Exploring food insecurity screening and referral practices of pediatric providers in metropolitan Washington, DC

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.