Questionnaire-Based Measures Are Valid for the Identification of Rural Households with Hunger and Food Insecurity

This study assessed the validity of questionnaire-based measures for the identification of rural households with hunger and food insecurity. Data used were from a 1993 survey of 193 households with women and children living at home in a rural county. Two interviews provided data on demographics, factors contributing to food insecurity, coping strategies, fruit and vegetable consumption, disordered eating behaviors, height, weight, dietary recall and household food-stores inventory. This information was used to develop a definitive criterion measure for hunger and food insecurity to compare with hunger and food insecurity items from Radimer/Cornell, the Community Childhood Hunger Identification Project (CCHIP) and the Third National Health and Nutrition Examination Survey (NHANES III). The Radimer/Cornell and CCHIP questionnaire-based measures had good specificity (i.e., percentage of truly food secure correctly classified; 63-71%) and excellent sensitivity (i.e., percentage of truly food insecure correctly classified; 84-89%) when compared with the criterion measure. Estimates of the prevalence of household food insecurity from the criterion, Radimer/Cornell and CCHIP measures were almost identical. The overall agreement of the Radimer/Cornell and CCHIP measures was very good. These measures can be validly used to screen for hunger and food insecurity among rural households similar to those studied and to target subpopulations for food programs. The NHANES III item alone had excellent specificity but poor sensitivity, and underestimated prevalence.