شاخص مختصری از امنیت انرژی خانگی: رابطه آن با امنیت غذا، سلامت و رشد کودک در میان نوزادان و کودکان ایالات متحده آمریکا A Brief Indicator of Household Energy Security: Associations With Food Security, Child Health, and Child Development in US Infants and Toddlers

The concept of HES, although recognized implicitly in the past, has not been extensively developed empirically or previously analyzed in relation to children’s health and development. In this study, we introduced, defined, and measured HES and empirically examined hypotheses regarding its associations with household and child food security, child health, and reported developmental issues. Household FI has been shown to be positively associated with adverse health outcomes in infants and toddlers28–۳۰,۳۳ and with negative outcomes on health, social functioning, problem behaviors, academic achievement, and school performance in children in other age ranges.34–۳۹ The results reported here indicate that energy insecurity is positively and strongly associated with both household and child FI, even after controlling for a number of covariates that are associated with both energy security and food security. Moreover, statistically significant increments in the odds that children who were younger than 3 years experienced either household or child FI when comparing associations of moderate versus severe energy insecurity with food security in these data are noteworthy. These results indicate that HES is ordinally associated with household and child FI in these data and suggest that additional research to examine this relationship by using data from other contexts would be useful. We examined the possibility that associations found in this study between HES and child health and development outcomes might be mediated by food security and that the effects of HES on those outcomes might be modified by food security. Results indicate that neither the direction nor the magnitude of associations between HES and study outcomes changed; neither was statistical significance of these associations affected. These tests confirm that although household and child food security are associated with HES, neither acts as a mediator or an effect modifier in the associations of HES with child health and developmental risk in these analyses; however these results do not necessarily indicate that the effects of energy insecurity on the child health outcomes are completely independent from those of FI or other correlates of poverty. Although results of this study indicate that energy security/insecurity seems to be a clinically meaningful construct and that the HES scale seems to be ordinal across the categories of household and child food security, it does not seem to be ordinal with respect to the other outcomes examined in these data. The odds of children in moderately energy-insecure households having their health status reported as “fair/poor” versus “excellent/good” are essentially the same as those for children in severely energy-insecure households. This finding suggests a low “threshold effect” of energy insecurity on parents’ reports of child health status that, once passed, does not increase significantly at more severe levels of energy insecurity. Conversely, parental concerns about their children’s development seem to appear only at more severe levels of energy insecurity, suggesting a higher threshold for this effect. Interpretation of the association of HES with lifetime hospitalization is more complex. In that case, the absence of significant association between severe energy insecurity and the odds of having been hospitalized since birth appears together with significantly greater odds of having been hospitalized for children in moderately energy-insecure households. One possible explanation for this is that fewer children in the most severely energyinsecure households are taken to clinics or EDs for care, and, thus, fewer experience hospitalizations. In addition, because HES was measured for the 12 months before the interview only, whereas hospitalizations were reported for the child’s entire lifetime (
۳۶ months), the 2 measures are not fully congruent in the time periods covered. These relationships could also be clarified by additional research.