{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T03:09:44Z","timestamp":1782529784984,"version":"3.54.5"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Household food insecurity (FI), even at marginal levels, is associated with poor child health outcomes. The Nutrition Screening Tool for Every Preschooler (NutriSTEP\u00ae) is a valid and reliable 17-item parent-completed measure of nutrition risk and includes a single item addressing FI which may be a useful child-specific screening tool. We evaluated the diagnostic test properties of the single NutriSTEP\u00ae FI question using the 2-item Hunger Vital Sign\u2122 as the criterion measure in a primary care population of healthy children ages 18\u2009months to 5\u2009years.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The sample included 1174 families, 53 (4.5%) of which were marginally food secure. An affirmative response to the single NutriSTEP\u00ae question \u201cI have difficulty buying food I want to feed my child because food is expensive\u201d had a sensitivity of 85% and specificity of 91% and demonstrated good construct validity when compared with the Hunger Vital Sign\u2122.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The single NutriSTEP\u00ae question may be an effective screening tool in clinical practice to identify marginal food security in families with young children and to link families with community-based services or financial assistance programs including tax benefits.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p><jats:italic>TARGet Kids!<\/jats:italic> practice-based research network (Registered June 5, 2013 at <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">www.clinicaltrials.gov<\/jats:ext-link>; NCT01869530); <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.targetkids.ca\">www.targetkids.ca<\/jats:ext-link><\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12887-021-02674-4","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T05:03:11Z","timestamp":1619154191000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Screening for marginal food security in young children in primary care"],"prefix":"10.1186","volume":"21","author":[{"given":"Imaan","family":"Bayoumi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine S.","family":"Birken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly M.","family":"Nurse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia C.","family":"Parkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathon L.","family":"Maguire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Macarthur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janis A.","family":"Randall Simpson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia M.","family":"Borkhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"issue":"5","key":"2674_CR1","doi-asserted-by":"publisher","first-page":"e1431","DOI":"10.1542\/peds.2015-3301","volume":"136","author":"Council on Community Pediatrics Con","year":"2015","unstructured":"Council on Community Pediatrics Con. Promoting food security for all children. Pediatrics. 2015;136(5):e1431\u2013e38. https:\/\/doi.org\/10.1542\/peds.2015-3301.","journal-title":"Pediatrics"},{"key":"2674_CR2","volume-title":"Household Food Insecurity in Canada, 2014","author":"V Tarasuk","year":"2016","unstructured":"Tarasuk V, Mitchell A, Dachner N. Household Food Insecurity in Canada, 2014. Toronto: Research to identify policy options to reduce food insecurity (PROOF); 2016."},{"issue":"2","key":"2674_CR3","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1097\/DBP.0000000000000383","volume":"38","author":"P Shankar","year":"2017","unstructured":"Shankar P, Chung R, Frank DA. Association of food insecurity with children\u2019s behavioral, emotional, and academic outcomes: a systematic review. J Dev Behav Pediatr. 2017;38(2):135\u201350. https:\/\/doi.org\/10.1097\/DBP.0000000000000383.","journal-title":"J Dev Behav Pediatr"},{"issue":"3","key":"2674_CR4","doi-asserted-by":"publisher","first-page":"e859","DOI":"10.1542\/peds.2006-0239","volume":"118","author":"RC Whitaker","year":"2006","unstructured":"Whitaker RC, Phillips SM, Orzol SM. Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children. Pediatrics. 2006;118(3):e859\u2013w68. https:\/\/doi.org\/10.1542\/peds.2006-0239.","journal-title":"Pediatrics"},{"issue":"1","key":"2674_CR5","doi-asserted-by":"publisher","first-page":"51","DOI":"10.3945\/an.112.003228","volume":"4","author":"JT Cook","year":"2013","unstructured":"Cook JT, Black M, Chilton M, Cutts D, Ettinger de Cuba S, Heeren TC, et al. Are food Insecurity\u2019s health impacts underestimated in the U.S. population? Marginal food security also predicts adverse health outcomes in young U.S. children and mothers. Adv Nutr. 2013;4(1):51\u201361. https:\/\/doi.org\/10.3945\/an.112.003228.","journal-title":"Adv Nutr"},{"key":"2674_CR6","volume-title":"ER-256R","author":"A Coleman-Jensen","year":"2018","unstructured":"Coleman-Jensen A, Rabbitt MP, Gregory CA, et al. Household food security in the United States in 2017. In: ER-256R: U.S. Department of Agriculture, Economic Research Service; 2018."},{"key":"2674_CR7","volume-title":"U.S. Household food security survey module: three stage design, with screeners","author":"United States Department of Agriculture","year":"2012","unstructured":"United States Department of Agriculture. U.S. Household food security survey module: three stage design, with screeners 2012 [Accessed 27 Jun 2019]. Available from: http:\/\/www.ers.usda.gov\/datafiles\/Food_Security_in_the_United_States\/Food_Security_Survey_Modules\/hh2012.pdf."},{"issue":"1","key":"2674_CR8","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.1542\/peds.2009-3146","volume":"126","author":"ER Hager","year":"2010","unstructured":"Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, et al. Development and validation of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126(1):e26\u201332. https:\/\/doi.org\/10.1542\/peds.2009-3146.","journal-title":"Pediatrics"},{"issue":"6","key":"2674_CR9","doi-asserted-by":"publisher","first-page":"e1616","DOI":"10.1542\/peds.2013-3663","volume":"133","author":"HB Urke","year":"2014","unstructured":"Urke HB, Cao ZR, Egeland GM. Validity of a single item food security questionnaire in Arctic Canada. Pediatrics. 2014;133(6):e1616\u201323. https:\/\/doi.org\/10.1542\/peds.2013-3663 [published Online First: 2014\/05\/28].","journal-title":"Pediatrics"},{"issue":"6","key":"2674_CR10","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1038\/sj.ejcn.1602780","volume":"62","author":"J Randall Simpson","year":"2008","unstructured":"Randall Simpson J, Keller H, Rysdale L, et al. Nutrition screening tool for every preschooler (NutriSTEP): validation and test\u2013retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers. Eur J Clin Nutr. 2008;62(6):770\u201380. https:\/\/doi.org\/10.1038\/sj.ejcn.1602780.","journal-title":"Eur J Clin Nutr"},{"issue":"9","key":"2674_CR11","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1139\/apnm-2015-0048","volume":"40","author":"J Randall Simpson","year":"2015","unstructured":"Randall Simpson J, Gumbley J, Whyte K, Lac J, Morra C, Rysdale L, et al. Development, reliability, and validity testing of toddler NutriSTEP: a nutrition risk screening questionnaire for children 18\u201335 months of age. Appl Physiol Nutr Metab. 2015;40(9):877\u201386. https:\/\/doi.org\/10.1139\/apnm-2015-0048.","journal-title":"Appl Physiol Nutr Metab"},{"issue":"3","key":"2674_CR12","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1093\/ije\/dyu123","volume":"44","author":"S Carsley","year":"2015","unstructured":"Carsley S, Borkhoff CM, Maguire JL, Birken CS, Khovratovich M, McCrindle B, et al. Cohort profile: the applied research Group for Kids (TARGet Kids!). Int J Epidemiol. 2015;44(3):776\u201388. https:\/\/doi.org\/10.1093\/ije\/dyu123.","journal-title":"Int J Epidemiol"},{"issue":"1","key":"2674_CR13","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s10995-019-02785-6","volume":"24","author":"E Barnidge","year":"2019","unstructured":"Barnidge E, Krupsky K, LaBarge G, Arthur J. Food insecurity screening in pediatric clinical settings: a caregivers\u2019 perspective. Matern Child Health J. 2019;24(1):101\u20139. https:\/\/doi.org\/10.1007\/s10995-019-02785-6.","journal-title":"Matern Child Health J"},{"key":"2674_CR14","doi-asserted-by":"publisher","unstructured":"Mozaffarian D, Fleischhacker S, Andr\u00e9s JR. Prioritizing nutrition security in the US. JAMA. 2021. https:\/\/doi.org\/10.1001\/jama.2021.1915.","DOI":"10.1001\/jama.2021.1915"},{"issue":"3","key":"2674_CR15","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1071\/he06247","volume":"17","author":"M Nolan","year":"2006","unstructured":"Nolan M, Williams M, Rikard-Bell G, et al. Food insecurity in three socially disadvantaged localities in Sydney, Australia. Health Promot J Austr. 2006;17(3):247\u201354. https:\/\/doi.org\/10.1071\/he06247 [published Online First: 2006\/12\/21].","journal-title":"Health Promot J Austr"},{"key":"2674_CR16","unstructured":"Bayoumi I, Coo H, Purkey E. et al. Implementing a Clinical Tool to Screen for Poverty in Primary and Pediatric Care Settings. North American Primary Care Research Group Annual Meeting. Montreal; 2017."},{"issue":"4","key":"2674_CR17","doi-asserted-by":"publisher","first-page":"e20192395","DOI":"10.1542\/peds.2019-2395","volume":"144","author":"PH Dworkin","year":"2019","unstructured":"Dworkin PH, Garg A. Considering approaches to screening for social determinants of health. Pediatrics. 2019;144(4):e20192395. https:\/\/doi.org\/10.1542\/peds.2019-2395.","journal-title":"Pediatrics"},{"issue":"2","key":"2674_CR18","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.acap.2016.01.001","volume":"16","author":"AF Beck","year":"2016","unstructured":"Beck AF, Klein MD. Moving from social risk assessment and identification to intervention and treatment. 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Dr. Birken reports receiving an unrestricted grant from Walmart Canada Community Grants, unrelated to this study. Dr. Parkin reports receiving a grant from the Hospital for Sick Children Foundation during the conduct of the study. Dr. Parkin reports receiving the following grants unrelated to this study: a grant from Canadian Institutes of Health Research (FRN # 115059) for an ongoing investigator-initiated trial of iron deficiency in young children, for which Mead Johnson Nutrition provides non-financial support (Fer-In-Sol\u00ae liquid iron supplement) (2011\u20132017); and peer-reviewed grants for completed investigator-initiated studies from Danone Institute of Canada (2002\u20132004 and 2006\u20132009), Dairy Farmers of Ontario (2008\u20132010). Dr. Maguire reports receiving an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011\u20132012). Dr. Randall Simpson reports receiving grants for investigator-initiated studies from the Canadian Institutes for Health Research, the Danone Institute of Canada, and the Canadian Foundation for Dietetic Research for completed NutriSTEP\u00ae-related studies. Dr. Borkhoff reports previously receiving a grant for a completed investigator-initiated study from the Sickkids Centre for Health Active Kids (CHAK) (2015\u20132016) involving the development and validation of a risk stratification tool to identify young asymptomatic children at risk for iron deficiency. These agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review, or approval of the manuscript. The remaining authors report no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"196"}}