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Impacting Food Insecurity Through the Use of Screening Tools and Training

  • Kofi EsselEmail author
  • Baraka D. Floyd
  • Melissa Klein
Chapter
Part of the SpringerBriefs in Public Health book series (BRIEFSPUBLIC)

Abstract

Food insecurity is described as invisible due to the unreliability of growth parameters or laboratory tests to detect struggling families. Effective screening requires standardized utilization of screening tools integrated into the clinical workflow and well-trained clinicians. In this chapter, we will first introduce a variety of screening tools that can be used clinically, either individually or as part of a more comprehensive social risk screening program. We will also introduce innovative curricula and evaluation tools to train clinicians, including trainees, to recognize the impact of FI and learn to appropriately screen families.

Keywords

Food Insecurity Screening Tool Hunger Vital Sign Social Determinants of Health Education and Training Curriculum 

Abbreviations

AAP

American Academy of Pediatrics

EHR

Electronic Health Record

FI

Food Insecurity

FRAC

Food Research & Action Center

HFSSM

Household Food Security Survey Module

HVS

Hunger Vital Sign

SDH

Social Determinants of Health

US

United States

References

  1. 1.
    Coleman-Jensen A, McFall W, Nord M. Food insecurity in households with children. 2013 [cited 2017 Sep 18];2010–1. Available from: www.ers.usda.gov.
  2. 2.
    Chilton M, Black MM, Berkowitz C, Casey PH, Cook J, Cutts D, et al. Food insecurity and risk of poor health among US-born children of immigrants. [cited 2017 Sep 26]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661461/pdf/556.pdf.
  3. 3.
    Chilton M, Chyatte M, Breaux J. The negative effects of poverty & food insecurity on child development. Indian J Med Res [Internet]. 2007 Oct [cited 2017 Sep 28];126(4):262–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18032801.
  4. 4.
    Sun J, Knowles M, Patel F, Frank DA, Heeren TC, Chilton M. Childhood adversity and adult reports of food insecurity among households with children. Am J Prev Med [Internet]. 2016 May [cited 2017 Sep 28];50(5):561–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26596189.CrossRefGoogle Scholar
  5. 5.
    Jyoti DF, Frongillo EA, Jones SJ. Food insecurity affects school children’s academic performance, weight gain, and social skills. J Nutr [Internet]. 2005 Dec [cited 2017 Sep 28];135(12):2831–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16317128.CrossRefGoogle Scholar
  6. 6.
    Nord M, Bickel G. Measuring children’s food security in U.S. households, 1995–99. US Households [Internet]. [cited 2017 Oct 13];1995–9. Available from: https://www.ers.usda.gov/webdocs/publications/46613/31444_fanrr25_002.pdf?v=41479.
  7. 7.
    National Academies of Sciences E and M. Meeting the dietary needs of older adults [Internet]. Rogers AB, Oria M, editors. Washington, DC: National Academies Press; 2016 [cited 2017 Oct 8]. Available from: http://www.nap.edu/catalog/23496.
  8. 8.
    Berkowitz SA, Seligman HK, Basu S. Impact of food insecurity and SNAP participation on healthcare utilization and expenditures. [cited 2017 Oct 8]. Available from: http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1105&context=ukcpr_papers.
  9. 9.
    Messer E, Ross EM, Ldn. Talking to patients about food insecurity. Nutr Clin Care [Internet]. 2002 Aug;5(4):168–81. Available from: http://10.0.4.22/j.1523-5408.2002.00303.x.CrossRefGoogle Scholar
  10. 10.
    Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics [Internet]. 2010 Jul 1;126(1):e26 LP–e32. Available from: http://pediatrics.aappublications.org/content/126/1/e26.abstract.
  11. 11.
    Promoting Food Security for All Children. Pediatrics [Internet]. 2015 Nov;136(5):e1431–8. Available from: http://proxygw.wrlc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=26498462&site=eds-live&scope=site&authtype=ip,uid&custid=s8987071.
  12. 12.
    Hoisington AT, Braverman MT, Hargunani DE, Adams EJ, Alto CL. Health care providers’ attention to food insecurity in households with children. Prev Med (Baltim) [Internet]. 2012 Sep 1;55:219–22. Available from: http://10.0.3.248/j.ypmed.2012.06.007.
  13. 13.
    Barnidge E, LaBarge G, Krupsky K, Arthur J. Screening for food insecurity in pediatric clinical settings: opportunities and barriers. J Community Health [Internet]. 2017 Aug 4. Available from: http://proxygw.wrlc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=27492774&site=eds-live&scope=site&authtype=ip,uid&custid=s8987071.
  14. 14.
    Palakshappa D, Vasan A, Khan S, Seifu L, Feudtner C, Fiks AG. Clinicians’ perceptions of screening for food insecurity in suburban pediatric practice. Pediatrics [Internet]. 2017 Jul 20 [cited 2017 Oct 8];140(1):e20170319. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28634247.
  15. 15.
    Burkhardt MC, Beck AF, Conway PH, Kahn RS, Klein MD. Enhancing accurate identification of food insecurity using quality-improvement techniques. Pediatrics [Internet]. 2012 Feb 1 [cited 2017 Oct 8];129(2):e504–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22250022.
  16. 16.
    Garg A, Butz AM, Dworkin PH, Lewis RA, Serwint JR. Screening for basic social needs at a medical home for low-income children. [cited 2017 Oct 8]. Available from: http://journals.sagepub.com/doi/pdf/10.1177/0009922808320602.
  17. 17.
    Fleegler EW, Lieu TA, Wise PH, Muret-Wagstaff S. Families’ health-related social problems and missed referral opportunities. Pediatrics [Internet]. 2007 Jun 1 [cited 2017 Oct 10];119(6):e1332–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17545363.
  18. 18.
    Wieland ML, Beckman TJ, Cha SS, Beebe TJ, McDonald FS, Underserved Care Curriculum Collaborative. Resident physicians’ knowledge of underserved patients: a multi-institutional survey. Mayo Clin Proc [Internet]. 2010 Aug [cited 2017 Oct 8];85(8):728–33. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20675511.
  19. 19.
    O’Toole JK, Burkhardt MC, Solan LG, Vaughn L, Klein MD. Resident confidence addressing social history. Clin Pediatr (Phila) [Internet]. 2012 Jul 7 [cited 2017 Oct 8];51(7):625–31. Available from: http://journals.sagepub.com/doi/10.1177/0009922812438081.
  20. 20.
    Knowles MS. Andragogy in action. San Francisco: Jossey-Bass; 1984. 444 p.Google Scholar
  21. 21.
    Garg A, Dworkin PH. Applying surveillance and screening to family psychosocial issues: implications for the medical home. J Dev Behav Pediatr [Internet]. 2011 Jun [cited 2016 Nov 16];32(5):418–26. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00004703-201106000-00010.CrossRefGoogle Scholar
  22. 22.
    Chung EK, Siegel BS, Garg A, Conroy K, Gross RS, Long DA, et al. Screening for social determinants of health among children and families living in poverty: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care [Internet]. 2016 May [cited 2017 Oct 8];46(5):135–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27101890.CrossRefGoogle Scholar
  23. 23.
    Garg A, Boynton-Jarrett R, Dworkin PH. Avoiding the unintended consequences of screening for social determinants of health. JAMA [Internet]. 2016 Aug 23 [cited 2017 Oct 8];316(8):813. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.9282.
  24. 24.
    Addressing food insecurity: a toolkit for pediatricians. 2017 [cited 2017 Oct 9]. Available from: http://www.frac.org/wp-content/uploads/frac-aap-toolkit.pdf.
  25. 25.
    Palakshappa D, Doupnik S, Vasan A, Khan S, Seifu L, Feudtner C, et al. Suburban families’ experience with food insecurity screening in primary care practices. Pediatrics [Internet]. 2017 Jul 20 [cited 2017 Oct 8];140(1):e20170320. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28634248.
  26. 26.
    Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household food security in the United States in 2016. 2017 [cited 2017 Sep 18]. Available from: https://www.ers.usda.gov/webdocs/publications/84973/err-237.pdf?v=42979.
  27. 27.
    Jones AD, Ngure FM, Pelto G, Young SL. What are we assessing when we measure food security? A compendium and review of current metrics. Adv Nutr [Internet]. 2013 Sep 1 [cited 2017 Sep 23];4(5):481–505. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24038241.
  28. 28.
    Bickel G, Nord M, Price C, Hamilton W, Cook J. Measuring food security in the United States guide to measuring household food security revised 2000. [cited 2017 Sep 23]. Available from: http://www.fns.usda.gov/oane.
  29. 29.
    Council NR. Food insecurity and hunger in the United States [Internet]. Washington, DC: National Academies Press; 2006 [cited 2017 Sep 18]. Available from: http://www.nap.edu/catalog/11578.
  30. 30.
    Gundersen C, Engelhard EE, Crumbaugh AS, Seligman HK. Brief assessment of food insecurity accurately identifies high-risk US adults. Public Health Nutr [Internet]. 2017 Jun 20 [cited 2017 Oct 8];20(8):1367–71. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28215190.
  31. 31.
    Kleinman RE, Murphy JM, Wieneke KM, Desmond MS, Schiff A, Gapinski JA. Use of a single-question screening tool to detect hunger in families attending a neighborhood health center. Ambul Pediatr. 2007 Jul;7(4):278–84.CrossRefGoogle Scholar
  32. 32.
    Goldman N, Sheward R, Ettinger de Cuba S, Black M, Sandel M, Cook J, et al. The hunger vital sign: a new standard of care for preventive health [Internet]. Children’s Healthwatch Policy Action Brief. Boston; 2014 [cited 2018 Jan 3]. Available from: http://www.childrenshealthwatch.org/wp-content/uploads/FINAL-Hunger-Vital-Sign-2-pager1.pdf.
  33. 33.
    Makelarski JA, Abramsohn E, Benjamin JH, Du S, Lindau ST. Diagnostic accuracy of two food insecurity screeners recommended for use in health care settings. Am J Public Health [Internet]. 2017 Nov [cited 2017 Dec 11];107(11):1812–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28933929.CrossRefGoogle Scholar
  34. 34.
    Gottlieb LM, Hessler D, Long D, Laves E, Burns AR, Amaya A, et al. Effects of social needs screening and in-person service navigation on child health. JAMA Pediatr [Internet]. 2016 Nov 7 [cited 2017 Oct 9];170(11):e162521. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27599265.
  35. 35.
    Kleinman RE, Michael Murphy J, Little M, Pagano M, Wehler CA, et al. Hunger in children in the United States: potential behavioral and emotional correlates. [cited 2017 Oct 8]. Available from: http://pediatrics.aappublications.org/content/pediatrics/101/1/e3.full.pdf.
  36. 36.
    Connell CL, Nord M, Lofton KL, Yadrick K. Community and international nutrition food security of older children can be assessed using a standardized survey instrument 1. J Nutr [Internet]. 2004 [cited 2017 Oct 9];134:2566–72. Available from: http://jn.nutrition.org/content/134/10/2566.full.pdf.CrossRefGoogle Scholar
  37. 37.
    Coleman-Jensen A, Nord M. Self-administered food security survey module for children ages 12 years and older. J Nutr [Internet]. 2004 [cited 2017 Oct 9];134(10):2566–72. Available from: https://www.ers.usda.gov/media/8283/youth2006.pdf.
  38. 38.
    Baer TE, Scherer EA, Fleegler EW, Hassan A. Food insecurity and the burden of health-related social problems in an urban youth population. J Adolesc Heal [Internet]. 2015 Dec [cited 2017 Oct 8];57(6):601–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26592328.CrossRefGoogle Scholar
  39. 39.
    Adams E, Hargunani D, Hoffmann L, Blaschke G, Helm J, Koehler A. Screening for food insecurity in pediatric primary care: a clinic’s positive implementation experiences. J Health Care Poor Underserved [Internet]. 2017 [cited 2017 Oct 14];28(1):24–9. Available from: https://muse.jhu.edu/article/648742.CrossRefGoogle Scholar
  40. 40.
    Fierman AH, Beck AF, Chung EK, Tschudy MM, Coker TR, Mistry KB, et al. Redesigning health care practices to address childhood poverty. Acad Pediatr [Internet]. 2016 Apr [cited 2017 Oct 10];16(3):S136–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27044692.CrossRefGoogle Scholar
  41. 41.
    Cheng TL, Emmanuel MA, Levy DJ, Jenkins RR. Child health disparities: what can a clinician do? [cited 2017 Oct 9]. Available from: http://pediatrics.aappublications.org/content/pediatrics/early/2015/10/06/peds.2014-4126.full.pdf.
  42. 42.
    Keller D, Jones N, Savageau JA, Cashman SB. Development of a brief questionnaire to identify families in need of legal advocacy to improve child health. Ambul Pediatr [Internet]. 2008 Jul [cited 2017 Oct 10];8(4):266–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18644550.
  43. 43.
    Garg A, Toy S, Tripodis Y, Silverstein M, Freeman E. Addressing social determinants of health at well child care visits: a cluster RCT. Pediatrics [Internet]. 2015 Feb;135(2):e296–304. Available from: http://proxygw.wrlc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=25560448&site=eds-live&scope=site&authtype=ip,uid&custid=s8987071.CrossRefGoogle Scholar
  44. 44.
    Billioux A, Katherine V, Anthony S, Alley D. Standardized screening for health-related social needs in clinical settings the accountable health communities screening tool. Washington, DC: National Academy of Medicine; 2017.Google Scholar
  45. 45.
    Bikson K, McGuire J, Blue-Howells J, Seldin-Sommer L. Psychosocial problems in primary care: patient and provider perceptions. Soc Work Health Care [Internet]. 2009 Nov 20 [cited 2017 Oct 10];48(8):736–49. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20182986.CrossRefGoogle Scholar
  46. 46.
    Schor EL. Rethinking well-child care. Pediatrics. 2004;114(1):210 LP–216.CrossRefGoogle Scholar
  47. 47.
    Thackeray J, Stelzner S, Downs SM, Miller C. Screening for intimate partner violence. J Interpers Violence [Internet]. 2007 Jun 2 [cited 2017 Oct 10];22(6):659–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17515428.
  48. 48.
    Gottlieb L, Hessler D, Long D, Amaya A, Adler N. A randomized trial on screening for social determinants of health: the iScreen study. Pediatrics [Internet]. 2014 Dec 3 [cited 2017 Oct 10];134(6):e1611–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25367545.
  49. 49.
    Mackenzie SLC, Kurth AE, Spielberg F, Severynen A, Malotte CK, St. Lawrence J, et al. Patient and staff perspectives on the use of a computer counseling tool for HIV and sexually transmitted infection risk reduction. J Adolesc Heal [Internet]. 2007 Jun [cited 2017 Oct 10];40(6):572.e9–572.e16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17531766.CrossRefGoogle Scholar
  50. 50.
    Hussain N, Sprague S, Madden K, Hussain FN, Pindiprolu B, Bhandari M. A comparison of the types of screening tool administration methods used for the detection of intimate partner violence. Trauma, Violence, Abus [Internet]. 2015 Jan 15 [cited 2017 Oct 10];16(1):60–9. Available from: http://journals.sagepub.com/doi/10.1177/1524838013515759.CrossRefGoogle Scholar
  51. 51.
    Connell CL, Lofton KL, Yadrick K, Rehner TA. Children’s experiences of food insecurity can assist in understanding its effect on their well-being. J Nutr [Internet]. 2005 Jul [cited 2017 Sep 26];135(7):1683–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15987850.CrossRefGoogle Scholar
  52. 52.
    Fram MS, Frongillo EA, Jones SJ, Williams RC, Burke MP, DeLoach KP, et al. Children are aware of food insecurity and take responsibility for managing food resources. J Nutr [Internet]. 2011 Jun 1 [cited 2017 Sep 26];141(6):1114–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21525257.CrossRefGoogle Scholar
  53. 53.
    Bradley KA, Lapham GT, Hawkins EJ, Achtmeyer CE, Williams EC, Thomas RM, et al. Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med [Internet]. 2011 Mar [cited 2017 Oct 10];26(3):299–306. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20859699.CrossRefGoogle Scholar
  54. 54.
    Williams EC, Achtmeyer CE, Thomas RM, Grossbard JR, Lapham GT, Chavez LJ, et al. Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: a multi-site qualitative study. J Gen Intern Med [Internet]. 2015 Aug [cited 2017 Oct 10];30(8):1125–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25731916.CrossRefGoogle Scholar
  55. 55.
    Henize AW, Beck AF, Klein MD, Adams M, Kahn RS. A road map to address the social determinants of health through community collaboration. Pediatrics [Internet]. 2015 Sep 1 [cited 2017 Oct 10];peds.2015–0549. Available from: http://pediatrics.aappublications.org/content/early/2015/09/15/peds.2015-0549.CrossRefGoogle Scholar
  56. 56.
    Beck AF, Klein MD, Kahn RS. Identifying social risk via a clinical social history embedded in the electronic health record. Clin Pediatr (Phila) [Internet]. 2012 Oct 17 [cited 2017 Oct 10];51(10):972–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22511197.
  57. 57.
    Bazemore AW, Cottrell EK, Gold R, Hughes LS, Phillips RL, Angier H, et al. “Community vital signs”: incorporating geocoded social determinants into electronic records to promote patient and population health. J Am Med Informatics Assoc [Internet]. 2016 Mar [cited 2017 Dec 11];23(2):407–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26174867.CrossRefGoogle Scholar
  58. 58.
    Troseth MR. American academy of nursing endorses social behavioral determinants of health in electronic health records. Comput Inform Nurs [Internet]. 2017 Jul [cited 2017 Dec 11];35(7):329–30. Available from: http://insights.ovid.com/crossref?an=00024665-201707000-00002.PubMedGoogle Scholar
  59. 59.
    Reed S, Shell R, Kassis K, Tartaglia K, Wallihan R, Smith K, et al. Applying adult learning practices in medical education. Curr Probl Pediatr Adolesc Health Care [Internet]. 2014 Jul [cited 2017 Dec 11];44(6):170–81. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1538544214000182.CrossRefGoogle Scholar
  60. 60.
    Russell SS. An overview of adult-learning processes. Urol Nurs [Internet]. 2006 Oct [cited 2017 Dec 11];26(5):349–52, 370. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17078322.
  61. 61.
    O’Toole JK, Solan LG, Burkhardt MC, Klein MD. Watch and learn: an innovative video trigger curriculum to increase resident screening for social determinants of health. Clin Pediatr (Phila) [Internet]. 2013 Apr 7 [cited 2017 Dec 11];52(4):344–50. Available from: http://journals.sagepub.com/doi/10.1177/0009922813475702.
  62. 62.
    Knowles MS, Holton EF, Swanson RA. THE ADULT LEARNER the definitive classic in adult education and human resource development. Elsevier; 2005. 1–378 p.Google Scholar
  63. 63.
    Community Pediatrics Training Initiatives [Internet]. [cited 2017 Oct 27]. Available from: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/CPTI/Pages/default.aspx.
  64. 64.
    U.S. Child Poverty Curriculum [Internet]. [cited 2017 Oct 13]. Available from: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/CPTI/Pages/U-S-Child-Poverty-Curriculum.aspx.
  65. 65.
    Chamberlain LJ, Hanson ER, Klass P, Schickedanz A, Nakhasi A, Barnes MM, et al. Childhood poverty and its effect on health and well-being: enhancing training for learners across the medical education continuum. Acad Pediatr [Internet]. 2016 Apr [cited 2017 Dec 11];16(3):S155–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27044694.CrossRefGoogle Scholar
  66. 66.
    Klein MD, Alcamo AM, Beck AF, O’Toole JK, McLinden D, Henize A, et al. Can a video curriculum on the social determinants of health affect residents’ practice and families’ perceptions of care? Acad Pediatr [Internet]. 2014 Mar [cited 2017 Dec 11];14(2):159–66. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1876285913003161.
  67. 67.
    LNCO Advocacy training [Internet]. Oregon Health & Science University. Available from: http://www.ohsu.edu/xd/health/services/doernbecher/research-education/education/pediatric-residency-program/program/advocacy.cfm.
  68. 68.
    O’Brien MJ, Garland JM, Murphy KM, Shuman SJ, Whitaker RC, Larson SC. Training medical students in the social determinants of health: the Health Scholars Program at Puentes de Salud. Adv Med Educ Pract [Internet]. 2014 Sep [cited 2017 Dec 11];5:307–14. Available from: http://www.dovepress.com/training-medical-students-in-the-social-determinants-of-health-the-hea-peer-reviewed-article-AMEP.
  69. 69.
    Northrip KD, Bush HM, Li H-F, Marsh J, Chen C, Guagliardo MF. Pediatric residents’ knowledge of the community. Acad Pediatr [Internet]. 2012 Jul [cited 2017 Dec 11];12(4):350–6. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1876285912000691.
  70. 70.
    Real FJ, Beck AF, Spaulding JR, Sucharew H, Klein MD. Impact of a neighborhood-based curriculum on the helpfulness of pediatric residents’ anticipatory guidance to impoverished families. Matern Child Health J [Internet]. 2016 Nov 1 [cited 2017 Dec 11];20(11):2261–7. Available from: http://link.springer.com/10.1007/s10995-016-2133-7.CrossRefGoogle Scholar
  71. 71.
    Community Health and Advocacy Rotation | BCRP | Boston Children’s Hospital [Internet]. [cited 2017 Oct 11]. Available from: http://www.childrenshospital.org/bcrp/program/benefiting-the-community/community-health-and-advocacy-rotation.
  72. 72.
    Lujan HL, DiCarlo SE. First-year medical students prefer multiple learning styles. Adv Physiol Educ. 2006;30(1):13–6.CrossRefGoogle Scholar
  73. 73.
    VARK Questionnaire [Internet]. [cited 2017 Dec 22]. Available from: http://vark-learn.com/the-vark-questionnaire/.
  74. 74.
    Palis AG, Quiros PA. Adult learning principles and presentation pearls. Middle East Afr J Ophthalmol [Internet]. 2014 [cited 2017 Dec 11];21(2):114–22. Available from: http://www.meajo.org/text.asp?2014/21/2/114/129748.CrossRefGoogle Scholar
  75. 75.
    Real FJ, Michelson CD, Beck AF, Klein MD. Location, location, location: teaching about neighborhoods in pediatrics. Acad Pediatr [Internet]. 2017 Apr [cited 2017 Dec 11];17(3):228–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27988207.CrossRefGoogle Scholar
  76. 76.
    Blumberg SJ, Bialostosky K, Hamilton WL, Briefel RR. The effectiveness of a short form of the Household Food Security Scale. Am J Public Health [Internet]. 1999 Aug [cited 2017 Oct 8];89(8):1231–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10432912.CrossRefGoogle Scholar
  77. 77.
    Blumberg J Bialostosky K Hamilton W Briefel R. U.S. household food security survey module: six-item short form economic research service, USDA September 2012. Am J Public Health [Internet]. 1999;89:1231–4. Available from: https://www.ers.usda.gov/media/8282/short2012.pdf.CrossRefGoogle Scholar
  78. 78.
    Billioux A. Standardized screening for health-related social needs in clinical settings the accountable health communities screening tool. 2017 [cited 2017 Oct 10]; Available from: https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf.
  79. 79.
    Urke HB, Cao ZR, Egeland GM. Validity of a single item food security questionnaire in Arctic Canada. Pediatrics [Internet]. 2014 Jun 1 [cited 2017 Dec 11];133(6):e1616–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24864166.
  80. 80.
    Nord M, Hopwood H. Recent advances provide improved tools for measuring children’s food security. J Nutr [Internet]. 2007 Mar;137(3):533–6. Available from: http://proxygw.wrlc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=17311935&site=eds-live&scope=site&authtype=ip,uid&custid=s8987071.CrossRefGoogle Scholar
  81. 81.
    Kenyon C, Sandel M, Silverstein M, Shakir A, Zuckerman B. Revisiting the social history for child health. Pediatrics [Internet]. 2007 Sep 1 [cited 2017 Dec 11];120(3):e734–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17766513.
  82. 82.
    Riddell J, Jhun P, Fung C-C, Comes J, Sawtelle S, Tabatabai R, et al. Does the flipped classroom improve learning in graduate medical education? J Grad Med Educ [Internet]. 2017 Aug [cited 2017 Dec 11];9(4):491–6. Available from: http://www.jgme.org/doi/10.4300/JGME-D-16-00817.1.
  83. 83.
    Community Pediatrics CO. Poverty and child health in the United States. Pediatrics [Internet]. 2016 Apr 1 [cited 2017 Dec 11];137(4):e20160339–e20160339. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26962238.
  84. 84.
    Klein MD, Kahn RS, Baker RC, Fink EE, Parrish DS, White DC. Training in social determinants of health in primary care: does it change resident behavior? Acad Pediatr [Internet]. 2011;11(5):387–93. Available from:  https://doi.org/10.1016/j.acap.2011.04.004 CrossRefGoogle Scholar
  85. 85.
    Klein M, Vaughn LM. Teaching social determinants of child health in a pediatric advocacy rotation: small intervention, big impact. Med Teach. 2010;32(9):754–9.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  1. 1.Children’s National Health SystemThe George Washington University, School of Medicine & Health SciencesWashingtonUSA
  2. 2.Stanford School of MedicineStanfordUSA
  3. 3.Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of MedicineCincinnatiUSA

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