Development of a Spanish-language version of the US household food security survey module

A survey module used to monitor the prevalence of household food insecurity and hunger in the United States was developed by a broadly based collaborative project with leadership from the USDA and the National Center for Health Statistics (NCHS). It has been administered annually since 1995 as a supplement to the Census Bureau's Current Population Survey (CPS) and is part of the National Health and Nutrition Examination Survey (NHANES) and other national surveys. Spanish is the second most common language in the United States, yet no standardized Spanish-language version of this instrument has yet been sanctioned by the relevant federal agencies. In the CPS, interviewers free-translate the questions while interviewing respondents who prefer to have the interview conducted in Spanish. National prevalence data indicate relatively high rates of food insecurity for Hispanic households, raising the question whether methodological artifacts may contribute to these rates. We analyzed eight Spanish-language versions of the instrument that have been used in published work for variability in wording and phrasing. We then conducted focus groups of low-income Spanish-speaking participants from Mexico, Central America, Puerto Rico and Cuba to refine a single Spanish-language instrument. We also employed professional translators to render the English instrument into "standard" Spanish; both instruments were then back-translated. The focus group-derived instrument uses simpler language and grammar; its back-translation integrity to the English version was slightly better than the professionally translated version. We provide the instrument for use and further testing by other investigators.