Shining a Spotlight on Food Insecurity Research and Innovation

One of the real privileges of being in a field for 2 decades is experiencing the joy and pride that comes from seeing your colleagues around the country and world expand the scope of the good we can do hospitalized kids and families. I am proud of fully hospital-based innovations like rapid response teams and new, better medications for many conditions, but what inspires me more are innovations that acknowledge that (1) hospitalization is a traumatic and scary event for families and that (2) kids and families live almost their entire lives outside of the hospital. Hospitalization then may, on the whole, make a larger difference in families’ lives not by safely and efficiently treating a pneumonia (a profound goal that we own and are accountable to), but by identifying social hardships and then linking families to outside-the-hospital interventions to get children on better and healthier trajectories. Of course, work on such programs is not new to the field or the journal; in fact, our first Jennifer Daru Award winners were Beck and colleagues for exceptional work in asthma.1The most recent estimates have found that almost 14 million children live in households with food insecurity, a number that is increasing. As we know that poverty and other social drivers of health increase the risk of both food insecurity and hospitalization, it is likely that the rate of food insecurity for hospitalized kids and families is considerably higher than for the nation as a whole. We are delighted to feature 10 pieces on food insecurity in this issue of Hospital Pediatrics. Unlike other occasions when we devote a sizeable portion of an issue to one topic, we did not make a call for a special issue. Instead, seeing that food insecurity is clearly a priority topic for the field, we were able to group 5 methodologically diverse and impactful original research studies in this issue, many of these from the clear leaders in this field in North America. This issue also includes a perspective by Plecner and colleagues, pushing our entire community to action in research, quality improvement, and advocacy.2 Finally, we invited additional leaders in hospital-based screening and intervention in food insecurity to write commentaries reflecting on the strength and limitations of the science to date and to share critical next steps that will drive the field forward.Collectively, the combined impact of this work is immense. Kovaric and colleagues show the power of qualitative methods and centering lived experience in order to understand gaps and design better interventions3 to connect families to community resources. We are also delighted by this team’s decision to include Spanish-speaking participants in this study, a critical step that we are seeing both more of and still not enough in submissions to Hospital Pediatrics. In related work, Stokes et al qualitatively asked hospitalized families to share their experiences in screening for social needs.4 Families provided practical advice on how, where, and when this should best occur. Hardy and colleagues shared a series of successful quality improvement interventions that also provide compelling data on universal approaches to inpatient food insecurity as both their work and others have identified challenges in screening reliably and at scale.5 Lugo and colleagues penned a compelling commentary on this piece, contextualizing their findings with other quality improvement and pushing the field on how to measure and design toward equity in quality improvement.6Lopez et al present the results of a single-arm prospective trial that aims to address food insecurity in the transition from hospital home. This team found high rates of food insecurity and strong but imperfect connections to community base organizations, a critical step in providing durable solutions to household food insecurity.7 In their commentary, Luke and colleagues recount this study’s many strengths and also call out logical next steps when it comes to assessing more distal outcomes and thinking about dissemination and scalability. They note that like all well-done studies, Lopez and colleagues provided answers to many research questions but perhaps more importantly provided the field with a clearer sense of the right next steps.8 Peterson and team use our still rather new Research Brief article type to share a focused analysis of the complex relationship between food insecurity before and during hospitalization.9 In this health services research study, they find associations between hospital length of stay and both forms of food insecurity. This issue also highlights the immense value of diverse research methods sets to answer questions in one focused clinical area. Using mixed methods, Jungbauer et al performed a multisite study across Oregon, finding quite varied approaches to screening and action.10 In qualitative interviews that followed, they shared complicated barriers and stumbling blocks for hospitals and hospital-based clinicians. Auger’s accompanying commentary builds upon this work and details why it is so hard for families to find affordable foods in children’s hospitals. Then, and more importantly, she details what a fraught and complicated problem it is to figure out how hospitals can best do this and how to best sustainably support food programs that might have sizeable budgets. Both pieces also focus on the really difficult place bedside clinicians find themselves in when families are hungry.11Collectively, this issue provides a comprehensive look about what we know and what we can do to better understand and intervene on food insecurity for hospitalized children and their families. Many next steps are clear. To the field of pediatric hospital medicine: Let’s get to work.