The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Assessing Food Insecurity in Primary Care: A Comparison Between an Internal Medicine– and a Student-Run Clinic

Authors: Nicolas Abchee, BS, Eric Han BS, Elena Encinas, BS, Candice Keogh, BS, Monica Rodriguez Fernandez, MD, Rami Hatem, MD, Brianna Simmons, MD, Catherine Paciotti, MD, Matthew McCabe, MD, Hechu Li Prasada, MD, Jessica Portillo, MD

Abstract

Objectives: Food insecurity has been rising in the United States, disproportionally affecting populations with no insurance, low socioeconomic status, and racial minorities. It is associated with overall poorer health, especially in terms of glycemic control, mental health, and cardiovascular disease. Addressing it is critical because although studies show its significance, most physicians do not screen for different social determinants of health, including food insecurity.

Methods: A cross-sectional study of household food security status was performed on 209 patients from June to August 2021 at the University of Florida’s Springhill Clinic (run by Internal Medicine) and the Equal Access Clinic, a student-run free clinic. The US Department of Agriculture’s Spanish and English versions of the Household Food Security Survey were used. The χ2 tests were used to determine whether the number of respondents in each food security category varied significantly by sex, age group, primary language, presence of children in the home, insurance status, and clinic site.

Results: Among the 209 participants, food insecurity was reported by 23.4% of patients. The only statistically significant sociodemographic factors that corresponded to food security status levels were the patient’s insurance status and clinic site. A total of 82.6% of insured patients were food secure, whereas only 65.2% of uninsured patients were food secure. A total of 14.5% of Equal Access Clinic patients experience severe food insecurity, whereas 0% of patients at the Springhill Clinic do. The χ2 tests determined that the number of respondents in each food security category varied significantly by insurance status (P = 0.01).

Conclusions: This study highlights the prevalence of food insecurity at primary care clinics, especially student-run clinics. Although limited by sample size and cultural barriers of the given survey, the findings emphasize the gap in standardized screening protocols for food security and the importance of physician sensitivity. Addressing this topic can improve food security and the health benefits that follow through early intervention.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Feeding America – Map the Meal Gap. (2024). Accessed: July 29, 2024: https://www.feedingamerica.org/sites/default/files/2024-05/MMG%202024%20Executive%20Summary%20%281%29.pdf.
 
2. USDA ERS - Definitions of Food Security. (2024). Accessed: July 29, 2024: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.
 
3. Berkowitz SA, Baggett TP, Wexler DJ, et al. Food insecurity and metabolic control among U. S. adults with diabetes. Diabetes Care 2013;36:3093–3099.
 
4. Berkowitz SA, Palakshappa D, Seligman HK, et al. Changes in food insecurity and changes in patient-reported outcomes: a nationally representative cohort study. J Gen Intern Med 2022; 37:3638–3644.
 
5. Sun Y, Liu B, Rong S, et al. Food insecurity is associated with cardiovascular and all-cause mortality among adults in the United States. J Am Heart Assoc 2020;9.
 
6. Kirby JB, Bernard D, Liang L. The prevalence of food insecurity is highest among Americans for whom diet is most critical to health. Diabetes Care 2021;44.
 
7. Thareja SK, Marting S, Davies W, et al. Associated SDOH needs of patients without health insurance and experiencing food insecurity. Discov Soc Sci Health 2024;4:25.
 
8. Park S, Chen J, Bustamante AV. Adverse consequences of food insecurity among U.S. adults beyond health outcomes. Am J Prev Med 2024;66:146–153.
 
9. USDA ERS - Food Security and Nutrition Assistance. (2024). Accessed: July 29, 2024: https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance.
 
10. US Census Bureau – Black Individuals Had Record Low Official Poverty Rate in 2022. (2023). Accessed: July 28, 2024. https://www.census.gov/library/stories/2023/09/black-poverty-rate.html.
 
11. Fraze TK, Brewster AL, Lewis VA, et al. Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals. JAMA Netw Open 2019;2.
 
12. McLeod MR, Vasudevan A, Warnick S Jr, et al. Screening for food insecurity in the primary care setting: type of visit matters. J Gen Intern Med 2021;36:3907–3909.
 
13. Lundeen EA, Siegel KR, Calhoun H, et al. Clinical-community partnerships to identify patients with food insecurity and address food needs. Prev Chronic Dis 2017;14.
 
14. Kopparapu A, Sketas G, Swindle T. Food insecurity in primary care: patient perception and preferences. Fam Med 2020;52:202–205.
 
15. USDA ERS - Survey Tools. (2024). Accessed: July 31, 2024: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools.
   
17. Proaño G, Coccia C. Food security status among South Florida families during the COVID-19 pandemic. J Acad Nutr Diet 2022;122.
 
18. Smith S, Malinak D, Chang J, et al. Implementation of a food insecurity screening and referral program in student-run free clinics in San Diego, California. Prev Med Rep 2016;5:134–139.
 
19. Runkle NK, Nelson DA. The silence of food insecurity: disconnections between primary care and community organizations. J Patient Cent Res Rev 2021;8:31–38.
 
20. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr 2010;140:304–310.
 
21. Liu Y, Eicher-Miller HA. Food insecurity and cardiovascular disease risk. Curr Atheroscler Rep 2021;23:24.
 
22. Te Vazquez J, Feng SN, Orr CJ, et al. Food insecurity and cardiometabolic conditions: a review of recent research. Curr Nutr Rep 2021;10:243–254.
 
23. Thareja SK, Samudrala S, Thareja SK, et al. Patients without health insurance and experiencing food insecurity are more likely to suffer from anxiety and depression—a cross-sectional study at a Milwaukee student-run free clinic. J Clin Transl Sci 2023; 7(Suppl 1):62–63.
 
24. Bernhardt C, Hou SI, King C, et al. Identifying barriers to effective patient-provider communication about food insecurity screenings in outpatient clinical settings in Central Florida: a mixed-methods study. J Public Health Manag Pract 2022;28.
 
25. Edwards MK, Valdivieso M, Leey JA, et al. Assessment of household food insecurity during a medical mission to Chincha, Peru. Cureus 2021;13.