Relationship Between Food Insecurity and Neighborhood Child Opportunity Index in a Pediatric Emergency Department

Background: Food insecurity (FI) is a major public health concern affecting more than six million children living in the United States. Identifying neighborhood-level characteristics is important to inform place-based interventions to address FI. The Child Opportunity Index (COI) is a publicly available measure of neighborhood resources and conditions that affect a child’s health. It evaluates 29 indicators of neighborhood opportunity in educational, health/environmental, and social/economic domains across all census tracts within metropolitan areas. The COI has been previously associated with increased acute care visits and asthma-related hospitalizations. However, the association between COI and FI has not yet been established.

Methods: This was a secondary analysis of the BearSCREEN, a comprehensive screening instrument for social determinants of health and behavioral health risks. It was administered in an urban pediatric emergency department to adolescents aged 13-21 years and caregivers of children 0-17 years from July 2017 to August 2019. FI was assessed using the two-item Hunger Vital Sign. Residential addresses were geocoded and linked with census tract level COI data. Participants were categorized as living in areas of very high/high, moderate, or low/very low opportunity. GIS mapping was used to identify areas of FI compared to COI. Bivariable and multivariable logistic regression models were developed to measure the relationship between COI and FI.

Results: Of the 954 (384 adolescent, 570 caregivers) participants who underwent screening, 15.7% identified FI (14.3% of adolescent and 16.7% of caregiver participants). The mean age of all patients in the study was 10.0 years and the majority (62.3%) of the study population was non-Hispanic Black and publicly insured (56.6%). Adolescents 14-17 years had a lower likelihood of reporting FI when compared to patients 0-13 years old (aOR: 0.7 [0.4, 0.9]) (Table 1). The majority of participants lived in low/very low opportunity tracts [overall: 76.8%; food secure: 74.5%; food insecure: 88.3%]. FI was clustered in census tracts with low child opportunity (Figure 1). In adjusted analyses, participants living in census tracts with low child opportunity had three times greater odds of being food insecure compared to children living in high child opportunity (aOR: 3.0 [1.4, 6.3]) (Table 1).

Conclusion: Addressing FI is a vital step in improving health outcomes and reducing longstanding disparities in healthcare. We demonstrate that FI is associated with lower neighborhood opportunity. Our results could inform future screening initiatives and support the development of novel, place-based interventions to tackle the complex issue of food insecurity.