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Children with Special Health Care Needs, Supplemental Security Income, and Food Insecurity

Rose-Jacobs, Ruth ScD; Goodhart Fiore, Jennifer MD; Ettinger de Cuba, Stephanie MPH; Black, Maureen PhD; Cutts, Diana B. MD; Coleman, Sharon M. MPH; Heeren, Timothy PhD; Chilton, Mariana PhD; Casey, Patrick MD; Cook, John PhD; Frank, Deborah A. MD

Journal of Developmental & Behavioral Pediatrics: February/March 2016 - Volume 37 - Issue 2 - p 140–147
doi: 10.1097/DBP.0000000000000260
Original Articles

Objectives: To assess food insecurity in low-income households with young children with/without special health care needs (SHCN) and evaluate relationships between child Supplemental Security Income (SSI) receipt and food insecurity.

Methods: A cross-sectional survey (2013–2015) of caregivers was conducted at 5 medical centers. Eligibility included index child age <48 months without private health insurance and a caregiver fluent in English or Spanish. Interviews included sociodemographics, 5-item Children with Special Health Care Needs Screener, 18-item US Food Security Survey Module, household public assistance program participation, and child SSI receipt. Household and child food insecurity, each, were evaluated using multivariable logistic regression models.

Results: Of 6724 index children, 81.5% screened negative for SHCN, 14.8% positive for SHCN (no SSI), and 3.7% had SHCN and received SSI. After covariate control, households, with versus without a child with SHCN, were more likely to experience household (Adjusted odds ratios [AOR] 1.24, 95% confidence intervals [CI], 1.03–1.48) and child (AOR 1.35, 95% CI, 1.11–1.63) food insecurity. Among households with children with SHCN, those with children receiving, versus not receiving SSI, were more likely to report household (AOR 1.42, 95% CI, 0.97–2.09) but not child food insecurity.

Conclusion: Low-income households with young children having SHCN are at risk for food insecurity, regardless of child SSI receipt and household participation in other public assistance programs. Policy recommendations include reevaluation of assistance programs' income and medical deduction criteria for households with children with SHCN to decrease the food insecurity risk faced by these children and their families.

*Department of Pediatrics, Boston University School of Medicine, Boston, MA;

Department of Pediatrics, Boston Medical Center and Boston Children's Hospital, Boston, MA;

Data Coordinating Center, Boston University School of Public Health, Boston, MA;

§Department of Pediatrics, University of Maryland, Baltimore, MD;

Hennepin County Medical Center, Minneapolis, MN;

Department of Epidemiology, Boston University School of Public Health, Boston, MA;

#Department of Community Health and Prevention, Drexel University School of Public Health, Philadelphia, PA;

**Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.

Address for reprints: Ruth Rose-Jacobs, ScD, Department of Pediatrics, Boston University School of Medicine, 771 Albany St, Dowling Building Room G509, Boston, MA; e-mail:

This project was supported by a grant from the University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Food & Nutrition Service, (contract # AG-3198-B-10-0028). A generous group of individuals and foundations have supported the data collection and analysis work of Children's HealthWatch. The complete list is available at

Disclosure: The authors declare no conflict of interest. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. No one working for or representing any of these sources of support played any role in any aspect of this research and article, including study concept and design; acquisition and interpretation of data; statistical analysis; drafting, review, and revision of the manuscript; administrative, technical, and material support; and study supervision.

Received August , 2015

Accepted December , 2015

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