Cisneros Victor, Olliffe Ian Dennis Capo, Esteban Marco Santos, Bui Joseph, Takallou Armin, Lotfipour Shahram, Chakravarthy Bharath
Eisenhower Health, Department of Emergency Medicine, Rancho Mirage, California.
University of California, Irvine, Department of Emergency Medicine, Irvine, California.
West J Emerg Med. 2025 Mar 15;26(3):396-405. doi: 10.5811/westjem.40006.
Food insecurity (FI) remains a pervasive issue in the United States, affecting over 12.8% of households. Marginalized populations, particularly those in urban areas, are disproportionately impacted. The emergency department (ED) holds potential as a vital outreach hub, given its diverse patient population and extensive service coverage. In this study we explore the feasibility of implementing an ED-based FI screening and referral program at an urban, academic teaching hospital. We aimed to assess the prevalence of FI among ED patients and evaluate the feasibility of a three- and six-week follow-up to assess patients' FI and related barriers to resource referral utilization.
This single-center, observational study was conducted at an urban, academic ED from 2018-2024. Initial FI screening was performed using a validated two-question survey adapted from the Hunger Vital Sign screening tool. Participants who screened positive were enrolled and completed the 10-item US Department of Agriculture Adult Food Security survey, received a food assistance guide, and were followed up at three- and six-week intervals to assess changes in FI status.
Among 6,339 participants, 1,069 (16.9%) experienced FI, with the highest rates among Black non-Hispanic (24.7%) and Spanish-speaking participants (28.7%). Of the 1,069 participants who screened positive for FI, 630 (59.0%) were enrolled in the study. Of the enrolled participants, 161 (25.6%) completed the three-week follow-up phone calls, and 48 (7.6%) completed the six-week follow-up. The mean FI score for these 48 participants decreased from 6.67 (SD 2.68) at enrollment to 4.75 (SD 2.85) at the three-week follow-up (P < 0.001), and to 4.25 (SD 3.48) by the six-week follow-up (P < 0.001). Barriers to using the food resource guide, such as time constraints, transportation, and misplacement of resources, limited many participants' engagement.
This study demonstrated the feasibility and effectiveness of an ED-based food insecurity screening and resource referral program, associated with a significant reduction in food insecurity scores among participants. However, barriers such as time constraints, transportation issues, and misplacement of referral materials limited engagement. Addressing these barriers through tailored follow-up and systematic support systems, including universal screening during ED intake and personalized assistance, can enhance the program's accessibility and impact.
粮食不安全问题在美国仍然普遍存在，影响着超过12.8%的家庭。边缘化人群，尤其是城市地区的人群，受到的影响尤为严重。急诊科因其患者群体多样且服务覆盖范围广泛，有潜力成为一个重要的外展中心。在本研究中，我们探讨了在一家城市学术教学医院实施基于急诊科的粮食不安全筛查和转诊项目的可行性。我们旨在评估急诊科患者中粮食不安全的患病率，并评估为期三周和六周的随访的可行性，以评估患者的粮食不安全状况以及资源转诊利用的相关障碍。
本单中心观察性研究于2018年至2024年在一家城市学术急诊科进行。最初的粮食不安全筛查使用了一种经过验证的两题调查问卷，该问卷改编自饥饿生命体征筛查工具。筛查呈阳性的参与者被纳入研究，并完成了美国农业部的10项成人粮食安全调查问卷，收到了一份粮食援助指南，并在三周和六周的间隔时间进行随访，以评估粮食不安全状况的变化。
在6339名参与者中，1069人（16.9%）经历了粮食不安全，其中非西班牙裔黑人（24.7%）和讲西班牙语的参与者（28.7%）的比例最高。在1069名粮食不安全筛查呈阳性的参与者中，630人（59.0%）被纳入研究。在纳入研究的参与者中，161人（25.6%）完成了三周的随访电话，48人（7.6%）完成了六周的随访。这48名参与者的平均粮食不安全得分从入组时的6.67（标准差2.68）降至三周随访时的4.75（标准差2.85）（P<0.001），到六周随访时降至4.25（标准差3.48）（P<0.001）。使用粮食资源指南的障碍，如时间限制、交通和资源丢失，限制了许多参与者的参与。
本研究证明了基于急诊科的粮食不安全筛查和资源转诊项目的可行性和有效性，该项目使参与者的粮食不安全得分显著降低。然而，时间限制、交通问题和转诊材料丢失等障碍限制了参与度。通过量身定制的随访和系统的支持系统来解决这些障碍，包括在急诊科就诊时进行普遍筛查和提供个性化援助，可以提高该项目的可及性和影响力。
