Food Insecurity and Family Dynamics: A Systematic Review

Abstract

Background:

Undernutrition is related to numerous childhood outcomes. However, little research has investigated the relationship between food insecurity and family dynamics. This systematic review seeks to validate the evidence for a relationship between these two factors.

Methods:

A systematic literature review was conducted in Embase, PubMed, and Scopus. Inclusion criteria include peer-reviewed research articles published during or after 1996 in English, standardized measures of family function and food insecurity. Exclusion criteria include measurement of parent or child characteristics without assessing household or family characteristics or demographics. Two reviewers independently voted using Covidence and Alpha agreement was determined at each phase.

Results:

A total of 15 studies were included for data extraction after the initial search being completed in April 2022. All included studies were found to be appropriate in numerous categories for quality assessment. Primary findings from these studies show a potential relationship exists between food insecurity and family dynamics.

Discussion:

The findings in this review suggest that effects of food insecurity expand to various aspects of healthy family functioning. Unhealthy family dynamics in childhood can also expose children to trauma and lead to increased physical and mental health disorders in the future.

Introduction

Food insecurity is measured by the United States Department of Agriculture (USDA) using a survey of some 45,000 households that qualifies difficulties affording and procuring sufficient nutrition for household members¹. Recent studies have shown that up to 21% of families with children and adolescents struggle with food insecurity², and while these numbers have been in decline for many years, challenges during the COVID-19 pandemic saw an increase in the percentage of households with children suffering from food insecurity¹. Undernutrition has been well studied in the literature and is known to be related to childhood behavioral, emotional, and academic outcomes, as well as psychosocial disorder diagnosis^2,3. While the relationship between food insecurity and childhood development is well-studied and better understood, relatively little research has investigated the relationship between food insecurity and other aspects of the family beyond sociodemographics, such as family relationships and dynamics.

Family dynamics refers to the complex interactions and relationship patterns that are formed between relatives, as well as the roles, actions and factors that drive these personal interactions. Due to the nature of emotional, physical, spiritual and other forms of support provided by families, these relationships are a major driver of feelings of security and stress for individuals⁴. Studies have shown that variability in family relationships and interactions can have long term influence on the well-being of an individual through critical interactions with psychological, social, physical, and behavioral development pathways⁵. Family dynamics can be influenced by many factors including shared feelings of cohesion and warmth, stability, and flexibility along with isolation, disorganization, and role conflict⁴.

Given the nature of food insecurity and its complex interplay with socioeconomic factors, it is intuitive a correlation may be present between access to sufficient quality food to meet nutritional needs and familial relationships and their dynamics. For example, parenting approaches to meal planning and preparation, and response to between-meal food requests by children may influence spending patterns of heads of households. This systematic review seeks to validate the overall evidence for a relationship between these two factors, and explore the potential negative impacts they may have on the development and growth of children and adolescents who experience them.

Methods

This study used the “Five steps to conducting a systematic review” outlined by Khalid et al to guide this review⁶. Reporting of results was organized using the PRISMA systematic review checklist (Figure 1). The checklist is divided into several sections including how to create the title, abstract, introduction, methods, results, and discussion throughout the process of completing the systematic review.

Figure 1.

Prisma flowchart showing studies included and excluded at each stage of the review.

The research team completed searches in March 2022 with a final search completed in July 2023 in Embase, PubMed, and Scopus with the filter of studies published starting in 1996 to ensure feasibility of the review and focus on current underpinnings within the fields of nutrition and family dynamics. Results were then uploaded to Covidence systematic review tool⁷.

During title and abstract screening, two reviewers (SK, JC) independently voted on whether a reference would be relevant to answer the primary research questions based on the presence of a set of food insecurity and family dynamics keywords (Table 1). Reviewers then voted to include or exclude each reference to continue to full text review.

Table 1.

Highlights and keywords utilized to include studies during the initial abstract screening stage.

Food Insecurity Terms	Family Dynamics Terms
Food insecurity	Family
Hunger	Family Dynamic(s)
Food Supply	Family Function
Nutrition Insecurity	Family Chaos
Food Insecure	Family Conflict
Food Insecurities	Family Relation(s)
	Family Communication(s)
	Household Chaos
	Household Conflict

During full text review, 62 studies were independently reviewed by two members of the research team (SK, JC). At this stage, studies were included or excluded based on their adherence to inclusion and exclusion criteria. Inclusion criteria for references included publication after the year 1996, peer review, use of a standardized measure of family function, and utilization of a standardized or clinically useful measure of food insecurity. Criteria for exclusion included publication prior to 1996, lack of peer review, and reporting of parent or child characteristics without a standardized measure of family function or food insecurity. Specific inclusion and exclusion criteria can be found in Table 2.

Table 2.

Inclusion and exclusion criteria utilized to screen full texts of studies.

Inclusion	Exclusion
Articles published in the last 15 years during or after 1996 in English	Articles published before 1996
Peer-reviewed research article (Quantitative studies, qualitative studies, case studies included.)	Non-peer-reviewed research, reviews, or commentaries (including editorials and commentaries).
Must include a standardized measure of family function (observational or self-report questionnaire). An intervention may measure family functioning but not directly intervene on family functioning and still be included. Family function may measure family conflict, behavior control, family communication/chaos, relationships, family structure etc.	Measurement of parent characteristics (such as feeding and mealtime practices, parental stress, or parental mental health status/ general health status) demographics is not a sufficient measure of family function, and outside the scope of this review.
Must include a standardized or clinically useful measure of food insecurity (self-report questionnaire). Example: 18 item US Department of Agriculture Household Food Security Survey Module (HFSSM).	Measurement of child characteristics (such as feeding and mealtime practices, parental stress, or parental mental health status/ general health status) demographics is not a sufficient measure of family function.

Alpha agreement was determined at each phase of review and conflicts between reviewers were resolved through discussion. If consensus could not be reached, the final decision was made by the senior member of the investigative team (JAS). Details on inclusion and exclusion of studies during each phase of review and reasons for exclusion are included in Figure 1.

In the final stage of data extraction, the remaining 15 studies were reviewed by the research team and were organized via Excel spreadsheet to identify key points within each study including location, size of study, population description, aim of study, primary vs. secondary analysis, how food insecurity was assessed and at what level, how family dynamics were assessed, covariates, outcomes, main findings, and tests for confounding variables. Information from this spreadsheet was qualitatively summarized and categorized into studies that support, weakly support, or do not support the initial hypothesis of the systematic review. Quality of studies were also assessed using a modified form of the STROBE checklist for cross-sectional studies to synthesize a quality assessment template (Supplementary Table 1) evaluating the 15 included studies on the following criteria: appropriate and well-described methods, relevant participant pool, objective criteria used to measure the variable of interest, conflicts of interest present, sufficient sample size, appropriate statistical analyses chosen, presence of statistically significant results, and generalizability to our population of interest.

Results

The database search yielded 3005 studies after duplicates were removed. After conducting title and abstract screening, 62 papers were retained for full text screening. Of these, 47 papers were excluded for one of the following reasons: non-peer reviewed article, wrong study design, wrong variables analyzed, wrong statistical analysis, wrong intervention, non-primary source, or wrong language. A total of 15 studies met the inclusion criteria and were included for data extraction after the initial screening with the initial search being completed in April 2022. The 15 included studies examined the association between food insecurity and family dynamics.

Data on study location, population, total number of participants, population description, age range (child and/or parent/s), aim of study, primary vs secondary analysis, food insecurity assessment tool, family dynamics/functioning assessment tool, categories for analysis (food insecurity and family dynamics/functioning), covariates included, outcomes, main analysis findings, and tests for interactions and confounding were extracted using a standardized extraction spreadsheet.

In the assessment of quality of included studies, all were found to be appropriate in the following categories: objective criteria, conflicts of interest, participants, sample size, application to our population of interest, and statistical analysis. All except one included study had statistically significant results. Seven studies used the “gold standard” USDA 18-item Household Food Security Survey Module or an abbreviated version to assess food insecurity. Four studies used another survey method to assess food insecurity and 4 studies used a single question to assess food insecurity. Five studies used the Family Assessment Device (FAD)⁸ or Family Functioning Scale (FFS)⁹ to assess family dynamics. Four studies used the Family Conflict Scale¹⁰ for Conflict Tactics Scale¹¹ to assess family dynamics and 2 studies used the Confusion, Hubbub, and Order Scale (CHAOS)¹². Five studies used another method to assess family dynamics including measurement of family routines, parent peer attachment, family relationships, and perceived need for care. The location of 11 included studies was the United States and 1 was in Canada. The other 3 studies were conducted in India, Malaysia, and Europe. Table 3 summarizes the characteristics of studies included.

Table 3.

Data extraction table showing the 15 studies included in the review.

Study ID	Author (Year)	Title	Location	Total number of participants	Population description	Age range	Aim of study	Primary vs secondary	FI Assesment Tool	FI level of assessment	FI Categories for Analysis	FD Assesment Tool	FD level of Assessment	FD Categories for Analysis	Covariates Included	Outcomes (FI vs FD measurement)	Main Analysis Findings
2300	Glynn LM et al. (2021)	A predictable home environment may protect child mental health during the COVID-19 pandemic	United States (CA)	169	Mother-child pairs in longitudinal study examining prenatal and early life influences and child development	Mean Child Age 4.1 (Range 2.6 to 6)	To investigate mental health symptoms in American preschool children during the COVID-19 pandemic and test the hypothesis that maintenance of family routines serves as a protective factor for children’s mental health during the pandemic crisis	Secondary analysis	5 question USDA food security model- short form	Household	Scale 0 – 5	Modified 6-item Family Routines Inventory	Household	Scale 0–18	Child age and sex, dual parent household status, pre-pandemic annual houshold income, food security during the pandemic, maternal perceived stress, and maternal depressive symptoms	Family Routine Inventory Score (0–18) vs Food Insecurity Score (0–5)	Statistically significant weak negative association (0.28) between food insecurity and food routines
2202	Shaw SA et al. (2021)	Parenting Among Rohingya and Afghan Refugee Parents Residing in Malaysia	Malaysia	140	Participants were 18 years of age or older, had at least one child under age 18 years, and were refugees or asylum seekers in Malaysia.	Mean Parent Age (SD): 31.3 (8.3)	To examine the measurement properties of parenting-related measures among 140 Rohingya and Afghan refugee parents residing in Malaysia, then examine factors associated with these parenting outcomes.	Primary analysis	One question regarding food availability in the past 90 days.	Household	Yes or No, regarding availability of food in the past 90 days	Family Functioning Scale (FFS), 3 questions rleated to family conflict were used	Household	Numeric score, with higher score associated with more conflict	None	Food insecurity vs Family Conflict	No significant relationship between food insecurity and intimacy or conflict, measured using family functioning scale.
1634	Jansen E et al. (2020)	Hunger in Vulnerable Families in Southeastern Europe: Associations With Mental Health and Violence	Southeastern Europe	140	Participants were age 18 or older and the primary caregiver of a child age 2 to 9 living with the child at least 4 nights a week and from the 3 included Southeastern European countries.	Child age: Mean (SD) - 5.8 (2.0); Parent age: Mean (SD) - 35.3 (7.5)	To simultaneously examine associations between four sets of risk factors - lack of financial, mental, familial, and social resources - and the experience of hunger in families living in three low-and middle-income Southeastern European countries	Primary analysis	Three items on food shortage and hunger within the family based on the “Hunger Scale”	Household	Yes or No: Experienced at least one form of hunger in the past 30 days	FAD, 12 items (general functioning subscale of the Family Assessment Device short form)	Household	Numeric score 1–4 (higher score is lower family functioning)	None	FAD score (family functioning) vs experience of hunger	Statistically significant differences in family functioning among those who experienced hunger vs those who have not
1525	Helton JJ et al. (2019)	Household Food Insecurity and Parent-to-Child Aggression	USA	2330	American respondents from the Fragile Families and Childhood Wellbeing Study (FFCWS)	Child: 57 – 72 months; Mother: 15 – 43 years	To show that household food insecurity at baseline measurement will be associated with more severe parent-to-child psychological and physical aggression at follow-up waves of measurement, and persistent food insecurity over two-time periods will be associated with higher rates of psychological and physical aggression at follow-up measurement, while accounting for measures of maternal depression, impulsiveness, and other socioeconomic variables	Primary analysis	18-item US Food Security Module	Household	Food insecure (1), and Not Food insecure (0)	Conflict Tactics Scale for Physical and Non-Physical (Psychological) acts of aggression; Total aggression and Composite aggression calculated using sum of physical and psychological aggression	Household	Total Aggression: low, moderate, high	Child age, Child race, Child sex, Maternal age, Maternal education, Household income, Public assistance, Socioeconomic status, Maternal depression and impulsivity	Household food insecurity vs parent-to-child aggression	Greater degree of household food insecurity was associated with increased rates of psychological, physical, and total aggression.
1479	Lombe M et al. (2017)	Household adversity and food security: The case of youth in public housing neighborhoods	United States (Baltimore)	124	African American youth and adolescents living in a public housing neighborhood located in West Baltimore	Range 13–18 (mean 15.4, SD- 1.9)	To study what extent demographics, household-level factors, and community-level factors affect the likelihood of experiencing food hardship	Primary analysis	Single-item question designed by community advisory board (CAB) research team	Child	Not at all, sometimes plus all the time	Family Conflict Scale	Household	Numeric score with higher score representing greater exposure to domestic conflict	None	Food hardship vs household conflict	Youth in households experiencing interpersonal conflict and violence reported significantly more food insecurities than did youth in households without household conflict
1244	Drucker ER et al. (2019)	Food insecurity, childhood hunger and caregiver life experiences among households with children in South Carolina, USA	United States (SC)	511	Households in 8 counties of South Carolina (SC) with a child under 18 living there at least 50% of time with an annual total household income <$US 100,000	N/A	How positive and negative life experiences of caregivers are associated with household food insecurity	Primary analysis	18-item USDA Household Food Security Survey Module (HFSSM)	Household, assessed at baseline	Food secure, food insecure without child hunger, child hunger	Modified 1978 Life Experiences Survey (LES)	Household, assessed at baseline	Family and other personal relationships (positive and negative)	Caregiver gender, race/ethnicity, urban residents, number of adults/children in household, an indicator variable related to recruitment type, and income	Positive and negative experiences with family and other personal relationships vs food insecurity	Negative life experience in the family and other relationships resulted in significant increased odds on food insecurity without child hunger and child hunger. Positive life experience in the family and other relationships resulted in significantly decreased odds of child hunger and was not associated with a change in odds of food insecurity without child hunger.
1217	Eagleton SG et al. (2022)	Food insecurity is associated with higher food responsiveness in low-income children: The moderating role of parent stress and family functioning	United States (PA)	504	Families of pre-school-aged children enrolled in Head Start in Central Pennsylvania	Parents: 32.28 (9.40) Children: 4.46 (0.66)	To examine food insecurity in relation to appetitive behaviors in low-income pre-schoolers and exploring the effects of social, emotional, and structural properties of the home environment on food security status and child appetitive behaviors	Primary analysis	18-item USDA Household Food Security Survey Module (HFSSM)	Household and Child	Household Food secure, Household Food Insecure, and Child Food Insecure	Family Assessment Device (FAD) general functioning scale, Confusion, Hubbub, and Order scale (CHAOS)	Household	N/A	Parent Age, Race/Ethnicity, Education, Marital Status, Income, Employment, SNAP, and WIC, BMI; Child age, sex, and race-ethnicity	Home environment factors (household chaos and family functioning) by food security status in three categories of household food secure, household food insecure, child food insecure	Household chaos was significantly higher in child FI and household FI groups compared to food secure group. Family functioning was significantly lower child FI compared to food secure group.
1100	Johnson AD & Markowitz AJ (2018)	Food Insecurity and Family Well-Being Outcomes among Households with Young Children	USA	2100–4700	Nationally representative children born in the US in 2001, drawn from the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B)	Child assessed at 9 months, 2 years, and 4 years	To estimate associations between food insecurity across early childhood and a comprehensive set of family well-being variables known to impact healthy child development during the critical early childhood years	Primary analysis	18-item USDA Food Security Module	Household	Food security, low food security, very low food security	Conflict Tactics Scale (parental conflict negativity)	Parent	numerical score 0–18 (higher score indicates higher level of negative conflict resolution strategies)	19 household economic and demographic variables theoretically or empirically linked with food insecurity, family well-being or both	Parent conflict negativity vs food insecurity	For children at preschool age, low and very low food security were significantly associated with increased parental conflict negativity
1076	Kotchick BA et al. (2021)	Food Insecurity and Adolescent Psychosocial Adjustment: Indirect Pathways through Caregiver Adjustment and Caregiver-Adolescent Relationship Quality	United States (Boston, Chicago, San Antonio)	687	Households with at least one child and living below 200% of the poverty line in 1999–2005 and part of the Welfare, Children, and Families study.	Caregiver age - 38.20 (SD- 8.25) range - 18–74 Child age - 11.74 (SD- 1.39) range - 10–14	To examine the longitudinal associations between household food insecurity experienced during early adolescence and psychosocial adjustment five years later and the indirect effects of household food insecurity on caregiver-adolescent relationship quality and caregiver depression symptoms.	Primary analysis	18-item USDA Household Food Security Module (HFSSM)	Household	High Food Security, Marginal Food Security, Low Food Security, Very Low Food Security	Abbreviated Inventory of Parent and Peer Attachment (IPPA)	Child	Numeric Score with higher scores indicating better relationship quality	Age of primary female caregiver, child age and sex, caregiver ethnicity, caregiver education, caregiver marital status, number of other adults living in household, number of other children living in household, and measure of domestic violence experienced by caregiver.	Food Insecurity vs Caregiver-Adolescent Relationship Quality	Significant negative relationship (weak) between household food insecurity scores and relationship quality.
1065	Potochnick S et al. (2019)	Food Insecurity Among Hispanic/Latino Youth: Who Is at Risk and What Are the Health Correlates?	United States (Bronx, Chicago, Miami, and San Diego)	16,415	Hispanic/Latino families selected from four major settlements.	Range 8 – 16	To examine the correlates and health implications of household food insecurity among Hispanic/Latino youth	Primary analysis	18-item USDA Food Security Survey Module	Household and child	Household food insecurity, child food insecurity, very low household food insecurity	12-item McMaster Family Functioning Scale	Household	Numeric scale 1–4 (with higher scores indicating higher severity)	Child demographic factors, Acculturation factors, socio-economic stress factors, family and social support	Family functioning vs household and child food insecurity	Youth in food insecure household experienced significantly lower family functioning. Strong family functioning was significantly negatively associated with all three food insecurity measures.
981	Fiese BH et al. (2016)	Family chaos and lack of mealtime planning is associated with food insecurity in low income households	United States (IL)	221	Parents participating in the Food and Family Project at 16 elementary schools in east Central Illinois	N/A	To understand the relation between food insecurity, family chaos, and mealtime planning	Primary analysis	6-item food security scale from Core Food Security Module (CFSM)	Household	Food Secure, Low Food Security, Very Low Food Security		Household	N/A	Parent Education, Marital Status, Parental Race and Ethnicity, Household Size, and Income	Household food insecurity status vs family dynamics (chaos measure)	Food secure households had less family chaos than food insecure. Not very low food secure (VLSF) households had less family chaos than VLSF.
494	Nebbitt VE et al. (2016)	Correlates of Food Security among Low-Resource Young People: An Assessment of Community Protective Factors within Public Housing Neighborhoods	United States (Baltimore)	151	African American adolescents and young adults living in public housing located in West Baltimore.	Range 18 – 29; Mean: 21 (SD: 2.7 years)	To assess how and whether household and community factors are associated with self-reported food security among young people living in public housing.	Primary analysis	Single item developed by community stakeholders	Household	Not at all, Sometimes, All the time	Family Conflict Scale	Household	Numeric Score of 1 – 4; with higher scores representing increased severity	Age, Gender, Employment Status, and Household Size	Household conflict vs Food security	Food security had a significant and inverse relationship with household conflict.
488	McIntyre L et al. (2012)	Coping with child hunger in Canada: have household strategies changed over a decade?	Canada	Cycle 2 (n = 7752), Cycle 7 (n = 15167)	Canadian children age 2–9 whose family participated in the National Longitudinal Survey of Children and Youth (NLSCY). Data used was collected between 1996–2007.	Children: 2–9	To determine if coping strategies have changed in Canadian families reporting child hunger between 1996 and 2007	Primary analysis	Single question in NLSCY to determine child hunger severity with additional question about frequency	Child	Child Hunger Severity: Regular, Occasional	12-item McMaster Family Functioning Scale	Household	Numeric score, with higher score indicating more dysfunction	Child female, person most knowledgeable (PMK) female, child age, PMK age, household size, own dwelling, household income, rural residence, immigrant, education, marital status, family functioning score, child has asthma, parental smoking, PMK health, child health, child in hospital past year.	Family Functioning Score vs Child Hunger	Child hunger is significantly associated with poor family functioning.
270	Joshi A et al. (2019)	Burden of household food insecurity in urban slum settings	Delhi, India	907	Participants were recruited from the New Delhi urban shelter improvement board, had to be 18 years or older, and residents of slums in New Delhi, India.	Mean (SD): 36 (13)	To examine the burden of food insecurity in India’s unnotified slums	Primary analysis	The Household Food Insecurity Access Scale	Household	Food secure, food insecure (mildly, moderately, severely)	The Percieved Need for Care Questionnaire (PCNQ)	Household	Needs for satisfactory family relationships: met, somewhat met, not met at all	None	Satisfactory family relationships vs food insecurity	Significantly higher mean household food insecurity scores among those whose needs for satisfactory family relationships were somewhat met and not met at all, compared to those whose needs were met
52	Wang M et al. (2022)	Adolescent Psychosocial Adjustment during COVID-19: An Intensive Longitudinal Study	United States	546	Adolescents age 13–18 from 38 states in the United State participating in an ongoing nationwide study during COVID-19 whose state government had issued stay-at-home orders.	Child: 13–18	To delineate the role of psychosocial and environmental factors in shaping youth’s emotional and behavioral well-being through the COVID-19 crisis	Secondary analysis	3-items from Child Food Security Survey Module	Household	Numeric score (higher score indicating more food secure)	4 items from Network of Relationship Inventory	Household	Numeric 5-point scale (higher score indicating higher conflict)	Numerical day of reporting and weekend, child age, child sex, child race, parent education, numeric day of the week reporting, child affect and behavioral problems	Food Insecurity vs child-parent conflict	Significant (weak) negative relationship between food security and parent-child conflict

The 15 included studies examined the association between food insecurity and family dynamics. One study did not find a significant association between food insecurity and intimacy or conflict, measured using family functioning scale. This study examined parenting-related measures among Rohingya and Afghan refugee parents residing in Malaysia, using a single question to assess food insecurity and the FFS to assess family dynamics¹³.

Four studies that found a significant association between food insecurity and family dynamics were categorized as finding moderate or weak associations between food insecurity and family dynamics or using only univariate analyses. One study examining the association between lack of financial, mental, familial, and social resources and the experience of hunger in families in Southeastern European found that worse family functioning showed univariate associations with family hunger¹⁴. The other studies in this category had significant yet weak associations between food insecurity and family dynamics^15–17.

The ten remaining studies found significant associations between food insecurity and various family dynamics and family functioning measures in unadjusted and adjusted analyses, in favor of the initial hypothesis. Helton et al examined parent-to-child aggression in relation to food insecurity and found that a greater deal of food insecurity was associated with increased rates of psychological, physical, and total aggression¹⁸. Lombe et al investigated the extent to which household- and community-level factors affected the likelihood of experiencing food hardship in public housing and found that youths in households experiencing interpersonal conflict and violence reported significantly more food insecurity than did youths in households not experiencing conflict and violence in their homes¹⁹. Drucker et al primarily studied the association of positive and negative life experiences with household food insecurity and reported that positive experiences in the family and other relationships were associated with a 22% lower odds of child hunger²⁰. Eagleton et al examined household chaos and family functioning in the context of food insecurity and found that household chaos was higher in both the child food insecure group and household food insecure groups, compared to the food secure group²¹. Additionally, family functioning was lower in the child food insecure group compared to the food secure group. Johnson et al set out to study the associations between food security across childhood developmental periods and various family well-being variables²². This study found that low and very low food security was associated with parental arguing and parental conflict negativity across various developmental periods of children, and that low and very low food security was also associated with harsh parental discipline when children were at preschool-age. Potochnick et al examined the correlates and health implications of household food insecurity among Hispanic and Latino youth and found that food insecure youth experienced greater acculturative stress, had access to fewer socioeconomic resources, and had more limited familial supports than their food secure peers²³. Additionally, they found strong family functioning was negatively associated with food insecurity measures. Fiese et al studied the relation between food insecurity, family chaos, and mealtime planning and found in bivariate comparisons, food secure households had less family chaos and more planning around mealtimes²⁴. A similar pattern was seen with a significant difference in family chaos among not – very low food security households compared with very low food security households. Additionally, in logistic regression models, family chaos was significantly associated with food insecurity though this relationship became non-significant when factoring in mealtime planning. Nebbitt et al assessed if household and community factors are associated with food security among young people living in public housing and found food security had a significant inverse association between household conflict in bivariate models²⁵. In multivariable regression models, a similar relationship was found with a negative association between food security and household conflict. An extended regression model suggested that the relationship between food security and household conflict is dependent/related on the presence of extended family in the same public housing location. McIntyre et al aimed to determine if coping strategies have changed in Canadian families reporting child hunger between 1996 and 2007 and found child hunger was significantly related to poor family functioning and lone-parent-led household²⁶. Joshi et al examined the burden of food insecurity in India’s unnotified slums and found food insecurity was significantly associated with basic needs around satisfactory family relationships being only somewhat met or not met at all, when compared to those whose needs were met²⁷.

Discussion

Primary findings from this systematic review show that a potential relationship exists between food insecurity and family dynamics. Though these findings suggest an association, we are unable to draw direct conclusions about the directionality or temporality of the relationship between food insecurity and family dynamics. It is important not to assume a causal relationship between family dynamics and family functioning. It is reasonable to posit that these two variables impact and affect one another and thus, future research questions should further explore how these two concepts influence one another. This is significant to highlight since this would help to illustrate structural and systemic issues underpinning negative family functioning and avoids placing blame on individuals or families for their experiences of food insecurity or family dynamics. Our study is the first to synthesize results examining the relationship between food insecurity and family dynamics, providing a deeper understanding of this complex relationship, and identifying future direction for further research in this domain.

We observed an association between food insecurity and family dynamics in 14 of 15 studies included in our study. Of these studies, the observed association was between the presence of food insecurity or an increased food insecurity measurement and negative family dynamics outcomes such as increased family conflict, decreased family functioning, and increased family chaos measurements. Eleven studies were conducted in the US and of these, 3 used nationally representative populations. We believe this illustrates the need for further research investigating the relationship between food insecurity and family dynamics using standardized measures of a nationally representative population in the US.

While there is a standardized and well-validated measure for food insecurity, only 7 of the 15 studies used the full or abbreviated USDA Food Insecurity Scale. Four studies used other validated modules or surveys to assess food insecurity, while the 4 remaining studies used a single item for assessment. Of the studies using a single item, 2 consulted a community advisory board or community stakeholders. Community representation plays an integral role in consolidating the academic-community partnership and has been accepted as best practice in community engaged research and community-based participatory research²⁸, making these single question items a strong alternative to using standardized measures. Thus, only 2 studies did not utilize a validated measure or a community-based alternative.

Unlike the USDA Food Insecurity Scale to measure FI, there is no gold standard to measure family dynamics, though standardized measures do exist. Family dynamics encompasses a broad collection of factors including family functioning, conflict, communication, interactions, and relationships, making a single measure of family dynamics complex. Ten of the included studies used what are considered standardized, well-validated measures of family dynamics; these include the Family Assessment Device (FAD) or Family Functioning Scale (FFS), the Family Conflict Scale for Conflict Tactics Scale, and the Confusion, Hubbub, and Order Scale (CHAOS). Five studies used another method to assess family dynamics including measurement of family routines, parent peer attachment, family relationships, and perceived need for care. Though most of these are a standardized measure of these variables, we consider them to be a less commonly used and indirect measure of family dynamics. It is important to note that there exists a separate body of literature around adverse childhood experiences (ACEs), and none of the studies included within this analysis measure or study ACEs in relation to food insecurity.

The literature reviewed in this study reveals a strong negative association between food insecurity and various measures of family functioning and dynamics. Food insecurity is known to have severe effects on health outcomes²⁹ and well-being³⁰ of individuals. The findings in this review suggest that the effects of food insecurity may also expand to various aspects of healthy family functioning. With a large body of literature that demonstrates the impact of family dynamics on health⁴ and well-being⁵, it is also possible that family dynamics play a role in mediating the relationship between food insecurity and health. Unhealthy family dynamics in childhood can also expose children to trauma and lead to increased physical and mental health disorders in the future³¹.

Limitations

Firstly, while standard practices for conducting systematic reviews were followed, it is possible that primary studies related to the topic of study were missed. However, this was likely minimized by the simultaneous use of three databases to conduct searches. Second, many of the studies included in this systematic review were evaluating associations between family dynamics and food insecurity as a secondary outcome or analysis and may not have been designed to answer the primary question of this review. Lastly, data obtained from included studies do not present themselves in a way that might be conducive for meta-analysis to better answer the primary question of the systematic review, necessitating further primary research in the topic.

Conclusion

A systematic review of the literature reveals a strong and significant association between food insecurity and family dynamics, that would benefit from further study. These findings illustrate potential relationships between food insecurity and numerous family functioning and dynamics measures including parent-to-child aggression, household chaos, household conflict and violence, family support, and poorer satisfaction with family relationships. Family dynamics may mediate the relationship between food insecurity and health, thus demonstrating the need for further direct study of the impact of food insecurity on family dynamics and functioning.