| Abstract: | Objectives. We recruited 248 farmworker families with preschool-aged children in North Carolina and examined food security indicators over 24 months to identify food security patterns and examine the dynamic of change over time.Methods. Participants in the Niños Sanos study, conducted 2011 to 2014, completed quarterly food security assessments. Based on responses to items in the US Household Food Security Survey Module, we identified different states of food security by using hidden Markov model analysis, and examined factors associated with different states. We delineated factors associated with changes in state by using mixed-effect ordinal logistic regression.Results. About half of the households (51%) consistently stayed in the most food-secure state. The least food-secure state was transient, with only 29% probability of this state for 2 consecutive quarters. Seasonal (vs migrant) work status, having immigration documents (vs not documented), and season predicted higher levels of food security.Conclusions. Heterogeneity in food security among farmworker households calls for tailoring intervention strategies. The transiency and unpredictability of low food security suggest that access to safety-net programs could reduce low food security risk in this population.Farmworkers in the United States experience challenging living conditions and economic insecurity because of low-paying and contingent employment. Although an exact number of farmworkers is not available, estimates place the population at 900 000, plus dependents.1 This includes migrant farmworkers, who establish temporary residences to do farm work, as well as seasonal workers who reside in one place and do farm work during the agricultural season.2 Currently, most farmworkers are Latino and foreign-born,3 which can limit their eligibility and access to food safety-net programs such as the Supplemental Nutrition Assistance Program. In addition, many reside in rural areas where access to healthy food retail stores may be limited by both availability and transportation, although home food production is sometimes possible.4 Together, these create a situation in which farmworker households are likely to experience low food security (resulting from insufficient household resources), but this may be episodic. Children in farmworker households may be particularly vulnerable to the effects of low food security.5Low food security is associated with negative developmental outcomes in infants and toddlers.6 Persistently low food security in early childhood is associated with long-term lower health status.7 For children at school age, this can adversely affect academic performance, weight gain, and social skills.8 With the large population of farmworkers in the United States, food security among their families is an important public health issue.Previous reports of food security for farmworker households have found 20% to 80% to be food insecure.9–14 However, all of these reports have been cross-sectional, and most have used an extended recall period, asking respondents to recall whether their household was food insecure at any time during the past year. Such data provide no information on the duration of food security states or on factors associated with transitions in and out of low food security. Examining food security over time as a dynamic construct is necessary to understand its duration and to develop protective measures for low food security.This repeated-measures study gathered data quarterly for 24 months, and examined different states of food security by using the 18-item US Household Food Security Survey Module.15 Instead of constructing a single score, we used the full item set to form a food security profile. The approach allowed us to delineate several different states of food security within the food security profile, and examine the dynamic of change in food security over the 24-month period. The aims of the study were to (1) describe multiple states of food security of farmworker households, (2) identify factors associated with the different food security states, and (3) delineate the dynamic of change in food security states across a period of 24 months. |
