Abstract
BackgroundWe tested the properties of the 18 Household Food Security Survey (HFSS) items, and the validity of the resulting food security classifications, in an English-speaking middle-income country.MethodsSurvey of primary school children in Trinidad and Tobago. Parents completed the HFSS. Responses were analysed for the 10 adult-referenced items and the eight child-referenced items. Item response theory models were fitted. Item calibrations and subject scores from a one-parameter logistic (1PL) model were compared with those from either two-parameter logistic model (2PL) or a model for differential item functioning (DIF) by ethnicity.ResultsThere were 5219 eligible with 3858 (74%) completing at least one food security item. Adult item calibrations (standard error) in the 1PL model ranged from -4.082 (0.019) for the 'worried food would run out' item to 3.023 (0.042) for 'adults often do not eat for a whole day'. Child item calibrations ranged from -3.715 (0.025) for 'relied on a few kinds of low cost food' to 3.088 (0.039) for 'child didn't eat for a whole day'. Fitting either a 2PL model, which allowed discrimination parameters to vary between items, or a differential item functioning model, which allowed item calibrations to vary between ethnic groups, had little influence on interpretation. The classification based on the adult-referenced items showed that there were 19% of respondents who were food insecure without hunger, 10% food insecure with moderate hunger and 6% food insecure with severe hunger. The classification based on the child-referenced items showed that there were 23% of children who were food insecure without hunger and 9% food insecure with hunger. In both children and adults food insecurity showed a strong, graded association with lower monthly household income (P < 0.001).ConclusionThese results support the use of 18 HFSS items to classify food security status of adults or children in an English-speaking country where food insecurity and hunger are more frequent overall than in the US.
Highlights
We tested the properties of the 18 Household Food Security Survey (HFSS) items, and the validity of the resulting food security classifications, in an English-speaking middle-income country
Our results show that the items generally perform in a very similar manner to results obtained from the US Current Population Survey [10,9]
Item calibrations were mostly ranked in a similar order to the one observed in the US and departures from the assumptions of the 1PL model were generally not great enough to require revision of the classification of food security status
Summary
We tested the properties of the 18 Household Food Security Survey (HFSS) items, and the validity of the resulting food security classifications, in an English-speaking middle-income country. Our previous studies in Trinidad and Tobago have shown that food insecurity without hunger is common in both adults and adolescents. It is associated with markers of poorer dietary quality [7,8] and is associated with underweight in adults [7]. The assessment of food insecurity and hunger in population surveys has been facilitated by the development in the US of a standard questionnaire measure which may be used to classify the food security status of adults and children [1,9]. In the US, only 0.7% of households with children were classified as having hunger among children in 1998–9 [10]
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