**U.S. Household Food Security Survey Module: Six-Item Short Form**

July 2008

**[Revision Notes:]{.underline}** The food security questions in the
6-item module are essentially unchanged from those in the original
module first implemented in 1995 and described previously in this
document.

***July 2008:***

-   Wording of resource constraint in AD2 was corrected to, "...because
    there wasn't enough money for food" to be consistent with the
    intention of the September 2006 revision.

***January 2008:***

-   Corrected user notes for coding AD1a.

    ***September 2006:***

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-   Minor changes were introduced to standardize wording of the resource
    constraint in most questions to read, "...because there wasn\'t
    enough money for food."

-   Question numbers were changed to be consistent with those in the
    revised Household Food Security Survey Module.

-   User notes following the questionnaire were revised to be consistent
    with current practice and with new labels for ranges of food
    security and food insecurity introduced by USDA in 2006.

**[Overview:]{.underline}** The six-item short form of the survey module
and the associated Six-Item Food Security Scale were developed by
researchers at the National Center for Health Statistics.

**[Background:]{.underline}** The six-item short form of the survey
module and the associated Six-Item Food Security Scale were developed by
researchers at the National Center for Health Statistics in
collaboration with Abt Associates Inc. and documented in "The
effectiveness of a short form of the household food security scale," by
S.J. Blumberg, K. Bialostosky, W.L. Hamilton, and R.R. Briefel
(published by the *American Journal of Public Health*, vol. 89, pp.
1231-34, 1999). ERS conducted additional assessment of classification
sensitivity, specificity, and bias relative to the 18-item scale.

If respondent burden permits, use of the 18-item U.S. Household Food
Security Survey Module or the 10-item U.S. Adult Food Security Survey
Module is recommended. However, in surveys that cannot implement one of
those measures, the six-item module may provide an acceptable
substitute. It has been shown to identify food-insecure households and
households with very low food security with reasonably high specificity
and sensitivity and minimal bias compared with the 18-item measure. It
does not, however, directly ask about children's food security, and does
not measure the most severe range of adult food insecurity, in which
children's food intake is likely to be reduced.

**\[Begin Six-Item Food Security Module\]**

**[Transition into Module]{.underline} :**

These next questions are about the food eaten in your household in the
last 12 months, since (current month) of last year and whether you were
able to afford the food you need.

**[NOTE:]{.underline}** If the placement of these items in the survey
makes the transition/introductory sentence unnecessary, add the word
"Now" to the beginning of question HH3: "Now I'm going to read you\...."

FILL INSTRUCTIONS: Select the appropriate fill from parenthetical
choices depending on the number of persons and number of adults in the
household.

HH3. I'm going to read you several statements that people have made
about their food situation. For these statements, please tell me whether
the statement was [often]{.underline} true, [sometimes]{.underline}
true, or [never]{.underline} true for (you/your household) in the last
12 months---that is, since last (name of current month).

> The first statement is, "The food that (I/we) bought just didn't last,
> and (I/we) didn't have money to get more." Was that
> [often]{.underline}, [sometimes]{.underline}, or [never]{.underline}
> true for (you/your household) in the last 12 months?
>
> \[ \] Often true
>
> \[ \] Sometimes true
>
> \[ \] Never true
>
> \[ \] DK or Refused

HH4. "(I/we) couldn't afford to eat balanced meals." Was that
[often]{.underline}, [sometimes]{.underline}, or [never]{.underline}
true for (you/your household) in the last 12 months?

> \[ \] Often true
>
> \[ \] Sometimes true
>
> \[ \] Never true
>
> \[ \] DK or Refused

AD1. In the last 12 months, since last (name of current month), did
(you/you or other adults in your household) ever cut the size of your
meals or skip meals because there wasn\'t enough money for food?

> \[ \] Yes
>
> \[ \] No (Skip AD1a)
>
> \[ \] DK (Skip AD1a)

AD1a. \[IF YES ABOVE, ASK\] How often did this happen---almost every
month, some months but not every month, or in only 1 or 2 months?

> \[ \] Almost every month
>
> \[ \] Some months but not every month
>
> \[ \] Only 1 or 2 months
>
> \[ \] DK

AD2. In the last 12 months, did you ever eat less than you felt you
should because there wasn\'t enough money for food?

> \[ \] Yes
>
> \[ \] No
>
> \[ \] DK

AD3. In the last 12 months, were you every hungry but didn\'t eat
because there wasn\'t enough money for food?

> \[ \] Yes
>
> \[ \] No
>
> \[ \] DK

**\[End of Six-Item Food Security Module\]**

**User Notes**

**[(1) Coding Responses and Assessing Households' Food Security
Status:]{.underline}**

Responses of "often" or "sometimes" on questions HH3 and HH4, and "yes"
on AD1, AD2, and AD3 are coded as affirmative (yes). Responses of
"almost every month" and "some months but not every month" on AD1a are
coded as affirmative (yes). The sum of affirmative responses to the six
questions in the module is the household's raw score on the scale.

Food security status is assigned as follows:

-   Raw score 0-1---High or marginal food security (raw score 1 may be
    considered marginal food security, but a large proportion of
    households that would be measured as having marginal food security
    using the household or adult scale will have raw score zero on the
    six-item scale)

-   Raw score 2-4---Low food security

-   Raw score 5-6---Very low food security

For some reporting purposes, the food security status of households with
raw score 0-1 is described as food secure and the two categories "low
food security" and "very low food security" in combination are referred
to as food insecure.

For statistical procedures that require an interval-level measure, the
following scale scores, based on the Rasch measurement model may be
used:

+----------------------------+------------------------------------------+
| Number of affirmatives     | Scale score                              |
+----------------------------+------------------------------------------+
| 0                          | NA                                       |
+----------------------------+------------------------------------------+
| 1                          | 2.86                                     |
+----------------------------+------------------------------------------+
| 2                          | 4.19                                     |
+----------------------------+------------------------------------------+
| 3                          | 5.27                                     |
+----------------------------+------------------------------------------+
| 4                          | 6.30                                     |
+----------------------------+------------------------------------------+
| 5                          | 7.54                                     |
+----------------------------+------------------------------------------+
| 6                          | 8.48                                     |
|                            |                                          |
| (evaluated at 5.5)         |                                          |
+----------------------------+------------------------------------------+

However, no interval-level score is defined for households that affirm
no items. (They are food secure, but the extent to which their food
security differs from households that affirm one item is not known.)

**[(2) Response Options:]{.underline}** For interviewer-administered
surveys, DK ("don't know") and "Refused" are blind responses---that is,
they are not presented as response options but marked if volunteered.
For self-administered surveys, "don't know" is presented as a response
option.

**[(3) Screening:]{.underline}** If it is important to minimize
respondent burden, respondents may be screened after question AD1.
Households that have responded "never" to HH3 and HH4 and "no" to AD1
may skip over the remaining questions and be assigned raw score zero. In
pilot surveys intended to validate the module in a new cultural,
linguistic, or survey context, however, screening should be avoided if
possible and all questions should be administered to all respondents.

**[(4) 30-Day Reference Period:]{.underline}** The questionnaire items
may be modified to a 30-day reference period by changing the "last
12-month" references to "last 30 days." In this case, items AD1a and
AD5a must be changed to read as follows:

AD1a/AD5a. \[IF YES ABOVE, ASK\] In the last 30 days, how many days did
this happen?

\_\_\_\_\_\_ days

\[ \] DK

**[(5) Self Administration:]{.underline}** The six-item module has been
used successfully in mail-out, take-home, and on-site self-administered
surveys. For self-administration, question AD1a may be presented in one
of two ways:

-   Indent AD1a below AD1 and direct the respondent to AD1a with an
    arrow from the "Yes" response box of AD1. In a parenthetical
    following the "No" response box of AD1, instruct the respondent to
    skip question AD1 and go to question AD2.

-   Present the following response options to question AD1 and omit
    question AD1a:

    -   Yes, almost every month

    -   Yes, some months but not every month

    -   Yes, only 1 or 2 months

    -   No

> In this case, either of the first two responses is scored as two
> affirmative responses, while "Yes, only 1 or 2 months" is scored as a
> single affirmative response.

The two approaches have been found to yield nearly equal results. The
latter may be preferred because it usually reduces the proportion of
respondents with missing information on how often this behavior
occurred.