It has been a challenging few years, learning to connect with patients while hiding my smile behind a facemask, in an environment where trust in the medical establishment has decreased and social media memes have become absolute truth. But screening for food insecurity has become a secret weapon for building rapport with my patients and fulfilling my calling as a pediatrician at a federally qualified health center serving an underserved community. When I walk into an exam room with a guide to healthy food resources in my hand, knowing that the family in front of me has limited access to food, I immediately connect with them on a personal level. We may not agree that today is the right day for their child to be vaccinated or that their child may benefit from weight loss, but we can unite on the fact that $7 for a dozen eggs is too expensive and $5 for a gallon of gas causes us to modify our spending habits. Our therapeutic alliance rests on the reality that so many people in our country are facing food insecurity, that our health center has recognized this and provided opportunities for me, their pediatrician, to address it.

Food insecurity is common. Nationally, 12.8% of families are food insecure. (1) Food insecurity may result in changes in eating habits, like consuming more calorie-dense and low nutritional value foods that tend to be more affordable and accessible. (2)(3) These habits can increase the likelihood of children developing chronic diseases like obesity. (4) Children also experience toxic stress associated with intense short-term and long-term food insecurity, even when their parents attempt to shield them from experiencing hunger. (4) This stress contributes to an increased risk of mental illness and is associated with health consequences such as depressed immune functioning. (5) Moreover, food insecurity negatively impacts children’s academic performance and future educational attainment. (4)

I’ve been a pediatrician at Northeast Valley Health Corporation (NEVHC) in the San Fernando Valley of Los Angeles for almost 23 years. I became a Champion Provider Fellow in 2017, which coincided with my becoming the pediatric medical director. At the time, we were not screening for food insecurity, but had grant funding to develop innovative ways to address social determinants of health impacting our patients. Feeling that adolescents would be very receptive to the use of technology to assess their health, we decided to use this funding to initiate food insecurity screening for pediatric patients ages 12-17 using OTECH tablets, devices that interface with our electronic health record (EHR). We used the validated two question Hunger Vital Sign to screen patients. The Hunger Vital Sign is considered positive for food insecurity if an adolescent answers “sometimes” or “often” to one of the following statements: “Within the past 12 months, I worried about not having enough to eat” or “Within the past 12 months, I tried not to eat so that our food would last.” (6)

We started out small, implementing screening at 2 of our 9 primary care pediatric health centers. We have since expanded to 5 (soon to be 6) clinics screening for food insecurity annually at all well child visits, from birth to age 17. When a patient screens positive, an alert pops up in our EHR, the diagnosis of food insecurity automatically populates in our assessment, and we are prompted to share a Food Rx Guide with the family. This guide includes QR codes with links to supplemental nutrition programs including CalFresh, Women, Infants, and Children (WIC) resources, and One Degree, as well as a list of local food pantries. The guide also includes food recipes, an explanation of the difference between a “use by” date and an “expiration” date, and graphics demonstrating appropriate portion sizes by age. Our health education department sends a text message inviting families who screen positive for food insecurity to obtain more information. A certified nutritionist, working in our organization, connects interested families with additional resources. The efficacy of this intervention is demonstrated in the data. At a site where we recently started screening and referring patients, 26% of patients were found to be food insecure. In contrast, January 2024 data from a health center where we have been screening for the past 5 years showed that a much lower percentage (1.33%) of patients had food insecurity. We believe this represents a true transformation in the lives of the families we care for.

There is still much work to be done and the Champion Provider fellowship has enabled me to build connections to enhance my impact. Since I completed the Fellowship in 2019, two additional pediatricians (Drs. Teda Arurnut and Saima Khan) from NEVHC have become Champion Provider Fellows. Dr. Arunrut helped develop a shared medical visit as part of our “Kids Fit” pediatric weight management health education course. The group class entails brief patient visits with a pediatrician followed by a “Walk with a doc” to the local park. This model is being expanded to include more clinicians across our health system. Dr. Saima Khan, a current fellow, is working with the LA Food bank to develop a mobile food pharmacy for our patients in the Santa Clarita Valley.

Applying the skills I gained as a Fellow, I am actively engaged in the fight against food insecurity on a policy level. In November 2021, I submitted a declaration supporting a preliminary injunction against LA County’s Department of Social Services (DPSS) regarding delays processing CalFresh applications for households eligible for expedited service. This case just fully resolved in September after DPSS maintained over 98% compliance with timely processing of emergency food stamps for nine consecutive months. I have recently been appointed to the LA County Community Prevention and Population Health Task Force, where I will have the opportunity to share recommendations for public health priorities to promote health, equity, and community well-being with a focus on population health improvement. The work is not yet finished, but I feel well equipped and inspired by my experience in the Champion Provider Fellowship to keep moving forward to promote healthier communities for all, starting in my corner of Los Angeles.

Gina Johnson, MD, has served the pediatric population at Northeast Valley Health Corporation, a Federally Qualified Health Center, since 2001. She has been the pediatric medical director since 2017, with special interests in addressing adverse childhood experiences, asthma, childhood literacy, and obesity prevention. Outside of the clinic, she continues to be actively involved in missions at her church and running marathons with Team World Vision to support providing clean water for African countries including Uganda and Rwanda.

1. United States Department of Agriculture (USDA). (2023, June 20). USDA ERS - Key Statistics & Graphics. Www.ers.usda.gov; US Department of Agriculture. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/
2. Maryah Stella Fram et al., Children Are Aware of Food Insecurity and Take Responsibility for Managing Food Resources, 141 J. of Nutrition 1114, 1117 (2011)
3. County of Los Angeles Public Health. FOOD INSECURITY IN LOS ANGELES COUNTY Before and During the COVID-19 Pandemic. (2021). http://ph.lacounty.gov/nut/media/nutrition-physical-activity-resources/LA_County_Food_Insecurity_Report_2021_508Compliant.pdf
4. Diana F. Jyoti et al., Food Insecurity Affects School Children’s Academic Performance, Weight Gain, and Social Skills 135 J. of Nutrition 2831, 2837 (2005)
5. Mariana Chilton and Jenny Jabinowich, Toxic Stress and Child Hunger Over the Life Course: Three Case Studies, Journal of Applied Research on Children: Informing Policy for Children at risk 1,5 (2012)
6. Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., & Frank, D. A. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26-e32)