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Key takeaways:
- Food insecurities and food assistance programs were linked to higher odds for wheezing with exercise.
- Asthma, night coughing and wheezing that interrupts sleep were also found in food insecurity categories.
WASHINGTON – Children living in a household that reportedly ran out of food faced heightened odds for asthma and signs of wheezing with exercise, according to research presented at the American Thoracic Society International Conference.
“In this pediatric population of a safety-net primary care clinic, we found that children who were food insecure were at increased odds of having asthma and more likely to experience increased asthma symptom burden,” Morgan Ye, MPH, of the department of medicine at the University of California, San Francisco, and colleagues wrote.
Data were derived from Ye M, et al. Associations between food insecurity and assistance with asthma and symptomology burden among children in a safety-net practice. Presented at: American Thoracic Society International Conference; May 19-24, 2023; Washington, D.C
In this study, Ye and colleagues assessed 555 children from the Pediatric Adverse Childhood Experiences (ACEs) Screening and Resiliency Study to understand how experiencing food insecurity and/or receiving food assistance are linked to asthma and symptom burden.
Of the total cohort, 236 children had asthma, which was found through the International Study of Asthma and Allergies in Childhood core questionnaire.
Researchers classified food insecurity/assistance into four different categories: No access to fresh fruits or vegetables at home, living in a household that reportedly ran out of food, receiving Calfresh and receiving free/reduced school breakfast/lunch.
Researchers used multivariable logistic and ordinal logistic regression models that accounted for several factors, including “gender, race, age, caregiver education, in-utero smoke exposure and median household income,” to examine associations.
When assessing the likelihood for asthma in this patient population, running out of food was the only food insecurity/assistance factor linked to heightened odds (adjusted OR = 2.15; 95% CI, 1.32-3.51), according to the abstract. In contrast, higher odds for wheezing with exercise were found in three of the four food insecurity/assistance categories: receiving Calfresh (aOR = 1.74; 95% CI, 1.02-2.96), receiving free/reduced school breakfast/lunch (aOR = 1.89 ; 95% CI, 1.04-3.43) and running out of food (aOR = 2.37; 95% CI, 1.43-3.94).
Researchers further found that wheezing that interrupts sleep in children was linked to receiving free/reduced school breakfast/lunch (aOR = 2.33; 95% CI, 1.01-5.34).
In terms of night coughing, these odds were elevated in those receiving Calfresh (aOR = 1.71; 95% CI, 1.06-2.77), as well as those who ran out of food (aOR = 1.94; 95% CI, 1.22-3.09) .
Researchers did not find significantly increased odds for severe wheezing or frequent wheezing attacks across the four food insecurity/assistance categories, according to the abstract.
For children living in households that ran out of food, the odds for asthma previously found were reduced after further adjusting for Calfresh and no access to fresh produce (aOR = 1.81; 95% CI, 1.03-3.19); however, odds for wheezing with exercise and night coughing in this food insecurity category were similar to those previously observed.
“Access to benefit programs attenuates the relationship with having asthma but does not impact symptoms, suggesting assistance programs may curb asthma development, but may be less impactful in reducing symptom burden,” Ye and colleagues wrote.
perspective
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Rachel HF Margolis, PhD
Despite a large body of evidence demonstrating a relationship between social risk factors and asthma morbidity, few studies have specifically examined the role of food insecurity. Ye et al’s study begins to examine this relationship, finding that food insecurity was associated with a higher odds of asthma symptoms in a sample of pediatric patients at a safety-net primary care clinic in California.
Overall, the results provide more evidence that social factors are associated with asthma morbidity. It was surprising that the researchers found higher odds of asthma symptoms with food assistance. Food assistance may be a marker for socioeconomic disadvantage more broadly, and assistance likely needs to address multiple social risk factors — not just food insecurity — to have an effect.
There are several limitations of this study that are important to consider. First, this study includes children aged as young as 3 months, but it is difficult to diagnose asthma in children aged younger than 4 to 5 years and the ISAAC core questionnaire does not appear to be validated for children aged younger than 6 years. Another limitation is that the researchers did not control for household environmental exposures. Families who are having difficulty meeting basic needs, such as food, may also be more likely to live in substandard housing conditions (eg, pests, mold, etc) that exacerbate asthma symptoms. Indeed, in the asthma clinic in Washington, DC, where I work, we have found that household asthma triggers and food are two of the most prevalent issues that families request assistance with on a social needs checklist administered at the beginning of each clinic visit.
Despite the limitations of the study, physicians can use the findings to improve care. First and foremost, this study is yet another reminder that physicians need to assess the social context of their patients, including food insecurity, as it directly relates to asthma prevalence and symptoms. Second, they can screen children and families for food insecurity and refer them to resources, including WIC and SNAP or local food pantries, which can help families of their impact on asthma symptoms. Lastly, physicians can continue to advocate for social policies that address social risk factors.
There are also several important areas for future research. First, it will be important to tease apart the impact of specific social risk factors by including food insecurity and household environmental exposures, among others, in the same models. Second, it would be illuminating to conduct qualitative research with asthma caregivers to gain a deeper understanding of the relationship between food insecurity and their child’s asthma. Lastly, prospective investigation is needed on the role of food assistance programs as a possible protective factor.
Rachel HF Margolis, PhD
Research Postdoctoral Fellow, Center for Translational Research, Children’s National Hospital
Disclosures: Margolis reports no relevant financial disclosures.
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