The Relationship Between Housing Instability and Poor Diet Quality Among Urban Families

Clement J Bottino; Eric W Fleegler; Joanne E Cox; Erinn T Rhodes

doi:10.1016/j.acap.2019.04.004

The Relationship Between Housing Instability and Poor Diet Quality Among Urban Families

Acad Pediatr. 2019 Nov-Dec;19(8):891-898. doi: 10.1016/j.acap.2019.04.004. Epub 2019 Apr 13.

Authors

Clement J Bottino¹, Eric W Fleegler², Joanne E Cox³, Erinn T Rhodes⁴

Affiliations

¹ Divisions of General Pediatrics (CJ Bottino and JE Cox); Department of Pediatrics, Boston Children's Hospital; and Harvard Medical School (CJ Bottino, EW Fleegler, JE Cox, and ET Rhodes) Boston, Mass. Electronic address: clement.bottino@childrens.harvard.edu.
² Emergency Medicine (EW Fleegler); Department of Pediatrics, Boston Children's Hospital; and Harvard Medical School (CJ Bottino, EW Fleegler, JE Cox, and ET Rhodes) Boston, Mass.
³ Divisions of General Pediatrics (CJ Bottino and JE Cox); Department of Pediatrics, Boston Children's Hospital; and Harvard Medical School (CJ Bottino, EW Fleegler, JE Cox, and ET Rhodes) Boston, Mass.
⁴ Endocrinology (ER Rhodes); Department of Pediatrics, Boston Children's Hospital; and Harvard Medical School (CJ Bottino, EW Fleegler, JE Cox, and ET Rhodes) Boston, Mass.

PMID: 30986548
DOI: 10.1016/j.acap.2019.04.004

Abstract

Objective: To examine associations between housing instability and poor diet quality in a sample of urban parents and children.

Methods: Cross-sectional study of 340 parent/guardian-child dyads visiting a pediatric primary care center in Boston, Massachusetts. The parent/guardian (hereafter, parent) completed 2 Harvard Service Food Frequency Questionnaires, one regarding their own dietary intake and one regarding their child's intake, and an assessment of health-related social needs. Diet quality was measured using the Healthy Eating Index-2010 (HEI-2010; score range 0-100). Housing instability was defined as: 1) homeless or in sheltered housing, 2) doubled up with another family, 3) utilities threatened or shut off, or 4) concerned about eviction. Multivariable logistic regression was used to measure associations between unstable housing and lowest-quartile HEI-2010 scores, adjusting for parent age, race/ethnicity, education, income, and child age.

Results: Median (interquartile range) parent and child HEI-2010 scores were 63.8 (56.3-70.8) and 59.0 (54.2-64.7), respectively. Housing instability was found in 136 dyads (40%). In multivariable analysis, it was associated with increased odds of lowest-quartile total parent HEI-2010 scores (adjusted odds ratio [aOR], 1.9; 95% confidence interval [95% CI], 1.1-3.5) but not child scores (aOR, 1.4; 95% CI, 0.8-2.5). It also was associated with increased odds of lowest-quartile parent HEI-2010 dietary component scores for Total vegetables and Greens and beans (aOR, 2.0; 95% CI, 1.1-3.7 and aOR, 2.5; 95% CI, 1.3-4.8, respectively).

Conclusions: In this urban primary care population, housing instability is associated with lower diet quality scores for parents but not children. Lower vegetable consumption appears to drive this association.

Trial registration: ClinicalTrials.gov NCT01374815.

Keywords: children; diet; diet quality; healthy eating index; housing; housing instability; parents; pediatrics; primary care; urban.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Boston
Child
Child, Preschool
Cross-Sectional Studies
Dairy Products
Diet / statistics & numerical data*
Diet, Healthy
Dietary Fats
Dietary Proteins
Female
Fruit
Housing / statistics & numerical data*
Humans
Ill-Housed Persons / statistics & numerical data*
Logistic Models
Male
Parents*
Poverty
Primary Health Care
Sodium, Dietary
Urban Population
Vegetables
Whole Grains

Substances

Dietary Fats
Dietary Proteins
Sodium, Dietary

Associated data

ClinicalTrials.gov/NCT01374815