Published online October 1, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. e867-e875 (doi:10.1542/peds.2008-0286)
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ARTICLE

A Brief Indicator of Household Energy Security: Associations With Food Security, Child Health, and Child Development in US Infants and Toddlers

John T. Cook, PhDa, Deborah A. Frank, MDa, Patrick H. Casey, MDb, Ruth Rose-Jacobs, PhDa, Maureen M. Black, PhDc, Mariana Chilton, PhD, MPHd, Stephanie Ettinger deCuba, MPHe, Danielle Appugliese, MPHe, Sharon Coleman, MS, MPHe, Timothy Heeren, PhDe, Carol Berkowitz, MDf and Diana B. Cutts, MDg

a Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
b Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
c Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
d Department of Community Health Prevention, Drexel University School of Public Health, Philadelphia, Pennsylvania
e Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts
f Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
g Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota

OBJECTIVE. Household energy security has not been measured empirically or related to child health and development but is an emerging concern for clinicians and researchers as energy costs increase. The objectives of this study were to develop a clinical indicator of household energy security and assess associations with food security, health, and developmental risk in children <36 months of age.

METHODS. A cross-sectional study that used household survey and surveillance data was conducted. Caregivers were interviewed in emergency departments and primary care clinics form January 2001 through December 2006 on demographics, public assistance, food security, experience with heating/cooling and utilities, Parents Evaluation of Developmental Status, and child health. The household energy security indicator includes energy-secure, no energy problems; moderate energy insecurity, utility shutoff threatened in past year; and severe energy insecurity, heated with cooking stove, utility shutoff, or ≥1 day without heat/cooling in past year. The main outcome measures were household and child food security, child reported health status, Parents Evaluation of Developmental Status concerns, and hospitalizations.

RESULTS. Of 9721 children, 11% (n = 1043) and 23% (n = 2293) experienced moderate and severe energy insecurity, respectively. Versus children with energy security, children with moderate energy insecurity had greater odds of household food insecurity, child food insecurity, hospitalization since birth, and caregiver report of child fair/poor health, adjusted for research site and mother, child, and household characteristics. Children with severe energy insecurity had greater adjusted odds of household food insecurity, child food insecurity, caregivers reporting significant developmental concerns on the Parents Evaluation of Developmental Status scale, and report of child fair/poor health. No significant association was found between energy security and child weight for age or weight for length.

CONCLUSIONS. As household energy insecurity increases, infants and toddlers experienced increased odds of household and child food insecurity and of reported poor health, hospitalizations, and developmental risks.

Key Words: energy security • food security • child health • development

Abbreviations: HEAG—household energy affordability gap • LIHEAP—Low-Income Home Energy Assistance Program • FI—food insecurity • ED—emergency department • RR—relative risk • HES—household energy security • C-SNAP—Children's Sentinel Nutrition Assessment Program • FSS—Food Security Scale • PEDS—Parents' Evaluation of Developmental Status • HEI—household energy insecurity • aOR—adjusted odds ratio • CI—confidence interval

Accepted Jun 16, 2008.


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