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Initial post
Food insecurity, not having reliable access to enough food for an active, healthy life, is a social determinant of health that nurses often miss because families don't volunteer it. Healthy People 2030 includes objectives on reducing household food insecurity and hunger (Office of Disease Prevention and Health Promotion, n.d.), and I think community clinics should screen every family rather than waiting for visible signs.
The best case for routine screening is that a validated tool takes less than a minute. Hager et al. (2010) developed the Hunger Vital Sign from the US Department of Agriculture's 18-item food security survey, using data from 30,098 families with young children at seven urban medical centers, 23% of whom were food insecure. Two statements were most often endorsed by food-insecure families:
- "Within the past 12 months we worried whether our food would run out before we got money to buy more."
- "Within the past 12 months the food we bought just didn't last and we didn't have money to get more."
Answering "often true" or "sometimes true" to either statement identified food insecurity with 97% sensitivity and 83% specificity. A positive screen was also associated with poor or fair child health, more hospitalizations and developmental risk.
At the clinic where I work, I would build the two questions into intake for every visit and link a positive screen to action: a same-day referral to a food bank or WIC, help applying for SNAP, and a note in the record so the team can follow up. Screening without a referral pathway risks embarrassing families and offering nothing in return.
Question for the class: How does your workplace ask about social needs without making families feel judged?
Reply to a classmate
Thanks, Jordan, for raising the concern that families may underreport food insecurity if a nurse asks in front of others. That's an important point about privacy. One option is to let families answer the two questions on a tablet or paper form before they see the nurse, then talk through any positive answers in the exam room. Because the screen is so sensitive (Hager et al., 2010), it's better at catching families at risk than at confirming the problem, so the follow-up conversation matters. I'd also suggest explaining why we ask, for example, "We ask every family because food costs affect health, and we have resources that can help."
References
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. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26–e32. https://doi.org/10.1542/peds.2009-3146
Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030: Nutrition and healthy eating. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/nutrition-and-healthy-eating
