Description
Background: Approximately 8% of U.S. children have food allergies, and food-allergic children are 39% more likely to experience family food insecurity. Rural families face compounded barriers including limited specialist access, transportation challenges, and elevated food insecurity rates, yet remain largely understudied. Objectives: This study aimed to identify the most effective setting for detecting food-insecure, food-allergic families; evaluate the acceptability of the Hunger Vital Sign screening tool in rural allergy clinics; and explore the lived experiences of affected families. Methods: Families were surveyed using the Hunger Vital Sign at 4 food pantries and 3 allergy clinics across Mississippi. A Chi-square test compared identification rates across settings. Focus groups with clinic personnel (n=8) and semi-structured telephonic interviews with caregivers (n=27) were analyzed using content analysis. Results: Of 429 families surveyed, 97 (22.6%) were food-insecure and food-allergic. Food pantries identified 87% of these families versus 13% at allergy clinics. Clinic staff found the Hunger Vital Sign easy to administer but rarely used it due to lacking EHR integration and concerns about patient embarrassment. Caregiver interviews revealed four thematic domains: (1) medical experiences, including ER-based diagnoses and limited allergy education; (2) financial experiences, with families spending ~$260/month on allergy-safe food and ~$690/year in medical costs out-of-pocket; (3) psychosocial experiences, including absenteeism and pervasive "allergy burden"; and (4) rural experiences marked by long travel distances, limited grocery access, and inadequate allergy resources at schools and food pantries. Conclusions: Food pantries are more effective than allergy clinics for identifying food-insecure, food-allergic families in rural Mississippi. Future efforts should prioritize integrating food insecurity screening into clinical EHR workflows, building referral pathways between clinics and food pantries, and improving allergen-safe food availability in community-based assistance programs.
Publication Info
2026.