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

• Published in: Academic pediatrics 2017-07, Vol.17 (5), p.497-503
• Main Authors: Bottino, Clement J., MD, MPH, Rhodes, Erinn T., MD, MPH, Kreatsoulas, Catherine, PhD, Cox, Joanne E., MD, Fleegler, Eric W., MD, MPH
• Format: Article
• Language: English
• Subjects: Adult; Child; Child, Preschool; children; family preferences; Female; Food Assistance; food insecurity; Food Supply; Humans; Male; medical home; Needs Assessment; Neonatal and Perinatal Medicine; Patient Selection; pediatric; Pediatrics; primary care; Primary Health Care; Referral and Consultation; screening; social needs
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2016.10.006

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.