Food insecurity, housing instability, and dietary quality among children with sickle cell disease: Assessment from a single urban center

Abstract

Background Food insecurity and housing instability, both social determinants of health (SDoH), disproportionately affect economically unstable, under‐resourced US communities in which children with sickle cell disease (SCD) live. Association between these SDoH markers and dietary quality among children with SCD is unknown. Procedures We assessed a cross‐sectional sample of dyadic parent–child patients and young adult patients up to age 21 from one pediatric SCD center. Food insecurity, housing instability, and dietary quality were measured using validated US instruments and a food frequency questionnaire. Better dietary quality was defined using US dietary guidelines. Multivariate regression assessed for associations among dietary quality and food insecurity with or without (±) housing instability and housing instability alone. Results Of 100 enrolled participants, 53% were Black and 43% Hispanic; mean age 10.6 ± 5.6 years. Overall, 70% reported less than or equal to one economic instability: 40% housing instability alone and 30% both food insecurity and housing instability. Eighty percent received more than or equal to one federal food assistance benefit. Compared to no economic instability, food insecurity ± housing instability was significantly associated with higher intake of higher dairy and pizza, while housing instability alone was significantly associated with higher dairy intake. Food insecurity ± housing instability was significantly associated with lower intake of whole grains compared to housing instability alone. Conclusions Our sample reported high frequencies of both food insecurity and housing instability; having more than or equal to one SDoH was associated with elements of poorer diet quality. Screening families of children with SCD for food insecurity and housing instability may identify those with potential nutrition‐related social needs.

Mental health assessment of youth with sickle cell disease and their primary caregivers during the COVID‐19 pandemic

“…We had hypothesized that pandemic‐related social and health concerns would be associated with social vulnerability, food insecurity, and mental health symptoms. Despite high SVI, only a modest proportion of dyads reported food insecurity, in contrast with our 2018 single‐site assessment and a national pandemic survey 3,15 . Comparing largely pre‐pandemic results from a different measure of depressive symptoms, prevalence of mental health symptoms appeared to have shifted over time: fewer youth and more caregivers were affected during the pandemic, but they were not the same participants over time.…”

“…Despite high SVI, only a modest proportion of dyads reported food insecurity, in contrast with our 2018 single‐site assessment and a national pandemic survey. 3 , 15 Comparing largely pre‐pandemic results from a different measure of depressive symptoms, prevalence of mental health symptoms appeared to have shifted over time: fewer youth and more caregivers were affected during the pandemic, but they were not the same participants over time. Nonetheless, a substantial proportion of both groups lacked optimism about the future.…”

“…22 We hypothesized that (a) our sample had high SVI; (b) mental health symptoms, including depressive symptoms, were common among HABIT dyads during the early months of the COVID-19 pandemic; and (c) food insecurity, a measure of economic instability, was frequently experienced. 3 From June to October 2020, enrolled dyads were offered participation in an open-access online survey of standardized adult core mental health symptoms, which focused on how the COVID-19 pandemic may have affected them personally. 23 We minimally adapted survey questions for study of youth.…”

“…Most people living with sickle cell disease (SCD) in the United States identify as Black and/or Latino, 1 whose communities are disproportionately underresourced and vulnerable to adverse social factors 2–4 . Social, economic, and disease‐related factors render youth with SCD and their caregivers susceptible to mental health issues; for example, depression and anxiety 5–11 .…”

“…Most people living with sickle cell disease (SCD) in the United States identify as Black and/or Latino, 1 whose communities are disproportionately underresourced and vulnerable to adverse social factors. 2 , 3 , 4 Social, economic, and disease‐related factors render youth with SCD and their caregivers susceptible to mental health issues; for example, depression and anxiety. 5 , 6 , 7 , 8 , 9 , 10 , 11 Among adolescents with chronic health conditions, depressive symptoms are associated with less disease self‐management and more disability and hospitalization.…”