Food security is defined as having access at all times to enough food for an active, healthy lifestyle [1,2]. This definition implies that safe and nutritious foods are available and that household resources are sufficient to meet cost. Recognition that hunger and food security are problems in the United States led to the development and implementation of measures of hunger and food security on national surveys. One of the national health objectives for 2010 is to increase food security and reduce the risk for hunger among all households (objective 19-18) [1]. To characterize state-level prevalence of concern about food security, data were analyzed for the eight states that used the Social Context Module of the Behavioral Risk Factor Surveillance System (BRFSS) during 1996-1998. This report summarizes the results of this analysis and indicates that approximately 4%-6% of adults reported a concern about having enough food for themselves or their family during the preceding month.

BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized U.S. population aged [greater than or equal to]18 years. A question on concern about food security was part of the Social Context Module, which states may choose to use in addition to the core BRFSS questionnaire. Maryland, Montana, Pennsylvania, and Virginia used this module in 1996 (n=11,485); Kansas, Louisiana, Maryland, South Carolina, and Virginia in 1997 (n=11,487); and Missouri and Virginia in 1998 (n=7100). Respondents were asked, "In the past 30 days, have you been concerned about having enough food for you or your family?" For this report, an answer of "yes" to this question was considered an indication of concern about food security. Sample estimates were weighted by sex, age, and race/ethnicity to reflect the state's noninstitutionalized civilian population, and all prevalence estimates were reported by year of data collection. To account for the complex sampling design, SUDAAN was used for data analysis.

 Overall, the prevalence of concern about food security was 6.0% in 1996, 6.2% in 1997, and 4.6% in 1998 and ranged from 3.1% to 9.4% for individual states (Table 1). This concern was higher among women than men and was highest among persons aged 18-34 years. It was lowest among non-Hispanic whites and among persons who were married, and highest among persons who were divorced or separated or who were never married. Concern about food security increased as the number of children in the house-hold increased; this finding was consistent when stratified by the age of the children ([less than]5, 5-12 and 13-17 years).

Responses to the BRFSS question varied by health and nutrition indicators. Concern about food security was highest among those whose self-reported general health wa

s fair or poor, those with 25-30 days of physical or mental health that were "not good" during the preceding month, and among those who reported lower intake of fruits and vegetables. The prevalence of concern about food security decreased as education level, annual household income, and time spent at current residence increased. The prevalence was highest among unemployed persons and lowest among retired persons.

Prevalence was higher among those who reported a time when they could not afford a doctor compared with those who could and among those whose last routine checkup was [greater than]2 years ago or never compared with those who had had a checkup during the preceding 2 years.

Reported by the following BRFSS coordinators: C Hunt, Kansas; B Bates, MSPH, Louisiana; A Weinstein, MA, Maryland; J Jackson-Thompson, PhD, Missouri; P Feigley, PhD, Montana; L Mann, Pennsylvania; M Wu, MD, South Carolina; K Carswell, MPH, Virginia. KR Evenson, PhD, AL Perry, Dept of Epidemiology, BA Laraia, PhD, Dept of Nutrition, Univ of North Carolina, Chapel Hill. State Br, Div of Applied Public Health Training, Epidemiology Program Office; Cardiovascular Health Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion; and an EIS Officer, CDC.

Editorial Note: Despite the trend toward increasing obesity in the United States [3], a small proportion of the population in these eight states reported a concern about having enough food for themselves or their family during the preceding month. This concern was related to indicators of low socioeconomic status and was highest among women, younger respondents, Hispanics and non-Hispanic blacks, unmarried, divorced, or separated persons, and households with a greater number of children. However, concern about food security was not limited to these groups.

Inadequate food in a household can have deleterious health and behavioral effects [1] and may contribute to poor nutrition [4-6]. Among an adult diabetic population seeking care at an urban county hospital, a high prevalence of hypoglycemic reactions was attributed to being unable to afford food [7]. The question respondents answered in this report asked about concern over having enough food for themselves and their families, but did not ask if the respondent or their family had gone hungry at any time during the preceding month. Conceptual models of food security and hunger indicate the complexity of its measurement because of its sensitive nature and the difficulty that those experiencing hunger may have in comprehending the question [8]. Concern about enough food can vary for individuals and households. Parents may skip meals to leave enough food for their children. The question used to assess concern about food security in this report combines individuals and households [9]. Also, an insufficient food supply can be experienced chronically or episodically [8]. The question used in this report assessed the time frame of the preceding month.

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