Understanding the relationship between food insecurity and low fruit and vegetable consumption among women using the BRFSS 2009 Social Context Module

Background: Food insecurity, a well-documented social determinant of health (SDoH), has been associated with low fruit and vegetable (F&V) consumption. Population-based data available to measure SDoH are largely limited to socioeconomic status (SES) and contain insufficient samples of racial/ethnic minorities. Previous analysis has shown that food insecurity is associated with low F&V consumption among women, but whether this persists after SES adjustment remains unknown.

Methods: We measured prevalence of low F&V consumption (<5 servings/day), stratified by food security status (“food insecure” is defined as always, usually, or sometimes worried/stressed about having enough money to buy nutritious meals), among 46,665 women in 12 states that used the 2009 Behavioral Risk Factor Surveillance System (BRFSS) Social Context Module (SCM). We conducted multivariate logistic regression, stratified by race/ethnicity and education, to determine the adjusted odds ratio (aOR) of the association between food insecurity and low F&V consumption.

Results: The overall prevalence of food insecurity was 21.7% and of low F&V consumption was 72.0%. Low F&V consumption was more common among women who reported food insecurity than those who did not (78.0% versus 70.7%; P <.001). Food insecurity was associated with low F&V consumption in the overall population [aOR=1.26; 95% CI(1.08–1.46)]; among whites [aOR=1.32; 95% CI(1.12–1.36)]; and among high school graduates [aOR=1.37; 95% CI(1.01–1.87)].

Conclusions: Food insecurity is associated with low F&V consumption among white women and among high school graduates in 12 states. Measures of SDoH–for example food insecurity–may establish population-based evidence to identify interventions addressing low F&V consumption.