PC1015: A Pediatric Emergency Department-based Electronic Food Insecurity Screening Program

Background: Food insecurity (FI), a public health crisis, affects 14% of homes with children < 18 years old nationally and up to 1 in 3 families in Rhode Island. Although most FI screening is done by primary care providers, the emergency department (ED), a community safety net, provides the opportunity for screening, particularly among vulnerable populations. Prior studies demonstrate that ED-based FI screenings among adults are feasible, with more honest answers provided via electronic-based surveys than with face-to-face screening.

Methods: An electronic survey was advertised to all families who visited the institution’s pediatric ED via posters located throughout the department. Surveys in English and Spanish were accessed on personal electronic devices via scanned QR codes. The survey included six United States Department of Agriculture (USDA) Household Food Security Questions (Figure 1) and sociodemographic questions. Respondents’ level of food security was calculated based on responses to the USDA survey questions. Descriptive analyses of patient sociodemographics and responses to FI questions were completed.

Results: Over a 2-month period, 268 surveys were initiated. 17 (6.3%) respondents declined consent and another 45 (16.8%) were excluded from analyses after consenting but not completing USDA survey questions. Among respondents who completed the survey, 111 (55%) demonstrated some degree of FI, 48 (23.8 %) of whom had low food security, and 63 (31.2%) very low food security (Table 1). Among those who had very low food security 72.4% identified as white and non-Hispanic and had a median household income of $15,000-24,999; 178 (86.8%) listed English as a primary language, and 95% identified a pediatric primary care provider.

Among all respondents, knowledge of supplemental food assistance was reported as: SNAP (79.5%), WIC (64.4%), free school meals (53.7%), or food banks (53.2%); only 13.2% reported knowledge of the USDA summer meals program. Respondents’ current use of services included: SNAP (27.8%), WIC (21%), free school meals (18.1%), and food banks (12.7%). Among respondents reporting annual household income of <$25,000 (n = 62) and among those with very low food security (n = 63), 27% and 18.8% currently do not access any food assistance, respectively.

Conclusion: 55% of families seeking care in a pediatric ED who participated in this survey were found to have low/very low food security. Despite most respondents identifying a pediatric primary care provider, many families were not aware of all of the available supplemental food resources, and approximately 1 in 4-5 families in the lowest income and food security categories were not accessing these resources. These results support that the ED is an important location for FI screening. A community-based FI intervention program for families who screened positive for FI with this survey is currently underway.