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Observational Study
. 2025 Mar 15;26(3):396-405.
doi: 10.5811/westjem.40006.

Feasibility of an Emergency Department-based Food Insecurity Screening and Referral Program

Victor Cisneros  1 , Ian Dennis Capo Olliffe  2 , Marco Santos Esteban  2 , Joseph Bui  1 , Armin Takallou  3 , Shahram Lotfipour  2 , Bharath Chakravarthy  2
Affiliations
Observational Study

Feasibility of an Emergency Department-based Food Insecurity Screening and Referral Program

Victor Cisneros et al. West J Emerg Med. .

Abstract

Introduction: Food insecurity (FI) remains a pervasive issue in the United States, affecting over 12.8% of households. Marginalized populations, particularly those in urban areas, are disproportionately impacted. The emergency department (ED) holds potential as a vital outreach hub, given its diverse patient population and extensive service coverage. In this study we explore the feasibility of implementing an ED-based FI screening and referral program at an urban, academic teaching hospital. We aimed to assess the prevalence of FI among ED patients and evaluate the feasibility of a three- and six-week follow-up to assess patients' FI and related barriers to resource referral utilization.

Methods: This single-center, observational study was conducted at an urban, academic ED from 2018-2024. Initial FI screening was performed using a validated two-question survey adapted from the Hunger Vital Sign screening tool. Participants who screened positive were enrolled and completed the 10-item US Department of Agriculture Adult Food Security survey, received a food assistance guide, and were followed up at three- and six-week intervals to assess changes in FI status.

Results: Among 6,339 participants, 1,069 (16.9%) experienced FI, with the highest rates among Black non-Hispanic (24.7%) and Spanish-speaking participants (28.7%). Of the 1,069 participants who screened positive for FI, 630 (59.0%) were enrolled in the study. Of the enrolled participants, 161 (25.6%) completed the three-week follow-up phone calls, and 48 (7.6%) completed the six-week follow-up. The mean FI score for these 48 participants decreased from 6.67 (SD 2.68) at enrollment to 4.75 (SD 2.85) at the three-week follow-up (P < 0.001), and to 4.25 (SD 3.48) by the six-week follow-up (P < 0.001). Barriers to using the food resource guide, such as time constraints, transportation, and misplacement of resources, limited many participants' engagement.

Conclusion: This study demonstrated the feasibility and effectiveness of an ED-based food insecurity screening and resource referral program, associated with a significant reduction in food insecurity scores among participants. However, barriers such as time constraints, transportation issues, and misplacement of referral materials limited engagement. Addressing these barriers through tailored follow-up and systematic support systems, including universal screening during ED intake and personalized assistance, can enhance the program's accessibility and impact.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This research was supported by Abound Food Care and the Undergraduate Research Opportunities Program (UROP) at the University of California, Irvine. There are no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart depicting screening, enrollment, and follow-up methodology. HIPAA, Health Insurance Portability and Accountability Act; USDA, US Department of Agriculture.
Figure 2
Figure 2
Longitudinal analysis of food insecurity (FI) scores among 48 participants who completed all follow-up surveys. FI, food insecurity.
Figure 3
Figure 3
Helpfulness of food resource referral rated by participants during phone follow-ups.
See this image and copyright information in PMC

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