Original Article

Rate of Food Insecurity Among Households with Children with Sickle Cell Disease is Above the National Average

Authors: Djamila Labib Ghafuri, MD, MPH, Mark Rodeghier, PhD, Michael Rutledge DeBaun, MD, MPH


Objectives: Despite studies demonstrating the negative impact of food insecurity on health in children, limited research has been done to assess the prevalence and sequelae of food insecurity in sickle cell disease (SCD). We tested the hypothesis that food insecurity is common in children with SCD and is associated with increased SCD morbidity.

Methods: Between May and November 2017, we conducted a single-center cross-sectional study using the previously validated, self-administered, US 18-item household food security survey module and the 9-item youth (12–17 years old) food security survey module during regular outpatient clinic visits. We also included the incidence of vaso-occlusive pain or acute chest syndrome requiring hospitalizations in the year before the questionnaire.

Results: A total of 75 caregivers and 24 children completed the surveys. The median age of the children was 10.4 years (interquartile range 5.5–15.3), 46.7% were boys. The rate of household food insecurity was 21.3% (16 of 75). Among the 24 children who completed the youth survey, 45.8% were classified as food insecure. Discordance occurred between caregivers’ and children’s assessment of food insecurity. A total of 81.8% (9 of 11) children reported being food insecure, whereas their caregivers reported to be food secure. The incidence for pain and acute chest syndrome in the year pre-enrollment was not different between food-secure and food-insecure children (59.3 and 43.8/100 patient-years, P = 0.54; 8.5 and 12.5/100 patient-years, P = 0.49, respectively).

Conclusions: In a tertiary care medical center in Tennessee, one in five households with children with SCD were assessed as food insecure, with a substantial discordance between caregiver and child assessment of food insecurity.
Posted in: Hematology10

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Hassell KL. Population estimates of sickle cell disease in the U. S. Am J Prev Med 2010;38(4 suppl):S512-S521.
2. Kauf TL, Coates TD, Huazhi L, et al. The cost of health care for children and adults with sickle cell disease. Am J Hematol 2009;84:323-327.
3. Coleman-Jensen A, Rabbitt MP, Gregory CA, et al. Household Food Security in the United States in 2017. https://www.ers.usda.gov/publications/pub-details/?pubid=90022. Published September 2018. Accessed February 5, 2020.
4. Cook JT, Frank DA. Food security, poverty, and human development in the United States. Ann NY Acad Sci 2008;1136:193-209.
5. Burke MP, Martini LH, Cayir E, et al. Severity of household food insecurity is positively associated with mental disorders among children and adolescents in the United States. J Nutr 2016;146:2019-2026.
6. Canales MK, Coffey N, Moore E. Exploring health implications of disparities associated with food insecurity among low-income populations. Nurs Clin North Am 2015;50:465-481.
7. Poole-Di Salvo E, Silver EJ, Stein RE. Household food insecurity and mental health problems among adolescents: what do parents report? Acad Pediatr 2016;16:90-96.
8. Belsky DW, Moffitt TE, Arseneault L, et al. Context and sequelae of food insecurity in children' development. Am J Epidemiol 2010;172:809-818.
9. Ryu JH, Bartfeld JS. Household food insecurity during childhood and subsequent health status: the early childhood longitudinal study-kindergarten cohort. Am J Public Health 2012;102:e50-e55.
10. Cook JT, Frank DA, Berkowitz C, et al. Food insecurity is associated with adverse health outcomes among human infants and toddlers. J Nutr 2004;134:1432-1438.
11. Banach LP. Hospitalization: are we missing an opportunity to identify food insecurity in children? Acad Pediatr 2016;16:438-445.
12. Ettinger de Cuba S, Casey PH, Cutts D, et al. Household food insecurity positively associated with increased hospital charges for infants. J Appl Res Child 2018;9:8.
13. US Census Bureau. Annual estimates of the resident population: April 1, 2010 to July 1, 2017. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed February 5, 2020.
14. Wilson NO, Ceesay FK, Hibbert JM, et al. Pregnancy outcomes among patients with sickle cell disease at Korle-Bu Teaching Hospital, Accra, Ghana: retrospective cohort study. Am J Trop Med Hyg 2012;86:936-942.
15. Thame MM, Osmond C, Serjeant GR. Fetal growth in women with homozygous sickle cell disease: an observational study. Eur Obstet Gynecol Reprod Biol 2013;170:62-66.
16. Carlson SJ, Andrews MS, Bickel GW. Measuring food insecurity and hunger in the United States: development of a national benchmark measure and prevalence estimates. J Nutr 1999;129(2 suppl):510S-516S.
17. US Department of Agriculture. U.S. Household Food Security Survey Module: Three-Stage Design, with Screeners. ers.usda.gov/media/8271/hh2012.pdf. Published September 2012. Accessed February 5, 2020.
18. Connell CL, Nord M, Lofton KL, et al. Food security of older children can be assessed using a standardized survey instrument. J Nutr 2004;134:2566-2572.
19. US Department of Agriculture, Economic Research Service. Definitions of food security. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security. Accessed February 5, 2020.
20. Nord M, Bickel G. Estimating the prevalence of children' hunger from the current population survey food security supplement. Second Food Security Measurement and Research Conference, Volume II: Papers. https://www.ers.usda.gov/webdocs/publications/46448/31750_fanrr11-2_002.pdf?v=0. Accessed February 5, 2020.
21. Bickel G, Nord M, Price C, et al. Measuring food security in the United States: guide to measuring household food security. https://fns-prod.azureedge.net/sites/default/files/FSGuide.pdf. Accessed February 5, 2020.
22. Nord M BG. Measuring food security in the United States: measuring children' food security in U.S. households, 1995-99. https://www.ers.usda.gov/webdocs/publications/46613/31436_fanrr25b_002.pdf?v=0. Accessed February 5, 2020.
23. US Department of Agriculture. Survey Tools. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools.aspx. Accessed March 3, 2020.
24. DeBaun MR, Gordon M, McKinstry RC, et al. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. The New England journal of medicine 2014;371:699-710.
25. Wolf RB, Saville BR, Roberts DO, et al. Factors associated with growth and blood pressure patterns in children with sickle cell anemia: Silent Cerebral Infarct Multi-Center Clinical Trial cohort. Am J Hematol 2015;90:2-7.
26. Glassberg JA, Wang J, Cohen R, et al. Risk factors for increased ED utilization in a multinational cohort of children with sickle cell disease. Acad Emerg Med 2012;19:664-72.
27. Bureau USC. 2017. https://www.census.gov/quickfacts/fact/table/US/SEX255218. Accessed March 3, 2020.
28. Palermo TM, Riley CA, Mitchell BA. Daily functioning and quality of life in children with sickle cell disease pain: relationship with family and neighborhood socioeconomic distress. J Pain 2008;9:833-840.
29. Santos IND, Damião JJ, Fonseca MJMD, et al. Food insecurity and social support in families of children with sickle-cell disease. J Pediatr (Rio J) 2019;95:306-313.
30. Adegoke SA, Braga JAP, D Adekile A, et al. Impact of hydroxyurea on anthropometry and serum 25-hydroxyvitamin D among children with sickle cell disease. J Pediatr Hematol Oncol 2018;40:e243-e247.
31. Hackney AC, Hezier W, Gulledge TP, et al. Effects of hydroxyurea administration on the body weight, body composition and exercise performance of patients with sickle-cell anaemia. Clin Sci (Lond) 1997;92:481-486.
32. Hankins JS, Aygun B, Nottage K, et al. From infancy to adolescence: fifteen years of continuous treatment with hydroxyurea in sickle cell anemia. Medicine (Baltimore) 2014;93:e215.
33. Frongillo EA, Nguyen HT, Smith MD, Coleman-Jensen A. Food insecurity is associated with subjective well-being among individuals from 138 countries in the 2014 Gallup World Poll. J Nutr 2017;147:680-687.