文章基本信息

标题：Heat or Eat? Cold-Weather Shocks and Nutrition in Poor American Families
本地全文：下载
作者：Jayanta Bhattacharya ; Thomas DeLeire ; Steven Haider 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2003
卷号：93
期号：7
页码：1149-1154
语种：English
出版社：American Public Health Association
摘要：Objectives. The authors sought to determine the effects of cold-weather periods on budgets and nutritional outcomes among poor American families. Methods. The Consumer Expenditure Survey was used to track expenditures on food and home fuels, and the Third National Health and Nutrition Examination Survey was used to track calorie consumption, dietary quality, vitamin deficiencies, and anemia. Results. Both poor and richer families increased fuel expenditures in response to unusually cold weather. Poor families reduced food expenditures by roughly the same amount as their increase in fuel expenditures, whereas richer families increased food expenditures. Conclusions. Poor parents and their children spend less on and eat less food during cold-weather budgetary shocks. Existing social programs fail to buffer against these shocks. In many parts of the United States, winters can impose a financial burden. Newspaper reports suggest that poor families are hardest hit. Such families face difficult decisions about where to place their resources, being forced to choose among heating their homes, feeding themselves, and feeding their children. For example, a 2001 article published in the New York Times 1 reported that parents reduce expenditures on utilities to pay for food. One family reported that “we owe $800 on the water bill and $500 for heat.” These tough choices may have a large effect on the nutritional well-being of children. Some of the harm will be tempered if parents can shield their children from nutritional deprivation. The same newspaper article also reported that some poor parents “routinely go without dinner to make sure their . . . children have enough to eat.” The purpose of this study was to investigate whether poor American families have lower food expenditures and worse nutritional outcomes than richer families during cold-weather periods and to determine the extent to which parents are able to protect their children from these shocks. We used 2 large and nationally representative data sets. The Consumer Expenditure Survey (CEX), administered by the US Bureau of Labor Statistics, includes extensive information regarding household expenditures on food and other items over a long time period. The third National Health and Nutrition Examination Survey (NHANES III) is the gold standard for nationally representative nutritional data. Actual starvation is rare in the United States, but poor nutritional choices are rampant. American children consume diets that are high in fat, high in sweets, and low in fruit and vegetables. 2 Few studies have revealed vitamin intake deficiencies in American children 3, 4 ; however, Bhattacharya and Currie 2 found high prevalence rates of anemia and of high blood cholesterol and some evidence of serum vitamin deficiencies among American adolescents. Whereas low serum vitamin levels are clinically difficult to evaluate in the context of a single patient, they are good measures of dietary inadequacy in broad populations. The relationship between micronutrient intake and blood levels of these nutrients is complicated. Because the body can store certain vitamins and minerals for long periods, it is not anomalous to find an individual who has not recently consumed the recommended amount of a particular vitamin and yet does not have a deficiency in that vitamin according to blood tests. For example, it can take between 3 and 6 years for a deficiency in vitamin B₁₂ to become clinically evident. 4 Nevertheless, blood tests, when properly interpreted, can provide objective evidence of micronutrient malnutrition. Although poor diets seldom result in classic vitamin deficiencies related to diseases such as scurvy or pellagra, low vitamin and mineral levels could have long-term health consequences. For example, even mild iron deficiency is associated with fatigue, shortened attention span, decreased work capacity, reduced resistance to infection, and impaired intellectual performance. 5 Several recent studies have examined whether poor children consume inadequate diets during the winter. Frank et al. 6 reported increases in the percentage of emergency room visits among small-for-age children during winter in a Boston hospital. However, relying on British data, Lawlor et al. 7 and Shah and Peacock 8 did not find any relation between excess winter mortality and deprivation. Economists have examined nutritional resource sharing in poor families. Wilde 9 and Wilde and Ranney 10 examined whether poor families receiving Food Stamp benefits eat less toward the end of a benefit month. They found that adults frequently eat less during the fourth week of a month, whereas children exhibit smooth food consumption patterns throughout the month. These results suggest that the food consumption of poor families is potentially vulnerable to financial strains but that parents in poor families can, to some extent, protect their children from the adverse effects of these strains.