Food Insecurity and the Emergency Physician:
Food insecurity has many implications for patients, including associations with frequent ED use, foregoing medication to afford food, and worsening control of chronic medical conditions (1). Screening for food insecurity is a potential tool for EPs to utilize to improve patient outcomes, assist in adherence to treatment plans, and reduce ED utilization.
What is the evidence for Food Insecurity Screening?:
A brief, two-question screening tool, the Hunger Vital Sign Screening Tool (sensitivity 97%, specificity 83%) [2], has been validated in multiple healthcare settings, including the ED, for detecting food insecurity in both pediatric [3] and adult [4] populations. Patients have also been shown to react positively to screening for food insecurity [5].
Study interventions aimed at addressing food insecurity have evaluated various primary outcomes and demonstrated reductions in ED visits, reduction in surveyed food insecurity scores, increase in fruit and vegetable intake, reduction in patient stress, and reductions in health-related outcomes (A1c, BMI, BP) [6-7]. These interventions include food prescription and pharmacy programs, medically tailored meal services, food/produce vouchers, and boxed meal distributions.
How can this be implemented in my practice?:
No social needs screening tool for EPs is currently universally used or endorsed for ED use by an academic society. However, as previously mentioned, the Hunger Vital Sign tool has been validated in the ED. The survey is brief, highly sensitive, and specific, making it efficient and applicable for use by EPs.
Residents, attendings, and stakeholders in emergency medical education should take the initiative to identify local community resources that serve areas where their at-risk patient populations reside. Familiarity and even relationships with these resources could facilitate streamlined referrals to address patients' food insecurity. Below are some local Chicago food resources:
Figure 2. List of services available to Chicago residents experiencing food insecurity.
References:
Estrella A, Scheidell J, Khan M, Castelblanco D, Mijanovich T, Lee DC, Gelberg L, Doran KM. Cross-sectional Analysis of Food Insecurity and Frequent Emergency Department Use. West J Emerg Med. 2021 Jul 14;22(4):911-918. doi: 10.5811/westjem.2021.3.50981.
Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., Ettinger de Cuba, S. A., Casey, P. H., Chilton, M., Cutts, D. B., Meyers A. F., Frank, D. A. (2010). Development and Validity of a 2-Item Screen to Identify Families at Risk for Food Insecurity. Pediatrics, 126(1), 26-32. doi:10.1542/peds.2009-3146.
Baer TE, Scherer EA, Fleegler EW, Hassan A. Food Insecurity and the Burden of Health-Related Social Problems in an Urban Youth Population. J Adolesc Health. 2015 Dec;57(6):601-7. doi: 10.1016/j.jadohealth.2015.08.013.
Gundersen C, Engelhard EE, Crumbaugh AS, Seligman HK. Brief assessment of food insecurity accurately identifies high-risk US adults. Public Health Nutr. 2017 Jun;20(8):1367-1371. doi: 10.1017/S1368980017000180.
Kress C, Durvasula J, Knievel A, Honsvall Hoefler AM, Manning LP, Pine DJ, Mullen D, Hayward A. Patient Perspectives: Valuable Food Insecurity Interventions. PRiMER. 2021 Nov 3;5:40. doi: 10.22454/PRiMER.2021.233359.
Little M, Rosa E, Heasley C, Asif A, Dodd W, Richter A. Promoting Healthy Food Access and Nutrition in Primary Care: A Systematic Scoping Review of Food Prescription Programs. American Journal of Health Promotion. 2022;36(3):518-536. doi:10.1177/08901171211056584
Palar K, Napoles T, Hufstedler LL, Seligman H, Hecht FM, Madsen K, Ryle M, Pitchford S, Frongillo EA, Weiser SD. Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health. J Urban Health. 2017 Feb;94(1):87-99. doi: 10.1007/s11524-016-0129-7.
Furbacher J, Fockele C, Buono BD, Janneck L, March C, Molina M, Duber HC, Doran KM, Lin MP, Cooper RJ, Modi P. 2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs. West J Emerg Med. 2022 Oct 10;23(6):817-822. doi: 10.5811/westjem.2022.8.57271.
Authored by Michael Hohl, MD
Edited by Rashid Kysia, MD