JAMA Netw Open. 2025 Sep 2;8(9):e2530691. doi: 10.1001/jamanetworkopen.2025.30691.
ABSTRACT
IMPORTANCE: In the US, children in food-insecure households are at risk for adverse psychological outcomes despite being shielded from hunger and malnutrition by their caregivers and school- and community-based programs. Parenting stress may be an important mechanism through which food insecurity is associated with negative outcomes for child mental health.
OBJECTIVE: To investigate associations of household food insecurity with child mental health, parenting stress, and family functioning.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a daily-diary design in a community-based sample to examine associations between daily fluctuations in food insecurity and child and family functioning. The study was conducted remotely during the COVID-19 pandemic in the rural (defined by the Health Resource Services Administration) Northeastern US. Caregivers of school-aged children were enrolled during the 2021 school year and completed a baseline visit followed by mobile surveys for 30 days. Participants were adult, legal caregivers of children ages 6 to 12 years who experienced food insecurity within the past month. Participants were required to have English proficiency and access to a device with internet and texting capabilities. Prospective participants completed an online questionnaire to determine eligibility. A total of 553 respondents were screened, of which 327 respondents (59.1%) met all inclusion criteria. The most common reason for ineligibility was not having a child in the study age range. Data analyses were performed between May 2022 and April 2023.
EXPOSURE: Household food insecurity.
MAIN OUTCOMES AND MEASURES: The primary outcomes were caregiver hunger, negative affect, executive functioning, and parent-child interactions (measured via a daily self-report survey) and child mental health problems (measured via the Child Behavior Checklist [CBCL]).
RESULTS: Among 61 caregivers (mean [SD] age, 36.1 [5.9] years; 51 women [83.6%]; 2 American Indian or Alaska Native [3.3%], 1 Black [1.6%], and 55 non-Hispanic White [90.2%]), greater day-to-day fluctuations in household and child food insecurity were associated with more severe child internalizing problems (CBCL Internalizing Problems scale: β = 0.40; P = .003 for household and β = 0.49; P < .001 for child food insecurity) and total mental health problems (CBCL Total Problems scale: β = 0.34; P = .01 for household and β = 0.35; P = .01 for child food insecurity). Additionally, the daily association between food insecurity and parent-child conflict was fully mediated via 2 sequential pathways of caregiver hunger and negative affect (b = .02; P = .001) and caregiver hunger and attention and impulse control (b = 0.01; P = .04). This model explained 17% of variability in daily parent-child conflict (R2 = 0.17).
CONCLUSIONS AND RELEVANCE: This study’s findings suggest that caregiver stress and household instability may be key mechanisms by which food insecurity is negatively associated with child mental health.
PMID:40911307 | DOI:10.1001/jamanetworkopen.2025.30691
