- Email: [email protected]
Diagnosing Food Insecurity
Diagnosing Food Insecurity Daily intake of vital nutrients is essential for good health across the lifespan. Unfortunately, far too many children and adults face periods of food insecurity. Food insecurity is defined as “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable food in socially acceptable ways.”1(p. 3) Families unable to afford healthy foods are considered to be food insecure. Food-insecure families are least likely to access nutrition services. The American Academy of Pediatrics and other national organizations have recommended health care providers screen for health-related social problems such as food insecurity and provide referrals for families in need.2 Nurse practitioners (NPs) are well positioned to screen and diagnosis food insecurity and provide referrals to socially acceptable food assistance programs.
behavior problems and poor academic performance compared with children from foodsecure families. Children may also develop chronic diseases secondary to undernutrition.1 For older adults, coexistence of food insecurity and polypharmacy complicates the management of chronic disease and other health problems associated with aging. Food insecurity results in a poor diet, which is often associated with excessive energy intake and obesity. In an effort to stretch the food dollars, the eating habits of food-insecure families are characterized by the purchase of cheap foods that are easier to access. Cheap foods are usually high in fat, sugar, and calories. Uncertainty of access to food may also cause family members to overconsume food to compensate for periods of food scarcity. Such feeding patterns have been associated with obesity.1
PREVALENCE OF FOOD INSECURITY
A recent economic research report from the United States Department of Agriculture indicates that 14.3% of American households were food insecure at least some time during the year in 2013. Another 5.6% of households had very low food security, meaning food intake of at least 1 household member was disrupted because the household lacked money and other resources. An estimated 62% of all food-insecure households participated in 1 or more of the 3 largest federal food and nutrition assistance programs.3 FOOD INSECURITY IS A HEALTH PROBLEM
Food insecurity is associated with several health problems. In pregnancy, food insecurity may result in negative outcomes ranging from birth defects to low-birthweight babies, and to depressive symptoms in the mother. In infancy, failure to thrive, developmental problems, risk for lifetime hospitalization, and poor health in general may be observed. Children from families with food insecurity are more likely to have www.npjournal.org
DIAGNOSTIC TIPS Serah Theuri, PhD, RD WHO ARE AT RISK?
Families at risk typically have a lack of sufficient funds to purchase healthy food; they also lack protection from unaffordable health care costs and are often unable to afford housing with facilities to store and prepare food. Lack of transportation to grocery stores that sell affordable and healthy foods, as well as lack of support systems during periods of poor access to healthy food, is common among foodinsecure families. Rates of food insecurity are substantially higher than the national average for households with incomes below the federal poverty line and The Journal for Nurse Practitioners - JNP
1
in households with children headed by single a parent. Black- and Hispanic-headed households are also often at risk. Food insecurity is common among residents of all areas, including large cities, suburban areas, exurban areas around large cities, and in rural areas.3 For households on food assistance programs, such as the Special Supplemental Nutrition Program; Women, Infants, Children Program; and the National School Lunch Program, the risk for food insecurity may stem from poor budgeting skills. SCREENING FOR FOOD INSECURITY
The Food Insecurity (FI) Screen was developed based on the Household Food Security Survey to identify families at risk for food insecurity. The FI Screen is a 2-question food insecurity screening tool that measures low-income families’ concerns and access to food, much the same way as health care providers check for vital signs such as blood pressure and pulse.4 The FI Screen is validated and already in use at select primary care locations across the US. The FI Screen asks the patient to respond to the following statements: 1. “Within the past 12 months we worried whether our food would run out before we got money to buy more.” 2. “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”
2
The Journal for Nurse Practitioners - JNP
Food insecurity is diagnosed if the response to either or both of the 2 statements is given as “often true” or “sometimes true” versus “never true.”4(p. e29) CONCLUSION
NPs need an efficient method for identifying families with food insecurity. NPs can use the FI Screen to diagnose food insecurity during routine primary or acute care visit. Routine screening can identify families at risk for food insecurity and provide referrals to effective resources to promote health. References 1. Haering SA, Syed SB. Community Food Security in United States Cities: A Survey of the Relevant Scientific Literature. Baltimore: John Hopkins Center for a Livable Future. 2009:1-86. 2. Gibson DM. Screening for household food insecurity in primary care settings: a commentary. Prev Med. 2012;55(3):223. 3. Coleman-Jensen A, Gregory C, Singh A. Household food security in the United States in 2013. ERR-173. September 2014. http://www.ers .usda.gov/media/1565415/err173/pdf/. 4. Hager ER, Quigg MA, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126:e26-e32.
Serah Theuri, PhD, RD, is an assistant professor of nutrition in the College of Nursing & Health Professions at the University of Southern Indiana in Evansville, and can be reached at [email protected]. Section Editor Mellisa Hall, DNP, can be reached at [email protected].
1555-4155/15/$ see front matter © 2015 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2015.05.004
Volume
-,
Issue
-, -/-
2015
behavior problems and poor academic performance compared with children from foodsecure families. Children may also develop chronic diseases secondary to undernutrition.1 For older adults, coexistence of food insecurity and polypharmacy complicates the management of chronic disease and other health problems associated with aging. Food insecurity results in a poor diet, which is often associated with excessive energy intake and obesity. In an effort to stretch the food dollars, the eating habits of food-insecure families are characterized by the purchase of cheap foods that are easier to access. Cheap foods are usually high in fat, sugar, and calories. Uncertainty of access to food may also cause family members to overconsume food to compensate for periods of food scarcity. Such feeding patterns have been associated with obesity.1
PREVALENCE OF FOOD INSECURITY
A recent economic research report from the United States Department of Agriculture indicates that 14.3% of American households were food insecure at least some time during the year in 2013. Another 5.6% of households had very low food security, meaning food intake of at least 1 household member was disrupted because the household lacked money and other resources. An estimated 62% of all food-insecure households participated in 1 or more of the 3 largest federal food and nutrition assistance programs.3 FOOD INSECURITY IS A HEALTH PROBLEM
Food insecurity is associated with several health problems. In pregnancy, food insecurity may result in negative outcomes ranging from birth defects to low-birthweight babies, and to depressive symptoms in the mother. In infancy, failure to thrive, developmental problems, risk for lifetime hospitalization, and poor health in general may be observed. Children from families with food insecurity are more likely to have www.npjournal.org
DIAGNOSTIC TIPS Serah Theuri, PhD, RD WHO ARE AT RISK?
Families at risk typically have a lack of sufficient funds to purchase healthy food; they also lack protection from unaffordable health care costs and are often unable to afford housing with facilities to store and prepare food. Lack of transportation to grocery stores that sell affordable and healthy foods, as well as lack of support systems during periods of poor access to healthy food, is common among foodinsecure families. Rates of food insecurity are substantially higher than the national average for households with incomes below the federal poverty line and The Journal for Nurse Practitioners - JNP
1
in households with children headed by single a parent. Black- and Hispanic-headed households are also often at risk. Food insecurity is common among residents of all areas, including large cities, suburban areas, exurban areas around large cities, and in rural areas.3 For households on food assistance programs, such as the Special Supplemental Nutrition Program; Women, Infants, Children Program; and the National School Lunch Program, the risk for food insecurity may stem from poor budgeting skills. SCREENING FOR FOOD INSECURITY
The Food Insecurity (FI) Screen was developed based on the Household Food Security Survey to identify families at risk for food insecurity. The FI Screen is a 2-question food insecurity screening tool that measures low-income families’ concerns and access to food, much the same way as health care providers check for vital signs such as blood pressure and pulse.4 The FI Screen is validated and already in use at select primary care locations across the US. The FI Screen asks the patient to respond to the following statements: 1. “Within the past 12 months we worried whether our food would run out before we got money to buy more.” 2. “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”
2
The Journal for Nurse Practitioners - JNP
Food insecurity is diagnosed if the response to either or both of the 2 statements is given as “often true” or “sometimes true” versus “never true.”4(p. e29) CONCLUSION
NPs need an efficient method for identifying families with food insecurity. NPs can use the FI Screen to diagnose food insecurity during routine primary or acute care visit. Routine screening can identify families at risk for food insecurity and provide referrals to effective resources to promote health. References 1. Haering SA, Syed SB. Community Food Security in United States Cities: A Survey of the Relevant Scientific Literature. Baltimore: John Hopkins Center for a Livable Future. 2009:1-86. 2. Gibson DM. Screening for household food insecurity in primary care settings: a commentary. Prev Med. 2012;55(3):223. 3. Coleman-Jensen A, Gregory C, Singh A. Household food security in the United States in 2013. ERR-173. September 2014. http://www.ers .usda.gov/media/1565415/err173/pdf/. 4. Hager ER, Quigg MA, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126:e26-e32.
Serah Theuri, PhD, RD, is an assistant professor of nutrition in the College of Nursing & Health Professions at the University of Southern Indiana in Evansville, and can be reached at [email protected]. Section Editor Mellisa Hall, DNP, can be reached at [email protected].
1555-4155/15/$ see front matter © 2015 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2015.05.004
Volume
-,
Issue
-, -/-
2015