Alice M Lee1, Michelle A Lopez2, Heather Haq3, Xian Yu4, Stephen Manning5, Ricardo Quiñonez6, Christopher Greeley7, Claire Bocchini8. 1. Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, 1102 Bates Ave, FC 1860, Houston, TX 77030, USA. Electronic address: alee50@northwell.edu. 2. Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, 1102 Bates Ave, FC 1860, Houston, TX 77030, USA. Electronic address: malopez@texaschildrens.org. 3. Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, 1102 Bates Ave, FC 1860, Houston, TX 77030, USA. Electronic address: heather.haq@bcm.edu. 4. Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd, Suite 01Y, Houston, TX 77021, USA, 713-791-1414 ext 10271. Electronic address: Xian.Yu@bcm.edu. 5. Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, 1102 Bates Ave, Houston, TX 77030, USA. Electronic address: essaymanning@gmail.com. 6. Department of Pediatrics, Section of Pediatric Hospital Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, 1102 Bates Ave, FC 1860, Houston, TX 77030, USA. Electronic address: raquinon@texaschildrens.org. 7. Department of Pediatrics, Section of Public Health and Child Abuse Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, 1102 Bates Ave, FC 1860, Houston, TX 77030, USA, 832-822-1935. Electronic address: greeley@bcm.edu. 8. Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, 1102 Bates Ave, FC 1150, Houston, TX 77030, USA, 832-824-4330. Electronic address: cb135591@bcm.edu.
Abstract
BACKGROUND AND OBJECTIVES: Amongst U.S. households with children, 14% are food insecure. Household food insecurity (FI) is associated with poorer health outcomes and increased hospital admissions. There is less known about caregivers' ability to obtain adequate food during hospitalization (inpatient FI). METHODS: We conducted a mixed methods study of primary caregivers of hospitalized children 0-18 years. A modified US Household Food Security Survey was used to identify inpatient FI. Associated factors were identified using logistic regression adjusted for covariables. Caregiver semi-structured interviews were conducted to elicit perceptions on food accessibility and effects of and solutions for inpatient FI. RESULTS: The prevalence of inpatient FI was 43%. Household FI was present in 38% of families. Inpatient FI was associated with household FI (p<0.01). In multivariable analysis, odds of inpatient FI were increased among caregivers with annual household income <$30,000 (aOR 2.14), public transportation use (aOR 6.33), living >30 miles from the hospital (aOR 2.80), self-rated fair/poor health (aOR 3.31), maternity leave (aOR 4.75), and past/current Supplemental Nutrition Assistance Program benefit utilization (aOR 2.52). Qualitative analysis identified barriers to food access, such as lack of affordable options, and found that caregivers made sacrifices for their hospitalized child, including skipping meals. Caregivers viewed their presence at their child's bedside and personal nourishment as important factors affecting their child's care. CONCLUSIONS: Inpatient FI may affect a significant proportion of hospitalized children's caregivers. Pediatric hospitals should ensure that caregivers have access to food in order to fully engage in their child's care.
BACKGROUND AND OBJECTIVES: Amongst U.S. households with children, 14% are food insecure. Household food insecurity (FI) is associated with poorer health outcomes and increased hospital admissions. There is less known about caregivers' ability to obtain adequate food during hospitalization (inpatient FI). METHODS: We conducted a mixed methods study of primary caregivers of hospitalized children 0-18 years. A modified US Household Food Security Survey was used to identify inpatient FI. Associated factors were identified using logistic regression adjusted for covariables. Caregiver semi-structured interviews were conducted to elicit perceptions on food accessibility and effects of and solutions for inpatient FI. RESULTS: The prevalence of inpatient FI was 43%. Household FI was present in 38% of families. Inpatient FI was associated with household FI (p<0.01). In multivariable analysis, odds of inpatient FI were increased among caregivers with annual household income <$30,000 (aOR 2.14), public transportation use (aOR 6.33), living >30 miles from the hospital (aOR 2.80), self-rated fair/poor health (aOR 3.31), maternity leave (aOR 4.75), and past/current Supplemental Nutrition Assistance Program benefit utilization (aOR 2.52). Qualitative analysis identified barriers to food access, such as lack of affordable options, and found that caregivers made sacrifices for their hospitalized child, including skipping meals. Caregivers viewed their presence at their child's bedside and personal nourishment as important factors affecting their child's care. CONCLUSIONS: Inpatient FI may affect a significant proportion of hospitalized children's caregivers. Pediatric hospitals should ensure that caregivers have access to food in order to fully engage in their child's care.