Hunger in an Adult Patient Population

Abstract

Context.-Although clinical observations suggest that some patients experience hunger and food insecurity, there are limited data on the prevalence of hunger in adult patients.Objective.-To determine the prevalence of hunger and food insecurity in adult patients at an urban county hospital.Design.-Cross-sectional survey conducted in 1997.Patients.-The primary survey included all patients aged 18 years or older who were admitted to the medicine, surgery, and neurology services during a 2-week period, and all patients who attended the hospital's general medicine clinic during 1 week. A second survey included primary care patients who received insulin from the hospital pharmacy during a 1-month period.Main Outcome Measures.-Rates of hunger and food insecurity.Results.-Of 709 eligible patients, 567 (participation rate, 80%) were interviewed in either the clinic (n=281) or hospital (n=286). An additional 170 patients who received insulin were interviewed by telephone (response rate, 75%). Of the primary sample, 68 (12%) respondents reported not having enough food, 75 (13%) reported not eating for an entire day, and 77 (14%) reported going hungry but not eating because they could not afford food. A total of 222 (40%) had received food stamps in the previous year and of those, 113 (50%) had their food stamps reduced or eliminated. Compared to those who had never received food stamps or had no reduction in food stamps, recipients whose food stamps had been eliminated or reduced were more likely to report not having enough food (10% vs 13% vs 18%, P = .006), not eating for a whole day (10% vs 16% vs 20%, P = .01), going hungry but not eating (11% vs 16 vs 20%, P = .08), and cutting down on the size of meals or skipping meals (20% vs 27% vs 33%, P = .01). In multivariate analysis, independent predictors of hunger included an annual income of less than $10 000 (odds ratio [OR], 7.55; 95% CI, 3.01-18.92), drug use (OR, 3.56; 95% CI,, and a reduction in food stamp benefits (OR, 1.73; 95% CI, 1.01-2.96). Predictors of food insecurity included an annual income of less than $10 000 (OR, 4.12; 95% confidence interval [CI], 1.98-8.58), drug use (OR, 2.11; 95% CI, 1.66-5.08), and a reduction in food stamps (OR, 2.02; 95% CI, 1.23-3.32). In addition, 103 (61%) patients in the sample of diabetics reported hypoglycemic reactions; 32 (31%) of these were attributed to inability to afford food.Conclusion.-Hunger and food insecurity are common among patients seeking care at an urban county hospital.

Food Insufficiency and Health Services Utilization in a National Sample of Homeless Adults

“…49 In a sample of diabetic patients at an urban county hospital, one-third of those with hypoglycemic episodes attributed their episodes to being unable to afford food; of these, one-fourth required ED treatment or hospitalization. 52 Among homeless HIV-positive individuals, food insecurity has been associated with lower rates of anti-retroviral treatment adherence and viral load suppression. 13 Finally, a portion of acute health services utilization by food insufficient homeless adults might be attributable to an effort to get food through these services.…”

Hunger in legal immigrants in California, Texas, and Illinois

“…The relation has been shown between hunger and susceptibility to disease 4 ; adverse medical outcomes for people with chronic illness 3 ; and abnormal growth patterns, 15 anxiety and aggression, 16 poor academic performance, and need for special educational services 17 among children. Adequate caloric and micronutrient intakes are critical to improve the health of members of our communities.…”

“…This finding was also demonstrated in the National Health and Nutrition Examination Survey III 21 and has been ascribed to the program's successfully targeting the most needy individuals and families. Furthermore, 2 recent studies 3,18 have reported that reduction or elimination of food stamps is associated with increased hunger. The study by the California Food Policy Advocates showed this effect among legal immigrants.…”

“…1 The 1995 US Department of Agriculture's (USDA) Food Security Measurement Study reported that among families with incomes below 50% of the federal poverty level, 41% were food insecure, including 16% with evidence of hunger. 2 Nelson et al 3 found high rates of food insecurity among a sample of adult patients at an urban county hospital, with nearly one fourth reporting hunger. We also found a high prevalence of food insecurity and hunger among families attending the pediatric primary care clinic at our institution.…”

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

“…In HIV, food insecurity is associated with increased risk of HIV acquisition [6] and transmission [7,8], poor medication adherence [9,10], worse immunologic [10,11] and virologic outcomes [10,12,13], morbidity [14], and mortality [15]. In diabetes, food insecurity is associated with increased risk of type 2 diabetes mellitus (T2DM) [4], poorer diabetes self-management [16,17], poorer glycemic (i.e., blood sugar) control [4], and increased hypoglycemic events [18]. Our previously published conceptual framework posits that food insecurity negatively impacts health through nutritional (e.g., weight, diet quality), mental health (e.g., depression, stress), and behavioral pathways (e.g., medication adherence and disease self-management) [19,20].…”