title: Food Insecurity and the Burden of Health-Related Social Problems in an Urban Youth Population.
abstract: OBJECTIVE
  Our study objectives were to (1) determine the prevalence of food insecurity; (2) examine the association between presence and level of food insecurity with other health-related social problems; and (3) assess the predictive values of a two-item food insecurity screen in an urban youth population.
  
  
  METHODS
  Patients aged 15-25 years completed a Web-based screening tool. Validated questions were used to identify problems in seven health-related social domains (food insecurity, health care access, education, housing, income insecurity, substance use, and intimate partner violence). Chi-square and Kruskal-Wallis tests and logistic regression models controlled for age, sex, and race/ethnicity, assessed the association between food insecurity and health-related social problems. Predictive values of a two-item food insecurity screen compared with the United States Department of Agriculture Food Security Survey were calculated.
  
  
  RESULTS
  Among 400 patients (mean age 18 years; 69.2% female; 54.6% black; 58.9% public insurance), 32.5% screened positive for food insecurity. Increasing food insecurity level was significantly associated with cumulative burden of social problems (p < .001). In adjusted analyses, food insecurity was associated with problems with health care access (aOR = 2.6, 95% confidence interval [CI] 1.7-4.1), education (aOR = 2.8, 95% CI 1.6-5.1), housing (aOR = 2.8, 95% CI 1.8-4.4), income insecurity (aOR = 2.3, 95% CI 1.2-4.5), and substance use (aOR = 2.5, 95% CI 1.5-4.3). The two-item screen demonstrated sensitivity of 88.5% and specificity of 84.1%.
  
  
  CONCLUSIONS
  One-third of youth in sample experienced food insecurity, which was strongly associated with presence of other health-related social problems. The two-item screen effectively detected food insecurity. Food insecurity screening may lead to identification of other health-related social problems that when addressed early may improve adolescent health.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: tamara.baer@childrens.harvard.edu.
authors.forename: Tamara E
authors.initials: TE
authors.lastname: Baer
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Scherer
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Fleegler
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Areej
authors.initials: A
authors.lastname: Hassan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006304:Health Status; D006798:Housing; D006801:Humans; D016015:Logistic Models; D008297:Male; D064890:Social Determinants of Health; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult
keywords: Adolescents; Food insecurity; Health-related social problems; Screening; Social determinants of health; Young adults