Characteristics associated with persistent versus transient food insecurity among US veterans screened in the Veteran Health Administration.

Abstract

Awareness of negative health impacts associated with food insecurity among US veterans is growing. Yet, little research has examined characteristics associated with persistent versus transient food insecurity. To investigate characteristics associated with persistent versus transient food insecurity among US veterans. The study used a retrospective, observational design to examine data from Veteran Health Administration (VHA) electronic medical records. The sample consisted of veterans (N=64,789) who screened positive for food insecurity in VHA primary care during fiscal years 2018-2020 and were rescreened within 3-15 months. Food insecurity was operationalized using the VHA food insecurity screening question. Transient food insecurity was a positive screen followed by a consecutive negative screen within 3-15 months. Persistent food insecurity was a positive screen followed by a consecutive positive screen within 3-15 months. A multivariable logistic regression model was used to assess characteristics (e.g., demographics, disability rating, homelessness, physical and mental health conditions) associated with persistent versus transient food insecurity. Veterans with increased odds of persistent versus transient food insecurity included men (AOR=1.08, 95%CI[1.01, 1.15]) and those from Hispanic (AOR=1.27, 95%CI[1.18, 1.37]) or Native American (AOR=1.30, 95%CI[1.11, 1.53]) racial/ethnic groups. Psychosis (AOR=1.16, 95%CI[1.06, 1.26]), substance use disorder excluding tobacco/alcohol (AOR=1.11, 95%CI[1.03, 1.20]), and homelessness (AOR=1.32, 95%CI[1.26, 1.39]) were associated with increased odds of persistent versus transient food insecurity. Veterans who were married (AOR=0.87, 95%CI[0.83, 0.92]) or had service-connected disability rating of 70-99% (AOR=0.85, 95%CI[0.79, 0.90]) or 100% (AOR=0.77, 95%CI[0.71, 0.83]) had lower odds of persistent versus transient food insecurity. Veterans at risk for persistent versus transient food insecurity may struggle with underlying issues like psychosis, substance use, and homelessness alongside racial/ethnic inequities and gender differences. More research is needed to understand characteristics and mechanisms that increase risk for persistent versus transient food insecurity among veterans.