BACKGROUND: Approximately 1 in 6 Americans live in food insecure households. Food insecurity is related to many social determinants of health, i.e. limited access and income. Literature suggests that food insecurity in children may be related to caregivers’ adverse childhood experiences (ACEs), which include experiences of verbal, physical, and sexual abuse. The aim of this study was to investigate if there was an association between caregiver’s ACEs score and children’s food insecurity in SC.
METHODS: Data from the Children’s Health Assessment Survey (CHAS) were obtained from 2014-2015. CHAS is a call-back survey to the SC Behavioral Risk Factor Surveillance System (SCBRFSS). It has been administered annually since 2012 and is weighted to mirror SC’s child population. CHAS and BRFSS data were linked, and the sample was restricted to records where the same individual responded to both surveys (n = 1,339). The ACEs module on the 2014 and 2015 SCBRFSS included 11 questions. The responses to these questions made up the ACEs score, e.g. if they reported any one ACE, their score was 1. The exposure was categorized into: 0, 1, 2, and 3+ ACEs. The food insecurity outcome was from CHAS, defined as ever cutting the size of children’s meals due to limited money for food in the past year (yes; no). Survey logistic regression was utilized to obtain unadjusted (ORs) and adjusted (aORs) odds ratios and 95% confidence intervals (CIs). Adjusted models included the following caregiver covariates from SCBRFSS: depression status, education, and self-rated health.
RESULTS: Significantly more caregivers reported having 3+ ACEs (38.8%; 95%CI: 35.4%-42.2%), compared to 25.8% (95%CI: 22.9%-28.6%) who reported having no ACEs. In the unadjusted model, each ACEs score was significant. Caregivers with 3+ ACEs had 6-fold higher odds of food insecurity (OR: 6.2; 95%CI: 1.4-27.3), compared to those with no ACEs. In the adjusted model, the highest ACEs score was no longer significant (aOR: 3.2; 95%CI: 0.7-15.1), compared to those with no ACEs. In the adjusted model, the caregiver’s self-rated health was significant (aOR: 4.1; 95%CI: 1.5-11.6).
CONCLUSIONS: While this study suggests that a caregiver’s ACEs score factors into their children’s food insecurity, the caregiver’s self-rated health may have more influence. Those with worse self-rated health had higher odds of food insecurity, which coincides with the literature. As these surveys are cross-sectional, temporality cannot be established. Other limitations to this analysis, i.e. small n and lack of dosing, call for further investigation.