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PORTLAND, Ore. - A survey of pediatric physicians and nurse practitioners in the Portland metro area shows that a majority are not regularly asking about household food practices, including nutritional quality or whether there is enough food in the home.

Oregon is one of the states ranked highest in "food insecurity," or the proportion of households that have limited access to nutritionally adequate food on a regular basis. About 13.9 percent of households in Oregon are "food insecure" and Oregon also has one of the highest rates of childhood hunger.

The American Academy of Pediatrics has identified food security as one of the top health-related social issues that should be addressed in a pediatric visit. Yet, in a new study published online recently in the journal Preventive Medicine, only 13 percent of health care providers in the Portland area reported asking about household food sufficiency, and only 9 percent considered themselves knowledgeable about the prevalence of food insecurity in Oregon.

The study's lead author, Anne Hoisington, an Oregon State University Extension specialist based at the Oregon Food Bank, said a positive aspect of the survey was that a large majority - almost 89 percent - of respondents said they would be willing to use a standardized screening question.

"A large percentage of our responding physicians and nurse practitioners were willing to engage, so I look at this as a huge opportunity that indicates that these providers want to learn more," she said. "We already offer an online training class, and I'd like to see this taken a step further."

The study showed that out of the 186 respondents, the health care providers who monitored food insecurity tended to be those with more years in practice.

Providers listed limited time available in the clinical visit as the main barrier to inquiring about the nutritional quality of their patients' food. In contrast, however, the main barriers to inquiring about food sufficiency - whether everyone in the family has enough to eat - were discomfort in discussing food insecurity and inadequate knowledge about the topic.

"We found that the prospect of discussing food sufficiency seems to make some providers uncomfortable," said Marc Braverman, a professor and Extension specialist in the College of Public Health and Human Sciences at OSU, who coauthored this study. "The topic is largely outside of their common practice, because food scarcity is perceived as a social problem rather than a medical problem, even though it has real and serious impacts on health."

Hoisington, who is also a nutrition specialist in the College of Public Health and Human Sciences, said food scarcity taps into one of the most sensitive areas in parenting - a parent's ability to care properly and provide resources for his or her child.

Ideally, Hoisington would like to develop a training video in collaboration with partners around Oregon that could be shared with pediatricians' offices. The training video would help model how health providers could deal with this sensitive topic with an upset parent.

In addition, the researchers said doctors should have materials on hand about underutilized food assistance programs such as SNAP, so they can provide parents with resources.

Hoisington said since this survey was conducted several years ago, more than 2,000 Oregonians have gone through an online training course on food insecurity developed by OSU Extension. More than 10 percent of those were physicians, and most others are medical students, nurses, dieticians, and other health care providers.

The survey was a project of the Childhood Hunger Coalition, which includes OSU Extension, Oregon Food Bank, Oregon Health and Science University, the Oregon Health Authority's WIC (Women, Infants, and Children) Program, Kaiser Permanente, and Partners for a Hunger-Free Oregon.

The next step is to conduct intervention studies, which are already in the works. Members of the Childhood Hunger Coalition are conducting pilot screenings and designing an intervention model in two clinics where doctors will screen patients on food insecurity.

 "With health care reform now a reality, I think there will be more focus on prevention," Hoisington said. "Hopefully that will mean we will become more attentive to issues such as health care disparity, hunger, and food insecurity."

Coauthors of this study included pediatrician Dr. Dana Hargunani and assistant professor Elizabeth Adams, both with OHSU, and Cheryl Alto with the Oregon WIC.