title: "Do You Wanna Breathe or Eat?": Parent Perspectives on Child Health Consequences of Food Insecurity, Trade-Offs, and Toxic Stress.
abstract: OBJECTIVE
  This study among 51 parents of young children under age four investigated how parents that report marginal, low and very low food security characterize how trade-offs associated with food insecurity affect parents' mental health and child well-being.
  
  
  METHODS
  We carried out 51 semi-structured audio-recorded interviews after participants responded to a survey regarding food security status and maternal depressive symptoms. Each interview was transcribed. Through a content analysis, we coded "meaning units" in each manuscript and organized them by themes in ATLAS.ti. Among participants reporting both food insecurity and depressive symptoms, we identified three primary areas of concern: trade-offs, mental health, and child well-being.
  
  
  RESULTS
  Parents described how trade-offs associated with food insecurity have a profound relationship with their mental health and home environment that strongly affects young children. Descriptions of hardships include anxiety and depression related to overdue bills and shut-off notices, strains with housing costs, and safety. Parents described how their own frustration, anxiety, and depression related to economic hardship have a negative impact on their children's physical health, and their social and emotional development.
  
  
  CONCLUSIONS
  Parents in food insecure households recognize that trade-offs between food and other basic necessities are associated with their personal stress and poor mental health that, in turn, affects their children's health and development. Partnerships between healthcare providers, policymakers, and parents are essential to successfully address and prevent the poor child health outcomes of toxic stress associated with food insecurity and poverty.
authors.affiliation: Drexel University School of Public Health, Philadelphia, PA, 19104, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Knowles
authors.affiliation: Las Mile Health, Zwedru, Liberia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Rabinowich
authors.affiliation: Boston University School of Public Health, Boston, MA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ettinger de Cuba
authors.affiliation: Hennepin County Medical Center, Minneapolis, MN, USA.
authors.forename: Diana Becker
authors.initials: DB
authors.lastname: Cutts
authors.affiliation: Drexel University School of Public Health, Philadelphia, PA, 19104, USA. mmc33@drexel.edu.
authors.forename: Mariana
authors.initials: M
authors.lastname: Chilton
mesh_terms: D000293:Adolescent; D002648:Child; D002657:Child Development; D000067576:Child Health / Q000592:standards / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D005523:Food Supply; D006801:Humans; D008297:Male; D008603:Mental Health / Q000592:standards / Q000706:statistics & numerical data; D010290:Parents / Q000523:psychology*; D011203:Poverty / Q000523:psychology; D036301:Qualitative Research; D012119:Respiration; D013315:Stress, Psychological / Q000150:complications*
keywords: Child development; Depression; Food insecurity; Toxic stress