Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.

Food insecurity is increasingly recognized as a major health crisis in the U.S. More than 42 million persons were food insecure in 2015, far higher than the levels preceding the 2007 Great Recession. Decades of research demonstrate that food insecurity diminishes individuals’ overall well-being. The recognition of food insecurity as a health crisis, however, stems from a more recent appreciation of the multiple negative health outcomes and, thus, higher health care costs, attributable to food insecurity. An extensive literature from multiple fields, including agricultural economics, economics, medicine, and nutrition, has emerged in recognition of food insecurity as a health crisis. Among other findings, food insecurity among children is associated with increased risks of some birth defects, anemia, lower nutrient intakes, cognitive problems, and aggression and anxiety. Food insecurity is also associated with higher risks of being hospitalized, poorer general health, worse oral health and with having asthma, behavioral problems, depression, and suicidal ideation. For adults, studies have shown that food insecurity is associated with decreased nutrient intakes; increased rates of mental health problems (including depression), diabetes, hypertension, and hyperlipidemia; being in poor or fair health; and poor sleep outcomes. Food insecurity and poor health are likely linked bi-directionally; that is, it is true both that living in a food insecure household predisposes an individual to poor health, and that poor health predisposes one to living in a food insecure household. After describing how food insecurity is measured, we turn to the multiple causes of food insecurity and potential pathways through which food insecurity leads to these negative health outcomes. Finally, we describe two recently articulated interventions designed to address both food insecurity and its health impact. The first is a targeted increase in benefit levels for supplemental nutrition assistance program (SNAP, formerly known as the Food Stamp Program) enrollees and near eligible households, and the second provides tailored support for food insecure individuals with diabetes.

ABSTRACT. Objective. Hunger, with its adverse consequences for children, continues to be an important national problem. Previous studies that document the deleterious effects of hunger among children cannot distinguish child from family hunger and do not take into account some critical environmental, maternal, and child variables that may influence child outcomes. This study examines the independent contribution of child hunger on children's physical and mental health and academic functioning, when controlling for a range of environmental, maternal, and child factors that have also been associated with poor outcomes among children.Methods. With the use of standardized tools, comprehensive demographic, psychosocial, and health data were collected in Worcester, Massachusetts, from homeless and low-income housed mothers and their children (180 preschool-aged children and 228 school-aged children). Mothers and children were part of a larger unmatched case-control study of homelessness among femaleheaded households. Hunger was measured by a set of 7 dichotomous items, each asking the mother whether she has or her children have experienced a particular aspect of hunger during the past year-1 concerns food insecurity for the entire family, 2 concern adult hunger, and 4 involve child hunger. The items, taken from the Childhood Hunger Identification Project measure, are summed to classify the family and divided into 3 categories: no hunger, adult or moderate child hunger, or severe child hunger (indicating multiple signs of child hunger). Outcome measures included children's chronic health condition count using questions adapted from the National Health Interview Survey, Child Health Supplement, and internalizing behavior problems and anxiety/ depression, measured by the Child Behavior Checklist. Additional covariates included demographic variables (ie, age, gender, ethnicity, housing status, number of moves, family size, income), low birth weight, child life events (ie, care and protection order, out of home placement, abuse, severe life events count), developmental problems (ie, developmental delay, learning disability, emotional problems), and mother's distress and psychiatric illness. Multivariate regression analyses examined the effect of child hunger on physical and mental health outcomes.Results. The average family size for both preschoolers and school-aged children was 3; about one third of both groups were white and 40% Puerto Rican. The average income of families was approximately $11 000. Among the school-aged children, on average 10 years old, 50% experienced moderate child hunger and 16% severe child hunger. Compared with those with no hunger, school-aged children with severe hunger were more likely to be homeless (56% vs 29%), have low birth weights (23% vs 6%), and have more stressful life events (9 vs 6) when compared with those with no hunger. School-aged children with severe hunger scores had parent-reported anxiety scores that were more than double the scores for children with no hunger and significant...

Food insecurity is experienced by millions of Americans, and its prevalence has increased dramatically in recent years. Due to its prevalence and many demonstrated negative health consequences, food insecurity is one of the most important nutrition-related public health issues in the U.S. In this article, we cover how economic insights and models have improved our understanding of the determinants of food insecurity, the effects of food insecurity on health outcomes, and the impact of food assistance programs on food insecurity. We conclude with a discussion of several issues where economists can provide further insights. Disciplines Behavioral Economics | Food Security | Health Economics | Social Welfare Comments This is a manuscript of an article published as Gundersen, Craig, Brent Kreider, and John Pepper. "The economics of food insecurity in the United States."

Household food insecurity has been associated with several negative health outcomes, yet little is known about the prevalence and correlates of household food insecurity during pregnancy. This study was conducted as part of the Pregnancy, Infection, and Nutrition prospective cohort study to identify risk factors of preterm birth. The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes

The literature assessing the efficacy of the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, has long puzzled over positive associations between SNAP receipt and various undesirable health outcomes such as food insecurity. Assessing the causal impacts of SNAP, however, is hampered by two key identification problems: endogenous selection into participation and extensive systematic underreporting of participation status. Using data from the National Health and Nutrition Examination Survey (NHANES), we extend partial identification bounding methods to account for these two identification problems in a single unifying framework. Specifically, we derive informative bounds on the average treatment effect (ATE) of SNAP on child food insecurity, poor general health, obesity, and anemia across a range of different assumptions used to address the selection and classification error problems. In particular, to address the selection problem, we apply relatively weak nonparametric assumptions on the latent outcomes, selected treatments, and observed covariates. To address the classification error problem, we formalize a new approach that uses auxiliary administrative data on the size of the SNAP caseload to restrict the magnitudes and patterns of SNAP reporting errors. Layering successively stronger assumptions, an objective of our analysis is to make transparent how the strength of the conclusions varies with the strength of the identifying assumptions. Under the weakest restrictions, there is substantial ambiguity; we cannot rule out the possibility that SNAP increases or decreases poor health. Under stronger but plausible assumptions used to address the selection and classification error problems, we find that commonly cited relationships between SNAP and poor health outcomes provide a misleading picture about the true impacts of the program. Our tightest bounds identify favorable impacts of SNAP on child health.

Background Household food insecurity is positively associated with weight among women. The association between household food insecurity and pregnancy related weight gain and complications is not well understood. Objective To identify if an independent association exists between household food insecurity and pregnancy related complications. Design Data from the Pregnancy, Infection and Nutrition prospective cohort study were used to assess household food insecurity retrospectively using the United States Department of Agriculture (USDA) 18-item Core Food Security Module (CFSM) among 810 pregnant women with incomes ≤ 400% of the income/poverty ratio, recruited between January 2001 and June 2005 and followed through pregnancy. Main outcome measures Self-reported pregravid body mass index, gestational weight gain, second trimester anemia, pregnancy-induced hypertension, and gestational diabetes mellitus. Statistical analyses performed: Multivariate linear, multinomial logistic and logistic regression analyses. Results Among 810 pregnant women, 76% were from fully food secure, 14% were from marginally food secure, and 10% were from food insecure households. In adjusted models, living in a food insecure household was significantly associated with severe pregravid obesity [adjusted odds ratio (AOR) 2.97, 95% confidence intervals (CI) 1.44, 6.14], higher gestational weight gain [adjusted β coefficient 1.87, 95% CI 0.13, 3.62] and with a higher adequacy of weight gain ratio [adjusted β 0.27, CI 0.07, 0.50]. Marginal food security was significantly associated with gestational diabetes mellitus [AOR 2.76, 95% CI 1.00, 7.66]. Conclusions This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain and pregnancy complications.

No abstract