Objective: Food insecurity is a salient health issue comprised of four dimensions – food access, availability, utilization and stability over time. The aim of the present study was to conduct a systematic literature review to identify all multi-item tools that measure food insecurity and explore which of the dimensions they assess.Design: Five databases were searched (CENTRAL, CINAHL plus, EMBASE, MEDLINE, TRIP) for studies published in English since 1999. Inclusion criteria included human studies using multi-item tools to measure food security and studies conducted in developed countries. Manuscripts describing the US Department of Agriculture Food Security Survey Module, that measures ‘food access’, were excluded due to wide acceptance of the validity and reliability of this instrument. Two authors extracted data and assessed the quality of the included studies. Data were summarized against the dimensions of food insecurity.Setting: A systematic review of the literature.Subjects: The majority of tools were developed in the USA and had been used in different age groups and cultures.Results: Eight multi-item tools were identified. All of the tools assessed the ‘food access’ dimension and two partially assessed the dimensions ‘food utilization’ and ‘stability over time’, respectively. ‘Food availability’ was not assessed by existing tools.Conclusions: Current tools available for measuring food insecurity are subjective, limited in scope, with a majority assessing only one dimension of food insecurity (access). To more accurately assess the true burden of food insecurity, tools should be adapted or developed to assess all four dimensions of food insecurity.

Objective: To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries.Design: A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked.Setting: High-income countries.Participants: Household food security experts in academia, government and non-government organisations who had published in the last 5 years.Results: Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem.Conclusions: This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.

Objective: To investigate the psychometric properties, validity and reliability of a newly developed measure of food insecurity, the Household Food and Nutrition Security Survey (HFNSS), among an Australian population.Design: Cross-sectional study.Setting: Metropolitan areas of Melbourne, Australia, identified as very high, high or medium vulnerability in the 2008 Vulnerability Assessment for Mortgage, Petrol and Inflation Risks and Expenditure index.Subjects: A convenience sample of 134 adults (117 females and fifteen males, aged over 18 years).Results: Rasch modelling and factor analysis identified four items for exclusion. The remaining items yielded excellent reliability among the current sample and assessed three underlying components: the adult experience of food insecurity (component one), initial/periodic changes to children’s food intakes (component two) and progressive/persistent decreases in children’s food intakes (component three). Compared with the widely used US Department of Agriculture Food Security Survey Module, the HFNSS identified a significantly higher proportion of food insecurity; this is likely due to the HFNSS’s identification of food insecurity due to reasons other than (and including) limited financial access.Conclusions: The HFNSS may be a valid and reliable tool for the assessment of food insecurity among the Australian population and provides a means of assessing multiple barriers to food security beyond poor financial access (which has been identified as a limitation of other existing tools). Future research should explore the validity and reliability of the tool among a more representative sample, as well as specifically among vulnerable population subgroups.

Food insecurity affects health and wellbeing. Little is known about the relationship between food insecurity across income levels. This study aims to investigate the prevalence and frequency of food insecurity in low-to-middle-income Victorian households over time and identify factors associated with food insecurity in these households. Prevalence and frequency of food insecurity was analysed across household income levels using data from the cross-sectional 2006–09 Victorian Population Health Surveys (VPHS). Respondents were categorised as food insecure, if in the last 12 months they had run out of food and were unable to afford to buy more. Multivariable logistic regression was used to describe factors associated with food insecurity in low-to-middle-income households (A$40 000–$80 000 in 2008). Between 4.9 and 5.5% for total survey populations and 3.9–4.8% in low-to-middle-income respondents were food insecure. Food insecurity was associated with limited help from friends, home ownership status, inability to raise money in an emergency and cost of some foods. Food insecurity exists in households beyond those on a very low income. Understanding the extent and implications of household food insecurity across all income groups in Australia will inform effective and appropriate public health responses.

There is limited evidence of how Australian low-to-middle income (AUD $40,000–$80,000) households maintain food security. Using a sequential explanatory mixed methods methodology, this study explored and compared the food security (FS) and insecurity (FIS) experiences of these households. An initial quantitative survey categorised participants according to food security status (the 18-item United States Department of Agriculture Household Food Security Survey Module) and income level to identify and purposefully select participants to qualitatively explore food insecurity and security experiences. Of the total number of survey participants (n = 134), 42 were categorised as low-to-middle income. Of these, a subset of 16 participants (8 FIS and 8 FS) was selected, and each participant completed an in-depth interview. The interviews explored precursors, strategies to prevent or address food insecurity, and the implications of the experience. Interview data were analysed using a thematic analysis approach. Five themes emerged from the analysis: (i) food decision experiences, (ii) assets, (iii) triggers, (iv) activation of assets, and (v) consequences and emotion related to walking the food security tightrope. The leverage points across all themes were more volatile for FIS participants. Low-to-middle income Australians are facing the challenges of trying to maintain or improve their food security status, with similarities to those described in lower income groups, and should be included in approaches to prevent or address food insecurity.