PROJECT SUMMARY/ABSTRACT Food insecurity is a prevalent, modifiable and overlooked determinant of health and health disparities along socioeconomic and racial lines in the United States. Lower income caregivers (parents, custodial grandparents, legal guardians) of children with illness requiring hospitalization are particularly vulnerable to food insecurity due to healthcare costs and prioritizing food for the child. The U.S. Centers for Medicare & Medicaid Services, the American Academy of Pediatrics, the National Academy of Medicine and others are calling for healthcare-based screening and intervention to address food insecurity, endorsing growing evidence about the deleterious effects on health and healthcare. Most caregivers and healthcare providers endorse that it is acceptable for providers to address food insecurity and related needs, yet physicians rarely screen or make referrals for these needs. Barriers include concerns about compromising caregiver or patient satisfaction by causing feelings of stigma and providers' lack of knowledge about food insecurity. The proposed mixed-methods research will fill a gap in knowledge about how best to intervene to support food insecure caregivers. We will conduct a double-blind randomized controlled trial to test the effect of the CommunityRx-Hunger (CRx-H) intervention on caregiver and child health outcomes over 12 months. CRx-H leverages hospital discharge processes used to prepare caregivers to care for an ill child, including education and activation of self- and family management strategies. Caregivers of hospitalized children will be screened for food insecurity, stratified by food security status, and randomized to either usual care (UC) or CRx-H. UC includes a hospital admission packet with information about food resources in the hospital. In addition to UC, CRx-H includes, at discharge: a brief educational intervention about food insecurity and common co-occurring needs, information about quality community resources for food and other support, and text messages from a community resource navigator over 90 days post-discharge. The specific aims of this research are to: (1) Evaluate the effects of CRx-H versus UC on food insecure caregiver self-efficacy, caregiver and child food insecurity, and adult and child health outcomes; (2) Among food secure and insecure caregivers, evaluate the effects of CRx-H versus UC on caregiver satisfaction with care and stigma; (3) Qualitatively assess food insecure caregivers' perspectives about: (a) their experiences with and attitudes toward the CRx-H intervention, (b) the role of stigma as a barrier to self- and family management, and (c) how healthcare providers can sensitively and effectively intervene to support food insecure caregivers.. Our objective is to improve self- and family management among food insecure caregivers with an ill child. The long-term goal of this work advances the mission of the NIMHD by generating evidence on public health practices to promote the health of caregivers and their families and to reduce health disparities due to socioeconomic disadvantage.

PROJECT NARRATIVE Food insecurity is a prevalent and modifiable, but largely overlooked, determinant of health and health disparities. Our objective is to improve self- and family management among food insecure caregivers of ill children by intervening at the critical time of the child’s hospital discharge. The long-term goal of this mixed-methods work advances the public health mission of NIH by promoting the health of caregivers and their families and reducing health disparities due to socioeconomic disadvantage.