2020
Social Science & Medicine (August 2020)
Jerome Dugana, Layla Booshehri, Pam Phojanakong, Falguni Patel, Emily Brown, Sandra Bloom, Mariana Chilton
Integrating trauma-informed peer support curriculum into the Temporary Assistance for Needy Families (TANF) program can help address caregiver trauma symptoms caused by exposures to violence and adversity that negatively impact one’s ability to maintain employment and improve earnings; yet, it is unclear if trauma-informed peer support interventions designed for TANF impact co-occurring disorders, such as depression and substance abuse, that inhibit resiliency in the labor market. The aim of this study is to examine whether integrating trauma-informed peer support curriculum into the TANF program is associated with reductions in co-occurring depression and substance abuse, and improvements in self-efficacy and economic security. These findings suggest that trauma-informed peer support programming improves economic security and self-efficacy and reduces the co-occurrence of depressive symptoms and alcohol abuse.
PLOS One (May 2020)
Emily Brown Weida, Pam Phojanakong, Falguni Patel, Mariana Chilton
F
Journal of Nutrition Education and Behavior (May 2020)
Pam Phojanakong, Seth Welles, Jerome Dugan, Layla Booshehri, Emily Brown Weida, Mariana Chilton
Food insecurity, or the lack of access to enough food for an active and healthy life because of limited economic resources, is a major public health challenge associated with negative health outcomes such as higher rates of hospitalization and developmental risk among infants, children, and adolescents, as well as higher rates of depression and chronic disease among adults. This study sought to test the effectiveness of a trauma-informed intervention to reduce household food insecurity, called the Building Wealth and Health Network (the Network). The Network was designed to improve health and economic security among parents of children under the age of 6 years, participating in public assistance programs.
American Journal of Public Health (March 2020)
Mariana Chilton, Sonya Jones
Public health is faced with a choice at this critical moment. Do we continue with business as usual, addressing the diseases of modernity, such as heart disease, without questioning the values underlying modernity? Or do we do what we in public health are best suited to do: transform the paradigm of health to be more inclusive and better encompass our current challenges?
2019
American Journal of Public Health (December 2019)
Tianna Gaines-Turner, Joanna Cruz Simmons, Mariana Chilton
SNAP is ensnared in much larger problems in US society related to the stigmatization of people who are poor and a lack of appreciation for the value and skills of their work. We encourage the public health community to think beyond SNAP, focus more assertively on wages and work supports, and replace our means-tested safety net with a new system of universal income that promotes equity, inclusion, and health for all. Although we offer recommendations to improve SNAP, the goal of most SNAP recipients has always been to move beyond the need for this program. The public health community can take the lead in finding more egalitarian, dignified, and effective ways to address poverty and food insecurity.
International Journal of Environmental Research and Public Health (November 2019)
Pam Phojanokang, Emily Brown Weida, Gabriella Grimaldi, Fêlice Lê-Scherban, Mariana Chilton
This study examines the associations of mothers' experiences of discrimination with household food insecurity, physical health, and depressive symptoms, while taking into account the influence of mothers' Adverse Childhood Experiences (ACEs) and public assistance participation. Mothers of young children under age 4 who self-identified as Latinx, Non-Latinx Black/African American and Non-Latinx white answered questions for a cross-sectional survey in an emergency room in a large children's hospital in Philadelphia between 2016 and 2018. Compared to those without experiences of discrimination, mothers with experiences of discrimination from police/courts and in workplaces had higher odds of household food insecurity.
American Journal of Preventive Medicine (November 2019)
Dylan Jackson, Mariana Chilton, Kecia Johnson, Michael Vaughn
Research has linked adverse childhood experiences to a host of negative health outcomes. The present study examines the link between individual and cumulative adverse childhood experience exposure and household food insecurity in a recent, nationally representative sample of children, and whether parent self-rated well-being attenuates these associations.
American Journal of Preventive Medicine (October 2019)
Stephanie Ettinger de Cuba, Allison Bovell-Ammon, John Cook, Sharon Coleman, Maureen Black, Mariana Chilton, Patrick Casey, Diana Cutts, Timothy Herren, Megan Sandel, Richard Sheward, Deborah Frank
The Supplemental Nutrition Assistance Program is the largest nutrition assistance program in the U.S. This study's objective was to examine the associations between SNAP participation and young children's health and development, caregiver health, and family economic hardships.
Pediatrics (September 2019)
Chloe Drennen, Sharon Coleman, Stephanie Ettinger de Cuba, Deborah Frank, Mariana Chilton, John Cook, Diana Cutts, Timothy Heeren, Patrick Casey, Maureen Black
Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children less than 4 years of age. Among these children, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.
Academic Pediatrics (September 2019)
Margot Tang, Stephanie Ettinger de Cuba, Sharon Coleman, Timothy Heeran, Megan Sandel, Mariana Chilton, Deborah Frank, Susanna Huh
Among US-born children of Latina US and Latina foreign-born mothers, to determine whether 1) household and child characteristics differ; 2) child health outcomes differ; 3) these differences diminish for children of foreign-born mothers with longer duration of residence in the US; and 4) these differences can be explained by food insecurity or by Supplemental Nutrition Assistance Program participation.
Psychiatric Services (July 2019)
Jonathan Purtie, Fêlice Lê-Scherban, Xi Wang, Emily Brown, Mariana Chilton
Adverse childhood experiences (ACEs) increase risk of adult behavioral health conditions. State legislators are an important audience to target with evidence about ACEs because they make policy decisions that can prevent ACE exposure and enhance resilience. This study sought to describe state legislators' opinions about ACEs as risk factors for adult behavioral health conditions and identify how opinions vary between legislators with different characteristics.
Pediatrics (July 2019)
Ruth Rose-Jacobs, Stephanie Ettinger de Cuba, Allison Bovell-Ammon, Maureen M. Black, Sharon M. Coleman, Diana Cutts, Mariana Chilton, Timothy Heeren, Patrick Casey, Eduardo Ochoa, Deborah Frank, Megan Sandel
Children with special health care needs (SHCNs) have significant medical and educational expenses affecting household finances. Housing instability can be detrimental to family well-being. Our objective was to evaluate housing instability in households of children with and without SHCNs.
Health Affairs (May 2019)
Stephanie Ettinger de Cuba, Mariana Chilton, Allison Bovell-Ammon, Moly Knowles, Sharon M. Coleman, Maureen Black, John Cook, Diana Becker Cutts, Patrick Casey, Timothy Heeren, Deborah Frank
The Supplemental Nutrition Assistance Program (SNAP) helps working families meet their nutritional needs. Families whose earned income increases in a given month may have their SNAP benefits abruptly reduced or cut off in the following month. Using sentinel sample data from 2007-15 for families with children younger than age four, we investigated how SNAP benefit reductions or cutoffs resulting from increased income were related to economic hardships (food and energy insecurity, unstable housing, forgone health and/or dental care, and health cost sacrifices) and to caregiver and child health.
International Journal of Environmental Research and Public Health February 2019)
Danielle Gallegos, Mariana Chilton
Drawing on examples from Australia and the United States, we outline the benefits of sharing expertise to identify new approaches to food and nutrition security. While there are many challenges to sharing expertise such as discrimination, academic expectations, siloed thinking, and cultural differences, we identify principles and values that can help food insecurity researchers to improve solutions.
2018
Pediatrics (September 2018)
Megan Sandel, Richard Sheward, Stephanie Ettinger de Cuba, Sharon Coleman, Timothy Heeren, Maureen Black, Patrick Casey, Mariana Chilton, John Cook, Diana Becker Cutts, Ruth Rose-Jacobs, Deborah Frank
After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.
Journal of Health Care for the Poor and Undeserved (February 2018)
Molly Knowles, Saba Khan, Deepak Palakshappa, Rachel Cahill, Evelyne Kruger, Bridget Poserina, Brittany Koch, Mariana Chilton
This study evaluated a food insecurity screening and referral program collaboration between Children's Hospital of Philadelphia (CHOP) and Benefits Data Trust (BDT). Of 7,284 families with children under five screened for food insecurity, over one thousand reported food insecurity and 630 were referred to a benefits access organization for connection to public benefits and community resources. This study used screening and referral data from CHOP and BDT along with key informant interviews and focus groups with 19 caregivers and 11 clinic staff to evaluate the initiative's effectiveness. Results demonstrate importance of integrated screening and referral consent processes, strong communication, and convenient outreach for families.
Journal of Child and Family Studies (January 2018)
Layla G. Booshehri, Jerome Dugan, Falguni Patel, Sandra Bloom, Mariana Chilton
Temporary Assistance for Needy Families (TANF) has limited success in building self-sufficiency, and rarely addresses exposure to trauma as a barrier to employment. The Building Wealth and Health Network's randomized controlled trial tested the effectiveness of financial empowerment combined with trauma-informed peer support against standard TANF programming. Despite high exposure to trauma and adversity, caregivers in the full intervention (financial empowerment and trauma-informed peer support) reported improved self-efficacy and depressive symptoms, and reduced economic hardship compared to the control and partial intervention groups. We conclude that financial empowerment education with trauma-informed peer support is more effective than standard TANF programming at improving behavioral health, reducing hardship, and increasing income. Policymakers may consider adapting TANF to include trauma-informed programming.
Pediatrics (January 2018)
Megan Sandel, Richard Sheward, Stephanie Ettinger de Cuba, Sharon Coleman, Deborah Frank, Mariana Chilton, Maureen Black, Timothy Heeren, Justin Pasquariello, Patrick Casey, Eduardo Ochoa, Diana Cutts
Caregivers of children 0 to 48 months of age were interviewed in five urban medical centers from May 2009 to December 2015. Caregivers reported on the following: caregiver health, maternal depressive symptoms, child's health, lifetime hospitalizations, developmental risk, and three housing circumstances, which were categorized as being behind on rent in the past 12 months, multiple moves, and child's lifetime history of homelessness. Of 22,324 families, 34% had at least one of the following adverse housing circumstances: 27% had been behind on rent, 8% had made multiple moves, and 12% had a history of being homeless. We concluded that three forms of housing instability were associated with adverse caregiver and child health among low-income renter households. The American Academy of Pediatrics recommends social screening within health care; providers could consider assessing for behind on rent, multiple moves, and homelessness in high-risk practices.
2016
BioMed Central Public Health (July 2016)
Jing Sun, Falguni Patel, Rachel Kirzner, Nijah Newton-Famous, Constance Owens, Seth L. Welles, Mariana Chilton
Families with children under age six participating in the Temporary Assistance for Needy Families Program (TANF) must participate in work-related activities for 20 hours per week. However, due to financial hardship, poor health, and exposure to violence and adversity, families may experience great difficulty in reaching self sufficiency. The purpose of this report is to describe study design and baseline findings of a trauma-informed financial empowerment and peer support intervention meant to mitigate these hardships.
American Journal of Preventive Medicine (May 2016)
Jing Sun, Molly Knowles, Falguni Patel, Deborah Frank, Timothy Heeren, Mariana Chilton
Exposure to childhood adversity, including abuse, neglect, and household dysfunction, is associated with negative long-term health and economic outcomes. This study used cross-sectional data from 1,255 female caregivers of children under 4 years surveyed in an urban clinical setting to investigate the association between caregivers' adverse childhood experiences (ACEs) and household and child food insecurity, taking into account depressive symptoms. Depressive symptoms and ACEs were independently associated with household and child food insecurity, and depressive symptoms modified the association between ACEs and household and child food insecurity. Comprehensive policy interventions incorporating nutrition assistance and behavioral health may address intergenerational transmission of disadvantage.
Journal of Hunger & Environmental Nutrition (May 2016)
Mariana Chilton, Molly Knowles, Sandra Bloom
Household food insecurity is linked with exposure to violence and adversity throughout the life course, suggesting its transfer across generations. Using grounded theory, we analyzed semistructured interviews with 31 mothers reporting household food insecurity where participants described major life events and social relationships. Through the lens of multigenerational interactions, 4 themes emerged: (1) hunger and violence across the generations, (2) disclosure to family and friends, (3) depression and problems with emotional management, and (4) breaking out of intergenerational patterns. After describing these themes and how they relate to reports of food insecurity, we identify opportunities for social services and policy intervention.
Journal of Developmental & Behavioral Pediatrics (February 2016)
Ruth Rose-Jacobs, Jennifer Goodhart Fiore, Stephanie Ettinger de Cuba, Maureen Black, Diana Cutts, Sharon Coleman, Timothy Heeren, Mariana Chilton, Patrick Casey, John Cook, Deborah Frank
T
2015
Human Organization (August 2015)
Molly Knowles, Jenny Rabinowich, Tianna Gaines-Turner, Mariana Chilton
Food insecurity is an under-recognized public health crisis in the United States affecting 19.5 percent of households with children and 35.4 percent of female-headed households with children. In 2013, approximately 15.8 million children (21.4%) lived in households that reported food insecurity, and 8.5 million children (23.7%) under age six lived in food insecure households. Lack of public attention and recent decisions by policymakers to cut nutrition assistance programs call into question current efforts to raise awareness and communicate about hunger and its public health impacts. As one contribution, we describe the methods of Witnesses to Hunger, a photovoice and participatory action research model of collaboration with low-income caregivers of young children who participate in nutrition assistance programs and offer solutions to public health professionals, policymakers, and journalists.
Maternal and Child Health Journal (July 2015)
Molly Knowles, Jenny Rabinowich, Stephanie Ettinger de Cuba, Diana Becker Cutts, Mariana Chilton
This study among 51 parents of young children under age four investigated how parents that report marginal, low and very low food security characterize how trade-offs associated with food insecurity affect parents' mental health and child well-being. We carried out 51 semi-structured audio-recorded interviews after participants responded to a survey regarding food security status and maternal depressive symptoms. Among participants reporting both food insecurity and depressive symptoms, we identified three primary areas of concern: trade-offs, mental health, and child well-being. Parents described how trade-offs associated with food insecurity have a profound relationship with their mental health and home environment that strongly affects young children. Partnerships between healthcare providers, policymakers, and parents are essential to successfully address and prevent the poor child health outcomes of toxic stress associated with food insecurity and poverty.
Housing Policy Debate (April 2015)
Kathryn Bailey, John Cook, Stephanie Ettinger de Cuba, Patrick Casey, Mariana Chilton, Sharon Coleman, Diana Becker Cutts, Timothy Heeren, Ruth Rose-Jacobs, Maureen Black, Deborah Frank
H
Journal of Applied Research on Children (February 2015)
Megan Sandel, Diana Cutts, Alan Meyers, Stephanie Ettinger de Cuba, Sharon Coleman
The results of this study inform and support current efforts by states to streamline online applications for social services and remove statutory legal barriers to accessing these subsidies simultaneously.
Preventing Chronic Disease (February 2015)
Amy Hillier, Mariana Chilton, Quian-Wei Zhao, Dorota Szymkowiak, Ryan Coffman, Giridhar Mallya
Tobacco advertising is widespread in urban areas with racial/ethnic minority and low-income households that participate in nutrition assistance programs. Tobacco sales and advertising are linked to smoking behavior, which may complicate matters for low-income families struggling with disparate health risks relating to nutrition and chronic disease. We investigated the relationship between the amount and type of tobacco advertisements on tobacco outlets and the outlet type and location. Policy makers may be able to mitigate the effects of this disparate exposure through tobacco retail licensing, local sign control rules, and SNAP and WIC authorization.
Public Health Nutrition (January 2015)
Mariana Chilton, Molly Knowles, Jenny Rabinowich, Kimberly Arnold
Adverse childhood experiences, including abuse, neglect and house-hold instability, affect lifelong health and economic potential. The study investigates how adverse childhood experiences are associated with food insecurity by exploring caregivers' perceptions of the impact of their childhood adversity on educational attainment, employment and mental health. Thirty-one mothers of children under the age of four who reporter low or very low household food security were interviewed. Participants described the impact of childhood adverse experiences with emotional and physical abuse/neglect, and household substance abuse, on their emotional health, school performance and ability to maintain employment. In turn, these experiences negatively affected their ability to protect their children from food insecurity.
2013
Journal of Applied Research on Children (December 2013)
Allison Bovell, Stephanie Ettinger de Cuba, Patrick Casey, Sharon Coleman, John Cook
Across the study period, households with SNAP were 17% less likely to experience household food insecurity. Receipt of SNAP vs. no SNAP was associated with decreased prevalence of household food insecurity and child food insecurity during much of the economic downturn; this impact waned as the buying power of the boost in benefit amounts during the American Recovery Reinvestment Act period eroded.
Pediatrics (May 2013)
Alan Meyers, Katherine Joyce, Sharon Coleman, John Cook, Diana Cutts, Stephanie Ettinger de Cuba, Timothy Heeren, Ruth Rose-Jacobs, Maureen Black, Patrick Casey, Mariana Chilton, Megan Sandel, Deborah Frank
To ascertain measures of health status among 6- to 24-month-old children classified as below normal weight-for-age by the Centers for Disease Control and Prevention 2000 growth reference but as normal weight-for-age by the World Health Organization 2006 standard.
2012
Public Health Nutrition (March 2012)
Mariana Chilton, Jenny Rabinowich, Nicholas Woolf
F
Journal of Applied Research on Children (February 2012)
Mariana Chilton, Jenny Rabinowich
The causes and contexts of food insecurity among children in the U.S. are poorly understood because the prevalence of food insecurity at the child level is low compared to the prevalence of household food insecurity. In addition, caregivers may be reluctant to admit their children may not be getting enough food due to shame or fear they might lose custody of their children. Based on our ongoing qualitative research with mothers of young children, we suggest that food security among children is related to adverse childhood experiences of caregivers. This translates into poor mental and physical health in adolescence and adulthood, which can lead to inability to secure and maintain meaningful employment that pays a living wage.
Journal of Applied Research on Children (February 2012)
Katherine Joyce, Amanda Breen, Stephanie Ettinger de Cuba, John Cook, Kathleen Barrett, Grace Paik, Natasha Rishi, Bianca Pullen, Ashley Schiffmiller, Deborah Frank
This paper explores Children's HealthWatch's research methods, selected findings, and examples of diverse approaches to dissemination of these findings in professional settings, national and local reports and briefs, and legislative testimony.
2011
American Journal of Public Health (August 2011)
Diana Becker Cutts, Alan Meyers, Maureen Black, Patrick Casey, Mariana Chilton, John Cook, Joni Geppert, Stephanie Ettinger de Cuba, Timothy Heeren, Sharon Coleman, Ruth Rose-Jacobs, Deborah Frank
Between 1998 and 2007, we interviewed 22069 low-income caregivers with children younger than 3 years who were seen in 7 US urban medical centers. We assessed food insecurity, child health status, developmental risk, weight, and housing insecurity for each child's household. Our indicators for housing insecurity were crowding and multiple moves. After adjusting for covariates, crowding was associated with household and child food insecurity compared with the securely housed, as were multiple moves. Multiple moves were associated with fair or poor child health, developmental risk, and lower weight-for-age. Housing insecurity is associated with poor health, lower weight, and developmental risk among young children. Policies that decrease housing insecurity can promote the health of young children and should be a priority.
2010
Pediatrics (July 2010)
Erin Hager, Anna Quigg, Maureen Black, Sharon Coleman, Timothy Heeren, Ruth Rose-Jacobs, John Cook, Stephanie Ettinger de Cuba, Patrick Casey, Mariana Chilton, Diana Cutts, Alan Meyers, and Deborah Frank
The goal of this publication is to develop a brief screen to identify families at risk for food insecurity and to evaluate the sensitivity, specificity, and convergent validity of the screen.
Pediatrics (May 2010)
Deborah Frank, Patrick Casey, Maureen Black, Ruth Rose-Jacobs, Mariana Chilton, Diana Cutts, Elizabeth March, Timothy Heeren, Sharon Coleman, Stephanie Ettinger de Cuba, John Book
The goals of this publication were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance.
2009
Health and Human Rights (May 2009)
Mariana Chilton, Jenny Rabinowich, Christina Council, Jennifer Breaux
When female-headed households and households with children have the highest prevalence of food insecurity and hunger in the US, the participation of low-income mothers in the development and administration of policies is fundamental to the process of ending hunger and improving child wellbeing.
American Journal of Public Health (March 2009)
Mariana Chilton, Maureen Black, Carol Berkowitz, Patrick Casey, John Cook, Diana Cutts, Ruth Rose Jacobs, Timothy Heeren, Stephanie Ettinger de Cuba, Sharon Coleman, Alan Meyers, Deborah A Frank
We investigated the risk of household food insecurity and reported fair or poor health among very young children who were US citizens and whose mothers were immigrants compared with those whose mothers had been born in the United States.
Health and Human Rights (January 2009)
Mariana Chilton and Donald Rose
Food insecurity is a serious public health problem associated with poor cognitive and emotional development in children and with depression and poor health in adults.
2008
Pediatrics (October 2008)
John Cook, Deborah Frank, Patrick Casey, Ruth Rose-Jacobs, Maureen Black, Mariana Chilton, Stephanie Ettinger de Cuba, Danielle Appugliese, Sharon Coleman, Timothy Heeren, Carol Berkowitz, Diana Cutts
The objectives of this study were to develop a clinical indicator of household energy security and assess associations with food security, health, and developmental risk in children less than 36 months of age.
Pediatrics (January 2008)
Ruth Rose-Jacobs, Maureen Black, Patrick Casey, John Cook, Diana Cutts, Mariana Chilton, Timothy Heeren, Suzette Levenson, Alan Meyers, Deobrah Frank
In this study, we evaluated the relationship between household food security status and developmental risk in young children, after controlling for potential confounding variables.