Household and pediatric inpatient food insecurity: Analysis and implications for national efforts

OBJECTIVE: Identifying and addressing food insecurity (FI) is a health care priority due to impacts on health outcomes, particularly in children. Screenings and interventions in outpatient settings are widely described, whereas evidence of pediatric hospital efforts in mitigating FI is limited. This study describes efforts in statewide pediatric hospitals to address household FI (HFI) and inpatient FI (IFI) and creates a conceptual model to guide nationwide hospital FI initiatives. 

METHODS: We conducted a mixed methods survey of staff responsible for FI work at statewide hospitals with pediatric beds; a quantitative survey (May 2023) was followed by qualitative interviews (November 2023-September 2024), with tailored questions based on survey responses. Quantitative data were summarized using descriptive statistics. Qualitative data were organized into themes, including program characteristics, internal and external partnerships, challenges, and innovative solutions. 

RESULTS: Seventeen hospitals reported a spectrum of screening methods for HFI, with positive screens referred to social work or local resources. Most assessed IFI through informal conversations. Diverse approaches to feeding caregivers were noted, most commonly meal trays, food pantries, and gift cards. Institutional support for sustainable programming was limited. Factors leading to hospital activation around FI include hospital leadership culture and engaged stakeholders. 

CONCLUSION: Although formal screening for IFI and HFI are limited, innovative programming addressing both are evident across hospitals. Identification of key factors for activation of hospital FI work can support hospitals interested in pursuing this work. Despite barriers, hospitals can support food security through advocacy, partnerships, and innovative programs. Sustainable efforts will require funding and broader governance for accountability.