title: The relationship between childhood adversity and food insecurity: 'It's like a bird nesting in your head'.
abstract: OBJECTIVE
  Adverse childhood experiences, including abuse, neglect and household instability, affect lifelong health and economic potential. The present study investigates how adverse childhood experiences are associated with food insecurity by exploring caregivers' perceptions of the impact of their childhood adversity on educational attainment, employment and mental health.
  
  
  METHODS
  Semi-structured audio-recorded in-person interviews that included (i) quantitative measures of maternal and child health, adverse childhood experiences (range: 0-10) and food security using the US Household Food Security Survey Module; and (ii) qualitative audio-recorded investigations of experiences with abuse, neglect, violence and hunger over participants' lifetimes.
  
  
  METHODS
  Households in Philadelphia, PA, USA.
  
  
  METHODS
  Thirty-one mothers of children <4 years old who reported low or very low household food security.
  
  
  RESULTS
  Twenty-one caregivers (68 %) reported four or more adverse childhood experiences, and this severity was significantly associated with reports of very low food security (Fisher's exact P=0·021). Mothers reporting emotional and physical abuse were more likely to report very low food security (Fisher's exact P=0·032). Qualitatively, participants described the impact of childhood adverse experiences with emotional and physical abuse/neglect, and household substance abuse, on their emotional health, school performance and ability to maintain employment. In turn, these experiences negatively affected their ability to protect their children from food insecurity.
  
  
  CONCLUSIONS
  The associations between mothers' adverse experiences in childhood and reports of current household food security should inspire researchers, advocates and policy makers to comprehensively address family hardship through greater attention to the emotional health of caregivers. Programmes meant to address nutritional deprivation and financial hardship should include trauma-informed approaches that integrate behavioural interventions.
authors.affiliation: 1School of Public Health,Drexel University,3600 Market Street, 7th Floor,Philadelphia,PA 19104,USA.
authors.forename: Mariana
authors.initials: M
authors.lastname: Chilton
authors.affiliation: 1School of Public Health,Drexel University,3600 Market Street, 7th Floor,Philadelphia,PA 19104,USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Knowles
authors.affiliation: 2Last Mile Health,Tiyatien Health,Zwedru,Grand Gedeh County,Liberia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Rabinowich
authors.affiliation: 1School of Public Health,Drexel University,3600 Market Street, 7th Floor,Philadelphia,PA 19104,USA.
authors.forename: Kimberly T
authors.initials: KT
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology; D002648:Child; D002649:Child Abuse; D000067576:Child Health; D005191:Family Characteristics; D005260:Female; D005523:Food Supply; D006801:Humans; D006815:Hunger; D008297:Male; D008603:Mental Health; D009035:Mothers / Q000523:psychology*; D010465:Perception; D015143:Philadelphia; D011203:Poverty; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Adverse childhood experiences; Food insecurity; Very low food security; Violence