摘要：Objectives. We investigated the risk of household food insecurity and reported fair or poor health among very young children who were US citizens and whose mothers were immigrants compared with those whose mothers had been born in the United States. Methods. Data were obtained from 19 275 mothers (7216 of whom were immigrants) who were interviewed in hospital-based settings between 1998 and 2005 as part of the Children's Sentinel Nutrition Assessment Program. We examined whether food insecurity mediated the association between immigrant status and child health in relation to length of stay in the United States. Results. The risk of fair or poor health was higher among children of recent immigrants than among children of US-born mothers (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.02, 1.55; P < .03). Immigrant households were at higher risk of food insecurity than were households with US-born mothers. Newly arrived immigrants were at the highest risk of food insecurity (OR = 2.45; 95% CI = 2.16, 2.77; P < .001). Overall, household food insecurity increased the risk of fair or poor child health (OR = 1.74; 95% CI = 1.57, 1.93; P < .001) and mediated the association between immigrant status and poor child health. Conclusions. Children of immigrant mothers are at increased risk of fair or poor health and household food insecurity. Policy interventions addressing food insecurity in immigrant households may promote child health. In the United States, 20% of children younger than 6 years have immigrant parents, and this group is the fastest growing population of children in the United States. 1 Although 93% of children of immigrants are US citizens and are therefore eligible for federal assistance, such programs often do not reach these children, and as a result they are potentially vulnerable to food insecurity and poor health. 2 The health and well-being of this child population will have a strong impact on future health care and education systems in the United States, as well as the future productivity of the US workforce. In comparison with households in which all members are US born, households with immigrants are at a highly elevated risk of household food insecurity. 3 – 9 Food insecurity refers to lack of access to enough food for an active and healthy life for all household members because of financial constraints. 10 In households experiencing food insecurity, not all members have access to enough food, and they may have reduced food intakes, consume poor-quality food, or have disrupted eating patterns. We and other researchers have found that among infants and toddlers aged 0 to 3 years, who are in the most sensitive period of brain growth and cognitive development, household food insecurity is related to reported fair or poor child health, 11 developmental risks, 12 and behavior problems. 13 Household food insecurity has also been associated with reported poor health among older children, 11 , 14 – 21 with adolescent and adult depression, 14 , 22 – 26 and with low academic performance. 24 , 27 , 28 Among mothers, household food insecurity has been associated with a greater risk of mental health problems, including depressive symptoms 14 and anxiety. 13 , 29 In turn, maternal mental health problems have a negative effect on the health and well-being of children, 30 – 35 including children of immigrants. For instance, among Mexican immigrants in the United States, maternal depressive symptoms and anxiety have been associated with child depressive symptoms and poor family functioning. 36 Most studies that have investigated associations between maternal and child health and food insecurity have not included immigrants or have controlled for immigrant status. In studies involving immigrants, assessments of the impact of duration of residence have not been possible because of small sample sizes. However, length of stay in the United States may be associated with both food security and child health. Longer length of residency has been shown to be related to increased acculturation and exposure to the diets, activities, and societal norms of United States citizens, resulting in health patterns that, over time, progressively resemble those of US citizens. 37 In addition, eligibility for public assistance programs such as the Food Stamp Program requires that immigrants not only provide legal documentation but also prove that they have been residents of the United States for at least 5 years. Therefore, in health research among immigrants, it is important to consider length of stay as a factor in food insecurity. We sought to investigate the risk of household food insecurity and reported fair or poor health among very young children who were US citizens and whose mothers were immigrants compared with children whose mothers were US born. Immigrant household outcomes were considered in terms of length of residence in the United States. We tested 4 hypotheses linking immigrant status, food security, and reported child health. First, we hypothesized that children of immigrant mothers would have higher odds of reported fair or poor health than would children of US-born mothers. Second, we hypothesized that immigrant households would have higher odds of food insecurity than would households with US-born mothers. Third, we hypothesized that household food insecurity would be associated with an increased risk of fair or poor child health, regardless of immigrant status. Finally, we hypothesized that food insecurity would mediate the association between immigrant status and reported fair or poor child health after we controlled for all covariates, including maternal depressive symptoms.
