Diagnostic accuracy of the Hunger Vital Sign screener for food insecurity in an obstetric population.

INTRODUCTION: The Hunger Vital Sign (HVS) is a two-item, validated food insecurity screener recommended by the American Academy of Pediatrics. Given its brevity, HVS could be useful in assessing food insecurity in pregnant populations, for whom high-quality nutrition and food access is essential. However, the HVS has not been evaluated in obstetric settings. Thus, we aimed to evaluate the performance of the HVS compared to the gold standard, the 18-item US Household Food Security Survey Module (HFSSM) among low-income, urban pregnant people. METHODS: We conducted a prospective study at a multi-hospital tertiary health system (September 2023 to April 2024) in the United States. English- or Spanish-speaking individuals from zip codes in which ≥10% of households were under the federal poverty line or who had publicly funded antenatal care completed a 20-min self-administered survey, which included the HFSSM and HVS. Food insecurity was defined as marginal, low, or very low food insecurity on the HFSSM; the prevalence of food insecurity was assessed and evaluated by participant characteristics. A positive screen on the HVS was defined as a "often true" or "sometimes true" to either item. Descriptive statistics were performed to characterize the performance of the HVS compared to the HFSSM. RESULTS: Of 713 potentially eligible participants based on medical record review, 192 (27%) completed an eligibility screener and were found to be eligible. Of these, 171 (89%) completed the survey. Nearly half (41%) of participants (n = 70; of whom 74% received publicly funded care) screened positive for food insecurity on the HFSSM. HVS sensitivity was 83%, while specificity was 96%. The positive predictive value of the HVS was 94% and negative predictive value was 89%. CONCLUSION: The two-item HVS had relatively high accuracy for detecting food insecurity in this low-income, urban obstetric population. Incorporating this brief screener into prenatal care may enable efficient, clinically useful food insecurity detection and intervention to address this need.