Project:
Summary of 3 Years of Food Security Measurement Research in Hawaii

Year: 2000

Investigator: Derrickson, Joda

Institution: Full Plate, Inc.

Project Contact:
Joda Derrickson, Ph.D., RD
Nutrition Consultant
Full Plate, Inc.
44-155-4 Laha Street
Kaneohe, HI 96744
Phone/Fax: 808-234-6317
laniwai4@pixi.com

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:

1. A qualitative study assessing the conceptual framework of the CFSM with Caucasian, Filipino, Hawaiian and Part-Hawaiian, and Samoan charitable food recipients (n=61);
2. A pilot stability study of recent recipients of charitable food who completed the CFSM over the phone twice (n=61);
3. 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;
4. 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
5. 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.