Ethnic Differences in Cumulative Exposure to Food Insecurity and Risk of Childhood Asthma

Background & Objectives Prevalence rates of asthma have steadily risen in the U.S. and are higher in non‐Hispanic black (NHB) than in non‐Hispanic white (NHW) or Hispanic children. Likewise, NHBs are at higher risk for food insecurity than the other 2 ethnic groups. Little is known about the relationship between cumulative exposure to household food insecurity and childhood asthma. The objective was to determine the relationship between exposure to food insecurity and asthma in NHW, NHB and Hispanic school‐aged children. Methods Data from 4 waves of the Early Childhood Longitudinal Study‐Kindergarten cohort (ECLS‐K) were analyzed beginning in kindergarten through 8th grade (N=6,031). Food insecurity was measured with the 18‐item USDA module and at each wave of data collection, an episode is defined as household food insecurity during the prior year. Ever‐diagnosis of asthma and sociodemographic characteristics were parent‐reported; anthropometric data were collected in person. Multivariate logistic regression models were stratified by race to test the association between cumulative exposure to food insecurity and ever being diagnosed with asthma, controlling for covariates. Results Among NHWs, odds of asthma were highest in children in households that had two episodes of food insecurity and were ever poor (OR 2.80, 95% CI 2.69–2.92). Among NHBs, one episode of food insecurity and ever being poor were associated with the highest odds of asthma (OR 2.05, 95% CI 1.97–2.14). Among Hispanics, one episode of food insecurity alone was associated with the highest odds of asthma (OR 1.63, 95% CI 1.58–1.69). Contrasting results appeared by ethnic group for parental depression, with odds for NHWs (OR 1.74, 95% CI 1.72–1.75) higher than Hispanics (OR 1.06, 95% CI 1.05–1.08) and NHBs (OR 0.98, 95% CI 0.96–0.99). Results were adjusted for child sex, birth weight, health insurance status, overweight or obesity, and maternal nativity and education. Conclusion In 2014, 19% of U.S. households with children experienced food insecurity, which we have previously demonstrated is associated with asthma. These results demonstrate that asthma is associated with strong ethnic differences in life course exposure to food insecurity and poverty. Thus, recent pediatric healthcare policy urging screening for food insecurity at pediatric visits may potentially reduce interethnic health disparities in asthma outcomes. Support or Funding Information Ms. Mangini and Dr. Forman are supported by the David Bruton, Jr. Professorship funds.