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Food Insecurity is the first of three Social Determinants of Health domains the Gravity Project will address during Phase 1 work.  

Community Homework

TaskInstructions and Due Dates

If you are not currently a registered member and would like to join the Gravity Project, click here.

Click here for food-related terminology, definitions and source materials. These are the definitions and descriptions we will be using to guide community discussions around food insecurity data elements.

Coding Submissions

The Gravity Project seeks to identify coded data elements and associated value sets to represent social determinants of health (SDOH) data documented across the following four clinical activities: screening, diagnosis, goals, and interventions. It focuses on identifying, developing, and validating 1) the data elements needed to document SDOH data across all four clinical activities, and 2) national standards to support the electronic capture and exchange SDOH data across a variety of systems and settings of care and social services.  The following formal submissions have been made to coding stewards in order to address the food insecurity data concept gaps identified during the domain work.  Codes that are accepted by the respective standards developing organizations will be published in upcoming releases.

ICD-10 Coding Submission May 2020

LOINC Coding Submission April 2020

SNOMED Coding Submission - Interventions June 2020

SNOMED Coding Submission - Diagnoses June 2020

Food Insecurity Data Elements

Final Food Insecurity Master List - Published

31 January

16 April 2020

<a href
<a href = "" download="Food Security MASTER_FINAL_20200203 (2).xlsx" >Click here to download the Food finalInsecurity Master List.</a>

Food Insecurity Consensus Voting Comments and Dispositions - Published 31 January 2020

<a href = "" download="consensus_votes_master_list_20200131_FINAL.xlsx">Click here to download the Consensus Voting Comments and Dispositions spreadsheet.</a>

Adjudicated Data Element Submission Statistics

Below is a list of how many of each food insecurity data element type has been adjudicated as of the date listed.

DateScreening Tool/Questions



17Oct1956 tools / 203 questions6013147220
12Sept1956 tools / 191 questions6012146218
29Aug1941 tools / 126 questions4411103158
15Aug1936 tools / 95 questions429100151
01Aug1928 tools / 71 questions38987134
18Jul199 tools / 34 questions



Interventions Framework

This is an updated draft (31 January 07 July 2020) of the framework for intervention data element concepts.  Thank you to everyone who submitted comments on the initial version!

Gravity Term
Gravity Definition Issues/Suggestions 

A type of order wherein clinicians/providers request services and/or assessment from other professionals and/or programs.

  • Provision.  For the purposes of the project, provision covers any concrete support that is able to be given to the patient directly at the point of service.
  • Counseling.  Psychosocial procedure that involves mental/behavioral strategies such as listening, reflecting, etc. to facilitate recognition of course of action/solution.
  • Education.  Procedure that is synonymous with those activities such as teaching, demonstration, instruction, explanation, and advice that aims to increase knowledge and skills, change behaviors, assist coping.
  • Assessment.  Assessment includes both the process of provider clinical observation and interpretation and the utilization of assessment tools. In

    The act of clinicians/providers sending or directing a patient to professionals and/or programs for services (e.g., evaluation, treatment, aid, information, etc.)

    Evaluation/ Assessment

    The process of both provider clinical observation and interpretation, and the application of assessment tools.  In both activities the aim is to arrive at outcomes that define the status of the patient in order to guide further care.

    Determination of a value, conclusion, or inference by evaluating evidence.


    Evaluation of eligibility

    .  Chosen

    (for <x>)

    Subtype of Evaluation

    Used to mark the activities prior to determination of eligibility.

    (Crucial for federal


    assistance programs).


    Suggestion: Process of determining eligibility by evaluating evidence

    Assistance/ Assisting

    Non-clinical aid with the tasks of care such as applications and setting up appointments

  • Coordination.  Organizing activities and sharing information.
  • Intervention Examples

  • Referral to:
    • Role (case manager, care navigator)
    • Organization (community action agency)
    • Program (senior congregate meal, SNAP)
  • Provision of: e.g., food, fresh fruit and vegetable voucher
  • Counseling: e.g., barriers to, readiness for, cognitive behavioral therapy
  • Education: e.g., nutrition related skills education
  • Assessment for/of: e.g., food insecurity, patient goals
  • Evaluation of eligibility for: e.g., WIC, home delivered meals
  • Assistance with application for: WIC, SNAP
  • Coordination of: e.g., care plan, care team

    To give support or aid to; help


    Psychosocial procedure that involves listening, reflecting, etc. to facilitate recognition of course of action / solution.

    Psychosocial procedure that involves listening, reflecting, etc. to facilitate recognition of course of action / solution.


    Procedure that is synonymous with those activities such as teaching, demonstration, instruction, explanation, and advice that aims to increase knowledge and skills, change behaviors, assist coping

    Procedure that is synonymous with those activities such as teaching, demonstration, instruction, explanation, and advice that aim to increase knowledge and skills.


    Covers any concrete support that is able to be given to the patient directly at the point of service

    To supply/make available for use


    Organizing activities and sharing information

    Process of organizing activities and sharing information to improve effectiveness

    Screening Tools

    Screening Tool




    The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) have made the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool to use in the AHC Model. This screening tool assesses 5 core domains:

    • Housing instability
    • Food insecurity
    • Transportation problems
    • Utility help needs
    • Interpersonal safety


    The CommunityConnect Social Needs Screening Tool was developed to capture social, medical, and behavioral health needs. The tool was designed to promote motivational interviewing, client engagement and rapport, allowing case managers from a range of disciplines to use the screening telephonically and in-field with patients.  The screening consists of 42 questions and crosses 10 domains including: housing instability, food security, transportation, interpersonal safety, vision & dental, behavioral and social support, medical, finances, education and employment, and legal needs.

    FIES-SMThe Food Insecurity Experience Scale (FIES) Survey Module (FIES-SM) consists of eight questions regarding people's access to adequate food, and can be easily integrated into various types of population surveys.
    Health Information National Trends Survey (HINTS)HINTS collects data about the use of cancer-related information by the American public. These data provide opportunities to understand and improve health communication.
    Health LeadsThe Health Leads Social Needs Screening Toolkit is a comprehensive blueprint for health systems seeking to identify and screen patients for adverse social determinants of health.

    HFIASHousehold Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide provides a simple and user-friendly approach for measuring the impacts of development food aid programs on the access component of household food insecurity. The guide includes a standardized questionnaire and data collection and analysis instructions. The HFIAS is composed of a set of nine questions that have been used in several countries and appear to distinguish food insecure from food secure households across different cultural contexts. The information generated by the HFIAS can be used to assess the prevalence of household food insecurity (access component) and to detect changes in the food insecurity situation of a population over time.
    Household Food Security Survey Module (HFSSM)

    The HFSSM focuses on self-reports of uncertain, insufficient or inadequate food access, availability and utilization due to limited financial resources, and the compromised eating patterns and food consumption that may result.  The HFSSM contains 18 questions about the food security situation in the household over the previous 12 months. Each question specifies a lack of money or the ability to afford food as the reason for the condition or behaviour. The questions range in severity from worrying about running out of food, to children not eating for a whole day.

    Note:  This is a Canadian survey adapted from the US Food Security Measurement Method.
    Hunger Vital SignThe Hunger Vital SignTM (HVS) is a validated 2-question food insecurity screening tool that allows clinicians to accurately identify households at risk of food insecurity and address patient needs appropriately.
    IHELPIHELP is a tool for collecting pediatric social histories. It includes both household needs (financial strain, insurance, hunger, domestic violence, housing stability and housing conditions) and several child-specific domains (child educational needs, child legal status, and power of attorney/guardianship).
    Kaiser Permanente Your Current Life Situation (YCLS)Kaiser Permanente's Your Current Life Situation (YCLS) survey was developed to capture a range of social and economic needs, including living situation, housing, food, utilities, childcare, debts, medical needs, transportation, stress, and social isolation.
    KleinmanDr. Arthur Kleinman determined that a person's own opinions and viewpoints can affect their health.  This set of open-ended questions has been used to explore how and why individuals believe what they do about illnesses and treatments to support shared decision making.

    NC Department of Health and Human Services (NCDHHS)DHHS, in partnership with a diverse set of stakeholders from across the state, developed a standardized set of SDOH screening questions.
    NC Safe Environment for Every Kid (SEEK)SEEK is an evidence-based, practical model for improving primary healthcare for children and their families. SEEK helps primary healthcare professionals (PCPs) address common psychosocial problems, such as parental depression and substance use. The SEEK Parent Questionnaire-R (PQ-R) screens for the targeted psychosocial problems.

    Medicare Total Health Assessment (THA)The Medicare Total Health Assessment (MTHA) is a survey used to assess several things, including food insecurity, in the elderly. The survey is offered to Medicare Advantage members in advance of Annual Wellness Visits that are a CMS-mandated benefit offering.
    PRAPAREThe Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) is a national effort to help health centers and other providers collect the data needed to better understand and act on their patients’ social determinants of health.

    SWYCThe Survey of Well-being of Young Children (SWYC)™ is a freely-available, comprehensive screening instrument for children under 5 years of age.
    US Household Food Security 6 ItemSix-Item Short Form of the Food Security Survey Module
    For surveys that cannot implement the 18-item or 10-item measures, this "Short Form" 6-item scale provides a reasonably reliable substitute. It uses a subset of the standard 18 items. This is the same six-item questionnaire that is in the Guide.

    US Household Food Security 10 ItemU.S. Adult Food Security Survey Module
    (10 items) Three-stage design with screeners. Screening keeps respondent burden to the minimum needed to get reliable data. Most households in a general population survey are asked only three questions. The questionnaire has been modified very slightly from that specified for households without children in the Guide.

    US Household Food Security 18 ItemU.S. Household Food Security Survey Module
    (18-items) Three-stage design with screeners. Screening keeps respondent burden to the minimum needed to get reliable data. Most households in a general population survey are asked only three questions (five if there are children in the household). The questionnaire has been modified slightly from that in the Guide, and the questions have been re-ordered to group the child-referenced questions after the adult-referenced questions.

    We CareWE CARE (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education) is a clinic-based screening and referral system developed for pediatric settings. The 12-question WE CARE screening tool assesses needs in 6 domains: parental educational attainment, employment, child care, risk of homelessness, food security, and household heat and electricity.

    Terminology, Definitions and Resources


    Definition or Description


    Food access

    There are many ways to measure food store access for individuals and for neighborhoods, and many ways to define which areas are food deserts—neighborhoods that lack healthy food sources. Most measures and definitions take into account at least some of the following indicators of access:

    • Accessibility to sources of healthy food, as measured by distance to a store or by the number of stores in an area.
    • Individual-level resources that may affect accessibility, such as family income or vehicle availability.
    • Neighborhood-level indicators of resources, such as the average income of the neighborhood and the availability of public transportation.

    Food desert

    The Food Access Research Atlas maps census tracts that are both low income (li) and low access (la), as measured by the different distance demarcations. This tool provides researchers and other users multiple ways to understand the characteristics that can contribute to food deserts, including income level, distance to supermarkets, and vehicle access.

    Food security

    Access by all people at all times to enough food for an active, healthy life.
    Food security range:  high food securityNo reported indications of food-access problems or limitations.
    Food security range:  marginal food securityOne or two reported indications—typically of anxiety over food sufficiency or shortage of food in the house. Little or no indication of changes in diets or food intake.
    Food insecurityLimited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.

    Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide To Measuring Household Food Security, Revised 2000. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service; 2000.

    Food insecurity range: low food security

    Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.
    Food insecurity range:  very low food securityReports of multiple indications of disrupted eating patterns and reduced food intake.
    HungerTerm should refer to a potential consequence of food insecurity that, because of prolonged, involuntary lack of food, results in discomfort, illness, weakness, or pain that goes beyond the usual uneasy sensation.

    Data Element Concept Leads




    Value Set Coding Subject Matter Expert

    Linda Hyde

    EMI Advisors, LLC
    Value Set Subject Matter ExpertTechnical DirectorLisa NelsonEMI Advisors, LLCMaxMD
    Food Insecurity Subject Matter ExpertSarah DeSilveyLarner College of Medicine at the University of Vermont
    Food Insecurity Subject Matter Expert

    Donna Partel

    Academy of Nutrition and Dietetics

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