ABSTRACT
BACKGROUND: Food insecurity (FI), defined as inadequate or insecure access to food, is a key determinant of child health. FI is associated with a number of adverse physical, psychological and developmental health outcomes and increased emergency department (ED) use. The COVID-19 pandemic has exacerbated financial hardship faced by many families with an unprecedented rise in use of charitable food programs. OBJECTIVE(S): We sought to determine the prevalence of FI among pediatric ED visits during the COVID-19 pandemic, compare this to pre-pandemic rates, and describe associated risk factors. DESIGN/METHODS: From September to December 2021, families presenting to a tertiary Canadian paediatric ED were asked to complete a survey screening for FI with a validated two-item questionnaire, along with socio-demographic and child health information. Results were compared to data collected in 2012. Multivariable logistic regression was used to measure associations with FI. RESULT(S): In 2021, 26% (n=173/665) of families identified as food insecure compared to 22.7% in 2012 (n=146/644), which was not statistically different (3.3%, 95% CI [-1.4%, 8.1%]). When the definition of FI is expanded to include use of charitable food assistance, the prevalence increased to 29.2%. In univariate analysis, FI was significantly associated with lack of primary care, caregivers born outside of Canada, status other than Canadian citizenship, having a child with a chronic medical condition, having financial strain related to medical expenses and reason for the ED visit being the child's chronic condition. In multivariable analysis, only having more children in the home (OR 1.19, 95% CI [1.01, 1.41]), financial strain from medical expenses (OR 5.31, 95% CI [3.45, 8.18]) and lack of primary care access (OR 1.27, 95% CI [1.08, 1.51]) remained independent predictors of FI. Approximately half (48.5%) of food insecure families reported use of food charity, most commonly food banks (31.7%), while one-quarter (26%) received help from family or friends. Food insecure families indicated their preferred means of support in hospital would be free/low cost meals and financial assistance with medical expenses. CONCLUSION(S): Greater than one in four families attending a Canadian tertiary pediatric ED screened positive for FI. FI was independently associated with lack of access to primary care, financial strain related to medical expenses, and greater number of children in the household. Further research is necessary to examine the effect of support interventions for families admitted to medical care facilities and financial support for chronic conditions.
ABSTRACT
Database, and Hospital Morbidity Database. The primary outcome was ambulatory care visits for a composite of suicidal ideation, intentional self-poisoning, and intentional self-harm. Results were stratified by age and sex and expressed as a rate (proportion of encounters with an outcome per 100 encounters). We compared the differences (delta) in slopes (average increase in outcomes) between April 1, 2015, to March 31, 2020, and April 1, 2020 to March 31, 2021 to determine if the expected rate (pre-pandemic) differed significantly from the observed rate (pandemic). RESULT(S): From April 1, 2020, to March 31, 2021, compared to April 1, 2015, to March 31, 2020, the rate of ambulatory care visits and admissions for all conditions decreased. The average quarterly rate of ambulatory care visits for the composite among males 10-14 years, increased by 40.3%, from 0.57 to 0.8 (slope delta=0.1;95% CI: 0.02, 0.18;p=0.012). Among females 10-14 years, the rate increased by 85.1%, from 1.81 to 3.35 (slope delta=0.7;95% CI: 0.43, 0.97;p<0.001). Among males 15-18 years, the rate increased by 29.5%, from 1.56 to 2.02 (slope delta=0.13;95% CI: -0.02, 0.28;p=0.078). Among females 15-18 years, the rate increased by 33.6%, from 3.18 to 4.25 (slope delta=0.26;95% CI: -0.16, 0.68;p=0.192). The average quarterly rate of admissions was significant for females 10-14 years and increased by 27.7%, from 8.59 to 10.97 (slope delta=1.99;95% CI: 0.57, 3.41;p=0.017). CONCLUSION(S): The proportion of ambulatory care visits and admissions for emotional symptoms, suicidal ideation, and self-harm during the first year of the COVID-19 pandemic increased compared to pre-pandemic rates among adolescents 10-14 years in Canada. Our findings underscore the importance of promoting public health policies that mitigate the impact of pandemics on adolescent mental health.