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Defining and Measuring Food Security

This chapter introduces the food security measure that has been used in the United States since 1995 and provides a brief history of its development, as described by workshop participants.1 This information is provided as background in this chapter because most speakers used the concept and measurement of food insecurity throughout the workshop.

DEFINING FOOD SECURITY

“Food security” is a status assigned to households and some individuals in households based on responses to questions that have constituted the Household Food Security Survey Module (HFSSM) in the Current Population Survey (CPS) since 1995 (Economic Research Service, 2012). Various aspects of it were described during the workshop by Craig Gundersen (Chapter 3), John Cook (Chapter 8), and Edward Frongillo (Chapter 9). As shown in Box 2-1, the HFSSM consists of 10 questions for households without children and 18 questions for households with children. Each question is qualified by the stipulation that the outcomes are due to a lack of financial resources. This version of the questionnaire uses a one-year reference period, asking many questions about the time period “in the last 12 months.” The questions may also be asked using a

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1Detailed information about the history of food security measurement and the measurement itself is available on the website of the Economic Research Service (ERS), U.S. Department of Agriculture. See http://www.ers.usda.gov/data-products/food-security-in-the-united-states.aspx [August 14, 2013].



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2 Defining and Measuring Food Security T his chapter introduces the food security measure that has been used in the United States since 1995 and provides a brief history of its development, as described by workshop participants.1 This informa- tion is provided as background in this chapter because most speakers used the concept and measurement of food insecurity throughout the workshop. DEFINING FOOD SECURITY “Food security” is a status assigned to households and some indi- viduals in households based on responses to questions that have con- stituted the Household Food Security Survey Module (HFSSM) in the Current Population Survey (CPS) since 1995 (Economic Research Service, 2012). Various aspects of it were described during the workshop by Craig Gundersen (Chapter 3), John Cook (Chapter 8), and Edward Frongillo (Chapter 9). As shown in Box 2-1, the HFSSM consists of 10 questions for households without children and 18 questions for households with children. Each question is qualified by the stipulation that the outcomes are due to a lack of financial resources. This version of the questionnaire uses a one-year reference period, asking many questions about the time period “in the last 12 months.” The questions may also be asked using a 1Detailed information about the history of food security measurement and the measure- ment itself is available on the website of the Economic Research Service (ERS), U.S. Depart- ment of Agriculture. See http://www.ers.usda.gov/data-products/food-security-in-the- united-states.aspx [August 14, 2013]. 4

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DEFINING AND MEASURING FOOD SECURITY 5 BOX 2-1 Questions Used to Assess Food Security of Households in the Current Population Survey To reduce burden on higher income respondents the full Food Security Supple- ment in the Current Population Survey is not administered to households that (1) report incomes above 185 percent of the federal poverty line and (2) give no indication of food access problems on both of two preliminary screening questions. The preliminary screening questions are listed below: 1.  eople do different things when they are running out of money for food P in order to make their food or their food money go further. In the last 12 months, since December of last year, did you ever run short of money and try to make your food or your food money go further? 2.  hich of these statements best describes the food eaten in your house- W hold—enough of the kinds of food we want to eat, enough but not always the kinds of food we want to eat, sometimes not enough to eat, or often not enough to eat? These households are deemed to be food secure and are not asked the ques- tions in the Household Food Security Survey Module. Household Food Security Survey Module Survey— One-Year Reference Period Now I’m going to read you several statements that people have made about their food situation. For these statements, please tell me whether the statement was OFTEN true, SOMETIMES true, or NEVER true for your household in the last 12 months.   1. We worried whether our food would run out before we got money to buy “ more.” Was that OFTEN, SOMETIMES, or NEVER true for you in the last 12 months?   2. The food that we bought just didn’t last, and we didn’t have money to get “ more.” Was that OFTEN, SOMETIMES, or NEVER true for you in the last 12 months?   3.  We couldn’t afford to eat balanced meals.” Was that OFTEN, SOMETIMES, “ or NEVER true for you in the last 12 months?   4. n the last 12 months, did you or other adults in the household ever cut the I size of your meals or skip meals, because there wasn’t enough money for food? (Yes/No)   5.  If yes to question 4) How often did this happen—almost every month, some ( months but not every month, or in only 1 or 2 months?   6. n the last 12 months, did you ever eat less than you felt you should, be- I cause there wasn’t enough money for food? (Yes/No)   7. n the last 12 months, were you ever hungry, but didn’t eat, because there I wasn’t enough money for food? (Yes/No) continued

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6 CAUSES AND CONSEQUENCES OF CHILD FOOD INSECURITY AND HUNGER BOX 2-1 Continued   8. n the last 12 months, did you lose weight, because there wasn’t enough I money for food? (Yes/No)   9. n the last 12 months, did you or other adults in your household ever not eat I for a whole day, because there wasn’t enough money for food? (Yes/No) 10. (If yes to question 9) How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months? (Questions 11–18 were asked only if the household included children age 0–17) Now I’m going to read you several statements that people have made about the food situation of their children. For these statements, please tell me whether the statement was OFTEN true, SOMETIMES true, or NEVER true in the last 12 months for any child under 18 years old living in the household. 11. We relied on only a few kinds of low-cost food to feed the children in our “ household, because we were running out of money to buy food.” Was that OFTEN, SOMETIMES, or NEVER true for you in the last 12 months? 12.  We couldn’t feed the children in our household a balanced meal, because “ we couldn’t afford that.” Was that OFTEN, SOMETIMES, or NEVER true for you in the last 12 months? 13. The children in our household were not eating enough, because we just “ couldn’t afford enough food.” Was that OFTEN, SOMETIMES, or NEVER true for you in the last 12 months? 14.  n the last 12 months, did you ever cut the size of any of the children’s meals, I because there wasn’t enough money for food? (Yes/No) 15. n the last 12 months, were the children ever hungry but you just couldn’t I afford more food? (Yes/No) 16.  the last 12 months, did any of the children ever skip a meal, because In there wasn’t enough money for food? (Yes/No) 17. (If yes to question 16) How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months? 18. n the last 12 months, did any of the children ever not eat for a whole day, I because there wasn’t enough money for food? (Yes/No) SOURCE: Coleman-Jensen et al. (2012:3–4). Reprinted with permission. Ques- tion text excerpted from December 2012 Current Population Survey Food Se- curity Supplement. See http://www.ers.usda.gov/datafiles/Food_Security_in_the_ United_States/Current_Population_Survey/2012/qn2012.pdf [October 10, 2013].

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DEFINING AND MEASURING FOOD SECURITY 7 30-day reference period. The CPS collects responses for both the previous 12 months and for the 30 days just prior to the survey. Households are classified into food security status categories based on the number of food-insecure responses to the questions,2 consistent with statistical evidence that this number reflects the level of food hard- ship experienced by the family. The three categories of household food s ­ ecurity are (1) food secure (fewer than 3 food-insecure responses); (2) low food security (more than 2 but fewer than 6 food-insecure responses for households without children, more than 2 but fewer than 8 food-insecure responses among households with children); and (3) very low food secu- rity (6 or more food-insecure responses among the 10 questions for house- holds without children, 8 or more food-insecure responses among the 18 questions for households with children). Families are said to be food i ­ nsecure if they fall in categories 2 or 3. Children in a food-insecure house- hold are said to have low food security if 2 to 4 of the child-related ques- tions have food-insecure responses. They are said to have very low food security if 5 or more of the child-related questions have food-­nsecurei responses. The responses to the HFSSM support three summary scales: (1) the 18-item food security scale, sometimes referred to as the combined adult- child scale; (2) the 10-item adult food security scale; and (3) the 8-item child food security scale (see Box 2-1). These are all considered house- hold-level measures because they reflect food-insecure conditions of any person in the household, any adult in the household, or any child in the household. HISTORY During the workshop, the history of the development of the HFSSM was described by Frongillo (see Chapter 9 for the rest of his presenta- tion) and Cook (see Chapter 8 for the rest of his presentation). Frongillo explained that the basic definition of food security used in the United States was developed for the American Institute of Nutrition by the Expert Panel on Core Indicators of Nutritional State for Difficult-to-Sample Pop- ulations, as documented in Anderson (1990). In Anderson’s work, food security was defined to be “access by all people at all times to enough food for an active, healthy life3 and includes at a minimum: (a) the ready 2According to Coleman-Jensen et al. (2012), food-insecure responses are indicated by responses of “often” or “sometimes” to questions 1–3 and 11–13; “almost every month” or “some months but not every month” to questions 5, 10, and 17; and “yes” to the other conditions shown in Box 2-1. 3ERS currently uses the first part of this definition to define food security. See http://www. ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us.aspx [August 20, 2013].

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8 CAUSES AND CONSEQUENCES OF CHILD FOOD INSECURITY AND HUNGER Physical, environmental, and personal factors Consequences, such as chronic Poor disease, Food dietary impaired intake Malnutrition insecurity performance Medical conditions FIGURE 2-1  Core concepts related to nutritional state. SOURCE: National Research Council (2006:44). Figure 2-1 availability of nutritionally adequate and safe foods, and (b) the assured ability to acquire acceptable foods in socially acceptable ways (e.g., with- out resorting to emergency food supplies, scavenging, stealing, and other coping strategies)” (Anderson, 1990:1560). Frongillo pointed out the basic definition has many different aspects. When the national surveillance effort began, he said, food security was conceptualized as one of the core concepts related to nutritional state (see Figure 2-1). Frongillo said that at the same time, Congress enacted the National Nutrition Monitoring and Related Research Act (P.L. 101-445) that led to the development of a 10-year plan for assessing the dietary and nutri- tional status of the U.S. population. Later in the workshop, Cook noted, as described in Bickel, Andrews, and Klein (1996), that the measure was developed by the Food Security Measurement Project (1995–1997), with a multiobjective mandate to develop reliable measures of food security, food insecurity, and hunger that were scientifically valid for the U.S. population, consistent with the goals and policies of the U.S. government.

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DEFINING AND MEASURING FOOD SECURITY 9 This project developed the 18-item HFSSM that was first administered in the CPS in April 1995, with minor refinements in 1998, 2005, 2006, and 2007. Cook noted that researchers use several different scales. The 18-item questionnaire can be used with a 12-month (see Box 2-1) or 30-day ref- erence period. There is also a 6-item abbreviated scale4 and the 10-item adult scale (the top 10 questions in Box 2-1). Of most interest in this work- shop, he said, is the 8-item child food security scale (the last 8 questions in Box 2-1), although he pointed out that this scale does not include a question about the affective component of food insecurity or the anxiety or worry that food would run out. MEASURING FOOD SECURITY5 The HFSSM has been included in a number of national-level periodic surveys. As noted above, the full 18 questions referenced to 12 months have been included in the Current Population Survey Food Security Sup- plement annually since 1995. For each question, an affirmative response is followed up with a query as to whether the condition or behavior occurred in the previous 30 days.6 The full 18 questions have also been included in the family question- naire of the National Health and Nutrition Examination Survey since 1999. In addition, from 2001–2010, a subset of the more severe questions with 30-day reference were asked about the sampled person rather than all persons in the household. The Survey of Income and Program Participation (SIPP) included a nonstandard module with five adult questions and a four-month refer- ence period in wave 8 (the adult well-being module), beginning with the 1996 panel and continuing through the end of the 2013 panel. 7 The Survey of Program Dynamics included the standard 18-item module with 12-month reference annually from 1998 to 2002. The Early Child- hood Longitudinal Study-Kindergarten (ECLS-K) Cohort included the standard 18-item questionnaire with 12-month reference for four rounds from 1998–2007 when children were in kindergarten, grade 3, grade 4The 6-item abbreviated scale uses questions 2, 3, 4, 5, and 6 in Box 2-1, plus a follow-up question, like 5, for question 2. 5The information below was provided by email from Mark Nord (ERS) on August 19, 2013. Much of this background is also on the ERS website, at the link shown in footnote 1. 6Prior to 2005, the 30-day follow-up questions were only administered for the more severe questions (those with a yes/no response) in the module. 7The five-item SIPP questions were chosen before the six-item short module was stan- dardized. Subsequent panels continued with the same questions for continuity. The SIPP beginning in 2014 will include the standard six-item short module.

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10 CAUSES AND CONSEQUENCES OF CHILD FOOD INSECURITY AND HUNGER 5, and grade 8. The module is also in the new ECLS-K beginning with the kinder­ arten class of 2010–2011. The Early Childhood Longitudinal g Study -Birth Cohort included the standard 18-item questionnaire with 12-month reference in the panel beginning in 2002. The food security questions were included in surveys in 2002, 2004, 2006–2007, and 2007– 2008. The National Health Interview Survey has included the standard adult 10-item questionnaire with a 30-day reference annually beginning in 2011. The Panel Study of Income ­ ynamics (PSID) included the stan- D dard 18 items with 12-month reference in its child development supple- ment in 1997, and in the core PSID in 1999, 2001, 2003, 2005, and 2007. As examples of other uses in large studies, the standard 18-item module was included in multiple waves of the Fragile Families Study and Children’s HealthWatch (previously Children’s Sentinel Nutritional Assessment Program) beginning in 1998. Although neither of these stud- ies is fully nationally representative, they represent large vulnerable populations.