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CENTER FOR NUTRITION POLICY AND PROMOTION 2 Expenditures on Children by Families, 1995 MarkLino Joanne F. Guthrie Research Summaries SO The American Diet: Health and Economic Consequences 53 Influence of OASDI and SSI Payments on Poverty Status of Families With Children 56 Improving Federal Efforts to Assess Hunger and Food Insecurity 58 Umited Financial Resources Constrain Food Choices Regular Items 60 Charts From Federal Data Sources 62 Recent Legislation Affecting Families 63 Research and Evaluation Activities in USDA 65 Data Sources 66 Journal Abstracts Poverty Thresholds Cost of Food at Home Consumer Prices Dan Glickman, Secretary U.S. Department of Agricultu re Ellen Haas, Under Secretary Food. Nutri tion, and Consumer Services Eileen Kennedy, Executive Director Center for Nutrition Policy and Promotion Jay Hirschman, Director utrition Policy and Analysis Staff Editorial Board Mohamed Abdei-Ghany University of Alabama Rhona Applebaum 0/ational Food Processors Association Johanna Dwyer ew England Medical Center Jean Mayer USDA Human utrition Research Center on Aging at Tufts University Helen Jensen Iowa State University Janet C. King \Ve~tern Human Nutrition Research Center U.S. Department of Agriculture C. J. Lee Kentucky State University Rebecca Mullis Georgia State ·Univ.ersi ty Suzanne Murphy University of California-Berkeley Donald Rose Economic Research Service U.S. Department of Agriculture Ben Senauer University of Minnesota Laura Sims University of Maryland Retia Walker Universi ty of Kentucky Editor Joan C. Courtless Managing Editor Jane W. Fleming Family Economics and Nutrition Review is written and published each quarter by the Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, Washington, DC. The Secretary of Agriculture has determined that publication of this periodical is necessary in the transaction of the public business required by law of the Department. This publication is not copyrighted. Contents may be reprinted without permission, but credit to Family Economics and Nutrition Review would be appreciated. Use of commercial or trade names does not imply approval or constitute endorsement by USDA. Family Economics and Nutrition Review is indexed in the following databases: AGRICOLA, Ageline, Economic Literature Index, ERIC, Family Resources, PAIS, and Sociological Abstracts. Family Economics and Nutrition Review is for sale by the Superintendent of Documents. Subscription price is $8.00 per year ($1 0.00 for foreign addresses). Send subscription orders and change of address to Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. (See subscription form on p. 72.) Original manuscripts are accepted for publication (See "guidelines for authors" on p. 71 ). Suggestions or comments concerning this publication should be addressed to: Joan C. Courtless, Editor, Family Economics and Nutrition Review, Center for Nutrition Policy and Promotion, USDA, 1120 20th St., NW, Su~e 200 North lobby, Washington, DC 20036. Phone (202) 60&4816. USDA prohib~ discrimination in ~ programs on the basis of race, color, national origin, sex, religion, age, disability, political beliefs, and marital or familial status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact the USDA Office of Communications at (202) 720-2791 . To file a complaint, write the Secretary of Agriculture, U.S. Department of Agriculture, Washington, DC 20250, or call (202) 720-7327 (voice) or (202) 72D-1127 (TOO). USDA is an equal employment opportunity employer. oc1nc1 1v1 '"uu1uun r-u11cy ana t"romotlon Feature Articles 2 21 33 Expenditures on Children by Families, 1995 MarkLino Assessment of Energy Intakes in the U.S. Population, 1989-91 Howard Riddick Dietary Patterns and Personal Characteristics of Women Consuming Recommended Amounts of Calcium Joanne F. Guthrie Research Summaries 50 The American Diet: Health and Economic Consequences 53 Influence of OASDI and SSI Payments on Poverty Status of Families With Children 56 Improving Federal Efforts to Assess Hunger and Food Insecurity 58 Limited Financial Resources Constrain Food Choices Regular Items 60 62 63 65 66 67 68 69 Charts From Federal Data Sources Recent Legislation Affecting Families Research and Evaluation Activities in USDA Data Sources Journal Abstracts Poverty Thresholds Cost of Food at Home Consumer Prices Volume 9, Number 3 1996 I 2 Feature Articles Expenditures on Children by Families, 1995 By Mark Lino Economist Center for Nutrition Policy and Promotion Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This article presents the most recent estimates for husband-wife and single-parent families using data from the 1990-92 Consumer Expenditure Survey, updated to 1995 dollars using the Consumer Price Index. Data and methods used in calculating child-rearing expenses are described. Estimates are provided for major components of the budget by age of child, family income, and region of residence. Expenses on the younger child in a two-child, husband-wife household for the overall United States averaged between $5,490 and $12,550 per year, depending on the child's age and family income group. Adjustment factors for number of children in the household are also provided. Results of this study can be used in developing State child support guidelines and foster care payments as well as in family educational programs. []] ince 1960, the U.S. Department of Agriculture (USDA) has provided estimates of expenditures on children from birth through age 17. These estimates are used in setting child support guidelines, foster care payments, and in educational programs on parenthood. This study presents the latest childrearing expense estimates, which are based on 1990-92 expenditure data updated to 1995 dollars. The study presents these new estimates for husbandwife and single-parent families. It briefly describes the data and methods used in calculating child-rearing expenses 1 and then discusses the estimated expenses. The estimates are provided for the United States overall. To partially adjust for price differentials and varying pattetns of expenditures, the child-rearing expense estimates for husband-wife families are also provided for urban areas in four regions (Northeast, South, Midwest, and West) and rural areas throughout the United States.2 For single-parent families, estimates are 1The report "Expenditures on Children by Families: 1995 Annual Report" provides a more detailed description of the data and methodology. To obtain a copy, contact: USDA, Center for Nutrition Policy and Promotion, 1120 20th Street NW, Suite 200 North Lobby, Washington, DC 20036 (Telephone Number: 202-208-2417). 2Urban areas are defined as Metropolitan Statistical Areas (MSA' s) and other places of 2,500 or more people outside an MSA; rural areas are places of less than 2,500 people outside an MSA. Family Economics and Nutrition Review Categories of Household Expenditures Housing expenses include shelter (mortgage interest, property taxes, or rent; maintenance and repairs; and insurance), utilities (gas, electricity, fuel, telephone, and water), and house furnishings and equipment (furniture, floor coverings, major appliances, and small appliances). It should be noted that for homeowners, housing expenses do not include mortgage principal payments; such payments are considered in the Consumer Expenditure Survey to be part of savings. So, total dollars allocated to housing by homeowners are underestimated in this report. Food expenses include food and nonalcoholic beverages purchased at grocery, convenience, and specialty stores, including purchases with food stamps; dining at restaurants; and household expenditures on school meals. Transportation expenses include the net outlay on purchase of new and used vehicles, vehicle finance charges, gasoline and motor oil, maintenance and repairs, insurance, and public transportation. Clothing expenses include children's apparel such as diapers, shirts, pants, dresses, and suits; footwear; and clothing services such as dry cleaning, alterations and repair, and storage. Health care expenses include medical and dental services not covered by insurance, prescription drugs and medical supplies not covered by insurance, and health insurance premiums not paid by employer or other organization. Child care and education expenses include day care tuition and supplies; baby-sitting; and elementary and high school tuition, books, and supplies. Miscellaneous expenses include personal care items, entertainment, and reading materials. provided only for the United States overall because of sample size limitations. Expenditures on children are estimated for the major budgetary components: The CE has been conducted annually since 1980 and interviews about 5,000 households each quarter over a 1-year period. Each quarter is deemed an independent sample by BLS, bringing the total number of households in the 1990- 92 survey to about 60,000. major sources of income, such as wages and salaries, self-employment income, and Social Security income. Quarterly expenditures were annualized. The sample consisted of 12,850 husbandwife households and 3,395 singleparent households and was weighted Housing, food, transportation, clothing, health care, child care and education, and miscellaneous goods and services. The box shown above describes each expenditure component. Source of Data Data used to estimate expenditures on children are from the 1990-92 Consumer Expenditure Survey (CE), administered by the Bureau of Labor Statistics (BLS). The CE collects information on sociodemographic characteristics and income of households as well as expenditures. From these households, husband-wife and single-parent families were selected for this study if: ( 1) they had at least one child of their own, age 17 or under, in the household, (2) they had six or fewer children, (3) there were no other related or unrelated people present in the household except their own children, and (4) they were complete income reporters. Complete income reporters are households that provide values for to reflect the U.S. population of interest, using BLS weighting methods. Although based on 1990-92 data, the expense estimates were updated to 1995 dollars using the Consumer Price Index (CPI-U) (1990 and 1991 expenditure and income data were first converted to 1992 dollars; then all 3 years of data were updated to 1995 dollars). 1996 Vol. 9 No.3 3 Methodology The CE collects overall household expenditure data for some budgetary components (housing, food, transportation, health care, and miscellaneous goods and services) and child-specific expenditure data for other components (clothing, child care, and education). Multivariate analysis was used to estimate household and child-specific expenditures, controlling for income level, family size, and age of the younger child so estimates could be made for families with these varying characteristics. Regional estimates were derived by controlling for region. The three income groups of husband-wife households (before-tax income under $31,000, between $31,000 and $52,160, and over $52,160 in 1992 dollars) were determined by dividing the sample for the overall United States into equal thirds. For each income level, the estimates were for husband-wife families with two children, with the younger child in one of six age categories (0-2, 3-5, 6-8, 9-11, 12-14, and 15-17 years). Households with four members (two children) were selected as the standard since this was the average size of two-parent families in 1990-92. The focus was on the younger child in a household since the older child was sometimes over age 17. It should be noted that the estimates are based on CE interviews of households with and without specific expenses; so for some families, expenditures may be higher or lower than the mean estimates, depending on whether they incur the expense or not. This particularly applies to child care and education for which about 50 percent of families in the study had no expenditure. Also, the estimates only cover out-of-pocket expenditures on children made by the parents and not 4 by others such as grandparents or friends. For example, the value of clothing gifts to children from grandparents would not be included in clothing expenses. On the other hand, some of the expenditures reported by parents may be gifts for children other than their own. Regional income categories are based on the national income categories in 1992 dollars, updated to 1995 dollars using regional CPI' s. The regional income categories are not divided into equal thirds for each region. As previously mentioned, the three income categories were calculated for the overall United States by dividing the sample into equal thirds. After the various overall household and child-specific expenditures were estimated, these total amounts were allocated amo~'g the four family members (husband, wife, older child, and younger child). The estimated expenditures for clothing and child care and education were only for children. It was assumed that these expenses were equally allocated to each child so the estimated expenditures were divided by two (the number of children in the household). Because the CE did not collect expenditures on food and health care by family member, data from other Federal studies were used to apportion these budgetary components to children by age. Food budget shares as a percentage of total food expenditures, for the younger child in a husband-wife household with two children, were determined using the 1994 USDA food plans (8). These shares were estimated by age of the child and household income level. The food budget shares were then applied to estimated household food expenditures to determine food expenses on children. Health care shares as a percentage of total health care expenses for the younger child in a husband-wife household with two children were calculated from the 1987 National Medical Expenditure Survey (NMES) (5). These shares were estimated by age of the child and applied to estimated household health care expenditures to determine expenses on children. Unlike food and health care, no research base exists for allocating estimated household expenditures on housing, transportation, and miscellaneous goods and services among individual household members. Two of the most common approaches for allocating these expenses are the marginal cost method and the per capita method. The marginal cost method measures expenditures on children as the difference in expenses between couples with children and equivalent childless couples. The method depends on development of an equivalency measure; however, there is no universally accepted measure. Various methods have been proposed, each yielding different estimates of expenditures on children.3 Some of the marginal cost approaches assume that parents do not alter their expenditures on themselves after a child is added to a household. In addition, couples without children often buy homes larger than they need at the time of purchase in anticipation of children. Comparing the expenditures of these couples to similar couples with children could lead to underestimates of expenditures on children. 3For a review of equivalency measures and estimates of expenditures on children resulting from them, see U.S. Department of Health and Human Services, Administration for Children and Families, 1990, Estimates of Expenditures on Children and Child Support Guidelines ( 10). Family Economics and Nutrition Review For these reasons, the USDA uses the per capita method to allocate housing, transportation, and miscellaneous goods and services among household members. The per capita method simply allocates expenses among household members in equal proportions. Although the per capita method has its limitations, these limitations were considered less severe than those of the marginal cost approach. A major limitation of the per capita method is that expenditures for an additional child may be less than average expenditures. Because of this, adjustment formulas for cases of one child or three or more children were devised for use when estimating expenditures on children for households of different sizes. These formulas are discussed later on. Transportation expenses resulting from employment activities are not related to expenses on children, so these costs were excluded from the estimated household transportation expenses using data from a 1990 study by the U.S. Department of Transportation ( 11 ). Although the USDA utilizes the per capita approach rather than a marginal cost approach in allocating housing, transportation, and miscellaneous expenditures to children in a household, a USDA study (6) examined how these expenses would be allocated using different marginal cost approaches. These approaches produced estimates of expenditures on children for housing and miscellaneous goods and services below-and estimates of transportation expenditures on children above-those produced by the per capita method. 1996 Vol. 9 No.3 Figure 1. Estimated 1995 annual family expenditures on a child, by before-tax income level and age of child1 Dollars 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 0-2 3-5 6-8 9-11 12-14 15-17 Age of child 0 Less than $33,700 • $33,700- $56,700 • More than $56,700 1U.S. average for the younger child in husband-wife families with two children. Estimated Expenditures on Children by Husband-Wife Households Estimates of family expenditures on the younger child in husband-wife households with two children for the overall United States, urban regions of the country, and overall rural areas are presented in tables 2 through 7 on pp. 14-20. Income levels of households were updated to 1995 dollars using the all-items category of the CPI-U, and expenditures were updated using the CPI for the corresponding item (that is, the CPI's for housing, food, etc.). Regional estimates were updated to 1995 dollars using the regional CPI's. Given the large amount of information in the tables, the following subsections highlight the child-rearing expense estimates for the younger child in a two-child household for the overall United States by income level, budgetary component, and age of the child, as well as expense estimates by region. Income Level Estimated expenses on children vary considerably by household income level (fig. 1). Depending on age of the child, the annual expenses range from $5,490 to $6,560 for families in the lowest income group (1995 before-tax income less than $33,700), from $7,610 to $8,710 for families in the middle-income group (1995 before-tax income between $33,700 and $56,700), and from $11 ,320 to $12,550 for families in the highest 5 6 As a proportion of total child-rearing expenses, housing accounts for the largest share ... income group (1995 before-tax income more than $56,700). On average, households in the lowest group spend 28 percent of their before-tax income per year on a child, those in the middle-income group, 18 percent, and those in the highest income group, 14 percent. The range in these percentages would be narrower if after-tax income were considered, since a greater proportion of income in higher income households goes toward taxes. Although families in the highest income group spend slightly less than twice the amount that families in the lowest income group spend on a child, on average, the amount varies by budgetary component. In general, expenses on a child for goods and services considered to be necessities (such as food and clothing) do not vary as much as those considered to be discretionary (such as miscellaneous expenses) among households in the three income groups. For example, clothing expenses on a child age 15-17 average $670 in the lowest income group and $1,010 in the highest income group, a 51-percent difference. Miscellaneous expenses on the same age child average $560 in the lowest income group and $1 ,420 in the highest income group, a 154-percent difference. Budgetary Component As a proportion of total child-rearing expenses, housing accounts for the largest share; figure 2 shows this for families in the middle-income group. Based on an average for the six age groups, housing accounts for 33 percent of child-rearing expenses for a child in Figure 2, Estimated family expenditures on a child through age 17, by budgetary share 1 Transportation 15% Clothing Health care and education Housing Miscellaneous Total Expenditures in 1995 dollars= $145,320 1 Estimates are for the younger child in middle-income (1995 before-tax income between $33,700 and $56,700), husband-wife families with two children. Family Economics and Nutrition Review Figure 3. Estimated 1995 annual family expenditures on a child, by age and budgetary share 1 Percent $7,610 $7,810 $7,870 $7,860 $8,580 $8,710 100 Miscellaneous Child care & education 80 Clothing Health care 60 Transportation 40 Food 20 Housing 0 0-2 3-5 6-8 9-11 12-14 15-17 Age of child 1U.S. average for the younger child in middle-income (1995 before-tax income between $33,700 and $56,700), husband-wife families with two children. the lowest and middle-income groups and 37 percent in the highest income group. Food is the second largest average expense on a child for families regardless of income level, accounting for 20 percent of child-rearing expenses for a child in the lowest income group, 18 percent in the middle-income group, and 15 percent in the highest income group. Transportation is the third largest child-rearing expense, making up 14 to 15 percent of child-rearing expenses across income levels. Miscellaneous goods and services (personal care items, entertainment, and reading materials) is the fourth largest expense on a child for families in all income groups. Clothing accounts for 6 to 8 percent of expenses on a child for families in the three income groups. 1996 Vol. 9 No.3 These estimates of children's clothing expenses do not include clothing received in the form of gifts or hand-me-downs. Child care and education are 7 to 10 percent and health care, 5 to 7 percent of child-rearing expenses across income groups. For health care, these estimated expenditures include only out-of-pocket expenses and not that portion covered by health insurance. Age of Child Expenditures on a child are lower in the younger age categories and higher in the older age categories. This held across income groups (fig. 3 depicts this for families in the middle-income group) even though housing expenses, the highest child-rearing expenditure, generally decline as the child grows older. The decline in housing expenses reflects diminishing interest paid by homeowners over the life of a mortgage. Payments on principal are not considered part of housing costs in the CE; they are deemed to be part of savings. Child-rearing food, transportation, clothing, and health care expenses generally increase over the age of a child for all three income groups. Transportation expenses are highest for a child age 15-17, when he or she would start driving. Child care and education expenses are highest for a child under age 6. Most of this expense may be attributable to child care at this age. The estimated expense for child care and education may seem low for those with the expense. However, as previously discussed, the estimates reflect the average of households with and without the expense. 7 Region Child-rearing expenses in the various regions of the country reflect patterns observed in the United States overall. In each region, expenses on a child increase with income level of the household and, generally, with age of the child. Overall child-rearing expenses are highest in the urban West, followed by the urban Northeast, and urban South; figure 4 shows total child-rearing expenses by region and age of a child for middle-income families. Childrearing expenses are lowest in the urban Midwest and rural areas. Much of the difference in expenses on a child among regions is related to housing costs. Total housing expenses on a child are highest in the urban West and urban Northeast and lowest in rural areas. However, child-rearing transportation expenses are highest for families in rural areas. This likely reflects the longer distances that must be traveled and the lack of public transportation in these areas. Adjustments for Older Children and Household Size The expense estimates on a child represent expenditures on the younger child at various ages in a husband-wife household with two children. It cannot be assumed that expenses on the older child are the same at these various ages. Expenses may vary by birth order. To determine whether a difference exists, the extent of this difference, and how the expenditures may be adjusted to estimate expenses on an older child, the method described on pp. 4-5 was repeated, with the focus being on the older child in each of the same age categories as used with the younger child. A family with two children was again used as the standard. Household income and region of residence were not held constant, so fmdings are applicable to all families. 8 Figure 4. Estimated 1995 annual family expenditures on a child, by region and age 1 Dollars 10,000 9,500 9,000 8,500 8,000 7,500 7,000 6,500 -A - 0 A 0 0 0·2 3·5 6-8 9-11 12-14 15-17 Age of child Urban Midwest . -11-- Rural Urban South Urban Northeast Urban West "" --4- -->!<- n 1U.S. average for the younger child in middle-income, husband-wife families with two children. For the urban West, the middle-income group had a 1995 before-tax income between $33,500 and $56,400; for the urban Northeast, between $33,500 and $56,300; for the urban South, between $33,800 and $56,900; for the urban Midwest, between $33,800 and $56,900; and for rural areas, between $34,000 and $57,200. It was found that, on average, husbandwife households with two children spend about the same amount on a younger and older child (except for differences caused by age). So, the figures in tables 2 through 7 reflect expenditures on either child in a two-child family. Thus, annual expenditures on children in a husband-wife, two-child family may be estimated by summing the expenses for the two appropriate age categories. For example, annual expenditures on children ages 9-11 and 15-17 in a husband-wife family in the middle income group for the overall United States would be $16,570 ($7,860 + $8,710). It should be noted that for specific budgetary components, annual expenses on an older child vary, compared with those on a younger child. Families spend more on clothing and education for an older child, but less on transportation. The estimates should also be adjusted if a household has only one child or more than two children. Families will spend more or less on a child depending on the number of other children in the household and economies of scale. To derive these adjustments, multivariate analysis was used to estimate expenditures for each budgetary component controlling for household size and age of the younger child, but not household income level and region of the country, so the results are applicable to all families. Family Economics and Nutrition Review Expenditures on Children Over Time Since 1960, the U.S. Department of Agriculture (USDA) has been providing estimates of expenditures on children from birth through age 17. The original estimates were based on the 1960 Consumer Expenditure Survey. The figure below examines how these expenditure estimates have changed over time at 5-year intervals. Depicted are the average total expenditures on a child from birth through age 17 in a middle-income husband-wife family. Expenditures are in nominal (not adjusted for inflation) dollars. Expenses to raise a child to age 18 have dramatically increased, from $25,230 in 1960 to $145,320 in 1995. Even when adjusted for inflation and converted into 1995 dollars, real expenditures on children have risen-from approximately $129,900 in 1960. Among factors causing this increase are new components of child-rearing costs, particularly child care. In 1960, child care expenses were negligible as many mothers were not in the labor force. In 1995, child care expenses were among the largest expenditures made on preschool children by middle-income families. The original intent of USDA's research on expenditures on children was primarily educational: expenditure estimates on child-rearing were to be used in financial planning guides and budgeting programs. Although still used for this purpose, the child-rearing expense estimates have gained new applications, such as in developing State child support guidelines and foster care payments. These new uses of the child-rearing expense estimates reflect the changing structure of families with children in the United States and thus, the importance of the ongoing nature of this area of research. Total expenditures on a child for the first 18 years of life1 1 Not adjusted for inflation $160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 $145,320 0 L-------------~-------------------------- 1960 65 70 75 80 85 90 95 Average expenditures for a middle-income husband-wife family, not adjusted for inflation. 1996 Vol. 9 No.3 These expenditures were then assigned to a child using the method previously described. Compared with expenditures ·for each child in a husband-wife, two-child family, husband-wife households with one child spend an average of 24 percent more on the single child, and those with three or more children spend an average of 23 percent less on each child. Therefore, to adjust the figures in tables 2 through 7 to estimate annual overall expenditures on an only child, 24 percent should be added to the total expense for the child's age category. To estimate expenditures on three or more children, 23 percent should be subtracted from the total expense for each child's age category, and these totals should be summed. As an example of adjustments needed for different numbers of children, the total expenses for a middle-income family in the overall United States on a child age 15-17 with no siblings would be $10,800 ($8,710 x 1.24) and the total expenses on three children ages 3-5, 12-14, and 15-17 would be $19,330 (($7,810 + $8,580 + $8,710) x .77). For a particular budgetary component, the percentages may be more or less. As family size increases, costs per child for food decrease less than for housing and transportation. Expenditures by Single-Parent Families The estimates of expenditures on children by husband-wife families do not apply to single-parent families, which account for an increasing percentage of families with children. Therefore, separate estimates of child-rearing expenses in single-parent households were made using the CE data. Most single-parent families in the survey (90 percent) were headed by a woman. 9 The method used in determining child-rearing expen es for two-parent households was followed. Multivariate analysis was u ed to estimate expenditures for each budgetary component, controlling for income level, household size (a single parent with two children was used as the tandard), and age of the younger child (the same age categories as u ed with children in two-parent families). Income group of single-parent households (before-tax income under $31,000 and $31 ,000 and over in 1992 dollars; these income groups were inflated to 1995 dollars in the table) were selected to correspond with the income groups used in estimating child-rearing expenditures in husband-wife households. This income includes child support payments. The two higher income groups of two-parent families (income between $31 ,000 and $52, 160 and over $52,160 in 1992 dollars) were combined because only 17 percent of singleparent households had a before-tax income of $31 ,000 and over. The sample was weighted to reflect the U.S. population of interest. Children's clothing and child care and education expenditures were divided between the two children in the oneparent household. For food and health care, household member shares were calculated for a three-member household (single parent and two children, with the younger child in one of the six age categories) using the USDA food plans and the 1987 NMES findings. These shares for the younger child in a single-parent family were then applied to estimated food and health care expenditures to determine expenses on the younger child in each age category. 10 Housing, transportation, and miscellaneous expenditures were allocated among household members on a per capita basis. Transportation expenses were adjusted to account for nonemploymentrelated activities in single-parent families. Income and expenses were updated to 1995 dollars. Child-rearing expense estimates for single-parent families are in table 8, p. 20. For the lower income group (1995 before-tax income less than $33,700), a comparison of estimated expenditures on the younger child in a single-parent family with two children with those of the younger child in a husband-wife family with two children is presented in table 1, p. 12; as previously discussed, 83 percent of single-parent families and 33 percent of husband-wife families were in this lower income group. More single-parent than husband-wife families fell in the bottom range of this lower income group. Average income for single-parent families in the lower income group is $14,100, compared with $21 ,000 for husband-wife families in this income group. However, total expenditures on a child through age 17 are, on average, only 5 percent lower in single-parent households than in two-parent households. Single-parent families in this lower income group, therefore, spend a larger proportion of their income on children. On average, housing expenses are higher, whereas transportation, health care, child care and education, and miscellaneous expenditures on a child are lower in single-parent than in husband-wife households. Childrelated food and clothing expenditures are similar, on average, in single-parent and in two-parent families. ... total expenditures on a child through age 17 are, on average, only 5 percent lower in single-parent households than in two-parent households. Family Economics and Nutrition Review Estimating Future Costs The estimates presented in this study represent household expenditures on a child of a certain age in 1995. To estimate these expenses for the first 17 years, future price changes need to be incorporated in the figures. To do this, a future cost formula is used such that: CJ = Cp(J + i)n where: CJ = projected future annual dollar expenditure on a child of a particular age Cp = present ( 1995) annual dollar expenditure on a child of a particular age i =projected annual inflation (or deflation) n = number of years from present until child will reach a particular age An example of estimated future Estimated annual expenditures on a child born in 1995, by income group1 expenditures on the younger child in a husband-wife family with two Income group children for each of the three income Year Age Lowest Middle Highest groups for the overall United States is presented. The example assumes a child is born in 1995, reaching 1995 <1 $5,490 $7,610 $11,320 age 17 in the year 2012, and the 1996 1 5,790 8,020 11,930 average annual inflation rate over 1997 2 6,100 8,450 12,580 this time is 5.4 percent (the average 1998 3 6,570 9,140 13,510 annual inflation rate over the past 1999 4 6,920 9,640 14,240 20 years) (9). As can be seen, total family expenses on a child through 2000 5 7,300 10,160 15,010 age 17 would be $176,420, $238,840, 2001 6 7,870 10,790 15,770 and $346,980 for households in the 2002 7 8,290 11 ,370 16,620 lowest, middle-, and highest income 2003 8 8,740 11 ,990 17,520 groups, respectively. In 1995 dollar 2004 9 9,260 12,620 18,350 values, these figures would be $106,890, $145,320, and $211 ,830. 2005 10 9,760 13,300 19,340 2006 11 10,290 14,020 20,380 Inflation rates other than 5.4 percent 2007 12 12,330 16,130 23,060 could be substituted into the formula 2008 13 13,000 17,000 24,310 if projections of these rates vary in the 2009 14 13,700 17,920 25,620 future. Also, it is somewhat unrealistic 2010 15 14,220 19,170 27,620 to assume that households remain in one income category as a child grows 2011 16 14,990 20,210 29,110 older. For most families, income rises 2012 17 15,800 21 ,300 30,690 over time. In addition, such projections Total $176,420 $238,840 $346,980 assume child-rearing expenditures change only with inflation, but parental I Estimates are for the younger child in husband-wife families with two children for the overall United expenditure patterns also change over States. time. 1996 Vol. 9 No. 3 11 Table 1. A comparison of estimated 1995 expenditures on a child by lower income single-parent and husband-wife families1 Single-parent Husband-wife Age of child households households 0-2 $4,650 $5,490 3-5 5,220 5,610 6-8 5,900 5,740 9- 11 5,510 5,770 12- 14 5,940 6,560 15- 17 6,640 6,460 Total (0 - 17) $101,580 $106,890 1Estimates are for the younger child in two-child families in the overall United States with 1995 beforetax income less than $33,700. For the higher income group of singleparent families (1995 before-tax income of $33,700 and over), child-rearing expense estimates are about the same as those for two-parent households in the before-tax income group of $56,700 and over; total expenses for the younger child through age 17 are $213,240 for single-parent families versus $211,830 for husband-wife families in 1995 dollars. Child-rearing expenses for the higher income group of single-parent families, therefore, also consume a larger proportion of income than in husband-wife families. It appears that expenditures on children do not differ very much between single-parent and husband-wife households. What differs is household income levels. As single-parent families have one less potential earner, on average, their total household income is lower and child-rearing expenses are a greater percentage of this income. Estimates only cover out-of-pocket childrearing expenditures made by the parent with primary care of the child and do not include child-related expenditures 12 made by the parent without primary care or others, such as grandparents. Such expenditures could not be estimated from the data. Overall expenses by both parents on a child in a single-parent household are likely greater than this study's estimates. To determine the extent of the difference in expenditures on an older child in single-parent households, the previous procedure was essentially repeated with the focus being on the older child. A family with two children was used as the standard. On average, single-parent households with two children spend 7 percent less on the older than on the younger child (in addition to differences caused by age). This contrasts with husband-wife households that spend about the same amount on the older and younger child. As with husband-wife households, more or less is spent if a single-parent household has only one child or three or more children. To determine these differences, multivariate analysis was used to estimate expenditures for each budgetary component controlling for household size and age of the younger child. These expenditures were then assigned to a child using the previous method. Compared with expenditures for the younger child in a single-parent, twochild family, single-parent households with one child spend an average of 35 percent more on the single child, and those with three or more children spend an average of 28 percent less on each child. Other Expenditures on Children Expenditures on a child estimated in this study are composed of direct parental expenses made on a child through age 17 for seven major budgetary components. These direct expenditures exclude costs related to childbirth and prenatal health care. In 1991, these particular health care costs averaged $4,720 for a normal delivery and $7,826 for a cesarean delivery (3). These costs may be reduced by health insurance. One of the largest expenses made on children after age 17 is the cost of a college education. The College Board (2) estimates that in 1995-96, average annual tuition and fees are $2,760 at 4-year public colleges and $10,514 at 4-year private colleges; annual room and board is $3,847 at 4-year public colleges and $4,535 at 4-year private colleges. For 2-year colleges in 1995-96, average annual tuition and fees are $1 ,405 at public colleges and $6,564 at private colleges; annual room and board is $3,997 at 2-year private colleges (no estimates are given for 2-year public colleges). Other parental expenses on children after age 17 include those associated with children living at home or, if children do not live at home, gifts and other contributions to them. Family Economics and Nutrition Review The estimates do not include all government expenditures on children. Examples of excluded expenses would be public education, Medicaid, and school meals. The actual expenditures on children (by parents and the government) would . be higher than reported in this study, especially for the lowest income group. Indirect costs involved in child rearing are also not included in the estimates. Although these costs are typically more difficult to measure than direct expenditures, they can be substantial. The time involved in rearing children is considerable. In addition, one or both parents may need to cut back on hours spent in the labor force to care for children, thus reducing current earnings and future career opportunities. The indirect costs ?f child rearing may very likely exceed the direct costs. For more on these indirect costs, see Bryant et al. (1), Ireland and Ward (4), and SpalterRoth and Hartmann (7). 1996 Vol. 9 No. 3 References 1. Bryant, W.K., Zick, C.D., and Kim, H. 1992. The Dollar Value of Household Work. College of Human Ecology, Cornell University, Ithaca, NY. 2. The College Board. 1995. News from the College Board. September 25 issue. 3. Health Insurance Association of America. 1994. Source Book of Health Insurance Data, 1994 ed. Washington, DC. 4. Ireland, T.R. and Ward, J.O. 1995. Valuing Children in Litigation: Family and Individual Loss Assessment. Lawyers and Judges Publishing Company, Inc., Tucson, AZ. 5. Lefkowitz, D. and Monheit, A. 1991. Health Insurance, Use of Health Services, and Health Care Expenditures. National Medical Expenditure Survey Research Findings 12. U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research Publication No. 92-0017. 6. Lino, M. and Johnson, D.S. 1995. Housing, transportation, and miscellaneous expenditures on children: A comparison of methodologies. Family Economics Review 8( 1):2-12. 7. Spalter-Roth, R.M. and Hartmann, H.I. 1990. Unnecessary Losses: Costs to Americans of the Lack of Family and Medical Leave. Institute for Women's Policy Research, Washington, DC. 8. U.S. Department of Agriculture, Agricultural Research Service. 1994. Cost of food at home. Family Economics Review 7(4):45. 9. U.S. Department of Commerce, Bureau of the Census. 1995. Statistical Abstract of the United States: 1995 (115th ed.). I 0. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. 1990. Estimates of Expenditures on Children and Child Support Guidelines. 11. U.S. Department of Transportation, Federal Highway Administration. 1994. 1990 Nationwide Personal Transportation Study. 13 Table 2. Estimated annual expenditures* on a child by husband-wife families, overall United States, 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneoust Income: Less than $33,700 (Average=$21,000) 0-2 $5,490 $2,100 $780 $700 $370 $370 $630 $540 3-5 5,610 2,080 870 680 360 360 710 550 6-8 5,740 2,010 1,120 790 410 410 420 580 9-11 5,770 1,810 1,340 860 450 450 250 610 12-14 6,560 2,020 1,410 970 760 450 180 770 15-17 6,460 1,630 1,520 1,300 670 480 300 560 Total $106,890 $34,950 $21 '120 $15,900 $9,060 $7,560 $7,470 $10,830 Income: $33,700 to $56,700 (Average=$44,800) 0-2 $7,610 $2,840 $930 $1 ,050 $440 $490 $1,030 $830 3-5 7,810 2,820 1,080 1,020 430 470 1,140 850 6-8 7,870 2,750 1,370 1 '130 470 540 730 880 9-11 7,860 2,550 1,620 1,200 520 580 480 910 12-14 8,580 2,760 1,630 1,310 880 590 350 1,060 15-17 8,710 2,370 1,810 1,660 790 620 600 860 Total $145,320 $48,270 $25,320 $22,110 $10,590 $9,870 $12,990 $16,170 Income: More than $56,700 (Average=$84,800) 0-2 $1 1,320 $4,520 $1 ,240 $1,470 $580 $560 $1 ,550 $1,400 3-5 11 ,540 4,490 1,400 1,440 570 540 1,690 1,410 6-8 11 ,500 4,420 1,690 1,550 620 620 1 '160 1,440 9-11 11,430 4,230 1,960 1,620 670 670 810 1,470 12-14 12,270 4,440 2,060 1,730 1,120 670 620 1,630 15-17 12,550 4,050 2,170 2,100 1,010 710 1,090 1,420 Total $211 ,830 $78,450 $31 ,560 $29,730 $13,710 $11 ,310 $20,760 $26,310 "Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. t Miscellaneous expenses include personal care items, entertainment, and reading materials. 14 Family Economics and Nutrition Review Table 3. Estimated annual expenditures* on a child by husband-wife families, urban West, t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous,* Income: Less than $33,500 (Average=$20,900) 0-2 $6,080 $2,520 $850 $770 $360 $320 $630 $630 3-5 6,210 2,510 940 750 350 300 710 650 6-8 6,370 2,470 1,210 850 390 350 420 680 9-11 6,490 2,330 1,450 920 440 380 250 720 12-14 7,210 2,500 1,510 1,030 730 390 180 870 15-17 7,180 2,150 1,640 1,360 650 410 300 670 Total $118,620 $43,440 $22,800 $17,040 $8,760 $6,450 $7,470 $12,660 Income: $33,500 to $56,400 (Average=$44,600) 0-2 $8,200 $3,240 $1,000 $1,120 $430 $430 $1,050 $930 3-5 8,420 3,230 1,150 1,100 420 410 1,160 950 6-8 8,500 3,190 1,460 1,200 460 470 740 980 9-11 8,570 3,050 1,730 1,270 510 510 480 1,020 12-14 9,250 3,220 1,730 1,390 860 520 360 1,170 15-17 9,400 2,870 1,920 1,730 760 540 610 970 Total $157,020 $56,400 $26,970 $23,430 $10,320 $8,640 $13,200 $18,060 Income: More than $56,400 (Average=$84,400) 0-2 $11,780 $4,800 $1,290 $1 ,550 $560 $510 $1 ,590 $1,480 3-5 12,020 4,780 1,450 1,530 540 490 1,730 1,500 6-8 12,000 4,750 1,750 1,630 600 550 1,190 1,530 9-11 11,980 4,610 2,040 1,690 650 590 830 1,570 12-14 12,770 4,780 2,140 1,810 1,080 600 640 1,720 15-17 13,100 4,430 2,250 2,170 980 630 1,120 1,520 Total $220,950 $84,450 $32,760 $31,140 $13,230 $10,110 $21,300 $27,960 *Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. tThe Western region consists of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. *Miscellaneous expenses include personal cam items, entertainment, and reading materials. 1996 Vol. 9 No.3 15 Table 4. Estimated annual expenditures* on a child by husband-wife families, urban Northeast, t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous* Income: Less than $33,500 (Average=$20,900) 0-2 $5,750 $2,520 $880 $580 $380 $360 $510 $520 3-5 5,870 2,500 980 560 370 340 580 540 6-8 6,090 2,470 1,250 660 420 390 330 570 9-11 6,230 2,330 1,490 730 470 420 190 600 12-14 7,030 2,500 1,560 850 790 430 140 760 15-17 6,930 2,150 1,680 1 '170 700 450 220 560 Total $113,700 $43,410 $23,520 $13,650 $9,390 $7,170 $5,910 $10,650 Income: $33,500 to $56,300 (Average=$44,500) 0-2 $7,830 $3,240 $1,030 $940 $450 $480 $870 $820 3-5 8,030 3,220 1 '180 920 440 460 970 840 6-8 8,190 3,190 1,500 1,020 490 520 600 870 9-11 8,290 3,050 1,770 ' 1,090 540 560 380 900 12-14 9,020 3,220 1,770 1,200 920 570 280 1,060 15-17 9,130 2,870 1,970 1,540 820 590 480 860 Total $151,470 $56,370 $27,660 $20,130 $10,980 $9,540 $10,740 $16,050 Income: More than $56,300 (Average=$84,300) 0-2 $11,340 $4,790 $1,320 $1,360 $590 $560 $1 ,350 $1,370 3-5 11,590 4,780 1,490 1,340 570 540 1,480 1,390 6-8 11,620 4,740 1,790 1,440 630 610 990 1,420 9-11 11,660 4,600 2,090 1,510 680 650 680 1,450 12-14 12,520 4,770 2,180 1,630 1,150 660 520 1,610 15-17 12,740 4,420 2,300 1,980 1,040 690 900 1,410 Total $214,410 $84,300 $33,510 $27,780 $13,980 $11 '130 $17,760 $25,950 *Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. tThe Northeast region consists of Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. iMiscellaneous expenses include personal care items, entertainment, and reading materials. 16 Family Economics and Nutrition Review Table 5. Estimated annual expenditures* on a child by husband-wife families, urban South,t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous* Income: Less than $33,800 (Average=$21,100) 0-2 $5,550 $2,070 $750 $700 $400 $420 $700 $510 3-5 5,670 2,050 840 680 390 400 780 530 6-8 5,810 2,010 1,090 780 440 460 470 560 9-11 5,910 1,870 1,320 850 490 490 290 600 12-14 6,670 2,050 1,380 970 810 500 210 750 15-17 6,630 1,690 1,500 1,300 710 530 350 550 Total $108,720 $35,220 $20,640 $15,840 $9,720 $8,400 $8,400 $10,500 Income: $33,800 to $56,900 (Average=$45,000) 0-2 $7,730 $2,790 $910 $1,060 $470 $550 $1,140 $810 3-5 7,940 2,780 1,050 1,040 460 530 1,250 830 6-8 8,010 2,740 1,340 1,140 510 600 820 860 9-11 8,050 2,600 1,590 1,210 570 640 540 900 12-14 8,740 2,770 1,600 1,330 940 650 400 1,050 15-17 8,950 2,420 1,790 1,670 840 680 700 850 Total $148,260 $48,300 $24,840 $22,350 $11,370 $10,950 $14,550 $15,900 Income: More than $56,900 (Average=$85,200) 0-2 $11,370 $4,370 $1,190 $1,480 $620 $640 $1,700 $1,370 3-5 11,600 4,350 1,360 1,460 600 610 1,840 1,380 6-8 11,580 4,320 1,640 1,570 660 690 1,290 1,410 9-11 11,530 4,170 1,920 1,630 720 740 909 1,450 12-14 12,350 4,350 2,010 1,750 1,180 750 710 1,600 15-17 12,710 3,990 2,120 2,110 1,070 770 1,250 1,400 Total $213,420 $76,650 $30,720 $30,000 $14,550 $12,600 $23,070 $25,830 ·Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. trhe Southern region consists of Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. *Miscellaneous expenses include personal care items, entertainment, and reading materials. 1996 Vol. 9 No.3 17 Table 6. Estimated annual expenditures* on a child by husband-wife families, urban Midwest,t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous; Income: Less than $33,800 (Average=$21,100) 0-2 $4,970 $1,860 $710 $610 $350 $340 $610 $490 3-5 5,100 1,840 800 590 340 330 690 510 6-8 5,250 1,810 1,040 700 380 370 410 540 9-11 5,340 1,670 1,260 760 430 410 240 570 12-14 6,070 1,840 1,320 880 720 410 170 730 15-17 6,000 1,480 1,440 1,210 630 430 290 520 Total $98,190 $31,500 $19,710 $14,250 $8,550 $6,870 $7,230 $10,080 Income: $33,800 to $56,900 (Average=$45,000) 0-2 $7,110 $2,590 $870 $970 $410 $460 $1,020 $790 3-5 7,310 2,570 1,010 950 400 440 1,130 810 6-8 7,390 2,530 1,290 1,060 450 500 720 840 9-11 7,430 2,390 1,540 1,120 500 540 470 870 12-14 8,120 2,560 1,550 1,240 840 550 350 1,030 15-17 8,250 2,210 1,730 1,580 750 570 590 820 Total $136,830 $44,550 $23,970 $20,760 $10,050 $9,180 $12,840 $15,480 Income: More than $56,900 (Average=$85, 1 00) 0-2 $10,670 $4,150 $1,160 $1,400 $540 $540 $1,540 $1,340 3-5 10,920 4,140 1,310 1,380 530 520 1,680 1,360 6-8 10,890 4,100 1,590 1,480 580 590 1,160 1,390 9-11 10,880 3,960 1,870 1,550 640 630 800 1,430 12-14 11,650 4,130 1,950 1,670 1,060 640 620 1,580 15-17 11,980 3,780 2,070 2,030 960 670 1,090 1,380 Total $200,970 $72,780 $29,850 $28,530 $12,930 $10,770 $20,670 $25,440 •estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. trhe Midwest region consists of Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. *Miscellaneous expenses include personal care items, entertainment, and reading materials. 18 Family Economics and Nutrition Review Table 7. Estimated annual expenditures* on a child by husband-wife families, Rural areas,t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous* Income: Less than $34,000 (Average=$21 ,200) 0-2 $5,020 $1 ,570 $720 $810 $370 $420 $620 $510 3-5 5,130 1,550 810 790 360 400 700 520 6-8 5,270 1,520 1,050 890 400 450 410 550 9-11 5,380 1,370 1,270 960 450 490 250 590 12-14 6,140 1,550 1,330 1,080 760 500 180 740 15-17 6,070 1 '190 1,450 1,410 670 520 290 540 Total $99,030 $26,250 $19,890 $17,820 $9,030 $8,340 $7,350 $10,350 Income: $34,000 to $57,200 (Average=$45,300) 0-2 $7,170 $2,310 $880 $1,170 $440 $540 $1,030 $800 3-5 7,360 2,290 1,020 1,150 420 520 1,140 820 6-8 7,440 2,250 1,300 1,250 470 590 730 850 9-11 7,480 2,110 1,550 1,320 520 630 470 880 12-14 8,200 2,290 1,550 1,440 890 650 350 1,030 15-17 8,350 1,920 1,740 1,790 790 670 600 840 Total $138,000 $39,510 $24,120 $24,360 $10,590 $10,800 $12,960 $15,660 Income: More than $57,200 (Average=$85,700) 0-2 $10,760 $3,900 $1 '160 $1,600 $570 $630 $1,560 $1,340 3-5 11,000 3,880 1,320 1,580 560 610 1,690 1,360 6-8 10,990 3,850 1,600 1,680 610 690 1,170 1,390 9-11 10,960 3,700 1,870 1,750 670 730 810 1,430 12-14 11 ,780 3,880 1,960 1,870 1,120 740 630 1,580 15-17 12,090 3,520 2,070 2,240 1,010 770 1,100 1,380 Total $202,740 $68,190 $29,940 $32,160 $13,620 $12,510 $20,880 $25,440 *Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. tRural areas are places of fewer than 2,500 people outside a Metropolitan Statistical Area. *Miscellaneous expenses include personal care items, entertainment, and reading materials. 1996 Vol. 9 No.3 19 Table 8. Estimated annual expenditures* on a child by single-parent families, overall United States, 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneoust Income: Less than $33,700 (Average=$14,100) 0-2 $4,650 $1,890 $860 $660 $340 $180 $390 $330 3-5 5,220 2,140 910 580 360 270 530 430 6-8 5,900 2,280 1,150 670 420 310 490 580 9-11 5,510 2,190 1,330 480 420 400 230 460 12-14 5,940 2,190 1,330 550 720 420 290 440 15-17 6,640 2,320 1,450 870 840 420 220 520 Total $101 ,580 $39,030 $21,090 $11,430 $9,300 $6,000 $6,450 $8,280 Income: $33,700 or more (Average=$51,100) 0-2 $10,590 $4,060 $1,330 $2,000 $480 $410 $960 $1,350 3-5 11,360 4,320 1,410 1,920 500 550 1,210 1,450 6-8 12,110 4,450 1,690 2,020 580 640 1,130 1,600 9-11 11,710 4,360 2,040 1,830 580 760 660 1,480 12-14 12,440 4,370 2,000 1,900 960 810 940 1,460 15-17 12,870 4,500 2,110 2,060 1,100 800 760 1,540 Total $213,240 $78,180 $31,740 $35,190 $12,600 $11,910 $16,980 $26,640 *Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the Consumer Price Index. The figures represent estimated expenses on the younger child in a single-parent, two-child family. For estimated expenses on the older child, multiply the total expense for the appropriate age category by 0.93. To estimate expenses for two children, the expenses on the younger child and older child-after adjusting the expense on the older child downward-should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.35. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.72-after adjusting the expenses on the older children downward. For expenses on all children in a family, these totals should be summed. tMiscellaneous expenses include personal care items, entertainment, and reading materials. 20 Family Economics and Nutrition Review 1996 Vol. 9 No.3 Assessment of Energy Intakes in the U.S. Population, 1989-91 By Howard Riddick Nutritionist Center for Nutrition Policy and Promotion The 1989-91 Continuing Survey of Food Intakes by Individuals was used to assess food energy intakes of subgroups within the U.S. population. For adolescents and adults, especially females, the average reported energy intakes were well below the Recommended Energy Allowances (REA) established by the National Research Council-not consistent with the increase in the proportion of individuals found to be overweight. Energy intakes as a percent of the REA ranged from 97 percent for children ages 1-3 to 73 percent for females ages 25-50. A ratio of reported energy intakes (EI) to an estimate of resting energy expenditure (REE) based on selfreported body weight, gender, and age was calculated to assess potential energy underreporting. Males ages 51 and over and females ages 25-50 and 51 and over had EI/REE ratios below 1.2, indicating energy underreporting (1 ). Lower EI/REE ratios were characteristic of individuals in higher weight-status categories. Very sedentary lifestyles may partly explain the low EI/REE ratios. National studies of daily activity levels would be critical to understanding the importance of inactivity versus underreporting. Future studies of food intake surveys should incorporate some assessment of energy reporting. ational surveys of dietary intakes provide estimates of food and nutrient intakes that help direct policy decisions related to food assistance programs, nutrition education efforts, food safety, and diet/health relationships. Accurate assessment of energy intake is important for several reasons. First, the number of servings recommended for the Pyramid food groups is based on the level of kilocalories needed (22). For example, a minimum of 6 bread group servings is recommended at the 1 ,600-kilocalorie level, whereas 11 bread group servings are recommended at the 2,800-kilocalorie level (22). Second, energy intake is one of several factors (diet, genetics, level of activity) associated with the development of obesity, a major public health problem that is increasing dramatically in the United States (12, 20). Finally, the intake of energy is associated with the intake of foods and food components. If estimates of food energy are biased, estimates of other dietary parameters may also be affected. 21 Measuring dietary intakes of individuals living in the community (rather than in institutions), however, is an inherently difficult process. Direct measures, such as collection of duplicate portions, are intrusive and affect behavior ( 13 ). Indirect measures depend on the selfreporting skills of individuals who must remember or record all foods eaten in a day along with an estimate of the quantity consumed. The descriptions given by the individual must then be assigned food codes that most closely match the description. Representative nutrient composition values are then calculated for the foods. Until recently, dietary methods were often validated by comparing results from one method with those from another method believed to be more accurate. One study employing unobtrusive observation and weighing of foods eaten found small intakes overreported and large intakes underreported by 24- hour recalls (6). The development of the doubly-labeled water technique1 has provided an objective, external test of the validity of dietary assessments of food energy. The doubly-labeled water technique and supervised feeding of diets have shown that self-reported dietary intakes underestimate energy intake by as much as 20 to 25 percent or more, especially among obese respondents (2, 5, 11, 13, 14, 17). However, these techniques assess only energy intake, not the intake of foods or nutrients. 1ln the doubly-labeled water method, subjects consume water that has both the hydrogen and oxygen molecules labeled as stable isotopes. Monitoring the elimination rate of labeled hydrogen in water and the elimination rate of labeled oxygen in water and carbon dioxide permits the calculation of energy expenditure. 22 If the cause of energy underreporting is primarily in estimating the quantity of food portions eaten, the estimates for many food components may be underestimated. lf omitted foods such as soft drinks or candy are the primary cause of underreporting, the estimates for food components such as fat and food energy might be low, but estimates for vitamins, minerals, and major food groups might be reasonable. Further complicating the impact of low energy reporting on estimates of nutrients and other food components is the possibility that certain nutrient-dense foods might be overreported. This paper examines the level of energy reporting in a national survey in relation to recommended levels of consumption for population subgroups. Methodology The sample is composed of individuals ages 1 and over surveyed in USDA's 1989-91 Continuing Survey of Food Intakes by Individuals (CSFII) ( 19 ). Along with household and individual characteristics, each individual was targeted to have one 24-hour recall and a 2-day dietary record to assess dietary intake. This study includes individuals with a complete 24-hour recall who were not bedridden, did not indicate they were on a weight loss diet, and for females, were not pregnant or lactating. The 24-hour recall was chosen for this study because the primary interest was in evaluating mean intakes, and the 2-day dietary record is no longer in use by USDA. In addition, the sample size for the 24-hour recall was larger than that for all 3 days. Independent samples of all-income households and low-income households (households at or below 130 percent of the poverty level) were combined during the weighting process. The survey design for both samples was a multistage national probability sample of households in the 48 conterminous States and Washington, DC. For each household sampled, all individuals were eligible for the survey. The overall response rate for individuals completing the 24-hour recall was 57.6 percent. Response rate is important in evaluating survey results because those not participating may have different characteristics and behavioral patterns from those who do participate. The application of weighting factors helps reduce but does not eliminate the potential for bias. Weighting factors were applied to: Adjust for non-response; adjust for oversampling of low-income households; match population characteristics; and to equalize interviews over the 12 months of the year and the 7 days of the week. The average design effect2 was about 2.3, reflecting the ~omplex sampling design and the weighting procedures (19). Mean intakes based on a cell size of 69 (30 times the average design effect) or less may be less statistically reliable than other estimates ( 19). The significance level for the regression analysis was set at 0.01 rather than 0.05 because of the complex survey design. 2The design effect is a measure of how much the variance of estimates is increased compared with a simple random sample. Family Economics and Nutrition Review For each individual, the energy in kilocalories per day required to maintain basic bodily functions when at rest (the Resting Energy Expenditure or REE) was calculated using formulas based on body weight in kilograms, gender, and age ( 15 ). Body weights and heights from the survey are selfreported and may be more or less than actual heights and weights (4, 16). Overweight individuals tend to underreport their weights, while underweight individuals tend to overreport (16): Because more individuals are overweight than underweight, a population REE from self-reported weights will tend to be lower than that using actual weights. The total food energy in kilocalories (Energy Intake or EI) estimated by the 24-hour recall was divided by the estimated REE to yield an EIIREE ratio. The EIIREE ratio for a given age/sex group reflects differences in selfreported body weight and is indicative of the general activity level. For example, a ratio in the 1.5-1 .6 range represents a light activity level, whereas a ratio of 1.3 is a minimum value that may not be compatible with cardiovascular fitness (15 ). Bingham has suggested that the ratio should be on the order of 1.5 for sedentary populations and that a population ratio of 1.2 or under is evidence of gross underreporting ( 1 ). The suggested levels of EIIREE ratios are based on what is known about variability in energy intakes, REE, and levels of physical activity. These ratio levels might need to be adjusted as additional research results become available. 1996 Vol. 9 No. 3 Table 1. Measures of energy intake: Mean intakes per individual in a day, by age and gender, 1 day, CSFII 1989-91 Population group Children 1 - 3 years 4-6 years 7- 10 years Males 11 - 14 years 15- 18 years 19-24 years 25-50 years 51 years and over Females 11- 14 years 15- 18 years 19-24 years 25-50 years 51 years and over n 757 719 912 466 332 473 2,159 1,510 396 381 584 2,714 2,320 kcal 1,262 1,559 1,875 2,252 2,591 2,559 2,324 1,947 1,891 1,700 1,700 1,611 1,467 %REA 97 87 94 90 86 88 80 85 86 77 77 73 77 EIIREEas EIIREE % standard 1 1.61 1.63 1.56 1.49 1.40 1.40 1.25 1.19 1.43 1.17 1.24 1.15 1.12 91 86 88 88 84 84 78 78 85 73 78 74 74 1 EIIREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE ratios used by the NRC to establish the REAs and multiplying by 100. Results Mean daily intakes of energy are presented in several different forms by age and gender in table 1, with the same population groups used by the National Research Council (NRC) to establish the Recommended Energy Allowance (REA) ( 15 ). Reported energy intake in kilocalories peaked during the 15-18 age group for males and the 11-14 age group for females and then declined with age. Almost all groups of children and females had average intakes at approximately the 1 ,600-kilocalorie level associated with the minimum number of food group servings identified in the Food Guide Pyramid. The exceptions were children 7-1 0 years old and females 11-14 years old who had intakes between the 1,600 and 2,200 levels. Among males, the 11-14 and the 25-50 age groups had reported energy intakes close to the 2,200-kilocalorie level at the midrange of the Pyramid, whereas the 15-18 and the 19-24 age groups had intakes between the midrange of 2,200 and 23 the maximum of 2,800. The 51 and over age group of males averaged about 2,000 kilocalories. Reported energy intakes as a percent of the REA ranged from a high of 97 percent for children 1-3 years old to a low of 73 percent for females 25-50 years old. For all age groups examined, males reported a higher proportion of their REA than did females. The EIIREE ratio was highest for children and lowest for females. Children and males 11-14 years old had ratios in the 1.5-1.6 range characteristic of sedentary populations. Males 15-18 and 19-24 years old and females 11-14 years old had ratios of about 1.4, still above the 1.3 minimum level cited in the NRC report (15). Males 25-50 years old and females 19-24 years old had ratios below the NRC minimum but still above the 1.2 minimum of Bingham. Males 51 years and over and females 15-18, 25-50, and 51 years and over had EI/REE ratios below the 1.2 level cited by Bingham as evidence of underreporting (1). The EI/REE ratios found in the CSFII were compared with the EI/REE ratios used by the NRC to establish the REA's (see figure). The pattern of change relative to age and gender found in the survey was similar to the NRC pattern. However, the survey level appears lower and the difference between males and females appears greater. Between females age 11-14 and 15-18, there was a much sharper drop in the ratio in the survey compared with the NRC. 24 EI/REE ratio used in establishing Recommended Energy Allowances (REA) and as estimated by CSFII 1989-91 reported weights and intakes 2.0 REA children ' 1.8 REA, ma les 1.6 I "' CSFII children REA females 1.4 CSFII males ,II- 1.2 CSFII females 1.0 1-3 4-6 7-10 11-14 Converting the EIIREE ratio to a percent of the ratio used by the NAS to establish the REA's yields percentages generally the same as the percentage of the REA. The EIIREE percentage is consistently lower than the REA percentage for children and males, with no clear pattern for females. Differences in the two measures may reflect differences in weight and activity patterns assumed for the REA's compared with the reported weights and/or kilocalorie levels in the survey. Measures of energy intake by weight status are presented for children in table 2. The three Body Mass Index3 (BMI) 3Body Mass Index is calculated by dividing weight in kilograms by the square of height in meters. 15-18 19-24 25-50 51+ categories are based on the BMI levels discussed in the report of the Dietary Guidelines Advisory Committee (2 I). As health indicators, the categories may not be valid for children, but they do provide a mechanism for energy intake comparisons. For age groups 1-3 and 4-6, there was no clear pattern of energy intake and weight status. Children 7-10 years old tended to exhibit lower EIIREE ratios and percentages with higher weight classes. Energy in kilocalories and percent REA showed no clear pattern. Children 7-10 years old in the highest weight category had an EI!REE ratio at the level (1.3) associated with minimal activity. Family Economics and Nutrition Review Table 2. Measures of energy intake of children: Mean intakes per individual in a day, by age and weight status,11 day, CSFII 1989-91 Age/Estimated EIIREE as BMI category n kcal %REA EIIREE % standard2 Age 1-3 BMI <19 404 1,280 98 1.63 92 BM119- 25 196 1,299 100 1.61 92 BM1>25 157 I, 171 90 1.56 89 Age 4-6 BMI <19 472 1,544 86 1.63 86 BMI 19-25 165 1,620 90 1.64 87 BMI >25 82 1,530 85 1.53 81 Age 7-10 BM1<19 568 1,861 93 1.63 92 BMI19 -25 254 1,928 96 1.47 83 BMI >25 90 1,809 90 1.32 74 1 Weight status is derived from self-reported heights and weights. 2EIIREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE ratios used by the NRC to establish the REAs and multiplying by 100. Among males (table 3, p. 26), there were limitations in sample size for the under 19 BMI category. However, for all age groups the over 25 BMI group had lower EIIREE ratios and lower EIIREE percentages than the 19-25 BMI group. As with children, kilocalories and percent REA showed no clear pattern relative to weight status for males. For all age groups, males in the over 25 BMI group had EIIREE ratios close to or below the 1.2 level indicative of underreporting. Among females (table 4, p. 27), EIIREE ratios in the over 25 BMI category were very low, at or below 1.0. EIIREE ratios in the under 19 BMI category were consistently at or above the 1.3 level. Females in the 19-25 BMI category generally had ratios around 1.2, except 1996 Vol. 9 No.3 those ages 11-14 who averaged about 1.4 and those ages 19-24 who averaged about 1.3. Adults in the top two BMI categories were subdivided into income levels (the number of subjects in the lowest BMI category was too small for further subdivision) (table 5, p. 28). At each of the three income levels, both males and females in the two age groups examined had a similar pattern of lower EIIREE ratios at higher BMI levels. For males and females ages 25-50, the EIIREE ratios were similar across the income levels; however, for older males and females, those with income at less than 131 percent of the poverty level appeared to have slightly lower ratios in each weight class. National studies of daily activity levels would be critical to understanding the importance of inactivity versus underreporting. 25 Table 3. Measures of energy intake of males: Mean intakes per individual The relationship between the sufficiency in a day, by age and weight status,l1 day, CSFII 1989-91 of household food supplies (self-described) and the EIIREE ratio is Age/Estimated EIIREE as presented in table 6, p. 28 by weight BMI category n kcal % REA EI/REE % standard2 category for males and females ages 25 and over. Households could choose among four levels of food sufficiency: Age 11- 14 "Enough of the kinds of food we want BMI <19 205 2,203 88 1.64 96 to eat"; "enough but not always what BMI 19-25 201 2,258 90 1.42 84 we want to eat"; "sometimes not BMI >25 603 2,398 96 1.25 74 enough to eat"; or "often not enough to eat." Because of sample size limitations, the age groups were combined, as well Age 15-18 as households that indicated either BMI<19 453 2,221 74 1.38 83 sometimes or often not enough to eat. BMI 19-25 227 2,704 90 1.48 88 Both males and females in households BMI >25 603 2,368 79 1.09 65 that sometimes or often did not have enough to eat appeared to have lower EIJREE ratios for both weight categories. Age 19-24 BMI <19 283 1,850 64 1.21 72 For each age group of children, males, BMI 19 ~ 25 289 2,632 91 1.49 89 and females, regression analysis ( 18) BMI>25 156 2,511 87 1.24 74 was performed to test for statistical significance between the EIIREE ratio and weight status, income level, and Age 25-50 sufficiency of household food supplies. BMI <19 403 2,334 80 1.47 92 Weight status was tested by using BMI BMI 19-25 906 2,355 81 1.35 84 as a continuous variable, whereas in- BMI >25 1,213 2,302 79 1.17 73 come and food sufficiency were tested as categorical variables. Age 51 and over The overall equations were significant BMI <19 313 1,625 71 1.29 86 at the O.Ollevel of probability for all BMI 19-25 602 1,915 83 1.26 84 the age subgroups examined. As shown BMI >25 877 1,978 86 1.12 75 in table 7, p. 29, the percent of variation explained (R2) ranged from less than I weight status is derived from self-reported heights and weights. 2 percent to around 9 percent. BMI was 2EIJREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE significant at the O.Ollevel for each ratios used by the NRC to establish the REAs and multiplying by I 00. age group. Living in a household below 3Due to the small number of subjects, estimates may be less statistically reliable than other estimates. 131 percent of the poverty level was significant only for males ages 15-18 and 51 and over and for females ages 51 and over. Living in households that sometimes or often did not have enough to eat was significant for males ages 11-14,25-50, and 51 and over; and for females ages 25-50 and 51 and over. 26 Family Economics and Nutrition Review Table 4. Measures of energy intake of females: Mean intakes per The level of R2 was lowest (under 2 individual in a day, by age and weight status, 1 1 day, CSFII 1989-91 percent) for children ages 1-3 and 4-6. This may reflect less accurate reporting Age/Estimated EIIREEas of heights and weights for children, BMI category n kcal %REA EIIREE % standard2 resulting in more errors in estimated BMI and weight status classification (4). Age 11- 14 The statistically significant regression BMI <19 177 1,838 84 1.49 89 coefficients in table 7 are all negatively BMT 19-25 175 1,967 89 1.43 86 related to the EIIREE ratio. For example, BMI >25 443 1,735 79 1.14 68 for males ages 51 and over, a one-unit increase in BMI is associated with a decrease in the EIIREE ratio of 0.021, Age 15-18 controlling for income status and house- BMI <19 693 1,765 80 1.32 82 hold food sufficiency. BMI 19-25 245 1,721 78 1.19 75 BMI >25 673 1,531 70 0.89 56 Discussion The Recommended Energy Allowance Age 19-24 (REA) is set to reflect the average need BMI <19 73 1,806 82 1.49 92 of a population subgroup, unlike the BMI 19-25 377 1,717 78 1.27 80 Recommended Dietary Allowances BMI>25 134 1,569 71 0.96 60 (RDA) that are set high enough above the estimated mean requirement to meet the needs of practically all healthy Age 25-50 individuals ( 1 5). For older children and BMI <19 181 1,712 78 1.38 89 adults, especially females, the reported BMI19 -25 1,402 1,616 73 1.20 78 energy intakes in this study were, on BMI>25 1 '131 1,582 72 1.03 66 average, well below the REA. Energy intakes consistently below requirements, over time, will lead to a loss in weight. Age 51 and over This is not consistent with recent studies BMI <19 163 1,459 77 1.31 87 of weight status in the U.S. population BMI19-25 1,029 1,498 79 1.19 80 ( 12, 20 ). For both children and adults, BMI >25 1,128 1,434 75 1.01 67 the percentage of individuals classified as overweight increased during the 1Weight status is derived from self-reported heights and weights. period from 1976-80 to 1989-91. Either 2EIIREE as% standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE the REA is set too high or reports of ratios used by the NRC to establish the REAs and multiplying by 100. energy intake are too low. 3Due to the small number of subjects, estimates may be less statistically reliable than other estimates. 1996 Vol. 9 No.3 27 The EI/REE ratios were consistently below the levels used by NRC to establi h the REA' s. For females and higher weight individuals in particular, the ratios were well below the recommended levels and often below the minimum level identified by NRC. Adult males and females starting in the teen years had ratios low enough to suggest major underreporting--especially in the higher weight groups. The lower ratios within weight groups for adults in households with restricted food supplies may indicate lower actual intakes in addition to underreporting. A summary of studies using the doublylabeled water technique supports the EI/REE ratios used by NRC. The mean ratio was 1.67 and the mean minus two standard deviations was 1.28 for the 105 adult males and females studied (7). Males averaged 1.78 while females averaged 1.62. Whether the activity levels found in these small studies is representative of the population remains a question. Table 8, p. 30, presents EIIREE ratios for adult men and women using the same age breaks and overweight definitions used in the NHANES ill survey ( 3 ). For all age groups of overweight females (using a BMI of27.3 or above as the criterion), both surveys found EI/REE ratios considerably below the 1.2 level indicating substantial underreporting. In CSFII, overweight males (using a BMI of 27.8 or above as the criterion) had average ratios below 1.2 for all age groups, whereas the NHANES ill found only overweight males ages 60 or over 28 Table 5. The mean EIIREE ratio for adult males and females by age, weight status, 1 and income level, CSFII 1989-91 Age/Estimated Household income as a percent of poverty level BMI category <131 13 1 -350 >350 Males age 25 - 50 BMI 19-25 1.33 1.36 1.34 (n = 291) (n = 336) (n = 279) BMI >25 1. 14 1. 16 1.18 (n = 363) (n = 475) (n = 375) Males age 51 and over BMI19-25 1.16 1.30 1.25 (n = 226) (n = 220) (n = 156) BMI >25 1.02 1.14 1.14 (n = 273) (n = 322) (n = 282) Females age 25 - 50 BMI 19- 25 1.18 1. 19 1.21 (n = 470) (n = 509) (n = 423) BMI>25 0.97 1.06 1.0 I (n = 530) (n = 390) (n= 2 11 ) Females age 51 and over BMI19-25 1.13 1.21 1.21 (n = 434) (n = 346) (n = 249) BMI >25 0.92 1.03 1.05 (n = 557) (n = 388) (n = 183) 1Weight status is derived from self-reported heights and weights. Table 6. The mean EIIREE ratio for adult males and females by weight status1 and household food sufficiency, CSFII 1989-91 Age/Estimated BMI category Males age 25 and over BMII9-25 BMI >25 Females age 25 and over BMI 19-25 BMI>25 Household food sufficiency Enough of the Enough but not Sometimes or kinds of foods always kinds of often not wanted food wanted enough to eat 1.31 1.40 1.19 (n = 1,070) (n = 362) (n = 72) 1.15 1.17 0.80 (n = 1,508) (n = 507) (n = 73) 1.21 1.17 0.97 (n = 1,765) (n = 566) (n = 96) 1.03 0.98 0.90 (n = 1,508) (n = 633) (n = 114) 1Weight status is derived from self-reported heights and weights. Family Economics and Nutrition Review Table 7. The relationship between the mean EIJREE ratio and BMI, income status, and household food sufficiency, CSFII 1989-91 Explanation ofEIJREE variation Age/sex (R2) Percent Children I - 3 years 1.5 4-6 years 1.6 7- 10 years 6.0 Males 11- 14 years 8.4 15- 18 years 5.3 19-24 years 5.5 25- 50 years 3.8 51 years and over 4.4 Females 11- 14 years 3.9 15- 18 years 5.4 19-24 years 9.1 25- 50 years 4.0 51 years and over 8.7 * PS 0.01. were below this level. For adults ages 20 and over, the CSFII values were about 85 percent of the NHANES III values for males and about 90 percent for females. Differences in 24-hour recall protocols between the two surveys have been identified ( 3 ). Another major difference is the use of self-reported heights and weights in CSFII compared with the measured heights and weights in the NHANES III survey. Overweight individuals, especially overweight females, have been found to underreport their weights (16). 1996 Vol. 9 No.3 Household income <131% BMI poverty level Beta coefficient -0.009* +0.000 -0.010* -0.043 -0.024* -0.040 -0.037* -0.112 -0.036* -0.247* -0.037* -0.089 -0.024* +0.015 -0.021* -0.092* -0.023* +0.030 -0.026* -0.043 -0.036* +0.074 -0.017* -0.001 -0.023* -0.086* Implications for Further Research Sometimes or often not enough to eat -0.101 -0.117 -0.143 -0.267* +0.444 -0.254 -0.155* -0.187* -0.106 -0.130 -0.165 -0.132* -0.168* Additional research is needed to understand energy reporting. A critical component is the activity level of population subgroups from nationally representative samples. Assessments of general activity levels need to be integrated into surveys of food energy intakes. Since body weight is another key component in estimating energy needs, a study should be done to assess the impact of using self-reported weights on estimating the REE and the EIIREE ratio. ... users of food intake survey data should assess energy reporting as a component of their analysis. 29 Table 8. Mean EIIREE ratio by selected age groups for adult males and females by weight status,1 CSFll1989-91 Males Females Overweight males* Overweight females* Age n EVREE n EVREE n 20-29 years 884 1.35 1,037 1.21 172 30-59 years 2,117 1.22 2,745 1.13 660 Over 60 years 1,064 1.20 1,734 1.14 264 Total over 20 years 4,065 1.24 5,516 1.15 1,096 1Weight status is derived from self-reported heights and weights. * Overweight individuals were defined as BMI ~ 27.8 for males. and ~ 27.3 for females. Methods to improve memory recall of foods and quantities eaten need to be explored. After cognitive testing and a pilot study, the procedures used to collect 24-hour recalls in CSFII 1989-91 have been modified to incorporate a multiple-pass approach for CSFII 1994-96 (8). Portion size estimation and the validity of standardized recipes are especially critical for frequently eaten foods. Representative weights of foods such as bagels and muffins may increase over time, and if food codebooks and software fail to reflect such changes, energy intakes will be underestimated. Psychological aspects of energy reporting also need additional exploration ( 10 ). Hebert found that higher scores on a social desirability scale4 were associated with lower energy reports with a 7 -day dietary recall (9). Such a scale might be used in studies of energy reporting to develop a mechanism to help make adjustments for underreporting. 4Social desirability is the tendency of an individual to convey an image in keeping with social norms and to avoid criticism in a "testing" situation (9). 30 A major question concerns the extent to which energy underreporting is related to the reporting of other dietary components. A recent study used the 24-hour urine nitrogen technique to divide a group of individuals into "underreporters" and "others" (1). Underreporters (n=34) reported significantly less food energy, protein, fat, and sugars than the others (n=45) but similar levels of starch, fiber, and vitamin C. This research, which needs to be replicated, indicates that overall estimates may be downward biased for some, but not all, food components. EVREE n EVREE 1.00 204 0.98 1.13 867 1.01 1.10 545 0.95 1.10 1,616 0.99 Until further research is completed, users of food intake survey data should assess energy reporting as a component of their analysis. The EI/REE ratio could be used as an assessment tool and/or as a control variable in a multivariate analysis. Consideration' of the potential impact of energy underreporting is most critical for studies involving adult females and for overweight individuals. Family Economics and Nutrition Review References 1. Bingham, S.A. 1994. The use of24-h urine samples and energy expenditure to validate dietary assessments. The American Journal of Clinical Nutrition 59(Suppl):227S-231S. 2. Black, A.E., Prentice, A.M., Goldberg, G.R., Jebb, S.A., Bingham, S.A., Livingstone, M.B.E., and Coward, W.A. 1993. Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake. Journal of the American Dietetic Association 93:572-579. 3. Briefel, R.R., McDowell, M.A., Alaimo, K., Caughman, C.R., Bischof, A.L., Carroll, M.D., and Johnson, C.L. 1995. Total energy intake of the US population: The third National Health and Nutrition Examination Survey, 1988-1991. The American Journal of Clinical Nutrition 62(Suppl): 1072S-1 080S. 4. Davis, H. and Gergen, P.J. 1994. Mexican-American mothers' reports of the weights and heights of children 6 months through 11 years old. Journal of the American Dietetic Association 94:512-516. 5. deVJjes, J.H.M., Zock, P.L., Mensink, R.P., and Katan, M.B. 1994. Underestimation of energy intake by 3-d records compared with energy intake to maintain body weight in 269 non obese adults. The American Journal of Clinical Nutrition 60: 855-860. 6. Gersovitz, M., Madden, J.P., and Smiciklas-Wright, H. 1978. Validity of the 24-hr dietary recall and seven-day record for group comparisons. Journal of the American Dietetic Association 73:48-55. 7. Goldberg, G.R., Black, A.E., Jebb, S.A., Cole, T.J., Murgatroyd, P.R., Coward, W.A., and Prentice, A.M. 1991. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify undercrecording. European Journal of Clinical Nutrition 45:569-581. 8. Guenther, P.M., DeMaio, T.J., Ingwersen, L.A., and Berlin, M. 1996. The multiplepass approach for the 24-hour recall in the Continuing Survey of Food Intakes by Individuals (CSFII) 1994-96. The FASEB Journal10(3):A198. 9. Hebert, J.R., Clemow, L., Pbert, L., Ockene, I.S., and Ockene, J.K. 1995. Social desirability bias in dietary self-report may compromise the validity of dietary intake measures. International Journal of Epidemiology 24:389-398. 10. Heymsfield, S.B., Darby, P.C., Muhlheim, L.S., Gallagher, D., Wolper, C., and Allison, D.B. 1995. The calorie: Myth, measurement, and reality. The American Journal of Clinical Nutrition 62(Suppl):1034S-1041S. 1996 Vol. 9 No. 3 31 11. Johnson, R.K., Goran, M.I., and Poehlman, E.T. 1994. Correlates of over- and underreporting of energy intake in healthy older men and women. The American Journal ofClinical Nutrition 59:1286-1290. 12. Kuczmarski, R.J., Flegal, K.M., Campbell, S.M., and Johnson, C.L. 1994. Increasing prevalence of overweight among US adults. Journal of the American Medical Association 272(3):205-211. 13. Mertz, W. 1992. Food intake measurements: Is there a "gold standard"? Journal of the American Dietetic Association 92( 12):1463-1465. 14. Mertz, W., Tsui, J.C., Judd, J.T., Reiser, S., Hallfrisch, J., Morris, E.R., Steele, P.D., and Lashley, E. 1991. What are people really eating? The relation between energy intake derived from estimated diet records and intake determined to maintain body weight. The American Journal of Clinical Nutrition 54:291-295. 15. National Research Council, Subcommittee on the Tenth Edition of the RDAs, Food and Nutrition Board. 1989. Recommended Dietary Allowances, 1Oth ed. National Academy Press, Washington, DC. 16. Rowland, M.L. 1990. Self-reported weight and height. The American Journal of Clinical Nutrition 52:1125-1133. 17. Schoeller, D.A. 1990. How accurate is self-reported dietary energy intake? Nutrition Reviews 48( 10):313-379. 18. SPSS Inc. 1988. SPSS-X User's Guide, 3rd Edition. Chicago, IL. 19. Tippett, K.S., Mickle, S.J., Goldman, J.D., Sykes, K.E., Cook, D.A., Sebastian, R.S ., Wilson, J.W., and Smith, J. 1995. Food and Nutrient Intakes by Individuals in the United States, 1 Day, 1989-91. Continuing Survey of Food Intakes by Individuals, 1989-91, Nationwide Food Surveys Rep. No. 91-2. U.S. Department of Agriculture, Agricultural Research Service. 20. Troiano, R.P., Flegal, K.M., Kuczmarski, R.J., Campbell, S.M., and Johnson, C.L. 1995. Overweight prevalence and trends for children and adolescents. Archives of Pediatrics and Adolescent Medicine 149: 1085-1091. 21. U.S. Department of Agriculture, Agricultural Research Service, Dietary Guidelines Advisory Committee. 1995. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 1995. 22. U.S. Department of Agriculture, Human Nutrition Information Service. 1992. The Food Guide Pyramid. Home and Garden Bulletin No. 252. 32 Family Economics and Nutrition Review 1996 Vol. 9 No. 3 Dietary Patterns and Personal Characteristics of Women Consuming Recommended Amounts of Calcium By Joanne F. Guthrie Nutritionist Center for Nutrition Policy and Promotion Encouraging adequate calcium intakes by women is a current public health objective. To obtain information that could be used to promote this objective, this study examined dietary patterns and personal characteristics of women consuming their Recommended Dietary Allowance (RDA) of calcium compared with women who did not meet their RDA. The sample consisted of 2,261 nonpregnant, nonlactating women who participated in USDA's 1990-91 Continuing Survey of Food Intakes by Individuals-Diet and Health Knowledge Survey. Women whose diets met their RDA for calcium consumed significantly more milk products, fruit, and grains, less regularcalorie soda, and more of several essential nutrients, saturated fat, and sodium than did other women. All other characteristics equal, women were less likely to meet their calcium RDA from food sources if they were Black, less than 25 years of age, ate more food away from home, reported avoidance of all types of milk, and reported dietary intake in either the summer or fall. Factors positively related to meeting the RDA from food sources were working part time, taking vitamin-mineral supplements, reporting avoidance of whole milk only, being aware of a relationship between calcium intake and health, and reporting a higher number of milk group servings as being recommended daily. Implications for design and targeting of messages promoting calcium intake are discussed. dequate calcium intake has been identi~ed as an _important factor m preventmg osteoporosis and may also play a role in the prevention of several other health conditions, including some other bone diseases, colon cancer, hypertension, and pre-eclampsia during pregnancy (26). Osteoporosis affects 25 million Americans, primarily women (26). Annual direct medical costs associated with osteoporosis in American women have been estimated at $5.2 billion (29). Yet, data suggest that most women's diets do not meet their current Recommended Dietary Allowance (RDA) for calcium ( 1 ). As a consequence, improvement of calcium intakes has received considerable emphasis as a public health priority (6). The NIH Consensus Development Conference on Optimal Calcium Intake has 33 recommended development of health education materials and programs to promote increased calcium consumption. Increasing calcium intake among adolescents and adults is one of the health objectives for the Nation promoted by the U.S. Department of Health and Human Services' Healthy People 2000 (39). The American Dietetic Association has made increasing women's awareness of osteoporosis and the lifestyle changes that can help prevent it a major component of their Nutrition and Health Campaign for Women (20). Other public and private groups are also working on projects to promote dietary changes that would increase calcium consumption ( 19, 24 ). Amidst this emphasis on improving calcium intakes, particularly those of women, one concern that has been raised is whether increasing calcium intake is compatible with improving overall dietary quality. If a healthful diet is defmed as one that contains adequate amounts of essential nutrients while meeting guidelines for moderation in consumption of such food components as fat, saturated fat, cholesterol, and sodium (9), previous research indicates that diets that are rich in calcium tend to be rich in other essential nutrients as well. However, these diets may be associated with excessive intakes of food components for which moderation is recommended. Examining the issue of overall nutrient quality of higher-calcium versus lowercalcium diets, Barger-Lux et a!. (2) and Holbrook and Barrett-Connor ( 14) both found that those with diets that were more calcium dense (i.e., had more calcium per 1,000 kilocalories (kcal) of intake) also had diets that had higher 34 densities of several other essential nutrients. However, Holbrook and Barrett-Connor also found that the highcalcium group's diet had a higher density of saturated fat than other groups. Similarly, Nowalk and Caggiula (27) found that among a sample of middleage premenopausal women, those whose diets met their RDA for calcium consumed greater amounts of total and saturated fat than those whose diets did not. These studies were done with local samples, and the results may not be generalizable to the American population. Nevertheless, they raise the concern that programs encouraging increased calcium intake may inadvertently result in increasing intakes of food components for which moderation is recommended. Given that nutrition intervention is intended to promote an overall healthful diet, it is important, therefore, to examine not only the calcium adequacy but the overall diet quality of individuals before planning nutrition education efforts. Such an examination should provide educators with information that would be useful to them in developing dietary guidance that would lead to overall dietary improvement as well as improved calcium intakes. A knowledge of personal characteristics associated with meeting or not meeting the calcium RDA should also be useful for targeting nutrition education efforts. Previous research has indicated that some personal characteristics seem to be associated with low calcium intakes. Data from several sources indicate that Black women tend to consume lower amounts of calcium than women of other races (18, 40). Analysis of dietary intake data collected by the U.S. Department of Agriculture in I 985-86 from a national sample of women ages 19-50 indicated that, along with race, other factors independently associated with higher calcium intakes included higher education, higher income, being employed part time as opposed to being employed full time or not at all, being younger, being taller, being part of a household that included a child or children, being a participant in the Food Stamp program, living in a central city or suburban area as opposed to a nonmetropolitan area, living in the Midwest or West as opposed to living in the Northeast or South, and being a regular supplement user (40). Both Lewis and Hollingsworth (17) and Haines eta!. ( 13) found that, for women, eating a higher proportion of food away from home is associated with lower calcium intakes. Nutrition educators would benefit from knowing how knowledge and attitudes related to calcium and calcium-rich foods influence food intake; however, national survey data capable of linking knowledge and attitudes to food and nutrient consumption have only recently become available. In a study of older women living in the Midwest, Chapman eta!. (5) found that women with low calcium intakes were more likely to dislike milk, to believe that it disagreed with them, and to avoid drinking it. Examining attitudes toward milk consumption in a national data set would provide an opportunity to assess how generalizable these findings are to the broader population of American women. Family Economics and Nutrition Review The purposes of this study are, therefore, to (I) examine overall food and nutrient consumption patterns of women whose 3-day diets meet or fail to meet their calcium RDAs for overall diet quality; and (2) identify socioeconomic, demographic, knowledge, attitude, and behavioral characteristics of women whose diets, over a 3-day period, meet the current calcium RDA for their agesex group, using data from the USDA's 1990-91 Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS). These surveys are unique in that, together, they provide the only federally collected data set capable of relating knowledge and attitudes concerning diet and health to actual dietary intake. The results may be used to indicate types of nutrition education messages that may be most effective in promoting adequate calcium intake and to target groups of women mo t likely to have lower-than-recommended calcium intakes. Methods Data and Sample The CSFII was designed to obtain a nationally representative ample of households in the 48 conterminous United State and consist of an allincome and a low-income sample. In the all-income sample, all households, including low-income households, were eligible to be interviewed. For the low-income sample, participation was limited to individuals in households with a gross income for the previous month at or below 130 percent of the Federal poverty thresholds ( 36 ). 1996 Vol. 9 No.3 For the 1990-91 CSFII, trained interviewers visited each household and obtained socioeconomic, demographic, and health-related data on households and their members. In addition, the interviewers obtained I day of dietary intake data, using the 24-hour recall method, and household members were asked to complete a record of foods consumed on the 2 days following the 24-hour recall. Only those who provided the complete 3 days of dietary data were considered for this study. For the DHKS, one member of each CSFII household was contacted about 6 weeks after dietary data were collected. Ideally, the individual contacted was the person who had identified himself or herself as the household's main meal planner/preparer. In some cases, interviewers were unable to contact the main meal planner/preparer; about 6 percent of DHKS respondents were not the main meal planner/preparer. Most interviews were conducted by telephone; in-person interviews were conducted when this was not feasible. DHKS respondents were asked a series of questions on their knowledge, attitudes, and practices related to diet and health. Some questions that were particularly relevant to calcium intake included those on whether the respondents were aware that there were any health problems related to how much calcium a person eats, whether they avoided certain calcium-rich foods (all milk, whole milk, or cheese), and how many servings of milk products they believed they should eat daily. Given that nutrition intervention is intended to promote an overall healthful diet, it is important. .. to examine not only the calcium adequacy but the overall diet quality of individuals before planning nutrition education efforts. 35 In 1990 and 1991, DHKS and 3-day food intake data were obtained from 2,960 respondents. From these, female meal planners age 18 years and over were selected to form the analysis data set. The small number of DHKS respondents who were not meal planners were excluded from the analysis because nonmeal planners likely have less control over their food choices than meal planners. Pregnant and lactating women were also excluded because the purpose of this analysis was to examine factors influencing calcium intake over the long-term and pregnancy and lactation would be expected to create short-term increases in calcium intake ( 4 ). The final analysis data set consisted of 2,261 female meal planners. To adjust for oversampling of low-income households and for differing response rates among population subgroups, DHKS sample weights were developed by USDA in cooperation with Iowa State University ( 34 ). Use of these weights for descriptive statistics is recommended, because the weighted sample more closely resembles the actual U.S. population (16); weighted data were used in this study to calculate all descriptive statistics. Measures of Dietary Intake Survey respondents reported amounts of food consumed using common household measures. These amounts were converted to their gram weight equivalents. The results reported here represent the average amounts consumed over the 3 days of dietary intake reported by survey respondents. Foods are reported in terms of major groups--e.g., milk and milk products; and by selected subgroups-- e.g., lowfat milks. Foods are 36 grouped by primary ingredient; for example, a hamburger with onions is placed in the meat group because meat is its primary ingredient. Food group consumption patterns are examined in terms of average amounts consumed over 3 days. Energy (kilocalorie), fat, cholesterol, and nutrient intakes were calculated using USDA's Nutrient Data Base for Food Consumption Surveys (34 ). Nutrient intakes represent values from food consumption only; although survey participants answered questions on supplement use, nutrient intake from supplements was not quantified. Sodium values represent naturally occurring sodium, sodium added during food processing, and an assumed amount of sodium used in food preparation. Sodium values do not include salt added at the table. In this study, nutrient intake is examined as a percent of the individual's RDA and in terms of nutrient density, defined as the amount of a nutrient in the diet per 1,000 kilocalories-a measure of diet quality that controls for differences in the absolute quantity. The National Academy of Sciences has established guidelines for recommended total intakes of cholesterol, sodium, and potassium (22). Here, cholesterol, sodium, and potassium intakes are examined both as total amounts consumed and in terms of density. Fat and saturated fat intakes are examined as percentages of total kilocalories, a measure that controls for differences in absolute quantity and also corresponds to current dietary guidance. Analysis of Food Consumption Patterns and Diet Quality Mean food group intakes, nutrient intakes, and fat, saturated fat, cholesterol, sodium, and potassium intakes by meal planners who met their RDA for calcium were compared with the intakes of meal planners who did not. For this analysis, weighted data were used and statistical tests were conducted using the SUDAAN software package, which accounts for the effects of the complex design of the CSFII-DHKS surveys (32). T-tests were used for comparing means of the two groups. Analysis of Personal Characteristics Influencing Calcium Intake Differences in socioeconomic, demographic, and personal characteristics between women who met their calcium RDA and those who did not were assessed using descriptive statistics. T-tests were used to compare means of continuous variables, and the chi-square test was used to compare distributions of categorical variables. Weighted data were used and analyses were conducted with the SUDAAN software package (32). A logistic regression analysis was used to identify the personal characteristics independently associated with the probability of a meal planner meeting her RDA for calcium. In accordance with recommendations for statistical analysis of USDA food consumption survey data, unweighted data were used for this analysis (16). The analysis was conducted using the SPSS-X statistical software package (33). Family Economics and Nutrition Review Independent variables selected for the analysis included race, RDA-based age group, the self-reported height of the individual and her body mass index (as calculated from self-reported height and weight), household income as a percent of the Federal poverty level, Food Stamp Program participation, education, employment status, presence of children in the household, region and urbanization level of residence, whether the individual was on a weight-loss diet, use of vitamin and/or mineral supplements, percent of total kilocalories consumed away from home over the 3-day period, whether the individual reported being aware of health problems related to calcium, how many servings of dairy products the individual believed she should consume each day, and whether the individual reported avoiding all milk, whole milk only, or cheese. Race was included because previous research has indicated that it is associated with calcium intake; meal planners were categorized as members of either the White, Black, or "other" race groups ("other" includes Asians, Native Americans, Pacific Islanders, and any other races). Individuals were dichotomized into two age groups-those under 25 and those over 25 years of age-because the Food and Nutrition Board of the National Academy of Sciences has established an RDA for calcium that is higher for women 18 to 24 than for older women (23 ); the higher RDA may affect their likelihood of meeting recommended intake levels. Income, Food Stamp Program participation, education, employment status (full time, part time, not employed), presence of children in the household, region and urbanization level of residence, and use of vitamin and/or 1996 Vol. 9 No.3 mineral supplements were also included because previous research has indicated their potential significance in influencing calcium intake. The percentage of total kilocalories consumed away from home over the 3-day period was used as a measure of the importance of eating away from home in the diet, since this has been associated with lower calcium intakes in some studies. The variables on awareness of health problems related to calcium, how many servings of dairy products the individual believed she should consume each day, and whether the individual reported avoiding all milk, whole milk only, or cheese have not previously been studied in relation to the calcium adequacy of women's diets using a large national data set, because they have only recently been added to national food consumption surveys. They were included because of the potential usefulness of information on their influence on calcium intake for nutrition education. Variables assessing temporal effects on intake-season in which intake was reported and whether weekend eating was reported-were included as control variables because previous research has indicated that they can affect food consumption (12). Another factor that needs to be controlled is individual differences in total energy intake, since at higher caloric levels an individual may be more likely to meet the calcium RDA. Unfortunately, the use of energy intake as an independent variable in a multivariate equation is problematic because within-individual variability in energy intake introduces error that will produce biased coefficients ( 3 ). Therefore, several variables that proxy differences in Women whose diets met their ADA for calcium consumed more than three times as much lowfat milk as other women and more than six times as much skim milk. 37 energy need were used as control variables. These include: Self-reported height and body mass index, as calculated from self-reported height and weight. since larger individuals are likely to consume more energy; being on a weight-loss diet; and whether individuals reported any days with either lower-than-usual or higherthan- usual dietary intakes. Results Description of Sample Of the 2,261 women studied, 442 or 19 percent met their calcium RDA. After applying survey weights to obtain a population estimate, 21 percent of adult female meal planners were estimated to have diets that met their RDA for calcium. The group that met its calcium RDA was significantly less likely to include younger women (table 1 ). Six percent of meal planners with lower calcium intakes were below 25 years of age; only 2 percent of those with higher calcium intakes were in that age group. Women with higher calcium intakes were significantly taller, averaging 64.7 inches in height, compared with an average of 64.0 inches for the low calcium group. The educational level and employment status of the two groups also differed significantly. Twenty-two percent of those with lower calcium intakes had not completed high school, whereas 37 percent were high school graduates, and 41 percent had at least some college education. Of those with higher calcium intakes, 13 percent had not completed high school, 35 percent were high school graduates, and 52 percent had at least some college education. Assessing 38 Table 1. Descriptive characteristics of women with diets meeting or not meeting their RDA for calcium 1 Variable Income as percent poverty Body mass index (BMI) Height in inches How many dairy servings should consume Race White Black Other RDA age group < 25 years > 25 years Education < High school High school graduate At least some college Employment status Full time Part time Not employed outside home Food Stamp household Children present Urbanization City Suburban Nonmetropolitan Dietary calcium belowRDA (n = 1,819) 345 25.2 64.0 2.2 Dietary calcium RDA or above (n = 442) 430 24.8 64.7 2.5 Significance * ** Percent 83 90 13 6 4 4 ** 6 2 94 98 ** 22 13 37 35 41 52 * 36 40 15 23 49 37 7 7 39 43 30 29 46 48 24 24 table continued Family Economics and Nutrition Review Table 1. Descriptive characteristics of women with diets meeting or not meeting their RDA for calcium1 (cont'd) Variable Region Northeast Midwest South West On weight loss diet Take vitamin-mineral supplement Percent food away from home Aware of health problems related to calcium A void all milk Avoid whole milk only A void cheese Season Spring Summer Fall Winter Lower than usual reported intake Higher than usual reported intake Weekend day included in 3-day report 1Weighted data. * p < .05. ** p < .01. 1996 Vol. 9 No.3 Dietary calcium belowRDA (n = 1,819) Dietary calcium RDAorabove (n = 442) Percent 21 22 23 28 37 31 19 20 6 7 35 42 22 20 65 76 17 7 47 65 17 11 26 26 26 22 24 25 25 28 29 27 14 13 55 62 Significance ** ** ** * employment status, 36 percent of women with lower calcium intakes were employed full time, 15 percent were employed part time, and 49 percent were not employed outside the home. Forty percent of those with higher calcium intakes were employed full time, 23 percent part time, and 37 percent had no outside employment. There were several differences between the two groups in terms of knowledge and attitudes related to calcium intake. A significantly higher percentage of women in the higher calcium group were aware that there were any health problems related to calcium intake. They were also likely to believe they should consume more servings from the dairy group daily. They were more likely to avoid whole milk only, but less likely to avoid all milk or to avoid cheese. Food Group Consumption Patterns Women whose diets met their RDA for calcium consumed significantly more milk and milk products than women whose diets did not (table 2, p. 40). This is not surprising, considering that milk products are the major source of calcium in the American food supply (8). Milk products vary in their calcium concentration; therefore, total intake of milk products is reported both as grams and as calcium equivalents (the amount in grams of fluid whole milk that has the same quantity of calcium as these milk products). 39 Since the USDA/DHHS Food Guide Table 2. Mean consumption of major food groups and selected subgroups Pyramid defines servings from the by women with diets meeting or not meeting their RDA for calcium1 Milk, Yogurt, and Cheese Group on the basis of the calcium content of 1 cup of Dietary calcium Dietary calcium milk (37), calcium equivalents can be Food group belowRDA RDA or above used to estimate intake of milk products intakes (n = 1,819) (n = 442) Significance in relationship to Food Guide Pyramid serving recommendations. Women in Total milk and milk products (CaEq)2 the lower calcium group averaged an 159 559 ** intake of 159 calcium equivalents per day from milk and milk products or Grams approximately two-thirds of a serving Total milk and milk products 129 463 ** from the Milk, Yogurt, and Cheese Group. Women who met their calcium Whole milk 26 91 ** RDA obtained 559 calcium equivalents Lowfat milk 46 145 ** from milk products, or approximately Skim milk 19 121 ** 2.3 servings, an amount within the 2-3 Cheese 10 20 ** servings per day recommended by the Milk desserts 13 29 ** Food Guide Pyramid and slightly less than the 2.5 servings per day that these Yogurt 5 20 ** women, on average, believed they Total vegetables 180 202 should consume. Dark green vegetables 11 17 Legumes 15 19 Women who met their calcium RDA Total fruit 127 173 ** also consumed significantly more of all of the subgroups within this category Citrus juices 45 51 that were examined. The differences Total grain products 206 281 ** were particularly striking for lowfat and Meat, poultry, fish, eggs, nuts 176 180 skim milks. Women whose diets met Fats and oils 14 16 their RDA for calcium consumed more Sugars and sweets 15 22 * than three times as much lowfat milk as other women and more than six times as Total nonalcoholic beverages 798 705 much skim milk. Women whose diets Coffee 367 359 met their calcium RDA also consumed Tea 164 119 significantly more fruit, grain products, Regular sodas 146 99 ** and sugars and sweets than other Lo-cal sodas 82 78 women. Women who did not meet their calcium RDA consumed more regular Total alcoholic beverages 31 40 sodas. 1Weighted data. 2caEq =calcium equivalents. * p < .05. ** p < .01. 40 Family Economics and Nutrition Review Nutrient Intakes Women who met their calcium RDA consumed significantly more kilocalories than those who did not- I ,861 kcal/day compared with I ,373 kcaVday-although both of these levels are below the average energy allowances recommended for adult women (23). These low intake levels may reflect some underreporting, a problem that is known to plague self-reported dietary intake data (21). 1 When nutrient intakes were examined as a percent of recommendations (RDA), women whose diets met their calcium RDA consumed significantly more of all vitamins and minerals examined, as well as protein (table 3). On average, both groups met their RDAs for protein, riboflavin, phosphorus, folate, thiamin, niacin, vitamin C, and vitamin B-12. Neither group met their RDA for zinc, although the group who met their RDA for calcium averaged 97 percent of their zinc RDA, significantly higher than those who did not meet the calcium RDA, whose average intake of zinc was 66 percent of their RDA. The group who met their RDA for calcium also met their RDAs for magnesium, vitamin E, vitamin B-6, iron, and vitamin A, but the other women did not. Some of the nutrient intake differences seen could reflect the higher average caloric intakes of women whose diets met their calcium RDA. However, when the nutrient densities of the diets of the two groups were compared, the women 1 See also the article by Riddick in this issue. 1996 Vol. 9 No.3 Table 3. Mean energy, nutrient intakes, and nutrient densities of intakes, by women with diets meeting or not meeting their RDA for calcium' Variable Dietary calcium Dietary calcium and belowRDA RDA or above nutrient density (n = 1,819) (n = 442) Significance Variable Energy (kcal) 1,373 1,861 ** Percent RDA Protein 114 156 ** Zinc 66 97 ** Magnesium 70 106 ** Iron 86 116 ** Phosphorus 103 173 ** Thiamin 106 149 ** Riboflavin 100 171 ** Niacin 118 148 ** Folate 105 156 ** Vitamin B-6 78 113 ** Vitamin B-12 186 279 ** Vitamin C 129 172 ** Vitamin A 97 170 ** Vitamin E 74 116 ** Nutrient density (nutrient/1,000 kcal) Protein (g) 41.9 43.0 Calcium (mg) 363.3 621.5 ** Zinc (mg) 5.9 6.6 ** Magnesium (mg) 148.8 166.4 ** Iron (mg) 7.8 8.1 Phosphorus (mg) 625.5 777.9 ** Thiamin (mg) 0.8 0.9 Riboflavin (mg) 0.9 1.2 ** Niacin (mg) 12.4 11.6 * Folate (flg) 143.0 155.5 * Vitamin B-6 (mg) 0.9 1.0 * Vitamin B-12 (flg) 2.7 3.1 Vitamin C (mg) 58.8 57.3 Vitamin A (RE)2 593.1 766.5 ** Vitamin E (TE)3 4.3 5.2 * 1Weighted data. 2RE = retinol equivalents. 3-rE = tocopherol equivalents. * p< .05. ** p< .01. 41 who met their calcium RDA were found to have diets that were more nutrient dense for zinc, magnesium, phosphorus, riboflavin, niacin, folate, vitamin B-6, vitamin A, and vitamin E, as well as calcium (table 3). Therefore, many of the differences in diet quality between the two groups appear to be due to qualitative as well as quantitative differences in intake. Fat, Saturated Fat, and Cholesterol Intakes Women whose diets met their calcium RDA averaged 33.7 percent kilocalories from fat, compared with 34.3 percent for other women; this difference was not significant (fig. 1). Women whose diets met their calcium RDA did consume significantly more saturated fat than other women, 12.5 percent, compared with 11.6 percent. For both groups, these intakes are above levels recommended by the Dietary Guidelines for Americans (38). Women whose diets met their calcium RDA also consumed significantly more cholesterol than other women, although neither group exceeded the 300 mg/day limit recommended by the National Academy of Sciences (fig. 2). On a density level, there was no significant difference in cholesterol intake between the two groups, indicating that the difference in absolute intake between the two groups was primarily due to the higher reported caloric intakes of the women who met their calcium RDA. 42 Figure 1. Mean percent calories from fat and saturated fat by women with diets meeting or not meeting their RDA for calcium 1 %kcal 40 34.3 30 20 10 0 L____! ___ _ 1Weighted data. •• p < .01. Total fat Dietary calcium below RDA (n = 1,819) • Dietary calcium RDA or above (n = 442) 11.6 12.5 Saturated fat** Figure 2. Mean daily cholesterol intakes and cholesterol densities of women with diets meeting or not meeting their RDA for calcium 1 Mean daily cholesterol intake** (mg/day) Mean cholesterol density (mg/1 ,000 kcal) 1 Weighted data. ** p < .01. 0 50 [J Dietary calcium below ADA (n= 1,819) • Dietary calcium ADA or above (n = 442) 100 150 200 250 300 Milligrams cholesterol Family Economics and Nutrition Review Sodium and Potassium Intakes On an absolute level (mg/day), women whose diets met their calcium RDA consumed more sodium than did other women; their total intake was above the 2,400 mg limit recommended by the National Academy of Sciences (fig. 3). On a density level, the difference was reversed; women with lower calcium intakes had significantly higher sodium densities than women who met their RDA for calcium. The difference in absolute intake and sodium density is probably due to the higher caloric intakes of women who met their RDAs for calcium. If the recommended limit of 2,400 mg of sodium is divided by the average Recommended Energy Allowances (REAs) for women established by the National Academy of Sciences (23), women under age 51, with a mean REA of 2,200 kcal!day, should consume no more than 1,091 mg sodium per 1 ,000 kcal, and women ages 51 and above, with a mean REA of 1,900 kcal/day, should consume no more than 1,263 mg sodium per 1,000 kcal, in order to meet this recommendation. Mean sodium densities of both women with lower and higher calcium diets were well above those limits. Women with higher calcium intakes also had higher potassium intakes, but there was no significant difference in the potassium density of the diets of the two groups. Neither group met the National Academy of Sciences intake recommendation of 3,500 mg of potassium daily. In order to meet the potassium recommendation, women consuming their average recommended energy allowance would have to consume at least 1,591 to 1,842 mg potassium per 1,000 kcal, depending on their age. Women whose diets met their calcium RDA had potassium densities that fell within this range, but other women did no
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Title | Family Economics and Nutrition Review [Volume 9, Number 3] |
Date | 1996 |
Contributors (group) | Center for Nutrition Policy and Promotion (U.S.) |
Subject headings |
Home economics--United States--Periodicals Nutrition policy--United State--Periodicals |
Type | Text |
Format | Pamphlets |
Physical description | v. : $b ill. ; $c 28 cm. |
Publisher | Washington, D.C. : U.S. Dept. of Agriculture |
Language | en |
Contributing institution | Martha Blakeney Hodges Special Collections and University Archives, UNCG University Libraries |
Source collection | Government Documents Collection (UNCG University Libraries) |
Rights statement | http://rightsstatements.org/vocab/NoC-US/1.0/ |
Additional rights information | NO COPYRIGHT - UNITED STATES. This item has been determined to be free of copyright restrictions in the United States. The user is responsible for determining actual copyright status for any reuse of the material. |
SUDOC number | A 77.245:9/3 |
Digital publisher | The University of North Carolina at Greensboro, University Libraries, PO Box 26170, Greensboro NC 27402-6170, 336.334.5482 |
Full-text | CENTER FOR NUTRITION POLICY AND PROMOTION 2 Expenditures on Children by Families, 1995 MarkLino Joanne F. Guthrie Research Summaries SO The American Diet: Health and Economic Consequences 53 Influence of OASDI and SSI Payments on Poverty Status of Families With Children 56 Improving Federal Efforts to Assess Hunger and Food Insecurity 58 Umited Financial Resources Constrain Food Choices Regular Items 60 Charts From Federal Data Sources 62 Recent Legislation Affecting Families 63 Research and Evaluation Activities in USDA 65 Data Sources 66 Journal Abstracts Poverty Thresholds Cost of Food at Home Consumer Prices Dan Glickman, Secretary U.S. Department of Agricultu re Ellen Haas, Under Secretary Food. Nutri tion, and Consumer Services Eileen Kennedy, Executive Director Center for Nutrition Policy and Promotion Jay Hirschman, Director utrition Policy and Analysis Staff Editorial Board Mohamed Abdei-Ghany University of Alabama Rhona Applebaum 0/ational Food Processors Association Johanna Dwyer ew England Medical Center Jean Mayer USDA Human utrition Research Center on Aging at Tufts University Helen Jensen Iowa State University Janet C. King \Ve~tern Human Nutrition Research Center U.S. Department of Agriculture C. J. Lee Kentucky State University Rebecca Mullis Georgia State ·Univ.ersi ty Suzanne Murphy University of California-Berkeley Donald Rose Economic Research Service U.S. Department of Agriculture Ben Senauer University of Minnesota Laura Sims University of Maryland Retia Walker Universi ty of Kentucky Editor Joan C. Courtless Managing Editor Jane W. Fleming Family Economics and Nutrition Review is written and published each quarter by the Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, Washington, DC. The Secretary of Agriculture has determined that publication of this periodical is necessary in the transaction of the public business required by law of the Department. This publication is not copyrighted. Contents may be reprinted without permission, but credit to Family Economics and Nutrition Review would be appreciated. Use of commercial or trade names does not imply approval or constitute endorsement by USDA. Family Economics and Nutrition Review is indexed in the following databases: AGRICOLA, Ageline, Economic Literature Index, ERIC, Family Resources, PAIS, and Sociological Abstracts. Family Economics and Nutrition Review is for sale by the Superintendent of Documents. Subscription price is $8.00 per year ($1 0.00 for foreign addresses). Send subscription orders and change of address to Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. (See subscription form on p. 72.) Original manuscripts are accepted for publication (See "guidelines for authors" on p. 71 ). Suggestions or comments concerning this publication should be addressed to: Joan C. Courtless, Editor, Family Economics and Nutrition Review, Center for Nutrition Policy and Promotion, USDA, 1120 20th St., NW, Su~e 200 North lobby, Washington, DC 20036. Phone (202) 60&4816. USDA prohib~ discrimination in ~ programs on the basis of race, color, national origin, sex, religion, age, disability, political beliefs, and marital or familial status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact the USDA Office of Communications at (202) 720-2791 . To file a complaint, write the Secretary of Agriculture, U.S. Department of Agriculture, Washington, DC 20250, or call (202) 720-7327 (voice) or (202) 72D-1127 (TOO). USDA is an equal employment opportunity employer. oc1nc1 1v1 '"uu1uun r-u11cy ana t"romotlon Feature Articles 2 21 33 Expenditures on Children by Families, 1995 MarkLino Assessment of Energy Intakes in the U.S. Population, 1989-91 Howard Riddick Dietary Patterns and Personal Characteristics of Women Consuming Recommended Amounts of Calcium Joanne F. Guthrie Research Summaries 50 The American Diet: Health and Economic Consequences 53 Influence of OASDI and SSI Payments on Poverty Status of Families With Children 56 Improving Federal Efforts to Assess Hunger and Food Insecurity 58 Limited Financial Resources Constrain Food Choices Regular Items 60 62 63 65 66 67 68 69 Charts From Federal Data Sources Recent Legislation Affecting Families Research and Evaluation Activities in USDA Data Sources Journal Abstracts Poverty Thresholds Cost of Food at Home Consumer Prices Volume 9, Number 3 1996 I 2 Feature Articles Expenditures on Children by Families, 1995 By Mark Lino Economist Center for Nutrition Policy and Promotion Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This article presents the most recent estimates for husband-wife and single-parent families using data from the 1990-92 Consumer Expenditure Survey, updated to 1995 dollars using the Consumer Price Index. Data and methods used in calculating child-rearing expenses are described. Estimates are provided for major components of the budget by age of child, family income, and region of residence. Expenses on the younger child in a two-child, husband-wife household for the overall United States averaged between $5,490 and $12,550 per year, depending on the child's age and family income group. Adjustment factors for number of children in the household are also provided. Results of this study can be used in developing State child support guidelines and foster care payments as well as in family educational programs. []] ince 1960, the U.S. Department of Agriculture (USDA) has provided estimates of expenditures on children from birth through age 17. These estimates are used in setting child support guidelines, foster care payments, and in educational programs on parenthood. This study presents the latest childrearing expense estimates, which are based on 1990-92 expenditure data updated to 1995 dollars. The study presents these new estimates for husbandwife and single-parent families. It briefly describes the data and methods used in calculating child-rearing expenses 1 and then discusses the estimated expenses. The estimates are provided for the United States overall. To partially adjust for price differentials and varying pattetns of expenditures, the child-rearing expense estimates for husband-wife families are also provided for urban areas in four regions (Northeast, South, Midwest, and West) and rural areas throughout the United States.2 For single-parent families, estimates are 1The report "Expenditures on Children by Families: 1995 Annual Report" provides a more detailed description of the data and methodology. To obtain a copy, contact: USDA, Center for Nutrition Policy and Promotion, 1120 20th Street NW, Suite 200 North Lobby, Washington, DC 20036 (Telephone Number: 202-208-2417). 2Urban areas are defined as Metropolitan Statistical Areas (MSA' s) and other places of 2,500 or more people outside an MSA; rural areas are places of less than 2,500 people outside an MSA. Family Economics and Nutrition Review Categories of Household Expenditures Housing expenses include shelter (mortgage interest, property taxes, or rent; maintenance and repairs; and insurance), utilities (gas, electricity, fuel, telephone, and water), and house furnishings and equipment (furniture, floor coverings, major appliances, and small appliances). It should be noted that for homeowners, housing expenses do not include mortgage principal payments; such payments are considered in the Consumer Expenditure Survey to be part of savings. So, total dollars allocated to housing by homeowners are underestimated in this report. Food expenses include food and nonalcoholic beverages purchased at grocery, convenience, and specialty stores, including purchases with food stamps; dining at restaurants; and household expenditures on school meals. Transportation expenses include the net outlay on purchase of new and used vehicles, vehicle finance charges, gasoline and motor oil, maintenance and repairs, insurance, and public transportation. Clothing expenses include children's apparel such as diapers, shirts, pants, dresses, and suits; footwear; and clothing services such as dry cleaning, alterations and repair, and storage. Health care expenses include medical and dental services not covered by insurance, prescription drugs and medical supplies not covered by insurance, and health insurance premiums not paid by employer or other organization. Child care and education expenses include day care tuition and supplies; baby-sitting; and elementary and high school tuition, books, and supplies. Miscellaneous expenses include personal care items, entertainment, and reading materials. provided only for the United States overall because of sample size limitations. Expenditures on children are estimated for the major budgetary components: The CE has been conducted annually since 1980 and interviews about 5,000 households each quarter over a 1-year period. Each quarter is deemed an independent sample by BLS, bringing the total number of households in the 1990- 92 survey to about 60,000. major sources of income, such as wages and salaries, self-employment income, and Social Security income. Quarterly expenditures were annualized. The sample consisted of 12,850 husbandwife households and 3,395 singleparent households and was weighted Housing, food, transportation, clothing, health care, child care and education, and miscellaneous goods and services. The box shown above describes each expenditure component. Source of Data Data used to estimate expenditures on children are from the 1990-92 Consumer Expenditure Survey (CE), administered by the Bureau of Labor Statistics (BLS). The CE collects information on sociodemographic characteristics and income of households as well as expenditures. From these households, husband-wife and single-parent families were selected for this study if: ( 1) they had at least one child of their own, age 17 or under, in the household, (2) they had six or fewer children, (3) there were no other related or unrelated people present in the household except their own children, and (4) they were complete income reporters. Complete income reporters are households that provide values for to reflect the U.S. population of interest, using BLS weighting methods. Although based on 1990-92 data, the expense estimates were updated to 1995 dollars using the Consumer Price Index (CPI-U) (1990 and 1991 expenditure and income data were first converted to 1992 dollars; then all 3 years of data were updated to 1995 dollars). 1996 Vol. 9 No.3 3 Methodology The CE collects overall household expenditure data for some budgetary components (housing, food, transportation, health care, and miscellaneous goods and services) and child-specific expenditure data for other components (clothing, child care, and education). Multivariate analysis was used to estimate household and child-specific expenditures, controlling for income level, family size, and age of the younger child so estimates could be made for families with these varying characteristics. Regional estimates were derived by controlling for region. The three income groups of husband-wife households (before-tax income under $31,000, between $31,000 and $52,160, and over $52,160 in 1992 dollars) were determined by dividing the sample for the overall United States into equal thirds. For each income level, the estimates were for husband-wife families with two children, with the younger child in one of six age categories (0-2, 3-5, 6-8, 9-11, 12-14, and 15-17 years). Households with four members (two children) were selected as the standard since this was the average size of two-parent families in 1990-92. The focus was on the younger child in a household since the older child was sometimes over age 17. It should be noted that the estimates are based on CE interviews of households with and without specific expenses; so for some families, expenditures may be higher or lower than the mean estimates, depending on whether they incur the expense or not. This particularly applies to child care and education for which about 50 percent of families in the study had no expenditure. Also, the estimates only cover out-of-pocket expenditures on children made by the parents and not 4 by others such as grandparents or friends. For example, the value of clothing gifts to children from grandparents would not be included in clothing expenses. On the other hand, some of the expenditures reported by parents may be gifts for children other than their own. Regional income categories are based on the national income categories in 1992 dollars, updated to 1995 dollars using regional CPI' s. The regional income categories are not divided into equal thirds for each region. As previously mentioned, the three income categories were calculated for the overall United States by dividing the sample into equal thirds. After the various overall household and child-specific expenditures were estimated, these total amounts were allocated amo~'g the four family members (husband, wife, older child, and younger child). The estimated expenditures for clothing and child care and education were only for children. It was assumed that these expenses were equally allocated to each child so the estimated expenditures were divided by two (the number of children in the household). Because the CE did not collect expenditures on food and health care by family member, data from other Federal studies were used to apportion these budgetary components to children by age. Food budget shares as a percentage of total food expenditures, for the younger child in a husband-wife household with two children, were determined using the 1994 USDA food plans (8). These shares were estimated by age of the child and household income level. The food budget shares were then applied to estimated household food expenditures to determine food expenses on children. Health care shares as a percentage of total health care expenses for the younger child in a husband-wife household with two children were calculated from the 1987 National Medical Expenditure Survey (NMES) (5). These shares were estimated by age of the child and applied to estimated household health care expenditures to determine expenses on children. Unlike food and health care, no research base exists for allocating estimated household expenditures on housing, transportation, and miscellaneous goods and services among individual household members. Two of the most common approaches for allocating these expenses are the marginal cost method and the per capita method. The marginal cost method measures expenditures on children as the difference in expenses between couples with children and equivalent childless couples. The method depends on development of an equivalency measure; however, there is no universally accepted measure. Various methods have been proposed, each yielding different estimates of expenditures on children.3 Some of the marginal cost approaches assume that parents do not alter their expenditures on themselves after a child is added to a household. In addition, couples without children often buy homes larger than they need at the time of purchase in anticipation of children. Comparing the expenditures of these couples to similar couples with children could lead to underestimates of expenditures on children. 3For a review of equivalency measures and estimates of expenditures on children resulting from them, see U.S. Department of Health and Human Services, Administration for Children and Families, 1990, Estimates of Expenditures on Children and Child Support Guidelines ( 10). Family Economics and Nutrition Review For these reasons, the USDA uses the per capita method to allocate housing, transportation, and miscellaneous goods and services among household members. The per capita method simply allocates expenses among household members in equal proportions. Although the per capita method has its limitations, these limitations were considered less severe than those of the marginal cost approach. A major limitation of the per capita method is that expenditures for an additional child may be less than average expenditures. Because of this, adjustment formulas for cases of one child or three or more children were devised for use when estimating expenditures on children for households of different sizes. These formulas are discussed later on. Transportation expenses resulting from employment activities are not related to expenses on children, so these costs were excluded from the estimated household transportation expenses using data from a 1990 study by the U.S. Department of Transportation ( 11 ). Although the USDA utilizes the per capita approach rather than a marginal cost approach in allocating housing, transportation, and miscellaneous expenditures to children in a household, a USDA study (6) examined how these expenses would be allocated using different marginal cost approaches. These approaches produced estimates of expenditures on children for housing and miscellaneous goods and services below-and estimates of transportation expenditures on children above-those produced by the per capita method. 1996 Vol. 9 No.3 Figure 1. Estimated 1995 annual family expenditures on a child, by before-tax income level and age of child1 Dollars 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 0-2 3-5 6-8 9-11 12-14 15-17 Age of child 0 Less than $33,700 • $33,700- $56,700 • More than $56,700 1U.S. average for the younger child in husband-wife families with two children. Estimated Expenditures on Children by Husband-Wife Households Estimates of family expenditures on the younger child in husband-wife households with two children for the overall United States, urban regions of the country, and overall rural areas are presented in tables 2 through 7 on pp. 14-20. Income levels of households were updated to 1995 dollars using the all-items category of the CPI-U, and expenditures were updated using the CPI for the corresponding item (that is, the CPI's for housing, food, etc.). Regional estimates were updated to 1995 dollars using the regional CPI's. Given the large amount of information in the tables, the following subsections highlight the child-rearing expense estimates for the younger child in a two-child household for the overall United States by income level, budgetary component, and age of the child, as well as expense estimates by region. Income Level Estimated expenses on children vary considerably by household income level (fig. 1). Depending on age of the child, the annual expenses range from $5,490 to $6,560 for families in the lowest income group (1995 before-tax income less than $33,700), from $7,610 to $8,710 for families in the middle-income group (1995 before-tax income between $33,700 and $56,700), and from $11 ,320 to $12,550 for families in the highest 5 6 As a proportion of total child-rearing expenses, housing accounts for the largest share ... income group (1995 before-tax income more than $56,700). On average, households in the lowest group spend 28 percent of their before-tax income per year on a child, those in the middle-income group, 18 percent, and those in the highest income group, 14 percent. The range in these percentages would be narrower if after-tax income were considered, since a greater proportion of income in higher income households goes toward taxes. Although families in the highest income group spend slightly less than twice the amount that families in the lowest income group spend on a child, on average, the amount varies by budgetary component. In general, expenses on a child for goods and services considered to be necessities (such as food and clothing) do not vary as much as those considered to be discretionary (such as miscellaneous expenses) among households in the three income groups. For example, clothing expenses on a child age 15-17 average $670 in the lowest income group and $1,010 in the highest income group, a 51-percent difference. Miscellaneous expenses on the same age child average $560 in the lowest income group and $1 ,420 in the highest income group, a 154-percent difference. Budgetary Component As a proportion of total child-rearing expenses, housing accounts for the largest share; figure 2 shows this for families in the middle-income group. Based on an average for the six age groups, housing accounts for 33 percent of child-rearing expenses for a child in Figure 2, Estimated family expenditures on a child through age 17, by budgetary share 1 Transportation 15% Clothing Health care and education Housing Miscellaneous Total Expenditures in 1995 dollars= $145,320 1 Estimates are for the younger child in middle-income (1995 before-tax income between $33,700 and $56,700), husband-wife families with two children. Family Economics and Nutrition Review Figure 3. Estimated 1995 annual family expenditures on a child, by age and budgetary share 1 Percent $7,610 $7,810 $7,870 $7,860 $8,580 $8,710 100 Miscellaneous Child care & education 80 Clothing Health care 60 Transportation 40 Food 20 Housing 0 0-2 3-5 6-8 9-11 12-14 15-17 Age of child 1U.S. average for the younger child in middle-income (1995 before-tax income between $33,700 and $56,700), husband-wife families with two children. the lowest and middle-income groups and 37 percent in the highest income group. Food is the second largest average expense on a child for families regardless of income level, accounting for 20 percent of child-rearing expenses for a child in the lowest income group, 18 percent in the middle-income group, and 15 percent in the highest income group. Transportation is the third largest child-rearing expense, making up 14 to 15 percent of child-rearing expenses across income levels. Miscellaneous goods and services (personal care items, entertainment, and reading materials) is the fourth largest expense on a child for families in all income groups. Clothing accounts for 6 to 8 percent of expenses on a child for families in the three income groups. 1996 Vol. 9 No.3 These estimates of children's clothing expenses do not include clothing received in the form of gifts or hand-me-downs. Child care and education are 7 to 10 percent and health care, 5 to 7 percent of child-rearing expenses across income groups. For health care, these estimated expenditures include only out-of-pocket expenses and not that portion covered by health insurance. Age of Child Expenditures on a child are lower in the younger age categories and higher in the older age categories. This held across income groups (fig. 3 depicts this for families in the middle-income group) even though housing expenses, the highest child-rearing expenditure, generally decline as the child grows older. The decline in housing expenses reflects diminishing interest paid by homeowners over the life of a mortgage. Payments on principal are not considered part of housing costs in the CE; they are deemed to be part of savings. Child-rearing food, transportation, clothing, and health care expenses generally increase over the age of a child for all three income groups. Transportation expenses are highest for a child age 15-17, when he or she would start driving. Child care and education expenses are highest for a child under age 6. Most of this expense may be attributable to child care at this age. The estimated expense for child care and education may seem low for those with the expense. However, as previously discussed, the estimates reflect the average of households with and without the expense. 7 Region Child-rearing expenses in the various regions of the country reflect patterns observed in the United States overall. In each region, expenses on a child increase with income level of the household and, generally, with age of the child. Overall child-rearing expenses are highest in the urban West, followed by the urban Northeast, and urban South; figure 4 shows total child-rearing expenses by region and age of a child for middle-income families. Childrearing expenses are lowest in the urban Midwest and rural areas. Much of the difference in expenses on a child among regions is related to housing costs. Total housing expenses on a child are highest in the urban West and urban Northeast and lowest in rural areas. However, child-rearing transportation expenses are highest for families in rural areas. This likely reflects the longer distances that must be traveled and the lack of public transportation in these areas. Adjustments for Older Children and Household Size The expense estimates on a child represent expenditures on the younger child at various ages in a husband-wife household with two children. It cannot be assumed that expenses on the older child are the same at these various ages. Expenses may vary by birth order. To determine whether a difference exists, the extent of this difference, and how the expenditures may be adjusted to estimate expenses on an older child, the method described on pp. 4-5 was repeated, with the focus being on the older child in each of the same age categories as used with the younger child. A family with two children was again used as the standard. Household income and region of residence were not held constant, so fmdings are applicable to all families. 8 Figure 4. Estimated 1995 annual family expenditures on a child, by region and age 1 Dollars 10,000 9,500 9,000 8,500 8,000 7,500 7,000 6,500 -A - 0 A 0 0 0·2 3·5 6-8 9-11 12-14 15-17 Age of child Urban Midwest . -11-- Rural Urban South Urban Northeast Urban West "" --4- -->!<- n 1U.S. average for the younger child in middle-income, husband-wife families with two children. For the urban West, the middle-income group had a 1995 before-tax income between $33,500 and $56,400; for the urban Northeast, between $33,500 and $56,300; for the urban South, between $33,800 and $56,900; for the urban Midwest, between $33,800 and $56,900; and for rural areas, between $34,000 and $57,200. It was found that, on average, husbandwife households with two children spend about the same amount on a younger and older child (except for differences caused by age). So, the figures in tables 2 through 7 reflect expenditures on either child in a two-child family. Thus, annual expenditures on children in a husband-wife, two-child family may be estimated by summing the expenses for the two appropriate age categories. For example, annual expenditures on children ages 9-11 and 15-17 in a husband-wife family in the middle income group for the overall United States would be $16,570 ($7,860 + $8,710). It should be noted that for specific budgetary components, annual expenses on an older child vary, compared with those on a younger child. Families spend more on clothing and education for an older child, but less on transportation. The estimates should also be adjusted if a household has only one child or more than two children. Families will spend more or less on a child depending on the number of other children in the household and economies of scale. To derive these adjustments, multivariate analysis was used to estimate expenditures for each budgetary component controlling for household size and age of the younger child, but not household income level and region of the country, so the results are applicable to all families. Family Economics and Nutrition Review Expenditures on Children Over Time Since 1960, the U.S. Department of Agriculture (USDA) has been providing estimates of expenditures on children from birth through age 17. The original estimates were based on the 1960 Consumer Expenditure Survey. The figure below examines how these expenditure estimates have changed over time at 5-year intervals. Depicted are the average total expenditures on a child from birth through age 17 in a middle-income husband-wife family. Expenditures are in nominal (not adjusted for inflation) dollars. Expenses to raise a child to age 18 have dramatically increased, from $25,230 in 1960 to $145,320 in 1995. Even when adjusted for inflation and converted into 1995 dollars, real expenditures on children have risen-from approximately $129,900 in 1960. Among factors causing this increase are new components of child-rearing costs, particularly child care. In 1960, child care expenses were negligible as many mothers were not in the labor force. In 1995, child care expenses were among the largest expenditures made on preschool children by middle-income families. The original intent of USDA's research on expenditures on children was primarily educational: expenditure estimates on child-rearing were to be used in financial planning guides and budgeting programs. Although still used for this purpose, the child-rearing expense estimates have gained new applications, such as in developing State child support guidelines and foster care payments. These new uses of the child-rearing expense estimates reflect the changing structure of families with children in the United States and thus, the importance of the ongoing nature of this area of research. Total expenditures on a child for the first 18 years of life1 1 Not adjusted for inflation $160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 $145,320 0 L-------------~-------------------------- 1960 65 70 75 80 85 90 95 Average expenditures for a middle-income husband-wife family, not adjusted for inflation. 1996 Vol. 9 No.3 These expenditures were then assigned to a child using the method previously described. Compared with expenditures ·for each child in a husband-wife, two-child family, husband-wife households with one child spend an average of 24 percent more on the single child, and those with three or more children spend an average of 23 percent less on each child. Therefore, to adjust the figures in tables 2 through 7 to estimate annual overall expenditures on an only child, 24 percent should be added to the total expense for the child's age category. To estimate expenditures on three or more children, 23 percent should be subtracted from the total expense for each child's age category, and these totals should be summed. As an example of adjustments needed for different numbers of children, the total expenses for a middle-income family in the overall United States on a child age 15-17 with no siblings would be $10,800 ($8,710 x 1.24) and the total expenses on three children ages 3-5, 12-14, and 15-17 would be $19,330 (($7,810 + $8,580 + $8,710) x .77). For a particular budgetary component, the percentages may be more or less. As family size increases, costs per child for food decrease less than for housing and transportation. Expenditures by Single-Parent Families The estimates of expenditures on children by husband-wife families do not apply to single-parent families, which account for an increasing percentage of families with children. Therefore, separate estimates of child-rearing expenses in single-parent households were made using the CE data. Most single-parent families in the survey (90 percent) were headed by a woman. 9 The method used in determining child-rearing expen es for two-parent households was followed. Multivariate analysis was u ed to estimate expenditures for each budgetary component, controlling for income level, household size (a single parent with two children was used as the tandard), and age of the younger child (the same age categories as u ed with children in two-parent families). Income group of single-parent households (before-tax income under $31,000 and $31 ,000 and over in 1992 dollars; these income groups were inflated to 1995 dollars in the table) were selected to correspond with the income groups used in estimating child-rearing expenditures in husband-wife households. This income includes child support payments. The two higher income groups of two-parent families (income between $31 ,000 and $52, 160 and over $52,160 in 1992 dollars) were combined because only 17 percent of singleparent households had a before-tax income of $31 ,000 and over. The sample was weighted to reflect the U.S. population of interest. Children's clothing and child care and education expenditures were divided between the two children in the oneparent household. For food and health care, household member shares were calculated for a three-member household (single parent and two children, with the younger child in one of the six age categories) using the USDA food plans and the 1987 NMES findings. These shares for the younger child in a single-parent family were then applied to estimated food and health care expenditures to determine expenses on the younger child in each age category. 10 Housing, transportation, and miscellaneous expenditures were allocated among household members on a per capita basis. Transportation expenses were adjusted to account for nonemploymentrelated activities in single-parent families. Income and expenses were updated to 1995 dollars. Child-rearing expense estimates for single-parent families are in table 8, p. 20. For the lower income group (1995 before-tax income less than $33,700), a comparison of estimated expenditures on the younger child in a single-parent family with two children with those of the younger child in a husband-wife family with two children is presented in table 1, p. 12; as previously discussed, 83 percent of single-parent families and 33 percent of husband-wife families were in this lower income group. More single-parent than husband-wife families fell in the bottom range of this lower income group. Average income for single-parent families in the lower income group is $14,100, compared with $21 ,000 for husband-wife families in this income group. However, total expenditures on a child through age 17 are, on average, only 5 percent lower in single-parent households than in two-parent households. Single-parent families in this lower income group, therefore, spend a larger proportion of their income on children. On average, housing expenses are higher, whereas transportation, health care, child care and education, and miscellaneous expenditures on a child are lower in single-parent than in husband-wife households. Childrelated food and clothing expenditures are similar, on average, in single-parent and in two-parent families. ... total expenditures on a child through age 17 are, on average, only 5 percent lower in single-parent households than in two-parent households. Family Economics and Nutrition Review Estimating Future Costs The estimates presented in this study represent household expenditures on a child of a certain age in 1995. To estimate these expenses for the first 17 years, future price changes need to be incorporated in the figures. To do this, a future cost formula is used such that: CJ = Cp(J + i)n where: CJ = projected future annual dollar expenditure on a child of a particular age Cp = present ( 1995) annual dollar expenditure on a child of a particular age i =projected annual inflation (or deflation) n = number of years from present until child will reach a particular age An example of estimated future Estimated annual expenditures on a child born in 1995, by income group1 expenditures on the younger child in a husband-wife family with two Income group children for each of the three income Year Age Lowest Middle Highest groups for the overall United States is presented. The example assumes a child is born in 1995, reaching 1995 <1 $5,490 $7,610 $11,320 age 17 in the year 2012, and the 1996 1 5,790 8,020 11,930 average annual inflation rate over 1997 2 6,100 8,450 12,580 this time is 5.4 percent (the average 1998 3 6,570 9,140 13,510 annual inflation rate over the past 1999 4 6,920 9,640 14,240 20 years) (9). As can be seen, total family expenses on a child through 2000 5 7,300 10,160 15,010 age 17 would be $176,420, $238,840, 2001 6 7,870 10,790 15,770 and $346,980 for households in the 2002 7 8,290 11 ,370 16,620 lowest, middle-, and highest income 2003 8 8,740 11 ,990 17,520 groups, respectively. In 1995 dollar 2004 9 9,260 12,620 18,350 values, these figures would be $106,890, $145,320, and $211 ,830. 2005 10 9,760 13,300 19,340 2006 11 10,290 14,020 20,380 Inflation rates other than 5.4 percent 2007 12 12,330 16,130 23,060 could be substituted into the formula 2008 13 13,000 17,000 24,310 if projections of these rates vary in the 2009 14 13,700 17,920 25,620 future. Also, it is somewhat unrealistic 2010 15 14,220 19,170 27,620 to assume that households remain in one income category as a child grows 2011 16 14,990 20,210 29,110 older. For most families, income rises 2012 17 15,800 21 ,300 30,690 over time. In addition, such projections Total $176,420 $238,840 $346,980 assume child-rearing expenditures change only with inflation, but parental I Estimates are for the younger child in husband-wife families with two children for the overall United expenditure patterns also change over States. time. 1996 Vol. 9 No. 3 11 Table 1. A comparison of estimated 1995 expenditures on a child by lower income single-parent and husband-wife families1 Single-parent Husband-wife Age of child households households 0-2 $4,650 $5,490 3-5 5,220 5,610 6-8 5,900 5,740 9- 11 5,510 5,770 12- 14 5,940 6,560 15- 17 6,640 6,460 Total (0 - 17) $101,580 $106,890 1Estimates are for the younger child in two-child families in the overall United States with 1995 beforetax income less than $33,700. For the higher income group of singleparent families (1995 before-tax income of $33,700 and over), child-rearing expense estimates are about the same as those for two-parent households in the before-tax income group of $56,700 and over; total expenses for the younger child through age 17 are $213,240 for single-parent families versus $211,830 for husband-wife families in 1995 dollars. Child-rearing expenses for the higher income group of single-parent families, therefore, also consume a larger proportion of income than in husband-wife families. It appears that expenditures on children do not differ very much between single-parent and husband-wife households. What differs is household income levels. As single-parent families have one less potential earner, on average, their total household income is lower and child-rearing expenses are a greater percentage of this income. Estimates only cover out-of-pocket childrearing expenditures made by the parent with primary care of the child and do not include child-related expenditures 12 made by the parent without primary care or others, such as grandparents. Such expenditures could not be estimated from the data. Overall expenses by both parents on a child in a single-parent household are likely greater than this study's estimates. To determine the extent of the difference in expenditures on an older child in single-parent households, the previous procedure was essentially repeated with the focus being on the older child. A family with two children was used as the standard. On average, single-parent households with two children spend 7 percent less on the older than on the younger child (in addition to differences caused by age). This contrasts with husband-wife households that spend about the same amount on the older and younger child. As with husband-wife households, more or less is spent if a single-parent household has only one child or three or more children. To determine these differences, multivariate analysis was used to estimate expenditures for each budgetary component controlling for household size and age of the younger child. These expenditures were then assigned to a child using the previous method. Compared with expenditures for the younger child in a single-parent, twochild family, single-parent households with one child spend an average of 35 percent more on the single child, and those with three or more children spend an average of 28 percent less on each child. Other Expenditures on Children Expenditures on a child estimated in this study are composed of direct parental expenses made on a child through age 17 for seven major budgetary components. These direct expenditures exclude costs related to childbirth and prenatal health care. In 1991, these particular health care costs averaged $4,720 for a normal delivery and $7,826 for a cesarean delivery (3). These costs may be reduced by health insurance. One of the largest expenses made on children after age 17 is the cost of a college education. The College Board (2) estimates that in 1995-96, average annual tuition and fees are $2,760 at 4-year public colleges and $10,514 at 4-year private colleges; annual room and board is $3,847 at 4-year public colleges and $4,535 at 4-year private colleges. For 2-year colleges in 1995-96, average annual tuition and fees are $1 ,405 at public colleges and $6,564 at private colleges; annual room and board is $3,997 at 2-year private colleges (no estimates are given for 2-year public colleges). Other parental expenses on children after age 17 include those associated with children living at home or, if children do not live at home, gifts and other contributions to them. Family Economics and Nutrition Review The estimates do not include all government expenditures on children. Examples of excluded expenses would be public education, Medicaid, and school meals. The actual expenditures on children (by parents and the government) would . be higher than reported in this study, especially for the lowest income group. Indirect costs involved in child rearing are also not included in the estimates. Although these costs are typically more difficult to measure than direct expenditures, they can be substantial. The time involved in rearing children is considerable. In addition, one or both parents may need to cut back on hours spent in the labor force to care for children, thus reducing current earnings and future career opportunities. The indirect costs ?f child rearing may very likely exceed the direct costs. For more on these indirect costs, see Bryant et al. (1), Ireland and Ward (4), and SpalterRoth and Hartmann (7). 1996 Vol. 9 No. 3 References 1. Bryant, W.K., Zick, C.D., and Kim, H. 1992. The Dollar Value of Household Work. College of Human Ecology, Cornell University, Ithaca, NY. 2. The College Board. 1995. News from the College Board. September 25 issue. 3. Health Insurance Association of America. 1994. Source Book of Health Insurance Data, 1994 ed. Washington, DC. 4. Ireland, T.R. and Ward, J.O. 1995. Valuing Children in Litigation: Family and Individual Loss Assessment. Lawyers and Judges Publishing Company, Inc., Tucson, AZ. 5. Lefkowitz, D. and Monheit, A. 1991. Health Insurance, Use of Health Services, and Health Care Expenditures. National Medical Expenditure Survey Research Findings 12. U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research Publication No. 92-0017. 6. Lino, M. and Johnson, D.S. 1995. Housing, transportation, and miscellaneous expenditures on children: A comparison of methodologies. Family Economics Review 8( 1):2-12. 7. Spalter-Roth, R.M. and Hartmann, H.I. 1990. Unnecessary Losses: Costs to Americans of the Lack of Family and Medical Leave. Institute for Women's Policy Research, Washington, DC. 8. U.S. Department of Agriculture, Agricultural Research Service. 1994. Cost of food at home. Family Economics Review 7(4):45. 9. U.S. Department of Commerce, Bureau of the Census. 1995. Statistical Abstract of the United States: 1995 (115th ed.). I 0. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. 1990. Estimates of Expenditures on Children and Child Support Guidelines. 11. U.S. Department of Transportation, Federal Highway Administration. 1994. 1990 Nationwide Personal Transportation Study. 13 Table 2. Estimated annual expenditures* on a child by husband-wife families, overall United States, 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneoust Income: Less than $33,700 (Average=$21,000) 0-2 $5,490 $2,100 $780 $700 $370 $370 $630 $540 3-5 5,610 2,080 870 680 360 360 710 550 6-8 5,740 2,010 1,120 790 410 410 420 580 9-11 5,770 1,810 1,340 860 450 450 250 610 12-14 6,560 2,020 1,410 970 760 450 180 770 15-17 6,460 1,630 1,520 1,300 670 480 300 560 Total $106,890 $34,950 $21 '120 $15,900 $9,060 $7,560 $7,470 $10,830 Income: $33,700 to $56,700 (Average=$44,800) 0-2 $7,610 $2,840 $930 $1 ,050 $440 $490 $1,030 $830 3-5 7,810 2,820 1,080 1,020 430 470 1,140 850 6-8 7,870 2,750 1,370 1 '130 470 540 730 880 9-11 7,860 2,550 1,620 1,200 520 580 480 910 12-14 8,580 2,760 1,630 1,310 880 590 350 1,060 15-17 8,710 2,370 1,810 1,660 790 620 600 860 Total $145,320 $48,270 $25,320 $22,110 $10,590 $9,870 $12,990 $16,170 Income: More than $56,700 (Average=$84,800) 0-2 $1 1,320 $4,520 $1 ,240 $1,470 $580 $560 $1 ,550 $1,400 3-5 11 ,540 4,490 1,400 1,440 570 540 1,690 1,410 6-8 11 ,500 4,420 1,690 1,550 620 620 1 '160 1,440 9-11 11,430 4,230 1,960 1,620 670 670 810 1,470 12-14 12,270 4,440 2,060 1,730 1,120 670 620 1,630 15-17 12,550 4,050 2,170 2,100 1,010 710 1,090 1,420 Total $211 ,830 $78,450 $31 ,560 $29,730 $13,710 $11 ,310 $20,760 $26,310 "Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. t Miscellaneous expenses include personal care items, entertainment, and reading materials. 14 Family Economics and Nutrition Review Table 3. Estimated annual expenditures* on a child by husband-wife families, urban West, t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous,* Income: Less than $33,500 (Average=$20,900) 0-2 $6,080 $2,520 $850 $770 $360 $320 $630 $630 3-5 6,210 2,510 940 750 350 300 710 650 6-8 6,370 2,470 1,210 850 390 350 420 680 9-11 6,490 2,330 1,450 920 440 380 250 720 12-14 7,210 2,500 1,510 1,030 730 390 180 870 15-17 7,180 2,150 1,640 1,360 650 410 300 670 Total $118,620 $43,440 $22,800 $17,040 $8,760 $6,450 $7,470 $12,660 Income: $33,500 to $56,400 (Average=$44,600) 0-2 $8,200 $3,240 $1,000 $1,120 $430 $430 $1,050 $930 3-5 8,420 3,230 1,150 1,100 420 410 1,160 950 6-8 8,500 3,190 1,460 1,200 460 470 740 980 9-11 8,570 3,050 1,730 1,270 510 510 480 1,020 12-14 9,250 3,220 1,730 1,390 860 520 360 1,170 15-17 9,400 2,870 1,920 1,730 760 540 610 970 Total $157,020 $56,400 $26,970 $23,430 $10,320 $8,640 $13,200 $18,060 Income: More than $56,400 (Average=$84,400) 0-2 $11,780 $4,800 $1,290 $1 ,550 $560 $510 $1 ,590 $1,480 3-5 12,020 4,780 1,450 1,530 540 490 1,730 1,500 6-8 12,000 4,750 1,750 1,630 600 550 1,190 1,530 9-11 11,980 4,610 2,040 1,690 650 590 830 1,570 12-14 12,770 4,780 2,140 1,810 1,080 600 640 1,720 15-17 13,100 4,430 2,250 2,170 980 630 1,120 1,520 Total $220,950 $84,450 $32,760 $31,140 $13,230 $10,110 $21,300 $27,960 *Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. tThe Western region consists of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. *Miscellaneous expenses include personal cam items, entertainment, and reading materials. 1996 Vol. 9 No.3 15 Table 4. Estimated annual expenditures* on a child by husband-wife families, urban Northeast, t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous* Income: Less than $33,500 (Average=$20,900) 0-2 $5,750 $2,520 $880 $580 $380 $360 $510 $520 3-5 5,870 2,500 980 560 370 340 580 540 6-8 6,090 2,470 1,250 660 420 390 330 570 9-11 6,230 2,330 1,490 730 470 420 190 600 12-14 7,030 2,500 1,560 850 790 430 140 760 15-17 6,930 2,150 1,680 1 '170 700 450 220 560 Total $113,700 $43,410 $23,520 $13,650 $9,390 $7,170 $5,910 $10,650 Income: $33,500 to $56,300 (Average=$44,500) 0-2 $7,830 $3,240 $1,030 $940 $450 $480 $870 $820 3-5 8,030 3,220 1 '180 920 440 460 970 840 6-8 8,190 3,190 1,500 1,020 490 520 600 870 9-11 8,290 3,050 1,770 ' 1,090 540 560 380 900 12-14 9,020 3,220 1,770 1,200 920 570 280 1,060 15-17 9,130 2,870 1,970 1,540 820 590 480 860 Total $151,470 $56,370 $27,660 $20,130 $10,980 $9,540 $10,740 $16,050 Income: More than $56,300 (Average=$84,300) 0-2 $11,340 $4,790 $1,320 $1,360 $590 $560 $1 ,350 $1,370 3-5 11,590 4,780 1,490 1,340 570 540 1,480 1,390 6-8 11,620 4,740 1,790 1,440 630 610 990 1,420 9-11 11,660 4,600 2,090 1,510 680 650 680 1,450 12-14 12,520 4,770 2,180 1,630 1,150 660 520 1,610 15-17 12,740 4,420 2,300 1,980 1,040 690 900 1,410 Total $214,410 $84,300 $33,510 $27,780 $13,980 $11 '130 $17,760 $25,950 *Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. tThe Northeast region consists of Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. iMiscellaneous expenses include personal care items, entertainment, and reading materials. 16 Family Economics and Nutrition Review Table 5. Estimated annual expenditures* on a child by husband-wife families, urban South,t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous* Income: Less than $33,800 (Average=$21,100) 0-2 $5,550 $2,070 $750 $700 $400 $420 $700 $510 3-5 5,670 2,050 840 680 390 400 780 530 6-8 5,810 2,010 1,090 780 440 460 470 560 9-11 5,910 1,870 1,320 850 490 490 290 600 12-14 6,670 2,050 1,380 970 810 500 210 750 15-17 6,630 1,690 1,500 1,300 710 530 350 550 Total $108,720 $35,220 $20,640 $15,840 $9,720 $8,400 $8,400 $10,500 Income: $33,800 to $56,900 (Average=$45,000) 0-2 $7,730 $2,790 $910 $1,060 $470 $550 $1,140 $810 3-5 7,940 2,780 1,050 1,040 460 530 1,250 830 6-8 8,010 2,740 1,340 1,140 510 600 820 860 9-11 8,050 2,600 1,590 1,210 570 640 540 900 12-14 8,740 2,770 1,600 1,330 940 650 400 1,050 15-17 8,950 2,420 1,790 1,670 840 680 700 850 Total $148,260 $48,300 $24,840 $22,350 $11,370 $10,950 $14,550 $15,900 Income: More than $56,900 (Average=$85,200) 0-2 $11,370 $4,370 $1,190 $1,480 $620 $640 $1,700 $1,370 3-5 11,600 4,350 1,360 1,460 600 610 1,840 1,380 6-8 11,580 4,320 1,640 1,570 660 690 1,290 1,410 9-11 11,530 4,170 1,920 1,630 720 740 909 1,450 12-14 12,350 4,350 2,010 1,750 1,180 750 710 1,600 15-17 12,710 3,990 2,120 2,110 1,070 770 1,250 1,400 Total $213,420 $76,650 $30,720 $30,000 $14,550 $12,600 $23,070 $25,830 ·Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. trhe Southern region consists of Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. *Miscellaneous expenses include personal care items, entertainment, and reading materials. 1996 Vol. 9 No.3 17 Table 6. Estimated annual expenditures* on a child by husband-wife families, urban Midwest,t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous; Income: Less than $33,800 (Average=$21,100) 0-2 $4,970 $1,860 $710 $610 $350 $340 $610 $490 3-5 5,100 1,840 800 590 340 330 690 510 6-8 5,250 1,810 1,040 700 380 370 410 540 9-11 5,340 1,670 1,260 760 430 410 240 570 12-14 6,070 1,840 1,320 880 720 410 170 730 15-17 6,000 1,480 1,440 1,210 630 430 290 520 Total $98,190 $31,500 $19,710 $14,250 $8,550 $6,870 $7,230 $10,080 Income: $33,800 to $56,900 (Average=$45,000) 0-2 $7,110 $2,590 $870 $970 $410 $460 $1,020 $790 3-5 7,310 2,570 1,010 950 400 440 1,130 810 6-8 7,390 2,530 1,290 1,060 450 500 720 840 9-11 7,430 2,390 1,540 1,120 500 540 470 870 12-14 8,120 2,560 1,550 1,240 840 550 350 1,030 15-17 8,250 2,210 1,730 1,580 750 570 590 820 Total $136,830 $44,550 $23,970 $20,760 $10,050 $9,180 $12,840 $15,480 Income: More than $56,900 (Average=$85, 1 00) 0-2 $10,670 $4,150 $1,160 $1,400 $540 $540 $1,540 $1,340 3-5 10,920 4,140 1,310 1,380 530 520 1,680 1,360 6-8 10,890 4,100 1,590 1,480 580 590 1,160 1,390 9-11 10,880 3,960 1,870 1,550 640 630 800 1,430 12-14 11,650 4,130 1,950 1,670 1,060 640 620 1,580 15-17 11,980 3,780 2,070 2,030 960 670 1,090 1,380 Total $200,970 $72,780 $29,850 $28,530 $12,930 $10,770 $20,670 $25,440 •estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. trhe Midwest region consists of Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. *Miscellaneous expenses include personal care items, entertainment, and reading materials. 18 Family Economics and Nutrition Review Table 7. Estimated annual expenditures* on a child by husband-wife families, Rural areas,t 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneous* Income: Less than $34,000 (Average=$21 ,200) 0-2 $5,020 $1 ,570 $720 $810 $370 $420 $620 $510 3-5 5,130 1,550 810 790 360 400 700 520 6-8 5,270 1,520 1,050 890 400 450 410 550 9-11 5,380 1,370 1,270 960 450 490 250 590 12-14 6,140 1,550 1,330 1,080 760 500 180 740 15-17 6,070 1 '190 1,450 1,410 670 520 290 540 Total $99,030 $26,250 $19,890 $17,820 $9,030 $8,340 $7,350 $10,350 Income: $34,000 to $57,200 (Average=$45,300) 0-2 $7,170 $2,310 $880 $1,170 $440 $540 $1,030 $800 3-5 7,360 2,290 1,020 1,150 420 520 1,140 820 6-8 7,440 2,250 1,300 1,250 470 590 730 850 9-11 7,480 2,110 1,550 1,320 520 630 470 880 12-14 8,200 2,290 1,550 1,440 890 650 350 1,030 15-17 8,350 1,920 1,740 1,790 790 670 600 840 Total $138,000 $39,510 $24,120 $24,360 $10,590 $10,800 $12,960 $15,660 Income: More than $57,200 (Average=$85,700) 0-2 $10,760 $3,900 $1 '160 $1,600 $570 $630 $1,560 $1,340 3-5 11,000 3,880 1,320 1,580 560 610 1,690 1,360 6-8 10,990 3,850 1,600 1,680 610 690 1,170 1,390 9-11 10,960 3,700 1,870 1,750 670 730 810 1,430 12-14 11 ,780 3,880 1,960 1,870 1,120 740 630 1,580 15-17 12,090 3,520 2,070 2,240 1,010 770 1,100 1,380 Total $202,740 $68,190 $29,940 $32,160 $13,620 $12,510 $20,880 $25,440 *Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed. tRural areas are places of fewer than 2,500 people outside a Metropolitan Statistical Area. *Miscellaneous expenses include personal care items, entertainment, and reading materials. 1996 Vol. 9 No.3 19 Table 8. Estimated annual expenditures* on a child by single-parent families, overall United States, 1995 Child care Transpor- Health and Miscel- Age of child Total Housing Food tation Clothing care education laneoust Income: Less than $33,700 (Average=$14,100) 0-2 $4,650 $1,890 $860 $660 $340 $180 $390 $330 3-5 5,220 2,140 910 580 360 270 530 430 6-8 5,900 2,280 1,150 670 420 310 490 580 9-11 5,510 2,190 1,330 480 420 400 230 460 12-14 5,940 2,190 1,330 550 720 420 290 440 15-17 6,640 2,320 1,450 870 840 420 220 520 Total $101 ,580 $39,030 $21,090 $11,430 $9,300 $6,000 $6,450 $8,280 Income: $33,700 or more (Average=$51,100) 0-2 $10,590 $4,060 $1,330 $2,000 $480 $410 $960 $1,350 3-5 11,360 4,320 1,410 1,920 500 550 1,210 1,450 6-8 12,110 4,450 1,690 2,020 580 640 1,130 1,600 9-11 11,710 4,360 2,040 1,830 580 760 660 1,480 12-14 12,440 4,370 2,000 1,900 960 810 940 1,460 15-17 12,870 4,500 2,110 2,060 1,100 800 760 1,540 Total $213,240 $78,180 $31,740 $35,190 $12,600 $11,910 $16,980 $26,640 *Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the Consumer Price Index. The figures represent estimated expenses on the younger child in a single-parent, two-child family. For estimated expenses on the older child, multiply the total expense for the appropriate age category by 0.93. To estimate expenses for two children, the expenses on the younger child and older child-after adjusting the expense on the older child downward-should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the appropriate age category by 1.35. To estimate expenses for each child in a family with three or more children, multiply the total expense for each appropriate age category by 0.72-after adjusting the expenses on the older children downward. For expenses on all children in a family, these totals should be summed. tMiscellaneous expenses include personal care items, entertainment, and reading materials. 20 Family Economics and Nutrition Review 1996 Vol. 9 No.3 Assessment of Energy Intakes in the U.S. Population, 1989-91 By Howard Riddick Nutritionist Center for Nutrition Policy and Promotion The 1989-91 Continuing Survey of Food Intakes by Individuals was used to assess food energy intakes of subgroups within the U.S. population. For adolescents and adults, especially females, the average reported energy intakes were well below the Recommended Energy Allowances (REA) established by the National Research Council-not consistent with the increase in the proportion of individuals found to be overweight. Energy intakes as a percent of the REA ranged from 97 percent for children ages 1-3 to 73 percent for females ages 25-50. A ratio of reported energy intakes (EI) to an estimate of resting energy expenditure (REE) based on selfreported body weight, gender, and age was calculated to assess potential energy underreporting. Males ages 51 and over and females ages 25-50 and 51 and over had EI/REE ratios below 1.2, indicating energy underreporting (1 ). Lower EI/REE ratios were characteristic of individuals in higher weight-status categories. Very sedentary lifestyles may partly explain the low EI/REE ratios. National studies of daily activity levels would be critical to understanding the importance of inactivity versus underreporting. Future studies of food intake surveys should incorporate some assessment of energy reporting. ational surveys of dietary intakes provide estimates of food and nutrient intakes that help direct policy decisions related to food assistance programs, nutrition education efforts, food safety, and diet/health relationships. Accurate assessment of energy intake is important for several reasons. First, the number of servings recommended for the Pyramid food groups is based on the level of kilocalories needed (22). For example, a minimum of 6 bread group servings is recommended at the 1 ,600-kilocalorie level, whereas 11 bread group servings are recommended at the 2,800-kilocalorie level (22). Second, energy intake is one of several factors (diet, genetics, level of activity) associated with the development of obesity, a major public health problem that is increasing dramatically in the United States (12, 20). Finally, the intake of energy is associated with the intake of foods and food components. If estimates of food energy are biased, estimates of other dietary parameters may also be affected. 21 Measuring dietary intakes of individuals living in the community (rather than in institutions), however, is an inherently difficult process. Direct measures, such as collection of duplicate portions, are intrusive and affect behavior ( 13 ). Indirect measures depend on the selfreporting skills of individuals who must remember or record all foods eaten in a day along with an estimate of the quantity consumed. The descriptions given by the individual must then be assigned food codes that most closely match the description. Representative nutrient composition values are then calculated for the foods. Until recently, dietary methods were often validated by comparing results from one method with those from another method believed to be more accurate. One study employing unobtrusive observation and weighing of foods eaten found small intakes overreported and large intakes underreported by 24- hour recalls (6). The development of the doubly-labeled water technique1 has provided an objective, external test of the validity of dietary assessments of food energy. The doubly-labeled water technique and supervised feeding of diets have shown that self-reported dietary intakes underestimate energy intake by as much as 20 to 25 percent or more, especially among obese respondents (2, 5, 11, 13, 14, 17). However, these techniques assess only energy intake, not the intake of foods or nutrients. 1ln the doubly-labeled water method, subjects consume water that has both the hydrogen and oxygen molecules labeled as stable isotopes. Monitoring the elimination rate of labeled hydrogen in water and the elimination rate of labeled oxygen in water and carbon dioxide permits the calculation of energy expenditure. 22 If the cause of energy underreporting is primarily in estimating the quantity of food portions eaten, the estimates for many food components may be underestimated. lf omitted foods such as soft drinks or candy are the primary cause of underreporting, the estimates for food components such as fat and food energy might be low, but estimates for vitamins, minerals, and major food groups might be reasonable. Further complicating the impact of low energy reporting on estimates of nutrients and other food components is the possibility that certain nutrient-dense foods might be overreported. This paper examines the level of energy reporting in a national survey in relation to recommended levels of consumption for population subgroups. Methodology The sample is composed of individuals ages 1 and over surveyed in USDA's 1989-91 Continuing Survey of Food Intakes by Individuals (CSFII) ( 19 ). Along with household and individual characteristics, each individual was targeted to have one 24-hour recall and a 2-day dietary record to assess dietary intake. This study includes individuals with a complete 24-hour recall who were not bedridden, did not indicate they were on a weight loss diet, and for females, were not pregnant or lactating. The 24-hour recall was chosen for this study because the primary interest was in evaluating mean intakes, and the 2-day dietary record is no longer in use by USDA. In addition, the sample size for the 24-hour recall was larger than that for all 3 days. Independent samples of all-income households and low-income households (households at or below 130 percent of the poverty level) were combined during the weighting process. The survey design for both samples was a multistage national probability sample of households in the 48 conterminous States and Washington, DC. For each household sampled, all individuals were eligible for the survey. The overall response rate for individuals completing the 24-hour recall was 57.6 percent. Response rate is important in evaluating survey results because those not participating may have different characteristics and behavioral patterns from those who do participate. The application of weighting factors helps reduce but does not eliminate the potential for bias. Weighting factors were applied to: Adjust for non-response; adjust for oversampling of low-income households; match population characteristics; and to equalize interviews over the 12 months of the year and the 7 days of the week. The average design effect2 was about 2.3, reflecting the ~omplex sampling design and the weighting procedures (19). Mean intakes based on a cell size of 69 (30 times the average design effect) or less may be less statistically reliable than other estimates ( 19). The significance level for the regression analysis was set at 0.01 rather than 0.05 because of the complex survey design. 2The design effect is a measure of how much the variance of estimates is increased compared with a simple random sample. Family Economics and Nutrition Review For each individual, the energy in kilocalories per day required to maintain basic bodily functions when at rest (the Resting Energy Expenditure or REE) was calculated using formulas based on body weight in kilograms, gender, and age ( 15 ). Body weights and heights from the survey are selfreported and may be more or less than actual heights and weights (4, 16). Overweight individuals tend to underreport their weights, while underweight individuals tend to overreport (16): Because more individuals are overweight than underweight, a population REE from self-reported weights will tend to be lower than that using actual weights. The total food energy in kilocalories (Energy Intake or EI) estimated by the 24-hour recall was divided by the estimated REE to yield an EIIREE ratio. The EIIREE ratio for a given age/sex group reflects differences in selfreported body weight and is indicative of the general activity level. For example, a ratio in the 1.5-1 .6 range represents a light activity level, whereas a ratio of 1.3 is a minimum value that may not be compatible with cardiovascular fitness (15 ). Bingham has suggested that the ratio should be on the order of 1.5 for sedentary populations and that a population ratio of 1.2 or under is evidence of gross underreporting ( 1 ). The suggested levels of EIIREE ratios are based on what is known about variability in energy intakes, REE, and levels of physical activity. These ratio levels might need to be adjusted as additional research results become available. 1996 Vol. 9 No. 3 Table 1. Measures of energy intake: Mean intakes per individual in a day, by age and gender, 1 day, CSFII 1989-91 Population group Children 1 - 3 years 4-6 years 7- 10 years Males 11 - 14 years 15- 18 years 19-24 years 25-50 years 51 years and over Females 11- 14 years 15- 18 years 19-24 years 25-50 years 51 years and over n 757 719 912 466 332 473 2,159 1,510 396 381 584 2,714 2,320 kcal 1,262 1,559 1,875 2,252 2,591 2,559 2,324 1,947 1,891 1,700 1,700 1,611 1,467 %REA 97 87 94 90 86 88 80 85 86 77 77 73 77 EIIREEas EIIREE % standard 1 1.61 1.63 1.56 1.49 1.40 1.40 1.25 1.19 1.43 1.17 1.24 1.15 1.12 91 86 88 88 84 84 78 78 85 73 78 74 74 1 EIIREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE ratios used by the NRC to establish the REAs and multiplying by 100. Results Mean daily intakes of energy are presented in several different forms by age and gender in table 1, with the same population groups used by the National Research Council (NRC) to establish the Recommended Energy Allowance (REA) ( 15 ). Reported energy intake in kilocalories peaked during the 15-18 age group for males and the 11-14 age group for females and then declined with age. Almost all groups of children and females had average intakes at approximately the 1 ,600-kilocalorie level associated with the minimum number of food group servings identified in the Food Guide Pyramid. The exceptions were children 7-1 0 years old and females 11-14 years old who had intakes between the 1,600 and 2,200 levels. Among males, the 11-14 and the 25-50 age groups had reported energy intakes close to the 2,200-kilocalorie level at the midrange of the Pyramid, whereas the 15-18 and the 19-24 age groups had intakes between the midrange of 2,200 and 23 the maximum of 2,800. The 51 and over age group of males averaged about 2,000 kilocalories. Reported energy intakes as a percent of the REA ranged from a high of 97 percent for children 1-3 years old to a low of 73 percent for females 25-50 years old. For all age groups examined, males reported a higher proportion of their REA than did females. The EIIREE ratio was highest for children and lowest for females. Children and males 11-14 years old had ratios in the 1.5-1.6 range characteristic of sedentary populations. Males 15-18 and 19-24 years old and females 11-14 years old had ratios of about 1.4, still above the 1.3 minimum level cited in the NRC report (15). Males 25-50 years old and females 19-24 years old had ratios below the NRC minimum but still above the 1.2 minimum of Bingham. Males 51 years and over and females 15-18, 25-50, and 51 years and over had EI/REE ratios below the 1.2 level cited by Bingham as evidence of underreporting (1). The EI/REE ratios found in the CSFII were compared with the EI/REE ratios used by the NRC to establish the REA's (see figure). The pattern of change relative to age and gender found in the survey was similar to the NRC pattern. However, the survey level appears lower and the difference between males and females appears greater. Between females age 11-14 and 15-18, there was a much sharper drop in the ratio in the survey compared with the NRC. 24 EI/REE ratio used in establishing Recommended Energy Allowances (REA) and as estimated by CSFII 1989-91 reported weights and intakes 2.0 REA children ' 1.8 REA, ma les 1.6 I "' CSFII children REA females 1.4 CSFII males ,II- 1.2 CSFII females 1.0 1-3 4-6 7-10 11-14 Converting the EIIREE ratio to a percent of the ratio used by the NAS to establish the REA's yields percentages generally the same as the percentage of the REA. The EIIREE percentage is consistently lower than the REA percentage for children and males, with no clear pattern for females. Differences in the two measures may reflect differences in weight and activity patterns assumed for the REA's compared with the reported weights and/or kilocalorie levels in the survey. Measures of energy intake by weight status are presented for children in table 2. The three Body Mass Index3 (BMI) 3Body Mass Index is calculated by dividing weight in kilograms by the square of height in meters. 15-18 19-24 25-50 51+ categories are based on the BMI levels discussed in the report of the Dietary Guidelines Advisory Committee (2 I). As health indicators, the categories may not be valid for children, but they do provide a mechanism for energy intake comparisons. For age groups 1-3 and 4-6, there was no clear pattern of energy intake and weight status. Children 7-10 years old tended to exhibit lower EIIREE ratios and percentages with higher weight classes. Energy in kilocalories and percent REA showed no clear pattern. Children 7-10 years old in the highest weight category had an EI!REE ratio at the level (1.3) associated with minimal activity. Family Economics and Nutrition Review Table 2. Measures of energy intake of children: Mean intakes per individual in a day, by age and weight status,11 day, CSFII 1989-91 Age/Estimated EIIREE as BMI category n kcal %REA EIIREE % standard2 Age 1-3 BMI <19 404 1,280 98 1.63 92 BM119- 25 196 1,299 100 1.61 92 BM1>25 157 I, 171 90 1.56 89 Age 4-6 BMI <19 472 1,544 86 1.63 86 BMI 19-25 165 1,620 90 1.64 87 BMI >25 82 1,530 85 1.53 81 Age 7-10 BM1<19 568 1,861 93 1.63 92 BMI19 -25 254 1,928 96 1.47 83 BMI >25 90 1,809 90 1.32 74 1 Weight status is derived from self-reported heights and weights. 2EIIREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE ratios used by the NRC to establish the REAs and multiplying by 100. Among males (table 3, p. 26), there were limitations in sample size for the under 19 BMI category. However, for all age groups the over 25 BMI group had lower EIIREE ratios and lower EIIREE percentages than the 19-25 BMI group. As with children, kilocalories and percent REA showed no clear pattern relative to weight status for males. For all age groups, males in the over 25 BMI group had EIIREE ratios close to or below the 1.2 level indicative of underreporting. Among females (table 4, p. 27), EIIREE ratios in the over 25 BMI category were very low, at or below 1.0. EIIREE ratios in the under 19 BMI category were consistently at or above the 1.3 level. Females in the 19-25 BMI category generally had ratios around 1.2, except 1996 Vol. 9 No.3 those ages 11-14 who averaged about 1.4 and those ages 19-24 who averaged about 1.3. Adults in the top two BMI categories were subdivided into income levels (the number of subjects in the lowest BMI category was too small for further subdivision) (table 5, p. 28). At each of the three income levels, both males and females in the two age groups examined had a similar pattern of lower EIIREE ratios at higher BMI levels. For males and females ages 25-50, the EIIREE ratios were similar across the income levels; however, for older males and females, those with income at less than 131 percent of the poverty level appeared to have slightly lower ratios in each weight class. National studies of daily activity levels would be critical to understanding the importance of inactivity versus underreporting. 25 Table 3. Measures of energy intake of males: Mean intakes per individual The relationship between the sufficiency in a day, by age and weight status,l1 day, CSFII 1989-91 of household food supplies (self-described) and the EIIREE ratio is Age/Estimated EIIREE as presented in table 6, p. 28 by weight BMI category n kcal % REA EI/REE % standard2 category for males and females ages 25 and over. Households could choose among four levels of food sufficiency: Age 11- 14 "Enough of the kinds of food we want BMI <19 205 2,203 88 1.64 96 to eat"; "enough but not always what BMI 19-25 201 2,258 90 1.42 84 we want to eat"; "sometimes not BMI >25 603 2,398 96 1.25 74 enough to eat"; or "often not enough to eat." Because of sample size limitations, the age groups were combined, as well Age 15-18 as households that indicated either BMI<19 453 2,221 74 1.38 83 sometimes or often not enough to eat. BMI 19-25 227 2,704 90 1.48 88 Both males and females in households BMI >25 603 2,368 79 1.09 65 that sometimes or often did not have enough to eat appeared to have lower EIJREE ratios for both weight categories. Age 19-24 BMI <19 283 1,850 64 1.21 72 For each age group of children, males, BMI 19 ~ 25 289 2,632 91 1.49 89 and females, regression analysis ( 18) BMI>25 156 2,511 87 1.24 74 was performed to test for statistical significance between the EIIREE ratio and weight status, income level, and Age 25-50 sufficiency of household food supplies. BMI <19 403 2,334 80 1.47 92 Weight status was tested by using BMI BMI 19-25 906 2,355 81 1.35 84 as a continuous variable, whereas in- BMI >25 1,213 2,302 79 1.17 73 come and food sufficiency were tested as categorical variables. Age 51 and over The overall equations were significant BMI <19 313 1,625 71 1.29 86 at the O.Ollevel of probability for all BMI 19-25 602 1,915 83 1.26 84 the age subgroups examined. As shown BMI >25 877 1,978 86 1.12 75 in table 7, p. 29, the percent of variation explained (R2) ranged from less than I weight status is derived from self-reported heights and weights. 2 percent to around 9 percent. BMI was 2EIJREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE significant at the O.Ollevel for each ratios used by the NRC to establish the REAs and multiplying by I 00. age group. Living in a household below 3Due to the small number of subjects, estimates may be less statistically reliable than other estimates. 131 percent of the poverty level was significant only for males ages 15-18 and 51 and over and for females ages 51 and over. Living in households that sometimes or often did not have enough to eat was significant for males ages 11-14,25-50, and 51 and over; and for females ages 25-50 and 51 and over. 26 Family Economics and Nutrition Review Table 4. Measures of energy intake of females: Mean intakes per The level of R2 was lowest (under 2 individual in a day, by age and weight status, 1 1 day, CSFII 1989-91 percent) for children ages 1-3 and 4-6. This may reflect less accurate reporting Age/Estimated EIIREEas of heights and weights for children, BMI category n kcal %REA EIIREE % standard2 resulting in more errors in estimated BMI and weight status classification (4). Age 11- 14 The statistically significant regression BMI <19 177 1,838 84 1.49 89 coefficients in table 7 are all negatively BMT 19-25 175 1,967 89 1.43 86 related to the EIIREE ratio. For example, BMI >25 443 1,735 79 1.14 68 for males ages 51 and over, a one-unit increase in BMI is associated with a decrease in the EIIREE ratio of 0.021, Age 15-18 controlling for income status and house- BMI <19 693 1,765 80 1.32 82 hold food sufficiency. BMI 19-25 245 1,721 78 1.19 75 BMI >25 673 1,531 70 0.89 56 Discussion The Recommended Energy Allowance Age 19-24 (REA) is set to reflect the average need BMI <19 73 1,806 82 1.49 92 of a population subgroup, unlike the BMI 19-25 377 1,717 78 1.27 80 Recommended Dietary Allowances BMI>25 134 1,569 71 0.96 60 (RDA) that are set high enough above the estimated mean requirement to meet the needs of practically all healthy Age 25-50 individuals ( 1 5). For older children and BMI <19 181 1,712 78 1.38 89 adults, especially females, the reported BMI19 -25 1,402 1,616 73 1.20 78 energy intakes in this study were, on BMI>25 1 '131 1,582 72 1.03 66 average, well below the REA. Energy intakes consistently below requirements, over time, will lead to a loss in weight. Age 51 and over This is not consistent with recent studies BMI <19 163 1,459 77 1.31 87 of weight status in the U.S. population BMI19-25 1,029 1,498 79 1.19 80 ( 12, 20 ). For both children and adults, BMI >25 1,128 1,434 75 1.01 67 the percentage of individuals classified as overweight increased during the 1Weight status is derived from self-reported heights and weights. period from 1976-80 to 1989-91. Either 2EIIREE as% standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE the REA is set too high or reports of ratios used by the NRC to establish the REAs and multiplying by 100. energy intake are too low. 3Due to the small number of subjects, estimates may be less statistically reliable than other estimates. 1996 Vol. 9 No.3 27 The EI/REE ratios were consistently below the levels used by NRC to establi h the REA' s. For females and higher weight individuals in particular, the ratios were well below the recommended levels and often below the minimum level identified by NRC. Adult males and females starting in the teen years had ratios low enough to suggest major underreporting--especially in the higher weight groups. The lower ratios within weight groups for adults in households with restricted food supplies may indicate lower actual intakes in addition to underreporting. A summary of studies using the doublylabeled water technique supports the EI/REE ratios used by NRC. The mean ratio was 1.67 and the mean minus two standard deviations was 1.28 for the 105 adult males and females studied (7). Males averaged 1.78 while females averaged 1.62. Whether the activity levels found in these small studies is representative of the population remains a question. Table 8, p. 30, presents EIIREE ratios for adult men and women using the same age breaks and overweight definitions used in the NHANES ill survey ( 3 ). For all age groups of overweight females (using a BMI of27.3 or above as the criterion), both surveys found EI/REE ratios considerably below the 1.2 level indicating substantial underreporting. In CSFII, overweight males (using a BMI of 27.8 or above as the criterion) had average ratios below 1.2 for all age groups, whereas the NHANES ill found only overweight males ages 60 or over 28 Table 5. The mean EIIREE ratio for adult males and females by age, weight status, 1 and income level, CSFII 1989-91 Age/Estimated Household income as a percent of poverty level BMI category <131 13 1 -350 >350 Males age 25 - 50 BMI 19-25 1.33 1.36 1.34 (n = 291) (n = 336) (n = 279) BMI >25 1. 14 1. 16 1.18 (n = 363) (n = 475) (n = 375) Males age 51 and over BMI19-25 1.16 1.30 1.25 (n = 226) (n = 220) (n = 156) BMI >25 1.02 1.14 1.14 (n = 273) (n = 322) (n = 282) Females age 25 - 50 BMI 19- 25 1.18 1. 19 1.21 (n = 470) (n = 509) (n = 423) BMI>25 0.97 1.06 1.0 I (n = 530) (n = 390) (n= 2 11 ) Females age 51 and over BMI19-25 1.13 1.21 1.21 (n = 434) (n = 346) (n = 249) BMI >25 0.92 1.03 1.05 (n = 557) (n = 388) (n = 183) 1Weight status is derived from self-reported heights and weights. Table 6. The mean EIIREE ratio for adult males and females by weight status1 and household food sufficiency, CSFII 1989-91 Age/Estimated BMI category Males age 25 and over BMII9-25 BMI >25 Females age 25 and over BMI 19-25 BMI>25 Household food sufficiency Enough of the Enough but not Sometimes or kinds of foods always kinds of often not wanted food wanted enough to eat 1.31 1.40 1.19 (n = 1,070) (n = 362) (n = 72) 1.15 1.17 0.80 (n = 1,508) (n = 507) (n = 73) 1.21 1.17 0.97 (n = 1,765) (n = 566) (n = 96) 1.03 0.98 0.90 (n = 1,508) (n = 633) (n = 114) 1Weight status is derived from self-reported heights and weights. Family Economics and Nutrition Review Table 7. The relationship between the mean EIJREE ratio and BMI, income status, and household food sufficiency, CSFII 1989-91 Explanation ofEIJREE variation Age/sex (R2) Percent Children I - 3 years 1.5 4-6 years 1.6 7- 10 years 6.0 Males 11- 14 years 8.4 15- 18 years 5.3 19-24 years 5.5 25- 50 years 3.8 51 years and over 4.4 Females 11- 14 years 3.9 15- 18 years 5.4 19-24 years 9.1 25- 50 years 4.0 51 years and over 8.7 * PS 0.01. were below this level. For adults ages 20 and over, the CSFII values were about 85 percent of the NHANES III values for males and about 90 percent for females. Differences in 24-hour recall protocols between the two surveys have been identified ( 3 ). Another major difference is the use of self-reported heights and weights in CSFII compared with the measured heights and weights in the NHANES III survey. Overweight individuals, especially overweight females, have been found to underreport their weights (16). 1996 Vol. 9 No.3 Household income <131% BMI poverty level Beta coefficient -0.009* +0.000 -0.010* -0.043 -0.024* -0.040 -0.037* -0.112 -0.036* -0.247* -0.037* -0.089 -0.024* +0.015 -0.021* -0.092* -0.023* +0.030 -0.026* -0.043 -0.036* +0.074 -0.017* -0.001 -0.023* -0.086* Implications for Further Research Sometimes or often not enough to eat -0.101 -0.117 -0.143 -0.267* +0.444 -0.254 -0.155* -0.187* -0.106 -0.130 -0.165 -0.132* -0.168* Additional research is needed to understand energy reporting. A critical component is the activity level of population subgroups from nationally representative samples. Assessments of general activity levels need to be integrated into surveys of food energy intakes. Since body weight is another key component in estimating energy needs, a study should be done to assess the impact of using self-reported weights on estimating the REE and the EIIREE ratio. ... users of food intake survey data should assess energy reporting as a component of their analysis. 29 Table 8. Mean EIIREE ratio by selected age groups for adult males and females by weight status,1 CSFll1989-91 Males Females Overweight males* Overweight females* Age n EVREE n EVREE n 20-29 years 884 1.35 1,037 1.21 172 30-59 years 2,117 1.22 2,745 1.13 660 Over 60 years 1,064 1.20 1,734 1.14 264 Total over 20 years 4,065 1.24 5,516 1.15 1,096 1Weight status is derived from self-reported heights and weights. * Overweight individuals were defined as BMI ~ 27.8 for males. and ~ 27.3 for females. Methods to improve memory recall of foods and quantities eaten need to be explored. After cognitive testing and a pilot study, the procedures used to collect 24-hour recalls in CSFII 1989-91 have been modified to incorporate a multiple-pass approach for CSFII 1994-96 (8). Portion size estimation and the validity of standardized recipes are especially critical for frequently eaten foods. Representative weights of foods such as bagels and muffins may increase over time, and if food codebooks and software fail to reflect such changes, energy intakes will be underestimated. Psychological aspects of energy reporting also need additional exploration ( 10 ). Hebert found that higher scores on a social desirability scale4 were associated with lower energy reports with a 7 -day dietary recall (9). Such a scale might be used in studies of energy reporting to develop a mechanism to help make adjustments for underreporting. 4Social desirability is the tendency of an individual to convey an image in keeping with social norms and to avoid criticism in a "testing" situation (9). 30 A major question concerns the extent to which energy underreporting is related to the reporting of other dietary components. A recent study used the 24-hour urine nitrogen technique to divide a group of individuals into "underreporters" and "others" (1). Underreporters (n=34) reported significantly less food energy, protein, fat, and sugars than the others (n=45) but similar levels of starch, fiber, and vitamin C. This research, which needs to be replicated, indicates that overall estimates may be downward biased for some, but not all, food components. EVREE n EVREE 1.00 204 0.98 1.13 867 1.01 1.10 545 0.95 1.10 1,616 0.99 Until further research is completed, users of food intake survey data should assess energy reporting as a component of their analysis. The EI/REE ratio could be used as an assessment tool and/or as a control variable in a multivariate analysis. Consideration' of the potential impact of energy underreporting is most critical for studies involving adult females and for overweight individuals. Family Economics and Nutrition Review References 1. Bingham, S.A. 1994. The use of24-h urine samples and energy expenditure to validate dietary assessments. The American Journal of Clinical Nutrition 59(Suppl):227S-231S. 2. Black, A.E., Prentice, A.M., Goldberg, G.R., Jebb, S.A., Bingham, S.A., Livingstone, M.B.E., and Coward, W.A. 1993. Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake. Journal of the American Dietetic Association 93:572-579. 3. Briefel, R.R., McDowell, M.A., Alaimo, K., Caughman, C.R., Bischof, A.L., Carroll, M.D., and Johnson, C.L. 1995. Total energy intake of the US population: The third National Health and Nutrition Examination Survey, 1988-1991. The American Journal of Clinical Nutrition 62(Suppl): 1072S-1 080S. 4. Davis, H. and Gergen, P.J. 1994. Mexican-American mothers' reports of the weights and heights of children 6 months through 11 years old. Journal of the American Dietetic Association 94:512-516. 5. deVJjes, J.H.M., Zock, P.L., Mensink, R.P., and Katan, M.B. 1994. Underestimation of energy intake by 3-d records compared with energy intake to maintain body weight in 269 non obese adults. The American Journal of Clinical Nutrition 60: 855-860. 6. Gersovitz, M., Madden, J.P., and Smiciklas-Wright, H. 1978. Validity of the 24-hr dietary recall and seven-day record for group comparisons. Journal of the American Dietetic Association 73:48-55. 7. Goldberg, G.R., Black, A.E., Jebb, S.A., Cole, T.J., Murgatroyd, P.R., Coward, W.A., and Prentice, A.M. 1991. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify undercrecording. European Journal of Clinical Nutrition 45:569-581. 8. Guenther, P.M., DeMaio, T.J., Ingwersen, L.A., and Berlin, M. 1996. The multiplepass approach for the 24-hour recall in the Continuing Survey of Food Intakes by Individuals (CSFII) 1994-96. The FASEB Journal10(3):A198. 9. Hebert, J.R., Clemow, L., Pbert, L., Ockene, I.S., and Ockene, J.K. 1995. Social desirability bias in dietary self-report may compromise the validity of dietary intake measures. International Journal of Epidemiology 24:389-398. 10. Heymsfield, S.B., Darby, P.C., Muhlheim, L.S., Gallagher, D., Wolper, C., and Allison, D.B. 1995. The calorie: Myth, measurement, and reality. The American Journal of Clinical Nutrition 62(Suppl):1034S-1041S. 1996 Vol. 9 No. 3 31 11. Johnson, R.K., Goran, M.I., and Poehlman, E.T. 1994. Correlates of over- and underreporting of energy intake in healthy older men and women. The American Journal ofClinical Nutrition 59:1286-1290. 12. Kuczmarski, R.J., Flegal, K.M., Campbell, S.M., and Johnson, C.L. 1994. Increasing prevalence of overweight among US adults. Journal of the American Medical Association 272(3):205-211. 13. Mertz, W. 1992. Food intake measurements: Is there a "gold standard"? Journal of the American Dietetic Association 92( 12):1463-1465. 14. Mertz, W., Tsui, J.C., Judd, J.T., Reiser, S., Hallfrisch, J., Morris, E.R., Steele, P.D., and Lashley, E. 1991. What are people really eating? The relation between energy intake derived from estimated diet records and intake determined to maintain body weight. The American Journal of Clinical Nutrition 54:291-295. 15. National Research Council, Subcommittee on the Tenth Edition of the RDAs, Food and Nutrition Board. 1989. Recommended Dietary Allowances, 1Oth ed. National Academy Press, Washington, DC. 16. Rowland, M.L. 1990. Self-reported weight and height. The American Journal of Clinical Nutrition 52:1125-1133. 17. Schoeller, D.A. 1990. How accurate is self-reported dietary energy intake? Nutrition Reviews 48( 10):313-379. 18. SPSS Inc. 1988. SPSS-X User's Guide, 3rd Edition. Chicago, IL. 19. Tippett, K.S., Mickle, S.J., Goldman, J.D., Sykes, K.E., Cook, D.A., Sebastian, R.S ., Wilson, J.W., and Smith, J. 1995. Food and Nutrient Intakes by Individuals in the United States, 1 Day, 1989-91. Continuing Survey of Food Intakes by Individuals, 1989-91, Nationwide Food Surveys Rep. No. 91-2. U.S. Department of Agriculture, Agricultural Research Service. 20. Troiano, R.P., Flegal, K.M., Kuczmarski, R.J., Campbell, S.M., and Johnson, C.L. 1995. Overweight prevalence and trends for children and adolescents. Archives of Pediatrics and Adolescent Medicine 149: 1085-1091. 21. U.S. Department of Agriculture, Agricultural Research Service, Dietary Guidelines Advisory Committee. 1995. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 1995. 22. U.S. Department of Agriculture, Human Nutrition Information Service. 1992. The Food Guide Pyramid. Home and Garden Bulletin No. 252. 32 Family Economics and Nutrition Review 1996 Vol. 9 No. 3 Dietary Patterns and Personal Characteristics of Women Consuming Recommended Amounts of Calcium By Joanne F. Guthrie Nutritionist Center for Nutrition Policy and Promotion Encouraging adequate calcium intakes by women is a current public health objective. To obtain information that could be used to promote this objective, this study examined dietary patterns and personal characteristics of women consuming their Recommended Dietary Allowance (RDA) of calcium compared with women who did not meet their RDA. The sample consisted of 2,261 nonpregnant, nonlactating women who participated in USDA's 1990-91 Continuing Survey of Food Intakes by Individuals-Diet and Health Knowledge Survey. Women whose diets met their RDA for calcium consumed significantly more milk products, fruit, and grains, less regularcalorie soda, and more of several essential nutrients, saturated fat, and sodium than did other women. All other characteristics equal, women were less likely to meet their calcium RDA from food sources if they were Black, less than 25 years of age, ate more food away from home, reported avoidance of all types of milk, and reported dietary intake in either the summer or fall. Factors positively related to meeting the RDA from food sources were working part time, taking vitamin-mineral supplements, reporting avoidance of whole milk only, being aware of a relationship between calcium intake and health, and reporting a higher number of milk group servings as being recommended daily. Implications for design and targeting of messages promoting calcium intake are discussed. dequate calcium intake has been identi~ed as an _important factor m preventmg osteoporosis and may also play a role in the prevention of several other health conditions, including some other bone diseases, colon cancer, hypertension, and pre-eclampsia during pregnancy (26). Osteoporosis affects 25 million Americans, primarily women (26). Annual direct medical costs associated with osteoporosis in American women have been estimated at $5.2 billion (29). Yet, data suggest that most women's diets do not meet their current Recommended Dietary Allowance (RDA) for calcium ( 1 ). As a consequence, improvement of calcium intakes has received considerable emphasis as a public health priority (6). The NIH Consensus Development Conference on Optimal Calcium Intake has 33 recommended development of health education materials and programs to promote increased calcium consumption. Increasing calcium intake among adolescents and adults is one of the health objectives for the Nation promoted by the U.S. Department of Health and Human Services' Healthy People 2000 (39). The American Dietetic Association has made increasing women's awareness of osteoporosis and the lifestyle changes that can help prevent it a major component of their Nutrition and Health Campaign for Women (20). Other public and private groups are also working on projects to promote dietary changes that would increase calcium consumption ( 19, 24 ). Amidst this emphasis on improving calcium intakes, particularly those of women, one concern that has been raised is whether increasing calcium intake is compatible with improving overall dietary quality. If a healthful diet is defmed as one that contains adequate amounts of essential nutrients while meeting guidelines for moderation in consumption of such food components as fat, saturated fat, cholesterol, and sodium (9), previous research indicates that diets that are rich in calcium tend to be rich in other essential nutrients as well. However, these diets may be associated with excessive intakes of food components for which moderation is recommended. Examining the issue of overall nutrient quality of higher-calcium versus lowercalcium diets, Barger-Lux et a!. (2) and Holbrook and Barrett-Connor ( 14) both found that those with diets that were more calcium dense (i.e., had more calcium per 1,000 kilocalories (kcal) of intake) also had diets that had higher 34 densities of several other essential nutrients. However, Holbrook and Barrett-Connor also found that the highcalcium group's diet had a higher density of saturated fat than other groups. Similarly, Nowalk and Caggiula (27) found that among a sample of middleage premenopausal women, those whose diets met their RDA for calcium consumed greater amounts of total and saturated fat than those whose diets did not. These studies were done with local samples, and the results may not be generalizable to the American population. Nevertheless, they raise the concern that programs encouraging increased calcium intake may inadvertently result in increasing intakes of food components for which moderation is recommended. Given that nutrition intervention is intended to promote an overall healthful diet, it is important, therefore, to examine not only the calcium adequacy but the overall diet quality of individuals before planning nutrition education efforts. Such an examination should provide educators with information that would be useful to them in developing dietary guidance that would lead to overall dietary improvement as well as improved calcium intakes. A knowledge of personal characteristics associated with meeting or not meeting the calcium RDA should also be useful for targeting nutrition education efforts. Previous research has indicated that some personal characteristics seem to be associated with low calcium intakes. Data from several sources indicate that Black women tend to consume lower amounts of calcium than women of other races (18, 40). Analysis of dietary intake data collected by the U.S. Department of Agriculture in I 985-86 from a national sample of women ages 19-50 indicated that, along with race, other factors independently associated with higher calcium intakes included higher education, higher income, being employed part time as opposed to being employed full time or not at all, being younger, being taller, being part of a household that included a child or children, being a participant in the Food Stamp program, living in a central city or suburban area as opposed to a nonmetropolitan area, living in the Midwest or West as opposed to living in the Northeast or South, and being a regular supplement user (40). Both Lewis and Hollingsworth (17) and Haines eta!. ( 13) found that, for women, eating a higher proportion of food away from home is associated with lower calcium intakes. Nutrition educators would benefit from knowing how knowledge and attitudes related to calcium and calcium-rich foods influence food intake; however, national survey data capable of linking knowledge and attitudes to food and nutrient consumption have only recently become available. In a study of older women living in the Midwest, Chapman eta!. (5) found that women with low calcium intakes were more likely to dislike milk, to believe that it disagreed with them, and to avoid drinking it. Examining attitudes toward milk consumption in a national data set would provide an opportunity to assess how generalizable these findings are to the broader population of American women. Family Economics and Nutrition Review The purposes of this study are, therefore, to (I) examine overall food and nutrient consumption patterns of women whose 3-day diets meet or fail to meet their calcium RDAs for overall diet quality; and (2) identify socioeconomic, demographic, knowledge, attitude, and behavioral characteristics of women whose diets, over a 3-day period, meet the current calcium RDA for their agesex group, using data from the USDA's 1990-91 Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS). These surveys are unique in that, together, they provide the only federally collected data set capable of relating knowledge and attitudes concerning diet and health to actual dietary intake. The results may be used to indicate types of nutrition education messages that may be most effective in promoting adequate calcium intake and to target groups of women mo t likely to have lower-than-recommended calcium intakes. Methods Data and Sample The CSFII was designed to obtain a nationally representative ample of households in the 48 conterminous United State and consist of an allincome and a low-income sample. In the all-income sample, all households, including low-income households, were eligible to be interviewed. For the low-income sample, participation was limited to individuals in households with a gross income for the previous month at or below 130 percent of the Federal poverty thresholds ( 36 ). 1996 Vol. 9 No.3 For the 1990-91 CSFII, trained interviewers visited each household and obtained socioeconomic, demographic, and health-related data on households and their members. In addition, the interviewers obtained I day of dietary intake data, using the 24-hour recall method, and household members were asked to complete a record of foods consumed on the 2 days following the 24-hour recall. Only those who provided the complete 3 days of dietary data were considered for this study. For the DHKS, one member of each CSFII household was contacted about 6 weeks after dietary data were collected. Ideally, the individual contacted was the person who had identified himself or herself as the household's main meal planner/preparer. In some cases, interviewers were unable to contact the main meal planner/preparer; about 6 percent of DHKS respondents were not the main meal planner/preparer. Most interviews were conducted by telephone; in-person interviews were conducted when this was not feasible. DHKS respondents were asked a series of questions on their knowledge, attitudes, and practices related to diet and health. Some questions that were particularly relevant to calcium intake included those on whether the respondents were aware that there were any health problems related to how much calcium a person eats, whether they avoided certain calcium-rich foods (all milk, whole milk, or cheese), and how many servings of milk products they believed they should eat daily. Given that nutrition intervention is intended to promote an overall healthful diet, it is important. .. to examine not only the calcium adequacy but the overall diet quality of individuals before planning nutrition education efforts. 35 In 1990 and 1991, DHKS and 3-day food intake data were obtained from 2,960 respondents. From these, female meal planners age 18 years and over were selected to form the analysis data set. The small number of DHKS respondents who were not meal planners were excluded from the analysis because nonmeal planners likely have less control over their food choices than meal planners. Pregnant and lactating women were also excluded because the purpose of this analysis was to examine factors influencing calcium intake over the long-term and pregnancy and lactation would be expected to create short-term increases in calcium intake ( 4 ). The final analysis data set consisted of 2,261 female meal planners. To adjust for oversampling of low-income households and for differing response rates among population subgroups, DHKS sample weights were developed by USDA in cooperation with Iowa State University ( 34 ). Use of these weights for descriptive statistics is recommended, because the weighted sample more closely resembles the actual U.S. population (16); weighted data were used in this study to calculate all descriptive statistics. Measures of Dietary Intake Survey respondents reported amounts of food consumed using common household measures. These amounts were converted to their gram weight equivalents. The results reported here represent the average amounts consumed over the 3 days of dietary intake reported by survey respondents. Foods are reported in terms of major groups--e.g., milk and milk products; and by selected subgroups-- e.g., lowfat milks. Foods are 36 grouped by primary ingredient; for example, a hamburger with onions is placed in the meat group because meat is its primary ingredient. Food group consumption patterns are examined in terms of average amounts consumed over 3 days. Energy (kilocalorie), fat, cholesterol, and nutrient intakes were calculated using USDA's Nutrient Data Base for Food Consumption Surveys (34 ). Nutrient intakes represent values from food consumption only; although survey participants answered questions on supplement use, nutrient intake from supplements was not quantified. Sodium values represent naturally occurring sodium, sodium added during food processing, and an assumed amount of sodium used in food preparation. Sodium values do not include salt added at the table. In this study, nutrient intake is examined as a percent of the individual's RDA and in terms of nutrient density, defined as the amount of a nutrient in the diet per 1,000 kilocalories-a measure of diet quality that controls for differences in the absolute quantity. The National Academy of Sciences has established guidelines for recommended total intakes of cholesterol, sodium, and potassium (22). Here, cholesterol, sodium, and potassium intakes are examined both as total amounts consumed and in terms of density. Fat and saturated fat intakes are examined as percentages of total kilocalories, a measure that controls for differences in absolute quantity and also corresponds to current dietary guidance. Analysis of Food Consumption Patterns and Diet Quality Mean food group intakes, nutrient intakes, and fat, saturated fat, cholesterol, sodium, and potassium intakes by meal planners who met their RDA for calcium were compared with the intakes of meal planners who did not. For this analysis, weighted data were used and statistical tests were conducted using the SUDAAN software package, which accounts for the effects of the complex design of the CSFII-DHKS surveys (32). T-tests were used for comparing means of the two groups. Analysis of Personal Characteristics Influencing Calcium Intake Differences in socioeconomic, demographic, and personal characteristics between women who met their calcium RDA and those who did not were assessed using descriptive statistics. T-tests were used to compare means of continuous variables, and the chi-square test was used to compare distributions of categorical variables. Weighted data were used and analyses were conducted with the SUDAAN software package (32). A logistic regression analysis was used to identify the personal characteristics independently associated with the probability of a meal planner meeting her RDA for calcium. In accordance with recommendations for statistical analysis of USDA food consumption survey data, unweighted data were used for this analysis (16). The analysis was conducted using the SPSS-X statistical software package (33). Family Economics and Nutrition Review Independent variables selected for the analysis included race, RDA-based age group, the self-reported height of the individual and her body mass index (as calculated from self-reported height and weight), household income as a percent of the Federal poverty level, Food Stamp Program participation, education, employment status, presence of children in the household, region and urbanization level of residence, whether the individual was on a weight-loss diet, use of vitamin and/or mineral supplements, percent of total kilocalories consumed away from home over the 3-day period, whether the individual reported being aware of health problems related to calcium, how many servings of dairy products the individual believed she should consume each day, and whether the individual reported avoiding all milk, whole milk only, or cheese. Race was included because previous research has indicated that it is associated with calcium intake; meal planners were categorized as members of either the White, Black, or "other" race groups ("other" includes Asians, Native Americans, Pacific Islanders, and any other races). Individuals were dichotomized into two age groups-those under 25 and those over 25 years of age-because the Food and Nutrition Board of the National Academy of Sciences has established an RDA for calcium that is higher for women 18 to 24 than for older women (23 ); the higher RDA may affect their likelihood of meeting recommended intake levels. Income, Food Stamp Program participation, education, employment status (full time, part time, not employed), presence of children in the household, region and urbanization level of residence, and use of vitamin and/or 1996 Vol. 9 No.3 mineral supplements were also included because previous research has indicated their potential significance in influencing calcium intake. The percentage of total kilocalories consumed away from home over the 3-day period was used as a measure of the importance of eating away from home in the diet, since this has been associated with lower calcium intakes in some studies. The variables on awareness of health problems related to calcium, how many servings of dairy products the individual believed she should consume each day, and whether the individual reported avoiding all milk, whole milk only, or cheese have not previously been studied in relation to the calcium adequacy of women's diets using a large national data set, because they have only recently been added to national food consumption surveys. They were included because of the potential usefulness of information on their influence on calcium intake for nutrition education. Variables assessing temporal effects on intake-season in which intake was reported and whether weekend eating was reported-were included as control variables because previous research has indicated that they can affect food consumption (12). Another factor that needs to be controlled is individual differences in total energy intake, since at higher caloric levels an individual may be more likely to meet the calcium RDA. Unfortunately, the use of energy intake as an independent variable in a multivariate equation is problematic because within-individual variability in energy intake introduces error that will produce biased coefficients ( 3 ). Therefore, several variables that proxy differences in Women whose diets met their ADA for calcium consumed more than three times as much lowfat milk as other women and more than six times as much skim milk. 37 energy need were used as control variables. These include: Self-reported height and body mass index, as calculated from self-reported height and weight. since larger individuals are likely to consume more energy; being on a weight-loss diet; and whether individuals reported any days with either lower-than-usual or higherthan- usual dietary intakes. Results Description of Sample Of the 2,261 women studied, 442 or 19 percent met their calcium RDA. After applying survey weights to obtain a population estimate, 21 percent of adult female meal planners were estimated to have diets that met their RDA for calcium. The group that met its calcium RDA was significantly less likely to include younger women (table 1 ). Six percent of meal planners with lower calcium intakes were below 25 years of age; only 2 percent of those with higher calcium intakes were in that age group. Women with higher calcium intakes were significantly taller, averaging 64.7 inches in height, compared with an average of 64.0 inches for the low calcium group. The educational level and employment status of the two groups also differed significantly. Twenty-two percent of those with lower calcium intakes had not completed high school, whereas 37 percent were high school graduates, and 41 percent had at least some college education. Of those with higher calcium intakes, 13 percent had not completed high school, 35 percent were high school graduates, and 52 percent had at least some college education. Assessing 38 Table 1. Descriptive characteristics of women with diets meeting or not meeting their RDA for calcium 1 Variable Income as percent poverty Body mass index (BMI) Height in inches How many dairy servings should consume Race White Black Other RDA age group < 25 years > 25 years Education < High school High school graduate At least some college Employment status Full time Part time Not employed outside home Food Stamp household Children present Urbanization City Suburban Nonmetropolitan Dietary calcium belowRDA (n = 1,819) 345 25.2 64.0 2.2 Dietary calcium RDA or above (n = 442) 430 24.8 64.7 2.5 Significance * ** Percent 83 90 13 6 4 4 ** 6 2 94 98 ** 22 13 37 35 41 52 * 36 40 15 23 49 37 7 7 39 43 30 29 46 48 24 24 table continued Family Economics and Nutrition Review Table 1. Descriptive characteristics of women with diets meeting or not meeting their RDA for calcium1 (cont'd) Variable Region Northeast Midwest South West On weight loss diet Take vitamin-mineral supplement Percent food away from home Aware of health problems related to calcium A void all milk Avoid whole milk only A void cheese Season Spring Summer Fall Winter Lower than usual reported intake Higher than usual reported intake Weekend day included in 3-day report 1Weighted data. * p < .05. ** p < .01. 1996 Vol. 9 No.3 Dietary calcium belowRDA (n = 1,819) Dietary calcium RDAorabove (n = 442) Percent 21 22 23 28 37 31 19 20 6 7 35 42 22 20 65 76 17 7 47 65 17 11 26 26 26 22 24 25 25 28 29 27 14 13 55 62 Significance ** ** ** * employment status, 36 percent of women with lower calcium intakes were employed full time, 15 percent were employed part time, and 49 percent were not employed outside the home. Forty percent of those with higher calcium intakes were employed full time, 23 percent part time, and 37 percent had no outside employment. There were several differences between the two groups in terms of knowledge and attitudes related to calcium intake. A significantly higher percentage of women in the higher calcium group were aware that there were any health problems related to calcium intake. They were also likely to believe they should consume more servings from the dairy group daily. They were more likely to avoid whole milk only, but less likely to avoid all milk or to avoid cheese. Food Group Consumption Patterns Women whose diets met their RDA for calcium consumed significantly more milk and milk products than women whose diets did not (table 2, p. 40). This is not surprising, considering that milk products are the major source of calcium in the American food supply (8). Milk products vary in their calcium concentration; therefore, total intake of milk products is reported both as grams and as calcium equivalents (the amount in grams of fluid whole milk that has the same quantity of calcium as these milk products). 39 Since the USDA/DHHS Food Guide Table 2. Mean consumption of major food groups and selected subgroups Pyramid defines servings from the by women with diets meeting or not meeting their RDA for calcium1 Milk, Yogurt, and Cheese Group on the basis of the calcium content of 1 cup of Dietary calcium Dietary calcium milk (37), calcium equivalents can be Food group belowRDA RDA or above used to estimate intake of milk products intakes (n = 1,819) (n = 442) Significance in relationship to Food Guide Pyramid serving recommendations. Women in Total milk and milk products (CaEq)2 the lower calcium group averaged an 159 559 ** intake of 159 calcium equivalents per day from milk and milk products or Grams approximately two-thirds of a serving Total milk and milk products 129 463 ** from the Milk, Yogurt, and Cheese Group. Women who met their calcium Whole milk 26 91 ** RDA obtained 559 calcium equivalents Lowfat milk 46 145 ** from milk products, or approximately Skim milk 19 121 ** 2.3 servings, an amount within the 2-3 Cheese 10 20 ** servings per day recommended by the Milk desserts 13 29 ** Food Guide Pyramid and slightly less than the 2.5 servings per day that these Yogurt 5 20 ** women, on average, believed they Total vegetables 180 202 should consume. Dark green vegetables 11 17 Legumes 15 19 Women who met their calcium RDA Total fruit 127 173 ** also consumed significantly more of all of the subgroups within this category Citrus juices 45 51 that were examined. The differences Total grain products 206 281 ** were particularly striking for lowfat and Meat, poultry, fish, eggs, nuts 176 180 skim milks. Women whose diets met Fats and oils 14 16 their RDA for calcium consumed more Sugars and sweets 15 22 * than three times as much lowfat milk as other women and more than six times as Total nonalcoholic beverages 798 705 much skim milk. Women whose diets Coffee 367 359 met their calcium RDA also consumed Tea 164 119 significantly more fruit, grain products, Regular sodas 146 99 ** and sugars and sweets than other Lo-cal sodas 82 78 women. Women who did not meet their calcium RDA consumed more regular Total alcoholic beverages 31 40 sodas. 1Weighted data. 2caEq =calcium equivalents. * p < .05. ** p < .01. 40 Family Economics and Nutrition Review Nutrient Intakes Women who met their calcium RDA consumed significantly more kilocalories than those who did not- I ,861 kcal/day compared with I ,373 kcaVday-although both of these levels are below the average energy allowances recommended for adult women (23). These low intake levels may reflect some underreporting, a problem that is known to plague self-reported dietary intake data (21). 1 When nutrient intakes were examined as a percent of recommendations (RDA), women whose diets met their calcium RDA consumed significantly more of all vitamins and minerals examined, as well as protein (table 3). On average, both groups met their RDAs for protein, riboflavin, phosphorus, folate, thiamin, niacin, vitamin C, and vitamin B-12. Neither group met their RDA for zinc, although the group who met their RDA for calcium averaged 97 percent of their zinc RDA, significantly higher than those who did not meet the calcium RDA, whose average intake of zinc was 66 percent of their RDA. The group who met their RDA for calcium also met their RDAs for magnesium, vitamin E, vitamin B-6, iron, and vitamin A, but the other women did not. Some of the nutrient intake differences seen could reflect the higher average caloric intakes of women whose diets met their calcium RDA. However, when the nutrient densities of the diets of the two groups were compared, the women 1 See also the article by Riddick in this issue. 1996 Vol. 9 No.3 Table 3. Mean energy, nutrient intakes, and nutrient densities of intakes, by women with diets meeting or not meeting their RDA for calcium' Variable Dietary calcium Dietary calcium and belowRDA RDA or above nutrient density (n = 1,819) (n = 442) Significance Variable Energy (kcal) 1,373 1,861 ** Percent RDA Protein 114 156 ** Zinc 66 97 ** Magnesium 70 106 ** Iron 86 116 ** Phosphorus 103 173 ** Thiamin 106 149 ** Riboflavin 100 171 ** Niacin 118 148 ** Folate 105 156 ** Vitamin B-6 78 113 ** Vitamin B-12 186 279 ** Vitamin C 129 172 ** Vitamin A 97 170 ** Vitamin E 74 116 ** Nutrient density (nutrient/1,000 kcal) Protein (g) 41.9 43.0 Calcium (mg) 363.3 621.5 ** Zinc (mg) 5.9 6.6 ** Magnesium (mg) 148.8 166.4 ** Iron (mg) 7.8 8.1 Phosphorus (mg) 625.5 777.9 ** Thiamin (mg) 0.8 0.9 Riboflavin (mg) 0.9 1.2 ** Niacin (mg) 12.4 11.6 * Folate (flg) 143.0 155.5 * Vitamin B-6 (mg) 0.9 1.0 * Vitamin B-12 (flg) 2.7 3.1 Vitamin C (mg) 58.8 57.3 Vitamin A (RE)2 593.1 766.5 ** Vitamin E (TE)3 4.3 5.2 * 1Weighted data. 2RE = retinol equivalents. 3-rE = tocopherol equivalents. * p< .05. ** p< .01. 41 who met their calcium RDA were found to have diets that were more nutrient dense for zinc, magnesium, phosphorus, riboflavin, niacin, folate, vitamin B-6, vitamin A, and vitamin E, as well as calcium (table 3). Therefore, many of the differences in diet quality between the two groups appear to be due to qualitative as well as quantitative differences in intake. Fat, Saturated Fat, and Cholesterol Intakes Women whose diets met their calcium RDA averaged 33.7 percent kilocalories from fat, compared with 34.3 percent for other women; this difference was not significant (fig. 1). Women whose diets met their calcium RDA did consume significantly more saturated fat than other women, 12.5 percent, compared with 11.6 percent. For both groups, these intakes are above levels recommended by the Dietary Guidelines for Americans (38). Women whose diets met their calcium RDA also consumed significantly more cholesterol than other women, although neither group exceeded the 300 mg/day limit recommended by the National Academy of Sciences (fig. 2). On a density level, there was no significant difference in cholesterol intake between the two groups, indicating that the difference in absolute intake between the two groups was primarily due to the higher reported caloric intakes of the women who met their calcium RDA. 42 Figure 1. Mean percent calories from fat and saturated fat by women with diets meeting or not meeting their RDA for calcium 1 %kcal 40 34.3 30 20 10 0 L____! ___ _ 1Weighted data. •• p < .01. Total fat Dietary calcium below RDA (n = 1,819) • Dietary calcium RDA or above (n = 442) 11.6 12.5 Saturated fat** Figure 2. Mean daily cholesterol intakes and cholesterol densities of women with diets meeting or not meeting their RDA for calcium 1 Mean daily cholesterol intake** (mg/day) Mean cholesterol density (mg/1 ,000 kcal) 1 Weighted data. ** p < .01. 0 50 [J Dietary calcium below ADA (n= 1,819) • Dietary calcium ADA or above (n = 442) 100 150 200 250 300 Milligrams cholesterol Family Economics and Nutrition Review Sodium and Potassium Intakes On an absolute level (mg/day), women whose diets met their calcium RDA consumed more sodium than did other women; their total intake was above the 2,400 mg limit recommended by the National Academy of Sciences (fig. 3). On a density level, the difference was reversed; women with lower calcium intakes had significantly higher sodium densities than women who met their RDA for calcium. The difference in absolute intake and sodium density is probably due to the higher caloric intakes of women who met their RDAs for calcium. If the recommended limit of 2,400 mg of sodium is divided by the average Recommended Energy Allowances (REAs) for women established by the National Academy of Sciences (23), women under age 51, with a mean REA of 2,200 kcal!day, should consume no more than 1,091 mg sodium per 1 ,000 kcal, and women ages 51 and above, with a mean REA of 1,900 kcal/day, should consume no more than 1,263 mg sodium per 1,000 kcal, in order to meet this recommendation. Mean sodium densities of both women with lower and higher calcium diets were well above those limits. Women with higher calcium intakes also had higher potassium intakes, but there was no significant difference in the potassium density of the diets of the two groups. Neither group met the National Academy of Sciences intake recommendation of 3,500 mg of potassium daily. In order to meet the potassium recommendation, women consuming their average recommended energy allowance would have to consume at least 1,591 to 1,842 mg potassium per 1,000 kcal, depending on their age. Women whose diets met their calcium RDA had potassium densities that fell within this range, but other women did no |
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