Coping with child hunger in Canada: have household strategies changed over a decade?
McIntyre, Lynn ; Bartoo, Aaron C. ; Pow, Jody 等
Child poverty is a public health concern in Canada. Children who
live in poor households are more likely to experience inadequate access
to food. (1) Food insecurity results from a family's inability to
acquire enough food for the household, which is mostly attributed to
insufficient income levels. (2,3) Child hunger is an extreme
manifestation of food insecurity and is linked to inadequate dietary
intake, putting these children at risk for poor health. (4,5) The
National Longitudinal Survey of Children and Youth (NLSCY) is a
long-term nationally representative survey that monitors child health
and development. From its inception in 1994, it has also provided
information on child hunger in Canada. (2,6) The determinants of child
hunger or severe food insecurity have been well described in this and
other surveys, with increased odds related to lone-parent-led families,
increased number of siblings, low parental education, low household
income, and main source of income from social services or welfare.
(2,7-9)
Households in which children experience hunger use various coping
strategies to overcome deficits in food access. (10,11) They may cope by
using intrahousehold strategies such as the parent or child skipping a
meal, or reducing food variety to extend the purchasing power of limited
financial resources. (2,12) Coping can also occur external to the
household, such as visiting a food bank and/or seeking help from friends
or relatives. (10,13,14)
To address child hunger specifically, and food insecurity in
general, community intervention programming in Canada increased
substantially between the 1990s and the first decade of the 2000s.
For example, the number of food banks and affiliated agencies
jumped from 2,141 in 1998 to 3,540 in 2007. (15) Provincially-funded
child nutrition programs such as Breakfast for Learning were introduced
across Canada to provide children with proper food and nutrition to
promote healthy living and academic success. (16) Although their
original scope was to feed hungry children, these programs have
undergone major programmatic and structural changes since their
implementation in the 1990s. Their development from a voluntary-based
effort targeting food-insecure children towards a provincially-funded
strategy to promote healthy eating and prevent obesity has raised
questions about their validity as an intervention capable of targeting
vulnerable children. (17) Local community kitchens and community
gardens, initially founded in an effort to provide sustainable
strategies of food production and preparation for households
experiencing food insecurity, have also been on the rise during the same
time period. (18,19) As with children's nutrition programs, many of
these initiatives have undergone a transformation in the past two
decades and have turned into generalized programs for healthy eating and
local food production, available to entire communities/neighbourhoods.
The proliferation of these programs in cities, towns, and rural areas of
Canada has been notable. (20,21) While originally based on
nongovernmental funds, most provinces in Canada now financially support
components of these programs. (22-24), pp.5-6
Based on this context, the extent to which these community-based
programs are impacting families experiencing child hunger is uncertain.
(25,26) A shift from intrahousehold to external coping strategies over
this time period may provide evidence of a beneficial effect of these
interventions.
The purpose of this study was to determine if coping strategies
have changed in Canadian families reporting child hunger between 1996
and 2007. We utilized two NLSCY cycles to examine differences in coping
strategies between two independent samples of households with children
experiencing hunger.
METHODS
Data for this study were derived from Cycle 2 (1996/1997) and Cycle
7 (2006/2007) of the NLSCY.6 The NLSCY was a long-term survey conducted
jointly by Statistics Canada and Human Resources and Skills Development
Canada (HRSDC) since 1994, and collected data on the development and
well-being of Canadian children on a biennial basis until 2009. It
randomly sampled households with children across Canadian provinces and
contained both cross-sectional and longitudinal components. Our data set
was restricted to households with children aged 2 to 9 years to exclude
longitudinal households that were sampled in both cycles, permitting
cross-sectional analyses of two independent samples. After restriction,
our data included 8,165 respondents for Cycle 2 and 15,691 for Cycle 7.
Questions regarding the child and household circumstances were
answered by the person most knowledgeable, who was most often the mother
of the child, and the "hunger questions" were identical in
each cycle. The NLSCY includes a single question regarding child hunger:
"Has your child ever experienced being hungry because the family
has run out of food or money to buy food?" Response options are
yes, no, and don't know. If respondents answer yes, they are asked
"How often?" Frequency response options are regularly, end of
the month, more often than end of each month, every few months,
occasionally, not regularly. For coping strategies, respondents are
asked "How do you cope with feeding this child when this
happens?" Response choices include reduce food variety, parent
skips meals, child skips meals, seek help from food bank, seek help from
relatives, seek help from friends, seek help from social worker, use
school meal program, use other services.
Child hunger severity was classified as "regular"
(regularly; more often than end of month) or "occasional"
(occasionally; every few months). Coping strategies were categorized as
either intrahousehold (reduce food variety, parent skips meals, child
skips meals) or external (food bank use, help from friends, help from
relatives, or other (help from social worker, school meal program, other
services)). Descriptive statistics and t-tests (with bootstrap weights)
were used to compare changes in child hunger and coping strategies
between Cycle 2 and Cycle 7 with significance set at p<0.05. Logistic
regression was employed to determine the comparability of hunger
determinants over time using child hunger as the dichotomous outcome.
Covariates (child sex, child age, household size, home ownership,
household income, parental education, parental smoking, marital status,
parental health, region, and rural versus urban residence) were chosen
to reflect socio-demographic characteristics of children and households
that have previously been identified as associated with food insecurity.
(2,7-9,27,28) Previous studies of the NLSCY have examined child hunger
in relation to additional covariates, also examined here, including
child health status; presence of a chronic condition, including asthma;
hospitalization within the past year; family functioning; and
characteristics of the person most knowledgeable about the child
(PMK).2,5 Two parsimonious models for estimating the odds of different
coping strategies were assessed by logistic regressions using
cross-sectional weights provided by NLSCY. Ethical approval was received
from the Conjoint Health Research Ethics Board at the University of
Calgary.
RESULTS
Child hunger is a relatively rare event with a prevalence of 1.5%
(n=103) in 1997, falling significantly (p<0.001) to 0.7% (n=102) in
2007 (Table 1). A majority of households in both cycles of the NLSCY
described child hunger as occasional; however, regular hunger was
reported by 41.1% of households in Cycle 2 and 34.7% in Cycle 7 (Table
1). Significant factors related to child hunger, consistent in both
NLSCY cycles, were older child age, increased household size, lack of
home ownership, low household income, poor family functioning status,
and lone-parent-led household (Table 2).
Table 1 also presents the frequency of coping strategies used
within the household or through external resources for each cycle. Of
note, child skips meal, school program used, seeks help from social
worker, or help from other sources were so infrequently reported that
their cell sizes were too small for disclosure according to Statistics
Canada guidelines; (6) thus, they are captured under "other"
external strategies. Most households typically utilized more than one
strategy, and there was an overlap between intrahousehold and external
strategy users (and too small numbers to look at exclusive users by
dichotomous coping categories). In Cycle 2, external coping strategies
were more commonly used than intrahousehold strategies (69.2% vs. 45.1%,
p=0.26, respectively); however, in Cycle 7, these strategies were
similarly employed (61.7% external vs. 62.4% intrahousehold).
Between cycles, there was no change in the percentage of households
using specific external coping strategies such as using food banks or
seeking assistance from relatives or friends. There was a significant
increase in the percentage of households reducing food variety from
Cycle 2 to Cycle 7.
Separate regression analyses were conducted to determine the odds
of households using intrahousehold strategies and those using external
strategies to help them cope with child hunger, considering two areas of
potential differential vulnerability: 1) region of Canada, representing
different policy environments and accessibility to community
intervention programs, such as food banks (Table 3); and 2) health
issues, which require additional coping by the family which might limit
resources for food, especially in poorer families (Table 4). In Cycle 7
of the regional model, households in British Columbia, the Prairies and
Atlantic Canada were more likely to use external rather than
intrahousehold coping strategies compared with residents of the province
of Ontario (Table 3). This result could be interpreted as decreased
utilization of external coping strategies in the reference province
Ontario, (likely) between 1996 and 2007, or changes in coping strategies
used in three of the other five regions of Canada. In Cycle 7 of the
health model, where a child was younger and had been hospitalized within
the past year, there was greater likelihood that intrahousehold coping
strategies were utilized (Table 4).
DISCUSSION
Child hunger is an extreme manifestation of household food
insecurity that has impacts on both health and social well-being. (4,5)
Despite a significant decrease in the prevalence of child hunger in
Canada over a period of 10 years, we found that the sociodemographic
factors that contribute to child hunger remained constant. The
similarity of determinants across NLSCY cycles suggests that the
observed decrease in prevalence is associated with changes in
macroeconomic conditions within Canada, rather than changes in the
specific vulnerability of disadvantaged groups. This is supported by the
fact that the depth of child hunger (occasional versus regular) did not
change, indicating an overall reduction of hunger prevalence rather than
a change in the characteristics of households with hungry children. The
lack of any change in the profile of those reporting child hunger points
to limitations in targeted child tax and benefit policies to provide
sufficient support to those most vulnerable to child poverty.
Our analysis revealed that not only the determinants, but also the
coping strategies utilized by families experiencing child hunger have
remained similar over a decade of observation. Despite the substantial
increase in the number of community-based interventions aimed to combat
food insecurity (such as food banks, school programs, community kitchens
and gardens),17-21 the proportion of hungry households taking advantage
of these programs did not change between 1996 and 2007, arguing for a
lack of beneficial effect of these interventions for this population
over this time period.
The majority of Canada's current community-based food
insecurity programs focus on providing households with either actual
food (food banks, school programs),25 or personal capacity-building
(community kitchens and gardens). (12,18,19) These programs have either
failed to reach families experiencing child hunger or have been avoided
by these families for reasons that are unclear in the data.
The time period 1996-2007 also saw a significant increase in the
number of families using food variety reduction as a mechanism of
coping. This is likely related to food price increases which have
exceeded inflationary increases. (29), p.17 Diet quality compromises are
a component of food insecurity. (30) A decrease in food variety may also
occur as families utilize strategies to make their food purchases last
longer, which may include diluting milk and juice purchases to extend
the life of these products for their children. (13,31)
The fact that food-insecure households seem to rely of late more on
internal coping strategies might indicate that food insecurity and
specifically, child hunger, are increasingly regarded as private matters
that should stay within family boundaries. It has been previously shown
that food-insecure households in Canada more often choose to compromise
their nutrition by eating cheaper foods (46%) and skipping meals or
eating less (28%), rather than receive food from charity (22%). (14)
Similarly, our finding that intrahousehold strategies are more common
among families engaged in the health system as represented by having a
child hospitalized within the previous year suggests that a time
trade-off between seeking health services and seeking food support
outside of the home might be at play. (32)
On the other hand, the trend in the adoption of more intrahousehold
coping strategies in 2007 compared with a decade earlier was most
pronounced in Ontario, which saw major political change over the period
that might have contributed to the types of coping strategies families
used. Cycle 2 data were collected during a conservative government
regime that cut welfare rates in 1995 by 22%, and in that year enacted
legislation that penalized households for receiving regular gifts from
family members (33)--these policies are thought to have contributed to
increased food bank use, an external coping strategy. (34) Cycle 7 data
were collected five years into the mandate of a liberal government in
the province which had just been re-elected on a campaign of poverty
reduction. (35)
Given evidence for the strong correlation between a family's
income and food insecurity, (8,9) and given that Canadian families
reporting child hunger are relying more on intrahousehold coping
strategies than they did in the past, for whatever reason, despite the
proliferation of external food resources, it is ever more apparent that
income supports directed at vulnerable families are key to reducing
child hunger whether economic times are good or poor.
The NLSCY offered us an invaluable data set and precious
opportunity to study child hunger in Canada by providing us with a
natural experiment spanning a decade which would have been impossible to
set up deliberately. These households represent one of the most
vulnerable populations among food-insecure Canadians, and thus it is
vital to collect evidence about the adequacy of current interventions.
The strength of this study is the creation of two independent samples
representing the rare but socially important condition of child hunger
in Canada studied over a decade with consistent questions on coping
strategies employed, buttressed with detailed socio-demographic data.
The main weakness is the small numbers, with several results
incorporating wide confidence limits; this is not unexpected as child
hunger represents an extreme of food insecurity in Canada.
CONCLUSIONS
The types and distribution of coping strategies used by families
reporting child hunger did not change between 1996 and 2007, with the
exception that reduced food variety increased significantly. External
food supports were not taken up by these families whose vulnerability
characteristics also remained unchanged over the decade. Income supports
are needed so that households facing childhood hunger are not forced
into choices that compromise nutrition.
Acknowledgements: We thank Valerie Fleisch for manuscript
assistance.
Conflict of Interest: None to declare.
Received: March 8, 2012 Accepted: June 2, 2012
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Lynn McIntyre, MD, MHSc, FRCPC, Aaron C. Bartoo, PhD, Jody Pow, MA,
Melissa L. Potestio, PhD
Author Affiliations
Department of Community Health Sciences, Faculty of Medicine,
University of Calgary, Calgary, AB
Correspondence: Dr. Lynn McIntyre, Department of Community Health
Sciences, Faculty of Medicine, University of Calgary, Teaching Research
& Wellness (TRW) Building, Room 3E14 (3rd Floor), 3280 Hospital Dr.
NW, Calgary, AB T2N 4Z6, Tel: 403-220-8664, Fax: 403-270-7307, E-mail:
lmcintyr@ucalgary.ca Funding Sources: Operating grant: Canadian
Institutes of Health Research (Grant number: MOP-89731).
Table 1. Comparison of Child Hunger and Coping Strategies
NLSCY NLSCY
Cycle 2 Cycle 7
(1996-1997) (2006-2007) t-test
(n=8165) (n=15,691) ([dagger])
National child hunger (%) 1.5 0.7 p<0.001 *
Child hunger frequency (%) n=103 n=102
Occasional 58.6 65.3 p=0.49
Regular 41.1 34.7 p=0.49
Coping strategies (%)
Intrahousehold
Variety reduction 17.6 35.1 p=0.029 *
Parent skips meals 33.6 38.0 p=0.65
Any 45.1 62.4 p=0.067
External
Food bank 34.4 32.8 p=0.85
Friends 23.0 14.1 p=0.30
Relatives 35.1 33.3 p=0.84
Others 20.8 20.0 p=0.92
Any 69.2 61.7 p=0.41
* Cycles are significantly different, p<0.05.
([dagger]) t-tests performed using bootstrap weights.
Table 2. Logistic Regression Model for Child Hunger,
NLSCY Cycles 2 and 7
Odds Ratio (95% CI)
Cycle 2 Cycle 7
(1996/1997) (2006/2007)
Covariate n=7752 n=15,167
Child female 1.15 (0.64-2.07) 0.97 (0.54-1.73)
PMK ([dagger]) female 0.50 (0.10-1.11) 2.00 (0.15-26.31)
Child age 1.22 (1.04-1.42) ** 1.22 (1.06-1.41) **
PMK ([dagger]) age 0.99 (0.94-1.04) 0.97 (0.92-1.03)
Household size 1.58 (1.33-2.08) ** 1.30 (1.09-1.56) **
([double dagger])
Own dwelling 0.19 (0.08-0.43) ** 0.32 (0.16-0.63) **
Household income ([section]) 0.79 (0.63-0.98) * 0.82 (0.71-0.95) **
Rural residence 0.66 (0.28-1.58) 1.11 (0.52-2.38)
Immigrant 2.99 (0.44-20.37) (not disclosed)
Educational ([parallel]),
(ref. BA)
Less than high school 0.68 (0.29-1.58) 2.04 (0.79-5.31)
HS diploma 1.11 (0.43-2.85) 2.24 (1.01-4.97) *
Some postsecondary 0.65 (0.31-1.37) 2.00 (0.80-4.95)
Marital status (ref. Single)
Married ([paragraph]) 0.38 (0.17-0.83) ** 0.49 (0.25-0.95) **
Widowed, divorced, 0.99 (0.46-2.11) (not disclosed)
separated
Family functioning score 1.06 (1.01-1.11) * 1.08 (1.02-1.14) **
([dagger][dagger])
Health
Child has asthma 1.95 (0.96-3.96) 1.48 (0.76-2.89)
Parental smoking 1.95 (1.08-3.51) * 1.21 (0.66-2.22)
PMK health ([double 0.54 (0.26-1.13) 0.52 (0.25-1.08)
dagger][double dagger])
Child health ([double 0.30 (0.10-0.88) * 0.92 (0.09-9.74)
dagger][double dagger])
Child in hospital past 0.35 (0.11-1.13) 1.84 (0.19-17.41)
year
* Significantly different after weighting, p<0.05; ** p<0.01.
([dagger]) PMK = Person Most Knowledgeable about the child.
([double dagger]) Household size = continuous variable.
([section]) Income by $10,000 increments.
([parallel]) Highest education in household.
([paragraph]) Includes common-law.
([dagger][dagger]) Higher score = more dysfunction.
([double dagger][double dagger]) Self-reported health,
excellent=5; poor=1.
Table 3. Logistic Regression Models for Intrahousehold and External
Coping Strategies for Child Hunger, Considering Region of Canada,
NLSCY Cycles 2 and 7
Intrahousehold Strategies
Odds Ratio (95% CI)
Covariates Cycle 2 Cycle 7
n=103 n=101
Child female 2.07 (0.68-6.34) 0.41 (0.12-1.43)
PMK ([dagger]) female 25.57 (2.13-307.15) * 0.06 (0.0018-1.71)
Child age 1.09 (0.85-1.40) 0.71 (0.51-0.97)
PMK ([dagger]) age 0.98 (0.90-1.08) 1.16 (1.01-1.33) *
Household size ([double 1.06 (0.75-1.51) 0.72 (0.46-1.11)
dagger])
Own dwelling 1.07 (0.24-4.73) 1.52 (0.33-6.92)
Household income 0.96 (0.60-1.54) 1.17 (0.88-1.55)
([section])
Region (ref. Ontario)
Atlantic Canada 1.05 (0.19-5.88) 0.21 (0.026-1.69)
Quebec 0.69 (0.13-3.51) 0.57 (0.086-3.73)
Prairies 1.39 (0.33-5.82) 0.12 (0.022-0.61) *
British Columbia 1.65 (0.29-9.24) 0.08 (0.012-0.54) **
External Strategies
Odds Ratio (95% CI)
Covariates Cycle 2 Cycle 7
n=103 n=101
Child female 0.60 (0.19-1.91) 0.82 (0.25-2.67)
PMK ([dagger]) female 0.16 (0.27-0.92) * 18.33 (0.51-654.30)
Child age 1.10 (0.84-1.46) 1.40 (0.94-2.08)
PMK ([dagger]) age 0.98 (0.88-1.10) 0.97 (0.88-1.07)
Household size ([double 0.92 (0.63-1.33) 0.70 (0.48-1.02)
dagger])
Own dwelling 0.79 (0.17-3.75) 0.45 (0.087-2.27)
Household income 0.86 (0.57-1.30) 0.82 (0.60-1.13)
([section])
Region (ref. Ontario)
Atlantic Canada 0.34 (0.067-1.69) 9.66 (1.05-88.98) *
Quebec 0.57 (0.11-2.95) 0.68 (0.12-3.83)
Prairies 1.11 (0.21-5.94) 5.26 (1.004-27.53) *
British Columbia 1.00 (0.13-7.54) 10.45 (1.39-78.60) *
* Significantly different after weighting, p<0.05; ** p<0.01.
([dagger]) PMK = Person Most Knowledgeable about the child.
([double dagger]) Household size = continuous variable.
([section]) Income by $10,000 increments.
Table 4. Logistic Regression Models for Intrahousehold and External
Coping Strategies for Child Hunger, Considering Health, NLSCY
Cycles 2 and 7
Intrahousehold Strategies
Odds Ratio (95% CI)
Covariates Cycle 2 Cycle 7
n=85 n=97
Child female 1.62 (0.46-5.72) 0.52 (0.13-2.11)
PMK female ([dagger]) (not disclosed) 0.17 (0.003-11.10)
Child age 1.13 (0.80-1.58) 0.52 (0.34-0.79) *
PMK age ([dagger]) 1.00 (0.89-1.12) 1.36 (0.34-1.64)
Household size ([double 0.96 (0.66-1.39) 0.51 (0.13-1.02)
dagger])
Own dwelling 0.71 (0.10-4.90) 1.42 (0.26-7.60)
Household income 0.80 (0.48-1.33) 1.21 (0.26-1.58)
([section])
Rural residence 0.49 (0.054-4.36) 0.23 (0.044-1.24)
Family functioning score 1.14 (0.97-1.34) 0.87 (0.78-0.98) *
([paragraph])
Education ([paragraph])
(ref. BA)
Less than high school 0.27 (0.034-2.06) 8.45 (0.99-72.07)
HS diploma 0.30 (0.032-2.84) 7.38 (1.03-52.81)
Some postsecondary 0.72 (0.13-3.92) 0.38 (0.056-2.65)
Marital status (ref.
Single)
Married ** 6.01 (0.95-38.13) 1.47 (0.27-8.04)
Widowed, divorced, 1.97 (0.27-14.36) (not disclosed)
separated
Health
Child has asthma 4.56 (0.94-22.20) 3.76 (0.58-24.19)
Smoking 2.17 (0.50-9.35) 1.37 (0.39-4.84)
PMK health ([dagger] 2.79 (0.62-12.48) 1.50 (0.29-7.92)
[dagger])
Child health ([dagger] 2.41 (0.24-24.41) 7.25 (0.64-82.52)
[dagger])
Child in hospital 0.17 (0.0059-4.94) 12.78 (1.75-93.0) *
past year
External Strategies
Odds Ratio (95% CI)
Covariates Cycle 2 Cycle 7
n=92 n=93
Child female 0.56 (0.11-2.99) 0.58 (0.16-2.07)
PMK female ([dagger]) 0.12 (0.017-0.89) * 6.7 (0.72-62.53)
Child age 1.17 (0.84-1.64) 1.85 (1.11-3.08) *
PMK age ([dagger]) 0.89 (0.80-1.004) 0.87 (0.76-0.99) *
Household size ([double 0.96 (0.63-1.47) 0.92 (0.57-1.49)
dagger])
Own dwelling 2.86 (0.36-22.85) 1.60 (0.32-8.08)
Household income 1.14 (0.71-1.82) 0.63 (0.44-0.91) *
([section])
Rural residence 0.64 (0.057-7.16) 2.15 (0.39-11.89)
Family functioning score 0.89 (0.75-1.04) 1.08 (0.95-1.24)
([paragraph])
Education ([paragraph])
(ref. BA)
Less than high school 3.65 (0.44-30.15) 0.47 (0.032-6.90)
HS diploma 15.35 (1.56-150.7) * 0.07 (0.007-0.77) *
Some postsecondary 0.83 (0.17-4.07) 26.39 (0.91-768.2)
Marital status (ref.
Single)
Married ** 0.11 (0.016-0.83) * 0.91 (0.14-5.76)
Widowed, divorced, 5.15 (0.41-65.26) (not disclosed)
separated
Health
Child has asthma 0.28 (0.042-1.82) 4.74 (0.59-38.08)
Smoking 2.65 (0.48-14.60) 0.88 (0.17-4.64)
PMK health ([dagger] 1.36 (0.26-7.19) 11.20 (0.22-6.65)
[dagger])
Child health ([dagger] 0.09 (0.011-0.68) * (not disclosed)
[dagger])
Child in hospital 0.17 (0.0084-3.24) 0.06 (0.0002-26.61)
past year
* Significantly different after weighting, p<0.05.
([dagger]) PMK = Person Most Knowledgeable about the child.
([double dagger]) Household size = continuous variable.
([section]) Income by $10,000 increments.
([parallel]) Higher score = more dysfunction.
([paragraph]) Highest education in household.
** Includes common-law.
([dagger][dagger]) Self-reported health, excellent=5; poor=1.
