title: Associations between housing instability and food insecurity with health care access in low-income children.
abstract: OBJECTIVE
  Homelessness and hunger are associated with poor health care access among children. Housing instability and food insecurity represent milder and more prevalent forms of homelessness and hunger. The aim of this study was to determine the association between housing instability and food insecurity with children's health care access and acute health care utilization.
  
  
  METHODS
  We conducted a cross-sectional analysis of 12,746 children from low-income households included in the 2002 National Survey of America's Families (NSAF). In multivariate models controlling for important covariates, we measured the association between housing instability and food insecurity with 3 health care access measures: 1) no usual source of care, 2) postponed medical care, and 3) postponed medications. We also measured 3 health care utilization measures: 1) not receiving the recommended number of well-child care visits, 2) increased emergency department visits, and 3) hospitalizations.
  
  
  RESULTS
  Our analysis showed that 29.5% of low-income children lived in households with housing instability and 39.0% with food insecurity. In multivariate logistic regression models, housing instability was independently associated with postponed medical care, postponed medications, and increased emergency department visits. Food insecurity was independently associated with no usual source of care, postponed medical care, postponed medications, and not receiving the recommended well-child care visits.
  
  
  CONCLUSIONS
  Families that experience housing instability and food insecurity, without necessarily experiencing homelessness or hunger, have compromised ability to receive adequate health care for their children. Policy makers should consider improving programs that decrease housing instability and food insecurity, and clinicians should consider screening for housing instability and food insecurity so as to provide comprehensive care.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco General Hospital, CA 94143-1364, USA.
authors.forename: Christine T
authors.initials: CT
authors.lastname: Ma
authors.forename: Lauren
authors.initials: L
authors.lastname: Gee
authors.forename: Margot B
authors.initials: MB
authors.lastname: Kushel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005191:Family Characteristics; D005523:Food Supply / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011203:Poverty / Q000706:statistics & numerical data*; D014481:United States