Elsevier

Academic Pediatrics

Volume 17, Issue 5, July 2017, Pages 497-503
Academic Pediatrics

Pediatric Practice
Food Insecurity Screening in Pediatric Primary Care: Can Offering Referrals Help Identify Families in Need?

https://doi.org/10.1016/j.acap.2016.10.006Get rights and content

Abstract

Objective

To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection.

Methods

Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates.

Results

A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4–7.0).

Conclusions

In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs.

Section snippets

Study Design

We surveyed parent/guardians (hereafter termed “caregivers”) of 3- to 10-year-old children visiting a pediatric hospital-based primary care clinic in Boston, Massachusetts, as part of a broader study focused on health-related social problems and diet quality. We chose 3 to 10 years as a range when eating-routine flexibility (lowest in infancy) and parental control (lowest in adolescence) were relatively balanced. Eligibility criteria included: 1) routine visit for 3- to 10-year-old well-child

Sample Characteristics

Of 554 eligible caregivers recruited, 432 (78.0%) agreed to participate. The most common reason caregivers declined to participate was lack of time or not wanting to delay their visit. Participation rates were higher for caregivers identifying as female versus male (77.2% vs 54.8%; P < .01) or as Hispanic versus black (86.1% vs 66.3%; P < .01). Of the 432 caregivers who participated, 340 (78.7%) completed the survey. These 340 caregivers comprised the final study sample. The most common reason

Discussion

In this sample, a menu offering food-assistance referrals identified 15% more families than standard food insecurity screening alone. These were families who did not report food insecurity but who selected one or more referrals for food assistance. Food insecurity and referral selection were linked, but the overlap was only partial. Over 20% of the caregivers who did not report food insecurity selected one or more referrals. Nearly half of the caregivers who did report food insecurity did not

Conclusions

In this sample, there was incomplete overlap between food insecurity and referral selection for food assistance. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs.

Acknowledgments

The authors thank the Academic Pediatric Association Bright Futures Young Investigator Award Program; American Academy of Pediatrics' Bright Futures for donating child activity books; ROIhealth for donating grocery coupons; the dedicated research assistants (Kristina Ten Haagen, Saira Khanna, Dorothea Letner, Alexandra Geanacopoulos, Larissa Wenren, Jeremy Mudd, Lindsay Tsopelas); the HelpSteps technical team (Emily Krull, Ellen Reisinger, Aaron Pikcilingis, Glenn Marmon, Laura Reilly, Peter

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    Conflict of Interest: Dr Rhodes receives research funding from Merck. The other authors declare that they have no conflict of interest.

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