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Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269-4017 and * Department of Social and Preventive Medicine, University of Campinas, São Paulo, Brazil
2To whom correspondence should be addressed. E-mail: rafael.perez-escamilla{at}uconn.edu.
Until recently, Brazil did not have a national instrument with which to assess household food insecurity (FI). The objectives of this study were as follows: 1) to describe the process of adaptation and validation of the 15-item USDA FI module, and 2) to assess its validity in the city of Campinas. The USDA scale was translated into Portuguese and subsequently tested for content and face validity through content expert and focus groups made up of community members. This was followed by a quantitative validation based on a convenience (n = 125) and a representative (n = 847) sample. Key adaptations involved replacing the term "balanced meal" with "healthy and varied diet," to construct items as questions rather than statements, and to ensure that respondents understood that information would not be used to determine program eligibility. Chronbach’s 
was 0.91 and the scale item response curves were parallel across the 4 household income strata. FI severity level was strongly associated in a dose-response manner (P < 0.001) with income strata and the probability of daily intake of fruits, vegetables, meat/fish, and dairy. These findings were replicated in the 2 independent survey samples. Results indicate that the adapted version of the USDA food insecurity module is valid for the population of Campinas. This validation methodology has now been replicated in urban and/or rural areas of 4 additional states with similar results. Thus, Brazil now has a household food insecurity instrument that can be used to set national goals, to follow progress, and to evaluate its national hunger and poverty eradication programs.
KEY WORDS: • Brazil • household food insecurity • Fome Zero Program • hunger • USDA food insecurity module
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