WIC Participation and Attenuation of Stress-Related Child Health Risks of Household Food Insecurity and Caregiver Depressive Symptoms
WIC Participation and Attenuation of Stress-Related Child Health Risks of Household Food Insecurity and Caregiver Depressive Symptoms
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DOI：
10.1001/archpediatrics.2012.1
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发表时间：
2012-05-01
影响因子：
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通讯作者：
Frank, Deborah A.
中科院分区：
文献类型：
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作者：
Black, Maureen M.;Quigg, Anna M.;Frank, Deborah A.
目的：为了研究家庭压力源（家庭食物不安全和/或照顾者抑郁症状）与儿童健康有关，以及参与妇女、婴儿和儿童特别补充营养计划（WIC）是否会减弱与压力相关的儿童健康风险。设计：2000年1月1日至2010年12月31日的横断面家庭压力和累积压力模型。从巴尔的摩、波士顿、小石城、洛杉矶、明尼阿波利斯、费城和华盛顿的急诊科和/或初级保健招募的家庭参与者：参与者包括26 950名符合WIC条件的护理人员和年龄小于36个月的儿童; 55.2%为黑人，29.9%为西班牙裔，13.0%为白色。照顾者的平均年龄为25.6岁; 68.6%出生于美国，64.7%完成高中学业，38.0%已婚，36.5%有工作。主要暴露：参与者中，24.0%有家庭食物不安全，24.4%有抑郁症状; 9.1%有两种压力源，29.9%有一种压力源，61.0%没有压力源; 89.7%是WIC participator.Outcome措施：照顾者报告儿童健康，终身住院，和发展风险。测量了体重和长度。我们计算了体重饲料和身高年龄z分数和体重不足或超重的风险。良好的儿童复合材料包括良好/优秀的健康，没有住院，没有发育风险，既不体重不足，也不overweight.Results：在多变量分析调整协变量，作为压力增加，公平/健康状况不佳，住院，和发育风险的几率增加和良好的儿童状态的几率下降。WIC参与和压力源之间的相互作用在3个儿童健康指标上有利于双重压力源家庭中的WIC参与者而不是非参与者：（1）健康状况一般/较差：WIC参与者，调整后的比值比（aOR）为1.89（95% CI，1.66-2.14）vs非参与者，2.35（2.16-4.02）;（2）健康儿童状况：WIC参与者，0.73（0.62-0.84）与非参与者，0.34（0.21-0.54）;和（3）超重：WIC参与者，1.01（0.88-1.16）与非参与者，1.48（1.04-2.11）（P =.结论：随着应激源的增加，儿童健康风险增加。参加WIC减少了但并没有消除儿童健康风险。《儿科青少年医学文献》2012; 166（5）：444-451
Objectives: To examine how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) attenuates stress-related child health risks.Design: Cross-sectional family stress and cumulative stress models from January 1, 2000, through December 31, 2010.Setting: Families recruited from emergency departments and/or primary care in Baltimore, Boston, Little Rock, Los Angeles, Minneapolis, Philadelphia, and Washington, DC.Participants: Participants included 26 950 WIC-eligible caregivers and children younger than 36 months; 55.2% were black, 29.9% were Hispanic, and 13.0% were white. Caregivers' mean age was 25.6 years; 68.6% were US-born, 64.7% had completed high school, 38.0% were married, and 36.5% were employed.Main Exposures: Of the participants, 24.0% had household food insecurity and 24.4% had depressive symptoms; 9.1% had both stressors, 29.9% had 1 stressor, and 61.0% had neither; 89.7% were WIC participants.Outcome Measures: Caregivers reported child health, lifetime hospitalizations, and developmental risk. Weight and length were measured. We calculated weight-forage and length-for-age z scores and the risk of underweight or overweight. The well-child composite comprised good/excellent health, no hospitalizations, no developmental risk, and neither underweight nor overweight.Results: In multivariate analyses adjusted for covariates, as stressors increased, odds of fair/poor health, hospitalizations, and developmental risk increased and odds of well-child status decreased. Interactions between WIC participation and stressors favored WIC participants over nonparticipants in dual stressor families on 3 child health indicators: (1) fair/poor health: WIC participants, adjusted odds ratio (aOR), 1.89 (95% CI, 1.66-2.14) vs nonparticipants, 2.35 (2.16-4.02); (2) well-child status: WIC participants, 0.73 (0.62-0.84) vs nonparticipants, 0.34 (0.21-0.54); and (3) overweight: WIC participants, 1.01 (0.88-1.16) vs nonparticipants, 1.48 (1.04-2.11) (P =. 06).Conclusions: As stressors increased, child health risks increased. WIC participation attenuates but does not eliminate child health risks. Arch Pediatr Adolesc Med. 2012; 166(5): 444-451