Children's reporting of food insecurity in predominately food insecure households in Texas border colonias.

0.21 MB·English

by  Nalty, Courtney C

Naltyetal.NutritionJournal2013,12:15
http://www.nutritionj.com/content/12/1/15
RESEARCH Open Access
’
Children s reporting of food insecurity in
predominately food insecure households in Texas
colonias
border
Courtney C Nalty, Joseph R Sharkey* and Wesley R Dean
Abstract
Background: Food insecurity is associated with detrimental physical, psychological, behavioral, social, and
educational functioning in children and adults.Greater than one-quarter of allHispanichouseholds in theU.S. are
food insecure. Hispanic families inthe U.S. comprise 30% of households with food insecurity atthe child level, the
most severe form of thecondition.
Methods: Food security discordance was evaluatedamong 50 Mexican-origin children ages 6–11 and their
mothers livingin Texas border colonias from March to June 2010. Mothers and children were interviewed
separately using promotora-researcher administered Spanish versions ofthe Household Food Security Survey
Module and the Food Security Survey Modulefor Youth. Cohen’s kappa statistic (κ) was used to analyze dyadic
agreement of food security constructs and level of food security.
Results: Eighty percentof mothers reported household food insecurity while 64% ofchildrenidentifiedfood
insecurity at thechild level. There was slight inter-rater agreement infood security status (κ=0.13, p=0.15). Poor
agreement was observed onthe child hunger construct (κ=−0.06, p=0.66) withfair agreement in children not
eating for a full day (κ=0.26, p<0.01) and relying on low-cost foods(κ=0.23,p=0.05).
Conclusions: Mother and child-reported household and child-level food insecurity among this sample of
limited-resource Mexican-origin colonias residents far surpass national estimates. While the level ofdyadic
agreement was poor,discordance may be attributable to parental buffering, social desirability in responses, and/or
theage ofchildrenincluded inthe present analysis.Futureresearch should continue to explore how food security
is understood from theperspectives and experiences of children and adolescents.
Keywords: Food security, Mexican-origin, Child self-reports, Differential reporting, Discordance, Inter-rater
agreement
Background households were food secure during 2011, the remaining
Food security requires that sustenance be available, nu- 14.9%,or17.9 million, were foodinsecure [2].
tritionally adequate, and acquired in socially acceptable Households with low or very low food security are
manners [1]. Its converse, household food insecurity, is considered to be food insecure. Lowfoodsecurity,previ-
an economic and social condition characterized by ously known as food insecurity without hunger, occurs
reduced or unknown access to sufficient healthful and when individuals experience a reduction in food quality,
safe food or the limited ability to acquire fare in ways variety,ordesirability,andattimesareductioninfoodin-
deemed appropriate by society. While most (85.1%) U.S. take. Of the 17.9 million food insecure households in the
U.S., 9.2% experienced low food security while 5.7% had
verylowfoodsecurityin2011[2].Verylowfoodsecurity,
previously referred to as food insecurity with hunger,
*Correspondence:[email protected]
arises when at least one household member experiences
ProgramforResearchinNutritionandHealthDisparities,SchoolofRural
PublicHealth,TexasA&MHealthScienceCenter,MS1266,CollegeStation, “multiple indications of disrupted eating patterns and
Texas,TX77843-1266,USA
©2013Naltyetal.;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreative
CommonsAttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,and
reproductioninanymedium,providedtheoriginalworkisproperlycited.
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reduced food intake” [3]. In 2011, food insecurity at the Usingamodifiedandnon-validated child food security
child level was present in 10% of U.S. households with survey, Hadley and colleagues showed that Ethiopian
children under 18 years of age. Of households with food children ages 13–17 years were able to attest to their
insecurity experienced by children, 9% had low food se- own food security experiences [20]. Recent research by
curity among children and 1% of households had at least Fram and colleagues revealed children ages 9–16 years
onechildwithverylowfoodsecurity[2]. were capable of and willing to report their own food se-
Ordinarily, household food security status is assessed curity experiences when interviewed separately from
by the Household Food Security Survey Module, includ- parents [21]. While Fram’s research demonstrated that
ing three questions that pertain to the household, seven children are cognizant of food insecurity and manage
for adults, and eight questions that determine food inse- their own food resources, a validated measurement tool
curity at the child level [4-7]. One weakness of the 18- was not used. A further limitation of Fram’s study was
item Household Food Security Survey Module is that it that researchers were unable to compare adult and child
identifies food insecurity at the aggregate level, and is not reports as a parent did not respond to questions of
able to discern intra-household differences in food secur- household food security. Connell’s qualitative research
ityamongindividualadultsandchildren[8].Furthermore, assessed children’s understanding of household food in-
parent proxy reports of children’s food security may security, but queried participants about other social con-
present an inaccurate or incomplete representation of ac- tacts, and did not directly ask about the experiences of
tualexperiences.Relying on guardian accounts is justified each child participant. Research by Connell and collea-
by two assumptions; first, the parent controls food guesidentifiedquantity,quality,psychological,andsocial
resources in the home as well as how food insecurity, if components of children’s perceptions of household food
present, is felt by all household members; second, indivi- insecurity, yet further research is needed in order to bet-
duals experience food insecurity equally as reported by terunderstand food insecurityatthe child level[16].
the parent. However, these assumptions must be ques- Comparing multiple accounts of food security status
tioned, for while mothers may attempt to buffer children within a single household, even while using validated
from the effects of household food insecurity [9,10], they and reliable modules, might result in differential report-
maynotalwaysbefullyabletoprotectchildren.Itisdiffi- ing between mother and child. In order to better com-
cult to say with certainty that all household members ex- prehend instances of differential reporting, researchers
perience food insecurity in the same capacity, especially can compare scores from two scales for concordance,
considering that mothers may not be fully aware of chil- known as informant agreement. Previous studies investi-
dren’s experiences, resourcefulness, and actions taken to gating the relationship between self-report and reports
reducetheseverityoffoodinsecurity.Aschildrenwhoare by others concluded that discrepancies were issues of
food insecure often have poorer nutritional, educational, measurement error or some flaw in study design [22].
cognitive, developmental, and social outcomes compared Yet,whenresearcherskeptmethodsconstantforallparti-
tofoodsecurechildren[5,11-15],measuringfoodinsecur- cipantsandwhenmeasurementtoolswereshowntohave
ity in children, as reported by children, is an important good reliability, the discrepancy in reports remained high
nextstepinfoodsecurityresearch. [23-25]. Therefore, discordance is not due exclusively to
Thereisaneedtounderstandfoodinsecurityfromchil- poor methodology, but rather that children’s experiences
dren’s perspectives and experiences [16,17]. In order to andperceptionsmaydifferfromthoseofadults.
justifyusingchildreportsoffoodsecuritystatus,research- It is important to note that the 18-item Household
ers ascertained whether or not children could reliably re- Food Security Survey Module ascribes a categorization
port on their own experiences. Herjanic and colleagues of food security for all household members, and does
compared mother and child reports of behavior, learning not assign food security status to individuals within the
problems,psychiatricsymptomsandmentalstatusamong household. In the present study, mothers report food se-
children ages 6–16 years. With an overall 80% agreement curity at the level ofthe household,while children, using
in responses between parent and child, Herjanic et al. the 9-item Food Security Survey Module for Youth, de-
determined that children in this age group are capable of tail hisorherown food securityexperiencesandpercep-
providing reliable information and showed that concord- tions. The current research addresses a critical gap in the
anceisslightlyimprovedinfactualorobservableinforma- literature and aims to understand complexities of intra-
tion and lower in responses to questions of mental status household differences in food security. A disjuncture in
or other internalized symptomology [18]. Herjanic and mother and child food security status will prompt
colleagues continued their analysis of parent–child agree- researchers to examine the underlying factors associated
mentwitha larger sample and found thatmothers accur- with this difference, including buffering, different food
ately reported behavioral symptoms while youth were allocations for household members, cultural factors, or
betterabletoreporttheirownsubjectivesymptoms[19]. some other yet unrecognized association. The primary
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researchquestionforthe current studyisas follows:How Datacollection
do intra-household mother and child reports of food Data were collected in Spanish between March and June
security differ according to questions of the 18-item 2010 in participants’ homes by promotora-researchers.
Household Food Security Survey Module and the 9-item Mothers provided demographic covariates (age, educa-
Food Security Survey Module for Youth? Secondarily, tion, marital status, self-identified race/ethnicity, country
using the eight child-referenced items of the Household of birth, household size, total income, work status, and
Food Security Survey Module, how does mother-reported enrollment in nutrition assistance programs). Household
child food security contrast child-reports of food security food security was assessed through mother reports of the
when children report using the Food Security Survey United States Department of Agriculture (USDA) Eco-
ModuleforYouth? nomic Research Service 18-item U.S. Household Food
Security Survey Module, validated for use with Hispanic
populations [30]. Children completed the 9-item Child
Methods FoodSecuritySurveyModule[31].Overallhouseholdand
Setting child-levelfoodsecuritywereassessedusingthe complete
This study was conducted in forty spatially selected colo- 18- and 9-item surveys, respectively. However, mother-
niaswithintwofunctionallyruralareasinHidalgoCounty child agreement for individual food security constructs
along the Texas-Mexico border. Details of the study set- was limited to the nine items that had a corresponding
tingarefurtherexplainedelsewhere[12].Coloniasareun- item on the child food security module; these constructs
incorporated settlements of varying sizes in which included 1) worrying about food supplies, 2) running out
residentsoftenbuildtheirownhomesthatsometimeslack of food supplies, 3) using low cost foods for children’s
sanitary living conditions, water and sewer systems, and meals, 4) lack of a balanced diet for children, 5) children
paved roads [26]. Residents in these two areas are not eating enough, 6) reducing children’s portion size, 7)
predominately Hispanic (93.6% and 95.6%, respectively), children skipping meals, 8) children experiencing hunger,
compared to the national rate of 15.1%, and within and 9) children going a full day without eating. Mothers’
Hidalgo County, 82.3% of residents speak Spanish in the reports of household food security, along with child food
home [27]. These colonias residents encounter economic security derived from the eight child-referenced items of
andlocationaldisadvantages[28]andaredifficulttoreach the Household Food Security Survey Module, were each
by researchers and public health workers. Furthermore, compared with child reports using the child module. See
research conducted in colonias has broad national applic- Table 1 for full detail of comparative question sets. For
ability as colonias are prototypes for newly emerging mothersandchildren,athreemonthreferenceperiodwas
immigrantdestinationselsewhereintheU.S.[29]. used to assess food security. Promotora-researchers inter-
viewedchildrenseparatelyfrommotherstoavoidparental
influenceandbias.Additionally,childrenself-reportedage
Studysample at time of survey. Both versions of the USDA Economic
Fifty mother-child dyads (100 study participants) were Research Service survey modules were translated from
recruited by promotora-researchers (certified community English to Spanish and then back-translated by a certified
health workers trained in research methods who are multi-lingual translator and reviewed by a team of native
residentsofthe community and native Spanishspeakers) Spanish speakers. With all study participants, promotora-
for a cohort study. Twenty-five dyads from western researchersassistedwithsurveyadministrationbyreading
Hidalgo County colonias and twenty-five dyads from aloudquestionsandrecordingresponsesonpapercopies.
eastern colonias were enrolled in the study. Promotora-
researchers delivered letters of invitation to participants’ Analysis
homes. Inclusion criteria necessitated that a child be- Data were entered from hard copy into Access databases
tween the ages of 6–11 years reside in the household. and verified for accuracy by an independent coder. Af-
Interviews with children led by promotora-researchers firmative responses on the household scale (“Often true”
indicated that colonia-dwelling Mexican-origin children or “Sometimes true”) were coded as Yes while negative
in this age group understood concepts of food security responses(“Nevertrue”)were codedasNo.Similarly,re-
and were willing to report their experiences. Mothers sponse options on the children’s scale were based on
were advised on the nature of the study (assessments, frequency (“A lot,” “Sometimes,” or “Never,”); for ana-
confidentiality, and financial incentive) and provided lysis the two affirmative responses were coded as Yes
consent for herself andher child while children provided while “Never” was coded as No. Scoring for the food se-
assent to participate in the study. All materials and pro- curity assessments was in accordance with USDA Eco-
tocols were approved by the Texas A&M University In- nomic Research Service recommendations. Affirmative
stitutionalReviewBoard. responses were summed as ordinal variables; the 18-item
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Table1Foodsecurityconstructsusedtocomparemothers’andchildren’sresponses
Foodsecurityconstruct HouseholdFoodSecuritySurveyModuleQuestion FoodSecuritySurveyModuleforYouthQuestion
HH2)“(I/We)worriedwhether(my/our)foodwouldrun 1)Didyouworrythatfoodathomewouldrunout
outbefore(I/we)gotmoneytobuymore.”Wasthat beforeyourfamilygotmoneytobuymore?
Worryaboutfoodsupplies
oftentrue,sometimestrue,ornevertruefor(you/your
household)inthelast3months?
HH3)“Thefoodthat(I/we)boughtjustdidn'tlast,and 2)Didthefoodthatyourfamilyboughtrunout,and
(l/we)didn'thavemoneytogetmore.”Wasthatoften, youdidn’thavemoneytogetmore?
Runoutoffoodsupplies
sometimes,ornevertruefor(you/yourhousehold)in
thelast3months?
CH1)“(I/we)reliedononlyafewkindsoflow-cost 3)Didyourmealsonlyincludeafewkindsofcheap
foodtofeed((my/our)child/thechildren)because foodsbecauseyourfamilywasrunningoutof
Lowcostfoodsforchildren (Iwas/wewere)runningoutofmoneytobuyfood.” moneytobuyfood?
Wasthatoften,sometimes,ornevertruefor(you/your
household)inthelast3months?
CH2)“(I/We)couldn’tfeed((my/our)child/thechildren) 4)Howoftenwereyounotabletoeatabalanced
Lackofabalanceddietfor abalancedmealbecause(I/we)couldn’taffordthat.“ mealbecauseyourfamilydidn’thaveenoughmoney?
children Wasthatoften,sometimes,ornevertruefor(you/your
household)inthelast3months?
CH3)“My/Ourchildwas/Thechildrenwere)noteating 5)Didyouhavetoeatlessbecauseyourfamilydidn’t
enoughbecause(I/we)justcouldn'taffordenough haveenoughmoneytobuyfood?
Childrennoteatingenough food.”Wasthatoften,sometimes,ornevertruefor
(you/yourhousehold)inthelast3months?
CH4)Inthelast3months,didyouevercutthesizeof 6)Hasthesizeofwasyourmealsbeencutbecause
Reducechildren’sportionsizes (yourchild’s/anyofthechildren’s)mealsbecausethere yourfamilydidn’thaveenoughmoneyforfood?
wasn'tenoughmoneyforfood?
CH5)Inthelast3months,did(CHILD’SNAME’anyof 7)Didyouhavetoskipamealbecauseyourfamily
Childrenskipmeals thechildren)everskipmealsbecausetherewasn’t didn’thaveenoughmoneyforfood?
enoughmoneyforfood?
CH6)Inthelast3months,(wasyourchild/werethe 8)Wereyouhungrybutdidn’teatbecauseyour
Childrenarehungry children)everhungrybutyoujustcouldn’taffordmore familydidn’thaveenoughfood?
food?
CH7)Inthelast3months,did(yourchild/anyofthe 9)Didyounoteatforawholedaybecauseyour
Childrengofulldaywithout children)evernoteatforawholedaybecausethere familydidn’thaveenoughmoneyforfood?
eating wasn’tenoughmoneyforfood?
survey was scored in the following manner: 0=high food [SBP] and National School Lunch Program [NSLP])) as
security, 1-2=marginal food security, 3-7=low food se- wellasthechild-reportedvariable(age)werecalculated.
curity, 8-18=very low food security. Child food security The amount of agreement, or precision, between
asdeterminedfromthehouseholdmodulewascomputed motherand childreports of food security statusand indi-
through the summation of affirmative responses on items vidualfoodsecurityconstructswasassessedusingCohen’s
CH1-CH7 and scored in the following manner: 0=high kappa (κ) statistic, which provides the amount of agree-
food security among children, 1=marginal food security mentbetween two unique raters after considering chance
among children, 2-4=low food security among children, agreement [33]. Terminology for describing the strength
5-8=very low food security among children [32]. The of agreement originated from work by Landis and Koch,
child-reported 9-item survey was scored in the following who ascribe κ of <0.00 as “poor,” 0.00-0.20 as “slight,”
manner:0=highfoodsecurity,1=marginalfoodsecurity, 0.21-0.40 as “fair,” 0.41-0.60 as “moderate,” 0.61-0.80 as
2-5=low food security, 6-9=very low food security “substantial,”and0.81-1.00as“almostperfect”[34].While
[17,31]. Complete food security data were available on other measures of agreement, including intraclass correl-
100%ofstudyparticipants. ation coefficient, exist, kappa was chosen for the current
Descriptive statistics (median, standard deviation, num- analysis as it is a preferred method for nominal (food
berandpercent)formother-reportedvariables(age,coun- security outcome variable was coded as 0=food secure,
try of birth, education, race/ethnicity, marital status, 1=food insecure), rather than ordinal, outcomes [33]. To
householdsize,householdmonthlyincome,andutilization furtherinvestigatetheroleofintra-householdchilddemo-
of nutrition assistance programs, including Supplemental graphics in food security agreement, the number of
Nutrition Assistance Program (SNAP), Supplemental Nu- children in each age group (according to cut-points
tritionProgramforWomen,Infants,andChildren(WIC), recommended by the Centers for Disease Control and
andschoolnutritionprograms(SchoolBreakfastProgram Prevention)aswellasthetotalnumberofchildrenineach
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home, were cross tabulated by agreement; Fisher’s Exact in reporting, with poor agreement on one, slight agree-
Tests assessed significant associations among the limited ment on six, and fair agreement on two constructs. The
sample size. Information on power analysis for discord- poorest agreement was on the construct of child hunger
ancemeasuresusingkappastatisticsislimited,althoughit (κ=−0.06, p=0.66). Fair agreement was observed among
is estimated that a sample size of 30 with two unique the constructs of children going a full day without eating
raters is sufficient given an expected kappa of 0.40 or (κ=0.26, p=0.003) and using low cost foods for house-
greater [35]; in the present analysis, the sample size of 50 hold meals (κ=0.23, p=0.05). Furthermore, 34% of chil-
dyads may accommodate lower rates of agreement. All dren reduced portion sizes and 30% of children skipped
analyses were performed using Stata Statistical Software: meals, compared to affirmative responses by 12% of
Release 11 (College Station, TX: Stata Corp, 2009) and mothers reporting on behalf of their children for each
p-valueslessthan0.05weredeemedstatisticallysignificant. construct(seeTable3).
Eighty percent of mothers reported household food in-
Results securitywhile64%ofchildrenexperiencedfoodinsecurity
Table 2 displays demographic characteristics of the sam- at the child level. Mothers were more likely to report low
ple. Median age (SD) of mothers was 34.5 years (± 6.9) or very low food security at the household level (58 and
while child median age was 8.5 years (± 1.3). Ninety-two 22 percent, respectively) than were children to report low
percent of mothers were born in Mexico, with the re- orverylowfoodsecurityatthechildlevel(44and20per-
mainder born in the United States, and mothers com- cent, respectively). Furthermore, the observed agreement
pleted a median nine years (± 2.5) of school. Median between mother and child self-reports of the two-level
household size was six adults and children (± 1.5, range: food security categorization was 64%,or “slight” (κ=0.13,
3–10) and median number of children living in the p=0.15).Thegreatestmother-childagreement was noted
home was 3.5 (± 1.2, range: 1–6). In this sample, 96% of amongfoodinsecurefamilies;thirty-twochildrenreported
children were enrolled in SBP, 88% of families utilized food insecurity at the child level, while 27 mothers
SNAP, 58% of families relied on WIC, 58% of children reported household-level food insecurity. Of the re-
were enrolled in NSLP, and 32% of families were en- maining18children,whobyself-reportswerefoodsecure,
rolled inallfournutritionassistance programs. onlyfivemothersagreedandreportedhouseholdfoodse-
Equivalent mother and child-reported food security curity(SeeTable4).Amongdiscordantpairs,smallsample
constructsfromthetwomoduleswereusedtoanalyzedif- χ2 analyses revealed no significant differences in food se-
ferential reporting. Analyses revealed a striking difference curity when considering the total number of children or
the ages of all children in the household. Comparing
Table2Selectdemographiccharacteristicsofmother- mothers’ reports of child food security with child reports
childdyads(n=100)
of child food security revealed 56%, or slight agreement,
Median±SD Range N(%) betweenthebinaryoutcomes(κ=0.09,p=0.26).
Motherage,y 34.5±6.9 20-55
Childage,y 8.5±1.3 6-11 Discussion
Mothereducation,y 9.0±2.5 1-16 The aim of the present study was to analyze inter-rater
agreement of food security among a sample of Mexican-
Householdsize 6.0±1.5 3-10
origin children age 6–11 years and their mothers living
Childreninhousehold 3.5±1.2 1-6
in Texas border colonias. In this research, the first of the
Childsex authors’ knowledge to contrast mother and child
Female 31(62) accounts of food security, analyses revealed differential
Mothercountryofbirth response rates in food security status among dyads. The
Mexico 46(92) prevalence of mother-reported household food insecur-
ity (80%) surpassed children’s reports of food insecurity
USA 4(8)
(64%), indicating only slight inter-rater agreement. The
Motherrace/ethnicity
prevalence of mother-reported child food insecurity
Hispanic 16(32)
(56%), as determined through the household scale, was
Mexican 34(68) less than the prevalence of child food insecurity as
Nutritionassistance reported by the children themselves (64%). Therefore, if
SNAP 44(88) we consider children’s reports of their own food insecur-
ity to be reliable, then there is some evidence that
WIC 29(58)
mothers may not be fully protecting children from the
Schoolbreakfast 48(96)
effects of household food insecurity. Thinking of food
Schoollunch 29(58)
security as distinct from food insecurity, children in this
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Table3Proportionofmothersandchildrenrespondingaffirmativelytofoodsecurityconstructs
Foodsecurityconstruct Affirmativeresponse Kappa Strengthof
Mothern(%)1 Childn(%)2 (p-value) Agreement
Worryaboutfoodsupplies 46(92) 25(50) 0.08(0.15) slight
Runoutoffoodsupplies 30(60) 23(46) 0.02(0.45) slight
Lowcostfoodsforchildren 30(60) 27(54) 0.23(0.05) fair
Lackofabalanceddietforchildren 29(58) 20(40) 0.19(0.08) slight
Childrennoteatingenough 17(34) 16(32) 0.05(0.36) slight
Reducechildren’sportionsizes 6(12) 17(34) 0.10(0.19) slight
Childrenskipmeals 6(12) 15(30) 0.14(0.13) slight
Childrenarehungry 2(4) 4(8) −0.06(0.66) poor
Childrengofulldaywithouteating 1(2) 6(12) 0.26(0.003) fair
1Affirmativeresponseisacombinationof“oftentrue”and“sometimestrue”.
2Affirmativeresponseisacombinationof“alot”and“sometimes”.
sample of Mexican-origin colonias residents were reli- neither by the overall number of children living in the
able reporters of their own food insecurity as it corre- household nor by the number of children within each
lates with household and mother-reported child-level five-year incremental age group. Consequently, for this
food insecurity, but children’s reports of child-level food limited sample of Mexican-origin colonias residents, dif-
security did not correspond well with mothers’ reports ferential food security reporting was not influenced by
of household or child level food security. Thus, there is household structure. Still, alternate reasons for discord-
some evidence that children as young as six years of age ancemaybeatplay,includingsocialdesirabilityinherent
may possess some ability to reliably report instances of in mothers’ reports or parental buffering of children,
foodinsecurity,althoughfurther cognitivetestingamong which may diminish reports of household and child-
alargersampleisencouraged. levelfood insecurity,respectively.
In the current study, mothers reported food security Previous food security research using the U.S. House-
for the household, including other adults and multiple hold Food Security Survey Module has relied almost ex-
children in the home, while children reported their clusively on mothers’ perceptions of children’s food
unique experiences of food security. Discordance may security and is unable to provide individual-level infor-
therefore arise from mothers’ responses for all children mation [4-7].However,researchutilizingchild reportsof
inthehome(asthemoduleinstructs)andnot solelythat food security is emerging. Children’s very low food se-
of the index child who completed the youth module. curity, as reported by Mexican-origin children ages
This becomes of particular interest when considering 6–11 years, was associated with significantly higher in-
demographics of children in the home, as teenagers may take of total energy, fat, and added sugar as compared to
buffer younger children from the effects of food insecur- food secure children in a recent finding by Sharkey and
ity. However, among the discordant pairs, there were no colleagues [12]. Additionally, recent qualitative research
statistically significant differences by family composition, has begun the process of understanding the unique ways
in which children understand, cope with, and attempt to
alleviatethe symptomsoffoodinsecurity[16,21,36].
Prior research established that children age 6–16 years
Table4Agreementinmotherandchildself-reportsof
can be reliable reporters [18,19] and at ages as young as
foodsecuritystatus
nine can share valuable information regarding their food
Participant Child
security [16,21]. Herjanic and colleagues detected con-
Leveloffood Food Food Total %
security secure1 insecure2 cordance between mother-child reports of observable
behavioral symptomology among children and less
Mother Foodsecure1 5 5 10 20
agreement among children’s internalized emotions [19].
Foodinsecure2 13 27 40 80
The results of the present study indicate overall poor
Total 18 32 50 agreement of food security status among mother and
% 36 64 child reports but particularly poor accord among sub-
Kappa(p-value) 0.13(0.15) jective experiences. In fact, mothers and children had
the strongest agreement in the construct of children not
StrengthofAgreement Slight
eating for a full day, which may be more likely to be
1Highfoodsecurityandmarginalfoodsecurity.
2Lowfoodsecurityandverylowfoodsecurity. noticed than internal emotions, such as worrying about
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food supplies. The constructs in which children more researcherswhoresidewithinthestudylocale.Relyingon
frequently reported an occurrence than mothers were local promotora-researchers as data collectors and com-
reducing portion sizes, skipping meals, or being hungry, munity advocates established trust among this sample.
which all showed poor agreement. While mothers’ Additionally, the food security instruments used in the
responses may be influenced in part by social desirabil- present research were developed with the USDA Eco-
ity, it could also be that these events were not as fre- nomic Research Service, have high internal validity, and
quently observed by mothers and thus may demonstrate are approved for use both among children and Hispanic
actions taken by children to preserve food for a lean populations [16,17,30]. Finally, complete food security
period. Numerous recently published articles have com- datawerecollectedon100%ofparticipants.
pared parent-proxy and child reports of children’s Yet, there are limitations that warrant mention. First,
experiences and perceptions of medical conditions or the study included 50 dyads and utilized a cross-sectional
overall quality of life. One review article of nineteen research design. Thus, there is limited generalizability to
quality of life subscales (including data on children ran- other populations. A larger study in a broader locale may
ging in age from 5–20 years) used intraclass correlation improve researchers’ understanding of differential report-
coefficients to determine interrater agreement and con- ingamong mothersand their children.Second, the age of
cluded thatparent–child agreementrangedfrompoorto children in this study may have affected reporting. While
good [37]. In research not included in the review article, theFoodSecuritySurveyModulefor Youthwasdesigned
Creemens and colleagues found low intraclass correl- for use with children age 12 years and older, the children
ation between parents and children ages 5.5-8.5 years on in the present study were 6–11 years of age. Interviews
quality of life reporting, and suspect that level of dis- withpromotora-researchers indicated thatchildreninthis
agreement may be a result of child age, analysis method- age group understood food security and showed willing-
ology, the domain analyzed, or parent’s own quality of ness to report while other research demonstrated the
life [38]. Finally, qualitative techniques were used among abilityofchildrentoself-reportatasyoungassixyearsof
15 parent–child pairs to discern the underlying reasons age [18-20]. Although the present study’s child sample is
for discordance in reporting of quality of life scales in a within the acceptable age range of children’s reliability to
study by Davis and colleagues. Research revealed that self-report conditions, future researchers may elect to
among a sample of 5–11 year old children and their par- focusonanadolescentpopulation.Becausethehousehold
ents, discordance may be a result of different reasoning food security module asks mothers to report the experi-
methods and response styles [39]. Overall low correl- encesofallchildreninthehome,whileonechildreported
ation among parent–child agreement in child health- his/her individualexperiences, researchers wereunable to
related quality of life is consistent with the findings of directly compare individual-level discordance. This add-
the present study of agreement in food security status. itionally hindered the researchers’ understanding of food
Research in other fields offers some basis of comparison, security among several children within a household. Fi-
yet there is a dearth of literature on agreement in par- nally, the reference period for the food security modules
ent–childfood security reporting. was the previous three months and not 30 days, which
There are several strengths to this original research. prior research has indicated may be more reliable when
This isthe first study of which the authors are aware that surveyingchildren[31].
utilized children’s self-reports of food security constructs
andleveloffoodsecuritycontrastedwithreportsprovided Conclusions
by mothers. This study answers the call to consider the The Mexican-origin population in the United States is
perspective of the child in analyzing the prevalence and growing rapidly, with a 54.1% increase from 2000 to
correlates of food insecurity [16,17,21]. Second, this re- 2010. Furthermore, the nearby four-city area of McAllen-
search provided valuable information about a sample of Edinburg-Pharr-Mission, Texas is comprised of 96.8%
hard-to-reach, limited-resource Mexican-origin families residents of Mexican origin [41]. Due to the detrimental
living in Texas border colonias. As the Hispanic popula- nutritional, behavioral, social, academic, and health-
tion in the U.S. is growing, and is expected to comprise related outcomes among children living in food insecure
29% of the population by 2050 [38,40], and South Texas households [5,11-15], and because school-based nutrition
colonias may represent an archetype for new-immigrant programs may not be adequate in addressing children’s
destinations elsewhere in the U.S. [29], understanding nutritional needs [12], children’s food insecurity among
foodinsecurityamongthispopulationisimperativetode- the increasingMexican-origin population in the U.S. can-
creasing the burden of health disparities, especially those not be overlooked. This research addresses a gap in chil-
related to nutrition. Third, data were collected using dren’s food security literature and sheds light onto a
Spanish-language surveys and interviews within par- difficult-to-reach population of Mexican-origin families
ticipants’ homes and obtained by trained promotora- livinginTexasbordercolonias.Futureresearchendeavors
Naltyetal.NutritionJournal2013,12:15 Page8of9
http://www.nutritionj.com/content/12/1/15
ought toassess food security from children’s perspectives, 13. CookJT,FrankDA,BerkowitzC,BlackMM,CaseyPH,CuttsDB,MeyersAF,
among a larger and slightly older sample, in accordance ZaldivarN,SkalickyA,LevensonS,HeerenT,NordM:Foodinsecurityis
associatedwithadversehealthoutcomesamonghumaninfantsand
with the recommendations by the USDA Economic toddlers.JNutr2004,134:1432–1438.
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PM:Childhealth-relatedqualityoflifeandhouseholdfoodsecurity.Arch
Competinginterests PediatrAdolescMed2005,159:51–56.
Theauthorsdeclarethattheyhavenocompetinginterests. 15. Rose-JacobsR,BlackMM,CaseyPH,CookJT,CuttsDB,ChiltonM,HeerenT,
LevensonSM,MeyersAF,FrankDA:Householdfoodinsecurity:Associations
Authors’contributions withat-riskinfantandtoddlerdevelopment.Pediatrics2008,121:65–72.
JRSdesignedtheresearchstudy,andworkedonthedevelopmentofthe 16. ConnellCL,LoftonKL,YadrickK,RehnerTA:Children’sexperiencesoffood
instrumentsandtheprotocolforcollectionofdata.CCNdevelopedthe insecuritycanassistinunderstandingitseffectontheirwell-being.
researchquestionandconductedtheanalysis.CCN,JRS,andWRDwrotethe JNutr2005,135:1683–1690.
firstdraftofthepaper.CCN,JRS,andWRDreadandapprovedthefinal 17. ConnellCL,NordM,LoftonKL,YadrickK:Foodsecurityofolderchildren
manuscript. canbeassessedusingastandardizedsurveyinstrument.JNutr2004,
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18. HerjanicB,HerjanicM,BrownF,WheattT:Arechildrenreliablereporters?
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