key: cord-0024996-35aot2kp authors: Paquin, Vincent; Muckle, Gina; Bolanis, Despina; Courtemanche, Yohann; Castellanos-Ryan, Natalie; Boivin, Michel; Tremblay, Richard; Côté, Sylvana; Geoffroy, Marie-Claude title: Longitudinal Trajectories of Food Insecurity in Childhood and Their Associations With Mental Health and Functioning in Adolescence date: 2021-12-20 journal: JAMA Netw Open DOI: 10.1001/jamanetworkopen.2021.40085 sha: 954df29429ff312c2e6dbae1099d78da15e05be0 doc_id: 24996 cord_uid: 35aot2kp IMPORTANCE: Household food insecurity has been associated with mental health problems in children independently of family income and other confounders. It is unclear whether food insecurity during childhood is also associated with mental health and functioning during adolescence. OBJECTIVE: To evaluate longitudinal trajectories of household food insecurity during the first 13 years of life, characteristics associated with these trajectories, and the associations of the trajectories with externalizing, internalizing, substance use, and social adjustment problems at 15 years of age. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included participants from the Québec Longitudinal Study of Child Development, a cohort of 2120 children born in Québec, Canada, in 1997 and 1998 and followed up annually or biannually from 5 months to 15 years of age (1998-2013). Data were analyzed from November 2020 to October 2021. EXPOSURES: When children were aged 1.5, 4, 8, 10, 12, and 13 years, mothers reported whether a family member experienced hunger because the family had run out of food or money to buy food in the past 12 months. MAIN OUTCOMES AND MEASURES: Group-based trajectory modeling was used to identify differential exposure to food insecurity from 1.5 to 13 years according to logit functions of age. At 15 years of age, adolescents completed validated questionnaires assessing externalizing, internalizing, substance use, and social adjustment problems. Associations between trajectories of food insecurity and outcomes were assessed using linear regressions. RESULTS: A total of 2032 individuals were included in the analyses of trajectories of food insecurity (1026 [50.5%] male) and 1441 in the analysis of the association with outcomes at 15 years of age (752 [52.2%] female). Two trajectories of food insecurity were identified between 1.5 and 13 years of age: high risk (73 children [3.6%]) and low risk (1959 children [96.4%]). At 5 months, the high-risk and low-risk groups differed in household characteristics including income insufficiency (58 [80.6%] vs 405 [21.0%]), single parenthood (21 [29.2%] vs 135 [6.9%]), and parental history of depression (mothers: 30 [43.5%] vs 411 [21.7%]; fathers: 12 [32.4%] vs 209 [13.5%]). The high-risk trajectory from 1.5 to 13 years of age was associated with cannabis use (β, 0.47; 95% CI, 0.12-0.81), peer bullying (β, 0.43; 95% CI, 0.08-0.77), and dropout potential (β, 0.38; 95% CI, 0.03-0.68) at 15 years of age after adjustment for sex, household income insufficiency, and parental mental health. CONCLUSIONS AND RELEVANCE: In this cohort study, few children experienced a persistent high risk of food insecurity, which was associated with psychosocial problems later in adolescence after adjustment for confounders including low income. Early identification of risk for food insecurity may guide the delivery of tailored interventions to improve functioning in adolescence. All scales were shown to have good to excellent internal reliability and good convergent and discriminant validity in the current sample. 1 Response options for all items below were: 1=never, 2=sometimes, and 3=often. 1. I was impulsive (reacted quickly without thinking). 2. I said things before thinking them through. 3 . I did or said things without stopping to think. 4. I had difficulty waiting for my turn in games or group activities. 5 . I often blurted out the answer to a question that hadn't yet been completely asked. 6 . I got into trouble because I did things without thinking. 7. I felt very restless, I was constantly on the move. 8 . I often stood up in class or in other situations where I was supposed to remain seated. 9 . I often had trouble staying calm during games or leisure activities. 10 The 5 confounding variables controlled for in our analyses (i.e., income sufficiency, maternal/paternal depression history, and maternal/paternal antisocial behaviors in adolescence) were selected a priori using a directed acyclic graph (DAG). DAGs are visual tools that illustrate assumptions of causal associations between variables. 2 Traditional methods of covariable selection may inadvertently introduce conditional associations between exposure and outcome, creating bias instead of reducing it. Established analytical rules for DAGs allow the analyst to identify a set of control variables that will minimize bias, based on the directionality of associations between exposure, covariables, and outcome. 2 A DAG shows confounding ("backdoor") pathways which are non-causal paths between an exposure and an outcome. Using a validated algorithm, 2,3 the DAG allows us to identify the minimal set(s) of confounders that need to be controlled to block all backdoor pathways. Multiple potential confounders may lie along a single backdoor pathway, but controlling one is sufficient to block the overall pathway along which they lieassuming there is no other pathway connecting these confounders to the exposure and outcome. See Suttorp et al. 4 for further explanations and an example. Potential confounding factors were identified from the literature 5-10 for their documented associations with food insecurity and/or adolescent mental health. We built the DAG using the "ggdag" package in R, 3 which applies the aforementioned analytical rules to identify the minimal set of confounding factors to adjust for. Below are the causal assumptions that were entered in the graph (see eFigures 1-2 for the DAG and its set of control variables). Each bullet point below addresses one downstream variable (on the left-hand side of the tilde [~], in bold) and describes all the upstream variables (on the right-hand side of the tilde) that are assumed to be directly (causally) associated with it. These direct causal associations are assembled in the DAG to visually represent both direct and indirect pathways of causations between all variables. . Food insecurity trajectory: dichotomized as high risk vs. low risk for food insecurity (between age 1.5 and 13 years). Variables from "Sex" to "Maternal/Parental.Antisocial" (i.e., antisocial behaviors in adolescence) were measured at age 5 months, except "Maternal/Paternal Depression" (i.e., history of depression, measured at 2 9 months). Variables from "ADHD" (i.e., attention deficit and hyperactivity) to "Bullying" were measured at age 15 years. Corr: Pearson correlations among pairwise complete observations. 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