Children’s reporting of food insecurity in predominately food insecure households in Texas border colonias

Food security requires that sustenance be available, nutritionally adequate, and acquired in socially acceptable manners [1]. Its converse, household food insecurity, is an economic and social condition characterized by reduced or unknown access to sufficient healthful and safe food or the limited ability to acquire fare in ways deemed appropriate by society. While most (85.1%) U.S. households were food secure during 2011, the remaining 14.9%, or 17.9 million, were food insecure [2].

Households with low or very low food security are considered to be food insecure. Low food security, previously known as food insecurity without hunger, occurs when individuals experience a reduction in food quality, variety, or desirability, and at times a reduction in food intake. Of the 17.9 million food insecure households in the U.S., 9.2% experienced low food security while 5.7% had very low food security in 2011 [2]. Very low food security, previously referred to as food insecurity with hunger, arises when at least one household member experiences “multiple indications of disrupted eating patterns and reduced food intake” [3]. In 2011, food insecurity at the child level was present in 10% of U.S. households with children under 18 years of age. Of households with food insecurity experienced by children, 9% had low food security among children and 1% of households had at least one child with very low food security [2].

Ordinarily, household food security status is assessed by the Household Food Security Survey Module, including three questions that pertain to the household, seven for adults, and eight questions that determine food insecurity at the child level [4‐7]. One weakness of the 18-item Household Food Security Survey Module is that it identifies food insecurity at the aggregate level, and is not able to discern intra-household differences in food security among individual adults and children [8]. Furthermore, parent proxy reports of children’s food security may present an inaccurate or incomplete representation of actual experiences. Relying on guardian accounts is justified by two assumptions; first, the parent controls food resources in the home as well as how food insecurity, if present, is felt by all household members; second, individuals experience food insecurity equally as reported by the parent. However, these assumptions must be questioned, for while mothers may attempt to buffer children from the effects of household food insecurity [9, 10], they may not always be fully able to protect children. It is difficult to say with certainty that all household members experience food insecurity in the same capacity, especially considering that mothers may not be fully aware of children’s experiences, resourcefulness, and actions taken to reduce the severity of food insecurity. As children who are food insecure often have poorer nutritional, educational, cognitive, developmental, and social outcomes compared to food secure children [5, 11‐15], measuring food insecurity in children, as reported by children, is an important next step in food security research.

There is a need to understand food insecurity from children’s perspectives and experiences [16, 17]. In order to justify using child reports of food security status, researchers ascertained whether or not children could reliably report on their own experiences. Herjanic and colleagues compared mother and child reports of behavior, learning problems, psychiatric symptoms and mental status among children ages 6–16 years. With an overall 80% agreement in responses between parent and child, Herjanic et al. determined that children in this age group are capable of providing reliable information and showed that concordance is slightly improved in factual or observable information and lower in responses to questions of mental status or other internalized symptomology [18]. Herjanic and colleagues continued their analysis of parent–child agreement with a larger sample and found that mothers accurately reported behavioral symptoms while youth were better able to report their own subjective symptoms [19].

Using a modified and non-validated child food security survey, Hadley and colleagues showed that Ethiopian children ages 13–17 years were able to attest to their own food security experiences [20]. Recent research by Fram and colleagues revealed children ages 9–16 years were capable of and willing to report their own food security experiences when interviewed separately from parents [21]. While Fram’s research demonstrated that children are cognizant of food insecurity and manage their own food resources, a validated measurement tool was not used. A further limitation of Fram’s study was that researchers were unable to compare adult and child reports as a parent did not respond to questions of household food security. Connell’s qualitative research assessed children’s understanding of household food insecurity, but queried participants about other social contacts, and did not directly ask about the experiences of each child participant. Research by Connell and colleagues identified quantity, quality, psychological, and social components of children’s perceptions of household food insecurity, yet further research is needed in order to better understand food insecurity at the child level [16].

Comparing multiple accounts of food security status within a single household, even while using validated and reliable modules, might result in differential reporting between mother and child. In order to better comprehend instances of differential reporting, researchers can compare scores from two scales for concordance, known as informant agreement. Previous studies investigating the relationship between self-report and reports by others concluded that discrepancies were issues of measurement error or some flaw in study design [22]. Yet, when researchers kept methods constant for all participants and when measurement tools were shown to have good reliability, the discrepancy in reports remained high [23‐25]. Therefore, discordance is not due exclusively to poor methodology, but rather that children’s experiences and perceptions may differ from those of adults.

It is important to note that the 18-item Household Food Security Survey Module ascribes a categorization of food security for all household members, and does not assign food security status to individuals within the household. In the present study, mothers report food security at the level of the household, while children, using the 9-item Food Security Survey Module for Youth, detail his or her own food security experiences and perceptions. The current research addresses a critical gap in the literature and aims to understand complexities of intra-household differences in food security. A disjuncture in mother and child food security status will prompt researchers to examine the underlying factors associated with this difference, including buffering, different food allocations for household members, cultural factors, or some other yet unrecognized association. The primary research question for the current study is as follows: How do intra-household mother and child reports of food security differ according to questions of the 18-item Household Food Security Survey Module and the 9-item Food Security Survey Module for Youth? Secondarily, using the eight child-referenced items of the Household Food Security Survey Module, how does mother-reported child food security contrast child-reports of food security when children report using the Food Security Survey Module for Youth?

Table 2 displays demographic characteristics of the sample. Median age (SD) of mothers was 34.5 years (± 6.9) while child median age was 8.5 years (± 1.3). Ninety-two percent of mothers were born in Mexico, with the remainder born in the United States, and mothers completed a median nine years (± 2.5) of school. Median household size was six adults and children (± 1.5, range: 3–10) and median number of children living in the home was 3.5 (± 1.2, range: 1–6). In this sample, 96% of children were enrolled in SBP, 88% of families utilized SNAP, 58% of families relied on WIC, 58% of children were enrolled in NSLP, and 32% of families were enrolled in all four nutrition assistance programs.

Equivalent mother and child-reported food security constructs from the two modules were used to analyze differential reporting. Analyses revealed a striking difference in reporting, with poor agreement on one, slight agreement on six, and fair agreement on two constructs. The poorest agreement was on the construct of child hunger (κ = −0.06, p = 0.66). Fair agreement was observed among the constructs of children going a full day without eating (κ = 0.26, p = 0.003) and using low cost foods for household meals (κ = 0.23, p = 0.05). Furthermore, 34% of children reduced portion sizes and 30% of children skipped meals, compared to affirmative responses by 12% of mothers reporting on behalf of their children for each construct (see Table 3).

Eighty percent of mothers reported household food insecurity while 64% of children experienced food insecurity at the child level. Mothers were more likely to report low or very low food security at the household level (58 and 22 percent, respectively) than were children to report low or very low food security at the child level (44 and 20 percent, respectively). Furthermore, the observed agreement between mother and child self-reports of the two-level food security categorization was 64%, or “slight” (κ = 0.13, p = 0.15). The greatest mother-child agreement was noted among food insecure families; thirty-two children reported food insecurity at the child level, while 27 mothers reported household-level food insecurity. Of the remaining 18 children, who by self-reports were food secure, only five mothers agreed and reported household food security (See Table 4). Among discordant pairs, small sample χ ² analyses revealed no significant differences in food security when considering the total number of children or the ages of all children in the household. Comparing mothers’ reports of child food security with child reports of child food security revealed 56%, or slight agreement, between the binary outcomes (κ = 0.09, p = 0.26).

The aim of the present study was to analyze inter-rater agreement of food security among a sample of Mexican-origin children age 6–11 years and their mothers living in Texas border colonias. In this research, the first of the authors’ knowledge to contrast mother and child accounts of food security, analyses revealed differential response rates in food security status among dyads. The prevalence of mother-reported household food insecurity (80%) surpassed children’s reports of food insecurity (64%), indicating only slight inter-rater agreement. The prevalence of mother-reported child food insecurity (56%), as determined through the household scale, was less than the prevalence of child food insecurity as reported by the children themselves (64%). Therefore, if we consider children’s reports of their own food insecurity to be reliable, then there is some evidence that mothers may not be fully protecting children from the effects of household food insecurity. Thinking of food security as distinct from food insecurity, children in this sample of Mexican-origin colonias residents were reliable reporters of their own food insecurity as it correlates with household and mother-reported child-level food insecurity, but children’s reports of child-level food security did not correspond well with mothers’ reports of household or child level food security. Thus, there is some evidence that children as young as six years of age may possess some ability to reliably report instances of food insecurity, although further cognitive testing among a larger sample is encouraged.

Previous food security research using the U.S. Household Food Security Survey Module has relied almost exclusively on mothers’ perceptions of children’s food security and is unable to provide individual-level information [4‐7]. However, research utilizing child reports of food security is emerging. Children’s very low food security, as reported by Mexican-origin children ages 6–11 years, was associated with significantly higher intake of total energy, fat, and added sugar as compared to food secure children in a recent finding by Sharkey and colleagues [12]. Additionally, recent qualitative research has begun the process of understanding the unique ways in which children understand, cope with, and attempt to alleviate the symptoms of food insecurity [16, 21, 36].

Prior research established that children age 6–16 years can be reliable reporters [18, 19] and at ages as young as nine can share valuable information regarding their food security [16, 21]. Herjanic and colleagues detected concordance between mother-child reports of observable behavioral symptomology among children and less agreement among children’s internalized emotions [19]. The results of the present study indicate overall poor agreement of food security status among mother and child reports but particularly poor accord among subjective experiences. In fact, mothers and children had the strongest agreement in the construct of children not eating for a full day, which may be more likely to be noticed than internal emotions, such as worrying about food supplies. The constructs in which children more frequently reported an occurrence than mothers were reducing portion sizes, skipping meals, or being hungry, which all showed poor agreement. While mothers’ responses may be influenced in part by social desirability, it could also be that these events were not as frequently observed by mothers and thus may demonstrate actions taken by children to preserve food for a lean period. Numerous recently published articles have compared parent-proxy and child reports of children’s experiences and perceptions of medical conditions or overall quality of life. One review article of nineteen quality of life subscales (including data on children ranging in age from 5–20 years) used intraclass correlation coefficients to determine interrater agreement and concluded that parent–child agreement ranged from poor to good [37]. In research not included in the review article, Creemens and colleagues found low intraclass correlation between parents and children ages 5.5–8.5 years on quality of life reporting, and suspect that level of disagreement may be a result of child age, analysis methodology, the domain analyzed, or parent’s own quality of life [38]. Finally, qualitative techniques were used among 15 parent–child pairs to discern the underlying reasons for discordance in reporting of quality of life scales in a study by Davis and colleagues. Research revealed that among a sample of 5–11 year old children and their parents, discordance may be a result of different reasoning methods and response styles [39]. Overall low correlation among parent–child agreement in child health-related quality of life is consistent with the findings of the present study of agreement in food security status. Research in other fields offers some basis of comparison, yet there is a dearth of literature on agreement in parent–child food security reporting.

There are several strengths to this original research. This is the first study of which the authors are aware that utilized children’s self-reports of food security constructs and level of food security contrasted with reports provided by mothers. This study answers the call to consider the perspective of the child in analyzing the prevalence and correlates of food insecurity [16, 17, 21]. Second, this research provided valuable information about a sample of hard-to-reach, limited-resource Mexican-origin families living in Texas border colonias. As the Hispanic population in the U.S. is growing, and is expected to comprise 29% of the population by 2050 [38, 40], and South Texas colonias may represent an archetype for new-immigrant destinations elsewhere in the U.S. [29], understanding food insecurity among this population is imperative to decreasing the burden of health disparities, especially those related to nutrition. Third, data were collected using Spanish-language surveys and interviews within participants’ homes and obtained by trained promotora-researchers who reside within the study locale. Relying on local promotora-researchers as data collectors and community advocates established trust among this sample. Additionally, the food security instruments used in the present research were developed with the USDA Economic Research Service, have high internal validity, and are approved for use both among children and Hispanic populations [16, 17, 30]. Finally, complete food security data were collected on 100% of participants.

Yet, there are limitations that warrant mention. First, the study included 50 dyads and utilized a cross-sectional research design. Thus, there is limited generalizability to other populations. A larger study in a broader locale may improve researchers’ understanding of differential reporting among mothers and their children. Second, the age of children in this study may have affected reporting. While the Food Security Survey Module for Youth was designed for use with children age 12 years and older, the children in the present study were 6–11 years of age. Interviews with promotora-researchers indicated that children in this age group understood food security and showed willingness to report while other research demonstrated the ability of children to self-report at as young as six years of age [18‐20]. Although the present study’s child sample is within the acceptable age range of children’s reliability to self-report conditions, future researchers may elect to focus on an adolescent population. Because the household food security module asks mothers to report the experiences of all children in the home, while one child reported his/her individual experiences, researchers were unable to directly compare individual-level discordance. This additionally hindered the researchers’ understanding of food security among several children within a household. Finally, the reference period for the food security modules was the previous three months and not 30 days, which prior research has indicated may be more reliable when surveying children [31].

The Mexican-origin population in the United States is growing rapidly, with a 54.1% increase from 2000 to 2010. Furthermore, the nearby four-city area of McAllen-Edinburg-Pharr-Mission, Texas is comprised of 96.8% residents of Mexican origin [41]. Due to the detrimental nutritional, behavioral, social, academic, and health-related outcomes among children living in food insecure households [5, 11‐15], and because school-based nutrition programs may not be adequate in addressing children’s nutritional needs [12], children’s food insecurity among the increasing Mexican-origin population in the U.S. cannot be overlooked. This research addresses a gap in children’s food security literature and sheds light onto a difficult-to-reach population of Mexican-origin families living in Texas border colonias. Future research endeavors ought to assess food security from children’s perspectives, among a larger and slightly older sample, in accordance with the recommendations by the USDA Economic Research Service.