Brief assessment of food insecurity accurately identifies high-risk US adults

Abstract

Objective: To facilitate the introduction of food insecurity screening into clinical settings, we examined the test performance of 2-item screening questions for food insecurity against the US Department of Agriculture's Core Food Security Module.Design: We examined sensitivity, specificity, and accuracy of various 2-item combinations of questions assessing food insecurity in the general population and high-risk population subgroups.Setting: 2013 Current Population Survey December Supplement, a population-based US survey Subjects: All survey participants from the general population and high-risk subgroups Results:The test characteristics of multiple 2-item combinations of questions assessing food insecurity have adequate sensitivity (>97%) and specificity (>70%) for widespread adoption as clinical screening measures. Conclusions:We recommend two specific items for clinical screening programs based on their widespread current use and high sensitivity for detecting food insecurity. These items query how often the household "worried whether food would run out before we got money to buy more" and how often "the food that we bought just didn't last and we didn't have money to get more." The recommended items have sensitivity across high-risk population sub-groups of ≥97% and a specificity ≥74% for food insecurity.

Diagnostic Accuracy of Two Food Insecurity Screeners Recommended for Use in Health Care Settings

“…The sensitivity of the HVS tool using 12-month recall in our population was similar to that recently reported for a large, nationally representative sample. 19 Although we found the HVS to have higher sensitivity than the AAP tool, the specificity was lower (82% vs 93%). The positive and negative likelihood ratios—the likelihood that a positive screen indicates food insecurity and a negative screen indicates food security—were similar, although our study likely lacked power to detect small differences.…”

“…More recently, the HVS was tested for accuracy and performed well in a national population-based sample of adults that included multiple high-risk groups (≥|97% sensitive; ≥|74% specific). 19 …”

Clinical-Community Partnerships to Identify Patients With Food Insecurity and Address Food Needs

“…These 2 brief, easy-to-administer questions may be the most feasible screening tool for health care entity–based food insecurity programs. Research indicates that this tool provides a valid measure of food security status in various populations (23). Using the Hunger Vital Signs questions, the Hunger Safety Net Workgroup of the Nutrition and Obesity Policy Research and Evaluation Network has developed food insecurity screening algorithms to guide physicians in screening pediatric and senior patients for food insecurity and referring patients to emergency and long-term food resources in the community (24).…”

Food insecurity screening: A missing piece in cancer management

“…12 Food insecurity often forces patients to make trade-offs between food and other resources; for example, the Hunger in America 2014 survey found that approximately 66% of households receiving food resources from the Feeding America network of food banks had to choose between paying for food and medicine or medical care. 20,21 Patients screen positive for food insecurity using the HVS if they respond "often true" or "sometimes true" (vs "never true") to either or both of the following statements: "Within the past 12 months we worried whether our food would run out before we got money to buy more" and "Within the past 12 months the food we bought just didn't last and we didn't have money to get more. Individuals who are uninsured or who have public insurance are more likely to be food insecure compared with their privately insured counterparts.…”

“…67 The DT form contains an adjunct 39-item problem list used to identify key sources of distress in 5 life domains: Practical, Family, Emotional, Spiritual/Religious, and Physical. 20 Several resources and interventions currently are available to patients who are food insecure. This structure provides a useful framework through which oncologists also can identify food insecurity.…”