Food Insecurity, Diet Quality, Home Food Availability, and Health Risk Behaviors Among Emerging Adults: Findings From the EAT 2010–2018 Study

Abstract

Objectives. To examine emerging adults’ experiences of food insecurity in relation to measures of diet quality, food literacy, home food availability, and health behaviors.

Methods. We used EAT 2010–2018 (Eating and Activity over Time) study data on 1568 participants who completed surveys as adolescents in 2009 to 2010 and follow-up surveys in 2017 to 2018 (mean age = 22.0 ±2.0 years; 58% female). At baseline, participants were recruited from 20 urban schools in Minneapolis–St Paul, Minnesota. Food insecurity was defined by emerging adult report of both eating less than they thought they should and not eating when hungry because of lack of money.

Results. The prevalence at follow up of experiencing food insecurity in the past year was 23.3% among emerging adults. Food insecurity was associated with poorer diet quality (e.g., less vegetables and whole grains, more sugar-sweetened drinks and added sugars), lower home availability of healthy foods, skipping breakfast, frequently eating at fast-food restaurants, binge eating, binge drinking, and substance use (all P < .01).

Conclusions. Assistance programs and policies are needed to address food insecurity among emerging adults and should be coordinated with other services to protect health.

Food security is defined as having consistent, dependable access to enough food for active, healthy living.¹ Food insecurity is a prevalent problem that is linked to poor health.^2–6 National data from 2018 indicate that 11% of US households were affected by food insecurity at some time during the previous year.¹ Experiences of food insecurity during the transition from adolescence to adulthood, a stage often termed “emerging adulthood” (18–26 years), are not well understood, and there is a critical need for data regarding the experiences of young people outside of college and university settings. The existing data on postsecondary students suggest that food insecurity is prevalent among emerging adult populations; however, additional research is needed to guide programs and policies. There is particularly a need to understand how food insecurity during emerging adulthood may co-occur with health risk behaviors.

Adequate food and nutrient intake are important for supporting rapid growth and development during adolescence and promotion of healthy weight and reproductive outcomes in early adulthood.^7,8 Research suggests that young people experiencing food insecurity during these life stages are more likely to experience health problems (e.g., elevated blood pressure, prediabetes)^5,9 and behavioral risk factors.^10–12 For example, national cross-sectional survey data indicate that food-insecure adolescents are more likely to report skipping breakfast, inadequate sleep, smoking cigarettes, and consuming alcohol.¹¹ These cross-sectional linkages between food insecurity and health behavior suggest the need to examine long-lasting or cumulative impacts on future health as a result of experiencing food insecurity and engaging in poor health behaviors.

Most research on food insecurity in early adulthood and its co-occurrence with other health risk factors is focused on postsecondary students.¹³ Research in diverse population samples is needed to build a better understanding of interrelationships between these risk factors and trajectories of food insecurity over time to inform responsive public health strategies. Programs designed to enhance food management and preparation skills are often recommended to reduce food insecurity; however, food literacy (i.e., proficiency in food-related skills and knowledge) may have a very limited impact without accompanying interventions to enhance healthy food availability. It is further important to understand how food insecurity is related to other health risk behaviors so programs and services can be coordinated to best serve the needs of vulnerable populations.

The current study addressed 3 interrelated aims. The first aim was to inform the targeting of program services and responsive policies by describing the prevalence of food insecurity among a population-based sample of emerging adults. Second, we aimed to examine how experiencing food insecurity in emerging adulthood is related to diet quality, food literacy, home food availability, and other health risk behaviors. The third aim was to examine how emerging adult experiences of food insecurity are related to adolescent experiences of food insecurity and whether adolescent experiences play a role in observed linkages with health risk behaviors.

METHODS

EAT 2010–2018 (Eating and Activity over Time) is a population-based, longitudinal study of weight-related health behaviors and associated factors. The analytic sample included 908 females, 649 males, and 11 participants identifying with another gender identity. This sample enrolled in the EAT 2010 study as adolescents during the 2009–2010 academic year and completed follow-up EAT 2018 surveys in 2017 to 2018. For EAT 2010, middle-school and senior high-school students at 20 urban public schools in Minneapolis–St Paul, Minnesota, completed classroom surveys.^14,15 Schools were selected on the basis of students’ demographic characteristics as an important goal of the study was to learn about the weight-related health of ethnically/racially and socioeconomically diverse adolescents. EAT 2018 was designed to examine changes in weight-related behaviors (e.g., eating and physical activity patterns) as participants progressed through adolescence and into young adulthood.

Of the original 2793 participants, 410 (14.7%) were lost to follow-up, primarily because of missing contact information at EAT 2010 or no address found at follow-up. Invitations to the online EAT 2018 survey were mailed to the remaining 2383 young people. All participants were mailed a financial incentive following survey completion.

The diverse sample of 1568 participants who completed surveys at both time points represents 65.8% of original participants for whom contact information was available at EAT 2018. As attrition did not occur completely at random, we used inverse probability weighting to account for missing data.¹⁶ Inverse probability weighting minimizes response bias attributable to missing data and allows for extrapolation back to the original EAT 2010 school-based sample. There were no statistically significant demographic differences between the EAT 2010 sample of adolescents and the weighted EAT 2018 survey respondent sample described in the results.

Survey Development and Measures

The EAT 2018 survey was based on EAT 2010 and other surveys of weight-related health.¹⁴ The 2018 measures of food insecurity were selected from a 6-item validated tool¹⁷; however, only 2 items were included to limit participant burden within the context of the broad survey. If participants responded “yes” when asked “did you ever eat less than you felt you should” and also “yes” when asked “were you ever hungry but didn’t eat” because “there was not enough money for food” in the past year, they were categorized as food insecure. Focus groups (n = 29) were conducted to pretest the survey and comments made by group participants informed minor revisions to improve relevance and readability (e.g., modified the language of some items, addition of response options). After the survey was finalized, test–retest reliability of measures was examined by using data from 112 participants who completed the survey twice over 3 weeks. The EAT 2018 survey was the source of nearly all personal and health behavior risk measures described in Appendix A (available as a supplement to the online version of this article at http://www.ajph.org), including food literacy, home food availability, skipping breakfast, frequent eating at fast-food restaurants, binge eating, and substance use (test–retest agreement range = 79%–96%).¹⁸ Dietary quality was assessed in relation to the Dietary Guidelines for Americans by using a food frequency questionnaire.^19,20 Adolescent food security status (test–retest agreement = 96%), parental socioeconomic status (SES; test–retest r = 0.90), and ethnicity/race (test–retest agreement range = 98%–100%) were assessed on the EAT 2010 survey.^14,20,21 Adolescent food security was assessed briefly by using 2 items modified from the US Household Food Security Survey Module (FSSM).^22,23 If participants indicated that they had experienced hunger and inadequate food at home in the past year, they were categorized as food insecure. The test–retest reliability of EAT 2010 survey items was determined over a 1-week period among 129 adolescents.

Statistical Analysis

We addressed the first aim regarding food insecurity prevalence and the need for information to better target program services and responsive policy approaches through descriptive statistics. We used frequencies and percentages to examine prevalence of food insecurity across the personal participant characteristics. We used the χ² test to examine unadjusted differences in prevalence across characteristics.

We accomplished the second aim by using regression models to produce least square mean estimates for markers of health behavior among food-secure and food-insecure emerging adults. We used generalized linear models to examine statistical associations of each health behavior with food security status (P values associated with maximum likelihood parameter estimates) and estimate corresponding average dietary intake values among food-secure and food-insecure persons; likewise, we used binomial models with the inverse linked scale option to estimate adjusted prevalences for markers of health behavior. We examined regression models without adjustment and also adjusted for parental SES and emerging adult characteristics that were identified as correlates of food security and the health behavior on the basis of previous research.^24,25 We additionally adjusted models used for examining associations with dietary measures for energy intake by using the nutrient density method (intake per 1000 calories).

We accomplished the third aim by creating a dichotomous indicator of adolescent food insecurity. To address the potential for adolescent food insecurity to influence observed differences in dietary quality and health risk behavior, we examined the regression models described previously with adolescent food security status as a covariate. Another set of models involved adding the main effect and interaction terms (adolescent food security by emerging adult food security status) to each model to examine whether associations between food insecurity in emerging adulthood and health risk markers were consistent across the adolescent food security groups. For each case in which the P value for an interaction term was < .10, providing some evidence of effect modification, we reran models stratified by adolescent food security and adjusted for covariates. We selected the liberal cut-off of .10 to permit a thorough exploration of group differences.

We conducted analyses with SAS version 9.4 (SAS Institute Inc, Cary, NC) and, as described previously, used inverse probability weighting to account for missing data.¹⁶ The results of analyses are presented in a manner that emphasizes patterns and the magnitudes of observed associations.

RESULTS

The weighted sample of 1568 participants had a mean age of 14.4 ±2.0 years at EAT 2010 and 22.0 ±2.0 years at EAT 2018; ethnic/racial backgrounds of participants were 18.8% White, 29.0% African American or Black, 19.8% Asian American, 16.9% Hispanic, 3.7% Native American, and 11.8% mixed or other. The distribution across categories of parental SES based primarily on baseline educational attainment was 39.4% low, 22.2% low–middle, 17.9% middle, 13.1% upper–middle, and 7.5% high. Past-year prevalence of food insecurity, defined by both eating less than you felt you should and experiencing hunger because of lack of money for food, was 23.3% among emerging adults.

Table 1 presents the distribution of food insecurity across participant characteristics and prevalence differences (all P < .05). Food insecurity prevalence was highest among those identifying as Black (28.3%), Native American (29.0%), or mixed or other ethnicity/race (33.3%) and lowest among those who identified as Hispanic (17.1%). Prevalence of food insecurity among emerging adults with no postsecondary degree was elevated among those who were not currently enrolled as a student (29.0%) in comparison with those who were a postsecondary student (19.7%) or high-school student (21.9%). Educational attainment was also related to food insecurity for nonstudents with a particularly high prevalence among those having no high-school degree (45.2%). Food insecurity was elevated among subgroups who were unemployed or seeking work (30.5%), had parents of low SES (28.5%), and lived in a household receiving public assistance benefits (33.3%). Living with a parent appeared to be protective (18.2%) in comparison with other living arrangements (28.1%), and emerging adults living with children of their own had an elevated prevalence of food insecurity (38.5%) compared with emerging adults without children (21.6%).

TABLE 1—

Prevalence of Food Insecurity Among Emerging Adults Who Participated at Baseline in the EAT 2010 Study in Minneapolis–St Paul, MN, and a Follow-Up Survey in 2017–2018

Characteristics	Sample No.	Food Insecure, %a	P
Overall	1518	23.3
Gender			.06
Female	629	25.1
Male	878	21.0
Ethnicity/race			< .001
White	359	18.5
Black or African American	330	28.3
Hispanic or Latino	263	17.1
Asian American	346	18.8
Native American	59	29.0
Mixed or other	156	33.3
Parent socioeconomic statusb			< .001
Low	539	28.5
Low–middle to middle	576	20.5
Upper–middle to high	366	17.6
Student status among those with no postsecondary degree or certificate			.002
Not a student	618	29.0
High-school student	46	21.9
Postsecondary student	480	19.7
Educational attainment among nonstudents			< .001
No high-school degree	77	45.2
High-school graduate or equivalent	541	26.6
Associate or trade degree	88	28.9
4-y college or advanced degree	131	12.4
Employment status			.027
Working full time	771	23.9
Working part time	422	21.7
Stay-at-home caregiver	47	21.2
Unemployed, seeking work	171	30.5
Not working for pay	94	13.3
Public assistance			< .001
No	1138	20.2
Yes	368	33.3
Living with a parent			< .001
No	787	28.1
Yes	731	18.2
Living with a child(ren) of your own			< .001
No	1368	21.6
Yes	150	38.5

Note. EAT = Eating and Activity over Time. One third (31.2%) of emerging adults responded “yes” to the question “In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food?” There were 26.8% of emerging adults who responded “yes” to the question “In the last 12 months, were you ever hungry but didn’t eat because there was not enough money for food?” Food insecurity was determined by reporting “yes” to both questions.

^aValues are weighted to reflect the probability of responding to the follow-up EAT 2018 survey.

^bBased primarily on baseline educational attainment.

Food Insecurity and Health Risk Markers

Diet quality.

Emerging adult food insecurity was related to poorer diet quality in unadjusted and adjusted models (Table 2). In both sets of models, food insecurity was related to lower intake of total fruit and vegetables, dark green vegetables, red or orange vegetables, whole grains, potassium, vitamin D, calcium, and fiber (all P < .05). Food insecurity was also related to higher intake of sugar-sweetened drinks, added sugars, and saturated fat (all P < .05). For example, for a daily energy intake of 2000 kilocalories, adjusted results indicate that food-insecure emerging adults consumed a daily average of 1 less serving of fruit or vegetables and 9 grams more of added sugars in comparison with food-secure emerging adults.

TABLE 2—

Emerging Adults’ Report of Food Insecurity and Measures of Dietary Quality: Findings From a 2017–2018 Survey of Participants in the EAT 2010 Study in Minneapolis–St Paul, MN

	Unadjusted			Adjusteda
Servings or Amount per 1000 kcal/day	Food Secureb	Food Insecureb	P	Food Secureb	Food Insecureb	Pc
Fruit and vegetables (total servings), mean	2.1	1.8	< .001	2.2	1.7	< .001
Whole fruit (excluding juice), mean	0.8	0.7	.09	0.8	0.7	.022
Fruit juice, mean	0.3	0.3	.86	0.3	0.3	.27
Vegetables (excluding potatoes), mean	1.4	1.1	< .001	1.4	1.1	< .001
Dark green vegetables, mean	0.3	0.2	.005	0.3	0.2	.001
Red and orange vegetables, mean	0.3	0.2	.012	0.3	0.2	.015
Dairy, mean	0.7	0.7	.22	0.7	0.7	.18
Whole grains, mean	1.1	0.9	.004	1.1	0.9	.014
Sugar-sweetened drinks, mean	0.3	0.4	.008	0.3	0.4	.004
Potassium, mg/1000 kcal	1498	1390	< .001	1505	1386	< .001
Vitamin D, µg/1000 kcal	104	93	.016	104	94	.03
Calcium, mg/1000 kcal	451	425	.043	452	424	.031
Iron, mg/1000 kcal	7.0	6.8	.09	7.0	6.9	.5
Fiber, g/1000 kcal	11.1	9.9	< .001	11.2	9.9	< .001
Added sugars, g/1000 kcal	29.0	33.7	< .001	28.9	33.5	< .001
Sodium, mg/1000 kcal	1050	1049	.93	1049	1045	.81
Saturated fat, mean % of total energy	10.6	11.2	.003	10.6	11.1	.034

Note. EAT = Eating and Activity over Time. Determined by reporting “yes” to both questions: “In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food?” and “In the last 12 months, were you ever hungry but didn’t eat because there was not enough money for food?”

^aAdjusted model includes gender identity, ethnicity/race, parent socioeconomic status, student status, employment status, receipt of public assistance, and living situation. Generalized linear models were used to examine statistical associations of each dietary quality marker with food security status and estimate mean daily serving values.

^bValues are weighted to reflect the probability of responding to the follow-up EAT 2018 surveys.

^cP values associated with maximum likelihood parameter estimates for the main effect in adjusted model. Separate models were used to examine whether observed associations between food insecurity in emerging adulthood and dietary quality markers were consistent across the adolescent food security groups. Among 17 interaction tests (adolescent food security by emerging adult food security status), there were no tests with P < .05 and P = .09 for vegetable servings. Stratified models showed that emerging adult average daily serving intake of vegetables was lower among those who were currently food insecure (insecure as adolescent: 0.9, secure as adolescent: 1.0) versus food secure (insecure as adolescent: 1.7, secure as adolescent: 1.4), regardless of previous food insecurity during adolescence.

Food literacy, home food availability, and eating behaviors.

Experiencing food insecurity in emerging adulthood was unrelated to measures of food literacy. By contrast, food insecurity was consistently related to all measures of home food availability and eating behaviors in unadjusted and adjusted models (Table 3). For example, the prevalence of having vegetables as part of dinner was 50.6% among food-insecure emerging adults compared with 69.0% among food-secure emerging adults. Food-insecure emerging adults were also less likely to eat meals prepared at home and were more likely to report frequently eating food purchased from fast-food restaurants, skipping breakfast, and binge eating (all P < .05). For example, past-year prevalence of binge eating was 25.6% among food-insecure emerging adults compared with 17.8% among food-secure emerging adults.

TABLE 3—

Emerging Adults’ Food Insecurity and Markers of Food Literacy, Home Food Availability, and Health Risk Behaviors: Findings From a 2017–2018 Survey of Participants in the EAT 2010 Study in Minneapolis–St Paul, MN

	Unadjusted			Adjusteda
	Food Secureb	Food Insecureb	Pc	Food Secureb	Food Insecureb	Pc
Food literacy (% confident)
Plan meals	49.7	47.7	.52	50.2	48.9	.69
Follow a recipe	65.4	68.8	.24	67.2	73.1	.06
Prepare a meal from items on hand	65.5	66.5	.74	66.9	67.2	.92
Use basic cooking techniques	77.6	75.9	.50	79.6	78.6	.72
Stay within a food budget	65.8	62.4	.23	66.8	62.7	.2
Home food availability (% usually or always)
Fruits and vegetables are available	76.7	56.6	< .001	76.8	59.4	< .001
Vegetables are part of dinner	68.3	50.3	< .001	69.0	50.6	< .001
Fresh fruit is accessible	67.7	46.8	< .001	68.2	49.9	< .001
Ready-to-eat vegetables	55.1	42.2	< .001	54.5	44.5	.003
Whole-wheat bread is available	57.1	46.3	< .001	57.0	47.9	.006
Eating and meal behaviors
Skip breakfast (% ≥ 2 d/wk)	61.5	76.2	< .001	62.0	74.1	< .001
Prepare meals at home (% ≥ 5 times/wk)	41.0	32.8	.006	40.7	33.2	.022
Frequent fast-food intake (% ≥ 3 times/wk)	49.5	60.1	< .001	49.6	59.1	.004
Binge eating (% ever overeat)	18.4	25.3	.005	17.8	25.6	.003
Substance use
Cigarettes, marijuana, or other drugs (% any use past week)	18.8	34.3	< .001	16.5	28.3	< .001
Binge drinking (% any episode in past 2 weeks)	35.5	43.8	.005	35.2	44.4	.004

Note. EAT = Eating and Activity over Time. Food insecurity determined by reporting “yes” to both questions: “In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food?” and “In the last 12 months, were you ever hungry but didn’t eat because there was not enough money for food?”

^aAdjusted model includes gender identity, ethnicity/race, parent socioeconomic status, student status, employment status, receipt of public assistance, and living situation. Generalized linear models were used to examine statistical associations of each health behavior marker with food security status, and the inverse linked scale option was used to estimate adjusted prevalences.

^bValues are weighted to reflect the probability of responding to the follow-up EAT 2018 surveys.

^cP values associated with maximum likelihood parameter estimates for the main effect in adjusted model. Separate models were used to examine whether observed associations between food insecurity in emerging adulthood and health behavior markers were consistent across the adolescent food security groups. Among 16 interaction tests (adolescent food security by emerging adult food security status), there were no tests with P < .1.

Substance use.

Experiencing food insecurity in emerging adulthood was also related to higher prevalences of substance use and binge drinking (Table 3). Food-insecure emerging adults were more likely to report weekly substance use (cigarettes, marijuana, or other drugs) and engaging in binge drinking within the past 2 weeks (all P < .01). This association was most pronounced for weekly substance use, which was reported by 28.3% of food-insecure and 16.5% of food-secure emerging adults.

Reoccurring Experiences of Food Insecurity

Participants experiencing adolescent food insecurity were more likely to report past-year food insecurity in emerging adulthood (Table 4). The prevalence of experiencing food insecurity in the past year was 20.3% among emerging adults without a history of food insecurity and 37.4% among those who previously reported food insecurity (P < .001).

TABLE 4—

Prevalence of Food Insecurity Among Emerging Adults (2017–2018) by History of Past-Year Food Insecurity Experiences in Adolescence (2009–2010) When Surveyed at Baseline of the EAT 2010–2018 Study in Minneapolis–St Paul, MN

Adolescent Report	Emerging Adult Food Insecure, %
Hungry because your family could not afford more food
Almost every month	51.9
Some but not every month	46.9
Only 1–2 months	23.9
I have not been hungry for this reason	20.9
Food eaten in your home
Often we don’t have enough to eat	60.6
Sometimes we don’t have enough to eat	43.4
Enough to eat but not kinds of food we want	23.8
Enough to eat and kinds of food we want	20.4

Note. EAT = Eating and Activity over Time. Values are weighted to reflect the probability of responding to the follow-up EAT 2018 surveys.

Although many participants had experienced episodes of food insecurity in both adolescence and emerging adulthood, regression models including adolescent food security as a covariate produced results not meaningfully different from those presented in Table 2 and Table 3 (Appendix B, available as a supplement to the online version of this article at http://www.ajph.org). The 1 exception was that calcium intake did not differ by emerging adult food security in models that accounted for adolescent food security. In addition, as detailed in Tables 2 and 3, the models used to assess for interactions between adolescent and emerging adult food insecurity did not provide evidence of effect modification.

DISCUSSION

This study describes experiences of food insecurity in a population-based sample of emerging adults and investigates its relationship with dietary quality and health risk behaviors. Results indicate that food insecurity is prevalent, and vulnerable groups that may benefit from targeted interventions include emerging adults living with their own child(ren), persons in households receiving public assistance, and those who are not presently students but have no postsecondary degree or certificate. Furthermore, as several health risk factors (e.g., low fruit and vegetable intake, binge drinking) co-occurred with food insecurity, the results suggest that programs addressing emerging adult food insecurity may need to be coordinated with other health services. The current study did not find evidence that adolescent food insecurity has an impact on engagement in health risk behaviors in emerging adulthood; however, the results indicate that young people who experience adolescent food insecurity may be more likely to also experience food insecurity in emerging adulthood.

The prevalence of food insecurity among the EAT study sample of emerging adults was higher than the 2018 national average among US adults, but comparable to prevalences in emerging adult samples of college students (20%–50%).^1,13,26,27 The current study extends the finding that food insecurity is prevalent among postsecondary students to the broader population of emerging adults and suggests that young people who do not enroll in degree programs may in fact be more likely than students to be food insecure within a given community. Results of the current study add to the consistent finding that the transition from adolescence to adulthood is a period of vulnerability for food insecurity.

The observed co-occurrence of emerging adult food insecurity with low diet quality and health risk behaviors is in line with previous findings among postsecondary students and other age groups.^4,11,13 Links between health behaviors and food insecurity might be attributable to the psychological and emotional stresses associated with experiencing disrupted access to adequate food (e.g., binge eating when food is available) or chronic stresses of living in poverty (e.g., substance use).^11,28,29 If stresses associated with repeated episodes or an ongoing state of food insecurity across development have a cumulative impact on future health, then it would be expected that many young people who participated in the current study will be at high risk for future health problems. The results of the current study confirm that food insecurity tends to cluster with health risk factors overall and expands the scope of observed risks to include binge eating when food is available.¹³ Binge drinking and substance use were also elevated in prevalence among food-insecure emerging adults, but observed differences were not of a magnitude to suggest expenditures for alcohol and substances are a cause of insufficient money for food. The co-occurrence of poor diet quality and other health risk behaviors among food-insecure emerging adults is of concern given the likely consequences for long-term health.

Programs to enhance food management and preparation skills are often recommended to combat food insecurity; however, the extent to which skilled food selection and preparation can compensate for a limited food budget has not been established. In contrast to findings of research among postsecondary students,^10,12 the current study did not find evidence to support the potential for food skills to compensate for limited resources and protect against food insecurity. Additional research addressing food literacy among emerging adults could be useful to identify specific aspects of food skills (e.g., ability to quickly prepare nutritionally dense food) to promote improvements in diet quality among food-insecure young people.

Finally, this study is one of very few to date to use longitudinal data in examining food insecurity among emerging adults. Although we hypothesized that young people who experienced food insecurity in adolescence and emerging adulthood would be more likely than their counterparts (i.e., those who experienced food insecurity at only 1 time point) to experience other negative health outcomes, we did not find evidence of a cumulative impact. These findings are in concordance with findings from another longitudinal study that found that food insecurity was significantly correlated with adverse health behaviors of college freshmen and outcomes occurring at the same time point; however, independent of current food insecurity, previous food insecurity was not significantly associated with future outcomes.³⁰

Limitations

Study limitations include brevity of survey measures, inherent measurement error associated with using food frequency questionnaires to assess diet, and a lack of objective measures of food preparation behaviors.³¹ Furthermore, only a small portion of items on the US Household FSSM were included on the EAT 2018 survey, and different, age-appropriate measures were included on the surveys for adolescents at baseline.¹⁷ The validity of the short US Household FSSM was established by examining the 6-item tool, and only 2 items were used in EAT 2018.¹⁷ Because the 2-item assessment focused on having a sufficient quantity of food and did not capture challenges relating to food quality, it is possible the assessment underestimated food insecurity among emerging adults. Future research should address these limitations; for example, it would be informative to conduct cognitive interviews to address how emerging adults understand various survey measures of food security.

Study strengths include sociodemographic diversity of emerging adult participants, assessment of food security at multiple life stages, the range of diet quality markers from a validated food frequency questionnaire, and attention to both environmental and personal factors relevant to health.²¹ The unique design allowed for attention to a gap in the literature regarding the potential for food insecurity to have a greater impact on health when it is persistent versus transient during the transition from adolescence to adulthood.³⁰ However, it is important to further explore long-term and potentially cumulative impacts of food insecurity in both childhood and adulthood. There is also a need for future studies to examine what forms of public assistance are most effective for preventing poor health behaviors among emerging adults and improving health outcomes over time.

Public Health Implications

In summary, study findings suggest that assistance programs are needed to address existing gaps in preventing food insecurity among not just postsecondary students but also the broader population of emerging adults, and assistance should be coordinated with other health services (e.g., screening and treatment of binge eating, drug use). Early adulthood is a vulnerable stage of the life course as well as a time when young people may begin providing meals for children of their own.^8,32 Public health consequences of inadequate access to food for emerging adults may therefore extend to the next generation. Furthermore, epidemiological studies indicate that food-insecure parents are less likely to engage in feeding practices that promote healthy weights for their children (e.g., child satiety responsiveness).^33–35 Nutrition programs teaching food skills may benefit the health of emerging adults; however, the results of the current study suggest that such programs on their own are unlikely to alleviate food insecurity. Policy efforts could diminish adverse effects of food insecurity in emerging adulthood, including those aimed at simplifying the process of applying for Supplemental Nutrition Assistance Program benefits, expanding outreach around nutrition assistance programs to better reach emerging adults, and expanding the National School Lunch Program and other food security efforts to college campuses. Given that adolescents who experience food insecurity are at high risk for being food insecure in emerging adulthood, it may be valuable for health professionals to work with young people to prepare them and their families for the transition from having access to school meal programs to the need for accessing other forms of nutrition assistance.