Food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) are the main safety net to combat food insecurity in the United States. While food insecurity has been associated with poor nutritional outcomes among children, the WIC food package change that was implemented nationwide in 2009 has been linked with improvements in diet quality among WIC participants. The goal of this study was to investigate trends in the association between food insecurity and child consumption patterns among children 0-5 years participating in WIC only and in WIC + SNAP in Los Angeles County, California, between 2008 and 2017.
This study used data from the 2008, 2011, 2014, and 2017 Los Angeles County WIC Surveys. Each of these surveys included approximately 5,000 randomly selected families who received WIC benefits in Los Angeles County the year of the survey. Surveys were carried out by an independent third party through a computer-assisted telephone interviewing system; interviews were conducted in English or Spanish and averaged 20-25 minutes in length. Response rates for these surveys ranged between 50 percent and 67 percent, with cooperation rates ranging from 80 percent to 90 percent. The child consumption outcomes of interest in the current study were average daily consumption of fruits, vegetables, and milk (number of servings per day for fruits and vegetables, number of times per day for milk) and frequency of fast-food consumption (at least 1 or more times per week, at least once per month, and less than once per month or never). While a subset of food insecurity questions based on the U.S. Household Food Security Survey Module were included in all survey years, the included questions were different in 2008 versus 2011, 2014, and 2017. Thus, the predictors for this study, termed food insecurity experiences, were based on the answers to 2 questions that were included in every survey year: “The food that was bought just didn’t last, and we didn’t have money to get more” (Q1) and “We couldn’t afford to eat balanced meals” (Q2). Response options were dichotomized as often/sometimes versus never. Covariates included a child’s age and sex, mothers’ ethnicity and language preference (English-speaking Hispanic, Spanish-speaking Hispanic, non-Hispanic), maternal education (less than high school, high school graduate, and more than high school) and survey year. SNAP participation, obtained from WIC administrative data, was used to identify children who participated in SNAP in addition to WIC; our sample sizes across all years were 12,575 children who participated in WIC only and 5,748 children who participated in WIC +SNAP. General linear models were used to assess trends in the association between fruit, vegetable, and milk consumption and food insecurity experiences, while multinomial logistic regressions were used to assess trends in the association between frequency of fast-food consumption and food insecurity.
Across survey years, the sample was predominately Hispanic (86-90 percent) with the proportion of English-speaking Hispanics increasing over time. For all WIC participants, fruit and vegetable consumption increased over time and milk consumption decreased over time.
Frequency of fast-food consumption was high in all survey years (35-45 percent reporting fast-food consumption 1 or more times per week), though consumption frequency temporarily decreased in 2011 compared to 2008 before returning to 2008 consumption levels in 2014-2017. Reports of food insecurity experiences increased drastically between 2008 (Q1=21 percent, Q2=21 percent) and 2011 (Q1=42 percent, Q2=33 percent), with an observed decrease over time but not returning to 2008-levels.
For Q1, no associations were observed between food insecurity experiences and child food consumption patterns in multivariable analyses, for neither the WIC only nor the WIC + SNAP samples. For Q2, and among children who participated in WIC only, reporting food insecurity experiences sometimes or often (versus never) was associated with a significantly lower vegetable consumption of 0.07 servings/day, adjusting for child age and sex, maternal ethnicity and language, maternal education, and survey year. Interactions between food insecurity and survey year were not significant (p-value=0.1580), indicating that this association did not change over time. Aside from food insecurity experiences, maternal ethnicity and language was consistently associated with child consumption of fruits, vegetables, and fast food. Overall, compared to children whose mothers were Spanish-speaking Hispanics, consumption of fruits and vegetables was higher among children whose mothers were English-speaking Hispanics (WIC only and WIC + SNAP) and vegetable consumption was higher among children whose mothers were non- Hispanic (WIC only). Frequency of fast-food consumption was higher among children of English-speaking Hispanic mothers (WIC only) and lower among children of non-Hispanic mothers (WIC only and WIC + SNAP), compared to children of Spanish-speaking mothers.
Overall, food insecurity experiences were minimally or not associated with child food consumption patterns across time. These results should be confirmed using the validated 6-item or 18-item Household Food Security Survey Module. While fruit, vegetable, and milk consumption seemed adequate for this age group, fast food consumption was very common among WIC and WIC + SNAP participating children. Regardless of food security status, nutrition education provided to WIC families should continue to emphasize the importance of eating home cooked meals to reduce the high frequency of fast-food consumption observed in this sample.