Household food insecurity has substantial detrimental effects on children, resulting in behavior problems, disrupted social interactions, compromised school performance, poor dietary intake, and poor health. Although several mechanisms have been postulated to explain why food insecurity is detrimental for children, including altered parenting, hunger, distress, adverse family and social interactions, worry and anxiety, and feelings of deprivation and alienation, there are almost no empirical data regarding which mechanisms are important.
Alterations in child daily activities and experience of shame may be an important mechanism linking child food insecurity with its detrimental effects on behavior, social interactions, and school performance, but no study has been done to investigate these potential mechanisms in the United States. Therefore, the study aimed to understand alterations in child daily activities and shame associated with child experiences of food insecurity, and how these altered activities and shame in turn may result in adverse behavior, social interactions, and school performance.
A qualitative study was conducted of 40 children, aged 9 to 15 years old, with 20 in each of 2 rural areas of South Carolina and Oregon. An ethnically diverse sample was recruited of children living in environments that put them at risk of food insecurity, altered daily activities, and shame. The children were selected from settings such as farm markets, social safety-net programs, rural poor neighborhoods, churches, public schools, and household and child nutrition programs.
Data were collected from participants using individual, recorded, in-depth interviews that allowed for rich investigation of the experiences, thoughts, and behaviors of children and the connections among them. Interviews were conducted in private with all children in South Carolina and some in Oregon; one parent was present for many of the Oregon interviews. The semi-structured interview sessions included a set of closed-response items that measured food insecurity directly from children and assessed the family context. The sessions also included open-ended questions in an interview guide regarding children’s experiences that may be related with food insecurity. Once interviews were transcribed, the data were coded using a constant comparative method approach and triangulated from different parts of the interviews. Then the data were built up to identify relationships among the codes.
Eleven themes emerged from the in-depth interviews, which were subsequently organized into six categories:1) child experiences of food insecurity and hunger (physical awareness, and initiation and resource generation); 2) shame in being food-insecure and receiving food assistance; 3) eating patterns and food preferences; 4) activities and sleep (sedentary behavior, chores, sleep); 5) social behavior and interactions (disorganization, noise, and violence); and 6) school performance (missing days and lack of performance).
Findings showed that children experienced food insecurity and hunger in these rural contexts. Children were aware of the physical consequences of lack of food. They mentioned consequences like pain, changes in behavior, lack of energy to do certain activities, and lack of concentration. Children initiated strategies to stretch existing food resources in food-insecure environments. Some children reported having jobs as a strategy to alleviate food insecurity.
Shame for being food-insecure, which meant that others knew they did not have enough food, was a concern for children. The majority of children experienced feeling shame, and receiving food assistance triggered feeling shame. Eating patterns at home were disrupted when food was running low; in particular, children described eating separately from other family members or skipping meals. Altered food preferences occurred in food-insecure environments; food preferences varied because parents offered monotonous options to eat.
Alterations in activities occurred because children did not have enough money or food. Most children did not have any regular and organized activities after school, in their free time, or during vacations, and sedentary behavior was frequently reported. Doing chores was the most frequent activity that was reported for all the children interviewed. Many children had disrupted sleep. They went to sleep in late hours because they were watching television, playing video games, or could not sleep. Taking naps and going to sleep early were strategies children used when there was not enough food at home. Not having enough food at home could alter the flow of the usual social behavior and interactions, and arguments, fights, and violent situations were reported by a few children.
In times of food insecurity at home, attending school was a major strategy to access food. When the family had problems at home, children mentioned missing school for various reasons: parents need to spend more time doing activities to generate more resources for the home, absence of rules at home, sickness, laziness, or sleep disruptions.
In summary, children with food insecurity needed to share their time for studies, physical activity, and sleep with other time-consuming activities such as chores, taking care of siblings, and earning money from jobs or illegal means. The children in the study had alterations in their routine, educational, home, and recreational activities. They expressed having consequences for food insecurity, including disruptions in sleep and feeling shame for receiving food assistance.
Programmatic responses to food insecurity of children must take into account social and psychological consequences. Understanding the relationships among child food insecurity, food assistance, and shame may lead to provision of strategies to improve access to food in ways that are holistically beneficial for child development.