Validity of a Single Item Food Security Questionnaire in Arctic Canada

OBJECTIVES: Assess sensitivity and specificity of each of the 18 US Department of Agriculture (USDA) Household Food Security Scale Module (HFSSM) questionnaire items to determine whether a rapid assessment of child and adult food insecurity is feasible in an Inuit population. METHODS: Food insecurity prevalence was assessed by the 18-item USDA HFSSM in a randomized sample of Inuit households participating in the Inuit Health Survey and the Nunavut Inuit Child Health Survey. Questions were evaluated for sensitivity, specificity, predictive value (+/-), and total percent accuracy for adult and child food insecurity (yes/no). Child food security items were evaluated for both surveys. RESULTS: For children, the question In the last 12 months, were there times when it was not possible to feed the children a healthy meal because there was not enough money? had the best performance in both samples with a sensitivity and specificity of 92.3% and 97.3%, respectively, for the Inuit Health Survey, and 88.5% and 95.4% for the Nunavut Inuit Child Health Survey. For adults, the question In the last 12 months, were there times when the food for you and your family just did not last and there was no money to buy more? demonstrated a sensitivity of 93.0% and a specificity of 93.4%. CONCLUSIONS: Rapid assessment of child and adult food insecurity is feasible and may be a useful tool for health care and social service providers. However, as prevalence and severity of food insecurity change over time, rapid assessment techniques should not replace periodic screening by using the full USDA HFSSM questionnaire.