Meeting Youth Needs: The Importance of Incorporating Adolescent and Young Adult Perspectives in Food Insecurity Screening and Interventions

Food insecurity, or the inconsistent access to healthy and nutritious food, among households with children and adolescents has been on the rise since the end of federal supports after the COVID-19 pandemic. In 2024, 18.4% of such households were affected by food insecurity at some point during the year [1], which will continue to rise in the setting of worsening inflation and federal funding reductions to the Supplemental Nutrition Assistance Program (SNAP). While much of the literature has focused on households with young children, data have shown that adolescents were twice as likely to report food insecurity as young children, as the latter are often shielded from food insecurity by their parents [2]. Increasingly, health-care systems are integrating interventions to screen for and assist patients with food insecurity, including with the use of Food is Medicine (FIM) interventions that include produce prescriptions, medically tailored groceries, medically tailored meals, and referrals to the federal nutrition programs [3]. Despite the promise of FIM interventions, few studies have focused on developing and testing FIM interventions among adolescents and young adults with their perspectives in mind. A new study by Hill et al. [4] is one of the few to explore adolescent and young adults’ perspectives regarding food insecurity screening in clinical settings and a produce prescription intervention.

Although the United States Preventive Task Force concluded that there was no evidence to balance between benefits and harms of screening for food insecurity in clinical settings [5], medical societies, including the Society for Adolescent Health and Medicine, and regulatory bodies, such as the Joint Commission in 2023, have increasingly recommended and required screening [6]. For adolescent patients, caregivers are typically screened; in a survey of pediatricians, 21% screened both the caregiver and the adolescent [7]. However, when both caregivers and adolescents are screened, there is a clear discordance in caregiver proxy report and self-report [8-10]. Critically, few studies have explored preferences among adolescents for food insecurity screening in clinical settings, and fewer have focused on food insecurity in young adults aged 18–24 years.

In Dr. Hill et al.’s new study, researchers qualitatively analyzed data from the MyVoice nationwide cohort of youths aged 14–24 years who responded to weekly text message open-ended surveys on healthy eating, food insecurity, and produce prescriptions, which are vouchers or subsidies ‘prescribed’ by clinicians to patients to redeem fruits and vegetables from local farmer markets or grocery stores. With a 73% response rate (n = 573) and a mean (standard deviation) age of 20.2 (2.7) years, almost half of respondents (40.8%) reported experiencing difficulty affording healthy foods. Most (81.0%) believed that doctors should know about difficulty accessing food, and the majority of respondents (71.6%) were interested in receiving a produce prescription [4]. This study highlights the need to incorporate adolescent and young adult perspectives on food insecurity screening and FIM interventions given their positive reception. Indeed, research suggests that adolescents are aware of the household’s food insecurity and are often responsible for contributing to household finances, obtaining and preparing food, and/or feeding younger family members [11]. In addition, adolescents are developing dietary preferences and managing their own eating patterns, often eating meals outside of the home [12]. Therefore, understanding adolescents’ food insecurity by screening them in clinical settings is important, given that food insecurity is associated with a variety of adverse outcomes, especially among those with chronic physical and mental health conditions that increase the risk of harmful cardiometabolic health outcomes in adulthood [13-15].

Importantly, the study by Hill et al. is one of the few to include a focus on food insecurity among the young adult population (i.e., aged 18–24 years). National data from the annually administered Household Food Security Survey Module by the United States Department of Agriculture, which has been discontinued as of 2026, focuses on households with children and adolescents (i.e., under 18 years), but no data are available on the young adult population. Aside from studies examining food insecurity among students in higher education, with prevalence estimates ranging from 19% to 56% [16], little research has focused on food insecurity among young adults. The inclusion of young adults in the study by Hill et al. is a clear strength of this study, although unfortunately the results were not disaggregated by age group [4]. Future research is needed to determine the levels of food insecurity among young adults.

Hill et al. found that 40.9% of respondents of 14–24 years of age had difficulty accessing healthy food, although the MyVoice survey question was not validated to detect food insecurity. Furthermore, while the larger MyVoice survey included a question about who the respondent lived with [17], Hill et al. did not distinguish the difference in healthy food access between those who lived with a caregiver and those who did not. More research is needed to determine the prevalence of food insecurity among adolescents and young adults living with and without caregivers.

Although several child- and adolescent-focused self-report food insecurity assessment measures exist, the Hunger Vital Sign is a 2-item tool that has been validated in adolescents and young adults, and it is commonly used in clinical settings [18]. Developing workflows to incorporate screening adolescents for food insecurity with validated tools are needed, as well as FIM interventions that effectively address positive screens. Although the authors found positive reception to receiving produce prescriptions among adolescents and young adults, more research is necessary to determine their perspectives about other FIM interventions, such as medically tailored groceries, medically tailored meals, and referrals to federal nutrition programs, and the effectiveness of each of these interventions in reducing food insecurity.

Although the study by Hill et al. supports the incorporation of food insecurity screening and FIM interventions in clinical settings, barriers exist for doing so, and chief among them is lack of funding to support these screening and intervention efforts. Although the Centers for Medicare & Medicaid Services grants 1115 demonstration waivers to states to use Medicaid to address social needs, only 16 states have approved waivers [19]. For example, North Carolina’s Medicaid’s 1115 waiver, the Healthy Opportunities Pilots program, implemented screening for unmet health-related social needs, including food insecurity, by Medicaid-managed care plans and allowed Medicaid to pay for interventions to address unmet needs, such as healthy food boxes and housing navigation [20]. These waivers showed positive outcomes, including reduced emergency department utilization, hospitalizations, and adult health-care spending on adults [21,22]. There is a need for policies and health system models that support the reimbursement of these interventions in pediatric clinical settings. Although there is a growing body of research demonstrating the effectiveness and cost-effectiveness of different FIM interventions, little research exists for the effectiveness of FIM interventions among adolescents and young adults.

As Hill et al. demonstrate, adolescents and young adults frequently experience difficulty affording healthy foods and are receptive to food insecurity screening and interventions to assist with food insecurity in the clinical setting. With rising rates of food insecurity among households in the United States, clinicians caring for this population should consider directly screening adolescents and young adults for food insecurity and offering FIM interventions to patients who are interested. Future research should develop FIM interventions tailored to meet the unique developmental needs of adolescents and young adults.