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Performance of a two-item screening for household food insecurity during WIC services
Christopher E Anderson1, M Pia Chaparro2, Shannon E Whaley3
1Division of Research and Evaluation, Public Health Foundation Enterprises WIC Program, 13181 Crossroads Pkwy N #540, City of Industry, CA, 91746, USA. christophera@phfewic.org.
Background:
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in California introduced household food insecurity (HFI) screening during eligibility certifications in 2019. This study was conducted to evaluate the screening performance of the 2-item Hunger Vital Sign ™ Screener (HVSS2) for HFI during WIC eligibility certification visits in Los Angeles County (LAC), California.
Methods:
Study participants completed a 6-item USDA Household Food Security Survey Module (HFSSM6) assessment in either the 2020 LAC WIC Survey (July-December 2021) or the longitudinal WIC Cash Value Benefit Study (April 2021-May 2022) and had WIC administrative HVSS2 screening data within 30 days of HFSSM6 measurement (n = 1,113). HVSS2 performance (sensitivity, specificity, positive predictive value, negative predictive value) for detecting HFI (low or very low food security) was evaluated against the HFSSM6.
Results:
Nearly one-third (31.1%) of LAC WIC Survey respondents and one-half (50.5%) of WIC Cash Value Benefit Study respondents had HFI based on the HFSSM6, while 15.7% and 20.0% had HFI based on HVSS2 for the two studies, respectively. The HVSS2 had high specificity (0.90-0.93), moderate-to-high negative predictive value (0.54-0.74), low sensitivity (0.29-0.38), and moderate-to-high positive predictive value (0.57-0.83) for HFI.
Conclusions:
HVSS2 screening during WIC services has moderate-to-high negative (i.e., screen negative, are food secure) and positive (i.e., screen positive, are food insecure) predictive values for HFI. Dedicated staff training may be needed to improve the performance of the HVSS2 and to make HVSS2 data collected during WIC certifications more helpful in identifying and referring families experiencing HFI to more services.
