Running head: PROGRAM PLAN

Program Plan

FACS 330, Community Nutrition

Wednesday, April 29th, 2020

Candace Martell

Dr. Kimberlin

Certification of Authorship: I certify that I am the author of this paper and that any assistance I received
in its preparation is fully acknowledged and disclosed in the paper. I have also cited any sources from
which I used data, ideas, or words, either quoted directly or paraphrased. I also certify that this paper was
prepared by me specifically for the purpose of this assignment.

Signature(s): Candace Martell ONU ID No. 1821596

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Goal: Create social and physical environments that promote good health for all.

Objective NWS-12: Eliminate very low food security among children. (Healthy People 2020).

Community:

Kankakee County, Illinois

Community Description:

Illinois is located in the Midwest of the United States. This state had approximately 12.7

million people in 2019, with the majority of the people in the population being white at 76.9%,

and the lowest statistic was found to be 0.1% for Native Hawaiian and another Pacific Islander.

The African American population was 14.6%, American Indian was documented to be 0.6%,

Asian at 5.9%, and Hispanic or Latino at 17.4%. In households with children, food insecurity is

higher than average as well as in homes with Hispanic ethnicities (Fernald & Gosliner,

2019). Gathering information on the background of the state and county being studied can

promote the community assessment process of implementing programs to reach the Healthy

People 2020 objective. Therefore, the median household income based on 2018 data, displayed

the dollar amount to be $63,575, while 12.1% are poverty-stricken (United States.Census

Bureau, 2019). According to Feeding America (2019), as the target audience is children, the

estimated number of food insecure children is 4,330 in Kankakee County, Illinois while 12.2% is

the statistic altogether. Within Illinois, the devastating number of children that experience food

insecurity is 453,260 (Feeding America, 2019).

Kankakee County is centered South from Chicago and encompasses 18 towns: Kankakee,

Bourbonnais, Bradley, Manteno, Momence, Hersher, Grant Park, Bonfield, Aroma Park, St.

Anne, Hopkins Park, Union Hill, Essex, Sun River Terrace, Buckingham, Sammons Point, and
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Irwin. Conclusively, there are 110,024 individuals, and of those 81.4% are white, 15% are

African American, 0.4% American Indians, 1.1% Asian, and 10.6% are Hispanic or

Latino (United States Census Bureau, 2019). According to Illinois (2020), the statistics for food

insecurity in Kankakee County is 13,550 households or about 12%, with 5,215 households that

have limited access to food. Finally, the number of children within Kankakee County who

receive reduced price or free lunch is 51% (Illinois, 2020).

Literature Review:

Reflecting on food insecurity enhances the need to identify why community-based

programs are needed for vulnerable populations. Liable and malnourished audiences include

school-aged children, children under five years, pregnant and lactating women as well as the

elderly. Paramount to acknowledge is that hunger is not parallel to food

security. Food insecure individuals can be classified as obese, overweight, or underweight and

stunting growth has influenced nearly 52 million children under the age of five (Visser,

McLachlan, Maayan, & Garner 2018). Food insecurity is often unpredictable. Under the United

Nations Children Fund (UNICEF), there are sectors of food insecurity that include; immediate

(inadequate food intake and illness), underlying that delves into insufficient maternal care, poor

access to baseline health services, limited availability to clean water, and basic that

involves poverty (Visser et al., 2018). According to Canter, Roberts, & Davis (2017), children

living in food insecure households consume significantly less vegetables as well. Overall, the

primary source of calories for youth are represented from fat, and children that live in absence of

resources rarely consume meals with family, which has a substantial negative force on the social

environment and influences during childhood. Additionally, iron deficiencies as well as low fruit

intakes have been reported for this age group (Holben & Berger, 2017). Children living in scarce
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conditions have been studied to have psychosocial and mental health complications, stomach

complaints, headaches, advanced hospital admissions, and have exhibited decreased abilities to

learn and develop properly. Furthermore, evidence-based research has shown that food insecurity

can amplify the severity of children's aggression levels, anxiety, and depression, and is

associated with dental concerns, hyperactivity, and higher risks of fractures (Holben & Berger,

2017). Considering the implications that stem from food insecurity, it is important that

Registered Dietitians (RD) and health certified professionals attempt to improve the wellbeing of

children.

Complementary to children, infants also encompass the vital demand of

gaining connection to adequate prenatal and lactating nutrition. Gross & Mendelsohn (2019)

suggest that food insecurity displays increased incidences of non-responsive mother and infant

feeding, that can lead to the lack of acknowledging when a child or infant is hungry. This absent

awareness varies from controlling, indulgent, and laissez-faire (non-interfering) from the

mother’s behalf, despite the child or infant requiring the form of nourishment.

Instrumental to community-based programs, is the examination of the numerous

initiatives that are already set in motion. Behind federally funded nutrition assistance for food

scarcity, preserving the programs that are readily available to apply for is critical. This is done by

the recognition of what other programs have helped establish, including laws. Examples of

programs include the Supplemental Nutrition Assistance Program (SNAP), National School

Lunch Program (NSLP), School Breakfast Program (SBP), and the Child and Adult Care Food

Program (CACFP). Highlighting the lasting effects of these programs, under the Hunger Free

Kids Act (HHFKA), benefits nutrition experts and RD’s that attempt to create their own

community plans for a healthier future (Roy & Stretch, 2018). Eligible schools in high poverty
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locations with regards to HHFKA, allow for the serving of free breakfast and lunch to children

for the first time in 15 years, in 2010 (Hayes & Dodson, 2018). The Expanded Food and

Nutrition Education Program (EFNEP) has helped over 377,702 children become educated by

professionals on food preparation and has fostered behavioral changes. During 2015 alone,

children who had learned under the care of EFNEP had improved their diets by an increase in

fruits and vegetables, reduced meat intakes, and incorporating foods low in sugar, fat, and

sodium (Roy & Stretch, 2018). There was an increase of investments in SNAP by 20% to 30% to

alleviate food insecurity (Fernald & Gosliner, 2019). It is important to note that if food insecurity

were not such a concern within the United States, there most likely would not be as many

programs as there currently are. Also, with the existing programs to eliminate food insecurity, it

would not be prevalent to heighten the weight of the programs and what they offer. However,

that is not the case.

Shifting to a research study, Rivera, Maulding, Abbott, Craig, & Eicher-Miller (2016)

investigated how SNAP education (SNAP-Ed) could benefit n=575 Indiana community members

who had children and were food insecure. The results found that SNAP-Ed improved food

insecurity levels. Similar to this program, the Garden Project program discussed later will

incorporate education on nutrition for guardians and children. It is evident that future

healthcare members can visualize a need to design more programs with the compelling

research.

Assessment Methods:

This project plan will be comprised of screening children for their Body Mass Index

(BMI) anthropometric measures to identify if the problem is prevalent within this community.

Synergistic to BMI, collecting food security surveys (See highlighted section of Appendix A)
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will be beneficial in providing insight on how many families within the Kankakee County that

visit the program are food insecure.

Materials and Manpower:

Materials needed consist of a facility to accurately and professionally measure children’s

BMI results as well as have guardians complete a food security survey (See highlighted section

of Appendix A). Developing connections with local food assistance programs such as WIC

offices, and visiting hospitals (Riverside and St. Mary’s) to implement possible resources for

places to use would be constructive. Additionally, it would be beneficial to collaborate with other

RD’s that can help take safe and precise BMI measures of the children and confidently address

the food security surveys with participants. RD’s may be located at hospitals, community centers

(through contacting Kankakee County Community Services), and Universities, such as Olivet

Nazarene University, or Kankakee Community College (KCC). Lastly, RD’s holding the

workshop need access to food donation packages to giveaway during the workshops and

program funding to supply the cooked meal. Implementation of the BMI measures as well as the

food security surveys will help justify the commitment to better access to sanitary and healthy

food for families with children.

The possible outcomes of the assessment are:

• There is not a significant portion of children that classify as overweight or obese with a

BMI of 25-30 (overweight) or ≥ 30 (obese).

• There is a significant portion of children that classify as overweight or obese with a BMI

of 25-30 (overweight) or ≥ 30 (obese).

• The sample size of children who are tested for BMI measures is too small to be

considered significant.
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• The sample size of guardians who participate in the food security survey is too small to

be considered significant.

• Significant portion of the population received scores that identify as low or very low food

security based on the food security survey.

• Significant portion of the population received scores that identify as marginal or high

food security based on the food security survey.

Identify Barriers:

Economically, female group ages ranging from 25-34, 18-24, and 6-11 are the highest

demographic to fall into poverty in Kankakee County (Data USA, 2017a). This barrier leaves

female children between 6-11 severely susceptible to experiencing food insecurity (Data USA,

2017a). While the largest number of the population is made up of white individuals, these

residents are the least likely to receive SNAP benefits at only 11%. African Americans make up

some of the population and receive the majority of food stamps at 48% (Data USA, 2017a).

Although minority groups are also at risk for food insecurity, the statistics indicate that more

white people not only encompass Kankakee County, but also have the highest poverty rates and

receive little assistance. This may suggest conflicts to build a stronger community.

Kankakee County has a high school graduation rate of 87.3% (Economic Alliance of

Kankakee County, 2019). This is high, however, there could be a possible level of illiteracy

among those that dropped out. Due to exploring households that are food insecure, it is likely

that many of the children who are tested and surveyed will have parents that received a high

school education but did not continue with a college degree. Considering this, participants may

not understand the vital statistics of food insecurity that support this program.
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Medical data shows that 92.9% of Kankakee County residents have health care coverage via

place of employment (Data USA, 2017b). This is not a significant barrier, but if those that do

receive health care through their employment are fired, laid off, state politics/economics

interference, etc., this would affect access to medical assistance.

Socially, while there are eight food pantries in Kankakee, Illinois, it would be beneficial to

see the expansion of these hopeful places to other areas of Kankakee County. However, many

other towns in Kankakee County have local churches that donate often. Expired food is

unfortunately a common donation from stores that must get rid of the old inventory.

Additionally, making sure that the products being donated are acknowledging a need for each

food category is essential. Due to a lack of proper storage facilities that donate, meat is not often

donated (Morello, 2019). Programs like the Food Drive Five developed by Brown County would

be a wise development for food banks to introduce nationwide. The Food Drive Five includes

fruits, whole grain pastas and cereals, soups low in sodium, protein sources (peanut butter, nuts,

seafoods, and poultry), and colorful vegetables (Canto, Ingham, Larson, Park-Mroch, & Gauley,

2018). Another program includes AMITA Health St. Mary’s Hospital micro food pantry in

Kankakee that is stocked and open 24-hours a day all year and offers foods that require minimal

preparation but are also nutritious (Nelson, 2019). Like St. Mary’s micro food pantry and

community gardens within the county that foster growing nutritious food, the idea for the

community program to be implemented in Kankakee County is complimentary to existing

programs. However, this program will focus on children rather than all ages.

Currently, there are 350 bus stops between Aroma Park, Kankakee, Bradley,

Bourbonnais, and Manteno using River Valley Metro. Metro Plus services allow for disabled

individuals to have access to transportation as well. Various passes have been included to allow
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for customer convenience in paying, with the most expensive monthly option that is all-inclusive

at $40.00 (River Valley Metro, n.d.). Therefore, transportation is not as profound as other

barriers. Greyhound bus station is another opportunity for travel. There is one station located in

Kankakee, however, limiting the option for other areas within Kankakee County. Access to

Walmart, Berkot’s Super Foods, Dollar General, Aldi’s, Jewels, and Meijer’s are the primary

grocery stores. All towns surrounding Kankakee County are on average within a 17-mile radius

from the Kankakee, Bradley, and Bourbonnais areas where the grocery stores are located.

Overall, this program could utilize Kankakee County Public Health Department as a location to

test for BMI and provide the food security survey as well as hold classes on food insecurity.

The program will address the nutrition related issue of food insecurity.

Kankakee County has a large prevalence of food insecurity with 67% being at poverty line to

receive SNAP benefits (Feeding America, 2017). This county needs a program that can decrease

the amount of food insecure children. In order to reduce limited access to healthy foods, this

program will attempt to identify those who experience food insecurity and help educate children

and parents on nutritious foods while receiving food donations in a positive social atmosphere.

The goal of the program will be to create a social environment for children to learn about

nutrition and have access to nutritious meals.

Objectives for goal: 1. After the workshop, children will be able to learn how to plant

with 100% accuracy.

2. After the workshop, children and parents will be able to prepare the recipe featured by

the RD with 95% accuracy.

Program content ideas:

• Free workshops for children to plant their own vegetable or herb

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• Food demos staring a vegetable or herb of the month

• Meal and food donations offered to children and guardians. Meal will be prepared

by a Registered Dietitian and volunteers that features the star vegetable or herb.

• Registered Dietitian education on the star vegetable or herb

How my program will be evaluated:

The process evaluation plan would acknowledge that the target population is children

and would utilize demographic statistics of the Kankakee County area. Acknowledging other

community programs that are similar to the objectives of this program would determine if this

could be a successful or interfering opportunity. Referring to participation levels for each activity

may address the efficiency of this program to reach its goal. Requiring guardians to sign in for

their children for each workshop and keeping a detailed record would display any inconsistencies

in attendance and participation for each of the activities.

The impact evaluation plan would suggest that any activities implemented would help

reach the goal of the program; to create a social environment for children to learn about nutrition

and have access to nutritious meals, would be assessed (See Appendix A). These include the

content ideas of free workshops for children to plant their own vegetable or herb, food demos

with a vegetable or herb of the month, meal and food donations offered to children and parents

who attend, a meal will be prepared by an RD and volunteers that feature the vegetable or herb

discussed, and an RD will provide education on the vegetable or herb. For this purpose, it would

be wise to acknowledge the attitudes of the children and guardians and the self-efficacy of the

guardians to handle the challenges that factor into food insecurity.

The outcome evaluation plan will be a structured survey given to participants of the

program within the Kankakee County area that identifies if the program had an impact on the
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food intake of food insecure children (See Appendix A). Families will be able to recognize if

they classify as food insecure and would like to join this program based upon the food security

survey results (See highlighted section of Appendix A).

Finally, the structured evaluation plan will be a survey that features questions in regard

to the facility of the program, the equipment provided, the social impact of the atmosphere for

the child (as this is a fundamental aspect of reaching the goal of the program), and the

professionality of the Registered Dietitian and volunteers (See Appendix A).

How this program will contribute to my professional goals:

My professional aspiration is to work within the community and provide community

presentations on various topics that I am asked to discuss. Throughout this planning process, I

did not realize the requirements it would take to build a reliable program. However, it has

certainly been enlightening. I appreciate and respect the opportunity that as a community

dietitian I would be able to work with various age groups, as I am excited to interact with each of

these populations and diversities. While all age groups I am passionate about, children have

always been on the forefront of my mind because they are one of the most susceptible

populations to nutritional deficiencies and concerns. Therefore, this program could guide me into

that direction and has ultimately sparked an increased awareness of children. As I am an

individual who enjoys freedom and creative endeavors, the building of this community idea is

something that I could see myself trying to implement within Kankakee County.

My interest in program planning:

Throughout my academic career, I have been able to maintain professional rapport when

talking with my instructors and peers. People want to feel like their voices are heard and it seems
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that I have a way of communicating with others that is inviting and charismatic. If I were to

provide community presentations as a professional dream, I believe my voice could help others

make a nutritional life-style change in a healthy way. Additionally, I can follow in other

footsteps and collaborate, but I have begun to encompass what it means to place myself into a

leadership position as well. Some interfering factors could be that I am a shy and nervous

individual, which would not be effective for community speaking. However, with practice I may

improve. Also, if given a choice, I would rather fall under the leadership of someone else rather

than myself be in that role. For program planning, this would be negative, but I would step up if

needed.

Ways to build my program planning skills:

While at Olivet, one of the greatest chances I have at developing program planning skills

is to become more active within the Student Dietetics club as I will be the next Secretary. As a

Secretary, it holds much responsibility to collaborate with other people in leadership positions as

well as allows me to join something much bigger than myself, which is the basis of program

planning. Furthermore, attending seminars such as FNCE (Food and Nutrition Conference &

Expo), or the Ingalls Dietetic Intern professional presentations and looking for opportunities to

obtain PDU’s (professional Developmental Units) would be appropriate.

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References

Canter, K. S., Roberts M. C., & Davis A., M. (2017). The role of health behaviors and food

insecurity in predicting fruit and vegetable intake in low-income children. Children’s

Health Care, 46(2), Retrieved from DOI 10.1080/02739615.2015.1124772.

Canto, A., B. Ingham, S. Larson, J Park-Mroch, & J. Gauley. (2018). Safe & healthy food

pantries project. Retrieved from https://fyi.extension.wisc.edu/safehealthypantries/

Data USA. (2017a). Kankakee County, IL. Retrieved from

https://datausa.io/profile/geo/kankakee-county-il#demographics

Data USA. (2017b). Kankakee County, IL. Retrieved from

https://datausa.io/profile/geo/kankakee-county-il#education

Data USA. (2017c). Kankakee County, IL. Retrieved from

https://datausa.io/profile/geo/kankakee-county-il#health

Economic Alliance of Kankakee County. (22 October 2019). Demographics. Retrieved from

https://www.kankakeecountyed.org/location-advantages/demographics/

Feeding America. (2017). Child food insecurity in Kankakee County. Retrieved from

https://map.feedingamerica.org/county/2017/child/illinois/county/kankakee

Feeding America. (2019). Hunger in Illinois. Retrieved

from https://www.feedingamerica.org/hunger-in-america/illinois.

Feeding America. (2019). Map the meal gap: Child food insecurity

in Kankakee County. Retrieved

from https://map.feedingamerica.org/county/2017/child/illinois/county/kankakee
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Fernald, L., & Gosliner, W. (2019). Alternatives to SNAP: Global approaches to addressing

childhood poverty and food insecurity. American Journal of Public Health,109(12),

Retrieved from DOI:10.2105/AJPH.2019.305365.

Gross, S. R., & Mendelsohn, L. A. (2019). Food insecurity during early childhood: Marker for

disparities in healthy growth and development 144(4), 1 & 2. Retrieved from DOI:

10.1542/peds.2019-2430

Hayes, D., & Dodson, L. (2018). Practice paper of the academy of nutrition and dietetics:

Comprehensive nutrition programs and services in schools. Journal of the Academy of

Nutrition and Dietetics, 118(5), 921. Retrieved from

DOI: https://doi.org/10.1016/j.jand.2018.02.025

Holben, H. D., & Berger M. (2017). Position of the academy of nutrition and dietetics: Food

insecurity in the United States. Journal of the Academy of Nutrition and

Dietetics, 117(12), 1995 & 1999. Retrieved from

DOI: https://doi.org/10.1016/j.jand.2017.09.027

Illinois. (2020). County Health Rankings and Roadmaps. Retrieved from

https://www.countyhealthrankings.org/app/illinois/2020/measure/factors/139/data

Morello, P. (24 January 2020). What to donate to a food bank and what to avoid. Feeding

America. Retrieved from https://www.feedingamerica.org/hunger-blog/what-donate-

food-bank-and-what-avoid

Nelson, T. (16 September 2019). AMITA health St. Mary’s Hospital Kankakee launches micro

food pantry on hospital campus. Retrieved from

https://www.amitahealth.org/news/amita-health-st-marys-hospital-kankakee-launches-

micro-food-pantry-on-hospital-campus
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River Valley Metro. (n.d.). Fares & passes – River Valley Metro. Retrieved from

https://www.rivervalleymetro.com/fares-passes/

Rivera, R. L., Maulding, M. K., Abbott, A. R., Craig, B. A., & Eicher-Miller, H. A. (2016).

SNAP-Ed (Supplemental Nutrition Assistance Program-Education) Increases Long-Term

Food Security among Indiana Households with Children in a randomized controlled

study. Journal of Nutrition, 146(11), 2375-2382. Retrieved from https://doi-

org.proxy.olivet.edu/10.3945/jn.116.231373

Roy G., P., & Stretch T. (2018). Position of the academy of nutrition and dietetics: Child and

adolescent federally funded nutrition assistance programs. Journal of the Academy of

Nutrition and Dietetics, 118(8), 1490-1495. Retrieved from

DOI: https://doi.org/10.1016/j.jand.2018.06.009

Statistical Atlas. (n.d.). The demographic statistical atlas of the United States. Retrieved from

https://statisticalatlas.com/county/Illinois/Kankakee-County/Food-Stamps

United States Census Bureau. (2019). Illinois. Retrieved

from https://www.census.gov/quickfacts/IL.

United States Census Bureau. (2019). Kankakee County, Illinois. Retrieved

from https://www.census.gov/quickfacts/kankakeecountyillinois.

Visser J, McLachlan, M. H., Maayan, N., & Garner, P. (2018). Community‐based supplementary

feeding for food insecure, vulnerable, and malnourished populations – an overview of

systematic reviews. Cochrane Database of Systematic Reviews, (11). Art. No.:

CD010578. DOI: 10.1002/14651858.CD010578.pub2.

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Appendix A
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Structured Evaluation Survey:

Please rate your agreements with the following statements:

1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree

1. The workshops were encouraged and educational.

2. The dietitians were professional and helpful.

3. The volunteers were welcoming and helpful.

4. The facility was effective for the workshops.

5. The equipment provided was adequate and safe.

6. My child looked forward to these workshops.

Questions:
1. Which activity was the most helpful?

2. Please describe your child’s attitude toward the workshops.

Impact Evaluation Survey: Did this program accomplish its goal?

Goal: To create a social environment for children to learn about nutrition and have access to

nutritious meals.

Please rate your agreements with the following statements:

1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree

1. My child interacted and socialized with other children.

2. My child ate the meal prepared by dietitians and volunteers.

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3. After the workshop, I took a box of donated food.

4. As a guardian, I learned about nutrition for my family.

U.S. HOUSEHOLD FOOD SECURITY SURVEY MODULE:

THREE-STAGE DESIGN, WITH SCREENERS
Economic Research Service, USDA
September 2012

Revision Notes: The food security questions are essentially unchanged from those in the original
module first implemented in 1995 and described previously in this document.
September 2012:
• Corrected skip specifications in AD5
• Added coding specifications for “How many days” for 30-day version of AD1a and
AD5a. July 2008:
• Wording of resource constraint in AD2 was corrected to, “…because there wasn’t
enough money for food” to be consistent with the intention of the September 2006
revision.
• Corrected errors in “Coding Responses” Section September 2006:
• Minor changes were introduced to standardize wording of the resource constraint in most
questions to read, “…because there wasn't enough money for food.”
• Question order was changed to group the child-referenced questions following the
household- and adult-referenced questions. The Committee on National Statistics panel
that reviewed the food security measurement methods in 2004-06 recommended this
change to reduce cognitive burden on respondents. Conforming changes in screening
specifications were also made. NOTE: Question numbers were revised to reflect the new
question order.
• Follow up questions to the food sufficiency question (HH1) that were included in earlier
versions of the module have been omitted.
• User notes following the questionnaire have been revised to be consistent with current
practice and with new labels for ranges of food security and food insecurity introduced
by USDA in 2006.

Transition into Module (administered to all households):

These next questions are about the food eaten in your household in the last 12 months, since
(current month) of last year and whether you were able to afford the food you need.

Household Stage 1: Questions HH2-HH4 (asked of all households; begin scale items).

[IF SINGLE ADULT IN HOUSEHOLD, USE "I," "MY," AND “YOU” IN

PARENTHETICALS; OTHERWISE, USE "WE," "OUR," AND "YOUR HOUSEHOLD."]
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HH2. Now I’m going to read you several statements that people have made about their food
situation. For these statements, please tell me whether the statement was often true,
sometimes true, or never true for (you/your household) in the last 12 months—that is,
since last (name of current month).

The first statement is “(I/We) worried whether (my/our) food would run out before (I/we)
got money to buy more.” Was that often true, sometimes true, or never true for
(you/your household) in the last 12 months?

[ ] Often true
[ ] Sometimes true
[ ] Never true
[ ] DK or Refused

HH3. “The food that (I/we) bought just didn’t last, and (I/we) didn’t have money to get more.”
Was that often, sometimes, or never true for (you/your household) in the last 12 months?

[ ] Often true
[ ] Sometimes true
[ ] Never true
[ ] DK or Refused

HH4. “(I/we) couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true
for (you/your household) in the last 12 months?

[ ] Often true
[ ] Sometimes true
[ ] Never true
[ ] DK or Refused

Screener for Stage 2 Adult-Referenced Questions: If affirmative response (i.e., "often true" or
"sometimes true") to one or more of Questions HH2-HH4, OR, response [3] or [4] to question
HH1 (if administered), then continue to Adult Stage 2; otherwise, if children under age 18 are
present in the household, skip to Child Stage 1, otherwise skip to End of Food Security Module.

Optional USDA Food Sufficiency Question/Screener: Question HH1 (This question is

optional. It is not used to calculate any of the food security scales. It may be used in
conjunction with income as a preliminary screener to reduce respondent burden for high
income households).

HH1. [IF ONE PERSON IN HOUSEHOLD, USE "I" IN PARENTHETICALS, OTHERWISE,

USE "WE."]
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Which of these statements best describes the food eaten in your household in the last 12
months: —enough of the kinds of food (I/we) want to eat; —enough, but not always the
kinds of food (I/we) want; —sometimes not enough to eat; or, —often not enough to eat?

[1] Enough of the kinds of food we want to eat

[2] Enough but not always the kinds of food we want
[3] Sometimes not enough to eat
[4] Often not enough to eat
[ ] DK or Refused

Screener for Stage 3 Adult-Referenced Questions: If affirmative response to one or more of

questions AD1 through AD4, then continue to Adult Stage 3; otherwise, if children under age 18
are present in the household, skip to Child Stage 1, otherwise skip to End of Food Security
Module.

NOTE: In a sample similar to that of the general U.S. population, about 8 percent of households
(20 percent of households with incomes less than 185 percent of poverty line) will pass this
screen and continue to Adult Stage 3.

Adult Stage 3: Questions AD5-AD5a (asked of households passing screener for Stage 3
adult-referenced questions).

AD5. In the last 12 months, did (you/you or other adults in your household) ever not eat for a
whole day because there wasn't enough money for food?

[ ] Yes
[ ] No (Skip AD5a)
[ ] DK (Skip AD5a)

AD5a. [IF YES ABOVE, ASK] How often did this happen—almost every month, some months
but not every month, or in only 1 or 2 months?

[] Almost every month

[] Some months but not every month
[] Only 1 or 2 months
[] DK

Child Stage 1: Questions CH1-CH3 (Transitions and questions CH1 and CH2 are
administered to all households with children under age 18) Households with no child under
age 18, skip to End of Food Security Module.

SELECT APPROPRIATE FILLS DEPENDING ON NUMBER OF ADULTS AND NUMBER

OF CHILDREN IN THE HOUSEHOLD.
PROGRAM PLAN 21

Transition into Child-Referenced Questions:

Now I'm going to read you several statements that people have made about the food situation of
their children. For these statements, please tell me whether the statement was OFTEN true,
SOMETIMES true, or NEVER true in the last 12 months for (your child/children living in the
household who are under 18 years old).
CH1. “(I/we) relied on only a few kinds of low-cost food to feed (my/our) child/the children)
because (I was/we were) running out of money to buy food.” Was that often, sometimes,
or never true for (you/your household) in the last 12 months?

[ ] Often true
[ ] Sometimes true
[ ] Never true
[ ] DK or Refused

CH2. “(I/We) couldn’t feed (my/our) child/the children) a balanced meal, because (I/we)
couldn’t afford that.” Was that often, sometimes, or never true for (you/your household)
in the last 12 months?

[ ] Often true
[ ] Sometimes true
[ ] Never true
[ ] DK or Refused

CH3. "(My/Our child was/The children were) not eating enough because (I/we) just couldn't
afford enough food." Was that often, sometimes, or never true for (you/your household)
in the last 12 months?

[ ] Often true
[ ] Sometimes true
[ ] Never true
[ ] DK or Refused
Screener for Stage 2 Child Referenced Questions: If affirmative response (i.e., "often true" or
"sometimes true") to one or more of questions CH1-CH3, then continue to Child Stage 2;
otherwise skip to End of Food Security Module.

NOTE: In a sample similar to that of the general U.S. population, about 16 percent of
households with children (35 percent of households with children with incomes less than 185
percent of poverty line) will pass this screen and continue to Child Stage 2.

Child Stage 2: Questions CH4-CH7 (asked of households passing the screener for stage 2
child-referenced questions).
NOTE: In Current Population Survey Food Security Supplements, question CH6 precedes
question CH5.
PROGRAM PLAN 22

CH4. In the last 12 months, since (current month) of last year, did you ever cut the size of (your
child's/any of the children's) meals because there wasn't enough money for food?

[ ] Yes
[ ] No
[ ] DK

CH5. In the last 12 months, did (CHILD’S NAME/any of the children) ever skip meals because there
wasn't enough money for food?

[ ] Yes
[ ] No (Skip CH5a)
[ ] DK (Skip CH5a)

CH5a. [IF YES ABOVE ASK] How often did this happen—almost every month, some months
but not every month, or in only 1 or 2 months?

[] Almost every month

[] Some months but not every month
[] Only 1 or 2 months
[] DK

CH6. In the last 12 months, (was your child/were the children) ever hungry but you just couldn't
afford more food?

[ ] Yes
[ ] No
[ ] DK

CH7. In the last 12 months, did (your child/any of the children) ever not eat for a whole day
because there wasn't enough money for food?

[ ] Yes
[ ] No
[ ] DK
END OF FOOD SECURITY MODULE
User Notes

(1) Coding Responses and Assessing Household Food Security Status:

Following is a brief overview of how to code responses and assess household food security status
based on various standard scales. For detailed information on these procedures, refer to the
Guide to Measuring Household Food Security, Revised 2000, and Measuring Children’s Food
PROGRAM PLAN 23

Security in U.S. Households, 1995-1999. Both publications are available through the ERS Food
Security in the United States Briefing Room.

Responses of “yes,” “often,” “sometimes,” “almost every month,” and “some months but not
every month” are coded as affirmative. The sum of affirmative responses to a specified set of
items is referred to as the household’s raw score on the scale comprising those items.

• Questions HH2 through CH7 comprise the U.S. Household Food Security Scale
(questions HH2 through AD5a for households with no child present). Specification of food
security status depends on raw score and whether there are children in the household (i.e.,
whether responses to child-referenced questions are included in the raw score).
o For households with one or more children:
▪ Raw score zero—High food security
▪ Raw score 1-2—Marginal food security
▪ Raw score 3-7—Low food security
▪ Raw score 8-18—Very low food security o For households with
no child present:
▪ Raw score zero—High food security
▪ Raw score 1-2—Marginal food security
▪ Raw score 3-5—Low food security
▪ Raw score 6-10—Very low food security

Households with high or marginal food security are classified as food secure. Those with
low or very low food security are classified as food insecure.

• Questions HH2 through AD5a comprise the U.S. Adult Food Security Scale.
▪ Raw score zero—High food security among adults
▪ Raw score 1-2—Marginal food security among adults
▪ Raw score 3-5—Low food security among adults
▪ Raw score 6-10—Very low food security among adults

• Questions HH3 through AD3 comprise the six-item Short Module from which the Six-
Item Food Security Scale can be calculated.
▪ Raw score 0-1—High or marginal food security (raw score 1 may be
considered marginal food security, but a large proportion of households that
would be measured as having marginal food security using the household or
adult scale will have raw score zero on the six-item scale)
▪ Raw score 2-4—Low food security
▪ Raw score 5-6—Very low food security

▪ Questions CH1 through CH7 comprise the U.S. Children’s Food Security
Scale.
PROGRAM PLAN 24

▪ Raw score 0-1—High or marginal food security among children (raw score 1
may be considered marginal food security, but it is not certain that all
households with raw score zero have high food security among children
because the scale does not include an assessment of the anxiety component of
food insecurity)
▪ Raw score 2-4—Low food security among children
▪ Raw score 5-8—Very low food security among children

(2) Response Options: For interviewer-administered surveys, DK (“don’t know”) and

“Refused” are blind responses—that is, they are not presented as response options, but marked if
volunteered. For self-administered surveys, “don’t know” is presented as a response option.

(3) Screening: The two levels of screening for adult-referenced questions and one level for
child-referenced questions are provided for surveys in which it is considered important to
reduce respondent burden. In pilot surveys intended to validate the module in a new cultural,
linguistic, or survey context, screening should be avoided if possible and all questions should
be administered to all respondents.

To further reduce burden for higher income respondents, a preliminary screener may be
constructed using question HH1 along with a household income measure. Households with
income above twice the poverty threshold, AND who respond <1> to question HH1 may be
skipped to the end of the module and classified as food secure. Use of this preliminary screener
reduces total burden in a survey with many higher-income households, and the cost, in terms of
accuracy in identifying food-insecure households, is not great. However, research has shown that
a small proportion of the higher income households screened out by this procedure will register
food insecurity if administered the full module. If question HH1 is not needed for research
purposes, a preferred strategy is to omit HH1 and administer Adult Stage 1 of the module to all
households and Child Stage 1 of the module to all households with children.

(4) 30-Day Reference Period: The questionnaire items may be modified to a 30-day reference
period by changing the “last 12-month” references to “last 30 days.” In this case, items
AD1a, AD5a, and CH5a must be changed to read as follows:

AD1a/AD5a/CH5a [IF YES ABOVE, ASK] In the last 30 days, how many days did this
happen?

______ days

[ ] DK

Responses of 3 days or more are coded as “affirmative” responses.

[ ] DK
PROGRAM PLAN 25

Children’s Coloring Sheet:

Center for Nutrition

PROGRAM PLAN 26