Objective: To facilitate the introduction of food insecurity screening into clinical settings, we examined the test performance of 2-item screening questions for food insecurity against the US Department of Agriculture's Core Food Security Module.Design: We examined sensitivity, specificity, and accuracy of various 2-item combinations of questions assessing food insecurity in the general population and high-risk population subgroups.Setting: 2013 Current Population Survey December Supplement, a population-based US survey Subjects: All survey participants from the general population and high-risk subgroups Results:The test characteristics of multiple 2-item combinations of questions assessing food insecurity have adequate sensitivity (>97%) and specificity (>70%) for widespread adoption as clinical screening measures. Conclusions:We recommend two specific items for clinical screening programs based on their widespread current use and high sensitivity for detecting food insecurity. These items query how often the household "worried whether food would run out before we got money to buy more" and how often "the food that we bought just didn't last and we didn't have money to get more." The recommended items have sensitivity across high-risk population sub-groups of ≥97% and a specificity ≥74% for food insecurity.

An extensive literature has described U.S. food insecurity and its determinants, but there has been little work on the geographic distribution of food insecurity and no work on the distribution of private food assistance by geography. To study the former, we use data from the Map the Meal Gap (MMG) project, which is broken down by Rural-Urban Continuum Codes. For the latter, we combine MMG data with data from the Hunger in America 2014 (HIA 2014) survey to determine the geographic distribution of charitable food assistance. At the national level, we find few differences across the rural-urban interface, but we do find differences within and across regions. We also find that regardless of how it is measured, the distribution of charitable food assistance is directed more toward counties with smaller populations—a finding that holds even after controlling for factors that influence the distribution of charitable assistance.

The Supplemental Nutrition Assistance Program (SNAP) serves as the primary tool to alleviate food insecurity in the United States. Its effectiveness has been demonstrated in numerous studies, but the majority of SNAP recipients are still food insecure. One factor behind this is the difference in food prices across the country-SNAP benefits are not adjusted to reflect these differences. Using information from Feeding America's Map the Meal Gap (MMG) project, we compare the cost of a meal by county based on the Thrifty Food Plan (TFP)which is used to set the maximum SNAP benefit-with the cost of the average meal for low-income food-secure households. We find that the cost of the latter meal is higher than the TFP meal for over 99 percent of the counties. We next consider the reduction in food insecurity if, by county, the maximum SNAP benefit level was set to the cost of the average meal for low-income food-secure households. We find that if this approach were implemented, there would be a decline of 50.9 percent in food insecurity among SNAP recipients at a cost of $23 billion.

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