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Data From a Multisite Surveillance Study

Alan Meyers, MD, MPH; Diana Cutts, MD; Deborah A. Frank, MD; Suzette Levenson, MEd, MPH; Anne Skalicky, MPH; Timothy Heeren, PhD; John Cook, PhD; Carol Berkowitz, MD; Maureen Black, PhD; Patrick Casey, MD; Nieves Zaldivar, MD

Arch Pediatr Adolesc Med. 2005;159:551-556.

Background  A critical shortage of affordable housing for low-income families continues in the United States. Children in households that are food insecure are at high risk for adverse nutritional and health outcomes and thus may be more vulnerable to the economic pressures exerted by high housing costs. Only about one fourth of eligible families receive a federally financed housing subsidy. Few studies have examined the effects of such housing subsidies on the health and nutritional status of low-income children.

Objective  To examine the relationship between receiving housing subsidies and nutritional and health status among young children in low-income families, especially those that are food insecure.

Design  Cross-sectional observational study.

Setting and Participants  From August 1998 to June 2003, the Children’s Sentinel Nutrition Assessment Program interviewed caregivers of children younger than 3 years in pediatric clinics and emergency departments in 6 sites (Arkansas, California, Maryland, Massachusetts, Minnesota, and Washington, DC). Interviews included demographics, perceived child health, the US Household Food Security Scale, and public assistance program participation. Children's weight at the time of the visit was documented. The study sample consisted of all renter households identified as low income by their participation in at least 1 means-tested program.

Main Outcome Measures  Weight for age, self-reported child health status, and history of hospitalization.

Results  Data were available for 11 723 low-income renter families; 27% were receiving a public housing subsidy, and 24% were food insecure. In multivariable analyses, stratified by household food security status and adjusted for potential confounding variables, children of food-insecure families not receiving housing subsidies had lower weight for age (adjusted mean z score, –0.025 vs 0.205; P<.001) compared with children of food-insecure families receiving housing subsidies. Compared with children in food-insecure, subsidized families, the adjusted odds ratio (95% confidence interval) for weight-for-age z score more than 2 SDs below the mean was 2.11 (1.34-3.32) for children in food-insecure, nonsubsidized families.

Conclusions  In a large convenience sentinel sample, the children of low-income renter families who receive public housing subsidies are less likely to have anthropometric indications of undernutrition than those of comparable families not receiving housing subsidies, especially if the family is not only low income but also food insecure.

Author Affiliations: Department of Pediatrics, Boston Medical Center, Boston, Mass (Drs Meyers, Frank, and Cook and Ms Skalicky); Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minn (Dr Cutts); Department of Biostatistics, Boston University School of Public Health, Boston (Ms Levenson and Dr Heeren); Department of Pediatrics, Harbor–University of California Los Angeles Medical Center, Los Angeles (Dr Berkowitz); Department of Pediatrics, University of Maryland School of Medicine, Baltimore (Dr Black); Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Casey); Department of Pediatrics, Mary’s Center for Maternal and Child Care, Washington, DC (Dr Zaldivar).

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