Journal of Community Health

, Volume 42, Issue 6, pp 1213–1219 | Cite as

Revealing the Prevalence and Consequences of Food Insecurity in Children with Epilepsy

  • Jennifer A. O’Malley
  • Bethany M. Klett
  • Melissa D. Klein
  • Nicole Inman
  • Andrew F. Beck
Original Paper


Food insecurity (FI) affects more than one in five American children and is increasingly addressed during pediatric primary care. Its relevance during subspecialty care, including in the treatment of chronic conditions like epilepsy, is largely unknown. This study sought to determine the FI prevalence among children with epilepsy and examine the relationship between FI and healthcare utilization, health-related quality-of-life (HR-QOL), and medication side effect control. This was a retrospective cohort study using electronic health record data from children, aged 2–17 years, seen for epilepsy management at an academic pediatric hospital. The primary predictor was household FI status, determined using a validated screening tool employed in the hospital’s pediatric neurology clinics. The primary outcome was unplanned healthcare utilization in the 6 months following initial FI screen. Secondary outcomes were standardized, validated assessments of HR-QOL and epilepsy medication side effects. Nearly 14% of the 691 children seen in the clinics for epilepsy lived in food insecure households. The impact of FI on healthcare utilization varied by race. For Caucasians, healthcare utilization rates were significantly higher among food insecure individuals than food secure individuals (37 vs. 17%, p = 0.003). Among African Americans, healthcare utilization rates did not vary with food security status (p = 0.6). Children in food insecure households had lower HR-QOL (p < 0.0001) and higher medication side effects (p = 0.0005). FI is common among children with epilepsy and may influence adverse health outcomes. Further exploration into how FI and other social determinants influence management of and determine outcomes for chronic diseases is warranted.


Epilepsy Food insecurity Child Healthcare utilization Quality of life 



Anti-epileptic drug


Advanced epilepsy therapy


Cincinnati Children’s Hospital Medical Center


Electronic health record


Emergency department


Food insecurity


Health-related quality-of-life


New-onset seizure


Pediatric Quality of Life inventory


Pediatric Epilepsy Side-Effects Questionnaire


U.S. Department of Agriculture



The authors would like to express sincere thanks to Dr. Diego Morita, Dr. Avani Modi and all staff members of the Cincinnati Children’s Hospital Medical Center New Onset Seizure clinic as well as Cincinnati Children’s Neurology social workers Debbie Morenz-Harbinger, Derek Racicki, and Jodi Christopfel for their support in project design and data collection.

Compliance with Ethical Standards

Conflict of interest

All five of the authors are responsible for the reported research and participated in the concept and design, analysis and interpretation of data, and drafting of the manuscript, and has approved of the submission in its present form. We have no financial relationships, no conflicts of interest related to this project, and no corporate sponsors to disclose.


  1. 1.
    Coleman-Jensen, A., Gregory, C., & Singh, A. (2014). Household food security in the United States in 2013. Vol ERR-173: Washington, DC: Economic Research Service.Google Scholar
  2. 2.
    Gundersen, C., Satoh, A., Dewey, A., et al. (2015). Map the Meal Gap 2015: Food Insecurity and Child Food Insecurity Estimates at the County Level. Published by Feeding America. Available at: Accessed January 29, 2016.
  3. 3.
    Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: Coming of age. Annual Review of Public Health, 32, 381–398.CrossRefPubMedGoogle Scholar
  4. 4.
    Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(Suppl 2), 19–31.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Alaimo, K., Olson, C. M., & Frongillo, E. A. (2002). Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. Journal of Nutrition, 132(4), 719–725.PubMedGoogle Scholar
  6. 6.
    Alaimo, K., Olson, C. M., Frongillo, E. A. Jr., & Briefel, R. R. (2001). Food insufficiency, family income, and health in US preschool and school-aged children. American Journal of Public Health, 91(5), 781–786.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Casey, P. H., Szeto, K. L., Robbins, J. M., et al. (2005). Child health-related quality of life and household food security. Archives of Pediatric and Adolescent Medicine, 159(1), 51–56.CrossRefGoogle Scholar
  8. 8.
    Kirkpatrick, S. I., McIntyre, L., & Potestio, M. L. (2010). Child hunger and long-term adverse consequences for health. Archives of Pediatric and Adolescent Medicine, 164(8), 754–762.CrossRefGoogle Scholar
  9. 9.
    Skalicky, A., Meyers, A. F., Adams, W. G., Yang, Z., Cook, J. T., & Frank, D. A. (2006). Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States. Maternal and Child Health Journal, 10(2), 177–185.CrossRefPubMedGoogle Scholar
  10. 10.
    Jyoti, D. F., Frongillo, E. A., & Jones, S. J. (2005). Food insecurity affects school children’s academic performance, weight gain, and social skills. Journal of Nutrition, 135(12), 2831–2839.PubMedGoogle Scholar
  11. 11.
    Rose-Jacobs, R., Black, M. M., Casey, P. H., et al. (2008). Household food insecurity: Associations with at-risk infant and toddler development. Pediatrics, 121(1), 65–72.CrossRefPubMedGoogle Scholar
  12. 12.
    Cook, J. T., Frank, D. A., Berkowitz, C., et al. (2004). Food insecurity is associated with adverse health outcomes among human infants and toddlers. Journal of Nutrition, 134(6), 1432–1438.PubMedGoogle Scholar
  13. 13.
    Kushel, M. B., Gupta, R., Gee, L., & Haas, J. S. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of General Internal Medicine, 21(1), 71–77.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Ma, C. T., Gee, L., & Kushel, M. B. (2008). Associations between housing instability and food insecurity with health care access in low-income children. Ambulatory Pediatrics, 8(1), 50–57.CrossRefPubMedGoogle Scholar
  15. 15.
    Beck, A. F., Henize, A. W., Kahn, R. S., Reiber, K. L., Young, J. J., & Klein, M. D. (2014). Forging a pediatric primary care-community partnership to support food-insecure families. Pediatrics, 134(2), e564–e571.CrossRefPubMedGoogle Scholar
  16. 16.
    Beck, A. F., & Klein, M. D. (2016). Moving From Social Risk Assessment and Identification to Intervention and Treatment. Academic Pediatrics, 16(2), 97–98.CrossRefPubMedGoogle Scholar
  17. 17.
    Beck, A. F., Tschudy, M. M., Coker, T. R., et al. (2016). Determinants of health and pediatric primary care practices. Pediatrics, 137(3), 1–11.CrossRefGoogle Scholar
  18. 18.
    Burkhardt, M. C., Beck, A. F., Conway, P. H., Kahn, R. S., & Klein, M. D. (2012). Enhancing accurate identification of food insecurity using quality-improvement techniques. Pediatrics, 129(2), e504–e510.CrossRefPubMedGoogle Scholar
  19. 19.
    Council On Community Pediatrics. (2016). Poverty and child health in the United States. Pediatrics, 137(4), e20160339.CrossRefGoogle Scholar
  20. 20.
    Garg, A., Toy, S., Tripodis, Y., Silverstein, M., & Freeman, E. (2015). Addressing social determinants of health at well child care visits: A cluster RCT. Pediatrics, 135(2), e296–e304.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Chung, E. K., Siegel, B. S., Garg, A., et al. (2016). Screening for social determinants of health among children and families living in poverty: A guide for clinicians. Current Problems in Pediatric and Adolescent Health Care, 46(5), 135–153.CrossRefPubMedGoogle Scholar
  22. 22.
    Cramer, J. A., Wang, Z. J., Chang, E., et al. (2014). Healthcare utilization and costs in children with stable and uncontrolled epilepsy. Epilepsy and Behavior, 32, 135–141.CrossRefGoogle Scholar
  23. 23.
    Modi, A. C., Rausch, J. R., & Glauser, T. A. (2014). Early pediatric antiepileptic drug nonadherence is related to lower long-term seizure freedom. Neurology, 82(8), 671–673.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Gordon, K. E., Dooley, J. M. (2015). Food insecurity and epilepsy in a nationally representative sample. Epilepsy and Behavior, 43, 139–142.CrossRefPubMedGoogle Scholar
  25. 25.
    Hager, E. R., Quigg, A. M., Black, M. M., et al. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26–e32.CrossRefPubMedGoogle Scholar
  26. 26.
    Modi, A. C., Ingerski, L. M., Rausch, J. R., & Glauser, T. A. (2011). Treatment factors affecting longitudinal quality of life in new onset pediatric epilepsy. Journal of Pediatric Psychology, 36(4), 466–475.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Varni, J. W., Seid, M., Kurtin, P. S. (2001) PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Medical Care, 39(8), 800–812.CrossRefPubMedGoogle Scholar
  28. 28.
    Morita, D. A., Glauser, T. A., & Modi, A. C. (2012). Development and validation of the pediatric epilepsy side effects questionnaire. Neurology, 79(12), 1252–1258.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Burkhardt, M. C., Beck, A. F., Kahn, R. S., & Klein, M. D. (2012). Are our babies hungry? Food insecurity among infants in urban clinics. Clinical Pediatrics, 51(3), 238–243.CrossRefPubMedGoogle Scholar
  30. 30.
    DeMartini, T. L., Beck, A. F., Kahn, R. S., & Klein, M. D. (2013). Food insecure families: Description of access and barriers to food from one pediatric primary care center. Journal of Community Health, 38(6), 1182–1187.CrossRefPubMedGoogle Scholar
  31. 31.
    Cheng, T. L., & Goodman, E., Committee on Pediatric Research (2015). Race, ethnicity, and socioeconomic status in research on child health. Pediatrics, 135(1), e225–e237.CrossRefPubMedGoogle Scholar
  32. 32.
    Malat, J., Oh, H. J., & Hamilton, M. A. (2005). Poverty experience, race, and child health. Public Health Reports, 120(4), 442–447.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Williams, D. R., Sternthal, M. (2010). Understanding racial-ethnic disparities in health: Sociological contributions. Journal of Health and Social Behavior, 51, S15–S27.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jennifer A. O’Malley
    • 1
  • Bethany M. Klett
    • 2
  • Melissa D. Klein
    • 3
  • Nicole Inman
    • 4
  • Andrew F. Beck
    • 5
  1. 1.Division of Child Neurology, Department of PediatricsLucile Packard Children’s HospitalPalo AltoUSA
  2. 2.University of Cincinnati College of MedicineCincinnatiUSA
  3. 3.Division of General and Community Pediatrics and Division of Hospital Medicine, Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.Division of Child Neurology, Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  5. 5.Division of General and Community Pediatrics and Division of Hospital Medicine, Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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