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The Effectiveness of Food Insecurity Screening in Pediatric Primary Care
Wendy Gwirtzman Lane1,2, Howard Dubowitz1, Susan Feigelman1
1Department of Pediatrics, University of Maryland School of Medicine, Center for Families, 520 W. Lombard St., Baltimore, MD 21201, USA.
Insights
A single food insecurity (FI) screen is valid and stable for identifying at-risk families. While screening helps maintain enrollment in food programs, it may not fully alleviate food insecurity.
Area of Science:
- Public Health
- Pediatrics
- Nutrition Security
Background:
- Children facing food insecurity are susceptible to medical and developmental issues.
- Effective screening and intervention strategies are crucial for this vulnerable population.
Purpose of the Study:
- To assess the validity and stability of a single-item food insecurity (FI) screen.
- To determine if implementing the screen reduces food insecurity among pediatric patients.
Main Methods:
- A cluster randomized controlled trial assigned pediatric residents to either the SEEK (Screening, Brief Intervention, Referral, and Treatment) group or a control group.
- A single FI question was administered to families in the SEEK group.
- Parents completed the USDA Food Security Scale at baseline and 6 months to evaluate screen validity (sensitivity, specificity, PPV, NPV).
Main Results:
- The FI screen demonstrated substantial agreement (Cohen's kappa = 0.69), with sensitivity of 59% and specificity of 87%.
- Positive Predictive Value (PPV) was 70%, and Negative Predictive Value (NPV) was 81%.
- SEEK families showed significantly higher screening rates (24% vs. 4.1%) and maintained Supplemental Nutrition Assistance Program (SNAP) enrollment more effectively (97% vs. 81%).
Conclusions:
- A single-item screen effectively identifies families experiencing food insecurity.
- Screening can aid in maintaining enrollment in essential food assistance programs.
- The study suggests that while screening is beneficial, it may not be sufficient to resolve food insecurity on its own.
Background:
Food insecure children are at increased risk for medical and developmental problems. Effective screening and intervention are needed.
Methods:
Our purpose was to (1) evaluate the validity and stability of a single item food insecurity (FI) screen. (2) Assess whether use may lead to decreased FI. Part of a larger cluster randomized controlled trial, pediatric residents were assigned to SEEK or control groups. A single FI question (part of a larger questionnaire) was used on SEEK days. SEEK residents learned to screen, assess, and address FI. A subset of SEEK and control clinic parents was recruited for the evaluation. Parents completed the USDA Food Security Scale ("gold standard"), upon recruitment and 6-months later. Validity, positive and negative predictive values (PPV, NPV) was calculated. The proportion of screened families with initial and subsequent FI was measured. Screening effectiveness was evaluated by comparing SEEK and control screening rates and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits between initial and 6-month assessments.
Results:
FI screen stability indicated substantial agreement (Cohen's kappa =0.69). Sensitivity and specificity was 59% and 87%, respectively. The PPV was 70%; NPV was 81%. SEEK families had a larger increase in screening rates than control families (24% vs. 4.1%, p<0.01). SEEK families were more likely to maintain SNAP enrollment (97% vs. 81%, p=0.05). FI rates remained stable at approximately 30% for both groups.
Conclusions:
A single question screen can identify many families with FI, and may help maintain food program enrollment. Screening may not be adequate to alleviate FI.
