Comparison of an Adapted Food Security Module for College Students with the United States Department of Agriculture Adult Food Security Module.

The United States Department of Agriculture's 10-item adult food security survey module (AFSSM) has not been validated in college students, raising concern about measuring food insecurity (FI) in this population. The objective of this study was to adapt and validate the 10-item AFSSM for use among college students. Researchers conducted a mixed methods study including individual- (n = 20) and group- (n = 13) cognitive interviews among students at 3 United States universities. Researchers independently evaluated interview data and met to discuss whether AFSSM adaptations were warranted. A Rasch model was used to evaluate the psychometric validity of the official compared with adapted AFSSM among a sample (n = 2897) of students at 4 United States universities. In individual cognitive interviews, students were confused about the terms "household" and "balanced meal" and in differentiating between frugality and FI. Nine items were revised, and 1 item was removed. In group cognitive interviews, students discussed nonfinancial factors impacting FI and suggested wording changes. Seven items were changed. In the survey study, 35.4% were food insecure using the official AFSSM compared with 28.4% using the adapted AFSSM (P < 0.05). The adapted AFSSM captured greater severity of FI for several questions and changed the relative ordering of questions. Regardless of which wording was used, the questions on food not lasting and balanced meals captured different FI prevalence than the general population. The official and adapted AFSSM provides psychometrically valid measures of FI among college students, but adjustments may be required before making direct comparisons with FI measures for the general population.