title: Food Insecurity Screening in Pediatric Primary Care: Can Offering Referrals Help Identify Families in Need?
abstract: To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection.
  
  
  
  Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates.
  
  
  
  A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4-7.0).
  
  
  
  In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs.
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: clement.bottino@childrens.harvard.edu.
authors.forename: Clement J
authors.initials: CJ
authors.lastname: Bottino
authors.affiliation: Division of Endocrinology, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Erinn T
authors.initials: ET
authors.lastname: Rhodes
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Mass.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kreatsoulas
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Cox
authors.affiliation: Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Fleegler
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D063105:Food Assistance; D005523:Food Supply; D006801:Humans; D008297:Male; D020380:Needs Assessment; D018579:Patient Selection; D011320:Primary Health Care; D012017:Referral and Consultation
keywords: children; family preferences; food insecurity; medical home; pediatric; primary care; screening; social needs