The Unequal Impact of Food Insecurity on Cognitive and Behavioral Outcomes Among 5-Year-Old Urban Children

Abstract Objective To examine the associations of food insecurity with children's cognitive and behavioral outcomes using quantile regression. Design Secondary analysis of the Fragile Families and Child Wellbeing Study dataset. Participants A total of 2,046 children aged 5 years. Main Outcome Measures Child behavioral outcomes were measured using externalizing (aggressive) and internalizing (emotional) behavior problems. Child cognitive outcomes were measured using the Peabody Vocabulary test and the Woodcock–Johnson letter–word identification test. Food insecurity was measured using the US Department of Agriculture's Food Security Module. Analysis Unconditional quantile regressions were employed. Statistical significance was set at P  ≤ .05. Results Negative associations between food insecurity and child behavior problems (externalizing and internalizing) were largest for children with the most behavior problems. For Peabody Vocabulary scores, the negative association with food insecurity was statistically significant only for children in the top half of the distribution (≥50th percentile). The analysis found mixed evidence of an association between food insecurity and the Woodcock–Johnson letter–word identification test. These associations were similar for boys and girls. Conclusions and Implications Because children's cognitive skills and behavioral problems have long-lasting implications and effects later in life, reducing the risk of food insecurity might particularly benefit children with greater externalizing and internalizing behavior problems.