Food security has been defined as “Access by all
people at all times to enough food for an active,
healthy life.” In 1997, the Federal Government
released the first national food security measure, called
the Core Food Security Module (CFSM). The 18-item
CFSM is designed to measure the extent and severity
of household food insecurity over 12 months. It actually
consists of two measures: a scale measure based
on Rasch item-response theory, and a categorical
measure. The categorical measure is used to estimate
the prevalence of household food insecurity and
hunger. Each respondent’s sum of affirmative
responses is used to categorize households: zero to 2
affirmative responses yields classification as food
secure. For households with children, 3 to 7 affirmative
responses leads to a categorization of food insecurity
without hunger, 8 to 12 affirmative responses as
food insecurity with moderate hunger, and 13 or more
affirmative responses as food insecure with severe
hunger. A subscale of six food security items has also
been proposed as a food security monitoring tool.
Derrickson, who received small grants in 2 consecutive
years to conduct research on food security in
Hawaii, has consolidated her findings and presents her
recommendations here. The practical outcome of her
research has been to develop an effective food security
monitoring tool for use in Hawaii.
Derrickson used five samples and various methodological
approaches to study food insecurity measurement
in the ethnically diverse State of Hawaii, as follows:
- A qualitative study assessing the conceptual framework
of the CFSM with Caucasian, Filipino,
Hawaiian and Part-Hawaiian, and Samoan charitable
food recipients (n=61);
- A pilot stability study of recent recipients of charitable
food who completed the CFSM over the phone
twice (n=61);
- A series of quantitative studies used to assess the
scale measure, the categorical measure, and the individual-
level CFSM; this sample consisted of 1459
respondents from the 1998 Hawaii Health survey (a
statewide telephone survey) and 206 charitable food
recipients;
- A qualitative study examining (1) definitions of
food insecurity and hunger, (2) how hunger should
be measured, (3) interpretations of reports on the
CFSM and an alternative Face Valid Food Security
Measure (FVFSM), and (4) the value of specific
indicators among food security stakeholders in
Hawaii (a sample of 19 WIC nutritionists, 10 food
pantry providers, 4 food bank board members, 4
social workers, 3 legislators, and 3 providers of food
to the homeless); and
- A statewide “food security monitoring pilot study”
that used six of the CFSM indicators (n=4351).
Derrickson compared her findings to outcomes of
previous food security research and to the CFSM technical
research report released in 1997. Her study is the
first comprehensive, independent assessment of the
CFSM. She found that:
- The CFSM yields valid and reliable scale measures
among Asians and Pacific Islanders in Hawaii,
except possibly with American Samoans (n=18).
- The CFSM is a “face valid” measure of food security
among Asians and Pacific Islanders in Hawaii.
- The CFSM categorical algorithm appears to yield
inconsistent results: 27 percent of 111 households
identified as food secure with one or more affirmative
responses replied affirmatively to the “Unable
to afford to eat balanced meals” item; only 50
percent of 64 households classified as experiencing
moderate hunger responded affirmatively to
“Respondent hungry” item.
- There is a need to reduce the response burden
of the 18-item measure for hungry households
with children.
- An alternative “face valid” categorical algorithm
provided a more sensitive way to categorize affirmative
responses. The alternative would classify those
respondents with one affirmative response as “at
risk of hunger” and those who responded affirmatively
to either the “respondent hungry” item or the
“adults didn’t eat for a whole day” item as “adult
hungry.” Those who responded affirmatively to the
“children hungry” item were classified as having
“child hunger” under this alternative. Compared to
the CFSM, this algorithm classifies a lower
percentage of households as food secure, but a
similar percentage as hungry.
- An alternative “simple food security monitoring
tool” based on the “face valid” algorithm had strong
Rasch goodness-of-fit statistics and was more
consistent with the information desired by food
security stakeholders in Hawaii than the recommended
six-question food security subscale. It estimates
the number of households experiencing “food
anxiety,” hunger among adults and hunger among
children, and can be used to approximate the CFSM.
A similar tool was used in the Hawaii Health Survey
1999 study.
Derrickson derives a number of recommendations
from her findings. First, she recommends continuing
ongoing food security research efforts that: (a)
examine the robustness of the CFSM across diverse
population groups; (b) develop simple measures of
individual-level hunger; (c) develop measures of duration
of household food insecurity and individual
hunger among adults and children; and (d) develop
and use shorter tools that effectively capture what policymakers
and food assistance program managers need
to know to ameliorate household food insecurity in
their local communities.
Her second set of recommendations suggests
reassessing fundamental aspects of the national food
security monitoring tool, including: (a) the intended
purpose of food security monitoring and the definitions
used; (b) the importance of measuring “food
insecurity” vs. “food insufficiency”; (c) the psychological
element of food insecurity (i.e., Q2 “worried”);
(d) adding items to the scale measure that confirm
food security; (e) the wording of the general balanced
meal indicator, “unable to afford to eat balanced
meals”; and (f) the “face” (i.e., content) validity of the
CFSM categorical measure.
Third, she urges support for local and State food security
monitoring, using a simple food security measurement
tool. Derrickson suggests that monitoring be
used to identify the best survey methods for ensuring
the accuracy of household food security prevalence
data and for screening “at risk” households.
Derrickson cautions that prudence be used when
extending findings to ethnic groups and areas not
studied. She argues that her findings support the need
for further assessment of the purpose of food security
monitoring. Future research should address effective
use of food security monitoring at the State or local
level to achieve the Healthy People 2010 food security
objective, and ultimately to end resource-constrained
hunger in the United States.
