being lower), food insecurity3 and low-quality diets, and behaviors that do not support healthy lifestyles (DHHS and AHRQ, 2005; NCHS, 2005). African-American, Hispanic/Latino, and American Indian/Alaska Native households are substantially overrepresented among all U.S. households with incomes below the poverty level (DeNavas-Walt et al., 2005; NRC, 2006b; Robert and House, 2000). Moreover, children and adults in families with incomes below or near the federal poverty level4 have poorer health outcomes than those in families with higher incomes (DHHS and AHRQ, 2005; IOM, 2003).

In 2003, 11 percent of U.S. children had no health insurance (Annie E. Casey Foundation, 2006). Children in low-income families are substantially more likely than children in higher-income families to lack health care coverage (NCHS, 2005). In 2002 and 2003, uninsured children were three times more likely than their counterparts with insurance (32 percent versus 11 percent, respectively) to have not had a visit to a physician or health clinic for health care within the previous year (NCHS, 2005). Racial/ethnic minority children and youth face a number of barriers to receiving timely, appropriate, and high-quality health care services (NCHS, 2005; NRC, 2006a). Children covered by Medicaid are nearly six times more likely than children covered by private insurance to be treated for obesity. In addition, the treatment of obesity in children covered by Medicaid is more expensive (approximately $6,700/year) than the treatment of obesity for children covered by private insurance (approximately $3,700/year) (Thomson Medstat, 2006). Children with obesity experience higher rates of hospitalizations and greater use of physician services than their nonobese peers (Thomson Medstat, 2006).

The percentage of Americans living in poverty increased from 11.3 percent in 2000 to 12.5 percent in 2003. The 2004 poverty rate among children under 6 years of age was 21 percent (Annie E. Casey Foundation, 2006). In 2004, 38.2 million individuals (an estimated 11.9 percent of the total population), including 13.9 million children, lived in households with food insecurity (Nord et al., 2005). Several studies examining the relationships among food insecurity, SES, and obesity in children or youth have not been able to demonstrate a strong association or causal effect after adjustment for other factors (Hofferth and Curtin, 2005; Kaiser et al., 2002; Matheson et al., 2002; Whitaker and Orzol, 2006).

3

Food insecurity describes households that have limited or an uncertain availability of nutritionally adequate and safe foods or that have the inability to acquire such foods in a socially acceptable way.

4

Federal poverty guidelines are issued annually in the Federal Register by the U.S. Department of Health and Human Services and are used to determine the financial eligibility of individuals and households for federal assistance programs (DHHS, 2006a).



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