What

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Whats a Child Nutrition Program?

• Subsidized Housing and the Low-Income Home Energy
  Assistance Program (LIHEAP) Are Linked to
  Improved Growth Outcomes for Young Children of
  Color

Stephanie Ettinger de Cuba, MPH Childrens
Sentinel Nutrition Assessment Program
(C-SNAP) Boston University School of Public
Health Boston Medical Center Tuesday, November 7,
2006
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Authors

• Stephanie Ettinger de Cuba, MPH
• Deborah A. Frank, MD
• Nicole Neault, MPH
• Mariana Chilton, PhD
• John Cook, PhD
• Carol Berkowitz, MD
• Maureen Black, PhD
• Patrick Casey, MD, MPH
• Diana Cutts, MD
• Alan Meyers, MD, MPH
• Nieves Zaldivar, MD
• Suzette Levenson, MPH, EdM
• Timothy Heeren, PhD
• Zhaoyan Yang, MS

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Childrens Sentinel Nutrition Assessment Program
(C-SNAP)

• A national network of clinicians and public
  health specialists for research in multiple
  pediatric settings on the effect of U.S. social
  policy on young, low-income childrens health and
  nutrition.

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C-SNAP Study Sites
C-SNAP Study Sites

• Little Rock, AR -Boston, MA -Washington, D.C.
• Baltimore, MD -Minneapolis, MN
• Philadelphia, PA -Los Angeles, CA

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Study Objective

• Evaluate the importance of federal assistance
  programs not commonly identified with child
  nutrition, such as LIHEAP and Subsidized Housing,
  to child growth and health outcomes among young
  black and Latino children

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Study Methods

• August 1998 December 2004
• Sentinel sample
• Interview caregivers
• Children 0-3 years
• Emergency departments acute care clinics
• Black and Latino children - over 80
• Weight length measurements -- outcome of
  interest accepted international indicator of
  wellbeing

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Eligible Families

• Sample restricted to
• Low-income renters of color with children under 3
• Participate in at least one means-tested program
• Subsidized Housing sample
• (n 13,069)
• LIHEAP sample (n 4,091)
• additionally
• Excludes private insurance
• Only renters - heat not included

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Analytic Methods

• Multiple logistic regression
• Covariates for each program separate
• - depending on correlation with program/outcome

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Subsidized Housing analyses controlled for

• Mother born in US
• Receipt of TANF
• Receipt of WIC
• Food insecurity status

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LIHEAP analyses controlled for

• Mother born in US
• Year of interview
• Food insecurity status
• Receipt of either TANF or Food Stamps
• Receipt of WIC
• Receipt of Housing Subsidy
• Caregiver marital status
• Caregiver employment

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2004 Poverty Rates AmongHouseholds with Children
Poverty Highest among black and Latino families
US Census Bureau, 2005
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2004 Food Insecurity Rates among Households with
Children
Food insecurity highest among black and Latino
families
Nord, Andrews, and Carlson, 2005
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2004 National Eligible Household Participation in
LIHEAP
U.S. Department of Health Human Services, 2004
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Housing LIHEAP onlyreach a fraction of
eligibleC-SNAP families
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Subsidized Housing Helps Black Children Grow
Outcome Subsidy (n3,116) No Subsidy (n4,977) P Value
2 SD Weight/Age below the mean 1.00 1.33 P 0.006
Outcome Subsidy (n3,116) No Subsidy (n4,977) P Value
Mean Z-Height/Age Z 0.134 Z-0.005 Plt.0001
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LIHEAP Improves YoungBlack Childrens Growth
Outcome LIHEAP (n778) No LIHEAP (n3,313) P Values
At Nutritional Risk for Growth Problems 1.00 1.29 P 0.05
Nutritional risk lt 5th percentile for
weight-for-age or lt10th percentile for
weight-for-height
Outcome LIHEAP (n778) No LIHEAP (n3,313) P Values
Mean Z-Weight/Age Z 0.061 Z-0.051 P .04
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Subsidized Housing Helps Latino Children Grow
Outcome Subsidy (n720) No Subsidy (n4,256) P Value
2 SD Height/Age below the mean 1.00 1.99 P 0.02
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LIHEAP and Latino Children

• Results for Latino children and LIHEAP not
  presented since did not reach statistical
  significance, probably due to small sample size.
• Limited program participation reflects sample
  characteristics
• most Latino children lived in California, where
  few families of any ethnicity access LIHEAP.

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Overweight?

• No associations between overweight and LIHEAP or
  Subsidized Housing

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Limitations

• Interviews in English, Spanish, and Somali (MN
  only)
• Only blacks and Latinos
• Exclusion of the most severely ill or injured
  children
• Associations are not causation
• Difficult to make national extrapolations

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Non-food assistance programscan improve
childrens growth

• Programs like LIHEAP and Subsidized Housing
  linked to improved growth outcomes
• Heat or eat phenomenon Food budget only
  variable expense
• Food most easily decreased to pay for other
  expenses, leading to increased food insecurity,
  particularly during winter months.

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Implications for Young Black Latino Children

• Growth is indicator of health in young children
• Adverse child growth outcomes associated with not
  receiving benefits
• Safety net programs buffer young children from
  effects of poverty

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UN Convention on the Rights of the Child

• Article 27
• 1.States Parties recognize the right of every
  child to a standard of living adequate for the
  childs physical, mental, spiritual, moral and
  social development
• 3. States Parties shall take appropriate
  measures to assist parentsto provide material
  assistance and support programmes, particularly
  with regard to nutrition, clothing and housing.

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Why does it matter?

• Housing and Energy are Health Issues
• Early growth failure sets children up for
  long-term health development problems.

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Why does it matter?

• Affordable Housing and Energy are Human Rights
  Issues
• Black Latino children gt 35 of all children in
  US.
• Black Latino children higher risk for living in
  poor HHs
• Also at greater risk for negative growth effects
  associated with poverty and food insecurity.
• Food insecurity and its effects exacerbate
  achievement gaps and deepen racial/ethnic health
  disparities, depriving victims of other rights.
• Society Has a Duty to Guarantee Childrens Basic
  Rights
• Macro perspective Denial of basic rights -gt
  disastrous effects on workforce participation and
  health of national economy.

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What can we do aboutchanging policy?

• Educate Policymakers to
• Reconsider standard view of which assistance
  programs influence child nutrition.
• Food Non Food Optimal Child Health
• Understand that safety-net programs good
  medicine but dosage and availability inadequate.
• Stop cutting or freezing funding for safety-net
  programs - created health crisis for poor
  children, especially children of color
• Give recommended dosage Full package of
  benefits -gt social investment -gt reduction of
  racial/ethnic disparities

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Acknowledgements

• Report sponsored by the Joint Center for
  Political and Economic Studies
• Thanks to Avi Perry, Bill Emerson National Hunger
  Fellow, for his assistance in preparing this
  presentation.

C-SNAP operations and analyses have been
supported by the Abell Foundation, the Annie E.
Casey Foundation, the Anthony Spinazzola
Foundation, the Candle Foundation, the Claneil
Foundation, the Daniel Pitino Foundation, the EOS
Foundation, the Gold Foundation, the Gryphon
Fund, the Hartford Foundation for Public Giving,
Jennifer Kaminsky, MAZON A Jewish Response to
Hunger, the Minneapolis Foundation, the New
Hampshire Charitable Foundation, Project Bread,
the Sandpiper Philanthropic Foundation, the
Schaffer Foundation, Susan P. Davies and Richard
W. Talkov, Susan Schiro and Peter Manus, the
Thomas Wilson Sanitarium for Children of
Baltimore City, the United States Department of
Agriculture, Vitamin Litigation Funding, with
major funding from the W. K. Kellogg Foundation.
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• Please visit us on the web
• www.c-snap.org
• Thank you!