Development and Validation of a Nutrition Security Screener

Compared with people who have food-security, people experiencing food insecurity typically have worse nutrition and higher risk for diet-related diseases, compounding health and financial disparities. Although the concept of food security technically includes access to nutritious foods, major clinical and public health tools to assess and reduce food security do not consider nutritional quality. For example, the detailed Department of Agriculture’s (USDA’s) eighteen-question US Household Food Security Survey Module assessment includes no questions about nutritional quality (“balanced meal” is mentioned twice). Shorter food security screening tools, most often used in public health and clinical practice, also contain no information on nutritional quality. Measurement tools are crucial because measurement drives interventions. When measurement tools focus on stable access to sufficient calories, rather than on access to healthful foods, corresponding major public health, policy, and clinical interventions have a similar focus.

Growing recognition of the distinction between access to calories and access to nourishing foods—or quantity alone versus quantity and quality—has spurred an evolution in health care, public health, and policy toward a new, complementary concept to food security: nutrition security (exhibit 1).

A recently proposed definition of nutrition security is “consistent access, availability, and affordability of foods and beverages that promote well-being and prevent and if needed, treat disease.” This new construct was designed to complement, not replace, measures of food security. The USDA now emphasizes nutrition security across its programs, and the Centers for Disease Control and Prevention (CDC) also now includes and emphasizes nutrition security in its programming.

For any public health or clinical goal, measurement is essential. Nutrition security measurement remains nascent, with several proposed tools being evaluated at this time. In contrast, two decades of research on food security have led to established measurement tools and associations with important end points such as mental health, academic achievement, disease outcomes, and health care use. This work aims to develop and validate a nutrition security screening tool. The tool is currently being evaluated in our Produce Rx intervention and in the Kaiser Permanente National Social Needs Survey.

Aim One

To develop and validate a nutrition security screening tool.

Aim Two

To integrate nutrition security screening into the electronic health record and assess its relationships with health outcomes and utilization.

Aim Three

To determine the responsiveness of nutrition security screening to Food is Medicine interventions.