SDOH
Loren Bonner
Food insecurity—defined as inadequate food or food that lacks nutrition—has quickly become another social determinant of health (SDOH) that could be addressed in a range of environments, including health care settings. For example, if a patient or their family has insufficient food at home, how could they effectively follow advice for healthy eating and physical activity to prevent obesity?
In a JAMA research article from March 11, 2025, the U.S. Preventive Services Task Force (USPSTF) recognized the challenges of screening for food insecurity in health care settings. After reviewing the evidence, the task force said that it was “insufficient to make a recommendation for or against screening for food insecurity in primary care.”
Authors of a JAMA Viewpoints article published simultaneously with the USPSTF evidence report said that as the task force continues to examine the best way to screen for SDOH, clinicians should continue to address food insecurity among their patients.
“It would be antithetical to a patient- and family-centered approach to ignore the presence of food insecurity for patients while awaiting more evidence,” the authors wrote. “Interventions to help those who are food insecure could include medically tailored meals, food prescriptions, and food boxes or food pantries associated with the primary care clinic, as well as helping patients navigate
Pharmacy settings
Prior research has linked the ability of community pharmacists to intervene successfully in SDOH. For instance, a 2022 study from Humana and Outcomes Medication Therapy Management found significant reductions in medical spending and an insignificant increase in pharmacy spending when SDOH practice models were incorporated within pharmacies.
In a JAPhA study published April 22, 2024, researchers examined patient’s willingness to screen with the two-question Hunger Vital Sign tool and accept education regarding food assistance programs at their community pharmacy. Researchers also wanted to gauge pharmacy personnel’s comfort using the screener and providing education.
Results were positive: Many patients accepted education regardless of screening results. Qualitative information found that the intervention led teams to have meaningful discussions around food insecurity, and many pharmacy personnel who participated said they wanted to strengthen their patient counseling in this area.
In addition, patients in the study screened at a higher rate of “at-risk for food insecurity” than their counties reported.
Data are lacking
In the JAMA research article, USPSTF said food insecurity is a problem that cannot be solved alone within the primary care setting but must be addressed more broadly within a societal and economic context. They also noted that there must be evidence to show an improvement in a patient’s health when they are screened. Finally, the task force’s established methods for assessing the benefits and harms of a preventive intervention may not be the best approach to address all SDOH topics, said the authors.
According to the U.S. Department of Agriculture Economic Research Service’s Current Population Survey, 12.8% of households were food insecure in 2022, with 7.7% of households experiencing low food security and 5.1% facing very low food security.
The survey also noted differences by race and ethnicity with 22.4% of Black non-Hispanic households and 20.8% of Hispanic households experiencing food insecurity in 2022, compared with 9.3% of white homes. Additionally, American Indian/Alaska Native groups were more than twice as likely to experience food insecurity compared to white populations.
In examining the available evidence to come to their conclusion about screening, USPSTF analyzed a total of 9,435 abstracts and 413 full-text articles for inclusion.
“Evidence to support preventive interventions for food insecurity in primary care was very limited,” USPSTF researchers wrote. “The evidence on the benefits of screening was rated as insufficient; only one study examined the impact of a screening for food insecurity and found no improvement in food security.”
No studies reported harms of assessment for food insecurity, however.
The USPSTF authors said their findings are consistent with other published research regarding screening and intervention for food security.
“So much of the evidence is limited to study designs at higher risk of bias and focused on process (e.g., receipt of referral) or food insecurity status outcomes, rather than patient health outcomes,” they wrote. ■