Njai Rashid, Siegel Paul, Yin Shaoman, Liao Youlian
MMWR Morb Mortal Wkly Rep. 2017 Jan 13;66(1):12-15. doi: 10.15585/mmwr.mm6601a2.
Recent global (1) and national (2,3) health equity initiatives conclude that the elimination of health disparities requires improved understanding of social context (4,5) and ability to measure social determinants of health, including food and housing security (3). Food and housing security reflect the availability of and access to essential resources needed to lead a healthy life. The 2013 Behavioral Risk Factor Surveillance System (BRFSS) included two questions to assess perceived food and housing security in 15 states.* Among 95,665 respondents, the proportion who answered "never or rarely" to the question "how often in the past 12 months would you say you were worried or stressed about having enough money to buy nutritious meals?" ranged from 68.5% to 82.4% by state. Among 90,291 respondents living in housing they either owned or rented, the proportion who answered "never or rarely" to the question, "how often in the past 12 months would you say you were worried or stressed about having enough money to pay your rent/mortgage?" ranged from 59.9% to 72.8% by state. Food security was reported less often among non-Hispanic blacks (blacks) (68.5%) and Hispanics (64.6%) than non-Hispanic whites (whites) (81.8%). These racial/ethnic disparities were present across all levels of education; housing security followed a similar pattern. These results highlight racial/ethnic disparities in two important social determinants of health, food and housing security, as well as a substantial prevalence of worry or stress about food or housing among all subgroups in the United States. The concise nature of the BRFSS Social Context Module's single-question format for food and housing security makes it possible to incorporate these questions into large health surveys so that social determinants can be monitored at the state and national levels and populations at risk can be identified.
近期的全球（1）和国家（2,3）健康公平倡议得出结论，消除健康差距需要更好地理解社会背景（4,5）以及衡量健康的社会决定因素的能力，包括食品和住房保障（3）。食品和住房保障反映了过上健康生活所需基本资源的可得性和获取情况。2013年行为风险因素监测系统（BRFSS）在15个州纳入了两个问题，以评估人们对食品和住房保障的感知情况。*在95,665名受访者中，对于“在过去12个月里，你多久会担心或因没有足够的钱购买营养膳食而感到压力？”这个问题，回答“从不或很少”的比例在不同州从68.5%到82.4%不等。在90,291名居住在自有或租住房屋中的受访者中，对于“在过去12个月里，你多久会担心或因没有足够的钱支付房租/房贷而感到压力？”这个问题，回答“从不或很少”的比例在不同州从59.9%到72.8%不等。非西班牙裔黑人（黑人）（68.5%）和西班牙裔（64.6%）报告食品安全的比例低于非西班牙裔白人（白人）（81.8%）。这些种族/族裔差异在所有教育水平中都存在；住房保障也呈现类似模式。这些结果凸显了健康的两个重要社会决定因素——食品和住房保障方面的种族/族裔差异，以及美国所有亚群体中对食品或住房的担忧或压力的普遍存在。BRFSS社会背景模块针对食品和住房保障采用的单问题格式简洁明了，使得将这些问题纳入大型健康调查成为可能，从而能够在州和国家层面监测社会决定因素，并识别出有风险的人群。
