Screening for Food Insecurity in Pediatric Clinical Settings: Opportunities and Barriers

Abstract

Food insecurity is a serious health concern among children in the United States with 15.3 million children living in food insecure households. The American Academy of Pediatrics recommends that pediatricians screen for food insecurity at health maintenance visits as identifying children at risk is a crucial step in the amelioration of food insecurity. Two surveys were administered in a Midwest pediatric clinic. A cross-sectional survey was electronically distributed to pediatric providers to assess perceptions of food insecurity among patients, provider readiness to conduct food security screenings, and barriers to conducting those screenings. A cross-sectional caregiver survey was administered to assess demographics, household food security status, participation in nutrition assistance programs, and barriers to getting enough food to eat. Descriptive statistics and odds ratios were calculated. Eighty-eight percent of physicians believe that food insecurity is a challenge for some of their patients. Only 15 % of providers reported screening for food insecurity, while 80 % were willing to screen. Physicians were most concerned with knowing how to handle a positive screen. Among caregivers, 57 % screened positive for food insecurity. Those experiencing food insecurity were more likely to be non-white, participate in SNAP and to feel discomfort towards the idea of talking to a doctor or nurse about food needs. Caregivers reporting food insecurity were significantly less likely to have a personal vehicle. Effective food insecurity screening requires addressing caregiver and health provider barriers in order to increase the likelihood of identifying households most at risk.

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

“…Routine screening for food insecurity is feasible in the health setting 4,31,32 and can enable support for food and other health-related basic needs. 22,29,30 Wilson and Jungner’s widely accepted criteria for effective screening require that the test be acceptable to the population.…”

“…4 Prevalence of food insecurity is highest among households with children: 1 in 5 of all households with children, 1 in 4 non-Hispanic Black households with children, and nearly 1 in 3 households with children headed by a single woman is food insecure. 3 Food insecurity has been associated with costly health consequences for adults and children, including poorer physical and mental health and more frequent hospitalizations.…”

“…12 Studies in both ambulatory and hospital settings have shown that the majority of caregivers of children believe that it is appropriate for health care practitioners to address food insecurity. 4,13,14 Likewise, the majority of practitioners are willing to screen patients for food insecurity. Yet few practitioners actually do screen, citing a lack of valid tools and insufficient knowledge or resources to support families who screen positive.…”

“…Yet few practitioners actually do screen, citing a lack of valid tools and insufficient knowledge or resources to support families who screen positive. 4,13,15 …”

Food insecurity as a basis for drafting a Strategic Food Sovereignty Plan: A case study of the Kutai Kartanegara District, Indonesia

“…Communities usually challenged by food insecurity are those in which people are poor, affected by natural disasters, or live in a place that is geographically far from food resources, thereby limiting their access to food (Kollannoor-Samuel et al 2011;Crush and Caesar 2014;Barnidge et al 2017;Denney et al 2017). Food insecurity may be chronic or temporary (transient) (WFP 2009).…”