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Study finds that simple 2-question survey can better identify hungry children

Asking parents just two simple screening questions could help health care providers and social workers to easily and quickly identify families whose young children are suffering from hunger, enabling early interventions that could prevent serious health consequences, according to a new study led by University of Maryland School of Medicine researchers. The study, published July 1 in the journal Pediatrics, analyzed data gathered from more than 30,000 families nationwide, about a quarter of whom suffered from hunger.

The researchers examined whether the time-consuming, 18-question Household Food Security Survey provided by the federal government could be shortened and still be effective in identifying hungry families. They found that just the first two statements, with which families were asked to agree or disagree, were key: "Within the past 12 months we worried whether our food would run out before we got money to buy more;" and "Within the past 12 months the food we bought just didn't last and we didn't have money to get more."

The researchers found that 92.5 percent of the hungry families answered "yes" to the first question, and 81.9 percent of the families answered yes to the second, meaning that positive answers to those questions alone could accurately identify most families affected by hunger.

Such an efficient screening test can save time and get help to more hungry families faster, according to lead author Erin Hager, Ph.D., assistant professor of pediatrics at the University of Maryland School of Medicine. "This paper is the evidence that it works," Dr. Hager says. "Now, this can immediately be used by any social service agency or any clinic to more quickly get hungry children connected with the assistance they need to stay nourished, healthy and developmentally on track."

Hunger can be invisible in American children because they do not physically appear skinny or emaciated, according to senior author Maureen Black, Ph.D., the John A. Scholl, M.D., and Mary Louise Scholl, M.D., Professor of Pediatrics at the University of Maryland School of Medicine. "Unlike hungry children in Third World countries who may go without food, American parents have access to cheap, nutrient-deprived foods they can use to fill their children's bellies and maintain their weight. However, without critical nutrients such as iron, babies and toddlers can suffer from serious health consequences."

Health care professionals rarely ask parents if they have enough nutritious food to feed their families. "People who are hungry and who can't feed their kids are often anxious and depressed," says Dr. Black. "They don't feel good about this food is a basic need you're supposed to provide for your children."

Identifying hungry children and intervening early is so important because of the serious health effects kids can suffer without proper nutrition. Children younger than three who live in food-insecure households are 90 percent more likely to be in fair or poor health (versus good or excellent health) than children in food-secure homes. Hungry babies and toddlers are 31 percent more likely to have been hospitalized since birth, and 76 percent more likely to be at increased developmental risk than children in food-secure homes.

A quick, easy way of identifying hungry families can help them get assistance before the hunger seriously impacts the children's health. "Food stamps, welfare and programs like WIC can provide these families with nutrient-rich food to avoid the negative consequences of hunger," says Dr. Black.The researchers hope social workers, health professionals and other outreach workers who come in contact with needy families will begin using the quiz right away, and will immediately seek help for those who need it. Health care professionals in Baltimore can use a Web site set up by the City Health Department ( to identify nutritional resources for families who are at risk for food insecurity.

The study was conducted as part of Children's HealthWatch (, a nationwide consortium of urban medical centers devoted to monitoring how national policies and environmental conditions affect the health, growth and development of children under three years of age. Working in emergency departments and pediatric primary care clinics, Children's HealthWatch interviewers asked 30,098 families all 18 questions on the U.S. Household Food Security Scale. The scale is a survey developed by the U.S. Department of Agriculture to track food insecurity in America. About 23 percent of the families who participated were food insecure.

Dr. Black and colleagues analyzed the families' responses to all 18 questions see if fewer queries could be just as definitive as the full survey. The responses to the first two questions accurately identified the vast majority of hungry families. The researchers evaluated statistical factors and found a sensitivity of 97 percent, meaning that only three percent of families who experience food insecurity were likely to be misclassified as food-secure using the two-question survey. The results are encouraging, and the new test can be implemented right away, says Dr. Black.

"We're hoping our findings will immediately enable clinics and other outreach centers screen families for food insecurity," she says. "We want children and their parents to get help as soon as they can to prevent long-term health and developmental consequences."

"This study is an example of how taking an innovative approach to evaluating existing methods can help us find a better way and improve human health," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs, University of Maryland, and John Z. and Akiko K. Bowers Distinguished Professor and dean, University of Maryland School of Medicine. "We are confident these findings will have an immediate impact on the health of America's babies and toddlers. We're proud of Dr. Black's work toward a better life for children who are at risk."


Contact: Karen Buckelew
University of Maryland Medical Center

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