Non-citizen immigrant families experience increased food insecurity compared to US-born households. Food insecurity (FI), lack of adequate and regular access to food that meets nutritional requirements to maintain an active lifestyle, is linked to serious behavioral and physical health conditions such as problematic eating behaviors, poorer overall health, behavioral and developmental problems among children, and increased risk of depression and anxiety. FI research on immigrants is scarce. Given the increased risk of FI and expected growth in this population, research understanding risk factors associated with FI among immigrants is imperative. This study examines household demographic (education, employment), behavioral (smoking), and psychosocial (depression, anxiety) factors among US citizens and foreign-born non-citizens (FBNC).
Using NHANES (2011-2012) data, latent class analysis (LCA) was used to identify underlying risk profiles for risk factors with an association with FI: education, employment, smoking, anxiety, and depression. Two separate LCA models were examined – one each for citizens and non-citizens. Logistic regression was used to assess effect of latent class profiles on household food security (food secure/insecure) for both citizens and non-citizens, based on unique results of separate LCAs. All models controlled for age, race, poverty, and household composition.
A significantly higher number of non-citizens were food insecure compared to citizens (29.0% vs. 22.4%; p<.001). A three-class model demonstrated best overall fit for both citizens and non-citizens. Among citizens, the three classes included overall low risk; high risk for low education and smoking; and high risk for depression and anxiety. Among non-citizens, the three classes included overall low risk; high risk for depression, anxiety, and low education; and high risk for smoking. Logistic regression analysis among citizens indicated that respondents at high risk for smoking and low education were 1.8 times more likely to be food insecure compared to the low risk group (p<.001) and those who were at high risk for depression and anxiety were 2.5 times more likely to be food insecure compared to the low risk group (p<.001). Among non-citizens, the group that was high risk for depression, anxiety, and lower education was 2.7 times more likely to be food insecure than those who were low risk (p=.04). The group that was high risk for smoking was not significantly more likely to be food insecure compared to the low risk group.
LCA results indicate similar risk profiles for citizens and non-citizens, with some slight variations. Overall, results indicate that mental health has an important relationship with food security status for both citizens and non-citizens. However, the role of education differs between the two groups, with those at greater risk of being depressed/anxious, also at an increased risk of having lower education among non-citizens. These results suggest that education may amplify the effects of depression and anxiety with regard to food insecurity among non-citizens compared to citizens. Food insecurity intervention efforts should address those with mental health concerns, with an additional focus on the limitations in resources and education for non-citizen immigrant groups for reducing overall risk.