Validity of a Single Item Food Security Questionnaire in Arctic Canada

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Food insecurity is best measured by comprehensive assessments. However, rapid assessments can be useful in certain circumstances, but their validity is not characterized. WHAT THIS STUDY ADDS:Rapid assessment of food insecurity is feasible among Inuit adults and children. abstract OBJECTIVES: Assess sensitivity and specificity of each of the 18 US Department of Agriculture (USDA) Household Food Security Scale Module (HFSSM) questionnaire items to determine whether a rapid assessment of child and adult food insecurity is feasible in an Inuit population. METHODS:Food insecurity prevalence was assessed by the 18-item USDA HFSSM in a randomized sample of Inuit households participating in the Inuit Health Survey and the Nunavut Inuit Child Health Survey. Questions were evaluated for sensitivity, specificity, predictive value (+/2), and total percent accuracy for adult and child food insecurity (yes/no). Child food security items were evaluated for both surveys.RESULTS: For children, the question "In the last 12 months, were there times when it was not possible to feed the children a healthy meal because there was not enough money?" had the best performance in both samples with a sensitivity and specificity of 92.3% and 97.3%, respectively, for the Inuit Health Survey, and 88.5% and 95.4% for the Nunavut Inuit Child Health Survey. For adults, the question "In the last 12 months, were there times when the food for you and your family just did not last and there was no money to buy more?" demonstrated a sensitivity of 93.0% and a specificity of 93.4%.CONCLUSIONS: Rapid assessment of child and adult food insecurity is feasible and may be a useful tool for health care and social service providers. However, as prevalence and severity of food insecurity change over time, rapid assessment techniques should not replace periodic screening by using the full USDA HFSSM questionnaire. Pediatrics 2014;133:e1616-e1623 AUTHORS:

Challenges in the Assessment of Inuit Food Security

“…Such items may be an appropriate focus of screening for rapid assessment in cases where more detailed studies are impossible (cf. Urke et al, 2014). Although the results of this study suggest that food security module items that refer to country food may create problems of underlying construct validity, it is clear that such modules are effective in assessing access to store food, as confirmed by other research (Egeland et al, 2011;Huet et al, 2012).…”

Developing and Implementing a Food Insecurity Screening Initiative for Adult Patients Living With Type 2 Diabetes

“…Three screening questions were identified (see Table 1) that originated from the United States Department of Agriculture's Household Food Security Survey Module (15). Single-and 2-item versions of these questions have been validated in several studies (16)(17)(18)(19)(20)(21). As per providers' feedback during the focus group, the period of inquiry assessed by the screening questions was adjusted from 12 months to 3 months.…”

Food Hardship and Obesity in a Sample of Low-Income Immigrants

“…This item is similar to other single and 2-item screener questions validated in diverse and low-income samples (e.g., “Within the past 12 months we worried whether our food would run out before we got money to buy more”) which have demonstrated high sensitivity and specificity when compared with the 18 item USDA measure [22,30]. …”

“…In the U.S., food insecurity is often measured by an 18-item USDA measure [5]. While this measure is comprehensive and appropriate for surveillance, it has high participant burden, particularly for large community surveys [22]. As an alternative, other metrics have focused on single dimensions of poor food access – for example, psychological concerns about food access [9,12], food insufficiency [6,23] or food hardship, which occurs when households have inconsistent financial resources to buy food [24,25].…”