Pediatrics
Volume 126, Issue 1, 2010, Pages e26-e32

Development and validity of a 2-item screen to identify families at risk for food insecurity (Article)

Hager E.R. , Quigg A.M. , Black M.M. , Coleman S.M. , Heeren T. , Rose-Jacobs R. , Cook J.T. , Ettinger De Cuba S.A. , Casey P.H. , Chilton M. , Cutts D.B. , Meyers A.F. , Frank D.A.
  • a Department of Pediatrics, University of Maryland School of Medicine, 737 W Lombard St, Baltimore, MD 21201, United States
  • b Department of Pediatrics, University of Maryland School of Medicine, 737 W Lombard St, Baltimore, MD 21201, United States, Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, United States
  • c Department of Pediatrics, University of Maryland School of Medicine, 737 W Lombard St, Baltimore, MD 21201, United States
  • d Data Coordinating Center, Boston University School of Public Health, Boston, MA, United States
  • e Data Coordinating Center, Boston University School of Public Health, Boston, MA, United States
  • f Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
  • g Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
  • h Data Coordinating Center, Boston University School of Public Health, Boston, MA, United States
  • i Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
  • j Department of Health Management and Policy, Drexel University School of Public Health, Philadelphia, PA, United States
  • k Department of Pediatrics, Hennepin County Medical Center, Minneapolis, MN, United States
  • l Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
  • m Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States

Abstract

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 af-firmative 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. Copyright © 2010 by the American Academy of Pediatrics.

Author Keywords

Food insecurity Hunger Child development Screening tools nutrition

Index Keywords

food deprivation validity immigrant Nutritional Requirements Caregivers Population Surveillance human risk assessment Odds Ratio Confidence Intervals priority journal Food Supply screening test Health Surveys academic achievement Breast Feeding United States Humans developmental disorder Interviews as Topic Infant, Newborn male preschool child Socioeconomic Factors Infant Child, Preschool female Child Welfare child health sensitivity and specificity Incidence Article major clinical study food security child hospitalization Poverty Areas Aid to Families with Dependent Children ethnicity family assessment nutritional status Child Development employment caregiver hunger Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-77954374542&doi=10.1542%2fpeds.2009-3146&partnerID=40&md5=2486d849120a2ed1de6a092ef6f66c38
DOI: 10.1542/peds.2009-3146
ISSN: 00314005
Cited by: 226
Original Language: English