INVESTIGATING THE RELATIONSHIP BETWEEN HOUSEHOLD FOOD INSECURITY AND ACADEMIC PERFORMANCE AMONG NOVA SCOTIA ELEMENTARY SCHOOL STUDENTS
von Maltzahn, Anna
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Background: Education is a fundamental determinant of health, and as such, good academic performance of children has instrumental importance for their health. Household food insecurity, given its association with poor development, may play a critical role in determining academic performance among children. A population-based cross-sectional survey conducted in the Tri-County Region of Nova Scotia, Canada in Spring 2014 provided a unique opportunity to investigate an association between household food insecurity and academic performance. Research questions: We set out to answer the following research questions: (1) Is household food insecurity associated with the academic performance among grade 4-6 students of the Tri-County Regional School Board in Nova Scotia? and (2) Is diet quality a mediator in the association between household food insecurity and student academic performance? Methods: This study was a secondary data analysis of a population-based cross-sectional survey, the Influence of Comprehensive School Health on School Culture and Health Behaviors in Children, conducted in 2014 with children in grade 4-6 (n=590) in the Tri-County Regional School Board of Nova Scotia. We used a dichotomous household food insecurity measure (food secure or food insecure); two dichotomous measures of academic performance (English Language Arts and Mathematics ratings of poor or good); and two continuous diet quality measures, the Youth Healthy Eating Index (YHEI) and Diet Quality Index-International (DQI-I). We followed a classic mediation analysis, the Four Step Approach, to examine the associations between household food insecurity, diet quality, and academic performance, separately for each of the diet quality and academic performance measures, using logistic or linear regression models adjusting for household education. Results: In the sample of grade 4-6 students, 24.2% of children were living with household food insecurity. Results were inconclusive regarding whether diet quality was a mediator in the association between household food insecurity and academic performance because prerequisites were not met to complete mediation analysis with the Four Step Approach: Step 1 did not find a consistent total effect of household food insecurity on academic performance: children with household food insecurity were 1.92 times more likely to have poor academic performance in Mathematics (95% confidence interval [CI]: 1.06, 3.46) but association of household food insecurity with English Language Arts was statistically insignificant. Step 2 did not find a consistent moderate or strong association between household food insecurity and diet quality: children with household food insecurity scored 3.31 points lower YHEI than children without household food insecurity (95% CI: -5.23, -1.36) but association of household food insecurity with DQI-I was statistically insignificant. Step 3 did not find a consistent moderate or strong association between diet quality and academic performance: for every unit increase in children’s diet quality (on a 100-point scale), odds of poor academic performance in English Language Arts and Mathematics decreased by 5 and 3%, respectively. Conclusions: This study did not find the mediating role of diet quality in the relationship between household food insecurity and academic performance. Further research with a larger sample and better measures is necessary to conduct mediation analysis of the relationships and causal pathways between household food insecurity, diet quality, and academic performance.