Relationship Between Food Insecurity and Neighborhood Child Opportunity Index

Document Type

Journal Article

Publication Date



The Journal of pediatrics




OBJECTIVES: To evaluate the association between the Child Opportunity Index (COI) and food insecurity. STUDY DESIGN: This was a secondary analysis of a comprehensive screening instrument for social determinants of health and behavioral health risks. It was administered in two urban pediatric emergency departments to adolescents aged 13-21 years and caregivers of children 0-17 years. FI was assessed using the two-item Hunger Vital Sign. Residential addresses were geocoded and linked with COI data. Bivariable and multivariable logistic regression models were developed to measure the relationship between COI and FI. RESULTS: Of the 954 participants (384 adolescents, 570 caregivers) who underwent screening, 15.7% identified food insecurity (14.3% of adolescent and 16.7% of caregiver participants). The majority of participants were non-Hispanic Black (overall: 62.3%; food secure: 60.9%; food insecure: 72.0%), publicly insured (overall: 56.6%; food secure: 53.1%; food insecure: 73.3%) and lived in neighborhoods of low/very low opportunity (overall: 76.9%; food secure: 74.7%; food insecure: 88.3%). In adjusted analyses, participants living in neighborhoods of low/very low child opportunity had three times greater odds of being food insecure compared with children living in neighborhoods of high child opportunity (aOR: 3.0; 95% CI: 1.4, 6.3). CONCLUSION: We demonstrate that FI is associated with lower neighborhood opportunity. Our results could inform future screening initiatives and support the development of novel, place-based interventions to tackle the complex issue of food insecurity.