<p><strong>BACKGROUND: </strong>National organizations recommend pediatricians screen for food insecurity (FI). Although there has been growing research in urban practices, little research has addressed FI screening in suburban practices. We evaluated the feasibility, acceptability, and impact of screening in suburban practices.</p>

<p><strong>METHODS: </strong>We conducted a mixed methods study that implemented FI screening in 6 suburban pediatric primary care practices. We included all children presenting for either a 2-, 15-, or 36-month well-child visit (N = 5645). Families who screened positive were eligible to be referred to our community partner that worked to connect families to the Supplemental Nutrition Assistance Program. We conducted focus groups with clinicians to determine their perceptions of screening and suggestions for improvement.</p>

<p><strong>RESULTS: </strong>Of the 5645 children eligible, 4371 (77.4%) were screened, of which 122 (2.8%) screened positive for FI (range: 0.9%-5.9% across practices). Of the 122 food-insecure families, only 1 received new Supplemental Nutrition Assistance Program benefits. In focus groups, 3 themes emerged: (1) Time and workflow were not barriers to screening, but concerns about embarrassing families and being unable to provide adequate resources were; (2) Clinicians reported that parents felt the screening showed caring, which reinforced clinicians' continued screening; (3) Clinicians suggested implementing screening before the visit.</p>

<p><strong>CONCLUSIONS: </strong>We found it is feasible and acceptable for clinicians to screen for FI in suburban practices, but the referral method used in this study was ineffective in assisting families in obtaining benefits. Better approaches to connect families to local resources may be needed to maximize the effectiveness of screening in suburban settings.</p>

<p><strong>BACKGROUND: </strong>Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents' experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices.</p>

<p><strong>METHODS: </strong>We conducted 23 semistructured interviews with parents of children &lt;4 years of age who presented for well-child care in 6 suburban pediatric practices and screened positive for FI. In the interviews, we elicited parents' perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved.</p>

<p><strong>RESULTS: </strong>Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs.</p>

<p><strong>CONCLUSIONS: </strong>Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources.</p>

<p>Building on prior research, this study tested two theories: (1) differences in child health care utilization can predict household food insecurity (FI), and (2) FI is associated with subsequent increased acute health care use. We conducted a prospective cohort study of 3,335 children screened for FI at three-year well-child visits in three urban practices, evaluating their acute care use one year before and after FI screening. Prior to screening, food-insecure participants had fewer acute primary care visits, but there were no differences in emergency department visits or hospitalizations. Overall, child demographic characteristics and health care use were no better than chance in predicting household FI. For those who screened positive, there were no differences in subsequent acute care use. This study suggests that the risk of FI among three-year olds cannot be reliably predicted based on acute health care use patterns, and FI may not be associated with subsequent acute health care use.</p>