Cumulative Risk and Food Justice: A Food Insecurity Latent Class Analysis

Background and Purpose

Food insecurity(FI) is a lack of adequate food to maintain a healthy lifestyle, and occurs disproportionately among oppressed communities – African American, Latino, female-headed and low-income households in comparison to White, dual parent, and middle/high income families. FI is associated with physical and mental health among adolescents and adults.  Multiple demographic and risk factors contribute to household food insecurity including caregiver employment, education, smoking, and mental health.  Each of these risk factors uniquely contributes to food insecurity, yet may contribute cumulatively.  Research on the cumulative effect of risk factors that increase food insecurity is limited.  This study addresses this gap by examining how cumulative risk and risk profiles comprised of demographic (employment and education), behavioral (smoking), and psychosocial (anxiety and depression) risks are associated with food insecurity. 

Methods

Using a nationally representative sample of 9,756 participants (NHANES, 2011-2012), a cumulative risk index (CRI) was calculated using education, employment, smoking, anxiety, and depression data.  Latent class analysis (LCA) was used to identify underlying risk profiles for the aforementioned individual risk factors. Taylor series linearization was applied to three logistic regression models to assess the effect of each individual risk variable (model 1), cumulative risk (model 2), and latent class profiles (model 3) on household food security (food secure/insecure).   All models controlled for age, race, and poverty level.

Results

The majority of participants were food secure (83%, n=7,460).  Approximately one in six were food insecure (17%, n=2,247).  Among risk variables, 38% were high risk for lower education (n=4,399), 19% were high risk for unemployment/underemployment (n=562), 12% were high risk for smoking (n=1,229), 8% were high risk for depression (n=442), and 25% were high risk for anxiety (n=1,372).  In model 1, odds of food insecurity were highest for those at high risk for anxiety (OR=1.76, p=.040) and depression (OR=1.59, p=.008). CRI (model 2) was not associated with food insecurity. LCA results identified three risk profiles:  high risk for smoking/lower education (class #1 n=424, 3.7%), high risk for anxiety/depression (class #2, n=453, 5.3%), and overall low risk (class #3, n=8,863, 90.9%).  In model 3, participants in class #1 (OR=2.3) and class #2 (OR=3.0) were more likely to be food insecure, compared to participants in class #3 (p<.001).

Conclusion and Implications

Model comparisons show the combination of smoking/education risk factors increase risk of food insecurity, although not independently; yet depression and anxiety increase risk both independently and cumulatively. To promote equitable access to food, social work interventions should target these risk factors  food insecurity with clients.  Although the risk factors included in this study were individual-level demographic, psychosocial, and behavioral risks, they may be tied to broader macro issues in the social (cultural) and physical environment.  Macro social work must focus on increasing equitable food security through addressing community level issues associated with food security such as employment and education opportunities, access to mental health services, and access to smoking cessation, especially in low-income communities and communities of color.