Do the SCOFF items function differently by food-security status in U.S. college students?: Statistically, but not...

Area of Science:

• Psychiatry
• Public Health
• Psychometrics

Background:

• Food insecurity (FI) is a significant public health concern associated with increased risk for eating disorders (EDs).
• Existing research has not thoroughly investigated the psychometric properties of ED screening tools among individuals experiencing FI.
• Understanding potential differential item functioning (DIF) is crucial for ensuring equitable screening across diverse populations.

Purpose of the Study:

• To evaluate whether items on the SCOFF eating disorder screening tool exhibit differential item functioning (DIF) based on food security status.
• To examine if the SCOFF performs differently across food security status when considering gender identity and perceived weight status.
• To determine the clinical utility of the SCOFF for screening eating disorders in populations experiencing food insecurity.

Main Methods:

• Utilized data from the 2020/2021 Healthy Minds Study (N=122,269) to assess past-year food insecurity using the two-item Hunger Vital Sign.
• Employed differential item functioning (DIF) analyses, including uniform and non-uniform DIF, to compare SCOFF item endorsement probabilities between individuals with and without FI.
• Stratified analyses were conducted based on gender identity and perceived weight status to explore interactions with food security status.

Main Results:

• Several SCOFF items showed statistically significant uniform and non-uniform DIF, but effect sizes did not reach practical significance (pseudo ΔR² ≤ 0.006).
• When stratified by gender identity and perceived weight status, most items still showed statistically significant DIF.
• The SCOFF item assessing body-size perception demonstrated practically significant non-uniform DIF concerning perceived weight status.

Conclusions:

• The SCOFF demonstrates appropriate performance as a screening measure for eating disorder pathology among college students experiencing food insecurity.
• Preliminary evidence supports the use of the SCOFF in individuals with FI, including those with marginalized gender identities and varying perceived weight statuses.
• Further research is warranted to confirm the SCOFF's cross-cultural and cross-diagnostic validity in diverse populations facing food insecurity.