Use of a single-question screening tool to detect hunger in families attending a neighborhood health center

Objective: To examine the use and accuracy of a brief screening tool to identify family hunger, administered in an inner-city primary health care setting and the use of food assistance programs by families in this setting.

Methods: Parents were asked to complete a screening tool for hunger during a routine visit with their children to their neighborhood health center. To evaluate the accuracy of the single-question screening, a subsample of parents who completed the screening participated in an extended interview. Patients were from a neighborhood health center in Chelsea, Massachusetts. A total of 1750 families were screened, and 122 parents completed extended interviews. The US Department of Agriculture (USDA) Household Food Security Scale (HFSS) was used as the standard to assess the accuracy of the brief hunger screening tool. The USDA Food Assistance Program Participation Survey was used to gather information about food program use.

Results: The brief hunger screening tool showed 83% sensitivity and 80% specificity (kappa = .62) compared with the HFSS. The screening also had significant time-to-time reliability (77%). Among families screened as hungry, no food assistance programs were fully used.

Conclusions: The single-question screening tool had acceptable sensitivity, specificity, and reliability. Hungry families underused all types of food assistance programs. Taken together, these findings suggest that screening for hunger could become an important addition to routine pediatric health care in low-income neighborhoods.