{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:08:39Z","timestamp":1792112919160,"version":"4.4.0"},"reference-count":32,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,10,1]]},"abstract":"<jats:p>Objective. Hunger, with its adverse consequences for children, continues to be an important national problem. Previous studies that document the deleterious effects of hunger among children cannot distinguish child from family hunger and do not take into account some critical environmental, maternal, and child variables that may influence child outcomes. This study examines the independent contribution of child hunger on children\u2019s physical and mental health and academic functioning, when controlling for a range of environmental, maternal, and child factors that have also been associated with poor outcomes among children.<\/jats:p><jats:p>Methods. With the use of standardized tools, comprehensive demographic, psychosocial, and health data were collected in Worcester, Massachusetts, from homeless and low-income housed mothers and their children (180 preschool-aged children and 228 school-aged children). Mothers and children were part of a larger unmatched case-control study of homelessness among female-headed households. Hunger was measured by a set of 7 dichotomous items, each asking the mother whether she has or her children have experienced a particular aspect of hunger during the past year\u20141 concerns food insecurity for the entire family, 2 concern adult hunger, and 4 involve child hunger. The items, taken from the Childhood Hunger Identification Project measure, are summed to classify the family and divided into 3 categories: no hunger, adult or moderate child hunger, or severe child hunger (indicating multiple signs of child hunger). Outcome measures included children\u2019s chronic health condition count using questions adapted from the National Health Interview Survey, Child Health Supplement, and internalizing behavior problems and anxiety\/depression, measured by the Child Behavior Checklist. Additional covariates included demographic variables (ie, age, gender, ethnicity, housing status, number of moves, family size, income), low birth weight, child life events (ie, care and protection order, out of home placement, abuse, severe life events count), developmental problems (ie, developmental delay, learning disability, emotional problems), and mother\u2019s distress and psychiatric illness. Multivariate regression analyses examined the effect of child hunger on physical and mental health outcomes.<\/jats:p><jats:p>Results. The average family size for both preschoolers and school-aged children was 3; about one third of both groups were white and 40% Puerto Rican. The average income of families was approximately $11 000. Among the school-aged children, on average 10 years old, 50% experienced moderate child hunger and 16% severe child hunger. Compared with those with no hunger, school-aged children with severe hunger were more likely to be homeless (56% vs 29%), have low birth weights (23% vs 6%), and have more stressful life events (9 vs 6) when compared with those with no hunger. School-aged children with severe hunger scores had parent-reported anxiety scores that were more than double the scores for children with no hunger and significantly higher chronic illness counts (3.4 vs 1.8) and internalizing behavior problems when compared with children with no hunger. There was no relationship between hunger and academic achievement.<\/jats:p><jats:p>Among preschool-aged children, who averaged 4 years of age, 51% experienced moderate child hunger and 8% severe child hunger. For preschoolers, compared with children with no hunger, severe hunger was associated with homelessness (75% vs 48%), more traumatic life events (8.5 vs 6), low birth weight (23% vs 6%), and higher levels of chronic illness and internalizing behavior problems. Mothers of both preschoolers and school-aged children who reported severe hunger were more likely to have a lifetime diagnosis of posttraumatic stress disorder.<\/jats:p><jats:p>For school-aged children, severe hunger was a significant predictor of chronic illness after controlling for housing status, mother\u2019s distress, low birth weight, and child live events. For preschoolers, moderate hunger was a significant predictor of health conditions while controlling for potential explanatory factors. For both preschoolers and school-aged children, severe child hunger was associated with higher levels of internalizing behavior problems. After controlling for housing status, mother\u2019s distress, and stressful life events, severe child hunger was also associated with higher reported anxiety\/depression among school-aged children.<\/jats:p><jats:p>Conclusion. This study goes beyond previous research and highlights the independent relationship between severe child hunger and adverse physical health and mental health outcomes among low-income children. Study findings underscore the importance of clinical recognition of child hunger and its outcomes, allowing for preventive interventions and efforts to increase access to food-related resources for families.<\/jats:p>","DOI":"10.1542\/peds.110.4.e41","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:17:55Z","timestamp":1092442675000},"page":"e41-e41","source":"Crossref","is-referenced-by-count":335,"title":["Hunger: Its Impact on Children\u2019s Health and Mental Health"],"prefix":"10.1542","volume":"110","author":[{"given":"Linda","family":"Weinreb","sequence":"first","affiliation":[{"name":"Department of Family Medicine and Community Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Wehler","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical School, Worcester, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Perloff","sequence":"additional","affiliation":[{"name":"Heller School, Brandeis University, Waltham, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Scott","sequence":"additional","affiliation":[{"name":"Honors College, Conway, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hosmer","sequence":"additional","affiliation":[{"name":"University of Massachusetts School of Public Health, Worcester, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Sagor","sequence":"additional","affiliation":[{"name":"Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Gundersen","sequence":"additional","affiliation":[{"name":"US Department of Agriculture, Economic Research Service, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2002,10,1]]},"reference":[{"key":"2021121006404551900_R1","unstructured":"Andrews M, Nord M, Bickel G, Carlson S. Household Food Security in the United States, 1999, U.S. Department of Agriculture, Economic Research Service, Food and Nutrition Research Report, 11-2, Washington, DC; 2001. Available at: www.ers.usda.gov\/publications\/fanrr8\/fanrr8.pdf"},{"key":"2021121006404551900_R2","unstructured":"Wehler CA, Scott RI, Anderson JJ, Summer L, Parker L. Community Childhood Hunger Identification Project: A Survey of Childhood Hunger in the United States. Washington, DC: Food Research and Action Center; 1995"},{"key":"2021121006404551900_R3","doi-asserted-by":"crossref","unstructured":"Murphy JM, Wehler CA, Pagano M, Little M, Kleinman RE, Jellinek MS. The relationship between hunger and psychosocial functioning in low-income American children. J Am Acad Child Adolesc Psychiatry.1998;37:163\u2013170","DOI":"10.1097\/00004583-199802000-00008"},{"key":"2021121006404551900_R4","doi-asserted-by":"crossref","unstructured":"Kleinman RE, Murphy JM, Little M, et al. Hunger in children in the United States: potential behavioral and emotional correlates. Pediatrics.1998;101(1). Available at: http:\/\/www.pediatrics.org\/cgi\/content\/full\/101\/1\/e3","DOI":"10.1542\/peds.101.1.e3"},{"key":"2021121006404551900_R5","doi-asserted-by":"crossref","unstructured":"Alaimo K, Olson CM, Frongillo EA, Briefel RR. Food insufficiency, family income, and health in US preschool and school-aged children. Am J Public Health.2001;91:781\u2013786","DOI":"10.2105\/AJPH.91.5.781"},{"key":"2021121006404551900_R6","doi-asserted-by":"crossref","unstructured":"Alaimo K, Olson CM, Frongillo E. Food insufficiency and American school-aged children\u2019s cognitive, academic and psychosocial development. Pediatrics.2001;108:44\u201353","DOI":"10.1542\/peds.108.1.44"},{"key":"2021121006404551900_R7","doi-asserted-by":"crossref","unstructured":"Bassuk EL, Weinreb L, Buckner J, Browne A, Salomon A, Bassuk S. The characteristics and needs of sheltered homeless and low-income housed mothers. JAMA.1996;286:640\u2013646","DOI":"10.1001\/jama.276.8.640"},{"key":"2021121006404551900_R8","doi-asserted-by":"crossref","unstructured":"Bassuk EL, Weinreb LF, Dawson R, Perloff J, Buckner J. Determinants of behavior in homeless and low-income housed preschool children. Pediatrics.1997;100:92\u2013100","DOI":"10.1542\/peds.100.1.92"},{"key":"2021121006404551900_R9","doi-asserted-by":"crossref","unstructured":"Weinreb L, Goldberg R, Bassuk E, Perloff J. Determinants of health and service use patterns in homeless and low-income housed children. Pediatrics.1998;102:554\u2013562","DOI":"10.1542\/peds.102.3.554"},{"key":"2021121006404551900_R10","unstructured":"Achenbach TM. Manual for the Child Behavior Checklist\/4\u201318 and 1991 Profile. Burlington, VT: Department of Psychology, University of Vermont; 1993"},{"key":"2021121006404551900_R11","unstructured":"National Center on Health Statistics. Current Estimates From the National Health Interview Survey, 1988. Series 10, No 173. Washington, DC: US Government Printing Office; 1988"},{"key":"2021121006404551900_R12","unstructured":"Psychological Corporation. Wechsler Individual Achievement Test Screener\u2013Manual. San Antonio, TX: Psychological Corporation; 1992"},{"key":"2021121006404551900_R13","unstructured":"Wehler CA. Community Childhood Hunger Identification Project: New Haven Risk Factor Study. Hartford, CT: Connecticut Association for Human Services; 1986"},{"key":"2021121006404551900_R14","doi-asserted-by":"crossref","unstructured":"Wehler CA, Scott RI, Anderson JJ. Community Childhood Hunger Identification Project: A Survey of Childhood Hunger in the United States. Washington, DC: Food Research and Action Center; 1991","DOI":"10.1016\/S0022-3182(12)80135-X"},{"key":"2021121006404551900_R15","doi-asserted-by":"crossref","unstructured":"Masten AS, Neemann J, Andenas S. Life events and adjustment in adolescents: the significance of event independence, desirability, and chronicity. J Res Adolesc.1994;4:71\u201397","DOI":"10.1207\/s15327795jra0401_5"},{"key":"2021121006404551900_R16","unstructured":"Derogatis LR. Symptom Checklist-90-R. Administration, Scoring and Procedures Manual. Minneapolis, MN: National Computer Systems, Inc; 1994"},{"key":"2021121006404551900_R17","unstructured":"Spitzer RL, Williams JB, Gibben M, Fist MB. Structured Clinical Interview for DMS-III-R Non-Patient Edition (SCID-NP, Version 1.0). Washington, DC: American Psychiatric Press; 1990"},{"key":"2021121006404551900_R18","unstructured":"Stakes ME. Recent Advances in Categorical Data Analysis. Cary, NC: SAS Institute Inc; 2000"},{"key":"2021121006404551900_R19","unstructured":"SAS Institute. SAS\/ETS Software: Changes and Enhancements, Release 8.1. Cary, NC: SAS Institute Inc; 2000"},{"key":"2021121006404551900_R20","doi-asserted-by":"crossref","unstructured":"Hosmer DW, Lemeshow S. Applied Logistic Regression. 2nd ed. New York, NY: John Wiley & Sons Inc; 2000","DOI":"10.1002\/0471722146"},{"key":"2021121006404551900_R21","doi-asserted-by":"crossref","unstructured":"Buckner J, Bassuk EL, Weinreb LF, Brooks MG. Homelessness and its relation to the mental health and behavior of low-income school-age children. Dev Psychol.1999;35:246\u2013256","DOI":"10.1037\/0012-1649.35.1.246"},{"key":"2021121006404551900_R22","doi-asserted-by":"crossref","unstructured":"Brooks-Gunn J, Duncan G. The Effect of Poverty on Children: The Future of Children. Los Altos, CA: David and Lucille Packard Foundation; 1997","DOI":"10.2307\/1602387"},{"key":"2021121006404551900_R23","doi-asserted-by":"crossref","unstructured":"Huston A, McLoyd V, Garcia Coll C. Children and poverty: issues in contemporary research. 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