title: WIC participation and attenuation of stress-related child health risks of household food insecurity and caregiver depressive symptoms.
abstract: OBJECTIVE
  To examine how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) attenuates stress-related child health risks.
  
  
  METHODS
  Cross-sectional family stress and cumulative stress models from January 1, 2000, through December 31, 2010.
  
  
  METHODS
  Families recruited from emergency departments and/or primary care in Baltimore, Boston, Little Rock, Los Angeles, Minneapolis, Philadelphia, and Washington, DC.
  
  
  METHODS
  Participants included 26,950 WIC-eligible caregivers and children younger than 36 months; 55.2% were black, 29.9% were Hispanic, and 13.0% were white. Caregivers' mean age was 25.6 years; 68.6% were US-born, 64.7% had completed high school, 38.0% were married, and 36.5% were employed.
  
  
  METHODS
  Of the participants, 24.0% had household food insecurity and 24.4% had depressive symptoms; 9.1% had both stressors, 29.9% had 1 stressor, and 61.0% had neither; 89.7% were WIC participants.
  
  
  METHODS
  Caregivers reported child health, lifetime hospitalizations, and developmental risk. Weight and length were measured. We calculated weight-for-age and length-for-age z scores and the risk of underweight or overweight. The well-child composite comprised good/excellent health, no hospitalizations, no developmental risk, and neither underweight nor overweight.
  
  
  RESULTS
  In multivariate analyses adjusted for covariates, as stressors increased, odds of fair/poor health, hospitalizations, and developmental risk increased and odds of well-child status decreased. Interactions between WIC participation and stressors favored WIC participants over nonparticipants in dual stressor families on 3 child health indicators: (1) fair/poor health: WIC participants, adjusted odds ratio (aOR), 1.89 (95% CI, 1.66-2.14) vs nonparticipants, 2.35 (2.16-4.02); (2) well-child status: WIC participants, 0.73 (0.62-0.84) vs nonparticipants, 0.34 (0.21-0.54); and (3) overweight: WIC participants, 1.01 (0.88-1.16) vs nonparticipants, 1.48 (1.04-2.11) (P = .06).
  
  
  CONCLUSIONS
  As stressors increased, child health risks increased. WIC participation attenuates but does not eliminate child health risks.
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA. mblack@peds.umaryland.edu
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
authors.forename: Anna M
authors.initials: AM
authors.lastname: Quigg
authors.forename: John
authors.initials: J
authors.lastname: Cook
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Casey
authors.forename: Diana Becker
authors.initials: DB
authors.lastname: Cutts
authors.forename: Mariana
authors.initials: M
authors.lastname: Chilton
authors.forename: Alan
authors.initials: A
authors.lastname: Meyers
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ettinger de Cuba
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.forename: Sharon
authors.initials: S
authors.lastname: Coleman
authors.forename: Ruth
authors.initials: R
authors.lastname: Rose-Jacobs
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Frank
mesh_terms: D000328:Adult; D049628:Body Size; D017028:Caregivers / Q000523:psychology*; D002657:Child Development; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D005522:Food Services; D005523:Food Supply / Q000706:statistics & numerical data; D006304:Health Status; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008960:Models, Psychological; D015999:Multivariate Analysis; D011632:Public Assistance; D012306:Risk; D013315:Stress, Psychological / Q000453:epidemiology; D014481:United States / Q000453:epidemiology