USDA Household Food Security Survey Research Articles

Examining measurement invariance of appetitive trait and ARFID symptom measures by food security status

ObjectiveMeasures assessing appetitive traits (i.e., individual differences in the desire to consume food) and disordered eating have generally been developed in predominantly food-secure populations. The current study aims to test measurement invariance (MI) for a measure of appetitive traits and a measure of Avoidant Restrictive Food Intake Disorder (ARFID) symptomology across food security status. MethodData from a sample of mothers (n = 634) and two undergraduate samples (n = 945 and n = 442) were used to assess MI for the Adult Eating Behavior Questionnaire (AEBQ), which measures appetitive traits, and the Nine Item ARFID Screen (NIAS), which measures ARFID symptomology. Current food security was assessed using the 18-item USDA Household Food Security Survey Module, which was dichotomized into two groups: 1) the ‘food insecure’ group included marginal, low, and very low food security and 2) the ‘food secure’ group included high food security. Overall and multi-group confirmatory factor analyses were conducted separately for each measure in each sample. ResultsResults demonstrated scalar (i.e., strong) MI for both measures across samples, indicating that these measures performed equivalently across food-secure and food-insecure individuals. ConclusionFindings suggest that differences in appetitive traits by food security status observed in prior research are not artifacts of measurement differences, but instead reflect true differences. Additionally, past mixed results regarding the relationship between food insecurity (FI) and ARFID symptomology are not likely driven by measurement error when using the NIAS.

Harnessing community expertise in understanding food insecurity to inform responses in a local government area in Victoria, Australia: a mixed methods photovoice study

BackgroundLocal food systems which support affordable, equitable, accessible, and sustainable food are important to enhance food access and reduce food insecurity. Cardinia Shire Council, a local government in Victoria, Australia has developed and endorsed a ‘Community Food Strategy’ to support their local food system and food security. This study aimed to explore local government community member perspectives regarding food access within their local food environment, and suggested areas to be addressed to better support access.MethodsA sequential mixed methods photovoice methodology was implemented. Participants aged over 18 years, who resided in Cardinia Shire, completed an online quantitative survey to explore demographics, food access and food security status and severity (18-item USDA Household Food Security Survey Module). The qualitative photovoice method was used, whereby participants were asked to take photographs that represent their experiences of food access. These photographs were used as prompts in a semi-structured interview Interview data were thematically analysed.ResultsSeventeen participants completed the study, of which five participants experienced varied severity levels of food insecurity. From the photovoice interviews four themes were developed: 1) Food: a connector to self, people and place, 2) Influencers of food access and triggers for food insecurity, 3) Savvy food literacy skills to support access to food, 4) Consequences of and struggles with food insecurity. Participants suggested recommendations for action to support future food access in their community.ConclusionsWhile food choice is influenced by a range of determinants, the local food environment greatly impacts both food access and food choice. A supportive local food system which promotes inclusion of a community voice, community connectedness, food literacy and physical and economic access to local produce is crucial to support food security.

Seasonality, food security, diet quality and nutritional status in urban poor adolescents in Malaysia

Seasonality was shown to have an effect on food availability and accessibility, increasing the risk of food insecurity and causing poor diet quality and malnutrition. Therefore, this study aimed to determine seasonal effects on household food security status, diet quality, and nutritional status of urban poor adolescents in Malaysia. A cohort study was conducted among 164 adolescents aged 10–17 from 12 People Housing Programme in Kuala Lumpur, Malaysia during the Northeast (November 2021 till March 2022) and Southwest (June 2022 till September 2022) monsoon. Household food security status was measured using the 18-item USDA Household Food Security Survey Module. Dietary intake was determined using a two-days 24-h dietary recall and translated into Standardized Malaysian Healthy Eating Index (S-MHEI). Anthropometric and haemoglobin level measurements were performed to determine nutritional status. Seasonality was found to have a significant effect on overall diet quality (p = 0.021), food groups such as fish (p < 0.001), meat/poultry/eggs (p = 0.003), and legumes/nuts (p < 0.001), and fat nutrient (p = 0.037) as well as anaemia status (p = 0.020) after controlling the confounders. Although food security did not vary with seasons, seasonality affected the consumption of certain food groups as well as anaemia status for urban poor adolescents. Seasonally sensitive nutrition initiatives should be developed to ensure diet adherence to recommendations, ultimately enhancing the diet quality of urban poor adolescents.

682-P: Intersectionality among Health-Related Social Needs Predicts Poor Mental Health among Youth and Young Adults with Diabetes

Little is known about how multiple health-related social needs may overlap to contribute to increased risk for poor mental health outcomes among youth and young adults (YYA) with diabetes. This study aims to understand how household food insecurity (HFI) intersects with other health-related social needs to influence poor mental health among YYA with type 1 diabetes (T1D). Analyses included a total of 829 YYA with T1D from the SEARCH Food Security Cohort study. Classification tree analysis was used to identify patterns among 11 health-related social needs, demographic, and socioeconomic characteristics that distinguish between moderate-to-severe and minimal-to-mild depressive symptoms. Health-related social needs included HFI, housing insecurity, need for reliable transportation, and experiences of discrimination. HFI was measured using the USDA Household Food Security Survey Module and experiences of discrimination were measured using the Everyday Discrimination Scale. The outcome of depressive symptoms was assessed using the Center for Epidemiological Studies-Depression (CES-D) scale. Overall, 35.6% reported moderate-to-severe depressive symptoms and 27.6% of YYA with T1D had anxiety symptoms; however, in the food insecure group, 73% and 56% were affected, respectively. Discrimination intersected with HFI among YYA with T1D such that 86% of YYA experiencing greater discrimination and HFI reported moderate-to-severe depressive symptoms (compared to 47% among the food secure group). In those reporting less discrimination, this corresponded to 56% and 17%, respectively. Adding discrimination to the model that included HFI, demographic, and socioeconomic measures improved the prediction accuracy (AUC= 0.71 versus AUC= 0.64). Study findings have implications for interventions to address multiple health-related social needs to decrease mental health problems among YYA with T1D. Disclosure A.D.Brown: None. A.Bellatorre: None. F.Malik: None. A.D.Liese: None. E.A.Frongillo: None. K.Flory: None. M.Lohman: None. J.Wei: None. J.A.Mendoza: None. B.A.Reboussin: None. E.T.Jensen: Consultant; Regeneron. L.M.Dolan: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK117461-01, 1UC4DK108173); National Institute of General Medical Sciences (T32GM081740)

550-P: Food Insecurity and the Efficacy of a Gestational Diabetes (GDM) Risk Reduction Intervention—Healthy Eating Outcomes among American Indian and Alaska Native (AI/AN) Female Adolescents and Young Adults (FAYAs)

AI/ANs are unduly impacted by GDM and food insecurity. Employing a clinical trials design, this secondary analysis used Stopping GDM trial data to describe and explore food insecurity as a moderator of the efficacy of a GDM risk reduction intervention on healthy eating behaviors and self-efficacy at 3 months among AI/AN FAYAs. Participants were AI/AN FAYAs and their mothers. Assessments included mother’s food insecurity using USDA Household Food Security Survey Module and FAYA’s healthy eating self-efficacy using Self-Efficacy for Healthy Eating and healthy eating behaviors from CDC Youth Risk Behavior Surveillance System. The sample (N=149 dyads) was FAYAs (mean age 16.7±3.0 years) and their mothers, with 64% (n=95) living together. More than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p=.045) and cohabitating dyads (p=.002). By 3 months healthy eating self-efficacy (p=.048) and limiting snacking between meals (p=.031) improved more in the control group than the intervention group but only for cohabitating dyads. For the full sample the intervention group had increases in times eating vegetables (p=.022) and fruit (p=.015), while the control group had declines. In the full sample food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p≥.05) but did moderate the group by time interaction for times drinking soda (p=.004) and days eating breakfast (p=.013). For cohabitating dyads food insecurity did moderate self-efficacy for eating 3 meals a day (p=.024) and days eating breakfast (p=.012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on ‘upstream causes’ of GDM health disparities among AI/AN communities. Disclosure S.M.Sereika: None. S.A.Stotz: None. L.E.Hebert: None. L.Scarton: None. K.R.Moore: Consultant; Novo Nordisk. D.Charron-prochownik: None. The stopping gdm study group: n/a. Funding National Institutes of Health (R01NR014831)

Exploring differences in disordered eating and related appetitive traits among women based on childhood and current food security status

Despite emerging evidence that food insecurity (FI) is associated with elevated rates of eating pathology, little is known about the lasting impact of FI on eating behaviors. Studies that have explored the association between FI during childhood and eating behavior in adulthood have not accounted for current FI. The present study explored differences in disordered eating (DE) and related appetitive traits among four groups of cisgender female mothers: individuals who (1) endorsed childhood FI only (n = 96), (2) endorsed current FI only (n = 134), (3) endorsed both childhood and current FI (n = 257), and (4) denied both childhood and current FI (n = 146). Participants responded to online questionnaires including items from the USDA Household Food Security Survey Module, the 7-item Eating Disorder Examination-Questionnaire, the Eating Disorder Diagnostic Scale, and the Adult Eating Behavior Questionnaire. Adjusting for age and race/ethnicity, ANCOVAs explored mean differences between groups in DE and appetitive traits, and a modified Poisson regression model examined differences in binge-eating prevalence across the four FI groups. The “current FI only” group consistently endorsed the highest levels of DE and related appetitive traits followed by the “current and childhood FI” group, suggesting newly food-insecure women may be at highest risk for DE. Interestingly, across almost all constructs, the “childhood FI only” group did not differ significantly from the “no FI” group. These findings suggest that improved access to food may help offset risk for adult DE related to experiences of FI in childhood.

Food Insecurity, the Food Environment, and COVID-19 in Rural South Carolina.

In this study, we explored the relationship between the food environment and food security among rural adults during the COVID-19 pandemic. Researchers, with assistance from community partners, conducted a cross-sectional survey assessing the impact of COVID-19 on food access, food security, and physical activity in 9 rural South Carolina (SC) counties. This survey was administered to a purposive sample (N = 587) from August 2020 to March 2021. The dependent variable was a binary indicator of food insecurity (past 3 months), in accordance with the USDA Household Food Security Survey Module. Independent variables were sociodemographic characteristics, food environment factors (eg, shopping at grocery stores, partial markets, and farmers' markets), and shopping behaviors during the pandemic. Overall, 31% of respondents were food insecure. Food security status differed by income and household composition. Results indicate that the odds of food insecurity were higher for respondents who shopped frequently at partial markets (adjusted odds ratio [AOR] = 1.61, 95% confidence interval [CI]: 1.01-2.56) and shopped more for food before the pandemic than during the pandemic (AOR = 1.68, 95% CI: 1.07-2.64). Findings underscore the importance of examining the relationship between the food environment and food insecurity during COVID-19 in rural settings.

The new normal for food insecurity? A repeated cross-sectional survey over 1 year during the COVID-19 pandemic in Australia

BackgroundFood insecurity during the COVID-19 pandemic has been impacted by necessary public health restrictions. Tasmania, an island state south of the Australian mainland, recorded no community transmission of COVID-19 between May 2020 to November 2021 due to strong border restrictions. This study aimed to determine the changes in prevalence and sociodemographic predictors of food insecurity throughout the COVID-19 pandemic in Tasmania, Australia.MethodsIn May 2020 (survey 1: during lockdown), September 2020 (survey 2: eased restrictions) and May 2021 (survey 3: 1-year post-lockdown), cross-sectional, online surveys using convenience sampling methods determined food insecurity in Tasmanian adults using the USDA Household Food Security Survey Module: Six-Item Short Form, in addition to key sociodemographic questions. Crude and age-adjusted prevalence of food insecurity was calculated, and binary logistic regression determined at-risk groups and changes in prevalence over time.ResultsThe age-adjusted prevalence of food insecurity was 27.9% during lockdown (n = 1168), 19.5% when restrictions had eased (n = 1097) and 22.6% 1-year post-lockdown (n = 1100). Young adults, Aboriginal and/or Torres Strait Islander people, individuals with disabilities, families with dependents and temporary residents were at highest risk across all time points.ConclusionsThe prevalence of food insecurity was higher than pre-pandemic levels across all three time points. Our results indicate the potential long-term impacts of the COVID-19 pandemic on food security in Australia, where despite easing social distancing restrictions and a lack of COVID-19 transmission, the prevalence of food insecurity reduced, but did not recover to pre-pandemic levels 1-year following a lockdown.

Household food insecurity and obesity risk in preschool-aged children: A three-year prospective study

BackgroundHousehold food insecurity (FI) is a pressing social, economic and public health issue. However, little is known regarding the effect of FI exposure during the first few years of life, the most active postnatal time for neurobiological and physiological development, on patterns of weight gain during early childhood. It is also unknown whether dietary quality would serve as a pathway through which FI affects children's weight development. MethodThis was a secondary data analysis from a three-year randomized clinical trial with five hundred and thirty-four parent/child dyads. Household FI in the past year was reported by parents at baseline when children were 2–4 years of age using the USDA Household Food Security Survey Module-Six Item Short Form. Children's dietary quality at baseline was measured by the US Department of Agriculture Healthy Eating Index (HEI). Child body mass index (BMI) was measured following standardized protocols at baseline and 12-, 24-, and 36-month follow-up. A latent growth curve model was used to examine 1) the association between baseline FI and sex-and-age-adjusted BMI z-scores in children and 2) the HEI pathway between the FI- BMI association. ResultsFI early in life was associated with higher baseline BMI z-scores. Children who had higher BMI at baseline maintained their higher BMI status over the next three years. Children's dietary intake quality did not explain the association between baseline FI and BMI z-scores. ConclusionEarly exposure to FI was associated with higher BMI in children as early as two years of age, setting them up for an increased likelihood of persistently high BMI-for-age in later childhood. These data suggest that the first few years may be a critical time for developing obesity risk, calling for policy and practices designed for early intervention of food insecurity.

570-P: Household Food Insecurity, Stress, and Anxiety among Youth and Young Adults with Diabetes

Although household food insecurity (HFI) has been associated with depressive symptoms in youth and young adults (YYA) with youth-onset diabetes, little is known about the association of HFI with other mental health comorbidities. We examined the association of HFI with stress and anxiety symptoms among YYA with diabetes using cross-sectional data from the SEARCH Food Security Cohort study (assessments conducted 2018-2020; n = 1030, age =23.8± 0.3, female =58.8%, type 1 diabetes (T1D) = 881, type 2 diabetes (T2D) =149) . HFI was defined as 3+ affirmations on the USDA Household Food Security Survey Module. The Generalized Anxiety Disorder (GAD-7) and Cohen’s Perceived Stress Scale (PSS-14) were used to assess outcomes of anxiety (score range 0-21) and stress (score range 0-56) , higher scores indicating greater anxiety or stress. Linear regression models were adjusted for age, sex, race/ethnicity, site, diabetes duration, parental education, income, and whether assessment was completed pre/post the coronavirus pandemic. Analyses were stratified by diabetes type. HFI was present in 17.3% of T1D and 35.6 % of T2D. Moderate/severe anxiety symptom scores (range 10-21) were found in 27.5 % (mean=6.9, s.d. =5.5) of T1D and 40.9% (mean=8.4, s.d. =6.5) of T2D. Mean stress scores were 26.7 (s.d.=6.3) for T1D and 27.9 (s.d.=6.3) for T2D. In T1D, HFI was associated with higher anxiety (β=4.8, p=&amp;lt;0.0001) and stress (β=4.9, p=&amp;lt;0.0001) symptom scores compared to those with food security adjusted for covariates. Among T2D, HFI was associated with greater anxiety symptoms (β=2.8, p=0.0247) but no association was observed with stress. These findings suggest that assessing and alleviating HFI may help improve stress and anxiety among YYA with diabetes, and further study is warranted to determine associations over time. Disclosure A.D.Brown: n/a. S.M.Marcovina: None. C.Pihoker: None. A.D.Liese: None. J.A.Mendoza: None. E.A.Frongillo: None. K.Flory: None. B.A.Reboussin: None. E.T.Jensen: Consultant; Regeneron Pharmaceuticals Inc. L.M.Dolan: None. A.Bellatorre: None. F.Malik: n/a. Funding NIH/NIDDK (1R01DK117461-01) ; NIH/NIDDK/CDC (1UC4DK108173) ; NIH/NIGMS (T32-GM081740)

Health-Related Social Needs and Diet Quality in Youth and Young Adults with Youth-Onset Type 1 Diabetes: Cross-Sectional Findings From the SEARCH Food Security Cohort Study

ObjectivesThis cross-sectional study from the SEARCH Food Security Cohort Study (2018–2020) examined the association between unmet health-related social needs (USN) and diet quality among 821 youth and young adults (YYA) with type 1 diabetes (T1D).MethodsDaily dietary intake of calcium, dairy, fiber, and fruits and vegetables (F/V) was estimated with the National Cancer Institute dietary screener questionnaire. USN included having one or more of the following: ≥3 affirmations on the USDA Household Food Security Survey Module, not having a personal vehicle in the past year, reporting housing instability over the past 90 days, or reporting health care costs as a big problem. Quantile regression examined associations between the count of USN and diet, and associations between specific social needs and diet, controlling for the presence of the other three needs.ResultsFor YYA with T1D (mean age: 22.6 ± 5), 36.9% had 1 + USN, with healthcare unaffordability most prevalent (24.6%), followed by food insecurity (17.5%). Overall diet quality was poor with estimated intakes below dietary guideline recommendations, especially for fiber. Consumption for all nutrients and F/V was lower across the intake distribution among those with 1 + USN, compared to no unmet needs. After adjustment, those with 1 + USN consumed significantly less calcium at the 10th and 25th percentiles (P < 0.05), fiber at the 25th and 50th percentiles (P < 0.05), and F/V at the 25th percentile (P = 0.02), compared to no unmet needs. For housing instability, unreliable transportation, and unaffordable healthcare, no diet quality indicator differed after further controlling for the presence of the other three needs. Independent of the other social needs, food insecurity was associated with lower fiber intake at the 10th, 25th, and 50th percentiles (P < 0.04), and F/V intake at the 50th and 75th percentiles (P < 0.01).ConclusionsUSN were associated with reduced intake of calcium, fiber, and F/V largely due to food insecurity, particularly among participants with lower intake. USN, arising from economic strain, is associated with poorer nutrition.Funding SourcesNational Institute of Diabetes and Digestive and Kidney Diseases.

Assessment of Weight Status, Food Security Level, and Fiber Intake Among Hispanic/Latino Adults Residing in New Hampshire

ObjectivesTo assess weight status, food security level, and dietary intake, emphasizing consumption of fiber-rich foods, among adults of Hispanic/Latino background. MethodsThis cross-sectional phone-based survey was administered in English or Spanish, and included questionnaires on weight history, dietary intake (NHANES Dietary Screener Questionnaire), and food security (USDA Household Food Security Survey Module) as experienced before and during the COVID-19 pandemic. Eligible participants were New Hampshire adult residents who identified as Hispanic/Latino. Responses were scored using protocols by questionnaire developers. Analysis of covariance was applied to determine the relationship between weight status, food security level, and dietary intake. Age and gender were included as covariates. ResultsParticipants (N = 73; mean (SD) age = 44 (15) years; 84% female) were predominantly immigrants (85%) who had lived in the US for 12.1 (9.4) years or were US citizens of Puerto Rican origin (11%). Self-perception of health status noted as ‘good,’ ‘very good,’ or ‘excellent’ was reported by 81% of participants. There was a high prevalence of overweight (35%) and obesity (33%), with an average self-reported body mass index (BMI) of 28.7 (5.5) kg/m2. Weight gain during the pandemic was reported by 44% of participants, particularly those with obesity (67%), while weight status was perceived to be in the healthy range by 49% of participants. Perceived weight status and BMI category matched for 48% of subjects with overweight and 88% for subjects with obesity. Estimated daily consumption of dietary fiber was lower (15 (2.4) g/d) than recommended levels (22–34 g/d) but was not correlated with food security level or BMI. On average, men consumed more fiber (18.7 vs. 14.7 g/d, p < .0001) and vegetables (1.8 vs. 1.5 cup equivalents/d, p < .0001) than women. Low and very low food security increased from 25% pre-pandemic to 27% during the pandemic, while marginal food security increased from 10% to 16%. ConclusionsThe exacerbation of food insecurity during the pandemic, along with a high burden of overweight/obesity, low awareness of overweight status, and low fiber intake among NH Hispanics warrant the development of interventions to enhance nutrition security and weight management in this population. Funding SourcesUniversity of New Hampshire.

Food Security of Temporary Foreign Farm Workers under the Seasonal Agricultural Worker Program in Canada and the United States: A Scoping Review.

Temporary foreign farm workers (TFWs) are among the most vulnerable and exploitable groups. Recent research shows alarming rates of food insecurity among them. This review explores research focussing on food security of TFWs in Canada and the United States, summarizes findings, and identifies research gaps. Online databases, including MEDLINE, Web of Science, Scopus, Google Scholar, and government and nongovernment websites, and websites of migrant worker-supporting organizations were searched for peer-reviewed and non-peer-reviewed papers and reports published between 1966 and 2020 regarding food security of TFWs. Articles reviewed were analyzed to determine publication type, country, year, target population, and main findings. Content analysis was performed to identify major themes. Of 291 sources identified, 11 met the inclusion criteria. Most articles (n=10) were based on studies conducted in the United States. The prevalence of food insecurity among TFWs ranged between 28% and 87%. From the content analysis, we formulated 9 themes, representing a diversity of perspectives, including access to resources, income, housing and related facilities, food access, dietary pattern and healthy food choices, and migrant's legal status. Instruments reported for the measurement of food security include USDA Household Food Security Survey Module (HFSSM; n = 8, 72.7%), the modified version of the USDA HFSSM (n = 1, 9%), hunger measure (n = 1, 9%), the modified CDC's NHANES (n = 1, 9%), and 24-h recall, diet history, and/or food-frequency questionnaire (n = 3, 27.3%). Factors impacting food security of TFWs working under the Seasonal Agricultural Worker Programs (SAWPs) in North America are understudied. There is a need to advance research looking particularly at policies and regulatory and administrative aspects of the SAWPs to improve the food security of this cohort. There is also a need for qualitative studies that explore lived experiences and perspectives of TFWs and key informants. Longitudinal studies may be useful to examine various factors, including policy-related, contributing to food insecurity of TFWs over time.

PERCEIVED EFFECTS OF FOOD PRICE INFLATION ON RURAL HOUSEHOLDS’ FOOD SECURITY SITUATION IN ENUGU STATE, NIGERIA

Objectives: This study examined the perceived effects of food price inflation on the food security status of rural farming households’ in Enugu state, Nigeria. Methods: The 18-item USDA household food security survey module was used in determining the food security status of the respondents. Mean scores were used to analyze the perceived causes and effects of food price inflation, respectively. Results: Majority of the households were food insecure, and the cost of production of major crops and prices of major stable foods had been on the increase for the 3 years (2016, 2015, and 2014) reviewed. The major cause of food price inflation was climate change while its major effects on household food insecurity were reduction in caloric intake, among others. Eating foods that are less preferred were the most frequently used coping strategy in cushioning the effects of food insecurity. Conclusion: The findings reveal how food price inflation affects rural farming households’ food security situation and thus assist the government and policy-makers to design and implement appropriate policy interventions.

Food Insecurity Among Older Urban Subsidized Housing Residents: The Importance of Social Connectedness

Poverty and food insecurity are associated with poor health in later life. Although housing is recognized as a social determinant of health; relatively little research has explored food insecurity in the marginalized population of older subsidized housing residents. In this study, we examined factors associated with food insecurity and particularly how social connectedness was associated with food insecurity. We hypothesized that social connection measures (i.e., loneliness, sense of belonging) independent of sociodemographic, health and food program variables would contribute to food insecurity. Our data are from interviews with 216 residents ages 55-plus (50% Black, 45% LatinX). The 6-item USDA Household Food Security Survey found high rates of food insecurity, 40% for ages 55-69 and 20% for ages 70-plus. Multivariate logistic regression models revealed that loneliness was significantly related to food insecurity even after other factors were controlled. Discussion centers on strategies for addressing social risk factors to ameliorate food insecurity.

The effect of food insecurity during college on graduation and type of degree attained: evidence from a nationally representative longitudinal survey.

To examine the effect of food insecurity during college on graduation and degree attainment. Secondary analysis of longitudinal panel data. We measured food insecurity concurrent with college enrolment using the 18-question United States Department of Agriculture Household Food Security Survey Module. Educational attainment was measured in 2015-2017 via two questions about college completion and highest degree attained. Logistic and multinomial logit models adjusted for socio-demographic characteristics were estimated. USA. A nationally representative, balanced panel of 1574 college students in the USA in 1999-2003 with follow-up through 2015-2017 from the Panel Study of Income Dynamics. In 1999-2003, 14·5 % of college students were food-insecure and were more likely to be older, non-White and first-generation students. In adjusted models, food insecurity was associated with lower odds of college graduation (OR 0·57, 95 % CI: 0·37, 0·88, P = 0·01) and lower likelihood of obtaining a bachelor's degree (relative risk ratio (RRR) 0·57 95 % CI: 0·35, 0·92, P = 0·02) or graduate/professional degree (RRR 0·39, 95 % CI: 0·17, 0·86, P = 0·022). These associations were more pronounced among first-generation students. And 47·2 % of first-generation students who experienced food insecurity graduated from college; food-insecure first-generation students were less likely to graduate compared to first-generation students who were food-secure (47·2 % v. 59·3 %, P = 0·020) and non-first-generation students who were food-insecure (47·2 % v. 65·2 %, P = 0·037). Food insecurity during college is a barrier to graduation and higher-degree attainment, particularly for first-generation students. Existing policies and programmes that help mitigate food insecurity should be expanded and more accessible to the college student population.

1121-P: Unmet Social Needs and Depressive Symptomatology among Youth and Young Adults with Type 1 Diabetes

Youth and young adults (YYA) with type 1 diabetes (T1D) may be at risk for unmet social needs and depression due to the disease-associated cost and stressors. Little is known about how unmet social needs are linked to depressive symptomatology. These cross-sectional analyses used data from the SEARCH Food Security ancillary study (2018-2020) to examine the association of unmet social needs on depressive symptoms among 685 YYA with T1D. The USDA Household Food Security Survey Module was used to measure household food insecurity (HFI) over the past 12 months (food insecure (≥3 affirmations) vs. food secure). Participants were queried about their primary mode of transportation (personal vehicle vs. other form of transportation) and if they had stable housing (all the time vs. some or none of the time) over the past 90 days. Total number of unmet social needs (0-3) were calculated by summing these items. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression (CES-D) scale (scores 0-60). Linear regression was used to examine the association between number of unmet social needs and depressive symptom scores. Among YYA with T1D (mean age 23.4, SD 4.6 years), 17.1% had HFI, 14.0% lacked adequate transportation, and 4.3% experienced unstable housing; 23.5% had one, 5.1% had two, and 0.9% had three unmet social needs. Mean (SD) CES-D score was 14.3 (11.9), which is below the cutoff score of 16 for risk of depression. Compared to YYA with no unmet social needs, those with 1 and 2-3 unmet social needs had depressive symptom scores 5.9 and 15.9 points higher, respectively (p&amp;lt;0.0001 for both exposure values), after adjusting for age, sex, race/ethnicity, diabetes duration, clinic site, parental education, and household income. Social needs among YYA with T1D are confluent and are jointly and cumulatively associated with depressive symptoms. Future studies should investigate the impact of alleviating unmet social needs on depressive symptomatology among YYA with T1D. Disclosure A. D. Brown: None. S. M. Marcovina: None. A. D. Liese: None. J. A. Mendoza: None. E. A. Frongillo: None. K. Flory: None. B. A. Reboussin: None. E. T. Jensen: None. L. M. Dolan: None. A. Bellatorre: None. F. Malik: None. Funding National Institutes of Health (R01DK117461, T32GM081740)

178-LB: Food Insecurity and Dietary Intake Adequacy in Youth and Young Adults with Type 1 and Type 2 Diabetes

Household food insecurity is associated with poor dietary intake in the general population, but little is known about persons with diabetes. We examined dietary intake among youth and young adults (YYA) with diabetes in relation to food security (FS) to identify differences in intake quantity and adherence to recommendations. The SEARCH for Diabetes in Youth cross-sectional study includes 1,134 YYA with type 1 diabetes (T1D, mean age: 21 years ± 5) and 274 YYA with type 2 diabetes (T2D, 25 years ± 4.2). Participants (or parents if &amp;lt;18 years) completed the USDA Household FS Survey Module, wherein ≥3 affirmations indicate food insecurity. Diet was assessed via food frequency questionnaire and compared to age- and sex-specific 2020-25 Dietary Guidelines for Americans (DGA) nutritional goals for daily energy, added sugar, saturated fat, calcium, fiber, iron, magnesium, potassium, sodium, vitamins C, D, and E. Associations of FS with daily intake and meeting guidelines were assessed with sex-stratified multivariate linear regression. No intake differences by FS were observed, except females with T1D consumed more sodium (+155 mg, p = .01) and percent of kilocalories from saturated fat (+0.7%, p = .04) when FS was absent. Males with T2D consumed more vitamin E (+1 mg, p = .03) when FS was present. Crude guideline adherence was poor across the board (i.e. below 60%). After multivariate adjustment for demographic, socioeconomic, clinical and diabetes characteristics, females with T1D and T2D, regardless of FS, on average met vitamin C and males met iron guidelines. Males with T2D met percent of kilocalories from saturated fat guidelines in the absence of FS. DGA adherence among YYA with diabetes is of grave concern given that diet is crucial to diabetes management. FS reflects very little enhancement in diet quality. YYA with diabetes consume excessive sodium, added sugars, and inadequate micronutrients except for vitamin C and iron, increasing risk for deficiency, weight gain, heart attack and stroke. Disclosure H. D. Bercaw: None. C. Mercado: None. A. D. Liese: None. L. A. Reid: None. J. A. Mendoza: None. E. A. Frongillo: None. K. A. Sauder: None. B. A. Reboussin: None. E. J. Mayer-davis: None. D. Dabelea: None. S. M. Marcovina: None.

Association between Food Insecurity and Health-Related Quality of Life: a Nationally Representative Survey.

Food insecurity, limited or uncertain access to enough food for an active, healthy life, affected over 37 million Americans in 2018. Food insecurity is likely to be associated with worse health-related quality of life (HRQoL), but this association has not been measured with validated instruments in nationally representative samples. Given growing interest understanding food insecurity's role in health outcomes, it would be useful to learn what HRQoL measures best capture the experience of those with food insecurity. To determine the association between food insecurity and several validated HRQoL instruments in US adults. Cross-sectional. US adults (age ≥ 18), weighted to be nationally representative. Food insecurity was assessed with three items derived from the USDA Household Food Security Survey Module. HRQoL was assessed using PROMIS-Preference (PROPr), which contains 7 PROMIS domains, self-rated health (SRH), Euroqol-5D-5L (EQ-5D), Health Utilities Index (HUI), and Short Form-6D (SF-6D). In December 2017, 4142 individuals completed at least part of the survey (31% response rate), of whom 4060 (98.0%) reported food security information. Of survey respondents, 51.7% were women, 12.5% self-identified as black, 15.8% were Hispanic, and 11.0% did not have a high school diploma. 14.1% of respondents reported food insecurity. In adjusted analyses, food insecurity was associated with worse HRQoL across all instruments and PROMIS domains (p < .0001 for all). The magnitude of the difference between food-insecure and food-secure participants was largest with the SF-6D, EQ-5D, and PROPr; among individual PROMIS domain scores, the largest difference was for ability to participate in social roles. Food insecurity is strongly associated with worse HRQoL, with differences between food-secure and food-insecure individuals best measured using the SF-6D, EQ-5D, and PROPr. Future work should develop a specific instrument to measure changes in HRQoL in food insecurity interventions.

Food Insecurity and Dental Caries in U.S. and South Korean Older Adults Ages 60+

There are no studies on the association between food insecurity and dental caries (tooth decay) in older adults. We analyzed nationally representative data from two countries – the U.S. and South Korea – to test the hypothesis that food insecurity would be positively associated with tooth decay in older adults ages 60+. The U.S. analyses focused on National Health and Nutrition Examination Survey data from three cycles (2011-12, 2013-14, and 2015-16) and the South Korean analyses focused on Korean National Health and Nutrition Examination Survey data from one cycle (2013-2015). Food insecurity was defined using the 18-item USDA Household Food Security Survey and a validated Korean version of the same survey. Tooth decay was defined as having at least one decayed tooth (no/yes). We ran logistic regression models to generate odds ratios and 95% confidence intervals (CI). The percentage of fully food secure older adults was 74.0% in the U.S. and 82.2% in South Korea. Twenty-three percent of U.S. older adults and 28% of South Korean older adults had at least one decayed tooth. Older adults in the U.S. with food insecurity were 2.03 times as likely to have untreated tooth decay (95% CI: 1.43, 2.87; P<0.0001). Findings were similar for South Korean older adults. Food insecurity is significantly associated with untreated tooth decay in both U.S. and South Korean older adults. Future research should identify the aspects of food insecurity that increase older adults’ risk for tooth decay, with an emphasis on those that are amenable to population-based interventions.