11 - Small Screens, Big Signals: Bridging Hunger to Healthcare through a First Geographically Stratified Study of Food Disparities in a High-Risk Capital City

Publication Number: 4010.11

Aysha Rafaquat, Southern Illinois University School of Medicine, Springfield, IL, United States; Maria Jose Vides Sanchez, Southern Illinois University School of Medicine, Springfield, IL, United States; Allison Mool, Southern Illinois University School of Medicine, Springfield, IL, United States; Shreepada Tripathy, Southern Illinois University Department of Pediatrics, Springfield, IL, United States; Enas Shanshen, SIU- SOM, Springfield, IL, United States

Background: Food insecurity (FI) is limited or uncertain access to adequate food, affects 1 in 7 children and harms their growth, recovery and healthcare use, worsens preventable health disparities. The American Academy of Pediatrics (AAP) recommends routine screening. In our capital city, disadvantaged neighborhood constrain access to nutritious food, yet area clinics lack standardized FI workflow.

Objective: Integrate AAP two-item Hunger Vital Sign (HVS) into routine pediatric care to quantify per-child FI prevalence and examine racial/ethnic, neighborhood, and seasonal variation and use results to implement equity-focused connections to food resources for families experiencing FI.

Design/Methods: IRB-approved, AAP-supported prospective implementation study (May 2023-Aug 2025) conducted by multidisciplinary team in a capital-city pediatric clinic serving an underserved regional catchment. All patients under 18 years were screened using the HVS integrated in the EHR intake across general pediatrics and subspecialties. Families with positive screens ('often/sometime true' to either item) received brief teaching from trained food champions, a local resource brochure, and a two-day emergency food basket. Primary outcomes were per-child prevalence and first-time positivity. Logistic regression examined adjusted odds by race, rurality, and season; ZIP-level heat maps depicted geographic variation. Records missing HVS were excluded; same-day duplicates were collapsed to one screen

Results: Among 11,358 children (42,750 visits), per-child positivity was 3.9% (food worry) and 3.7% (food out); first-time 1.9% each; per-visit rates were 1.04% and 1.0% (Tab 1). Children who are Black had over twice the adjusted odds vs White; food worry aOR 2.37 (1.78-3.16), food out aOR 2.48 (1.90-3.25); children identifying as >1 race also had higher odds. Rural residence had lower risk for food out (RR 0.58, 0.34-0.99). Winter peaks with lower odds in spring 0.51 (0.37-0.70) and fall 0.78 (0.64-0.96) for food out (Tab 2). On re-screening, ~86-89% were negative at next visit and ~96% reverted (median ≈100 days). Heat maps concentrated in 62702/62703 (Fig 1A/1B)

Conclusion(s): Clinic-wide HVS screening revealed racial, seasonal, and geographic disparities. High reversion on re-screening supports ongoing screening. Sustained implementation with closed-loop resource linkage strengthens equity-focused care. Next steps extend to inpatient and community pediatrics to identify more families and improve access to nutritious food. Scalable dissemination and adaptation of this pragmatic model advance health equity and reduce FI regionally and nationally.

Table 1. Prevalence of Positive Hunger Vital Sign (HVS) Screens
Table 1 presents per-child, first-time, and per-visit prevalence of positive Hunger Vital Sign (HVS) screens among pediatric patients between May 2023 and August 2025. "Food worry" reflects concern about food running out, while "food out" represents instances when food actually ran out. Per-child prevalence reflects children with ≥1 positive screen among those screened; first-time positivity represents the proportion positive at their initial HVS screen; and per-visit prevalence reflects positive screens across all visits during the study period.

Table 2. Adjusted Associations Between Race, Rurality, and Season with Food Insecurity Outcomes (Food Worry and Food Out)
Table 2 outlined adjusted odds ratios (ORs) and risk ratios (RRs) with 95% confidence intervals (CIs) for predictors of food insecurity among pediatric patients are shown in table form above and Forest plot below. Models were adjusted for age, gender, ethnicity, rurality, season, number of pediatric visits, and year fixed effects. Significant associations (p < 0.05) are shown in bold(red). Points on forest plot show adjusted ratios (OR unless noted as RR) with 95% CIs for Food worry (blue circles) and Food out (orange squares). Vertical line at 1.0 denotes no difference..

FIGURE 1. Reversion After a Positive Food Insecurity Screen and Geographic heat maps
FIGURE 1A and 1B.jpegFigure 1 shows 2 things.
Fig IA- Kaplan-Meier-style curves display the cumulative proportion of families reverting to a negative Hunger Vital Signs screen after an initial positive, by HVS item. Among children with follow-up after a first positive, ~86-89% screened negative at the next visit and ~96% reverted overall (median ≈100 days). Shaded areas represent 95 % CIs. Supporting routine re-screening and closed-loop linkage.
Fig 1B- Below pictures are ZIP-level heat maps showing the greatest concentration of positive screens in 62702 and 62703 within the capital-city catchment for both "Food worry on the left" and "Food Out on the right". These areas include multiple census tracts in the highest SVI quartiles and low/very-low COI tiers, consistent with neighborhood disadvantage