Food Security, Health, and Medication Expenditures of Emergency Department Patients


      Background: In the United States, 35 million people live in food-insecure households. Although food insecurity and hunger are undesirable in their own right, they also are potential precursors to nutritional, health, and developmental problems. Study Objectives: To examine the prevalence of household food insecurity and its association with health problems and medication expenditures among Emergency Department (ED) patients. Methods: We conducted a cross-sectional study in four Boston-area EDs and enrolled consecutive adult patients during two 24-h periods at each site. Food security status was measured using the validated 18-item US Household Food Security Survey Module. Results: Overall, 66 (13%; 95% confidence interval [CI] 10–17%) of 520 ED patients screened positive for food insecurity. Among these 66 patients, 32 (48%; 95% CI 36–61%) reported food insecurity with hunger. Patients from food-insecure households differed from food-secure patients with respect to sociodemographic factors. Food-insecure patients were more likely than food-secure patients to report a variety of chronic and mental health problems (all p < 0.05), including obesity. Food-insecure patients, compared to food-secure patients, also were more likely (all p < 0.001) to put off paying for medication to have money for food (27% vs. 4%, respectively), to take medication less often because they couldn't afford more (32% vs. 4%, respectively), to report needing to make a choice between buying medication and food (27% vs. 2%, respectively), and to report getting sick because they couldn't afford to take medication (27% vs. 1%, respectively). Conclusions: ED patients from food-insecure households report more chronic and mental health problems, and difficulty purchasing medication.


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        • Nord M.
        • Andrews M.
        • Carlson S.
        Household food security in the United States, 2006 (Report No.: ERR-49).
        United States Department of Agriculture, Economic Research Service, Washington, DC2007
        • Brown J.L.
        • Shepard D.
        • Martin T.
        • Orwat J.
        The economic cost of domestic hunger.
        Sodexho Foundation, Gaithersburg, MD2007
        • Cook J.T.
        • Frank D.A.
        • Levenson S.M.
        • et al.
        Child food insecurity increases risks posed by household food insecurity to young children's health.
        J Nutr. 2006; 136: 1073-1076
        • Kersey M.A.
        • Beran M.S.
        • McGovern P.G.
        • Biros M.H.
        • Lurie N.
        The prevalence and effects of hunger in an emergency department patient population.
        Acad Emerg Med. 1999; 6: 1109-1114
        • Bickel G.
        • Nord M.
        • Price C.
        • Hamilton W.
        • Cook J.T.
        Guide to measuring household food security.
        U.S. Department of Agriculture, Food and Nutrition Service, Alexandria, VA2000
        • Vozoris N.T.
        • Tarasuk V.S.
        Household food insufficiency is associated with poorer health.
        J Nutr. 2003; 133: 120-126
        • Klesges L.M.
        • Pahor M.
        • Shorr R.I.
        • Wan J.Y.
        Financial difficulty in acquiring food among elderly disabled women: results from the Women's Health and Aging Study.
        Am J Public Health. 2001; 91: 68-75
        • Dietz W.H.
        Does hunger cause obesity?.
        Pediatrics. 1995; 95: 766-767
        • Olson C.M.
        Nutrition and health outcomes associated with food insecurity and hunger.
        J Nutr. 1999; 129: 521S-524S
        • Adams E.J.
        • Grummer-Strawn L.
        • Chavez G.
        Food insecurity is associated with increased risk of obesity in California women.
        J Nutr. 2001; 133: 1070-1074
        • Townsend M.S.
        • Peerson J.
        • Love B.
        • Achterberg C.
        • Murphy S.P.
        Food insecurity is positively related to overweight in women.
        J Nutr. 2001; 131: 1738-1745
        • Rose D.
        • Bodor J.N.
        Household food insecurity and overweight status in young school children: results from the Early Childhood Longitudinal Study.
        Pediatrics. 2006; 117: 464-473
        • VanEenwyk J.
        • Sabel J.
        Self-reported concern about food security associated with obesity—Washington, 1995–1999.
        MMWR Morb Mortal Wkly Rep. 2003; 52: 840-842
        • Gundersen C.
        • Lohman B.J.
        • Eisenmann J.C.
        • Garasky S.
        • Stewart S.D.
        Child-specific food insecurity and overweight are not associated in a sample of 10- to 15-year-old low-income youth.
        J Nutr. 2008; 138: 371-378
        • Matheson D.M.
        • Varady J.
        • Varady A.
        • Killen J.D.
        Household food security and nutritional status of Hispanic children in the fifth grade.
        Am J Clin Nutr. 2002; 76: 210-217
        • Kaiser L.L.
        • Melgar-Quiñonez H.R.
        • Lamp C.L.
        • Johns M.C.
        • Sutherlin J.M.
        • Harwood J.O.
        Food security and nutritional outcomes of preschool-age Mexican-American children.
        J Am Diet Assoc. 2002; 102: 924-929
        • Hanson K.L.
        • Sobal J.
        • Frongillo E.A.
        Gender and marital status clarify associations between food insecurity and body weight.
        J Nutr. 2007; 137: 1460-1465
        • Drewnowski A.
        • Specter S.E.
        Poverty and obesity: the role of energy density and energy costs.
        Am J Clin Nutr. 2004; 79: 6-16
        • Morland K.
        • Wing S.
        • Diez Roux A.
        • Poole C.
        Neighborhood characteristics associated with the location of food stores and food service places.
        Am J Prev Med. 2002; 22: 23-29
        • Kleinman R.E.
        • Murphy J.M.
        • Wieneke K.M.
        • Desmond M.S.
        • Schiff A.
        • Gapinski J.A.
        Use of a single-question screening tool to detect hunger in families attending a neighborhood health center.
        Ambul Pediatr. 2007; 7: 278-284