PEDIATRICS Vol. 101 No. 1 January 1998, p. e3

ELECTRONIC ARTICLE:
Hunger in Children in the United States: Potential Behavioral and Emotional Correlates

Received Apr 9, 1997; accepted Sep 22, 1997.

Ronald E. Kleinman^*, , J. Michael Murphy^§, , Michelle Little^§, Maria Pagano^§, Cheryl A. Wehler^¶, Kenneth Regal^#, and Michael S. Jellinek^§,

From the ^* Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, Massachusetts; the  Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; the ^§ Child Psychiatry Service, Massachusetts General Hospital, Boston, Massachusetts; the  Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; ^¶ Community Childhood Hunger Identification Project, CAW and Associates, Framingham, Massachusetts; and ^# Just Harvest: A Center for Action Against Hunger, Homestead, Pennsylvania.

Objective.  Results from a recent series of surveys from 9 states and the District of Columbia by the Community Childhood Hunger Identification Project (CCHIP) provide an estimate that 4 million American children experience prolonged periodic food insufficiency and hunger each year, 8% of the children under the age of 12 in this country. The same studies show that an additional 10 million children are at risk for hunger. The current study examined the relationship between hunger as defined by the CCHIP measure (food insufficiency attributable to constrained resources) and variables reflecting the psychosocial functioning of low-income, school-aged children.

Methods.  The study group included 328 parents and children from a CCHIP study of families with at least 1 child under the age of 12 years living in the city of Pittsburgh and the surrounding Allegheny County. A two-stage area probability sampling design with standard cluster techniques was used. All parents whose child was between the ages of 6 and 12 years at the time of interview were asked to complete a Pediatric Symptom Checklist, a brief parent-report questionnaire that assesses children's emotional and behavioral symptoms. Hunger status was defined by parent responses to the standard 8 food-insufficiency questions from the CCHIP survey that are used to classify households and children as "hungry," "at-risk for hunger," or "not hungry."

Results.  In an area probability sample of low-income families, those defined as hungry on the CCHIP measure were significantly more likely to have clinical levels of psychosocial dysfunction on the Pediatric Symptom Checklist than children defined as at-risk for hunger or not hungry. Analysis of individual items and factor scores on the Pediatric Symptom Checklist showed that virtually all behavioral, emotional, and academic problems were more prevalent in hungry children, but that aggression and anxiety had the strongest degree of association with experiences of hunger.

Conclusion.  Children from families that report multiple experiences of food insufficiency and hunger are more likely to show behavioral, emotional, and academic problems on a standardized measure of psychosocial dysfunction than children from the same low-income communities whose families do not report experiences of hunger. Although causality cannot be determined from a cross-sectional design, the strength of these findings suggests the importance of greater awareness on the part of health care providers and public health officials of the role of food insufficiency and hunger in the lives of poor children.

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