Food Insecurity Education Series

Webinar 3

Identifying and Screening for Food Insecurity

Kathryn Tucker, MS, RD, LD, Administration for Community Living

Temitope A. Walker, PhD, Georgia Division of Aging Services

September 15, 2022

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Objectives

Define and characterize food insecurity

Identify the importance of assessing food insecurity

Explore the different food insecurity screens

Learn about the frequency of measuring food insecurity

Discover assessment training resources

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Speakers

Kathryn Tucker 

ACL Consultant

Temitope A. Walker, PhD

Senior Hunger & 

Nutrition Coordinator

Georgia Division of Aging Services

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What is food insecurity?

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Food insecurity is defined as “the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.”

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Levels of Food Insecurity

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Low food security 

Poor nutrition quality and limited variety. Little or no indication of reduced food intake.

Very low food security

Reports of skipping meals or not eating. Has reduced food availability.

Factors Influencing Food Insecurity

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Food Insecurity

Limited Income

Disparities

Food Deserts

Lack of Transportation

Lack of Employment

Social Isolation

Renting 

The Impact of Food Insecurity

78% more likely to experience depression

40% more likely to experience chest pain

55% more likely to develop asthma

10% more likely to experience high blood pressure

21% more likely to experience limitations in activity

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Importance of Food Insecurity Screening

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Program and Policy Development

Program Implementation 

Program Evaluation

Intervention Development

Supports Public Assistance Referral

Helps in Addressing Food Insecurity

Food Insecurity Screening in Georgia

Screen

Identify factors

Address factors

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Measuring Food Insecurity

“Food insecurity is measured as a household-level concept that refers to uncertain, insufficient, or unacceptable availability, access, or utilization of food.”

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Validated Food Security Survey Modules

18-Item U.S. Household Food Security Survey Module (USDA)

10-Item U.S. Adult Food Security Survey Module (USDA)

6-item Short Form of the Household Food Security Survey Module (USDA)

Hunger Vital SignTM two-question screening tool (Children’s HealthWatch)

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18-Item U.S. Household Food Security Survey Module (USDA)

Administered annually to around 45,000 households in the Census Bureau’s Current Population Survey (CPS-FSS)

First item addresses worries about food running out

Other items address possible reductions in food intake due to finances

Sample questions:

“Did you ever cut the size of any of the children’s meals because there wasn’t enough money for food?”

“Did any of the children ever not eat for a whole day because there wasn’t enough money for food?”

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10-Item U.S. Adult Food Security Survey Module (USDA)

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Ten-Item Questionnaire

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Advantages

Less respondent burden

Limitations

No information about food security of children

No children’s food security questions

Improves comparison of households with and without children

USDA Six-Item Short Form Questions 

The food that (I/we) bought didn’t last and we don’t have money to get more.

(I/We) couldn’t afford to eat a balanced meal.

In the last 12 months, did you cut the size of your meals or skip meals because there wasn’t enough money for food?

(If Yes) How often did this happen?

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

In the last 12 months, were you ever hungry but didn’t eat because there wasn’t enough money for food? 

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Six-Item Short Form

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Advantages

Less respondent burden

Limitations

Identifies food insecure and very low food security

High specificity and sensitivity

Minimal bias

Does not measure the most severe levels of food insecurity

Hunger Vital Sign

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Hunger Vital SignTM Screen: Two-Question Food Validated Insecurity Tool

97% probability of screening positive in food insecure homes

83% probability of screening negative in food secure homes

97% sensitivity among adults and young children

74% specificity range among adults

Easy to use in clinical and community settings

Administered verbally or in writing

Available in many languages

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Two-Item Questionnaire

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Advantages

Less respondent burden

Limitations

High specificity and sensitivity

Validated for children and adults

Does not measure the most severe levels of food insecurity

What We Do in Georgia

Validated six-item food insecurity measure since 2011

Statewide statistics of clients comparable to federal statistics

Identified critical unmet need for nutrition services

Shows significant contribution of receiving nutrition services to achieve food security

Highlights difficulty in meeting basic food and health care needs of food insecure older Georgians

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Modified six-item U.S. Household Food Security Survey Module
| 6-Item food insecurity survey questions                                                                                                    | Responses           |
|--------------------------------------------------------------------------------------------------------------------------------------------|---------------------|
| During the last 30 days, how often was this statement true: The food that we bought just didn't last, and we didn't have money to get more | OftenSometimesNever |
| During the last 30 days, how often was this statement true: We couldn't afford to eat balanced meals.                                      | OftenSometimesNever |
| In the past 30 days, did you or other adults in your household ever cut the size of your meals because there wasn't enough money for food? | Yes | No            |
| In the past 30 days, did you or other adults in your household ever skip meals because there wasn't enough money for food?                 | Yes | No            |
| In the last 30 days, did you ever eat less than you felt you should because there wasn't enough money to buy food?                         | Yes | No            |
| In the last 30 days, were you ever hungry but didn't eat because you couldn't afford enough food?                                          | Yes | No            |

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Quantifying Food Insecurity Using the Six-Item Survey Module 

Sum of affirmative responses (“Often”/”Sometimes” and “Yes”)

Food insecurity summary score (score of 0-6) is calculated

Individuals classified into one of four levels or two levels:

Food security (score 0)

Marginal food security (score 1)

Low food security (score 2-4)

Very low food security (score 5-6)

Food secure (score of 0-1)

Food insecure (score of 2-6)

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Levels of Severity of Food Insecurity

Least severe: Was this statement often, sometimes, or never true for you in the last 12 months? "We worried whether our food would run out before we got money to buy more."

Somewhat more severe: Was this statement often, sometimes, or never true for you in the last 12 months? "We couldn't afford to eat balanced meals."

Midrange severity: In the last 12 months, did you ever cut the size of your meals or skip meals because there wasn't enough money for food?

Most severe: In the last 12 months, did you ever not eat for a whole day because there wasn't enough money for food?

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When to Assess Food Insecurity

Initial intake

In conjunction with other relevant assessments

When identified by concerned staff or volunteer

During reassessments

When services change

Timepoints based on state and agency requirements

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Potential Assessment Training Resources

Review state and agency policy first; training may be available there.

USDA Food Security Survey Modules are standardized and provide a straightforward process in how they should be administered.

The short form of the U.S. Household Food Security Survey Module used in Georgia.

See this session’s takeaway sheet for additional resources from organizations such as Feeding America and the Food Research & Action Center (FRAC).

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Takeaways

Find a screen that works best for your agency

Recognize that these screens should not be used alone 

Determine the frequency of assessment

Identify participants at risk and screen them

Leverage the value of assessing food insecurity

Provide staff training on food insecurity and assessing it

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Food Insecurity Webinar Series & Educational Topics

Recordings available NRCNA website at acl.gov/senior-nutrition

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July 2022: Combating Food Insecurity with Collaboration

September 2022: Identifying and Screening for Food Insecurity

October 2022:

Referring Participants Who are Food Insecure

August 2022: 

State Unit Food Insecurity Promising Practices

For Dietitians

To receive CPEU credit, go to the CDR website.

Log the program:

Step 2: Activity Log under Activity Type 170 - Lecture/Seminar or 

Activity Type 171 - Teleseminar/Webinar

Claim 1 CPEU for every 1 contact hour spent during the activity. 

Save all documentation of the webinar and attendance for records.

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Questions?

Kathryn Tucker, MS, RD, LD, FAND: Kathryn.tucker@acl.hhs.gov

Temitope Walker, Ph.D.: Temitope.walker@dhs.ga.gov

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References

Food Insecurity (Healthy People 2030)

Food Insecurity and Health Outcomes (Gundersen, C. & Zilak, J.)

Food Insecurity and Hunger in the United States: An Assessment of the Measure (Panel to Review the U.S. Department of Agriculture’s Measurement of Food Insecurity and Hunger) Press. 

Food Security in the U.S. (USDA)

Food Security of Older Adults Requesting Older Americans Act Nutrition Program in Georgia can be Validly Measured Using a Short Form of the U.S. Household Food Security Survey Module (Lee, J., Johnson, M., Brown, A., & Nord, M.)

Nutritional and Health Consequences are Associated with Food Insecurity among U.S. Elderly Persons (Lee, J. & Frongillo, E.)

The Hunger Vital SignTM (Children’s HealthWatch)

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