title: Food security, health, and medication expenditures of emergency department patients.
abstract: BACKGROUND
  In the United States, 35 million people live in food-insecure households. Although food insecurity and hunger are undesirable in their own right, they also are potential precursors to nutritional, health, and developmental problems.
  
  
  OBJECTIVE
  To examine the prevalence of household food insecurity and its association with health problems and medication expenditures among Emergency Department (ED) patients.
  
  
  METHODS
  We conducted a cross-sectional study in four Boston-area EDs and enrolled consecutive adult patients during two 24-h periods at each site. Food security status was measured using the validated 18-item US Household Food Security Survey Module.
  
  
  RESULTS
  Overall, 66 (13%; 95% confidence interval [CI] 10-17%) of 520 ED patients screened positive for food insecurity. Among these 66 patients, 32 (48%; 95% CI 36-61%) reported food insecurity with hunger. Patients from food-insecure households differed from food-secure patients with respect to sociodemographic factors. Food-insecure patients were more likely than food-secure patients to report a variety of chronic and mental health problems (all p < 0.05), including obesity. Food-insecure patients, compared to food-secure patients, also were more likely (all p < 0.001) to put off paying for medication to have money for food (27% vs. 4%, respectively), to take medication less often because they couldn't afford more (32% vs. 4%, respectively), to report needing to make a choice between buying medication and food (27% vs. 2%, respectively), and to report getting sick because they couldn't afford to take medication (27% vs. 1%, respectively).
  
  
  CONCLUSIONS
  ED patients from food-insecure households report more chronic and mental health problems, and difficulty purchasing medication.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pallin
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005502:Food / Q000706:statistics & numerical data*; D005523:Food Supply / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D006815:Hunger; D008297:Male; D008875:Middle Aged; D014505:Urban Population