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The Four Domain Food Insecurity Scale (4D-FIS): Development and Evaluation of a Complementary Food Insecurity Measure


Johnson, Cassandra M.; Ammerman, Alice S.; Adair, Linda S.; Aiello, Allison E.; Flax, Valerie L.; Elliott, Sinikka; Hardison-Moody, Annie; & Bowen, Sarah K. (2020). The Four Domain Food Insecurity Scale (4D-FIS): Development and Evaluation of a Complementary Food Insecurity Measure. Translational Behavioral Medicine, 10(6), 1255-1265. PMCID: PMC7796713


The U.S. Department of Agriculture (USDA) Food Security Survey Module (FSSM) is a valuable tool for measuring food insecurity, but it has limitations for capturing experiences of less severe food insecurity. To develop and test the Four Domain Food Insecurity Scale (4D-FIS), a complementary measure designed to assess all four domains of the food access dimension of food insecurity (quantitative, qualitative, psychological, and social). Low-income Black, Latina, and White women (n = 109) completed semi-structured (qualitative) and structured (quantitative) interviews. Interviewers separately administered two food insecurity scales, including the 4D-FIS and the USDA FSSM adult scale. A scoring protocol was developed to determine food insecurity status with the 4D-FIS. Analyses included a confirmatory factor analysis to examine the hypothesized structure of the 4D-FIS and an initial evaluation of reliability and validity. A four-factor model fit the data reasonably well as judged with fit indices. Results showed relatively high factor loadings and inter-factor correlations indicated that factors were distinct. Cronbach's alpha (ɑ) for the overall scale was 0.90 (subscale ɑ ranged from 0.69 to 0.91) and provided support for the scale's internal consistency reliability. There was fair overall agreement between the 4D-FIS and USDA FSSM adult scale, but agreement varied by category. Findings provide preliminary support for the 4D-FIS as a complementary measure of food insecurity, with implications for researchers, practitioners, and policymakers working in U.S. communities.


Reference Type

Journal Article

Article Type


Year Published


Journal Title

Translational Behavioral Medicine


Johnson, Cassandra M.
Ammerman, Alice S.
Adair, Linda S.
Aiello, Allison E.
Flax, Valerie L.
Elliott, Sinikka
Hardison-Moody, Annie
Bowen, Sarah K.




United States of America