Hunger Vital Sign™, Abbreviated Child and Adult Food Security Scale, Housing Stability, and TSI-3 Released in LOINC® 2.82
As part of Gravity Project’s work to develop data standards to address the social determinants of health, we maintain ongoing relationships with authors of standardized instruments toward the goal of encoding open, pragmatic, validated instruments for all domains. This includes collaborating with authors long after our public consensus process for a domain has concluded, on paths to instrument enhancements. The February 24, 2026, LOINC® version 2.82 finalizes four examples of these efforts toward the LOINC representation of validated, open-use, pragmatic social risk screening instruments. It also includes open instruments for our initial three domains: food insecurity, housing insecurity, and transportation insecurity. These are Hunger Vital Sign™ (LOINC 88121-9), Abbreviated Child and Adult Food Security Scale (LOINC 107617-3), Housing Stability Vital Sign (LOINC 98975-6), and the Transportation Security Index – 3 Item (TSI-3) (LOINC 112492-4). Each instrument is encoded at both the panel and discrete question levels to support computable capture, exchange, and reuse across health and social care systems. All represent the ongoing success of the Gravity Project partnership with Regenstrief Institute to advance the encoding of standardized instruments for core social determinants of health.
Food Insecurity
Hunger Vital Sign™
The Hunger Vital Sign™ is a validated two-item food insecurity screening tool derived from, and aligned with, the gold standard U.S. Household Food Security Survey Module (Hager et al., 2010). It was developed by Children’s HealthWatch (CHW) in 2010. Although originally encoded as one of Gravity’s first instruments in 2019, recent enhancements have corrected references to ensure alignment with the original sources. Encoding in LOINC first enables computable scoring aligned with gold-standard psychometric methods. The two-item instrument represents a risk for food insecurity that is best addressed through following up with a more in-depth assessment. Additionally, it allows interoperable exchange of food insecurity risk data. Standardized capture supports integration with referral platforms, SNAP enrollment assistance, and food-as-medicine initiatives. It also supports consistent aggregation of food insecurity metrics across organizations for performance measurement and population health reporting.
Abbreviated Child and Adult Food Security Scale
As mentioned above, the Hunger Vital Sign™ is intended to assess risk for food insecurity rather than serve as a formal full food insecurity assessment aligned with the gold-standard U.S. Household Food Security Survey Module. The intention is to trigger further assessment. In addition to recent Hunger Vital Sign™ updates, the Gravity team also worked with instrument authors at Children’s HealthWatch to LOINC-encode the first brief assessment of household food insecurity that encompasses children, the Abbreviated Child and Adult Food Security Scale. Prior to the development of this assessment instrument, the USDA Six-Item Instrument was a brief, validated food insecurity assessment, but it did not include children. Given the rising rates of food insecurity among households with children, the instrument and its encoding are critical advances for the ecosystem.
Housing Instability
Housing Stability Vital Sign
Gravity worked with instrument authors, again, Children’s HealthWatch, as experts in the housing instability domain in 2020. The LOINC-encoding of the Housing Stability Vital Sign was a key part of this initial effort. The questions assess three elements of housing instability associated with health outcomes: concerns about eviction, frequent moves, and a history of homelessness (Cutts et al., 2018). In recent enhancements, the Gravity team worked with CHW to add an additional question that cascades from the third question on history of homelessness to confirm the respondent’s current housed status. This addition allows differentiation between housing instability (a history of homelessness) and homelessness, without affecting the existing implementations of the three initial questions. Standardized encoding supports referral workflows to housing navigation and eviction prevention services; facilitates structured data exchange between healthcare and housing partners; and enables aggregation of comparable housing instability data for quality measurement, research, and equity-focused analytics.
Image: Housing Stability Vital Sign Updates
Transportation Insecurity
Transportation Security Index – 3 Item (TSI-3)
Finally, the Transportation Security Index is an open, validated instrument developed by a team at the University of Minnesota (A. Murphy, J Griffin, A Gould-Werth 2025). Gravity has worked with the authors since addressing transportation insecurity in 2020 as the validated brief versions of the comprehensive Transportation Insecurity Index 16. The newly released, and now LOINC-encoded, Transportation Insecurity Index – 3 Item (TSI-3) measures transportation insecurity across access, reliability, and mobility barriers. Using TSI-3, encoded with LOINC, again supports a brief evidence-based assessment, with the possibility of following up with more robust, aligned methods. It also supports structured data capture in clinical and community settings and enables discrete analysis of transportation-related barriers. Interoperable transportation insecurity data strengthens care coordination, supports non-emergency medical transportation workflows, and enables analysis of disparities affecting rural, disabled, elderly, and economically vulnerable populations.
Standards Significance
Encoding validated social risk instruments in LOINC advances semantic interoperability by enabling consistent representation, exchange, and reuse of structured data across EHRs, health information exchanges, public health systems, and community-based organizations. Panel and item-level codes support flexible implementation models, including HL7 FHIR-based Questionnaire, QuestionnaireResponse, and Observation workflows, while preserving validated scoring logic.
About Gravity Project
Gravity Project is a national public collaborative focused on developing consensus-based standards for representing social risk and social care data using established terminology and interoperability frameworks. Through structured multi-stakeholder engagement, Gravity advances harmonized terminology, value sets, and implementation guidance to support interoperable, equity-centered social care integration.
References
Cutts, D. B., Meyers, A. F., Black, M. M., et al. (2018). Unstable housing and caregiver and child health. Pediatrics, 141(2), e20172199. https://doi.org/10.1542/peds.2017-2199
Hager, E. R., Quigg, A. M., Black, M. M., et al. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26–e32. https://doi.org/10.1542/peds.2009-3146
Murphy, A. K., Griffin, J., & Gould-Werth, A. (2025). Development and validation of a 3-item Transportation Security Index for social risk screening assessments and research into the many pathways through which transportation impacts health. AJE Advances: Research in Epidemiology, 1(3), uuaf020. https://doi.org/10.1093/ajeadv/uuaf020
Murphy, A. K., McDonald-Lopez, K., Pilkauskas, N., et al. (2025). Development and validation of a 3-item Transportation Security Index for social risk screening assessments and research into the many pathways through which transportation impacts health. AJE Advances: Research in Epidemiology, 1(3), uuaf020. https://doi.org/10.1093/ajeadv/uuaf020
Poblacion, A., Ettinger de Cuba, S., Frank, D. A., Esteves, G., Rateau, L. J., Heeren, T. C., Coleman, S., Black, M. M., Cutts, D., Lê-Scherban, F., Ochoa, E. R., Jr, Sandel, M., Sheward, R., & Cook, J. (2023). Development and Validation of an Abbreviated Child and Adult Food Security Scale for Use in Clinical and Research Settings in the United States. Journal of the Academy of Nutrition and Dietetics, 123(10S), S89–S102.e4. https://doi.org/10.1016/j.jand.2023.02.004
Regenstrief Institute. (2026, February 24). LOINC version 2.82 release. https://loinc.org/news/loinc-version-2-82-release-highlights/
