Thursday, May 29, 2014

Successfully Screening for Food Insecurity With Just Two Questions

Pediatrics Assistant Editor Lydia Furman, MD, shares her expert perspective on a new article from our June issue. To learn more about Dr. Furman and her work, check out her bio on our Contributors page.

By: Lydia Furman, MD

Photo by Hannah Yoon via Flickr
In an article from the June issue of Pediatrics we’re early releasing this week, Urke and colleagues (doi: 10.1542/peds.2013-3663) draw our attention to the Nunavut Inuit population in the high Canadian Arctic, among whom food insecurity is worrisomely prevalent. Can one or two questions adequately identify families with food insecurity, or are longer (18 question) standard surveys needed? The obvious twin benefits of reduced survey burden for families and speedier assessment for directed assistance drove this research.  Study conduct was marked by utmost respect for the surveyed population, with participatory survey development, an engaged local steering committee, and bilingual (Inuit dialects and English) surveyors.

Two questions, one adult and one child, were the winners, with the highest sensitivity, specificity, predictive values and overall accuracy. For adults, “In the last 12 months, were there times when the food for you and your family just did not last and there was no money to buy more?” showed 93.2 percent accuracy. For children, “In the last 12 months, were there times when it was not possible to feed the children a healthy meal because there was not enough money?” showed 94.7 percent accuracy. The key was combining the two items for a fuller picture of household need.

Prior studies examining one and two question screens for food insecurity were not uniformly successful. The authors point out that the predictive value and accuracy of any screen is dependent on the population prevalence of the condition. Therefore, before we can “grab and go” with this two question screen, additional testing in (economically) diverse populations is needed. This work challenges us to conduct similar studies among families living in urban, rural, hard-to-reach and underserved areas. The beauty of such a brief survey is that any and all of us, including community health nurses, lay health providers, “Help Me Grow” workers, and pediatricians alike will be able to screen and refer families to resources.

This lean, clean paper is an easy read and its potential applicability goes well beyond the unique population and setting.

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