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2019 HSR&D/QUERI National Conference Abstract

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1159 — Risk Factors for Veteran Food Insecurity: Findings from a New VA Food Insecurity Clinical Reminder

Lead/Presenter: Alicia Cohen,  COIN - Providence
All Authors: Cohen AJ (Long-Term Services and Supports, Providence), Thomas KS (Long-Term Services and Supports, Providence), Heisler M (Center for Clinical Management Research, Ann Arbor) Elwy AR (Center for Healthcare Organization and Implementation Research, Bedford) McConeghy R (Long-Term Services and Supports, Providence) Halladay C (Long-Term Services and Supports, Providence) Rudolph JL (Long-Term Services and Supports, Providence) Dosa DM (Long-Term Services and Supports, Providence)

Objectives:
Food insecurity is a pressing concern for Veterans, with an estimated prevalence as high as 27% among OEF/OIF/OND Veterans and 49% among homeless Veterans. In July 2017, VHA launched a food insecurity clinical reminder intended to screen all Veterans receiving care within the VA, focusing on identifying those most severely food insecure. Little is known about screening uptake across VA sites, or prevalence and correlates of food insecurity among those screened.

Methods:
Using the VA Corporate Data Warehouse, we conducted a retrospective cohort study to examine use of the VHA food insecurity clinical reminder between July 1, 2017-September 30, 2018 across VA facilities nationally, as well as prevalence and correlates of food insecurity among Veterans screened. Multivariable logistic regression models were estimated to identify sociodemographic, medical, and psychological characteristics associated with a positive food insecurity screen, controlling for facility-level fixed effects.

Results:
A total of 126 (89%) VA facilities implemented the food insecurity clinical reminder during the study period, screening 2,781,339 Veterans. Of these, 39,648 (1.4%) Veterans reported food insecurity. Among those screening positive, 61% were referred to social work and 4.6% were referred to a dietician. Correlates of screening positive for food insecurity included being African American or Hispanic (aOR 1.31, 95% CI 1.24-1.38 and aOR 1.14, 95% CI 1.08-1.21, respectively) and non-married/partnered (aOR 1.47, 95% CI 1.40-1.54). Veterans screening positive also had substantially higher odds of reporting homelessness/housing instability in the prior year (aOR 14.03, 95% CI 12.86-15.31). Medical and psychological/behavioral risk factors for screening positive included unintended weight loss (aOR 1.28, 95% CI 1.20-1.36), having one or more psychiatric diagnosis (aOR 1.32, 95% CI 1.25-1.40), and substance use disorder (aOR 1.12, 95% CI 1.07-1.17).

Implications:
Food insecurity among Veterans is associated with several medical and psychological comorbidities, as well as unmet social needs including homelessness. Veterans of color were also more likely to have a positive screen.

Impacts:
This is the first study to evaluate risk factors for Veteran food insecurity over the first 15 months following introduction of a new VA screener. Future work should examine targeted screening and interventions tailored to addressing food insecurity among Veterans at highest risk.