Development and Validation of a 1-Item Very Low Food Security Screen

Introduction The Centers for Medicare & Medicaid Services has made screening for Heath Related Social Needs (HRSN) mandatory since 2024. Patients screening positive for HRSN food insecurity (FI) are connected with Supplemental Nutrition Services using 1115 Demonstration waivers. With a shift in funding, Massachusetts adopted a more severe FI level screening protocol (very low food security - VLFS). To date there is no screening tool that identifies VLFS alone; thus, we developed a sensitive, specific, and valid screen to determine risk for VLFS. Methods Sensitivity, specificity, positive and negative predictive values were used to test combinations of questions compared with the USDA Household Food Security Survey Module using the 2022 Current Population Survey. Results The best VLFS screen was: “In the last 12 months, did you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food? ” (yes/no). The screen was highly sensitive, specific, and valid for detecting VLFS risk in US households with and without children (sensitivity 92.2% and 97.2%, specificity 96.2% and 97.4%, respectively), and with diverse populations. Conclusion The VLFS screen is recommended for use by states adopting a more severe FI level screening protocol.