Development and preliminary validation of a brief household food insecurity screening tool for paediatric health services in Australia

Abstract

Children from food insecure households are more likely to have substandard food and nutritional intakes, and experience developmental delays, behaviour issues and increased use of health services. In Australia, screening for household food insecurity (HFI) within health services is not undertaken routinely, limiting opportunities to optimise nutrition and healthcare. This research aimed to (a) identify the prevalence, potential determinants and outcomes of HFI among paediatric outpatients in two Queensland hospitals; and (b) identify questions suitable for screening households at risk of HFI. A cross-sectional survey collected data from caregivers of children attending paediatric appointments at two hospitals in Brisbane, Australia (n = 148).Sociodemographic, health and household-related characteristics were collected, and food security status was assessed using four HFI measures. Chi-square, independent t-tests, ANOVA and logistic regression explored associations between HFI and health-related characteristics. A potential HFI screener was identified based on the most frequently endorsed questions from any HFI measure, and its validity was assessed through calculation of sensitivity and specificity. Prevalence of HFI was 41%, with 16% experiencing very low food security. Households with a child of 'fair/poor' health had 5.59 times greater odds of being food insecure than being food secure, compared to households with a child of 'excellent/good' health (aOR 5.59, 95% CI: 1.3-23.5). HFI was also positively associated with household chaos (p = .006).A combination of two questions was identified as a possible screening tool, with a sensitivity of 96% and a specificity of 90%. This study demonstrated HFI may be highly prevalent in a paediatric outpatient population, which may result in difficulties in being able to follow nutrition prescriptions. A highly sensitive and specific two-question screening tool was identified and may assist practitioners in paediatric healthcare settings in identifying clients who are at risk of HFI. K E Y W O R D Schildren, food insecurity, health outcomes, paediatric primary care, screening tool | 1539 KERZ Et al.

Strategies used by schools to tackle food insecurity and hunger: a qualitative enquiry in 15 Victorian schools

“…Further research is required to quantify the extent of food insecurity amongst school students and to independently evaluate the food relief efforts of schools which require substantial resources. This would inform a more robust, coordinated and equitable policy response from government to address school food insecurity and help address the evidence‐gap which suggests research on food security interventions for children is lacking in robustness and the best options for the future are systems‐based approaches in both the implementation and evaluation of interventions 9 …”

“…In Australia, the FAO estimated 13.5% of households experienced food insecurity. 7 There is known higher prevalence of food insecurity among specific sub-groups in Australia including single-parents, 8 households with children with special healthcare needs 9 and families living in socioeconomically deprived neighbourhoods. 5 A range of food security strategies (i.e.…”

Consensus from an expert panel on how to identify and support food insecurity during pregnancy: A modified Delphi study

“…Including routine screening and then providing programs that link food insecure households or individuals to the services via health care settings is a solution that has grown out of the suggestion that supporting food security can lead to improvements in population health [46,47]. There is increasing interest in routine screening and the role of healthcare systems in addressing food insecurity in non-pregnancy healthcare settings [48,49]. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Z codes (Z55-Z65) allow for the classification and documentation of the social determinants of health in electronic medical health records.…”

“…In Australia, there is work underway that seeks to highlight the link between health care settings and actions that address food insecurity. For example Kerz, Bell [48], have validated a brief tool to be used in a Australian paediatric health care setting, with findings suggesting that food insecurity is prevalent among families of children attending paediatric outpatient hospital appointments. While McKay and colleagues [14] have demonstrated that a brief tool measuring food insecurity could be used in a clinical setting as a component of a referral pathway for pregnant women who are identified as food insecure.…”

“Food Is Our Love Language”: Using Talanoa to Conceptualize Food Security for the Māori and Pasifika Diaspora in South-East Queensland, Australia

“…In children, HFI has been associated with compromised mental health [ 16 ], as well as developmental, cognitive and behavioural (internalising and externalising) anomalies [ 17 ]. In parts of Australia, from one in four to one in two households experience food insecurity on a regular basis [ 7 , 18 , 19 , 20 , 21 , 22 ]. The primary determinant of HFI is low income combined with the high cost of living, including unaffordable housing, utilities, healthcare, education, and food [ 3 , 23 , 24 , 25 ].…”