P0168 - The Association between Food Insecurity Type and Health-Related Quality of Life in Adolescents and Young Adults in the National Health and Nutrition Examination Survey (NHANES)

Background/Purpose:
Screening for food insecurity as a social driver of health is rapidly increasing. The 18-question Household Food Security Survey (HFSS), which assesses four types of food insecurity, is the gold standard screening survey. Due to time constraints in the clinical setting, many clinics screen for food insecurity using a two-question screener, which evaluates only perception of food insecurity. This approach will quickly saturate limited food resources, and potential methods of risk stratification are needed. We aim to assess the prevalence of food insecurity types in adolescents and young adults (AYAs) and identify the association between food insecurity types and health-related quality of life (HRQOL).

Methods:
We conducted a cross-sectional analysis among adolescents (12-17 years) and young adults (18-26 years) in the National Health and Nutrition Examination Survey (2007-2016). Food insecurity was categorized as overall (any) insecurity, perception of food insecurity, poor food quality, and adult and child consequences of food insecurity (e.g., skipping meals) from the HFSS. HRQOL outcomes included self-rated health and last month number of poor physical or mental health days, activity limited days, and anxious days. Poisson generalized linear modeling was used to assess associations between food insecurity and HRQOL, controlling for sociodemographic characteristics with results stratified by income (≤200% federal poverty level; FPL).

Results:
Among the study sample (N=10,031), 49.4% of AYAs had a family income ≤200% FPL. The prevalence of overall food insecurity was 19.3% for adolescents and 20.7% for young adults. Perception of food insecurity was the most common type (29.7% adolescents; 30.9% young adults), while child (8.7% of adolescents) and adult (16.2% of young adults) consequences of food insecurity were the least common. Most AYAs (>75%) experiencing each food insecurity type had a family income ≤200% FPL (Figure 1). The presence of adult consequences of food insecurity was associated with at least one mentally unhealthy day (adolescents RR 1.31, 95% CI 1.12 - 1.54; young adults RR 1.28, 95% CI 1.16 - 1.41) and at least one anxious day (adolescents RR 1.17, 95% CI 1.01 - 1.36; young adults RR 1.23, 95% CI 1.14 - 1.32) (Table 1).

Conclusion:
Adult consequences of food insecurity (e.g. skipping meals) were most strongly associated with poor self-reported mental health in AYAs. Perception of food insecurity, which is the most common food insecurity type experienced by AYAs and also the most common type screened for clinically using the two-question screener, was not associated with any HRQOL outcomes. Understanding which types of food insecurity are most associated with poor health outcomes can inform future screening approaches and resource allocation to youth most at risk of health consequences.