Black Maureen M, Quigg Anna M, Cook John, Casey Patrick H, Cutts Diana Becker, Chilton Mariana, Meyers Alan, Ettinger de Cuba Stephanie, Heeren Timothy, Coleman Sharon, Rose-Jacobs Ruth, Frank Deborah A
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Arch Pediatr Adolesc Med. 2012 May;166(5):444-51. doi: 10.1001/archpediatrics.2012.1.
To examine how family stressors (household food insecurity and/or caregiver depressive symptoms) relate to child health and whether participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) attenuates stress-related child health risks.
Cross-sectional family stress and cumulative stress models from January 1, 2000, through December 31, 2010.
Families recruited from emergency departments and/or primary care in Baltimore, Boston, Little Rock, Los Angeles, Minneapolis, Philadelphia, and Washington, DC.
Participants included 26,950 WIC-eligible caregivers and children younger than 36 months; 55.2% were black, 29.9% were Hispanic, and 13.0% were white. Caregivers' mean age was 25.6 years; 68.6% were US-born, 64.7% had completed high school, 38.0% were married, and 36.5% were employed.
Of the participants, 24.0% had household food insecurity and 24.4% had depressive symptoms; 9.1% had both stressors, 29.9% had 1 stressor, and 61.0% had neither; 89.7% were WIC participants.
Caregivers reported child health, lifetime hospitalizations, and developmental risk. Weight and length were measured. We calculated weight-for-age and length-for-age z scores and the risk of underweight or overweight. The well-child composite comprised good/excellent health, no hospitalizations, no developmental risk, and neither underweight nor overweight.
In multivariate analyses adjusted for covariates, as stressors increased, odds of fair/poor health, hospitalizations, and developmental risk increased and odds of well-child status decreased. Interactions between WIC participation and stressors favored WIC participants over nonparticipants in dual stressor families on 3 child health indicators: (1) fair/poor health: WIC participants, adjusted odds ratio (aOR), 1.89 (95% CI, 1.66-2.14) vs nonparticipants, 2.35 (2.16-4.02); (2) well-child status: WIC participants, 0.73 (0.62-0.84) vs nonparticipants, 0.34 (0.21-0.54); and (3) overweight: WIC participants, 1.01 (0.88-1.16) vs nonparticipants, 1.48 (1.04-2.11) (P = .06).
As stressors increased, child health risks increased. WIC participation attenuates but does not eliminate child health risks.
研究家庭压力源（家庭粮食不安全和/或照顾者抑郁症状）与儿童健康的关系，以及参与妇女、婴儿和儿童特别补充营养计划（WIC）是否能减轻与压力相关的儿童健康风险。
2000年1月1日至2010年12月31日的横断面家庭压力和累积压力模型。
从巴尔的摩、波士顿、小石城、洛杉矶、明尼阿波利斯、费城和华盛顿特区的急诊科和/或初级保健机构招募的家庭。
参与者包括26950名符合WIC资格的照顾者和36个月以下的儿童；55.2%为黑人，29.9%为西班牙裔，13.0%为白人。照顾者的平均年龄为25.6岁；68.6%在美国出生，64.7%完成了高中学业，38.0%已婚，36.5%就业。
在参与者中，24.0%存在家庭粮食不安全，24.4%有抑郁症状；9.1%同时存在两种压力源，29.9%有一种压力源，61.0%两者都没有；89.7%是WIC参与者。
照顾者报告儿童健康状况、终身住院次数和发育风险。测量体重和身长。我们计算了年龄别体重和年龄别身长z评分以及体重过轻或超重的风险。健康儿童综合指标包括健康状况良好/优秀、无住院、无发育风险且体重既不过轻也不过重。
在对协变量进行调整的多变量分析中，随着压力源增加，健康状况一般/较差、住院和发育风险的几率增加，健康儿童状态的几率降低。在双压力源家庭中，WIC参与与压力源之间的相互作用在3项儿童健康指标上对WIC参与者比对非参与者更有利：（1）健康状况一般/较差：WIC参与者，调整后的优势比（aOR）为1.89（95%CI，1.66 - 2.14），而非参与者为2.35（2.16 - 4.02）；（2）健康儿童状态：WIC参与者为0.73（0.62 - 0.84），非参与者为0.34（0.21 - 0.54）；（3）超重：WIC参与者为1.01（0.88 - 1.16），非参与者为1.48（1.04 - 2.11）（P = 0.06）。
随着压力源增加，儿童健康风险增加。参与WIC可减轻但不能消除儿童健康风险。
