P2B015: The Impact of Food Insecurity and Social Determinants of Health on Families in a Pediatric Emergency Department

Background: Food insecurity (FI) in childhood has been shown to result in poor health outcomes and increased risk of chronic disease. FI also frequently occurs with other negative social determinants of health (SDH). The California Health Information Survey (CHIS) estimated that 18.8% of San Diego County children experienced FI in 2017. Our pediatric emergency department (PED) serves a large catchment area, and represents a unique location to identify a food insecure population. We aim to estimate the prevalence of FI in families presenting to the PED, compare sociodemographic factors between FI and non-FI families, and investigate geographical trends of FI in our region.

Methods: We conducted an electronic survey of caregivers presenting to the PED. The survey consisted of six previously validated FI screening questions, and 26 questions regarding demographics and SDH. Caregivers were approached via convenience sampling and were permitted to omit any items. Screening took place on participants’ personal electronic devices after scanning a QR code. FI was determined according to prior methods from CHIS. Food-secure and FI groups were compared using chi-square for categorical variables and student t-test for continuous variables. Spatial cluster analysis and geographic information systems (GIS) software was utilized to identify areas with high rates of FI.

Results: Between 06/2022 and 02/2023, 1000 caregivers were approached for participation with 526 completing the screening (52.6% survey completion). Food insecurity was reported by 50.0% of caregivers (95% CI 45.7% - 54.3%). Characteristics of food-secure and food-insecure families are presented in Table 1. Compared with food-secure caregivers, those reporting FI were significantly more frequently of Hispanic ethnicity or black race, reported lower household income, and higher rates of caregiver disability, difficulty paying rent/mortgage, and homelessness. Despite FI families frequently receiving local or government food services, greater than 50% of FI families reported not receiving services. Figure 1 geographically represents the proportion of FI by zip code, and identifies recognizable areas with high rates of FI.

Conclusion: Half of caregivers presenting to the PED screened positive for FI. Families experiencing FI were more likely to have lower income and experience housing and employment insecurity. Despite 90% of FI families reporting having a PCP, more than half additionally reported not receiving food services. Several zip codes demonstrated higher than average rates of FI. These results support the importance of FI screening and the potential impact of resource provision and social service support at the point-of-care in the PED, as well as community efforts targeted at geographic areas with higher FI burden.