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Food Insecurity and Hunger in the United States: An Assessment of the Measure 2 History of the Development of Food Insecurity and Hunger Measures Prior to the development of the current standardized measure of the prevalence of household food insecurity in 1995, estimates of the prevalence of lack of access to food varied widely and there was little consensus over which measure was most accurate. Unlike many developing countries with widespread chronic food insecurity because of general food scarcity, food insecurity and hunger in the United States occur in a land of abundant food. Food insecurity exists in a small proportion of the population, and a smaller proportion experience hunger at some time during a year because they cannot afford enough food (LeBlanc, Kuhn, and Blaylock, 2005). This chapter summarizes the history of the development of the measure of food insecurity in the United States from the late 1960s to the present. The chapter highlights some of the main events that have shaped the dialogue and outcomes over nearly four decades. These include government initiatives—both executive and legislative—as well as efforts of private researchers and organizations. EARLY EFFORTS TO DEFINE HUNGER “Hunger became a truly public issue in the United States in the late 1960s, even though a number of major federal assistance programs were already in place. The crucial period during which the issue emerged was bracketed by the April 1967 visit to the Mississippi Delta by the Senate Subcommittee on Employment, Manpower and Poverty led by Joseph Clark (D-Pa.) and Robert Kennedy (D-N.Y.), and the broadcast on May 28, 1968,
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Food Insecurity and Hunger in the United States: An Assessment of the Measure of the CBS television documentary, ‘Hunger in America’” (Eisinger, 1998, p. 12). The recognition that hunger exists in the United States led to an increase of federal programs and projects to eliminate the effects of poverty (Eisinger, 1996). Since the late 1960s, government agencies, academic researchers, nonprofit organizations, and advocacy groups have undertaken many studies to define and measure hunger in the American context, but without any consensus on the definition of hunger or its measurement strategy or estimates of the extent of the problem. As Radimer and colleagues observed (Radimer, Olson, and Campbell, 1990, p. 1545), “The definitions of hunger varied widely and measures of hunger were generally indirect and the definitions and measures often lacked congruence.” The term “hunger” was often used interchangeably with malnutrition, and medical and dietary intake data were used to measure the problem. Other studies attempted to use poverty data or trends in the number of people seeking food assistance as proxies for hunger. Still others attempted to gather data through various surveys. This discordance at times was a product of competing professional and political agendas (Eisinger, 1996, 1998). THE 1980s: THE PRESIDENT’S TASK FORCE ON FOOD ASSISTANCE This public attention to hunger led to increases in programs and projects to alleviate the condition. In the early 1980s, adverse economic conditions and efforts to limit federal spending led to a general belief that hunger was widespread in the United States and may have been increasing. This concern led President Reagan to establish a task force to examine the food assistance programs and the claims of a resurgence of hunger. The Task Force on Food Assistance concluded that the issue of hunger was complex and observed that the terms “hunger,” “poverty,” and “unemployment” were often used interchangeably although they are distinct problems. Also, the population that relied on food assistance was not a homogeneous group. After much investigative work, the task force made a distinction between two different working definitions of “hunger”: (1) a scientific, clinical definition in which hunger means “the actual physiological effects of extended nutritional deprivations” and (2) a definition of hunger as commonly defined, relating more to a social phenomenon than medical results, in which hunger is “the inability, even occasionally, to obtain adequate food and nourishment. In this sense of the term, hunger can be said to be present even when there are no clinical symptoms of deprivation” (U.S. President, Task Force on Food Assistance, p. 34). The task force concluded that “with this possible exception [the homeless], there is no evidence that widespread undernutrition is a major health
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Food Insecurity and Hunger in the United States: An Assessment of the Measure problem in the United States.” Yet it did find evidence of hunger “as commonly defined” (p. 36): To many people hunger means not just symptoms that can be diagnosed by a physician, it bespeaks the existence of a social, not a medical, problem: a situation in which someone cannot obtain an adequate amount of food, even if the shortage is not prolonged enough to cause health problems. It is the experience of being unsatisfied, of not getting enough to eat. This, of course, is the sense in which people ordinarily use the word. It is also the sense in which the witnesses before us and many of the reports and documents we have studied have spoken of hunger. This alternative definition of hunger relates directly to our communal commitment to ensure that everyone has adequate access to food, and to the nation’s endeavors to provide food assistance. And in this sense we cannot doubt that there is hunger in America. The task force, further noting in its report the lack of a definition of hunger and of documentation of it in the United States, articulated the need for measuring hunger (pp. 37, 39): There is no official “hunger count” to estimate the number of hungry people, and so there are no hard data available to estimate the extent of hunger directly. Those who argue that hunger is widespread and growing rely on indirect measures…. We regret our inability to document the degree of hunger caused by income limitations, for such lack of definitive, quantitative proof contributes to a climate in which policy discussions become unhelpfully heated and unsubstantiated assertions are then substituted for hard information. After the 1984 task force report, researchers in the private sector and government agencies increased their efforts to develop survey measures of the severity and extent of hunger in the United States. The Food Research and Action Center sponsored a major series of surveys—the Community Childhood Hunger Identification Project (CCHIP)—to study hunger among children. The research of Radimer, Olson, Campbell, and colleagues at the Cornell University Division of Nutritional Sciences was directed toward developing indicators to assess hunger (Radimer, Olson, Green, Campbell, and Habicht, 1992; Radimer et al., 1990). At the federal government level in the mid 1980s, the U.S Department of Agriculture (USDA) began to analyze information obtained from the single survey question on the adequacy of household food supplies added since 1977 to its periodic Nationwide Food Consumption Survey. In the late 1980s, a food sufficiency question similar to the one in the Nationwide Food Consumption Surveys, along with other questions on regular access to food supplies adapted from the CCHIP questionnaire, were included by the National Center for Health Statistics (NCHS) in the third National Health and Nutrition Examination Survey (NHANES III).
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Food Insecurity and Hunger in the United States: An Assessment of the Measure THE 1990s: A PERIOD OF TRANSITION The year 1990 marks the beginning of the emergence of consensus on the appropriate conceptual basis for defining and measuring hunger in the United States. In 1990, the Life Sciences Research Office (LSRO) of the Federation of American Societies for Experimental Biology prepared a report based on discussions of the ad hoc Expert Panel convened in 1989 on Core Indicators of Nutritional State for Difficult-to-Sample Populations for the American Institute of Nutrition, under the provisions of a cooperative agreement with the U.S. Department of Health and Human Services (DHHS). This report was published in the Journal of Nutrition (Anderson, 1990). It summarizes the discussions of an ad hoc expert panel charged with identifying core indicators to assess the nutritional status of difficult-to-sample populations. The report contains what have become the consensus conceptual definitions for the terms “food security,” “food insecurity,” and “hunger,” as relevant to the United States and notes the relationship of food insecurity to hunger and malnutrition (Anderson, 1990, pp. 1575–1576, 1598). Food security was defined by the expert panel as “access by all people at all times to enough food for an active, healthy life, and includes, at a minimum: (a) the ready availability of nutritionally adequate and safe foods and (b) an assured ability to acquire acceptable foods in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies).” Food insecurity exists whenever there is “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.” Hunger in its meaning of “the uneasy or painful sensation caused by a lack of food” is in this definition “a potential, although not necessary, consequence of food insecurity. Malnutrition is also a potential though not necessary consequence of food insecurity…. Hunger, as a recurrent and involuntary lack of access to food which may produce malnutrition over time, is discussed as food insecurity in this report.” Lack of a standard operational definition of hunger in the past had been a major obstacle in estimating the extent of the problem. The expert panel decided that redefining the hunger problem in terms of food security could overcome some of these problems. As observed by Anderson (1990, p. 1575), “Examining hunger problems in the United States in terms of
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Food Insecurity and Hunger in the United States: An Assessment of the Measure food security may allow both researchers and policymakers to confront this issue on a more objective basis.” While hunger has been an issue of public interest for a long time, the concept of household food insecurity emerged in the United States as a hunger-related concept relatively recently. Internationally (especially in the poorer countries and regions), the term “food insecurity” has been in use for some time to describe the inadequacy of national or regional food supplies over time. More recently, it has been expanded to include lack of food access at the household and individual levels (LeBlanc et al., 2005; Habicht, Pelto, Frongillo, and Rose, 2004). The LSRO conceptual definitions provided a basis for the USDA/DHHS initiative for developing operational definitions of food insecurity and hunger appropriate for use in large national population surveys. The National Nutrition Monitoring and Related Research Act Also in 1990, Congress enacted the National Nutrition Monitoring and Related Research Act (NNMRR) (Public Law 101-445). Section 103 of the act required the secretaries of the Department of Agriculture and the Department of Health and Human Services, with the advice of a board, to prepare and implement a ten-year comprehensive plan to assess the dietary and nutritional status of the U.S. population. Task V-C-2.4 in the plan specified (Federal Register, 1993, 58:32 752–806): Recommend a standardized mechanism and instrument(s) for defining and obtaining data on the prevalence of “food insecurity” or “food insufficiency” in the U.S. and methodologies that can be used across the NNMRR Program and at state and local levels. A National Nutrition Monitoring Advisory Council was established on January 25, 1991, by Executive Order of the President as required by the NNMRR act (sect. 201 (a)(1)). The purpose of the advisory council was to provide scientific and technical advice on the development and implementation of the coordinated National Nutrition Monitoring and Related Research Program and the ten-year comprehensive plan and to serve in an advisory capacity to the secretaries of health and human services and agriculture. Implementation of the Ten-Year Plan Beginning in 1992, USDA staff systematically reviewed the existing research literature on the definition and measurement of food insecurity and hunger and on the practical problems of developing a survey instrument for use in sample surveys at the national, state, and local levels. This was the first step toward carrying out the responsibilities under the ten-year plan.
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Food Insecurity and Hunger in the United States: An Assessment of the Measure The Federal Food Security Measurement Project Responding to the legislative requirements and to seek advice from a large group of experts, in 1992 USDA and DHHS brought together representatives from several federal agencies, academic researchers, private organizations, and other stakeholders to form the Federal Food Security Measurement Project. This interagency group developed over the course of several years the food security instrument, a set of food security scales that combine information from sets of questions in the instrument, and classification rules for characterizing the food security status of each household surveyed. First National Conference on Food Security Measurement and Research In January 1994, USDA and DHHS sponsored the First National Conference on Food Security Measurement and Research, which brought together a large group of experts from government, academia, and elsewhere who had worked in the area of identifying and measuring hunger and other aspects of food insecurity. This conference focused on issues of measurement and related research. The USDA and DHHS interest in measurement of food insecurity and hunger was that the measures developed be straightforward and relevant to public policy and policy makers and that they be scaled measures to reflect the variation in the level of severity of the condition observed. The purpose and objectives of the conference were to (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 1994, p. iv): review the existing state of the art in operationalizing and measuring the dimensions of hunger and food insecurity in American households; clarify and seek consistency in the terminology employed in discussing resource-constrained hunger and food insecurity; explore the extent of consensus that has developed in the scholarly and research communities on the technical means of identifying and measuring resource-constrained food insecurity and hunger; obtain advice on the next steps needed to create a state-of-the-art survey instrument and database from which national prevalence measurement of food insecurity and hunger can be made; and consider some of the implications for research that would result from the availability of a standardized, annual national data set for the measurement of household-level hunger and food insecurity.
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Food Insecurity and Hunger in the United States: An Assessment of the Measure The conference identified the initial consensus among the participants on the appropriate conceptual basis for a national measure of food insecurity and on the technical means and feasibility of measuring hunger and food insecurity. The participants decided that food insecurity was the most important concept to measure, but some in the group held that hunger should be part of the measurement project as a device for advocacy (Habicht et al., 2004). The conference also resulted in a working agreement on several key issues, previously unresolved, as to the best measurement approach for implementation of a measure in national data collection, and the optimal content and form of a food security survey instrument for application at the national level. Conference participants decided: to limit the measure to clearly poverty-linked or resource-constrained food insecurity and hunger and not attempt to measure hunger resulting from reasons other than resource constraints; to limit operational definitions and measurement approach to those aspects of food security that can be captured in household-level surveys; to focus on the behavioral and experiential dimensions of food insecurity and hunger (which were seen as the major gap in existing information and an essential component for policy makers); to estimate the prevalence of food insecurity and hunger from the resulting data by scaling items into a single measure across all observed levels of severity of the phenomenon being measured if feasible; and to develop a standard set of prevalence estimates at several designated levels of severity for consistent application and comparison across data sets from year to year. Participants further noted that agencies involved in collecting individual-level data might develop complementary approaches for measuring food insecurity at the specific individual level, whereas issues of community food security would require a different data collection strategy and orientation, outside the scope of the present effort (Hamilton et al., 1997a). As a follow-up to the conference, USDA held additional meetings with the interagency working group, interested conference participants, and the Census Bureau staff to further explore, develop, and expand on the themes articulated in the conference. In order to follow up on the technical issues surfaced during the conference, USDA also commissioned additional analytical work based on two independent data sets of comprehensive hunger and food insecurity indicator items: the data set developed by the research group at Cornell University Division of Nutritional Sciences and the data
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Food Insecurity and Hunger in the United States: An Assessment of the Measure set developed by the CCHIP (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 1994). FOOD SECURITY SUPPLEMENT TO THE CURRENT POPULATION SURVEY In February 1994, USDA entered into an interagency agreement with the Census Bureau to develop, test, analyze, and refine a food security questionnaire as a supplement to the April 1995 Current Population Survey (CPS). The draft version of the questionnaire from the research conference was revised after deliberations and extensive cognitive testing and review by an expert team from the Center for Survey Methods Research (CSMR) and the Current Population Survey Branch of the Census Bureau. Technical direction of these extensive survey method refinements was provided by Eleanor Singer and the CSMR. The revised questionnaire was field-tested in April 1994. The results of the field test were analyzed by the fall of 1994, and further revisions were made to the questionnaire based on the recommendations flowing from the analysis of the pretest results (Hess, Singer, and Ciochetto, 1996). The questionnaire was fielded as a supplement to the CPS of April 1995 (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 1994; Andrews, Bickel, and Carlson, 1998). The CPS is a representative national sample survey of about 60,000 households that are surveyed monthly by the U.S. Census Bureau for the U.S. Department of Labor. It is a probability sample based on a stratified sampling design of the civilian, noninstitutionalized population. The CPS is the primary source of information on labor force characteristics of the United States. Various federal agencies sponsor collection of specialized supplementary data by the CPS following the labor force interview. The Food Security Supplement (FSS) has been added to the CPS every year since 1995 (the supplement appears in Appendix A). It was repeated in September 1996, April 1997, August 1998, April 1999, September 2000, April 2001, December 2001, and in December of subsequent years. During 1996 and 1997, USDA made minor modifications to the questionnaire format and screening procedures. More substantial revisions in screening and format were introduced in 1998 to reduce respondent burden and improve data quality. The full FSS to the CPS includes more than 70 questions (including 2 follow-ups of about 15 questions) regarding expenditures for food, various aspects of food spending behavior and experiences during the 30 days and 12 months prior to the interview, use of federal and community food programs, food sufficiency and food security, and coping strategies. Within the FSS is the Household Food Security Survey Module (HFSSM)—a set of 10 questions for households with no children and 18 questions for households with children—that is used to calculate the house-
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Food Insecurity and Hunger in the United States: An Assessment of the Measure hold food security scale and then to estimate the prevalence of food insecurity (see Box 2-1). This set of questions appears in the section on food sufficiency and security in the FSS. The questions in the HFSSM have remained essentially unchanged over the years. These questions elicit information on whether the household experienced difficulty in meeting basic food needs due to a lack of resources. The severity of the food access problems covered by the food insecurity questions ranges from “worry about running out of food” to “children ever not eating for a whole day.” The questions specify that any behavior or condition must be due to a lack of economic or other resources to obtain food, so the scale is not affected by hunger due to voluntary dieting, fasting, or being too busy to eat or other similar reasons. In an effort to keep respondent burden and annoyance low and at the same time not miss very many food-insecure households, the food insecurity questions and questions about ways of augmenting inadequate food resources are asked only of households with incomes below 185 percent of the federal poverty line and of households with incomes above that line if they give any indication of food access problems on either of the two screener questions (described in Chapter 4). Households with annual incomes above 185 percent of the poverty line and who give no indication of food access problems on these preliminary screener questions (one at the start of the section on food assistance program and participation, and the second at the start of the section on food sufficiency and security) are presumed to be food secure and are not asked subsequent questions. USDA analysis has shown that, given the screeners, only a very small number of food-insecure households are missed. Research Activities on the Food Security Supplement USDA undertook a considerable amount of research after fielding the supplement in 1995. As a condition of the Terms of Clearance for the April 1995 Food Security Supplement to the CPS, the Office of Management and Budget requested that the Census Bureau’s Center for Survey Methods Research conduct an evaluation of the supplement questionnaire. Hess and colleagues (1996) conducted the evaluation, compared the results to those obtained during a pretest of the questionnaire conducted in August 1994, and provided recommendations for revising the questionnaire based on their evaluation. Initial analysis of the data from the 1995 FSS was undertaken by Abt Associates, Inc., through a contract with USDA, and in consultation with the interagency working group on food security measurement and other key researchers involved in developing the questionnaire. The analysis focused on developing and implementing a measure of the severity of food insecurity. The aim was to help develop and assess a scale based on the FSS
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Food Insecurity and Hunger in the United States: An Assessment of the Measure Box 2-1 Questions Used to Assess the Food Security of Households in the CPS Food Security Supplement “I/We worried whether my/our food would run out before I/we got money to buy more.” Was that often, sometimes, or never true for you/your household in the last 12 months? “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? “We couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true for you in the last 12 months? In the last 12 months, did you or other adults in the household ever cut the size of your meals or skip meals because there wasn’t enough money for food? (Yes/No) (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? In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food? (Yes/No) In the last 12 months, were you ever hungry, but didn’t eat, because you couldn’t afford enough food? (Yes/No) In the last 12 months, did you lose weight because you didn’t have enough money for food? (Yes/No) In the last 12 months did you or other adults in your household ever not eat for a whole day because there wasn’t enough money for food? (Yes/No) that measures the severity of deprivation in basic food needs as experienced by U.S. households, to consider technical issues that arose in the development of the scale, and to produce a measurement scale for the severity of food insecurity (for a detailed description of this analysis, see Hamilton et al., 1997a, 1997b). Following the collection of the 1996 and 1997 CPS food security data, USDA contracted with Mathematica Policy Research, Inc., to use multiple years of data from the FSS to consider empirical issues that had arisen, such
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Food Insecurity and Hunger in the United States: An Assessment of the Measure (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 are asked only if the household included children age 0-18) “We relied on only a few kinds of low-cost food to feed our children because we were running out of money to buy food.” Was that often, sometimes, or never true for you in the last 12 months? “We couldn’t feed our children a balanced meal because we couldn’t afford that.” Was that often, sometimes, or never true for you in the last 12 months? “The children 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? In the last 12 months, did you ever cut the size of any of the children’s meals because there wasn’t enough money for food? (Yes/No) In the last 12 months, were the children ever hungry but you just couldn’t afford more food? (Yes/No) In the last 12 months, did any of the children ever skip a meal because there wasn’t enough money for food? (Yes/No) (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? In the last 12 months, did any of the children ever not eat for a whole day because there wasn’t enough money for food? (Yes/No) SOURCE: Nord, Andrews, and Carlson (2005b) as the stability of the measurement scale over time, temporal adjustments to the categories for classifying severity of food security, the appropriate methods for assessing changes in the prevalence of food insecurity in the United States, screening issues, and imputation for missing data, among others (see Ohls, Radbill, and Schirm, 2001). The study focused on issues that arise in the development of a stable and consistent ongoing social indicator and issues that are critical when prevalence is measured on a routine basis and changes in prevalence are closely monitored by policy makers. The findings
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Food Insecurity and Hunger in the United States: An Assessment of the Measure of this study established the stability of the food security scale over the 1995–1997 period. At the same time, the authors recognized some of the limitations of the model, particularly the process used to translate the continuous food security scale into food security categories, which is more judgmental than the process of deriving continuous scale scores. On the basis of their analyses, the authors suggested several directions for future research. Under contract with USDA, IQ Solutions, Inc., assessed methodological issues and provided guidance with a specific focus on the 1998 and 1999 data and on measuring the food security of children in the first five years of CPS data collection (see Cohen et al., 2002). The focus of this study was to explore key technical issues related to the FSS, including techniques for the estimation of standard errors, the effect of alternating survey periods between spring and fall for the 1995–1999 CPS Supplement, and the effect of using different item response theory modeling approaches and software to create the food security scale. Finally, USDA entered into a cooperative agreement with a group of statisticians and economists at Iowa State University (1997–2003) to conduct research designed to strengthen and improve the measurement of food security and hunger. Their research considered various statistical issues in measuring food insecurity and hunger and specifically the statistical properties of the Rasch model, which is used to scale responses to the FSS (see Opsomer, Jensen, Nusser, Dringel, and Amemyia, 2002; Froelich, 2002; Opsomer, Jensen, and Pan, 2003). The study had two main purposes: to evaluate the robustness of the approach used for the measurement of food insecurity and to measure the effect of household-level variables on measured food insecurity. Both purposes were addressed by fitting the food security data with a class of models that generalizes the Rasch model and comparing the estimates obtained from the different models on several years of CPS data. An initial product of this work was a review of the statistical properties of the Rasch model used by USDA to obtain estimates of the prevalence and severity of poverty-linked food insecurity and hunger in the United States (Opsomer et al., 2002). The authors point to several issues intended as a basis for discussion concerning future directions for research and plans of work, raising questions about the current approach for estimating the severity and prevalence of food insecurity and hunger as implemented by USDA. They identified a number of important issues in the estimation of food insecurity in the United States, including the use of a one-parameter logistic item response model (also referred to as a Rasch model); question construction; the impact of changes introduced in the 1998 CPS questionnaire, especially the introduction of new skip patterns that need to be evaluated; possible uses for the responses to the 30-day items; and measuring food insecurity in certain subpopulations. Opsomer and colleagues (2002)
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Food Insecurity and Hunger in the United States: An Assessment of the Measure concluded that “food insecurity is a multidimensional concept, experienced differently by different household types and population groups. While an overall measure of food insecurity, valid for the whole U.S. population, would be desirable, it is likely that such a measure would underestimate hunger and food insecurity for certain subgroups, especially for children and elderly adults…. Food insecurity is a complex issue that may not be fully captured by a one-dimensional item response model, especially as it will be used to track food insecurity over time, across different surveys, and for different subpopulations” (p. 25). Opsomer and colleagues (2003) took a closer look at the measurement of food insecurity and the effect of household variables on measured food insecurity. Using data from the 1995, 1997, and 1999 food security module of the CPS, they evaluated the effects of demographic and survey-specific variables on the food insecurity/hunger scale using a generalized linear model with mixed effects. The Rasch model used by USDA assumes that the food insecurity questions are interpreted in the same manner by all households interviewed. If this assumption does not hold, the estimated question scores and the estimates derived from them are potentially biased. The generalized linear mixed model used by the authors makes it possible to incorporate household variables as well as interactions between these variables and the question scores. Having these types of variables explicitly in the model provides answers to such questions as: Are certain demographic groups more likely to be food insecure? Are survey mode effects present in the survey? Are certain questions understood differently by certain demographic groups? Opsomer and colleagues (2003) generally validated the model used by USDA across time periods; however, there was some evidence that interpretation of questions may vary among demographic groups, a conclusion also reached by other researchers. The authors recommended further research to understand the robustness of the method across different subgroups and in the context of alternate survey modes and experiences of hunger. Froelich (2002) examined the aspect of dimensionality in the USDA food insecurity measure using other analysis from the field of item response theory. The study focused on the dimensionality of the food security index for households with children. The paper introduces the item response theory definition of dimensionality, describes two different exploratory dimensionality analyses, and reports on the results of these analyses. The analyses provided evidence of the presence of two dimensions in the USDA food insecurity scale for households with children. The items in the first dimension measure food insecurity and hunger of the household adults, and the items in the second dimension measure the food insecurity of the children in the household. Froelich concluded that further research is needed to find the amount of the potential bias of the item severity estimates used to con-
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Food Insecurity and Hunger in the United States: An Assessment of the Measure struct the scale and to determine a method of dealing with the multidimensionality of food insecurity and hunger present in households with children. Second Conference on Food Security Measurement and Research In 1999, USDA and DHHS hosted the Second Conference on Food Security Measurement and Research. This conference focused on priorities for a future research agenda. Efforts were made to ensure a wide range of perspectives and to solicit critical review of the standard measure and prior research. The papers and proceedings of the conference were published by USDA (Andrews and Prell, 2001a, 2001b). The Interagency Working Group on Food Security Measurement met after the conference to review the proceedings and identified a set of research priorities that flowed from the conference. The major themes of highest priority are shown in Box 2-2. USES OF THE HOUSEHOLD FOOD SECURITY SURVEY MODULE IN OTHER SURVEYS The federal food security measurement project has developed standardized questionnaires and methods for producing household summary measures of food security status. These modules are, or have been, used at times with modifications in several national surveys and in a growing number of state, local, and regional studies. Also, there are several instances of their adaptation for use in other countries. Examples of some of these uses are briefly summarized below. Surveys in the United States The food security module, or a modification of it, has been incorporated at some time in national surveys by the various agencies participating in the Federal Food Security Measurement Project. Some of these surveys are shown below. The National Health and Nutrition Examination Survey (NHANES IV), conducted by NCHS, has included the 18-item HFSSM in the family interview part of the household interview since 1999. Individually referenced food security questions (7 for participants age 16 and older, 6 for participants younger than age 16) were added to the postdietary recall component of the examination section and were released with the 2001–2002 food security data release. NHANES continues to collect both the household- and individual-level food security data.
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Food Insecurity and Hunger in the United States: An Assessment of the Measure Box 2-2 Priority Research Agenda Research Priorities: Measurement Development and testing of individual (as opposed to household) scales for measurement of prevalence of food insecurity among adults and children; Improvements in the measurement and understanding of the dynamics of food insecurity, such as frequency and duration of episodes; Developing better questions and strategies for asking about nutritional quality (alternative to balanced meal questions); Assessment of the effects of the questionnaire structure, item sequencing, and survey context on response patterns and measured food security levels; and Determination of research situations appropriate for implementation of abbreviated household food security scales and/or scales with different time frames such as monthly versus annual. Research Priorities: Applications and Policy Focus on sampling and research on food insecurity and its consequences among high-risk groups with chronic health conditions, mental illness, and other biological vulnerability (especially among the homeless, elderly, and young children); Development of a research basis for linking community food security and household food insecurity; Better understanding of the context and determinants of food insecurity and hunger and their relationship to poverty, household resources, and time management; and Applications that assess and investigate the linkages between food insecurity measures, welfare reform, and measures of program performance. Source: Andrews and Prell (2001a) The Division of Nutrition of the Centers for Disease Control and Prevention (CDC), NCHS, and USDA have worked together to develop subscales of the 18-item scale, such as a 6-item set, that could be used to measure food insecurity and hunger in state surveillance systems, such as the NCHS State and Local Area Integrated Telephone Survey and the CDC Pediatric Nutrition Surveillance System.
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Food Insecurity and Hunger in the United States: An Assessment of the Measure The Census Bureau’s Survey of Program Dynamics, fielded for five consecutive years beginning in 1998, included the 18-item food security module. The Survey of Income and Program Participation (SIPP) included a subset of six questions (but not the standard six-item set) in the adult well-being module once during each panel beginning in 1998 (see Chapter 6 for further description of SIPP). The Early Childhood Longitudinal Survey, Kindergarten Class of 1998–1999 (ECLS-K) and Birth Cohort of 2002 (ECLS-B), incorporated the HFSSM. ECLS-K and ECLS-B are longitudinal surveys of the U.S. Department of Education’s National Center for Education Statistics. ECLS-K follows a nationally representative sample of about 22,000 children from kindergarten to fifth grade (and likely beyond); ECLS-B follows a nationally representative sample of about 10,000 newborn children for their first several years. The University of Michigan Panel Survey of Income Dynamics included the household food security survey module in a special supplement on women and children in 1997 and in the full sample beginning in 1999. The Behavioral Risk Factor Surveillance System included questions on food sufficiency in the social context module. Eight states collected the information at some point between 1996 and 1999. A number of state surveys used all or a part of the HFSSM: Oregon included the short six-item food security module in the Oregon Population Survey in 2000. The California Health Interview Survey included the short six-item food security module beginning in 2001. Welfare, Children and Families: A Three City Study was conducted in Boston, San Antonio, and Chicago. The study is a collaboration among several universities. It included limited food security and hunger questions, some of which appear to be taken directly from the Food Security Supplement. The Wisconsin Food Security Survey in the WIC population included the six-item limited interview. The survey was translated into Spanish, Hmong, and Russian. Iowa included the six-item food security module in a survey of WIC participants in English and Spanish beginning in 2003.
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Food Insecurity and Hunger in the United States: An Assessment of the Measure International Adaptations Several countries have developed food security measures based on approaches similar to those of the United States. At times this is achieved with simple translation of the questions in the U.S. module into the local language. At other times to achieve acceptable results, the U.S. measure has required adaptation to settings that may be culturally, linguistically, and economically different from the United States; this may require additional research, including focus groups and cognitive testing of proposed questions and statistical analysis of survey data. Such adaptations have been used in low-income populations in Orissa, India; Kampala, Uganda; and Bangladesh (see Nord, Sathpathy, Raj, Webb, and Houser, 2002, for a detailed description). Still other efforts in Bangladesh and Burkina Faso have taken the approach that was used to develop the U.S. module by conducting ethnographic interviews on people’s experience of food insecurity, developing questionnaire items, and testing them (Frongillo, Chowdhury, Ekström, and Naved, 2003; Frongillo and Nanama, 2003; Webb, Coates, and Houser, 2003). The following are brief summaries of some of the more significant international adaptations of the U.S. food security measurement methods.1 These are all nationally representative surveys. Pilot surveys and surveys of targeted populations have been conducted in many other countries. Israel conducted a national-level food security assessment as part of a national health and nutrition survey in 2003. The data were analyzed and reported by the JDC-Brookdale Institute (an academic research institution) in partnership with the Ministry of Health, the National Insurance Institute, the Ministry of Social Affairs, and the Forum to Address Food Insecurity and Poverty in Israel. Brazil—The government of Brazil conducted a nationally representative food security assessment in 2004 in connection with a national health and nutrition survey. The data have not yet been analyzed. The measurement project in Brazil has very high political visibility because the current president of Brazil ran on a platform of “zero hunger.” Results of one of the pilot surveys on which the final survey module and methods were based were published in the Journal of Nutrition (Pérez-Escamilla et al., 2004). 1 Email communication with Mark Nord, Economic Research Service, USDA, on April 29, 2005.
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Food Insecurity and Hunger in the United States: An Assessment of the Measure Colombia—Collection of nationally representative survey data on food security in Colombia is currently in progress. A report based on data collected in one province to pilot and finalize the methodology is available (in Spanish only), “Perfil Alimentario y Nutricional de los Hogares: Analisis Comparativeo entre las Regiones de Antioquia.” Serbia, Yugoslavia—United Nations Food and Agriculture Organization (FAO) staff assessed food security in the Republic of Serbia (Yugoslavia) in 2002 through five coordinated household surveys. The Economic Research Service of USDA provided technical assistance on data assessment and analysis. The results were used in FAO but have not been published. Argentina—The World Bank conducted a food security assessment in Argentina in connection with a survey to assess the social impact of a recent economic crisis. Yemen—A nationally representative assessment of food security was conducted in Yemen in 2003. The results have not yet been officially reported. In summary, the Food Security Supplement to the CPS is the cornerstone of the Federal Food Security Measurement Project, which began in 1992 to carry out a key task assigned by the Ten-Year Comprehensive Plan, namely, to develop a standard measure of food insecurity and hunger for the United States for use at the national, state, and local levels. A large body of literature has developed from research, both internal and external to USDA and DHHS, covering methodological topics related to the measurement of food security, and the measure has been adapted for use in several other countries. This research has prompted further refinements and modifications to the food security questionnaire, including among other things a shorter, six-item food security module and measure, separate adult and child food security measures, a revised 30-day measure, and the translation of the survey module into Spanish. The research has also raised questions that USDA should address.
Representative terms from entire chapter: