Protocol - Food Insecurity
Description
The six-item standard measure from the U.S. Department of Agriculture Economic Research Service is a short interviewer-administered questionnaire, modeled using information from the Community Population Survey, Bureau of Labor Statistics, and American Community Survey.
Specific Instructions
None
Availability
Protocol
Six-Item Standard Measure from USDA Economic Research Service
These next questions are about the food eaten in your household in the last 12 months, since (current month) of last year and whether you were able to afford the food you need.
NOTE: If the placement of these items in the survey makes the transition/introductory sentence unnecessary, add the word "Now" to the beginning of question 1: "Now Im going to read you...."
FILL INSTRUCTIONS: Select the appropriate fill from parenthetical choices depending on the number of persons and number of adults in the household.
1. I'm going to read you two statements that people have made about their food situation. Please tell me whether the statement was often true, sometimes true, or never true for (you/your household) in the last 12 months - that is, since last (name of current month).
The first statement is, "The food that (I/we) bought just didn't last, and (I/we) didn't have money to get more." Was that often, sometimes, or never true for (you/your household) in the last 12 months?
[ ] Often true
[ ] Sometimes true
[ ] Never true
[ ] DK or Refused
2. "(I/we) couldn't afford to eat balanced meals." Was that often, sometimes, or never true for (you/your household) in the last 12 months?
[ ] Often true
[ ] Sometimes true
[ ] Never true
[ ] DK or Refused
3. In the last 12 months, since (name of current month) did (you/you or other adults in your household) ever cut the size of your meals or skip meals because there wasn't enough money for food?
[ ] Yes
[ ] No (Skip 3a)
[ ] Don’t know (Skip 3a)
3a. [IF YES ABOVE, ASK] How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months?
[ ] Almost every month
[ ] Some months but not every month
[ ] Only 1 or 2 months
[ ] DK
4. In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money to buy food?
[ ] Yes
[ ] No
[ ] DK
5. In the last 12 months, were you ever hungry but didn't eat because there wasnt enough money for food?
[ ] Yes
[ ] No
[ ] DK
END
(1) Coding Responses and Assessing Households Food Security Status:
Responses of "often" or "sometimes" on questions 1 and 2, and "yes" on 3, 4, and 5 are coded as affirmative (yes). Responses of "almost every month" and "some months but not every month" on 3a are coded as affirmative (yes). The sum of affirmative responses to the six questions in the module is the households raw score on the scale.
Food security status is assigned as follows:
- Raw score 0-1 - High or marginal food security (raw score 1 may be considered marginal food security, but a large proportion of households that would be measured as having marginal food security using the household or adult scale will have raw score zero on the six-item scale)
- Raw score 2-4 - Low food security
- Raw score 5-6 - Very low food security
For some reporting purposes, the food security status of households with raw score 0-1 is described as food secure and the two categories “low food security” and “very low food security” in combination are referred to as food insecure.
For statistical procedures that require an interval-level measure, the following scale scores, based on the Rasch measurement model may be used:
| Number of affirmatives | Scale score |
| 0 | NA |
| 1 | 2.86 |
| 2 | 4.19 |
| 3 | 5.27 |
| 4 | 6.30 |
| 5 | 7.54 |
| 6 (evaluated at 5.5) | 8.48 |
However, no interval-level score is defined for households that affirm no items. (They are food secure, but the extent to which their food security differs from households that affirm one item is not known.)
(2) Response Options: For interviewer-administered surveys, DK ("dont know") and "Refused" are blind responses - that is, they are not presented as response options but marked if volunteered. For self-administered surveys, "dont know" is presented as a response option.
(3) Screening: If it is important to minimize respondent burden, respondents may be screened after question 3. Households that have responded "never" to 1 and 2 and "no" to 3 may skip over the remaining questions and be assigned raw score zero. In pilot surveys intended to validate the module in a new cultural, linguistic, or survey context, however, screening should be avoided if possible and all questions should be administered to all respondents.
(4) 30-Day Reference Period: The questionnaire items may be modified to a 30-day reference period by changing the "last 12-month" references to "last 30 days." In this case, item 3a must be changed to read as follows:
3a. [IF YES ABOVE, ASK] In the last 30 days, how many days did this happen?
______ days
[ ] DK
Responses of 3 days or more are coded as "affirmative" responses.
(5) Self Administration: The six-item module has been used successfully in mail-out, take-home, and on-site self-administered surveys. For self-administration, question 3a may be presented in one of two ways:
- Indent 3a below 3 and direct the respondent to 3a with an arrow from the "Yes" response box of 3. In a parenthetical following the "No" response box of 3, instruct the respondent to skip question 3 and go to question 4.
- Present the following response options to question 3 and omit question 3a:
- Yes, almost every month
- Yes, some months but not every month
- Yes, only 1 or 2 months
- No
In this case, either of the first two responses is scored as two affirmative responses, while "Yes, only 1 or 2 months" is scored as a single affirmative response.
The two approaches have been found to yield nearly equal results. The latter may be preferred because it usually reduces the proportion of respondents with missing information on how often this behavior occurred.
Personnel and Training Required
The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a “don’t know” response is provided.
In general, the U.S. Department of Agriculture recommends that any local group planning a food security survey seek to work cooperatively with university or other resource staff experienced in sample-survey work. Many sampling methods are available that are feasible and that can yield meaningful results, but expertise is needed to design these methods into a planned survey.
Equipment Needs
The PhenX Working Group acknowledges that these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer or handheld computer to administer a computer-assisted questionnaire.
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Interviewer-administered questionnaire
Lifestage
Adult
Participants
Adult
Selection Rationale
The six-item standard measure from the U.S. Department of Agriculture Economic Research Service is a validated, well-established measure of food insecurity that is easy to administer and score.
Language
Chinese, English, Spanish
Standards
| Standard | Name | ID | Source |
|---|
Derived Variables
None
Process and Review
Not applicable
Protocol Name from Source
U.S. Household Food Security Survey Module: Six-Item Short Form, Economic Research Service, USDA, 2024
Source
U.S. Department of Agriculture (USDA), Economic Research Service. (2024). Six-Item Short Form of the Food Security Survey Module, questions HH3, HH4, AD1, AD1a, AD2 and AD3. Retrieved from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools/
General References
Blumberg, S. J., Bialostosky, K., Hamilton, W. L., & Briefel, R. R. (1999). The effectiveness of a shortform of the household food security scale. American Journal of Public Health, 89, 1231–1234.
Gundersen, C., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839.
Jones, A. D., Ngure, F. M., Pelto, G., & Young, S. L. (2013). What are we assessing when we measure food security? A compendium and review of current metrics. Advances in Nutrition, 4(5), 481–505. PMID: 24038241
Lee, J. S. (2013). Food insecurity and healthcare costs: Research strategies using local, state, and national data sources for older adults. Advances in Nutrition, 4(1), 42–50.
Murthy, V. H. (2016). Food insecurity: A public health issue. Public Health Reports, 131(5), 655–657. PMID: 28123203
National Research Council. (2005). Measuring food insecurity and hunger: Phase 1 report. Washington, DC: National Academies Press.
Protocol ID
270301
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX270301_Food_Insecurity_Afford_Balanced_Meals_Last_12_Months | ||||
| PX270301020100 | (I/we) couldn't afford to eat balanced more | N/A | ||
| PX270301_Food_Insecurity_Afford_Balanced_Meals_Last_12_Months_Enumerated | ||||
| PX270301020200 | (I/we) couldn't afford to eat balanced more | N/A | ||
| PX270301_Food_Insecurity_Change_Diet_Frequency | ||||
| PX270301030300 | How often did this happen - almost every more | N/A | ||
| PX270301_Food_Insecurity_Change_Diet_Frequency_Enumerated | ||||
| PX270301030400 | How often did this happen - almost every more | N/A | ||
| PX270301_Food_Insecurity_Change_Diet_Last_12_Months | ||||
| PX270301030100 | In the last 12 months, since (date 12 months more | N/A | ||
| PX270301_Food_Insecurity_Change_Diet_Last_12_Months_Enumerated | ||||
| PX270301030200 | In the last 12 months, since (date 12 months more | N/A | ||
| PX270301_Food_Insecurity_Eat_Less_Last_12_Months | ||||
| PX270301040100 | In the last 12 months, did you ever eat less more | N/A | ||
| PX270301_Food_Insecurity_Eat_Less_Last_12_Months_Enumerated | ||||
| PX270301040200 | In the last 12 months, did you ever eat less more | N/A | ||
| PX270301_Food_Insecurity_Food_Money_Frequency_Past_12_Months | ||||
| PX270301010100 | The food that (I/we) bought just didn't more | N/A | ||
| PX270301_Food_Insecurity_Food_Money_Frequency_Past_12_Months_Enumerated | ||||
| PX270301010200 | The food that (I/we) bought just didn't more | N/A | ||
| PX270301_Food_Insecurity_Hungry_Last_12_Months | ||||
| PX270301050100 | In the last 12 months, were you ever hungry more | N/A | ||
| PX270301_Food_Insecurity_Hungry_Last_12_Months_Enumerated | ||||
| PX270301050200 | In the last 12 months, were you ever hungry more | N/A | ||
Measure Name
Food Insecurity
Release Date
May 11, 2020
Definition
Food insecurity measures the availability, accessibility, and affordability of nutritionally adequate food.
Purpose
Food insecurity can lead to hunger and/or malnutrition.
Keywords
Financial Resource Constraint, Food Insecurity, Food Security, hunger
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 270301 | Food Insecurity |
Publications
Levites Strekalova, Y. A., et al. (2024) Application of the Delphi method to the development of common data elements for social drivers of health: A systematic scoping review. Translational Behavioral Medicine. 2024 June; 14(7): 426-433. doi: 10.1093/tbm/ibae020
Burnett-Bowie, S. A. M., et al. (2024) The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. Journal of Bone and Mineral Research. 2024 May; 39(5): 517-530. doi: 10.1093/jbmr/zjae048
Nelson, K., et al. (2024) Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic BMC Public Health. 2024 March; 24(1). doi: 10.1186/s12889-024-18390-4
Bartholomew, T. S., et al. (2024) Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services Addiction Science & Clinical Practice. 2024 March; 19(1). doi: 10.1186/s13722-024-00447-9
Bart, T. A., et al. (2023) Measurement invariance of commonly used psychosis-screening scales in US Spanish- and English-speaking Hispanic participants. Psychological Assessment. 2023 April; 35(4): 300-310. doi: 10.1037/pas0001207
Davidson, J., et al. (2022) From Genes to Geography, from Cells to Community, from Biomolecules to Behaviors: The Importance of Social Determinants of Health. Biomolecules. 2022 December; 12(10): 7. doi: 10.3390/biom12101449
Chan, N. W., et al. (2022) Social Determinants of Health Data Capture Within National and Health System Data Sources. Journal of the American College of Surgeons. 2022 November; 235(5): S136. doi: 10.1097/01.XCS.0000894008.17070.09
Chan, N. W., et al. (2022) Social determinants of health data in solid organ transplantation: National data sources and future directions. Am J Transplant. 2022 October; 22(10): 2293-2301. doi: 10.1111/ajt.17096
Pomeroy, A., et al. (2022) Protocol for a Longitudinal Study of the Determinants of Metabolic Syndrome Risk in Young Adults. Translational Journal of the American College of Sports Medicine. 2022 April; 7(2): 8. doi: 10.1249/tjx.0000000000000197