Article Figures & Data
Figures
- Figure 1.
Clinician gender, age and graduate degree year influence Food insecurity (FI) screening based on patient-identified factors. (A) Female clinicians are more likely to screen for FI if a “patient reports a chance in living status compared with male clinicians (OR 1.82; 95% CI 1.26-2.62, P < .0001). (B and C) Clinicians older than 60 yrs. (OR 2.22, 1.09-4.56, P < .02) or who received their degree before 2000 (OR 0.55; 95% CI 0.34-0.89; P = .004) were more likely to screen for FI based on a patient’s history of homelessness or poverty. (D and E) Clinicians younger than 40 yrs. (OR = 0.39; 95% CI = 0.20-0.74; p < 0.0001) or who received their degree after 2010 were more likely to screen for FI based if the subject came up in conversation (OR = 1.81; 95% CI = 1.14-2.87; p =0.003).
- Figure 2.
Clinician demographics influence ranking of top 3 barriers to discussing Food insecurity (FI) during patient encounters. (A) Clinicians working in underserved areas were less likely to rank “inadequate time during appointments” as a top barrier (OR 0.58; 95% CI 0.36-0.91; P = .01). (B) Clinicians under 40 yrs. of age were more likely than clinicians over 60 yrs. of age to rank “lack of knowledge about available resources for FI” in the top barriers (OR 0.52; 95% CI 0.27-0.99; P < .05). (C) Clinicians practicing in rural locations were more likely to rank “lack of resources in the community to address FI” as a top barrier compared with urban locations (OR 0.53; 95% CI 0.30- 0.91; P = .01). (D) Lack of community resources was ranked as the number 1 barrier by rural clinicians compared with suburban clinicians (P = .001) and compared with urban clinicians (P = .001).
Tables
Food Insecurity Survey (n = 913) Age, years (n = 838) Mean (SD) 46.6 (11.2) Range 27 to 88 Gender (n = 903) Women 574 (63.6%) Men 324 (35.9%) Other 5 (0.5%) Race (n = 891) White, non-Hispanic 666 (74.7%) Black, non-Hispanic 41 (4.6%) Hispanic 58 (6.5%) Asian 95 (10.7%) Multi-racial/Other 31 (3.5%) (n = 910) Identify as under-represented in medicine 162 (17.8%) Education, highest degree (n = 912) MD/DO with PhD 47 (5.2%) MD 681 (74.7%) DO 100 (11.0%) PhD/Other Doctoral 68 (7.5%) Master's 16 (1.8%) Degree earned, year (n = 910) Before 2000 (1964 to 1999) 315 (34.6%) 2000 to 2010 273 (30.0%) After 2010 (2011 to 2022) 322 (35.4%) Practice region (n = 905) New England/Middle Atlantic 160 (17.7%) South Atlantic 159 (17.6%) East North Central 169 (18.7%) West North Central 96 (10.6%) South Central 96 (10.6%) Mountain 81 (8.9%) Pacific 144 (15.9%) Institute type (n = 910) Medical school (Allopathic/ Osteopathic) 515 (56.6%) Not medical school 395 (43.4%) Institute residency program (n = 909) Multiple residencies including Family medicine 633 (69.6%) Only family medicine residency 240 (26.4%) Multiple w/o family medicine/No residency 36 (4.0%) Location class area of work (n = 911) Urban 469 (51.5%) Suburban 295 (32.4%) Rural 147 (16.1%) (n = 907) Work in underserved area 248 (27.3%) Role in institution (n = 912) Faculty 463 (50.8%) Administrator/Chair/Director 279 (30.6%) Practice Physician 80 (8.8%) Behavior specialist 49 (5.4%) Other 41 (4.5%) Abbreviation: SD, standard deviation.
- Table 2.
Demographic Characteristics of Survey Respondents Based on How Often Clinician Personally Asked about Food Insecurity
Always/Freq (n = 61) Sometimes (n = 487) Rarely/Never (n = 365) p-Value Age, years (n = 54) (n = 446) (n = 338) Mean (SD) 46.0 (10.5) 46.6 (11.1) 46.8 (11.3) 0.88 Range 30 to 75 27 to 75 29 to 88 (n = 60) (n = 480) (n = 358) Gender (Female/Woman) 45 (75.0%) 317 (66.0%) 212 (59.2%) 0.023 Race (n = 60) (n = 474) (n = 357) White, non-Hispanic 42 (70.0%) 349 (73.6%) 275 (77.0%) 0.36 (n = 486) (n = 363) Identify as under-represented in medicine 17 (27.9%) 89 (18.3%) 56 (15.4%) 0.058 Education, highest degree (n = 364) MD/DO with PhD 1 (1.6%) 22 (4.5%) 24 (6.6%) 0.041 MD 39 (63.9%) 370 (76.0%) 272 (74.7%) DO 9 (14.8%) 54 (11.1%) 37 (10.2%) PhD/Other Doctoral/Master's 12 (19.7%) 41 (8.4%) 31 (8.5%) Degree earned, year (n = 485) (n = 364) Before 2000 (1964 to 1999) 19 (31.2%) 169 (34.8%) 127 (34.9%) 0.84 2000 to 2010 21 (34.4%) 139 (28.7%) 113 (31.0%) After 2010 (2011 to 2022) 21 (34.4%) 177 (36.5%) 124 (34.1%) Practice region (n = 483) (n = 361) New England/Middle Atlantic 12 (19.7%) 91 (18.8%) 57 (15.8%) 0.92 South Atlantic 11 (18.0%) 86 (17.8%) 62 (17.2%) East North Central 8 (13.1%) 86 (17.8%) 75 (20.8%) West North Central 8 (13.1%) 51 (10.6%) 37 (10.3%) South Central 6 (9.8%) 46 (9.5%) 44 (12.2%) Mountain 7 (11.5%) 44 (9.1%) 30 (8.3%) Pacific 9 (14.8%) 79(16.4%) 56 (15.5%) Institute type (n = 362) Medical school (Allopathic/Osteopathic) 37 (60.6%) 271 (55.6%) 207 (57.2%) 0.73 Not medical school 24 (39.3%) 216 (44.4%) 155 (42.8%) Institute residency program (n = 485) (n = 363) Multiple residencies including Family medicine 43 (70.5%) 330 (68.0%) 260 (71.6%) 0.71 Only family medicine residency 15 (24.6%) 133 (27.4%) 92 (25.3%) Multiple w/o family medicine/No residency 3 (4.9%) 22 (4.5%) 11 (3.0%) Location class area of work (n = 363) Urban 35 (57.4%) 264 (54.2%) 170 (46.8%) 0.21 Suburban 19 (31.2%) 147 (30.2%) 129 (35.5%) Rural 7 (11.5%) 76 (15.6%) 64 (17.6%) (n = 60) (n = 484) (n = 363) Work in underserved area 13 (21.7%) 110 (22.7%) 125 (34.4%) 0.0005 Abbreviation: SD, standard deviation.
- Appendix Table 1.
Top Factors Influencing Providers Decisions to Discuss Food Insecurity (FI) with Patients, by Respondent's Demographic Characteristics
Patient reports change in living status Patient/Family has history of homelessness/ Comes up in conversation Food Insecurity screen identifies an issue n % 95% CI % 95% CI % 95% CI % 95% CI Interaction Effect p-Value Gender Female 571 72.0 68.2 75.5 65.2 61.2 69.0 55.9 51.8 59.9 55.9 51.8 59.9 Male 321 58.6 53.1 63.8 64.8 59.4 69.8 59.5 54.0 64.7 50.8 45.3 56.2 Odds ratio (95% CI); p-value Gender*Reason Female versus Male 1.82 (1.26, 2.62); <0.0001 1.02 (0.70, 1.46); >0.99 0.86 (0.60, 1.23); >0.99 1.23 (0.86, 1.74); 0.57 0.005 Age <40 283 63.3 57.5 68.7 59.4 53.5 64.9 67.1 61.5 72.4 53.4 47.5 59.1 40 to 49 241 68.9 62.8 74.4 60.2 53.9 66.2 57.3 50.9 63.4 61.4 55.1 67.4 50 to 59 173 68.2 60.9 74.7 66.5 59.1 73.1 56.1 48.6 63.3 52.0 44.6 59.4 ≥60 136 69.9 61.6 77.0 76.5 68.6 82.9 44.1 36.0 52.6 46.3 38.1 54.7 Odds ratio (95% CI); p-value Age (P > .99) Age (P = .015) Age (P = .0004) Age (P = .129) Age*Reason<0.0001 ≥60 versus <40 2.22 (1.09, 4.56); 0.015 0.39 (0.20, 0.74); <0.0001 >60 versus 40 to 49 2.15 (1.03, 4.48); 0.032 Race White (non-hispanic) 661 66.3 62.6 69.8 65.7 62.0 69.2 57.5 53.7 61.2 54.8 51.0 58.5 Non-White/Multi-racial 225 68.4 62.1 74.2 62.2 55.7 68.3 57.3 50.8 63.6 51.6 45.0 58.0 Odds ratio (95% CI); p-value Race*Reason White versus Non-white 0.91 (0.60, 1.37); >0.99 1.16 (0.78, 1.73); >0.99 1.01 (0.68, 1.49); >0.99 1.14 (0.77, 1.67); >0.99 0.71 Under-represented in medicine Yes 161 67.7 60.1 74.5 58.4 50.6 65.8 56.5 48.8 64.0 54.0 46.3 61.6 No 742 67.0 63.5 70.3 65.6 62.1 69.0 57.6 54.0 61.1 54.0 50.4 57.6 Odds ratio (95% CI); p-value UnderRep*Reason Yes versus No 1.03 (0.65, 1.64); >0.99 0.74 (0.47, 1.14); 0.33 0.96 (0.62, 1.49); >0.99 1.00 (0.65, 1.55); >0.99 0.58 Year earned degree Before 2000 312 68.3 62.9 73.2 70.5 65.2 75.3 50.0 44.5 55.5 51.9 46.4 57.4 2000 to 2010 271 67.2 61.4 72.5 66.4 60.6 71.8 57.6 51.6 63.3 57.9 52.0 63.7 After 2010 320 65.6 60.3 70.6 56.9 51.4 62.2 64.4 59.0 69.4 52.5 47.0 57.9 Odds ratio (95% CI); p-value DegreeYr (P > .99) DegreeYr (P = .005) DegreeYr (P = .005) DegreeYr (P > .99) DegreeYr*Reason After 2010 versus Before 2000 0.55 (0.34, 0.89); 0.004 1.81 (1.14, 2.87); 0.003 0.002 Year earned degree MD/DO with PhD 46 67.4 52.7 79.3 58.7 44.1 71.9 67.4 52.7 79.3 56.5 42.1 70.0 MD 678 64.9 61.2 68.4 65.8 62.1 69.3 56.2 52.4 59.9 54.3 50.5 58.0 DO 100 73.0 63.5 80.8 58.0 48.1 67.3 57.0 47.2 66.3 53.0 43.2 62.6 Masters/PhD/Other Doctoral 81 77.8 67.5 85.5 64.2 53.2 73.9 60.5 49.5 70.5 51.9 41.1 62.5 Degree*Reason Among Degrees Degree (P = .27) Degree (P > .99) Degree (P > .99) Degree (P > .99) 0.31 Institute type Medical school (Allopath/Osteopath) 511 68.9 64.7 72.8 64.8 60.5 68.8 58.3 54.0 62.5 51.5 47.1 55.8 Not medical school 392 64.8 59.9 69.4 64.3 59.4 68.9 55.6 50.7 60.5 57.7 52.7 62.5 Odds ratio (95% CI); p-value InstType*Reason Med school versus not 1.20 (0.84, 1.72); 0.78 1.02 (0.72, 1.45); >0.99 1.12 (0.80, 1.57); >0.99 0.78 (0.56, 1.09); 0.26 0.18 Institute residency program Residency*Reason Family medicine + other 629 65.5 61.7 69.1 64.4 60.6 68.0 59.3 55.4 63.1 54.2 50.3 58.1 Family medicine only 237 70.9 64.8 76.3 65.0 58.7 70.8 52.7 46.4 59.0 54.4 48.1 60.7 No Family medicine/No residency 36 72.2 55.6 84.4 66.7 50.0 80.0 52.8 36.8 68.3 44.4 29.3 60.7 Among institute residency prog Residency (P > .99) Residency (P > .99) Residency (P = .76) Residency (P > .99) 0.46 Location class area of work LocClass*Reason Urban 466 66.5 62.1 70.7 62.9 58.4 67.2 59.0 54.5 63.4 55.6 51.0 60.0 Suburban 292 65.1 59.4 70.3 65.1 59.4 70.3 57.9 52.1 63.4 53.8 48.0 59.4 Rural 147 72.8 65.0 79.4 68.0 60.1 75.1 50.3 42.3 58.3 49.7 41.7 57.7 Among location class area LocClass (P > .99) LocClass (P > .99) LocClass (P = .70) LocClass (P > .99) 0.32 Work in underserved area Yes 244 68.0 61.9 73.6 67.2 61.1 72.8 55.3 49.0 61.5 56.2 49.9 62.3 No/unsure 656 66.8 63.1 70.3 63.4 59.7 67.0 58.2 54.4 62.0 53.2 49.4 57.0 Odds ratio (95% CI); p-value Underserved*Reason Yes versus no/unsure 1.06 (0.71, 1.58); >0.99 1.18 (0.80, 1.76); >0.99 0.89 (0.61, 1.30); >0.99 1.13 (0.77, 1.64); >0.99 0.65 *Note: For each demographic variable the p-values for the test of effect of demographic variable and pairwise comparisons have been adjusted for multiplicity (i.e. number of reasons and number of pairwise comparisons).
Abbreviation: CI, confidence interval.
- Appendix Table 2.
Most Challenging Obstacles in Addressing Food Insecurity (FI), by Respondent's Demographic Characteristics
Inadequate time during appointments Other medical issues take priority Lack of knowledge about available resources for food insecurity Lack of resources in community to address food insecurity n % 95% CI % 95% CI % 95% CI % 95% CI Interaction effect p-Value Gender Female 565 80.5 77.1 83.6 75.2 71.5 78.6 46.0 41.9 50.2 38.2 34.3 42.3 Male 317 83.9 79.5 87.6 75.7 70.7 80.1 44.5 39.1 50.0 39.1 33.9 44.6 Odds ratio (95% CI); p-value Gender*Obstacle Female versus Male 0.79 (0.50, 1.26); 0.85 0.97 (0.65, 1.46); >0.99 1.06 (0.75, 1.51); >0.99 0.96 (0.67, 1.38); >0.99 0.66 Age <40 281 83.6 78.8 87.5 73.3 67.8 78.2 54.5 48.6 60.2 35.2 29.9 41.0 40 to 49 238 81.5 76.1 86.0 74.8 68.9 79.9 43.3 37.1 49.7 43.7 37.5 50.1 50 to 59 172 81.4 74.9 86.5 82.6 76.2 87.5 44.8 37.5 52.3 31.4 24.9 38.7 ≥60 136 77.2 69.4 83.5 73.5 65.5 80.3 38.2 30.5 46.7 42.7 34.6 51.1 Odds ratio (95% CI); p-value Age (P > .99) Age (P = .52) Age (P = .030) Age (P = .143) Age*Obstacle ≥60 versus <40 0.52 (0.27, 0.99); 0.044 0.004 Race White (non-hispanic) 654 83.5 80.4 86.1 76.6 73.2 79.7 44.5 40.7 48.3 37.6 34.0 41.4 Non-White/Multi-racial 222 77.0 71.0 82.1 71.2 64.9 76.8 50.5 43.9 57.0 40.1 33.9 46.7 Odds ratio (95% CI); p-value Race*Obstacle White versus Non-white 1.51 (0.94, 2.43); 0.127 1.33 (0.86, 2.05); 0.42 0.79 (0.53, 1.16); 0.50 0.90 (0.61, 1.34); >0.99 0.099 Under-represented in medicine Yes 158 76.0 68.7 82.0 69.6 62.0 76.3 51.9 44.1 59.6 42.4 34.9 50.2 No 735 82.9 80.0 85.4 76.6 73.4 79.5 44.5 40.9 48.1 37.6 34.1 41.1 Odds ratio (95% CI); p-value UnderRep*Obstacle Yes versus No 0.65 (0.39, 1.10); 0.17 0.70 (0.43, 1.14); 0.26 1.35 (0.87, 2.09); 0.36 1.22 (0.78, 1.91); >0.99 0.061 Year earned degree Before 2000 308 79.2 74.3 83.4 78.3 73.3 82.5 41.9 36.5 47.5 39.0 33.7 44.5 2000 to 2010 267 79.0 73.7 83.5 76.0 70.5 80.8 43.8 38.0 49.8 37.5 31.9 43.4 After 2010 318 86.2 81.9 89.5 72.0 66.8 76.7 51.3 45.8 56.7 38.1 32.9 43.5 Among year earned degree DegreeYr (P = .142) DegreeYr (P = .75) DegreeYr (P = .188) DegreeYr (P > .99) DegreeYr*Obstacle 0.034 Highest Degree MD/DO with PhD 46 91.3 79.0 96.7 63.0 48.4 75.6 56.5 42.1 70.0 50.0 35.9 64.1 MD 676 81.7 78.6 84.4 77.1 73.8 80.1 45.3 41.6 49.0 37.3 33.7 41.0 DO 98 83.7 75.0 89.8 78.6 69.4 85.6 44.9 35.4 54.8 33.7 25.0 43.6 Masters/PhD/Other Doctoral 75 73.3 62.2 82.1 64.0 52.6 74.0 44.0 33.3 55.4 46.7 35.7 57.9 Among Degrees Degree (P = .39) Degree (P = .064) Degree (P > .99) Degree (P = .45) Degree*Obstacle 0.123 Institute type Medical school Allopath/Osteopath) 508 80.1 76.4 83.4 73.4 69.4 77.1 47.1 42.7 51.4 39.2 35.0 43.5 Not medical school 385 83.6 79.6 87.0 78.2 73.8 82.0 43.6 38.8 48.6 37.4 32.7 42.4 Odds ratio (95% CI); p-value InstType*Obstacle Med school versus not 0.79 (0.51, 1.23); 0.72 0.77 (0.52, 1.15); 0.41 1.15 (0.82, 1.61); >0.99 1.08 (0.76, 1.53); >0.99 0.29 Institute residency program Family medicine + other 623 82.0 78.8 84.8 73.5 69.9 76.8 49.0 45.1 52.9 38.4 34.6 42.3 Family medicine only 233 81.6 76.0 86.0 78.5 72.8 83.3 38.6 32.6 45.0 37.3 31.4 43.7 No Family medicine/No residency 36 77.8 61.5 88.5 88.9 73.9 95.8 38.9 24.6 55.4 38.9 24.6 55.4 Among Institute residency prog Residency (P > .99) Residency (P = .23) Residency (P = .074) Residency (P > .99) Residency*Obstacle 0.049 Location class area of work Urban 461 82.9 79.2 86.0 76.1 72.0 79.8 45.8 41.3 50.3 35.1 30.9 39.6 Suburban 288 81.9 77.1 86.0 76.7 71.5 81.3 46.2 40.5 52.0 37.2 31.8 42.9 Rural 146 77.4 69.9 83.5 70.6 62.7 77.4 44.5 36.7 52.7 50.7 42.6 58.7 Odds ratio (95% CI); p-value LocClass (P > .99) LocClass (P > .99) LocClass (P > .99) LocClass (P = .014) LocClass*Obstacle Urban versus Rural 0.53 (0.30, 0.91); 0.010 0.043 Suburban versus Rural 0.58 (0.32, 1.03); 0.078 Work in underserved area Yes 243 75.3 69.5 80.3 71.2 65.2 76.5 49.0 42.7 55.2 34.6 28.9 40.8 No/unsure 647 84.1 81.1 86.7 77.1 73.7 80.2 44.7 40.9 48.5 39.6 35.9 43.4 Odds ratio (95% CI); p-value Underserved*Reason Yes versus no/unsure 0.58 (0.36, 0.91); 0.011 0.73 (0.48, 1.12); 0.27 1.19 (0.82, 1.73); >0.99 0.81 (0.54, 1.19); 0.69 0.051 *Note: For each demographic variable the p-values for the test of effect of demographic variable and pairwise comparisons have been adjusted for multiplicity (i.e. number of reasons and number of pairwise comparisons).
Abbreviation: CI, confidence interval.
