Identifying and Addressing Childhood Food Insecurity in Healthcare and Community Settings

110 Pages·2018·2.28 MB·English

by  Hans B. Kersten

SPRINGER BRIEFS IN PUBLIC HEALTH
CHILD HEALTH
Hans B. Kersten · Andrew F. Beck 
Melissa Klein Editors
Identifying and
Addressing Childhood
Food Insecurity
in Healthcare and
Community Settings
123
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Child Health
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Hans B. Kersten • Andrew F. Beck
Melissa Klein
Editors
Identifying and Addressing
Childhood Food Insecurity
in Healthcare and
Community Settings
Editors
Hans B. Kersten Andrew F. Beck
St. Christopher’s Hospital for Children Cincinnati Children’s Hospital Medical
Drexel University College of Medicine Center
Philadelphia, PA, USA University of Cincinnati College of
Medicine
Melissa Klein Cincinnati, OH, USA
Cincinnati Children’s Hospital Medical
Center
University of Cincinnati College of
Medicine
Cincinnati, OH, USA
SpringerBriefs in Child Health
ISSN 2192-3698 ISSN 2192-3701 (electronic)
SpringerBriefs in Public Health
ISBN 978-3-319-76047-6 ISBN 978-3-319-76048-3 (eBook)
https://doi.org/10.1007/978-3-319-76048-3
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Contents
1 Epidemiology and Pathophysiology of Food Insecurity . . . . . . . . . . . . 1
Kofi Essel and Kelly A. Courts
2 Impacting Food Insecurity Through the Use of Screening
Tools and Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Kofi Essel, Baraka D. Floyd, and Melissa Klein
3 Scope of Interventions to Address Food Insecurity . . . . . . . . . . . . . . . . 43
Janine S. Bruce, Deepak Palakshappa, and Hans B. Kersten
4 Building and Evaluating the Impact of Food Insecurity-Focused
Clinical- Community Partnerships on Patients and Populations . . . . . 69
Adrienne W. Henize, Melissa Klein, and Andrew F. Beck
5 Developing an Action Plan to Fight Food Insecurity . . . . . . . . . . . . . . . 89
Baraka D. Floyd, Deepak Palakshappa, and Melissa Klein
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
v
Contributors
Andrew F. Beck Cincinnati Children’s Hospital Medical Center and University of
Cincinnati College of Medicine, Cincinnati, OH, USA
Janine S. Bruce Stanford University School of Medicine, Stanford, CA, USA
Kelly  A.  Courts St. Christopher’s Hospital for Children, Drexel University,
Philadelphia, PA, USA
Kofi Essel Children’s National Health System, The George Washington University
School of Medicine & Health Sciences, Washington, DC, USA
Baraka D. Floyd Stanford School of Medicine, Stanford, CA, USA
Adrienne  W.  Henize Cincinnati Children’s Hospital Medical Center and
University of Cincinnati College of Medicine, Cincinnati, OH, USA
Hans  B.  Kersten St. Christopher’s Hospital for Children, Drexel University
College of Medicine, Philadelphia, PA, USA
Melissa Klein Cincinnati Children’s Hospital Medical Center and University of
Cincinnati College of Medicine, Cincinnati, OH, USA
Deepak Palakshappa Wake Forest School of Medicine, Winston-Salem, NC, USA
vii
Chapter 1
Epidemiology and Pathophysiology
of Food Insecurity
Kofi Essel and Kelly A. Courts
Abbreviations
ASEC Annual Social and Economic Supplement (report)
CPS Current Population Survey
DHHS Department of Health and Human Services
FI Food Insecurity
FPL Federal Poverty Level
HFSSM Household Food Security Survey Module
LSRO Life Sciences Research Office
NHANES National Health and Nutrition Examination Survey
NNMRR National Nutrition Monitoring and Related Research Act
SDH Social Determinants of Health
USDA United States Department of Agriculture
Aims
1. Define key terms, including FI, hunger, and the SDH.
2. Outline the history of FI measurement in the U.S.
3. Describe the key tools that are currently used to measure FI in the U.S.
4. Discuss the trends and current epidemiology of FI in the U.S.
5. Discuss the pathophysiology of FI and its links to health outcomes originating in
childhood.
K. Essel (*)
Children’s National Health System, The George Washington University School
of Medicine & Health Sciences, Washington, DC, USA
e-mail: [email protected]
K. A. Courts
St. Christopher’s Hospital for Children, Drexel University, Philadelphia, PA, USA
© The Author(s) 2018 1
H. B. Kersten et al. (eds.), Identifying and Addressing Childhood Food
Insecurity in Healthcare and Community Settings, SpringerBriefs in Public
Health, https://doi.org/10.1007/978-3-319-76048-3_1
2 K. Essel and K.A. Courts
Food Insecurity as a Social Determinant of Health
At the core of western society lies a deeply held belief that children should not suffer,
that they be given all opportunities to thrive and develop in a supportive and enriching
environment. In reality, many children do not have such opportunities, and there exists
inherent inequities that may affect a child’s health and well-being from their early years
extending across the life-course. Current medical practice strives to prevent acute dis-
ease and buffer the progression of chronic disease. Increasingly, these objectives are
pushing physicians and other clinicians and medical professionals toward acknowl-
edgement of the complete array of risk factors that children might experience, includ-
ing those factors or stressors that can become “toxic.”
“Toxic stress” results from persistent exposures that incite physiologic hormonal
responses. When these stressors do not diminish, and without co-existent adequate
buffers, the stress response cannot be effectively shut down [1]. This can result in
less effective neurologic and immunologic responses, prompting cognitive
impairment, acute illnesses, and morbidity resulting from chronic disease processes
[1, 2]. Social, economic, and environmental factors frequently underlie these
stressors. As a result, the conditions in which individuals live, work, play, grow, and
age, the so-called social determinants of health (SDH), are increasingly recognized
as vital to health and well-being [3]. These SDH influence the severity and
consistency of stress exposures, driving health outcomes that include premature
death. Given disparities in how these stressors, and the SDH in general, are
experienced across populations, disparities in those outcomes result [4]. With
growing evidence highlighting the linkages between the SDH and “toxic” outcomes,
clinicians are increasingly turning toward socially-minded, community-connected
approaches to care provision. Indeed, clinicians must be able to address more than
just the clinical disease state of a patient; they, too, must acknowledge and then
address those upstream factors that influence the health of their patients.
One such factor is food insecurity (FI), defined as “the limited or uncertain avail-
ability of nutritionally adequate and safe foods or limited or uncertain ability to
acquire acceptable foods in socially acceptable ways” [5]. FI is a distinctly different
phenomenon than hunger. FI is typically examined at the household level, while
hunger is an individual’s sensation of pain or discomfort associated with food
deprivation [6]. Hunger may result from FI but is not necessarily the most persistent
or severe result of being food insecure. Although hunger is a recognizable and
accepted term used by many advocates, we will aim to provide a more technical
description and distinguish these terms for the reader [7].
Historical Context of FI
Before the late 1960s, barring the Great Depression years, hunger and FI were not
widely viewed as significant public health issues in the U.S. Consensus was lacking
on both definition and measurement making the true extent of the issue hard to
1 Epidemiology and Pathophysiology of Food Insecurity 3
determine and quantify. The airing of the CBS documentary, “Hunger in America,”
following a visit by the Senate Subcommittee on Employment, Manpower and
Poverty to the Mississippi Delta, brought the issue more directly into the public
discourse. Not until the 1980s, however, when economic conditions and the media
increased attention on the issue, did the question of whether hunger widely existed
in the U.S. come to the fore with then-President Reagan initiating a “Task Force on
Food Assistance” to investigate the prevalence of hunger and the effectiveness of
national food assistance programs. Their 1984 report indicated that hunger, defined
as individuals experiencing personalized undernutrition, was not widespread in the
U.S.; however, hunger, defined as a social phenomenon in which individuals may
have an “inability, even occasionally” to access adequate food, was present. In
addition, the report stressed the need for a more direct, objective measurement of
hunger, as opposed to the indirect measures like poverty and unemployment that
had traditionally been used [8].
As a result, researchers and advocates began to develop and test survey measures
to more accurately identify the problem. In 1990, a seminal report influenced by an
ad hoc expert panel and completed by the Life Sciences Research Office (LSRO) of
the Federation of American Societies for Experimental Biology created the
consensus conceptual definitions for “FI” and “hunger” while also developing a
consistent platform for future research [5, 8, 9]. In 1992, following the passage of
the National Nutrition Monitoring and Related Research Act (NNMRR), the USDA
and Department of Health and Human Services (DHHS) brought together
representatives from federal agencies, academic researchers, and members of
private organizations, among others, to form the Federal Food Security Measurement
Project. This group reached agreement on key issues related to the best approach for
national measurement of FI. Finally, in 1995, after field testing and revisions,
standardized measures of FI were incorporated into the Census Bureau’s “Current
Population Survey” (CPS) as the “Food Security Supplement” (FSS) [8].
Measurement of FI
The USDA has subsequently been able to report the nation’s annual food security
statistics since 1995. Sponsored and funded by the USDA’s Economic Research
Service (ERS) and conducted by the U.S. Census Bureau, this is considered the gold
standard summary report [6]. The CPS collects monthly data on approximately
50,000 households chosen to be representative of state and national civilian,
noninstitutionalized populations within the U.S [6, 8, 10]. The FSS (within the CPS)
measures: (1) the nation’s food security statistics with the Household Food Security
Survey Module (HFSSM); (2) household food expenditures; and (3) use of food and
nutritional assistance programs by FI households [6, 8].
The HFSSM, composed of 18 total questions, is designed to provide a precise
measure of the nation’s food security status (Table 1.1). The first 3 questions relate
to the household in general. The next 7 are designed to determine the FI status of