Exploring Food Insecurity Screening and Referral Practices of Pediatric Providers in Metropolitan Washington, DC
Authors: Essel Kofi , Burke Michael P , Weissman Mark , Dietz William 
Published: November 2023

Objectives

In 2015, 16.6% of households with children were food insecure in the United States (US). Given that most children in the US routinely see a pediatrician, it is important to understand how pediatric providers screen and treat food insecurity in their practice. The objectives of this study were to examine among pediatric providers the 1) frequency and type of food‐insecurity screening, 2) factors that are associated with food‐insecurity screening, and 3) resources offered to families who are food insecure.

Methods

Data were collected in 2016 from 85 practicing pediatric providers via an online survey. Providers were located in the Washington, DC metropolitan area. Descriptive statistics were calculated using univariate and bivariate analyses. Fisher's exact test was used to test the association between food‐insecurity screening, types of health insurance, and provider demographics.

Results

Sixty‐six percent of providers indicated that they infrequently screen for food insecurity in their practice. Only 13% of providers used a standardized food‐insecurity screening tool. Forty‐five percent of providers screened for food insecurity only when there was a concern for the patient. About 70% screened for food insecurity when a patient presented poor weight gain or were underweight. There was a significant association between screening for food insecurity and race and ethnicity, with African‐American providers being more likely to screen than White providers (p=.002). Furthermore, providers who had higher rates of patients receiving Medicaid (p=.016), or, conversely, had a patient population with lower use of private insurance(p=.033) were more likely to screen for food insecurity.

Conclusions

Few pediatricians frequently and adequately screen for food insecurity in their patients and families. Furthermore, pediatric providers do not use all available resources to treat food insecurity in their patients. Pediatric training that emphasizes the importance of social determinants of health and specific techniques for screening and managing food insecurity may be necessary to identify food insecurity in pediatric patients.

Support or Funding Information

This publication was supported by the National Institute on Minority Health And Health Disparities of the National Institutes of Health under Award Number P20MD000198. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Burke was supported in part by the NIH research Award and Dr. Essel is supported by the Children's National Health System General Academic Pediatric Research Fellowship(HRSA Faculty Training Grant‐D55HP23194). The Food & Research Action Center(FRAC) also funded raffle incentives for successful completion of survey by providers.

Demographic and medical practice descriptive statistics of pediatric providers in the Washington, DC metropolitan area (n=85)

Percentage (n)

Age (years)

25–34
22.4 (19)

35–44
29.4 (25)

45–54
22.4 (19)

>55
25.8 (22)

Gender

Male
18.8 (16)

Female
81.2 (69)

Race or ethnicity

White, non‐Hispanic
54.1 (46)

Black, non‐Hispanic
27.1(23)

Other race or ethnicity
18.8 (16)

Years of Clinical Practice

0–11
43.5(37)

12–23
36.5(31)

24 or more
20(17)

Location of Pediatric Practice

District of Columbia
53(45)

Virginia
29.4(25)

Maryland
12.9(11)

More than 1 State
4.7(4)

Practice Setting2

Urban Inner City
56.5(48)

Suburban
33(28)

Urban Non‐Inner City
14.1(12)

Rural
1.2(1)

Percentage of patients using Medicaid1

0–40%
35.3 (30)

41–100%
64.7 (55)

Percentage of patients using private insurance1

0–40%
62.4 (53)

41–100%
37.6(32)

Number of days provider sees patients per week

≤ 2 days
23.5 (20)

3 or more days
76.5 (65)

Pediatric provider's perceived percentage of patients using Medicaid or private health Insurance

Respondents could select multiple responses. Percentages represent percent of total responses and (n) Indicates number of respondents who select response.