Diagnostic Accuracy of Two Food Insecurity Screeners Recommended for Use in Health Care Settings

Am J Public Health. 2017 Nov;107(11):1812-1817. doi: 10.2105/AJPH.2017.304033. Epub 2017 Sep 21.


Objectives: To test the diagnostic accuracy of the American Academy of Pediatrics (AAP) recommended food insecurity screener.

Methods: We conducted prospective diagnostic accuracy studies between July and November 2016 in Chicago, Illinois. We recruited convenience samples of adults from adult and pediatric emergency departments (12-month recall study: n = 188; 30-day recall study: n = 154). A self-administered survey included the 6-item Household Food Security Screen (gold standard), the validated 2-item Hunger Vital Sign (HVS; often, sometimes, never response categories), and the 2-item AAP tool (yes-or-no response categories).

Results: Food insecurity was prevalent (12-month recall group: 46%; 30-day group: 39%). Sensitivity of the AAP tool using 12-month and 30-day recall was, respectively, 76% (95% confidence interval [CI] = 65%, 85%) and 72% (95% CI = 57%, 84%). The HVS sensitivity was significantly higher than the AAP tool (12-month: 94% [95% CI = 86%, 98%; P = .002]; 30-day: 92% [95% CI = 79%, 98%; P = .02]).

Conclusions: The AAP tool missed nearly a quarter of food-insecure adults screened in the hospital; the HVS screening tool was more sensitive. Public health implications. Health care systems adopting food insecurity screening should optimize ease of administration and sensitivity of the screening tool.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Chicago / epidemiology
  • Diet Surveys / methods
  • Food Supply* / standards
  • Food Supply* / statistics & numerical data
  • Humans
  • Mass Screening / methods
  • Mass Screening / standards
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Young Adult