Food Security and Mental Health in Adolescents: Exploring the Moderating Role of Race

Background and Purpose: Food insecurity (FI) among U.S. households with children rose from 17.3% in 2022 to 17.9% in 2023, highlighting ongoing challenges faced by families in securing adequate nutrition. FI has been associated with the increased odds of past-year mood and anxiety disorder for adolescents. FI can be a traumatic and stigmatizing experience; however, less is known about whether this experience affects the mental health (MH) of minoritized adolescents similarly or differently than their non-minoritized peers. The following research questions guided this study: (1) What is the association between FI and MH outcomes among youth (ages 4-17)? (2) Is the relationship between FI and MH outcomes moderated by racial and ethnic identity?

Methods: Using the 2019 National Health Interview Survey (NHIS) child survey the sample (n = 1,255) consisted of those who answered the Household Food Security Survey Module (HFSSM) and the Strength’s and Difficulties Questionnaire (SDQ). The SDQ contains five subscales: emotional problems (EP), conduct problems (CP), hyperactivity (HA), peer problems (PP) and prosocial behaviors (PS). Structural tests were conducted to examine the association of FI with each of the five SDQ domains. Pre-specified fit indices were assessed a priori for all models. Covariates included child gender, age, and income to poverty threshold. Moderation was performed via multiple group SEM using the Wald test. Categorizations of race tested in moderation included: (1) Non-Hispanic (NH) White and REM groups; (2) NH Black and non-NH Black; and (3) NH White and NH Black only.

Results: The sample was primarily NH White (37%), male (51%), and the mean age was 10.94 years (SD = 4.03), 35% reported low food security and 21% reported very low food security. Greater FI is associated with higher levels of EP (β= 0.692, p <.001), CP (β= 0.356, p <.001), HA (β= 0.640, p <.001), and PP (β= 0.426, p <.001) but the relationship was nonsignificant for PS behaviors (β= -0.113, p = 0.32). Wald test indicate a moderating effect of race on the relationship between FI and CP for White/REM groups (χ² = 3.808, df = 1, p <.05), Black/Non NH-Black (χ² = 4.154, df = 1, p <.04), Black/White (χ² = 4.404, df = 1, p <.04).

Conclusions and Implications: As FI increased among all youth, their EP, CP, HA, and PP also increased. The relationship between FI and CP was moderated by race with Black youth in FI households exhibiting lesser CP than all other racial and ethnic groups. These findings highlight the complex ways FI can affect youth mental health and behaviors which underscores the importance of support for youth experiencing FI related distress. Collaborative efforts among school social workers and administrative staff can use these insights to bolster food assistance initiatives by integrating mental health and behavioral supports. Black youth are disproportionately surveilled for perceived disruptive behavior in school and communities. Youth-serving professionals must recognize the ways systemic biases shape how Black youth’s behavior is monitored and interpreted to ensure systems prioritize their well-being rather than reinforcing punitive oversight.