paradox. J Am Diet Assoc. 2005;105:883–6.[Medline]
37. Gundersen C, Ribar D. Food insecurity and insufficiency at low levels of food expenditures. Institute for the Study of Labor (IZA) Working paper No. 1594. Bonn (Germany): IZA; 2005.
38. McIntyre L, Glanville N, Raine K, Dayle J, Anderson B, Battaglia N. Do low-income lone mothers compromise their nutrition to feed their children? Can Med Assoc J. 2003;168:686–91.
39. Laraia B, Siega-Riz A, Gundersen C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr. 2006;136:177–82.
40. Dutta I, Gundersen C. Measures of food insecurity at the household level. In: Guha-Khasnobis B, Acharya S, Davis B, editors. Food security indicators, measurement, and the impact of trade openness. Series: WIDER studies in development economics. Oxford: Oxford University Press; 2007. p. 42–61.
41. Nord M. Food insecurity in households with children. Washington, DC: USDA; 2003. Food Assistance and Nutrition Research Report No. 34–13.
42. Nord M, Hopwood H. Recent advances provide improved tools for measuring children's food security. J Nutr. 2007;137:533–6.
43. Nord M, Bickel G. Measuring children's food security in US households, 1995–1999. Washington, DC: USDA; 2002. Food Assistance and Nutrition Research Report No. 25.
44. Connell C, Lofton K, Yadrick K, Rehner T. Children's experiences of food insecurity can assist in understanding its effect on their well-being. J Nutr. 2005;135:1683–90.
45. Connell C, Nord M, Lofton K, Yadrick K. Food security of older children can be assessed using a standardized survey instrument. J Nutr. 2004;134:2566–72.
46. USDA, Food and Nutrition Service. Annual historical review: Fiscal year 1997. Washington, DC: USDA; 1999.
47. Gundersen C, Oliveira V. The Food Stamp Program and food insufficiency. Am J Agric Econ. 2001;83:875–87.
48. Wilde P, Nord M. The effect of food stamps on food security: a panel data approach. Rev Agric Econ. 2005;27:425–32.
49. Gundersen C, Kreider B. Food stamps and food insecurity: what can be learned in the presence of nonclassical measurement error? J Hum Resour. In press.
50. Gibson D. Long-term Food Stamp Program participation is positively related to simultaneous overweight in young daughters and obesity in mothers. J Nutr. 2006;136:1081–5.
51. Gibson D. Food Stamp Program participation is positively related to obesity in low income women. J Nutr. 2003;133:2225–31.
52. Kim K, Frongillo E. Participation in food assistance programs modifies the relation of food insecurity with weight and depression in elders. J Nutr. 2007;137:1005–10.
53. Jones S, Frongillo E. The modifying effects of Food Stamp Program participation on the relation between food insecurity and weight change in women. J Nutr. 2006;136:1091–4.
54. Jones S, Jahns L, Laraia B, Haughton B. Lower risk of overweight in school-aged girls who participate in food assistance: results from the Panel Study of Income Dynamics Child Development Supplement. Arch Pediatr Adolesc Med. 2003;157:780–4.
55. Ver Ploeg M, Mancino L, Lin B, Wang C. The vanishing weight gap: trends in obesity among adult food stamp participants (US), 1976–2002. Econ Hum Biol. 2007;5:20–36.[Medline]
56. Campbell M, Tessaro I, DeVellis B, Benedict S, Kelsey K, Belton L, Sanhueza A. Effects of a tailored health promotion program for female blue-collar workers: Health Works for Women. Prev Med. 2002;34:313–23.[Medline]
57. Ikeda M, Pham L, Nguyen K, Allhoff Mitchell R. Culturally relevant nutrition education improves dietary quality among WIC-eligible Vietnamese immigrants. J Nutr Educ Behav. 2002;34:151–8.[Medline]
58. Havas S, Ankiker J, Greenberg D, Block G, Block T, Blik C, Langenberg P, DiClemente C. Final results of the Maryland WIC Food for Life Program. Prev Med. 2003;37:406–16.[Medline]
59. Fries E, Edinboro P, McClish D, Manion L, Bowen D, Beresford S, Ripley J. Randomized trial of a low-intensity dietary intervention in rural residents. Am J Prev Med. 2005;28:162–8.[Medline]
60. Ammerman A, Lindquist C, Lohr K, Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev Med. 2002;35:25–41.[Medline]
This article has been cited by other articles:
|
|
 |
|
  C. Gundersen, S. Garasky, and B. J. Lohman Food Insecurity Is Not Associated with Childhood Obesity as Assessed Using Multiple Measures of Obesity J. Nutr., June 1, 2009; 139(6): 1173 - 1178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Widome, D. Neumark-Sztainer, P. J. Hannan, J. Haines, and M. Story Eating When There is Not Enough to Eat: Eating Behaviors and Perceptions of Food Among Food-Insecure Youths Am J Public Health, May 1, 2009; 99(5): 822 - 828. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Gundersen, B. J. Lohman, S. Garasky, S. Stewart, and J. Eisenmann Food Security, Maternal Stressors, and Overweight Among Low-Income US Children: Results From the National Health and Nutrition Examination Survey (1999-2002) Pediatrics, September 1, 2008; 122(3): e529 - e540. [Abstract] [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
