Household Food and Nutrition Security Among Publicly Insured Families of Hospitalized Children

To characterize household food and nutrition security among families during hospitalization and examine associations with government benefits and neighborhood conditions. We hypothesized Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or Supplemental Nutrition Assistance Program (SNAP) receipt or residence in higher Child Opportunity Index (COI) neighborhoods would be associated with higher food and nutrition security status.

We conducted a single-site cross-sectional study (October 2024-June 2025) of publicly insured families of a hospitalized child. Caregivers completed surveys assessing household characteristics, food security, nutrition security, and related measures of Dietary and Healthfulness Choice. Addresses were geocoded to nationally normed COI z scores. The outcome was an ordinal classification of food and nutrition security profiles, from least to most secure: (1) food insecure/nutrition insecure (FI/NI), (2) discordant profiles (FI/nutrition secure [NS] or food secure [FS]/NI), and (3) FS/NS. Ordinal logistic regression models examined outcome profiles and associations with WIC and SNAP receipt and COI, adjusting for patient age, preferred language, and significant bivariate results.

Among 401 caregivers, 54.9% were FS/NS, 29.6% had discordant profiles, and 15.5% were FI/NI. Older child age was associated with a lower likelihood of being in a higher secure category (eg, FS/NS) in SNAP- (odds ratio [OR], 0.96) and COI-associated models (OR, 0.96). Across all models, higher Healthfulness Choice (ORs, 4.91-4.94) and household income (ORs, 1.13-1.16) were associated with higher FS/NS status.

Families experience variation in household food and nutrition security. Food insecurity screening alone may not capture the full scope of food-related needs; incorporating nutrition security screening may better guide interventions and address unmet dietary quality needs.