Assessing Pediatric Food Insecurity During the COVID-19 Pandemic in Austin

According to previous studies, 21-23% of lower income families experience food insecurity, a
position of uncertainty about their ability to afford food or omitting meals for financial
reasons. Food insecurity in a family is detrimental to a child's mental and physical health,
and poses a risk to his/her development. Food insecurity prevalence has also been reported
higher than the state level prevalence in households impacted by disasters. It is therefore
reasonable to hypothesize that the unprecedented global COVID-19 pandemic has increased the
frequency of food insecurity among lower income families. However, no data are known about
the current incidence of food insecurity during a pandemic with quarantine procedures in
place. This knowledge will also add background for future studies on the effects of acute on
chronic food insecurity on low-income families facing similar adversities such as this
epidemic.

A 2-question tool has been validated to evaluate the presence of food insecurity. An
affirmative response to either question has been reported to yield a sensitivity of 97% and
specificity of 83-86%. Screening for basic needs may open a sensitive discussion about
economic difficulties associated with the adverse health outcomes previously discussed. While
this tool is a current standard of care as recommended by the American Academy of Pediatrics,
it is often not utilized in medical visits to a primary care provider whether for routine
well child care or for sick visits. During the study period, pediatricians at two FQHC
clinics will make a concentrated effort to ask these 2 screening questions in order to
collect data on the prevalence and magnitude of challenges of food insecurity at this time.

Although the investigators are seeking to evaluate the current standard of care, they may
want to share our findings in order to provide a foundation for more generalizable research.

The investigators will seek to take a random sampling of 500 pediatric patients (250 each
from 2 CommUnity Care clinics) and query the parent/guardian with the 2-question food
insecurity tool during their regular appointment, either in person or on the
phone/telehealth. The pediatricians (Co-Inv) will ask the questions and record the data.

2-questions to assess food insecurity as recommended by the American Academy of Pediatrics:

1. "We worried whether our food would run out before we got money to buy more." Was that
often true, sometimes true, or never true for your household in the last 12 months?

2. "The food we bought just didn't last, and we didn't have money to get more." Was that
often true, sometimes true, or never true for your household in the last 12 months? A
response of "often true" or "sometimes true" to either question = positive screen for
Food Insecurity.

The investigators will also ask the same 2 questions in the framework of "…in the last 1-2
months" to assess how the current situation has affected their immediate concerns. If the
parent/guardian response with a positive screen for food insecurity, the pediatrician will
refer the families to available community resources as is the usual standard of care.

The investigators will not record any identifiable information. This is not a longitudinal
study. In 4-6 months the investigators will repeat this procedure with another, different
random sampling of 500 patients to assess any long lasting effects of the COVID-19 pandemic
or to determine if the immediate food crisis due to the pandemic has passed. The
investigators requested a waiver of consent for this project.