Food insecurity screening: a 2-question check

How the check works

The two statements are the first two items of the USDA Household Food Security Survey, asked about the last 12 months (USDA ERS). An answer of often or sometimes true to either one flags the household as at risk. Against the full 18-item survey, this rule found 97% of food-insecure families (sensitivity) and correctly cleared 83% of the others (specificity) (Hager 2010).

Food insecurity means limited or uncertain access to enough nutritious food for an active, healthy life. It can be long term, temporary, come and go (such as running out of money at the end of the month) or follow an event such as a job loss. It is not the same as hunger, which is a physical state (USPSTF 2025).

What the USPSTF recommends

The USPSTF says this is neither a recommendation for nor against screening. Clinicians should use their judgment on whether to screen, be aware of the risk factors and listen to patient concerns (USPSTF 2025). It found adequate evidence that short screening tools are accurate, but little direct evidence that screening in health care improves health. In one trial of 789 families with children under 6, giving information on food assistance after screening did not change food insecurity at 6 months (29.6% vs 29.8%) (USPSTF 2025).

Why it matters

An estimated 12.8% of US households were food insecure in 2022, and nearly one third of households below the federal poverty line (USPSTF 2025). In children, living with food insecurity is linked to obesity, asthma, mental health conditions and worse oral health. In adults it is linked to obesity, diabetes, high blood pressure and heart disease (USPSTF 2025).

Where help comes from

• SNAP provides food benefits to low-income families to supplement their grocery budget (USDA FNS).
• WIC supports families from pregnancy until a child turns 5, with healthy foods, nutrition education, breastfeeding support and referrals (USDA FNS).
• School meals: the National School Lunch Program provides nutritionally balanced, low-cost or free lunches to children each school day (USDA FNS).
• Food banks: the Emergency Food Assistance Program supplies emergency food at no cost to people with low income (USDA FNS).

Clinics can also help through food prescription programs, food boxes or pantries linked to the clinic, medically tailored meals and help connecting to these programs (USPSTF 2025).

Common questions

Why answer this privately?

The USPSTF lists possible harms of screening: stigma, fear of involvement with the legal system, and privacy concerns (USPSTF 2025). This page keeps your answers in your browser; nothing is sent or stored.

What do other groups recommend?

As summarized by the USPSTF: the American Academy of Family Physicians recommends a social risk screening tool that includes food insecurity. The American Academy of Pediatrics, the American Diabetes Association and the Academy of Nutrition and Dietetics suggest the 2-item screen. The American College of Cardiology and American Heart Association, the American College of Physicians and the American College of Obstetricians and Gynecologists recommend screening without naming a tool (USPSTF 2025).

How often should I be asked?

There is little research on the right interval, and food security can change over time (USPSTF 2025).

Also see the child oral health check, the diabetes risk test, the partner violence screening check, the child abuse prevention check and all screening tests by age.