What is the Hunger Vital Sign™?

Children's HealthWatch About UsIn 2010, Drs. Erin Hager and Anna Quigg and the Children’s HealthWatch team developed the Hunger Vital Sign™, a 2-question screening tool based on the US Household Food Security Scale to identify young children in households at risk of food insecurity.

The Hunger Vital Sign™ identifies individuals and families as being at risk for food insecurity if they answer that either or both of the following two statements is ‘often true’ or ‘sometimes true’ (vs. ‘never true’):

• “ Within the past 12 months we worried whether our food would run out before we got money to buy more.”

• “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”

The peer-reviewed journal article on the Hunger Vital Sign™ has been cited in over fifty publications since its release and the screening tool has been used widely in medical settings around the country.  In October 2015, the American Academy of Pediatrics released a policy statement, recommending that pediatricians screen all children for food insecurity.


What does the Hunger Vital Sign™ tell us?

The Hunger Vital Sign™ measures families’ concerns about and access to food, much the way health care providers check other key vital signs, such as pulse and blood pressure.

How can I use the Hunger Vital Sign™?

Healthcare providers, social service providers, community-based outreach workers, teachers, and anyone who works with young children can use the Hunger Vital Sign™ to identify young children and families who may need assistance.


Resources from Children’s HealthWatch:

To read The Hunger Vital Sign™ policy action brief, click here.

To read a more detailed four-page version of The Hunger Vital Sign™ policy action brief, click here.

To read the peer-reviewed journal article on The Hunger Vital Sign™, click here.

To read a detailed report of best practices and ways you can implement The Hunger Vital Sign™, click here.


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Examples of Hunger Vital Sign™ use by location:

Arkansas Children’s Hospital 

Little Rock, Arkansas

Arkansas Children’s Hospital provides lunches to children by being a sponsor site of the Child and Adult Care Food Program, employs financial counselors trained to assist families with SNAP applications when applying for Medicaid, has WIC onsite one day per week, and provides boxes of food provided by a local food pantry when significant problems in household food availability are recognized.

Waste Not OC

Orange County, California

California’s Health Officer in Orange County has developed a set of three standard practices for community health clinics to address the issue of food insecurity: screen patients for food insecurity using the Hunger Vital Sign™, connect patients with resources to address hunger, and provide on-site emergency food for food insecure clients.

Kaiser Permanente & Hunger Free Colorado

Denver, Colorado

Kaiser Permanente in Colorado has incorporated food insecurity screening using the Hunger Vital Sign™ in the following work streams: new member onboarding, all first prenatal visits, registered dietitian visits, diabetes care management, asthma care management, pediatric and senior chronic care management, adolescent well visits, and cardiac rehabilitation visits.

Patients with positive screens are referred electronically to a community specialist, who assess for other social needs and also fax a referral to Hunger Free Colorado. Staff from the Hunger Free Colorado Hotline reach out to the patient and facilitate enrollment in government food assistance as well as other food resources.

New Haven, Connecticut

The Hunger Vital Sign™ was employed in a study examining the mental health processes by which everyday discrimination is associated with poor physical health outcomes.

Earnshaw V, Rosenthal L, Carroll-Scott A, Santilli A, Gilstad-Hayden K, Ickovics J. Everyday discrimination and physical health: Exploring mental health processes. Journal of Health Psychology. 2015. doi:10.1177/1359105315572456.

New Haven, Connecticut

Use of food insecurity screening with the Hunger Vital Sign™ has increased throughout the state of Connecticut.  At the Primary Care Center in New Haven, pediatricians screen for hunger during well visits at the benchmark ages of 2 months, 15 months, 30 months, 6 years, 10 years, 14 years, and 18 years old.

Nemours Alfred I. duPont Hospital for Children

Wilmington, Delaware

A study, which investigated ethnic disparities in parental confidence in the management of child weight-related behaviors, used the Hunger Vital Sign™ as a screener for food insecurity among the sample of parents with children aged four to seven with obesity.

Phan T, Curran J, Abatemarco D. Disparities in parent confidence managing child weight-related behaviors. Patient Education and Counseling. 2015;98(1):85-89. doi:10.1016/j.pec.2014.10.016.

Atlanta, Georgia

A study in Atlanta, Georgia explored how to improve screening methods in areas facing economic hardship in order to improve health outcomes.  Researchers encouraged use of the Hunger Vital Sign™ in mobile screening settings.

Moore C, Daraei P. Mobile health screening initiatives: a narrative of three unique programs in underserved populations. Innovation and Entrepreneurship in Health. 2015:41. doi:10.2147/ieh.s64529.

Chicago, Illinois

Food Rx, a food prescription program, developed collaboratively by a University of Chicago Medicine team, Walgreens, a local farmers market, and six health centers on the South Side of Chicago, aims to help people with diabetes improve their eating habits by overcoming the dual challenges of access and affordability.  Providers use screeners grounded in the Hunger Vital Sign™ as part of the program.  This report examines initial successes and challenges following Food Rx’s implementation.

Goddu A, Roberson T, Raffel K, Chin M, Peek M. Food Rx: A Community–University Partnership to Prescribe Healthy Eating on the South Side of Chicago. Journal of Prevention & Intervention in the Community. 2015;43(2):148-162. doi:10.1080/10852352.2014.973251.

Naperville, Illinois

Loaves & Fishes Community Services is strengthening partnerships with the medical community to implement the Hunger Vital Sign™ in local doctors’ intake notes to better connect the medical community to safety net organizations.

The University of Southern Indiana

Evansville, Indiana

An assistant professor of nutrition in the College of Nursing and Health Professions calls for the Hunger Vital Sign™ to be used by nurse practitioners to diagnose and mediate food insecurity in the clinical setting.

Theuri S. Diagnosing Food Insecurity. The Journal for Nurse Practitioners. 2015;11(8):834-835. doi:10.1016/j.nurpra.2015.05.004.

Addison Gilbert and Beverly Hospitals of Lahey Health

Beverly, Massachusetts

In coordination with The Open Door and Beverly Bootstraps food pantries in Massachusetts, the hospitals offer a Prescription Food Bag program, which screens emergency room patients for food insecurity using the Hunger Vital Sign™. Patients who have been identified as food insecure are given a bag of carefully selected nutritious foods along with details on how to access SNAP benefits and food pantry services

Boston Medical Center

Boston, Massachusetts

Boston Medical Center has incorporated the Hunger Vital Sign™ into its electronic medical records system. For patients who are identified as food-insecure, Boston Medical Center has co-located a WIC office across a corridor from its Preventive Food Pantry.

Maryland Hunger Solutions

Baltimore, Maryland

Maryland Hunger Solutions has developed a tool, known as the “FSP Nutrition Prescription for Better Health,” that incorporates the Hunger Vital Sign™ and can be used by healthcare providers to connect families to the Food Supplement Program (FSP, formerly food stamps) and ultimately help to reduce food insecurity and improve health. For more information about the FSP Nutrition Prescription, contact Rachel Tucker at rtucker@mdhungersolutions.org

The Bill Emerson Hunger Fellowship is a national anti-hunger program run by the Congressional Hunger Center.  In February 2011, Hannah Emple, a Bill Emerson National Hunger Fellow, published a report, entitled, “Food Insecurity Among Children Ages 0-3 in Baltimore City: Barriers to Access and Initiatives for Change.” The report discusses academic literature about food insecurity among young children and puts forth a set of policy recommendations and outreach strategies that could benefit families experiencing food insecurity in Baltimore.

Hennepin County Medical Center

Minneapolis, Minnesota

Hennepin County Medical Center in Minneapolis has a “Food Shelf,” food pantry, located in one of its buildings, provides breakfast and lunch to children by being a sponsor site for the USDA Summer Food Service Program, and uses the Hunger Vital Sign™ to provide e-referrals to a local social service agency for longer-term food assistance.

Hunger Solutions Minnesota

St. Paul, Minnesota

SNAP Rx is a collaborative effort to end hunger in Minnesota by intervening in healthcare settings. Through this project, Hunger Solutions Minnesota, AARP Minnesota and AARP Foundation hope to connect healthcare providers who utilize the Hunger Vital Sign™ with crucial food and nutrition resources to help patients better prevent and manage chronic and diet related illnesses.

Minnesota Department of Health – Family Home Visiting Program

St. Paul, Minnesota

The Minnesota Department of Health – Family Home Visiting Program incorporated the Hunger Vital Sign™ into their protocol along with referrals to financial and food resources.

Cincinnati Children’s Hospital Medical Center

Cincinnati, Ohio

Cincinnati Children’s Hospital Medical Center utilized the Hunger Vital Sign™ to screen patients for food insecurity as part of a research study.  The objective of the study was to use quality-improvement methods to increase identification of household food insecurity by the second-year pediatric residents working in the Pediatric Primary Care Center from 1.9% to 15.0% within 6 months. A secondary aim was to increase the proportion of second-year pediatric residents identifying food insecurity.

Burkhardt M, Beck A, Conway P, Kahn R, Klein M. Enhancing Accurate Identification of Food Insecurity Using Quality-Improvement Techniques. PEDIATRICS. 2012;129(2):e504-e510. doi:10.1542/peds.2011-1153.

Cincinnati Children’s Hospital used the Hunger Vital Sign™ to determine the prevalence of food insecurity, evaluate the effect public benefits have on food insecurity, assess strategies to stretch nutritional resources, and examine food insecurity’s relationship with anthropometric measurements among a sample infant caregivers.

Burkhardt M, Beck A, Kahn R, Klein M. Are Our Babies Hungry? Food Insecurity Among Infants in Urban Clinics. Clinical Pediatrics. 2011;51(3):238-243. doi:10.1177/0009922811426767.

Pediatricians and community collaborators at Cincinnati Children’s Hospital co-developed the Keeping Infants Nourished and Developing (KIND) program, a collaborative intervention designed for food-insecure families with infants. The report examined demographic, clinical, and social risk outcomes for those served by KIND during its first two years.

Beck A, Henize A, Kahn R, Reiber K, Young J, Klein M. Forging a Pediatric Primary Care-Community Partnership to Support Food-Insecure Families. PEDIATRICS. 2014;134(2):e564-e571. doi:10.1542/peds.2013-3845.

Pediatricians and researchers at Cincinnati Children’s Hospital encourage the use of the Hunger Vital Sign™ as a food insecurity screener in the clinical setting.  They call on pediatricians to reach out to multiple community agencies to develop a better sense of needs and challenges in the area and learn how to increase resource access for their patients.

O’Malley J, Beck A, Peltier C, Klein M. Revealing Hidden Hunger: How to Screen and Intervene. Contemporary Pediatrics. 2013;30(2). Available at: http://pediatrics.aappublications.org/content/129/2/e504.short. Accessed November 24, 2015.

Columbus, Ohio

The Hunger Vital Sign™ was used as a food insecurity screener in a study examining whether higher intake of healthy foods was associated with lower consumption of unhealthy foods among a sample of low-income preschool-aged children in Columbus, OH.

Anderson S, Kaye G, Andridge R, Smathers C, Peng J, Pirie P. Interrelationships of More Healthful and Less Healthful Aspects of Diet Quality in a Low-Income Community Sample of Preschool-Aged Children. Maternal and Child Health Journal. 2015. doi:10.1007/s10995-015-1788-9.

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A study used the Hunger Vital Sign™ to examine the consequences of childhood food insecurity on the mental and physical health outcomes of young adults.

Darling K, Fahrenkamp A, Wilson S, D’Auria A, Sato A. Physical and mental health outcomes associated with prior food insecurity among young adults. Journal of Health Psychology. 2015. doi:10.1177/1359105315609087.

Smoking Behaviors and Policies in Subsidized Housing in Columbus, Ohio

Two research studies examining smoking behaviors in subsidized housing units in Columbus, Ohio found smokers to be at a higher risk of food insecurity than non-smokers, using the Hunger Vital Sign™ as a screening tool.

Hood N, Ferketich A, Klein E, Wewers M, Pirie P. Smoking Behaviors and Cessation Interests Among Multiunit Subsidized Housing Tenants, Columbus, Ohio, 2011. Preventing Chronic Disease. 2013;10. doi:10.5888/pcd10.120302.

Hood N. Smoke-free Policies in Subsidized Housing. 2012.

The Childhood Hunger Coalition, a program of the Oregon Food Bank

Portland, Oregon

The Childhood Hunger Coalition developed a Childhood Hunger Screening and Intervention Algorithm, using the Hunger Vital Sign™, and also offers a free course on implementing screening and intervention for food insecurity.

Screen & Intervene, a program of the Oregon Food Bank

Portland, Oregon

Following the clinical research and pilot lead by the Childhood Hunger Coalition, Oregon Food Bank developed the Screen and Intervene Program in 2014. Screen and Intervene offers healthcare staff, dental and behavioral health workers two nationally used and validated screening questions and options for administering them. To date, family and patient screening is underway at roughly 200 locations across the state.

The Hemophilia Center at Oregon Health & Science University

Portland, Oregon

The Hunger Vital Sign™ was used as part of a research study to screen patients with children who have hemophilia for food insecurity.

A research study examining the extent to which physicians and nurse practitioners monitor household food insecurity in the Portland, Oregon region found that routine monitoring of patients’ household food insecurity by health care providers is an underutilized strategy for reducing the condition.  Authors suggested that introducing standardized screening procedures, like the Hunger Vital Sign™, can increase monitoring practices by primary care providers.

Hoisington A, Braverman M, Hargunani D, Adams E, Alto C. Health care providers’ attention to food insecurity in households with children. Preventive Medicine. 2012;55(3):219-222. doi:10.1016/j.ypmed.2012.06.007.

Rural Oregon

A research study explored the relationship between the family-home nutrition environment and dietary intake among children in rural Oregon.  The Hunger Vital Sign™ was used to screen for food insecurity in the study.

Jackson J, Smit E, Manore M,  John D,  Gunter K, The Family-Home Nutrition Environment and Dietary Intake in Rural Children.  Nutrients. 2015;7(12):9707-9720. doi:10.3390/nu7125495.

Greater Pittsburgh Community Food Bank

Pittsburgh, Pennsylvania

The Greater Pittsburgh Community Food Bank is developing a program to work with community health centers in addressing their patients’ food security. In addition to providing education and training to health center workers on the effects of hunger on health outcomes, the Greater Pittsburgh Community Food Bank’s National Hunger Fellow will conduct a pilot project with two health centers to assess patients’ food security using the Hunger Vital Sign™, and offer connections to local food assistance resources.

St. Christopher’s Hospital for Children

Philadelphia, Pennsylvania

St. Christopher’s Hospital for Children screens children using the Hunger Vital Sign™ in the outpatient clinic.  Click here to read an article from the Philadelphia Inquirer on screening for hunger at St. Christopher’s.

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study at Pennsylvania State University

University Park, PA

The study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention intended primarily for the prevention of obesity.  The Hunger Vital Sign™ is being used as the food insecurity screen in the study’s assessment of intervention impacts on both the primary outcome and intermediary behavioral processes.

Paul I, Williams J, Anzman-Frasca S et al. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study. BMC Pediatrics. 2014;14(1):184. doi:10.1186/1471-2431-14-184.

Community Health Center of Burlington

Burlington, Vermont

The Hunger Vital Sign™ is being used as part of intake forms at the Community Health Center of Burlington.

Fletcher Allen Health Care

Burlington, Vermont

The Hunger Vital Sign™ is being used during all pediatric inpatient admissions at Fletcher Allen Health Care.

Hunger Free Vermont

Burlington, Vermont

Hunger Free Vermont developed a free, online tutorial that gives pediatricians and other clinicians the information and tools to use the Hunger Vital Sign™ to screen, identify and help families whose young children are at risk of developing health problems caused by food insecurity.

Hunger Free Vermont has also developed three versions of a food and nutrition screening algorithm: one for pediatric primary care, one for Senior primary care and a third for health, education and other service providers, which utilize the Hunger Vital Sign™.

Children’s Hospital of Wisconsin

Milwaukee, Wisconsin

Researchers at the Children’s Hospital of Wisconsin designed a study, which used the Hunger Vital Sign™, to determine the prevalence of food insecurity with children that present to the emergency department.

Pabalan L, Dunn R, Gregori K et al. Assessment of Food Insecurity in Children’s Hospital of Wisconsin’s Emergency Department. WMJ. 2015;114(4). Available at: https://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/114/4/148.pdf. Accessed December 8, 2015.

Validity of a Single Item Food Security Questionnaire in Arctic Canada

A study in Artic Canada explored if rapid assessment of child and adult food insecurity is feasible in an Inuit population by assessing the sensitivity and specificity of each of the 18 US Department of Agriculture Household Food Security Scale Module questionnaire items.  The Hunger Vital Sign™ is highlighted as a highly sensitive and specific single- or 2-item questionnaire for food insecurity assessment.

Urke H, Cao Z, Egeland G. Validity of a Single Item Food Security Questionnaire in Arctic Canada. PEDIATRICS. 2014;133(6):e1616-e1623. doi:10.1542/peds.2013-3663.

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Examples of the Hunger Vital Sign™ use by category:

Are Our Babies Hungry?

Cincinnati Children’s Hospital used the Hunger Vital Sign™ to determine the prevalence of food insecurity, evaluate the effect public benefits have on food insecurity, assess strategies to stretch nutritional resources, and examine food insecurity’s relationship with anthropometric measurements among a sample of 144 infant caregivers.

Burkhardt M, Beck A, Kahn R, Klein M. Are Our Babies Hungry? Food Insecurity Among Infants in Urban Clinics. Clinical Pediatrics. 2011;51(3):238-243. doi:10.1177/0009922811426767.

Assessment of Food Insecurity in Children’s Hospital of Wisconsin’s Emergency Department

Researchers at the Children’s Hospital of Wisconsin designed a study, which used the Hunger Vital Sign™, to determine the prevalence of food insecurity with children that present to the emergency department.

Pabalan L, Dunn R, Gregori K et al. Assessment of Food Insecurity in Children’s Hospital of Wisconsin’s Emergency Department. WMJ. 2015;114(4). Available at: https://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/114/4/148.pdf. Accessed December 8, 2015

Disparities in Parent Confidence Managing Child Weight-Related Behaviors

The study investigated ethnic disparities in parental confidence in the management of child weight-related behaviors and used the Hunger Vital Sign™ as a screener for food insecurity among the sample of parents with children with obesity aged four to seven.

Phan T, Curran J, Abatemarco D. Disparities in parent confidence managing child weight-related behaviors. Patient Education and Counseling. 2015;98(1):85-89. doi:10.1016/j.pec.2014.10.016.

The Family-Home Nutrition Environment and Dietary Intake in Rural Children

A research study explored the relationship between the family-home nutrition environment and dietary intake among children in rural Oregon.  The Hunger Vital Sign™ was used to screen for food insecurity in the study.

Jackson J, Smit E, Manore M,  John D,  Gunter K, The Family-Home Nutrition Environment and Dietary Intake in Rural Children.  Nutrients. 2015;7(12):9707-9720. doi:10.3390/nu7125495.

Forging a Pediatric Primary Care-Community Partnership to Support Food-Insecure Families

Pediatricians and community collaborators at Cincinnati Children’s Hospital co-developed the Keeping Infants Nourished and Developing (KIND) program, a collaborative intervention designed for food-insecure families with infants. The report examined demographic, clinical, and social risk outcomes for those served by KIND during its first two years.

Beck A, Henize A, Kahn R, Reiber K, Young J, Klein M. Forging a Pediatric Primary Care-Community Partnership to Support Food-Insecure Families. PEDIATRICS. 2014;134(2):e564-e571. doi:10.1542/peds.2013-3845.

Health Care Providers’ Attention to Food Insecurity in Households with Children

The study the extent to which physicians and nurse practitioners monitor household food insecurity in the Portland, Oregon region found that routine monitoring of patients’ household food insecurity by health care providers is an underutilized strategy for reducing the condition.  Introducing standardized screening procedures, like the Hunger Vital Sign™, can increase monitoring practices by primary care providers.

Hoisington A, Braverman M, Hargunani D, Adams E, Alto C. Health care providers’ attention to food insecurity in households with children. Preventive Medicine. 2012;55(3):219-222. doi:10.1016/j.ypmed.2012.06.007.

Interrelationships of More Healthful and Less Healthful Aspects of Diet Quality in a Low-Income Community Sample of Preschool-Aged Children

The Hunger Vital Sign™ was used as a food insecurity screener in a study examining whether higher intake of healthy foods was associated with lower consumption of unhealthy foods among a sample of low-income preschool-aged children in Columbus, OH.

Anderson S, Kaye G, Andridge R, Smathers C, Peng J, Pirie P. Interrelationships of More Healthful and Less Healthful Aspects of Diet Quality in a Low-Income Community Sample of Preschool-Aged Children. Maternal and Child Health Journal. 2015. doi:10.1007/s10995-015-1788-9.

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study 

The Pennsylvania State University study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention intended primarily for the prevention of obesity.  The Hunger Vital Sign™ is being used as the food insecurity screen in the study’s assessment of intervention impacts on both the primary outcome and intermediary behavioral processes.

Paul I, Williams J, Anzman-Frasca S et al. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study. BMC Pediatrics. 2014;14(1):184. doi:10.1186/1471-2431-14-184.

Neglect: Failure to Thrive and Obesity

The study encourages a comprehensive approach for prevention of failure to thrive and calls for health care providers to screen children for food insecurity, using the Hunger Vital Sign™, at every visit.  Many of the risk factors for nutritional deficits like failure to thrive and obesity are the same risk factors associated with child maltreatment, thus screening is an important prevention tool in primacy care practice.

Harper N. Neglect: Failure to Thrive and Obesity. Pediatric Clinics of North America. 2014;61(5):937-957. doi:10.1016/j.pcl.2014.06.006.

Prevalence and Predictors of Food Insecurity in Children with Hemophilia

The Hunger Vital Sign™ was used as part of a research study in Portland, Oregon to screen patients with children who have hemophilia for food insecurity.

Towards a Prosperous Future for our Children

Screening for food insecurity in the pediatric clinical setting represents an upstream approach to promoting long-term health, but more research needs to be done on how to effectively address food insecurity.  The Hunger Vital Sign™ “offers a promising tool for screening.”

Hargunani D. Towards a Prosperous Future for Our Children. Journal of Applied Research on Children: Informing Policy for Children at Risk. 2012;3(1). Available at: http://digitalcommons.library.tmc.edu/childrenatrisk/vol3/iss1/15. Accessed November 24, 2015.

Disparities in Parent Confidence Managing Child Weight-Related Behaviors

The study investigated ethnic disparities in parental confidence in the management of child weight-related behaviors and used the Hunger Vital Sign™ as a screener for food insecurity among the sample of parents with children with obesity aged four to seven.

Phan T, Curran J, Abatemarco D. Disparities in parent confidence managing child weight-related behaviors. Patient Education and Counseling. 2015;98(1):85-89. doi:10.1016/j.pec.2014.10.016.

Food Insecurity and Increased BMI in Young Adult Women

The nationally representative study found that food insecurity was positively associated with BMI among a diverse sample of young adult women, but not in young adult men.  Based on their findings, the authors encourage providers to screen patients for food insecurity, using a measure like the Hunger Vital Sign™, when assessing and treating obesity, especially in women, and follow up by recommending patients with identified food insecurity to appropriate social services.

Gooding H, Walls C, Richmond T. Food Insecurity and Increased BMI in Young Adult Women. Obesity. 2011;20(9):1896-1901. doi:10.1038/oby.2011.233.

Food Rx: A Community-University Partnership to Prescribe Healthy Eating on the South Side of Chicago

Food Rx, a food prescription program, developed collaboratively by a University of Chicago Medicine team, Walgreens, a local farmers market, and six health centers on the South Side of Chicago, aims to help people with diabetes improve their eating habits by overcoming the dual challenges of access and affordability.  Providers use screeners grounded in the Hunger Vital Sign™ as part of the program.  This report examines initial successes and challenges following Food Rx’s implementation.

Goddu A, Roberson T, Raffel K, Chin M, Peek M. Food Rx: A Community–University Partnership to Prescribe Healthy Eating on the South Side of Chicago. Journal of Prevention & Intervention in the Community. 2015;43(2):148-162. doi:10.1080/10852352.2014.973251.

Diabetes Research

Clinical Management of Food-Insecure Individuals with Diabetes

The challenge of treating food-insecure individuals with diabetes can be mitigated by routine use of the Hunger Vital Sign™ and referrals to food and nutrition resources and nutrition counseling.  All patients with recent hypoglycemic episodes should be screened for food insecurity given demonstrated associations between food insecurity and hyperglycemia among adults and children with diabetes.

Lopez A, Seligman H. Clinical Management of Food-Insecure Individuals with Diabetes. Diabetes Spectrum. 2012;25(1):14-18. doi:10.2337/diaspect.25.1.14.

Food Insecurity and Glycemic Control Among Low-Income Patients with Type 2 Diabetes

Food insecurity is an independent risk factor for poor glycemic control in the among low-income patients, thus screening patients with diabetes for food insecurity using the Hunger Vital Sign™ may be helpful in reducing socioeconomic disparities in glycemic control, especially in the safety net setting.

Seligman H, Jacobs E, Lopez A, Tschann J, Fernandez A. Food Insecurity and Glycemic Control Among Low-Income Patients with Type 2 Diabetes. Diabetes Care. 2011;35(2):233-238. doi:10.2337/dc11-1627.

Food Insecurity and Hypoglycemia among Safety Net Patients with Diabetes

A cross-sectional study, conducted at community health clinics in San Francisco and Chicago, sought to determine whether food insecurity was an independent risk factor for 4 or more episodes of severe hypoglycemia.  Participants who were food insecure, as determined by the Hunger Vital Sign™ screener, were significantly more likely to report 4 or more hypoglycemic episodes than those who were food secure.  The authors of the study suggest that screening low-income patients who report frequent hypoglycemic episodes for food insecurity and providing assistance in accessing healthy food may help reduce socioeconomic disparities in diabetes care and outcomes.

Seligman H. Food Insecurity and Hypoglycemia among Safety Net Patients with Diabetes. Arch Intern Med. 2011;171(13):1204. doi:10.1001/archinternmed.2011.287.

Everyday Discrimination and Physical Health: Exploring Mental Health Processes

The Hunger Vital Sign™ was employed in a study examining the mental health processes by which everyday discrimination is associated with poor physical health outcomes.

Earnshaw V, Rosenthal L, Carroll-Scott A, Santilli A, Gilstad-Hayden K, Ickovics J. Everyday discrimination and physical health: Exploring mental health processes. Journal of Health Psychology. 2015. doi:10.1177/1359105315572456.

Physical and Mental Health Outcomes Associated with and without Prior Food Insecurity among Young Adults

The study examined differences in mental health and physical health outcomes among young adults with and without a history of food insecurity.  The Hunger Vital Sign™ was used as the food insecurity screener in the study.

Darling K, Fahrenkamp A, Wilson S, D’Auria A, Sato A. Physical and mental health outcomes associated with prior food insecurity among young adults. Journal of Health Psychology. 2015. doi:10.1177/1359105315609087.

Enhancing Accurate Identification of Food Insecurity Using Quality-Improvement Techniques

Cincinnati Children’s Hospital Medical Center utilized the Hunger Vital Sign™ to screen patients for food insecurity as part of a research study.  The objective of the study was to use quality-improvement methods to increase identification of household food insecurity by the second-year pediatric residents working in the Pediatric Primary Care Center from 1.9% to 15.0% within 6 months. A secondary aim was to increase the proportion of second-year pediatric residents identifying food insecurity.

Burkhardt M, Beck A, Conway P, Kahn R, Klein M. Enhancing Accurate Identification of Food Insecurity Using Quality-Improvement Techniques. PEDIATRICS. 2012;129(2):e504-e510. doi:10.1542/peds.2011-1153.

Mobile Health Screening Initiatives: a Narrative of Three Unique Programs in Underserved Populations

A study in Atlanta, Georgia explored how to improve screening methods in lower socioeconomic regions in order to improve health outcomes.  Researchers encouraged use of the Hunger Vital Sign™ in mobile screening settings.

Moore C, Daraei P. Mobile health screening initiatives: a narrative of three unique programs in underserved populations. Innovation and Entrepreneurship in Health. 2015:41. doi:10.2147/ieh.s64529.

Revealing Hidden Hunger: How to Screen and Intervene

Pediatricians and researchers at Cincinnati Children’s Hospital encourage the use of the Hunger Vital Sign™ as a food insecurity screener in the clinical setting.  They call on pediatricians to reach out to multiple community agencies to develop a better sense of needs and challenges in the area and learn how to increase resource access for their patients.

O’Malley J, Beck A, Peltier C, Klein M. Revealing Hidden Hunger: How to Screen and Intervene. Contemporary Pediatrics. 2013;30(2). Available at: http://pediatrics.aappublications.org/content/129/2/e504.short. Accessed November 24, 2015.

Validity of a Single Item Food Security Questionnaire in Arctic Canada

A study in Artic Canada explored if rapid assessment of child and adult food insecurity is feasible in an Inuit population by assessing the sensitivity and specificity of each of the 18 US Department of Agriculture Household Food Security Scale Module questionnaire items.  The Hunger Vital Sign™ is highlighted as a highly sensitive and specific single- or 2-item questionnaire for food insecurity assessment.

Urke H, Cao Z, Egeland G. Validity of a Single Item Food Security Questionnaire in Arctic Canada. PEDIATRICS. 2014;133(6):e1616-e1623. doi:10.1542/peds.2013-3663.

Smoking Behaviors and Policies in Subsidized Housing in Columbus, Ohio

Two research studies examining smoking behaviors in subsidized housing units in Columbus, Ohio found smokers to be at a higher risk of food insecurity than non-smokers, using the Hunger Vital Sign™ as a screening tool.

Hood N. Smoke-free Policies in Subsidized Housing. 2012.

Hood N, Ferketich A, Klein E, Wewers M, Pirie P. Smoking Behaviors and Cessation Interests Among Multiunit Subsidized Housing Tenants, Columbus, Ohio, 2011. Preventing Chronic Disease. 2013;10. doi:10.5888/pcd10.120302.

Everyday Discrimination and Physical Health: Exploring Mental Health Processes

The Hunger Vital Sign™ was employed in a study examining the mental health processes by which everyday discrimination is associated with poor physical health outcomes.

Earnshaw V, Rosenthal L, Carroll-Scott A, Santilli A, Gilstad-Hayden K, Ickovics J. Everyday discrimination and physical health: Exploring mental health processes. Journal of Health Psychology. 2015. doi:10.1177/1359105315572456.

Food Insecurity Among Children Ages 0-3 in Baltimore City: Barriers to Access and Initiatives for Change

The report discusses academic literature about food insecurity among young children and puts forth a set of policy recommendations and outreach strategies that could benefit families experiencing food insecurity in Baltimore.

Emple H. Food Insecurity Among Children Ages 0-3 In Baltimore City: Barriers To Access And Initiatives For Change. Congressional Hunger Center; 2011. Available at: http://www.hungercenter.org/publications/food-insecurity-among-children-ages-0-3-in-baltimore-city-barriers-to-access-and-initiatives-for-chang/. Accessed December 2, 2015.

The Impact of Cumulative Family Risks on Various Levels of Food Insecurity

The authors of a study exploring the impact of cumulative family risk on various levels of food insecurity recommend the usage of the Hunger Vital Sign™ in the clinical setting.

Hernandez D. The impact of cumulative family risks on various levels of food insecurity.  Social Science Research. 2015;50:292-302. doi:10.1016/j.ssresearch.2014.12.007.

Moving Electronic Medical Records Upstream: Incorporating Social Determinants of Health

Electronic medical records can improve the integration of social determinants of health (SDH) into healthcare delivery systems.  Validated food insecurity screeners, like the Hunger Vital Sign™, ought to be used in order to link better SDH interventions with health outcomes.

Gottlieb L, Tirozzi K, Manchanda R, Burns A, Sandel M. Moving Electronic Medical Records Upstream: Incorporating Social Determinants of Health. American Journal of Preventative Medicine. 2014;48(2):215-218. doi:10.1016/j.amepre.2014.07.009.

 

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