651847

research-article2016
ECXXXX10.1177/0014402916651847Exceptional ChildrenSonik et al.

Article
Exceptional Children
2016, Vol. 83(1) 42­–57
Food Insecurity in U.S. Households © 2016 The Author(s)
DOI: 10.1177/0014402916651847
That Include Children With ec.sagepub.com

Disabilities

Rajan Sonik1, Susan L. Parish1, Subharati Ghosh2,

and Leah Igdalsky1

Abstract
The authors examined food insecurity in households including children with disabilities, analyzing
data from the 2004 and 2008 panels of the Survey of Income and Program Participation, which
included 24,729 households with children, 3,948 of which had children with disabilities. Logistic
regression models were used to estimate the likelihood of food insecurity after adjusting
for adult disability status, income, and other sociodemographic factors. Compared to other
households with children, those including children with disabilities were more likely to report
household food insecurity of any kind, very low household food security, and child food
insecurity. Families raising children with disabilities were also more likely to receive Supplemental
Nutrition Assistance Program benefits. These results suggest that children with disabilities face
an increased risk of experiencing food insecurity and that there is a pressing need to improve
the safety net system for these children.

As of 2010, nearly a fifth of the U.S. population Williams, & Crossman, 2015; Warfield &
(18.7%; 56.7 million people) had some level of Gulley, 2006). In particular, children with dis-
disability, and 12.6% (38.3 million people) had abilities from low-income families are signifi-
a severe disability (Brault, 2012). Among chil- cantly more likely to experience barriers to
dren under 15 years old, 8.4% (5.2 million chil- health care access arising from poverty (DeVoe
dren) had a disability and 4.2% (2.6 million et al., 2007; Swanson, Wall, Kisker, & Peterson,
children) had a severe disability (Brault, 2012). 2011) as well as from difficulties obtaining med-
For these figures, the U.S. Census Bureau ications and contacting physicians (Iezzoni,
defined disability as a functional limitation 2011). In light of these financial challenges,
related to communication, mental health, or families with limited resources are forced to
mobility; severe disabilities were complete make constrained choices between food and
restrictions in functioning (e.g., being deaf ver- medical care, particularly when a family mem-
sus hard of hearing) or the presence of particu- ber has disabilities or health conditions (Nielsen,
lar conditions, such as autism spectrum disorder Garasky, & Chatterjee, 2010). In this article, we
or Alzheimer’s disease (Brault, 2012). further explore food insecurity in families that
Parents of children with disabilities face bar- include children with disabilities.
riers to securing care for their children with dis-
abilities due to the complexity of navigating 1
Brandeis University, Waltham, MA, USA
medical systems, time constraints, and the finan- 2
Tata Institute of Social Sciences, Mumbai, India
cial burdens of out-of-pocket costs (Krauss,
Corresponding Author:
Wells, Gulley, & Anderson, 2001; Parish, Leah Igdalsky, Brandeis University, MS 035, Brandeis
Shattuck, & Rose, 2009; Parish, Thomas, Rose, University, 415 South St., Waltham, MA 02453, USA.
Kilany, & Shattuck, 2012; Parish, Thomas, E-mail: igdalsky@brandeis.edu
Sonik et al. 43

Food Insecurity Frongillo, 2015; Jyoti et al., 2005); anemia

with iron deficiency (Skalicky et al., 2006);
Food insecurity refers to the lack of adequate, more stomachaches, headaches, and colds
nutritious, and safe foods, typically due to (Alaimo, Olsen, Frongillo, & Breifel, 2001);
financial resource constraints (Bickel, Nord, and more hospitalizations, worse overall
Price, Hamilton, & Cook, 2000). In the United health status, and reduced physical function-
States, food insecurity is usually measured ing (Alaimo, Olsen, Frongillo, et al., 2001;
through responses to the Household Food Bronte-Tinkew et al., 2007; Casey et al., 2005;
Security Survey Module, a tool developed by Cook et al., 2006; Gundersen & Garasky,
the U.S. Food Security Measurement Project 2012; Gundersen, Kreider, & Pepper, 2011;
to identify whether a household is food secure, Hager et al., 2010). Also, even when children
has low food security, or has very low food are shielded against directly experiencing
security (Kirkendall, House, & Citro, 2013). food insecurity, food insecurity in the house-
In 2014, 14% of U.S. households had low or hold increases their risk of developing behav-
very low food security (Coleman-Jenson, ioral disorders (Whitaker, Phillips, & Orzol,
Rabbit, Gregory, & Singh, 2015). Among 2006). Given this range of problems, identify-
households with children, the level was 19%. ing predictors of food insecurity in house-
Although parents sometimes skipped meals in holds with children is needed to develop
order to shield their children from hunger, the appropriate interventions.
children in about half of these food-insecure
homes directly experienced food insecurity
themselves (Coleman-Jenson et al., 2015). Disability Status and Food Insecurity
In addition to state-level correlates of food
Children with disabilities face an insecurity, such as income, housing, family
increased risk of experiencing food size, and education (Bartfeld & Dunifon,
insecurity and there is a pressing 2006), at least seven studies have shown that
need to improve the safety net when working-age adults have disabilities,
household food insecurity increases (Huang,
system for these children.
Guo, & Kim, 2010; Leete & Bania, 2010;
Marjerrison, Cummings, Glanville, Kirk, &
Cross-sectional and longitudinal investiga- Ledwell, 2011; Nord, 2007; Ribar & Hamrick,
tions have revealed associations between 2003; She & Livermore, 2007; Siefert, Heflin,
child food insecurity and a host of poor health Corcoran, & Williams, 2004). A report by the
and developmental outcomes. These include U.S. Department of Agriculture (USDA) found
psychosocial, behavioral, and emotional dys- that 33.5% of households with working-age
function (Alaimo, Olson, & Frongillo, 2001; adults who had disabilities making them
Casey et al., 2005; Kleinman et al., 1998; unable to work were food insecure, compared
Zaslow et al., 2009); reduced social skills to 24.8% when the disability did not prevent
(Jyoti, Frongillo, & Jones, 2005); a need for work and 12.0% when there was no disability
mental health counseling (Alaimo, Olson, & (Coleman-Jensen & Nord, 2013). Bartfield
Frongillo, 2001; Kleinman et al., 1998); low and Dunifon (2006) also found that having a
academic performance and grade retention household member with a disability increased
(Alaimo, Olson, & Frongillo, 2001; Jyoti child food insecurity, although they did not
et al., 2005; Kleinman et al., 1998; Winicki & identify which household members had dis-
Jemison, 2003); a need for special education abilities. In light of the already vulnerable
services (Kleinman et al., 1998); diets with health status of people with disabilities and
higher fat and sugar contents, reduced physi- the connections between food insecurity and
cal activity, and increased body mass index poor health outcomes, the higher rates of food
(Bronte-Tinkew, Zaslow, Capps, Horowitz, & insecurity among adults with disabilities is
McNamara, 2007; Fram, Ritchie, Rosen, & troubling. To understand this phenomenon,
44 Exceptional Children 83(1)

Huang and colleagues (2010) examined lower Existing studies show that families that
asset levels and higher income needs related include children with disabilities may be at
to having a disability as potential explanations risk for material hardships, like food insecu-
for the higher food insecurity. They found evi- rity. Living with disabilities or caring for chil-
dence for both mechanisms, although the dren with disabilities in the United States is
strength of their findings varied by which expensive. Direct costs include high out-of-
assets and degree of food insecurity were pocket health care expenditures as well as
modeled (Huang et al., 2010). unreimbursed spending for transportation,
Similar mechanisms leading to food insecu- navigating appointments, home modifica-
rity may exist in households where a child has tions, and therapy and supportive services
a disability, or where both a child and an adult (Krauss et al., 2001; Mitra, Findley, & Sam-
have a disability, but few studies have explored bamoorthi, 2009; Newacheck, Inkelas, &
this topic. One study conducted in Nova Scotia Kim, 2004; Parish et al., 2009, 2012, 2015;
(Marjerrison et al., 2011) found that families Warfield & Gulley, 2006). Indirect costs
including children with diabetes mellitus were include reduced employment and lost wages
more likely to be food insecure than other fam- due to parental disability or poor health (Sta-
ilies in the region, but food insecurity was not a bile & Allen, 2012), and lost wages and pro-
dependent variable in the researchers' regres- ductivity for time spent caring for children
sion analyses to explore this difference more with special health-care needs (Rupp &
precisely. Two cross-sectional studies (DeRi- Ressler, 2009). These direct and indirect
gne, Quinn, Stoddard-Dare, & Mallett, 2014; costs have short- and long-term economic
Parish, Rose, Grinstein-Weiss, Richman, & consequences for people with disabilities
Andrews, 2008) found that households includ- and their families, who have lower net worth
ing children with disabilities have higher odds than other families (Parish, Grinstein-Weiss,
of food insecurity than other households. How- HunYeo, Rose, & Rimmerman, 2010) and
ever, neither of these studies controlled for higher rates of income and asset poverty
adult disability status, despite its relationship to (Parish, Rose, & Andrews, 2010; Parish,
food insecurity;this is particularly problematic Rose, & Swaine, 2010). Even with income
because previous research has found that one and assets similar to other families, the
fourth of households that include a child with higher costs may increase the risk of food
disabilities also include a disabled adult, and insecurity for families that include children
that more than one third of households with with disabilities.
two or more disabled children include at least
one disabled adult (Ghosh & Parish, 2013).
SNAP
This suggests possible confounding if analyses
do not address the disability status of adults liv- On the other hand, federal nutrition policies
ing in these families. Further, Parish et al. ostensibly provide more generous benefits to
(2008) included only one measure of food inse- people with disabilities than to those without.
curity, and DeRigne and colleagues' study For example, SNAP is the largest program
(2008) was not a nationally representative sam- intended to alleviate food insecurity and its
ple. Neither study examined participation rates negative consequences in the United States,
for the Supplemental Nutrition Assistance Pro- reaching 47.6 million individuals in fiscal
gram (SNAP), the largest food assistance pro- year 2013 (SNAP, 2014), and it provides more
gram in the United States (SNAP, 2014). In its flexible asset and income calculation rules for
2013 report, which provided a comprehensive households that include a member with a dis-
review, synthesis, and analysis of the existing ability (SNAP, 2013). Despite these rules, the
research on children’s food insecurity, the association between adult disability status and
National Research Council concluded that food insecurity has persisted. Whether this
research about food insecurity and children persistence of food insecurity despite benefi-
with disabilities was sorely needed. cial SNAP rules is also present in the case of
Sonik et al. 45

families with children with disabilities is an core questions collect information about basic
important public policy question. demographics, social welfare program partici-
Existing research about the impact of pation, income, and employment from the
SNAP in general has mostly examined its preceding 4 months. Specific sets of topical
effects on food insecurity (National Research questions, meanwhile, are asked during only
Council, 2013). A major concern surrounding one or two waves of a panel. Topic modules
this research has been that self-selection bias include subjects such as work and marriage
confounds most of the available cross-sectional history, disability status, material hardship,
evidence, because program entrants tend to be medical expenditures, and assets and liabili-
highly food insecure (Gregory, Rabbitt, & ties. The U.S. Census Bureau imputes missing
Ribar, 2013; National Research Council, values for the SIPP. These imputed values are
2013). The suggestion is that sudden increases the ones published in the publicly available
in food insecurity precipitate application for data, which we analyzed as recommended by
and receipt of SNAP benefits, biasing poten- the Census Bureau (Westat, 2001).
tial analyses. Recent longitudinal evaluations
have found that SNAP participation modestly
decreases food insecurity (Mabli & Ohls,
Sample
2015; Nord & Golla, 2009). Combined with The analytic sample for the present study was
the cross-sectional data, these results imply drawn from core and topical data from Wave 5
that food insecurity tends to precede SNAP of the 2004 panel and Wave 6 of the 2008
receipt, which in turn moderately but incom- panel. These two waves were the only to use
pletely reduces food insecurity. the same topic modules that included ques-
tions about both food insecurity and the dis-
ability status of children and adults in the
Study Objectives household (in the 2008 panel, Wave 9 also
We aimed to address unanswered questions in included questions about food insecurity, but
the current literature by (a) examining the did not ask about disability). Other data sets
relationship between having a child with dis- include measures of food insecurity; however,
abilities and household and child food insecu- though the Current Population Survey (CPS)
rity while (b) controlling for adult disability is collected more frequently than SIPP, and
status (among other demographic factors the National Health and Nutrition Examina-
and family characteristics) and (c) measuring tion Survey (NHANES) contains more
levels of SNAP participation. To do so, we detailed health information than SIPP, SIPP
utilized data from the 2004 and 2008 panels contains more program participation data than
of the nationally representative Survey of other surveys and provides more contempora-
Income and Program Participation (SIPP). neous estimates of income and food security
(National Research Council, 2013). Desig-
nated parents or guardians served as respon-
Method dents for questions about children, including
their disability status. For study purposes, it
Data
was essential to identify the focal month of
The data for this study were pooled from the the topical module and extract all relevant
2004 and 2008 panels of SIPP. Fielded by the information from the corresponding core data.
U.S. Census Bureau, SIPP is representative of Out of the 37,368 households in Wave 5 of
the non-institutionalized U.S. civilian popula- the 2004 panel and 34,850 households from
tion (Westat, 2001). SIPP collects data from Wave 6 of the 2008 panel, the sample was lim-
respondents once every 4 months, with each ited to the 24,729 households that included at
session referred to as a wave. Each wave least one child (those under 18 years old) living
includes a repeated set of core questions and with a designated parent or guardian and where
changing modules of topical questions. The the head of household was age 18 or older.
46 Exceptional Children 83(1)

Measures children had sufficient food to eat. Specifi-

cally, respondents were asked to indicate
Food insecurity.  We used three food insecurity- whether it was often, sometimes, or never true
related dependent variables. The first two during the past 4 months that children in the
were created using a set of five questions from household had not eaten enough because food
the SIPP adult well-being module, a method could not be afforded. This item was asked if
shown by the USDA to provide a reliable respondents from households with children
measure of household food security (Nord, under 18 also reported that they had not had
2006). The five items, asked once during each enough to eat, food did not last, or they could
of the panels, were derived from the original not afford balanced meals. A dichotomous
18 items used in the CPS for calculating variable was created (never or sometimes/
household food insecurity (Coleman-Jensen, often).
Nord, Andrews, & Carlson, 2012):
Child disability. The independent variable of
1. The food that you bought just didn’t interest was, among households with children,
last and you didn’t have money to get whether the household included children with
more. Was that often, sometimes, or disabilities at the time of data collection. Chil-
never true for you in the last 4 months? dren with disabilities under 6 years of age
2. You couldn’t afford to eat balanced were identified through a question asking if
meals. Was that often, sometimes, or they had a serious or mental condition (or a
never true for you in the last 4 months? developmental delay) that limited their ordi-
3. In the past 4 months did you or the nary activities. Children with disabilities who
other adults in the household ever cut were 6 to 14 years old were identified if they
the size of meals or skipped meals were reported to have one or more of several
because there wasn’t enough money specific impairments (e.g., “mental retarda-
for food? tion,” developmental disability, or a learning
4. In the past 4 months did you or the disability), if they needed assistive aids for
other adults in the household ever eat mobility (e.g., crutches for more than 6
less than you felt you should because months or a wheelchair), or if they were
there wasn’t enough money to buy reported as having difficulty with one or more
food? of several activities of daily living (e.g., dress-
5. In the past 4 months did you or the ing, having speech understood, interacting
other adults in the household ever not with other children). SIPP considers those 15
eat for a whole day because there and older to be adults, and so children with
wasn’t enough money for food? disabilities who were 15 to 17 years old were
identified through a definition of disability for
Varying patterns of responses to these ques- adults described by the Centers for Disease
tions placed respondents in one of three cate- Control and Prevention (2001, 2009) in their
gories of food insecurity: food secure, low analyses of SIPP. Designated parents or guard-
food security, and very low food security—an ians responded to questions regarding chil-
appropriate measure to contrast hunger preva- dren under age 15, whereas 15- to 17-year-olds
lence across subpopulations (Nord, 2006). We answered questions directly unless they
used a combination of the latter two catego- lacked capacity to do so.
ries (low food security and very low food
security, or “any household food insecurity”) Control measures. Covariates included the
as one dependent variable and the most severe householder’s (a) age at the time of data col-
category (very low food security) as another. lection; (b) education (high school education
The third dependent variable was child or greater versus not) at the time of data col-
food insecurity, which was derived from a lection; (c) race or ethnicity (non-Hispanic
separate question that asked about whether White, non-Hispanic Black, non-Hispanic
Sonik et al. 47

other, Hispanic); (d) family structure (married odds ratios (ORs) presented here utilize the
householder, single male householder, single weights provided in the SIPP for both point
female householder); (e) household income in estimates and hypothesis testing. Overall
relationship to the federal poverty level (FPL), group differences were assessed using an
based on income over the prior 4 months; (f) adjusted Wald test for continuous measures
whether an adult in the household had dis- and design-based F-test for categorical mea-
abilities (yes or no, using the same criteria sures.
described previously for 15- to 17-year-olds) We used multivariate logistic regression to
at the time of data collection; and (g) panel assess group differences in food insecurity
year, which was controlled to account for the measures while controlling for demographic
economic differences between years that may factors. Findings are reported here for the full,
have affected food security. Each of these pooled sample. We ran logit models using
covariates has previously been shown to be Stata (Version 14.0), choosing the option to
associated with food insecurity (Bartfeld & automatically convert coefficients into more
Dunifon, 2006; Coleman-Jenson et al., 2015), readily interpretable ORs. To assess results
with the exception of the SIPP panel year. The among SNAP-eligible households, we con-
proposed mechanisms for these relationships ducted additional regressions on the subset of
is that being in a more marginalized group— households with income below 185% of the
be it based on race or ethnicity, education, FPL. This income cutoff was similar to that
income, or disability—likely increases one’s used by Coleman-Jensen et al. (2012), and it
vulnerability both to disabilities and to hard- is appropriate because of the SNAP income
ships such as food insecurity. eligibility ceiling of 185% of the FPL. Adult
We did not include in our models SNAP disability status was controlled for in all mod-
receipt or receipt of other nutrition assistance els. In addition, we ran models with and with-
programs, such as school meal programs or out an interaction term between child and
Women, Infants, and Children benefits. Given adult disability status to assess the relation-
the literature suggesting that rises in food ship between the effects of child disability and
insecurity precede receipt of these types of adult disability on household food insecurity.
benefits (Gregory et al., 2013; National The full logit model with the interaction term
Research Council, 2013), it appears that these took the following form:
benefits exist outside of potential pathways
that connect having a child with a disability to ln[ y / (1 – y)] = b0 + b1*(child disability) +
food insecurity. As a result, it was not appro- b2*(adult disability) b3*(child
priate to model them as confounders here. disability)*(adult disability) +
Moreover, modeling them as predictors would b4–13*(control measures),
require techniques such as instrumental vari-
ables approaches (Shaefer & Gutierrez, 2013) where child disability was a binary variable
and would be outside of the scope of the pres- representing the presence of a child with a
ent inquiry. disability in the home versus only children
without disabilities in the home, and adult dis-
ability was a binary variable representing the
Statistical Methods presence or absence of an adult with a disabil-
Because SIPP is a stratified multistage proba- ity in the home. The control measures were
bility sample, we used Stata (Version 14.0) to age, a binary variable regarding education level
adjust standard errors and inferential statistics (high school education or greater versus not),
estimates. We used Fay’s method for balanced marital status (binary variables for single man
repeated replication to estimate variances, as and single woman, with married as the refer-
recommended in the SIPP user guide, because ence), race-ethnicity (binary variables for non-
of how SIPP alters its primary sampling units Hispanic Black, non-Hispanic other, and
to prevent the identification of respondents Hispanic, with non-Hispanic White as the ref-
(Westat, 2001). The percentages, means, and erence), income level (binary variables for
48 Exceptional Children 83(1)

income below 100% FPL and for income from in the analysis had at least one child. After
100% FPL to below 200% FPL, with income applying weights, 15% (or approximately
above 200% FPL as the reference), and a 11.9 million households) had one or more
binary variable regarding SIPP panel year. We children with a disability. In these families,
also tested models including an interaction there were 5,149 children with disabilities.
term between the SIPP panel year and child Weighted, they represented approximately 15
disability variables, but we did not include million children, and 40.2% had more than
this interaction term in the final models one disability.
because it was consistently nonsignificant. Compared to households where no chil-
Predicted probabilities were calculated using dren had a disability, households with chil-
the Stata margins command, holding covari- dren with disabilities experienced a higher
ates at their means. prevalence of food not lasting (25.8% vs.
14.7%, p < .001), household members not
being able to afford balanced meals (21.0%
Results vs. 11.8%, p < .001), members having
We present the results in two sections. The skipped meals (12.3% vs. 5.1%, p < .001),
first simply describes the descriptive data. members having eaten less (13.0% vs. 5.6%,
The second presents the regression model. p < 0.001), and adult members not eating for
an entire day (3.9% vs. 1.5%, p < .001; Table
2). These households also experienced a
Descriptive Statistics greater prevalence of any household food
Table 1 presents the weighted demographic insecurity (21.3% vs. 11.1%, p < .001), very
factors and family characteristics of those in low household food security (9.3% vs. 3.8%,
the sample. All 24,729 households included p < .001), and child food insecurity (7.9% vs.

Table 1.  Descriptive Statistics of U.S. Households, Pooled Data From 2004 and 2008 SIPP Panels.a

Households Households
including children including children
with disabilities without disabilities
Variable (n = 3,948) (n = 20,781) F p value
Age in years, M (SE) 41.4 (0.2) 39.8 (0.1) 73.6 <.001
Respondent less than high school 14.9 12.4 10.6 .001
education, %
Race of respondent  
  White non-Hispanic, % 63.0 60.4 6.1 .01
  Black non-Hispanic, % 16.2 13.6 14.6 <.001
  Other non-Hispanic, % 5.7 6.8 4.8 .03
  Hispanic, % 15.1 19.2 24.6 <.001
Respondent household income <100% 22.5 15.9 84.6 <.001
of FPL, %
Respondent household income 25.9 20.9 36.7 <.001
between 100% and 199% of FPL, %
Households with adult with disability, 43.5 21.3 667.8 <.001
%
Respondent marital status  
  Married, % 58.0 70.1 189.8 <.001
  Single male, % 7.8 7.9 0.1 .80
  Single female, % 34.3 22.0 202.4 <.001

Note. SIPP = Survey of Income and Program Participation; FPL = federal poverty level.
a
For comparisons of weighted means (e.g., income), Stata conducts adjusted Wald tests, and for comparisons of
weighted percentages (e.g., marital status), Stata conducts corrected Pearson’s χ2 tests, and both produce F statistics.
Sonik et al. 49

4.6%, p < .001) (Table 2). However, among regressions for all three dependent variables
those with income below 185% FPL, those with and without an interaction term between
with children with disabilities were also the presence of children and adults with dis-
more likely to receive SNAP benefits (55.2% abilities in the household.
vs. 38.3%, p < .001) (Table 2). In models without the interaction term, the
predicted probability of experiencing any
food insecurity was 55% greater in families
Regression Models
including children with disabilities (OR =
We provide logistic regression models for 1.64, 95% CI [1.47, 1.83]), the predicted
all households with children and for those probability of experiencing very low food
with income below 185% FPL in Tables 3 security was 70% greater (OR = 1.73, 95% CI
and 4, respectively. Both sets of regressions [1.49, 2.02]), and the predicted probability of
controlled for sociodemographic factors, experiencing child food insecurity was 38%
including the presence of an adult with a dis- greater (OR = 1.40, 95% CI [1.17, 1.67])
ability in the household. Each table provides (Table 3). Once added, the interaction term

Table 2.  Comparison Between Households on Indicators of Food Insecurity and Receipt of SNAP
Benefits.

Households Households
including children including children
with disabilities without disabilities
Variable (n = 3,948), % (n = 20,781), % F p value
Items on the food insecurity scale  
  Food bought did not last 25.8 14.7 239.6 <.001
  Did not eat balanced meal 21.0 11.8 175.6 <.001
  Skipped meals 12.3 5.1 212.2 <.001
  Ate less 13.0 5.6 244.2 <.001
  Did not eat one full day 3.9 1.5 96.7 <.001
Low or very low household food security 21.3 11.1 245.1 <.001
(overall)
  If income <100% FPL 38.2 23.6 58.5 <.001
  If income 100% to 199% FPL 28.2 18.3 37.1 <.001
  If income >200% FPL 10.5 5.7 62.5 <.001
Very low household food insecurity 9.3 3.8 176.0 <.001
(overall)
  If income <100% FPL 18.9 9.6 49.5 <.001
  If income 100% to 199% FPL 12.1 6.2 27.6 <.001
  If income >200% FPL 3.8 1.6 41.2 <.001
Children in the household sometimes or 7.9 4.6 51.3 <.001
often did not have enough to eat
  If income <100% FPL 16.0 10.1 24.0 <.001
  If income 100% to 199% FPL 9.7 7.7 3.3 .07
  If income >200% FPL 3.5 2.1 10.8 .001
Receiving SNAPa 55.2 38.3 149.6 <.001
  If income <100% FPL 73.3 54.6 98.6 <.001

Note. Values are weighted percentages. Sample sizes for households with and without children with disabilities for
income <100% FPL were 898 and 3,311; for income 100% to 199% FPL, were 1,052 and 4,414; and for income >200%
FPL, were 1,998 and 13,056, respectively. SNAP = Supplemental Nutrition Assistance Program; FPL = federal poverty
level.
a
SNAP receipt reported among families with income below 185% of the federal poverty level; sample sizes for
households with and without children with disabilities were 1,828 and 7,116, respectively.
50 Exceptional Children 83(1)

Table 3.  Logistic Regression Models for Food Insecurity (All Income Levels; n = 24,729).

Full model without interaction Full model with interaction

Odds Odds
Variablea ratio (SE) t 95% CI ratio (SE) t 95% CI
b
Any food insecurity  
 ≥1 child in household 1.64*** (0.09) 8.99 [1.47, 1.83] 1.73*** (0.11) 8.27 [1.51, 1.97]
  with disability
 ≥1 adult in household 2.14*** (0.11) 15.32 [1.94, 2.36] 2.19*** (0.12) 14.55 [1.97, 2.44]
  with disability
 Interaction 0.90 (0.08) –1.20 [0.76, 1.07]
 Age 0.99*** (0.00) –7.28 [0.98, 0.99] 0.99*** (0.00) –7.29 [0.98, 0.99]
  <High school 1.34*** (0.08) 4.63 [1.18, 1.51] 1.33*** (0.08) 4.62 [1.18, 1.51]
  Non-Hispanic Black 1.24*** (0.07) 3.43 [1.09, 1.40] 1.24*** (0.08) 3.41 [1.09, 1.40]
  Non-Hispanic other 1.26* (0.11) 2.60 [1.06, 1.49] 1.26* (0.11) 2.61 [1.06, 1.50]
 Hispanic 1.47*** (0.10) 5.51 [1.28, 1.69] 1.47*** (0.11) 5.50 [1.28, 1.69]
  Income < 100% FPL 3.10*** (0.21) 16.73 [2.71, 3.55] 3.10*** (0.21) 16.71 [2.71, 3.55]
 Income 100% to 199% 2.65*** (0.16) 15.99 [2.35, 2.98] 2.65*** (0.16) 15.98 [2.35, 2.99]
 FPL
  Single man 1.23* (0.12) 2.10 [1.01, 1.50] 1.23* (0.12) 2.09 [1.01, 1.50]
  Single woman 1.73*** (0.09) 10.23 [1.56, 1.93] 1.73*** (0.09) 10.23 [1.56, 1.92]
  2008 panel 1.22*** (0.06) 4.11 [1.11, 1.35] 1.22*** (0.06) 4.10 [1.11, 1.35]
Very low food security  
 ≥1 child in household 1.73*** (0.13) 7.09 [1.48, 2.02] 2.11*** (0.25) 6.37 [1.67, 2.66]
  with disability
 ≥1 adult in household 2.65*** (0.20) 13.07 [2.29, 3.08] 2.92*** (0.26) 12.22 [2.45, 3.47]
  with disability
 Interaction 0.71* (0.10) –2.47 [0.54, 0.93]
Child food insecurityc  
 ≥1 child in household 1.40*** (0.12) 3.76 [1.17, 1.67] 1.38** (0.16) 2.73 [1.09, 1.75]
  with disability
 ≥1 adult in household 1.60*** (0.12) 6.06 [1.37, 1.86] 1.59*** (0.14) 5.29 [1.34, 1.89]
  with disability
 Interaction 1.02 (0.15) 0.15 [0.77, 1.36]

Note. Full model includes respondent age, education level, marital status, race-ethnicity, income level, and
Survey of Income and Program Participation panel year; results for covariates presented only for models with
any food insecurity as the dependent variable; constant not reported. CI = confidence interval; FPL = federal
poverty level.
a
Interaction signifies an interaction term between the child and adult parameters; reference for <high school was
completion of a high school diploma, GED, or a higher level of education; reference for race-ethnicity was non-
Hispanic White; reference for income was household income greater than or equal to 200% FPL; reference for single
heads of household was a married couple; reference for 2008 panel was the 2004 panel. bAny food insecurity includes
with those with either low or very low food security. cChild food insecurity includes households where children often
or sometimes did not have enough to eat.
*p < .05. **p < .01. ***p < .001.

was significant only in the model for very low For families below 185% FPL, results were
food insecurity (OR = 0.71, 95% CI [0.54, similar. Having a child with disabilities
0.93]), indicating that the effects of child and increased the predicted probability of experi-
adult disability status on food insecurity are encing any food insecurity by 44% (OR =
close to but slightly less than purely additive 1.62, 95% CI [1.44, 1.83]), the predicted
(Table 3). probability of experiencing very low food
Sonik et al. 51

Table 4.  Logistic Regression Models for Food Insecurity (Households With Income Below 185% FPL;
All Households Include at Least One Child; n = 8,944).

Full model without interaction Full model with interaction

Odds Odds
Variablea ratio (SE) t 95% CI ratio (SE) t 95% CI
b
Any food insecurity  
 ≥1 child in household 1.62*** (0.10) 7.84 [1.44, 1.83] 1.84*** (0.15) 7.34 [1.56, 2.16]
  with disability
 ≥1 adult in household 1.99*** (0.13) 10.44 [1.75, 2.27] 2.12*** (0.15) 10.49 [1.84, 2.44]
  with disability
 Interaction 0.78* (0.09) –2.16 [0.63, 0.98]
 Age 0.98*** (0.00) –6.55 [0.98, 0.99 0.98*** (0.00) –6.59 [0.98, 0.99]
  <High school 1.27*** (0.09) 3.45 [1.11, 1.46] 1.27*** (0.09) 3.43 [1.11, 1.46]
  Non-Hispanic Black 1.10 (0.09) 1.10 [0.93, 1.30] 1.09 (0.09) 1.06 [0.93, 1.29]
  Non-Hispanic other 1.14 (0.13) 1.19 [0.92, 1.42] 1.15 (0.13) 1.24 [0.92, 1.42]
 Hispanic 1.33*** (0.10) 3.69 [1.14, 1.56] 1.34*** (0.10) 3.69 [1.14, 1.56]
  Income < 100% FPL 1.23** (0.08) 3.36 [1.09, 1.39] 1.23** (0.08) 3.36 [1.09, 1.39]
  Single man 1.06 (0.13) 0.46 [0.83, 1.36] 1.06 (0.13) 0.45 [0.82, 1.36]
  Single woman 1.47*** (0.09) 6.12 [1.30, 1.67] 1.47*** (0.09) 6.08 [1.30, 1.67]
  2008 panel 1.00 (0.06) 0.06 [0.89, 1.13] 1.00 (0.06) 0.05 [0.89, 1.13]
Very low food security  
 ≥1 child in household 1.74*** (0.15) 6.24 [1.46, 2.08] 2.11*** (0.29) 5.50 [1.61, 2.77]
  with disability
 ≥1 adult in household 2.16*** (0.20) 8.46 [1.80, 2.58] 2.39*** (0.25) 8.46 [1.95, 2.93]
  with disability
 Interaction 0.71* (0.12) –2.01 [0.51, 0.99]
Child food insecurityc  
 ≥1 child in household 1.35*** (0.12) 3.41 [1.13, 1.61] 1.37* (0.18) 2.42 [1.06, 1.76]
  with disability
 ≥1 adult in household 1.54*** (0.14) 4.76 [1.28, 1.85] 1.55*** (0.16) 4.14 [1.26, 1.91]
  with disability
 Interaction 0.98 (0.17) –0.12 [0.70, 1.38]

Note. Full model includes respondent age, education level, marital status, race-ethnicity, income level, and
Survey of Income and Program Participation panel year; results for covariates presented only for models with
any food insecurity as the dependent variable; constant not reported. CI = confidence interval; FPL = federal
poverty level.
a
Interaction signifies an interaction term between the child and adult parameters; reference for <high school was
completion of a high school diploma, GED, or a higher level of education; reference for race-ethnicity was non-
Hispanic White; reference for income was household income greater than 100% to 184% FPL; reference for single
heads of household was a married couple; reference for 2008 panel was the 2004 panel.bAny food insecurity includes
with those with either low or very low food security.cChild food insecurity includes households where children often
or sometimes did not have enough to eat.
*p < .05. **p < .01. ***p < .001.

security by 65% (OR = 1.74, 95% CI [1.46, Discussion

2.08]), and the predicted probability of expe-
riencing child food insecurity by 31% (OR = Children with disabilities typically have
1.35, 95% CI [1.13, 1.61]). Once added, the conditions that require increased levels of
interaction term was marginally significant in medical care and ancillary services as com-
the any-food-insecurity (OR = 0.78, 95% CI pared to their peers without disabilities
[0.63, 0.98]) and very-low-food-insecurity (Benedict & Farel, 2003). They are also
(OR = 0.71, 95% CI [0.50, 0.99]) models. often vulnerable to the development of
52 Exceptional Children 83(1)

secondary conditions if their health needs diagnosis-based, which prevented consistent

are unmet (Boudreau et al., 2014). This analyses of the potentially differential effects
study provides new evidence of significantly of having a child with severe versus nonse-
elevated rates of low and very low food secu- vere disabilities. However, the existing litera-
rity in families raising children with disabili- ture suggests that parents are highly reliable
ties. Further, we found that children in these reporters of their children’s disabilities
families directly experience food insecurity (Wittenburg & Nelson, 2006). Further, there is
at higher rates in comparison with families little reason to suspect that the findings are
raising children without disabilities. These biased. Parents of children with disabilities
findings are more robust than previous are unlikely to report food insecurity or
research regarding child disability and food income in ways that materially differ from
insecurity, as they persist after controlling parents of children with no disabilities, though
for a host of potential confounders―most there is evidence that parents may under-
notably income, race and ethnicity―and report the food insecurity of older children
whether the home included an adult with a who may be adept at hiding their direct expe-
disability. rience of food insecurity from their parents
(Coleman-Jensen, McFall, & Nord, 2013).
Children in these families directly Another potential concern is that the refer-
experience food insecurity at higher ence period for the measures of food insecu-
rity in SIPP is 4 months, which does not
rates in comparison with families
permit a granular analysis or an appraisal of
raising children without how food insecurity might be dynamic. Nev-
disabilities. ertheless, SIPP’s food insecurity measure was
developed and validated by the USDA, it has
We also found that rates of SNAP partici- been in wide use, and its reliability has been
pation were higher in families raising chil- established (Coleman-Jensen & Gregory,
dren with disabilities compared to other 2015; Nord, 2006). Still, SIPP does not facili-
families with children. This is consistent with tate the type of nuanced investigations that
previous findings that families with greater would be preferred for unpacking the full
food insecurity disproportionately self-select story of food insecurity.
into the SNAP program, which partially but A final limitation is that the sample of
incompletely alleviates said food insecurity children with disabilities in the SIPP is
(Gregory et al., 2013; Shaefer & Gutierrez, not sufficient to provide stable state-level
2013). Participation was still low, though— estimates. There is compelling evidence,
just 55% of income-eligible families includ- though, that state-level factors influence food
ing children with disabilities reported insecurity—characterized by Bartfeld and
receiving SNAP. Dunifon as “the state food security infra-
structure” (2006). As such, exploring how
food insecurity in families raising children
Limitations
with disabilities varies by state depending on
We note that SIPP does not objectively verify the nature of their food infrastructures and
participant responses, as is typical in national disability policies is an important direction
surveys. Reliance on parental report for infor- for future research.
mation about food insecurity, disability status,
and demographic characteristics likely means
Implications
that there are some inaccuracies in the
data, particularly regarding income. More- The relationship between food insecurity and
over the SIPP provides different variables to poor health and nutritional status is well
identify children of different ages with dis- established among children generally, as is the
abilities and is mostly functional rather than relationship between resource deprivation
Sonik et al. 53

generally and worsened educational out- with our finding that these families are also
comes, emotional health, and social develop- more likely to be food insecure, this indicates
ment (Emerson, 2004; Ozawa, Joo, & Kim, that SNAP benefits are not sufficient to elimi-
2004). Our findings are thus particularly wor- nate food insecurity in many families raising
risome for children whose disabilities and children with disabilities. Although SNAP
comorbid conditions already heighten their rules offer added flexibility to families that
risk for poor health outcomes. Preventing include a member with disabilities, neither
children with disabilities from experiencing this additional flexibility nor the current level
food insecurity and the deleterious health con- of benefits appears adequate to overcome the
sequences that likely result should be a press- other forces that are causing these families to
ing public health concern. In addition, be food insecure. For SNAP to reduce the
especially given that many children with dis- food insecurity disparity that we observed,
abilities face already reduced academic attain- more benefits or even greater flexibility for
ment and achievement (U.S. Department of these families may be required. The observed
Education, 2002; Wagner, Newman, Cameto, disparity is particularly relevant given the
& Levine, 2006), a more aggressive approach ongoing policy debates suggesting cuts to the
to alleviating food insecurity for these chil- program as well as the 2013 expiration of the
dren may be necessary to see real educational increases to SNAP that were part of the Amer-
gains. Teachers of children with disabilities, ican Recovery and Reinvestment Act. Finally,
particularly special educators, may also need our finding that roughly half of the income-
training to recognize the potential signs of eligible families that include children with
hunger interfering with learning, as these may disabilities did not receive SNAP benefits is
be mistaken as part of a child’s disability. concerning. Even if insufficient, the existing
Partnering with local social service agencies program likely helps to some degree, and so
and anti-hunger organizations may facilitate greater efforts to improve participation rates
the development of such programs. in this population should be made. Collabora-
tions between educators and local organiza-
tions that help families apply for SNAP
Given the likely adverse benefits may help in such efforts.
consequences of food insecurity on
health and academic outcomes for
vulnerable children with Conclusion
disabilities, assertive policy This study provides added depth to the study
measures are needed. of food insecurity among U.S. families raising
children with disabilities. The results provide
We were unable to study the causes of ele- evidence of troubling rates of food insecurity
vated food insecurity among families of chil- among households that include children
dren with disabilities, but existing evidence with disabilities when compared to those with
regarding the high out-of-pocket costs of typically developing children. Despite the
meeting these children’s care needs (Parish & increased likelihood that families raising chil-
Cloud, 2006) suggests that these families are dren with disabilities received SNAP benefits,
highly resource constrained. They may well food insecurity was pervasive in such fami-
be forced to make difficult choices about lies. Given the likely adverse consequences of
spending money on either their children’s food insecurity on health and academic out-
disability-related care needs or food. comes for vulnerable children with disabili-
Looking to existing programs aimed at ties, who are generally in poorer health and
addressing this issue, we found that families have elevated educational needs, assertive
raising children with disabilities were more policy measures are needed to address food
likely to receive SNAP benefits. Combined insecurity in these families.
54 Exceptional Children 83(1)

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