Addressing Household Food Insecurity in Primary Care Practices

Statement of Problem

Food insecure families lack reliable access to a sufficient quantity of affordable and nutritious food. Unfortunately, in America food insecurity (FI) affects 49.1 million, including 15.8 million children. FI in children has been associated with a number of health-related problems including iron deficiency, anemia, poor academic performance and psychosocial and behavioral problems. Studies have also found that FI affects children’s use of the health care system – they visit the hospital more often, receive delayed needed medical care, don’t get needed medications on time and don’t receive the recommended number of well-child visits.

The reason food insecure individuals have higher acute health care utilization is unclear, but studies have suggested that competing demands or priorities could lead a family to use health care more acutely. For example, parents may be forced to choose between spending money on food or on medications. Therefore, it is crucial to understand the relationship between FI and acute health care use, so clinicians do not miss an opportunity to identify and address families’ unmet social needs. 


Understanding the Impact of Food Insecurity

Food Insecurity
Food Insecurity

Food insecurity, or the lack of reliable access to a sufficient quantity of affordable and nutritious food, affects nearly 16 percent of all households (15.8 million children) across the U.S. and has been associated with a multitude of health-related issues, poor academic performance, psychosocial and behavioral problems, and higher utilization of health care services.

PolicyLab researchers set out to test two theories: (1) whether differences in acute health care utilization could be used to predict which children will screen positive for FI in primary care practice settings, and (2) to determine if FI is associated with subsequent increased acute health care use. We examined this using a prospective cohort study of 3,335 children screened for FI at three-year well-child visits in three urban practices, evaluating their acute care use one year before and after FI screening.

Our team found few differences in health care utilization between food-secure and food insecure children. Furthermore, we found that child demographic characteristics and health care utilization were unable to predict which children suffer from household food insecurity. Therefore, providers who rely on particular child characteristics from the medical record or differences in health care utilization are unlikely to identify all children living in food insecure households. These results suggest that FI will likely remain unidentified unless all children and families are screened within primary care.

Next Steps

Identifying which families are food insecure is important for trying to assist families in obtaining services and minimizing the negative consequences of FI. Our work suggests that differences in demographic characteristics and health care use cannot identify which children are food insecure. Therefore, we are working to determine the most effective and appropriate strategies to screen all families within primary care practices for household food insecurity so as not to miss any opportunities to address the unmet food and social needs of families.

This project page was last updated in July 2019.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Addressing Household Food Insecurity in Primary Care Practices [Online] Available at: [Accessed: plug in date accessed here]. 

More projects from Family Support in Pediatric Settings View More Projects