Objective
To examine dual food and energy hardship and internalizing and externalizing behavior problems in 9 year-old children.

Methods
We conducted a cross-sectional analysis of the Fragile Families and Child Wellbeing Study, a prospective national urban birth cohort, when the children were 9 years-old. Maternal reported “food hardship” (ever hungry and/or ever received free food) and “energy hardship” (ever unable to pay utility bill and/or utility shut-off) within the past year, and child behavior using the Child Behavior Checklist/6-18 years were assessed. Multiple logistic regression analyses estimated associations between individual and dual food and energy hardship and child behavior problems, adjusting for a priori covariates (child sex, health insurance, maternal sociodemographic characteristics, poverty, reported health, attention deficit hyperactivity disorder, depressive symptoms, smoking, and substance and alcohol abuse).

Results
Approximately 10% of households reported dual food and energy hardship. Children experiencing dual food and energy hardship had 3 times greater odds of withdrawn/depressed behaviors (adjusted odds ratio [AOR]=2.8, 95% CI:1.4-5.5), 3 times greater odds of somatic complaints (AOR=3.2, 95% CI:1.5-6.9), and 4 times greater odds of rule breaking behavior (AOR=3.7, 95% CI:1.5-9.2) in the borderline/clinical range compared to children with no hardship, and had 4 times greater odds of borderline/clinical range somatic complaints (AOR=4.2, 95% CI: 1.7-10.3) compared to children with only energy hardship.

Conclusions
Children experiencing dual food and energy hardship have greater odds of coexisting internalizing and externalizing behaviors after controlling for possible confounders. Providers can consider screening and resource referrals for these addressable hardships alongside behavior assessments in the clinical setting.