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Published on: September 18, 2018
Development and validity of a 2-item screen to identify families at risk for food insecurity
Erin R Hager1, Anna M Quigg, Maureen M Black
1Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA. ehager@peds.umaryland.edu
Insights
A brief, 2-question food insecurity (FI) screen accurately identifies families with young children at risk. This tool helps providers offer timely support to mitigate negative health and developmental outcomes associated with food insecurity.
Area of Science:
- Public Health
- Pediatrics
- Nutrition Science
Background:
- Food insecurity (FI) negatively impacts child health and development.
- Existing screening tools for FI can be lengthy and burdensome for clinical settings.
- There is a need for brief, validated instruments to identify at-risk families efficiently.
Purpose of the Study:
- To develop a concise screening tool for identifying families at risk of food insecurity (FI).
- To evaluate the sensitivity, specificity, and convergent validity of the developed FI screen.
- To assess the screen's utility in a diverse, urban pediatric population.
Main Methods:
- A 2-item food insecurity (FI) screen was developed based on responses from the US Department of Agriculture 18-item Household Food Security Survey (HFSS).
- Sensitivity and specificity were calculated using HFSS results as the gold standard.
- Convergent validity was assessed by examining associations between the FI screen and child health, hospitalization, and developmental risk using logistic regression.
Main Results:
- The study included 30,098 families, with 23% identified as food insecure.
- The 2-item FI screen, based on HFSS questions 1 and 2, demonstrated high sensitivity (97%) and specificity (83%).
- Positive screen results correlated with increased risk of poor child health, lifetime hospitalizations, and developmental risk.
Conclusions:
- A 2-item food insecurity (FI) screen is a sensitive, specific, and valid tool for identifying at-risk families with young children.
- This brief screen enables rapid identification of households facing food insecurity.
- Early identification facilitates targeted interventions to address the health and developmental consequences of FI.
Objectives:
To develop a brief screen to identify families at risk for food insecurity (FI) and to evaluate the sensitivity, specificity, and convergent validity of the screen.
Patients And Methods:
Caregivers of children (age: birth through 3 years) from 7 urban medical centers completed the US Department of Agriculture 18-item Household Food Security Survey (HFSS), reports of child health, hospitalizations in their lifetime, and developmental risk. Children were weighed and measured. An FI screen was developed on the basis of affirmative HFSS responses among food-insecure families. Sensitivity and specificity were evaluated. Convergent validity (the correspondence between the FI screen and theoretically related variables) was assessed with logistic regression, adjusted for covariates including study site; the caregivers' race/ethnicity, US-born versus immigrant status, marital status, education, and employment; history of breastfeeding; child's gender; and the child's low birth weight status.
Results:
The sample included 30,098 families, 23% of which were food insecure. HFSS questions 1 and 2 were most frequently endorsed among food-insecure families (92.5% and 81.9%, respectively). An affirmative response to either question 1 or 2 had a sensitivity of 97% and specificity of 83% and was associated with increased risk of reported poor/fair child health (adjusted odds ratio [aOR]: 1.56; P < .001), hospitalizations in their lifetime (aOR: 1.17; P < .001), and developmental risk (aOR: 1.60; P < .001).
Conclusions:
A 2-item FI screen was sensitive, specific, and valid among low-income families with young children. The FI screen rapidly identifies households at risk for FI, enabling providers to target services that ameliorate the health and developmental consequences associated with FI.
