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

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.