• Julia I Caldwell, Alina Palimaru, Deborah A Cohen, Dipa Shah, and Tony Kuo.
• From the Nutrition and Physical Activity Program, Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA (JIC, DS); RAND, Santa Monica, CA (AP); Kaiser Permanente Research and Evaluation, Pasadena, CA (DAC); Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA (TK); Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (TK); Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA (TK). jcaldwell@ph.lacounty.gov.
• J Am Board Fam Med. 2023 Apr 3; 36 (2): 240250240-250.

IntroductionFood insecurity is a major public health problem in the United States which was exacerbated by the COVID-19 pandemic. We used a multi-method approach to understand barriers and facilitators to implementing food insecurity screening and referrals at safety net health care clinics in Los Angeles County before the pandemic.MethodsIn 2018, we surveyed 1013 adult patients across eleven safety-net clinic waiting rooms in Los Angeles County. Descriptive statistics were generated to characterize food insecurity status, attitudes toward receiving food assistance, and use of public assistance programs. Twelve interviews with clinic staff explored effective and sustainable approaches to food insecurity screening and referral.ResultsPatients welcomed the opportunity to access food assistance in the clinic setting; 45% preferred discussing food issues directly with the doctor. Missed opportunities to screen for food insecurity and refer patients to food assistance were identified at the clinic level. Barriers to these opportunities included: competing demands on staff and clinic resources, difficulty establishing referral pathways, and doubts surrounding data.DiscussionIntegrating food insecurity assessment in clinical settings requires infrastructure support, staff training, clinic buy-in, and more coordination and oversight from local government, health center entities, and public health agencies.© Copyright by the American Board of Family Medicine.

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