Day-to-day variation in adolescent food insecurity
Introduction
Food insecurity, defined as a household-level economic and social condition of limited or uncertain access to adequate food (Bickel et al., 2000), has been linked to adverse physical and mental health outcomes for adults and children. The majority of the research linking food insecurity and child well-being has focused on children in the early childhood period. The more limited research on adolescents, however, suggests that food insecurity is related to worse adolescent mental health (Burke et al., 2016, Dush, 2020, McLaughlin et al., 2012, Paquin et al., 2021, Shankar et al., 2017), including clinical levels of distress (Heflin et al., 2019), and higher levels of substance use (Baer et al., 2015). Food insecurity includes both an insufficiency in the type and quality of food available, and also the subjective aspect of worry about food access and sufficiency.
Although food insecurity is a risk factor for poor health among all children, it is important to focus specifically on how adolescents experience food insecurity because they have different familial roles and social experiences than younger children. As children move from middle childhood into adolescence, parents are less likely to shield children from hunger, and children begin to participate more actively in their households’ efforts to obtain food and manage food resources (Bernal et al., 2012, Fram et al., 2011, Waxman et al., 2015). Unlike younger children, adolescents are also more keenly aware of the stigma associated with not having enough to eat (Waxman et al., 2015). Indeed, adolescents can reliably self report about their own food insecurity (Gulliford et al., 2007) and their self reports do not always align with reports from adults in the same household (Nord & Hanson, 2012).
The majority of studies of adolescent food insecurity utilize parents’ report of food insecurity (Dush, 2020). There are several reasons to focus on adolescents’ reports about their own food insecurity. First, adolescents spend a considerable amount of time away from home with access to other food sources, such as school and with peers. Second, many adolescents work and can use their own earnings for the purchase of food. Third, adolescents have different metabolic and food needs. Finally, there is evidence that adolescents are able to reliably report about their own experiences with food insecurity (Dush, 2020). Taken together, understanding food insecurity from adolescents’ own perspectives, rather than relying on parents’ reports about the household in general, is crucial for understanding adolescents’ experience and health.
Food insecurity is typically conceptualized as a state of economic well-being, with families categorized as food secure or food insecure. Economic instability, however, is a common experience among economically disadvantaged families (Dahl et al., 2011) and this instability can trigger variability in food insecurity (Heflin, 2016). It is likely that a family’s experience of food insecurity frequently changes over time. Much of the literature on economic instability has focused on monthly or yearly variation (e.g., Gennetian et al., 2018a, Morris et al., 2015). Daily variation, however, matches the time scale of family life (Bolger et al., 2003); understanding families’ daily lives can facilitate culturally grounded inquiries about adolescent development in diverse families (Weisner, 2002). For example, a focus on daily variability has facilitated inquiry on how low socio-economic status relates to adolescents’ daily mood (Chiang et al., 2015, Rivenbark et al., 2019). However, no research has focused on daily variability in adolescents’ economic well-being.
A focus on variability in economic well-being is crucial because research has shown that economic instability is an additional risk factor for poor adolescent health, well-being and development, over and above the risks associated with low income (Gennetian et al., 2018b, Gennetian et al., 2015, Poonawalla et al., 2014, Sandstrom and Huerta, 2013). Variability in food insecurity may partially explain gaps in health between low-income and high-income adolescents, as unpredictability and repeated exposure to ups and downs is stressful for adolescents and their families. Thus, understanding economic instability itself is essential to understanding influences on adolescent well-being, especially among disadvantaged groups. No prior research has focused on variability in adolescents’ reports of their own food insecurity.
Variability in food insecurity may also be higher for adolescents from certain demographic groups. First, variability is likely to be higher among economically disadvantaged adolescents than not economically disadvantaged adolescents. Other types of variability, such as earnings and income volatility, are highest among the most economically disadvantaged (Dynan et al., 2012, Gottschalk and Moffitt, 2009, Morduch and Schneider, 2017). Even among low-income households, the most disadvantaged have experienced the largest increases in household income instability in the last two decades (Bania & Leete, 2009). Second, variability is likely to vary by adolescent race and ethnicity. Research has consistently shown that Black households experience higher levels of economic instability than White households (Hardy, 2017). Much less research has focused on differences by ethnicity, but emerging evidence suggests that, among households with children, the lowest-income Hispanic households have slightly less income instability than non-Hispanic Black or White households (Gennetian et al., 2018a). Finally, it is possible that variability differs by child gender. There is some evidence that girls experience more negative consequences of declines in family economic status than boys (Elder & Caspi, 1988). Girls may also experience more variability or have more heightened awareness of variability in food insecurity, in particular, because they are more likely than boys to be engaged in shopping and food preparation activities within the household: on average, girls complete more housework than boys, and children are also typically assigned gender-stereotyped housework (Raley & Bianchi, 2006).
The Supplemental Nutrition Assistance Program (SNAP; formerly Food Stamps), the United States’ largest nutrition assistance program, is successful in achieving its goal of reducing food insecurity and the severity of food insecurity for low-income families (Hoynes & Schanzenbach, 2015). Despite the success of the SNAP program in reducing food insecurity, there is a growing body of evidence that some variability in both food insecurity and other behavioral and well-being outcomes is related to the timing of receipt of SNAP benefits (Castellari et al., 2015, Gassman-Pines and Bellows, 2018, Gassman-Pines and Schenck-Fontaine, 2019, Goldin et al., 2016, Hastings and Washington, 2010, Schenck-Fontaine et al., 2017, Shapiro, 2005, Smith et al., 2016, Stephens, 2003, Todd, 2015, Wilde and Ranney, 2000). Parents of children in early childhood, for example, report higher levels of household food insecurity at the end of the SNAP month, compared to at the beginning (Gassman-Pines & Schenck-Fontaine, 2019). However, how adolescents in particular experience variability in food insecurity in relation to SNAP timing is not known.
In this study, we address these gaps in the literature by using data an ecological momentary assessment (EMA) study of a diverse population of adolescents to examine for whom variability in food insecurity is most evident. In EMA studies, participants are repeatedly sampled over a particular period, in order to gather information about behaviors and experiences in real-world settings and in real time (Shiffman et al., 2008). In the current EMA study, adolescents were asked to provide survey reports every day for 14 days. We use the daily survey reports to examine differences by adolescent characteristics in both average food insecurity and day-to-day variability in food insecurity. Finally, we conduct an exploratory analysis examining links between the timing of SNAP benefit receipt and adolescents’ daily food insecurity. This study is the first to examine variability in daily food insecurity among adolescents.
Based on the literature reviewed above, this study has several hypotheses. First, we hypothesize that adolescents’ reports of daily food insecurity will vary from day to day. Second, we hypothesize that this daily variation will be larger for adolescents with certain characteristics than others. In particular, we hypothesize that daily variability will be greater for economically disadvantaged, Black and female adolescents.
Section snippets
Participants
The sample of 395 adolescents was recruited between April 2016 and February 2017 for an in-depth study of daily experiences and health, composed of an initial interview and a 14-day EMA (see Fig. 1). Adolescents were selected from a population-representative study of children aged 9 to 15 in North Carolina public schools (Rivenbark et al., 2019) based on their: 1) proximity to two geographically distinct locations (central, urban NC, and western, rural NC) from which staff could make in-person
Sample characteristics
Demographic characteristics of the adolescent analysis sample are presented in Table 1. The vast majority of adolescents (94%) fell between the ages of 12–15 (full range = 10–17 years of age). The sample is fairly diverse in terms of race/ethnicity, with 19 percent of adolescents identified as non-Hispanic Black and 12 percent of adolescents identified as Hispanic. The sample is also diverse in terms of economic disadvantage, with half of adolescents (51%) sampled identified as never
Discussion
Food insecurity is linked with adverse health outcomes for adolescents, but adolescents have been understudied in the research on food insecurity. This study began to address that gap by examining adolescents’ daily reports of food insecurity over a two-week period. The innovation of our approach was to use daily reports from adolescents, facilitating an examination of variability, in addition to levels, of food insecurity. Results showed that daily variability in food insecurity was common,
Limitations
Other limitations of this study should be mentioned. First, racial group and economic disadvantage are likely confounded. Even models that include both race/ethnicity and economic disadvantage as predictors may not fully capture that complex interplay between race and economic disadvantage. Although we are able to ascertain whether adolescents were economically disadvantaged using administrative records of whether students were ever classified for free or reduced lunch, this measure is quite
Conclusion
Despite these limitations, this paper makes an important contribution to our understanding of adolescent food insecurity. Because of its links with adverse mental and physical health problems, food insecurity is a public health problem. Although food insecurity is typically thought of as a state of economic well-being, with families being categorized as either food secure or food insecure, economic instability is a common experience among economically disadvantaged families (Dahl et al., 2011)
CRediT authorship contribution statement
C. Odgers: Resources, Writing - reviewing and editing.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgements
This study was supported in part by National Institute on Drug Abuse (NIDA) Grant P30 DA023026. Earlier versions of this work were presented at the Association for Public Policy Analysis and Management Fall Research Conference and the Society for Research in Child Development Biennial Meeting.
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