MICHELLE CHAN

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Food Insecurity in Low-Income Youth: Summary, Synthesis, and Recommendations

Section 1: Summary and Synthesis

Introduction

The United States Department of Agriculture (USDA) defines food insecurity as a

household-level economic and social condition of limited or uncertain access to adequate food.

(1) In 2015, 6.4 million children lived in food-insecure households in the United States. (2) For

children living in these food-insecure households, food insecurity is associated with significantly

associated with a variety of negative health outcomes. Often, food insecurity is associated with a

lower socioeconomic status (SES), though other factors such as education level and

transportation access play roles in determining access and adoption of healthy diets. Children are

especially susceptible to food insecurity as they often lack agency over their own food choices.

Given the negative health outcomes children can face from food insecurity, ranging from

increased risk for diabetes to asthma to tooth decay, the need to address food insecurity for youth

is clear.

I serve as an after-school tutor at Ballinger Homes, a low-income housing complex

operated by the King County Housing Authority. The after school program, which is operated by

the Center for Human Services, is focused on providing a safe and productive after-school space

for the children, who are all residents of Ballinger Homes. The children, ranging in grades from

K-12, are provided with a snack, homework help, and other activities. However, interviews with

stakeholders have revealed food insecurity as a public health problem among the children as

many of the families at Ballinger lack the access, income, or time to make healthy food choices.

This paper first aims to explore the problem of food insecurity among low-income youth,

particularly some of the challenges that youth at Ballinger Homes might be facing. Then, based
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on the research discussed in the paper, I make recommendations for how Ballinger Homes can

help address the problem of food insecurity for the population they serve.

Population

As stated previously, all of the children are residents of Ballinger Homes. To qualify for

the low-income housing that the King County Housing Authority operates, families must apply

and are often placed on long waiting lists. The median household income of families served by

KCHA is about $16,200. (1) Thus, all of the children who attend the program come from low-

income backgrounds. A 2013 survey of youth in King County found that lower socioeconomic

students (measured by maternal education) were generally more likely to have worse health and

academic outcomes. Up to 40% of lower SES students are at academic risk. Meanwhile, lower

SES students are 16% less likely to have healthy body weight; they are 33% less likely to meet

physical activity guidelines; they also were up to 1.7 more likely to have had depressive feelings.

(2) These are just some of the risks associated with low-income status for youth; the effects of

food insecurity specifically will be documented in the next section.

Impacts of food insecurity on youth

The impact of food insecurity on youth has been well-documented; this section attempts

to summarize these effects and their implications. Often, youth who experience food insecurity

are more likely to suffer directly from a variety of worsened health outcomes, or were associated

with high-risk behaviors that could lead to worse health later on. It is important to note that some

of the health outcomes outlined below were not studied in specifically low-income youth, rather

children and youth and general, so they may not be generalizable to this particular population.

However, given that children and youth in low-income households are more likely to experience
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food insecurity, it might be reasonable to assume that low-income children are at even greater

risk for the negative health outcomes associated with food insecurity.

Several direct negative health outcomes have been linked to food insecurity in youth.

Tester et. al found in 2016 that low- income adolescents in households with marginal food

security have increased odds of having a pattern consistent with atherogenic dyslipidemia, that

is, elevated levels of harmful cholesterols such as triglycerides and low-density lipoprotein

(LDL) (3). Tooth decay, the most common childhood disease, also disproportionately affects

low-income children with food insecurity. Researchers also studied food insecurity as a dietary

risk factor in relation to tooth decay and found that low SES children were at higher risk for

tooth decay; however, the researchers concluded that future research should be done to clarify

the mechanisms linking low SES and tooth decay in children. (4) It is important to note that none

of these studies were randomized control trials so the link between food insecurity and negative

health outcomes may not be causative; however, the researchers did conclude that there was a

significant association in both cases.

Generally, a 2016 review found that food insecurity was more specifically associated

with higher risk for diabetes, respiratory, liver, or mental disorders; higher urinary anitimony,

bisphenol A, or pesticides. (5) It should be noted that this data was based on the National Health

and Nutrition Examination Survey from 2005-2006, so the findings may not be entirely current.

Additionally, this study included adults in its focus so may not be generalizable to low-income

youth. However, the variety of adverse health outcomes that were linked to food insecurity

should at least be a clear indicator of the need to conduct more research on interventions to

reduce food insecurity.

Stakeholder input
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For further insight on this problem, I consulted several stakeholders on the issue of food

insecurity for youth in King County or the Shoreline area in general. I first spoke with Marta

Buell, my site supervisor and director of the after-school program at Ballinger Homes. I believe

that Marta is a secondary stakeholder as the health and wellbeing of the kids in our program

certainly affect her job and life in that way, but she herself is not affected by the issue of food

insecurity to the same extent of some of the kids. In our interview, Marta emphasized the

importance of overall health to the childrens wellbeing and academic success; generally, if the

kids eat healthy, theyll probably be more healthy in general, so they will miss school less and be

able to learn more and concentrate better. Thus healthy eating, in her view, was a key

prerequisite for academic success. Marta said she thought the problem of food insecurity was

somewhat severe as there are households where parents worry about what their kids are eating,

but that wasnt always the case. Rather, she thought another issue was that if kids were allowed

to buy food by themselves they would be more likely to choose junk food.

She seemed pretty knowledgeable of some support for low-income households facing

food insecurity, such as the city of Lake Forest Parks program for Market Bucks, which families

can use to buy fresh produce at the local farmers market. She also mentioned that some of the

local schools provide bags of food for kids on free or reduced lunch so that they have additional

food support on the weekends when school is out of session. Lastly, she thought that education

about healthy eating is necessary, targeted at both parents and youth.

Whats being done?

In the King County area, several local agencies focus on the problem of food insecurity.

For example, Food Lifeline, founded in 1979, tackles both food security and food waste by

rescuing surplus food from farmers, grocery stores, etc. and delivering them to 275 food banks,
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shelters, and programs throughout Western Washington. (6) Northwest Harvest, founded in 1967,

operates statewide through 375 food banks; of the food they provide is fruits and vegetables.

(7) On a federal level, the largest program is the Supplemental Nutrition Assistance Program

(SNAP) which offers nutrition assistance to millions of low-income individuals and families.

SNAP is housed by the US Department of Agriculture. (8)

Research has also been done into effective interventions for food insecurity. In a cost-

effective analysis of reducing the price of fruit and vegetables, researchers found that SNAP

subsidies would reduce chronic disease morbidity, mortality, and healthcare costs over a long

time horizon unlikely to be observed in shorter trials. (9) On a smaller scale, attempts have been

made to increase access to healthier foods for low-income families. One study examined a

discount fresh fruit and vegetable market in Rhode Island. The market was found to be effective

in increasing fruits and vegetables among low-income children whose parents shopped there. The

authors concluded this could be potentially be replicated to other cities, but more studies should

be done to examine the plausibility of this prospect. (10)

As mentioned previously, food security is not the main focus of the after-school program

at Ballinger Homes. However, as Marta Buell mentioned in our stakeholder interview, food

security is a clear component of not only academic success but overall health and wellbeing.

Thus, the program addresses this somewhat by providing a snack every day after school.

Additionally, the sites offer a Summer Lunch program for children who depend on a free or

reduced lunch at school during the academic year.

Thus, based on the information presented here, I present my recommendations in the next

section to be implemented at Ballinger Homes to further address the issue of food insecurity.
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Section 2: Recommendations

The problem of food insecurity in youth is not only highly prevalent; it also requires

analysis of the many different factors that may affect a familys diet. However, based on the

research done that demonstrates a higher risk for negative health outcomes in low-income youth

who face food insecurity, it is clear that steps should be taken to improve the health of the

children we serve at Ballinger Homes in tangible ways. I do not intend to propose an end-all, be-

all solution to food insecurity. Rather, I think that taking small steps to make our kids diets

healthier, as well as to educate them on the benefits of eating more fresh food, could help in

setting healthier habits for the future.

I would like to direct my recommendation to the directors of Center for Human Services,

who are in charge of the funding for the afterschool program. Based on my interviews and

conversations with program administration, most of the leadership I encountered were fully

aware of the problem of food insecurity among our youth. However, budget and resources for the

program are limited.

However, I believe my recommendation would be both practical and implementable.

Essentially, I am asking the program to budget slightly more for an extra serving of fruits and

vegetables per snack session. Currently, snack planning is fairly lax, and while healthy foods are

encouraged, budget and time may not allow for it and some processed foods are used as

standbys, such as chips and crackers. This represents a missed opportunity to improve the kids

diet in a small way for the three days a week that the program runs. Ive found that there is

usually plenty of free time before the children arrive to prepare a substantive snack, and think

that a focus on healthy eating which is communicated to the children could have a real impact.

More clear guidelines should be set for snack planning, so that each day should have at least two
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servings of a fruit and a vegetable, a grain, and a protein. This would constitute a fairly nutritious

and well-rounded snack with an emphasis on fresh foods. Servings of ready and processed food

(veggie chips, popcorn, crackers, etc) should be cut back to just once a week at maximum instead

of three times a week. I have crafted a simple example table for a snack planning routine;

planners could have flexibility with the fruit and vegetable options based on what is in season or

on sale. (Appendix A)

I think that this recommendation, though simple and small-scale, could have a positive

impact on the kids in the program. As outlined previously, food subsidies which target low-

income families have had protective effects in reducing morbidity and mortality. Our community

map analysis of the neighborhood surrounding Ballinger Homes also revealed that just one

grocery store was within walking distance while many more fast food restaurants, such as

McDonalds and Dominos, were in the area. By directly offering a source of fresh fruit and

vegetables to the children, we can efficiently and simply improve access to healthier foods.

Though the impact may be small and limited to just our program, enabling access to an

extra two servings of fruits and vegetables per day that the children may not have from school

lunch or dinner at home will make a small but substantive impact on their health. Additionally,

communicating the health and personal benefits of eating fresh fruits and vegetables to the

children can set up the basis for education on proper nutrition and eating. I recommend that the

program print out or buy some colorful, informative, and accessible posters about healthy eating

to add to the collection of posters that are already up around the classroom. These can be easily

found online, and I have attached some in the appendix for reference. (Appendix B)

In conclusion, food security is a public health problem that has been linked to a variety

negative health outcomes. Additionally, food in secure children are less likely to perform well in
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school. Though the afterschool program I serve at values healthy eating and proper nutrition for

the kid, I believe that making the best use of our resources to specifically increase uptake of fruit

and vegetables can make slow but steady progress in increasing food security and healthy food

education for the children.

Appendices

A) Sample weekly snack planning worksheet / table

Tuesday Wednesday Thursday Notes

Fruit Grapes Apples Grapes Costco sale on
grapes
Vegetable Baby carrots Celery Baby carrots
Grain Ritz crackers Graham cracker Veggie chips
Protein Cheese sticks Peanut butter Cheese sticks

B) Sample posters/printouts to hang around classroom in order to improve education around

healthy eating for the children

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Source: https://www.fns.usda.gov/tn/myplate-kids-make-half-your-plate-fruits-and-

vegetables-poster
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Source: https://www.amazon.co.uk/d/School-Educational-Supplies/Nutrition-Poster-

Fruit-Vegetables-Pyramid-Learning-Charts/B00CT4SOWG
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References

1. King County Housing Authority > About Us > Key Facts. Kchaorg. 2017. Available
at: https://www.kcha.org/about/facts/. Accessed May 12, 2017.

2. Health Of Children And Youth In King County. Seattle: King County Public Health;
2016. Available at:
http://www.kingcounty.gov/depts/health/~/media/depts/health/data/documents/hea
lth-of-children-youth-king-county-2016.ashx. Accessed May 12, 2017.

3. Tester J, Laraia B, Leung C, Mietus-Snyder M. Dyslipidemia and Food Security in

Low-Income US Adolescents: National Health and Nutrition Examination Survey,
20032010. Preventing Chronic Disease. 2016;13. doi:10.5888/pcd13.150441.

4. Chi D, Dinh M, da Fonseca M, Scott J, Carle A. Dietary Research to Reduce

Childrens Oral Health Disparities: An Exploratory Cross-Sectional Analysis of
Socioeconomic Status, Food Insecurity, and Fast-Food Consumption. Journal of
the Academy of Nutrition and Dietetics. 2015;115(10):1599-1604.
doi:10.1016/j.jand.2015.02.011.

5. Shiue I. People with diabetes, respiratory, liver or mental disorders, higher urinary
antimony, bisphenol A, or pesticides had higher food insecurity: USA NHANES,
20052006. Environmental Science and Pollution Research. 2015;23(1):198-205.
doi:10.1007/s11356-015-5677-y.

6. About Food Lifeline. Food Lifeline. 2017. Available at:

https://foodlifeline.org/about. Accessed April 10, 2017.

7. About. Northwestharvestorg. 2017. Available at:

http://www.northwestharvest.org/about.

8. Supplemental Nutrition Assistance Program (SNAP) | Food and Nutrition

Service. Fnsusdagov. 2017. Available at:
https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snap.
Accessed April 11, 2017.

9. Choi S, Seligman H, Basu S. Cost Effectiveness of Subsidizing Fruit and Vegetable

Purchases Through the Supplemental Nutrition Assistance Program. American
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Journal of Preventive Medicine. 2017;52(5):e147-e155.

doi:10.1016/j.amepre.2016.12.013.

10. Gorham G, Dulin-Keita A, Risica P et al. Effectiveness of Fresh to You, a

Discount Fresh Fruit and Vegetable Market in Low-Income Neighborhoods, on
Childrens Fruit and Vegetable Consumption, Rhode Island, 2010
2011. Preventing Chronic Disease. 2015;12. doi:10.5888/pcd12.140583.