Food Insecurity, Neighborhood Environment, and Weight Trajectories in Young Children: Implications for Food Assistance Policy

近14%的美国家庭有孩子的粮食不安全开始之前， 于2019冠状病毒病危机期间，该数字大幅增加。粮食不安全（FI）- 家庭中的每个人都无法获得足够的食物，无法过上积极、健康的生活， 儿童早期发育受到严重影响，并可能使儿童面临短期和长期健康不良的风险。FI也是一个 儿童不平等的主要来源：与有孩子的白色家庭相比，黑人家庭是3 倍的可能性和拉丁裔家庭的两倍以上的可能性经验FI。家庭金融服务的程度 影响儿童的饮食和体重可根据看护者的保护行为而变化（例如，不吃饭 优先喂养他们的孩子），家庭居住的社区的特征（例如，健康食品 （三）参与粮食援助计划。 妇女、婴儿和儿童特别补充营养计划（WIC）是一项重要的 一项以证据为基础的计划，通过向有0-4岁儿童的家庭提供服务， 获得营养和发育适当的食物和咨询。然而，只有一半的人 有资格参加WIC;在那些谁参加，不赎回或部分赎回的 每月的福利是常见的。要最大限度地发挥这一基础粮食援助计划的效力， 了解影响家庭参与和使用福利的多层次因素。 拟议的探索性顺序混合方法研究的目标是为实施 WIC和其他粮食援助政策，分析家庭FI如何与体重轨迹相关联 以及这种联系如何被邻里环境和公共食品所改变 援助方案。我们将通过以下具体目标实现这一目标： 目标1：与低收入照顾者进行深入的定性重点小组调查，以调查家庭的食物 2019冠状病毒病危机和经济复苏期间的采购、喂养做法和粮食不安全， 包括最近WIC和社区特征的变化。 目的2：评估2至36个月时的FI是否可预测3岁和6岁之前的体重增加轨迹 以及COVID-19危机爆发后。 目标3：评估早期生活中FI和（焦点小组确定的）邻里环境之间的相互作用， 预测COVID-19危机爆发前后3岁和6岁儿童体重增加轨迹的指标。 我们将在综合报告中整合定性和定量研究结果，为WIC计划提供信息 建议，以最好地支持家庭的健康喂养选择和儿童的健康成长， 多层次的影响因素。我们提供的证据可用于改进WIC实施， 在大都市地区为有幼儿的家庭提供长期支助，并在危机时期提供支助。

PROJECT SUMMARY Nearly 14% of US households with children were food insecure before the start of the COVID-19 crisis, and this number increased dramatically during the pandemic. Food insecurity (FI)— inadequate access to enough food for every person in a household to live an active, healthy life—threatens critical early childhood growth and can put children at risk for poor short- and long-term health. FI is also a major source of inequity among children: compared to white households with children, Black households are 3 times as likely and Latinx households over twice as likely to experience FI. The degree to which household FI impacts children’s diet and weight may vary depending on caregivers’ shielding behaviors (e.g., skipping meals to prioritize feeding their children), characteristics of the neighborhoods where families live (e.g., healthy food access), and participation in food assistance programs. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is an important evidence-based program that supports equitable child health by providing families with children aged 0–4 access to nutritionally and developmentally appropriate foods and counseling. However, only half of those who are eligible for WIC participate; among those who do participate, nonredemption or partial redemption of the monthly benefit is common. Maximizing the effectiveness of this cornerstone food assistance program requires understanding the multilevel factors that influence families’ participation and use of the benefit. The goal of the proposed exploratory sequential mixed-methods study is to inform implementation of WIC and other food assistance policies by analyzing how household FI is associated with weight trajectories among young children, and how this association is modified by neighborhood environment and public food assistance programs. We will accomplish this goal through the following specific aims: Aim 1: Conduct in-depth qualitative focus groups with caregivers with low incomes to investigate families’ food purchasing, feeding practices, and food insecurity during the COVID-19 crisis and economic recovery, including recent changes in WIC and neighborhood characteristics. Aim 2: Assess whether FI at age 2 to 36 months predicts weight gain trajectories to age 3 and 6 years before and after onset of the COVID-19 crisis. Aim 3: Assess interactions between FI and (focus group-identified) neighborhood environments in early life as predictors of child weight gain trajectories to age 3 and 6 years before and after onset of the COVID-19 crisis. We will integrate qualitative and quantitative findings in an integrative report to inform WIC program recommendations to best support families’ healthy feeding choices and children’s healthy growth in the context of multilevel contributing factors. The evidence we produce can be used to improve WIC implementation to support families with young children in metropolitan areas long-term and in times of crisis.