Assessing nutrition security and its risk factors using the National Household Food Acquisition and Purchase Survey data

OBJECTIVE: To estimate the prevalence of nutrition security and examine its association with community food environment factors, including food access and affordability. DESIGN: This cross-sectional study used data from the 2012-2013 National Household Food Acquisition and Purchase Survey, including its restricted-use Geography Component (FoodAPS-GC). Household nutrition security measure was derived by combining self-assessed food security and self-rated diet quality indicators into four categories: food secure with high diet quality (FSHD), food secure with low diet quality (FSLD), food insecure with high diet quality (FIHD) and food insecure with low diet quality (FILD). Only FSHD households were considered nutrition secure. Multinomial logit analysis identified factors associated with nutrition security. PARTICIPANTS: 4685 households with primary respondents aged 20 years or older. SETTING: Nationally representative sample of US households. RESULTS: Approximately 31·0 % of households were classified as nutrition insecure, including 15·0 % as FSLD, 9·3 % as FIHD and 6·7 % as FILD. The remaining 69·0 % were nutrition secure (FSHD). Nutrition insecurity was significantly associated with younger age, lower educational attainment, lower income, obesity, smoking and poorer self-rated health. Food environment factors, including low geographic access to food and higher local food prices, were not significantly associated with nutrition security. Relying on someone else's car to reach a primary food store was linked to higher odds of nutrition insecurity. CONCLUSIONS: The proposed nutrition security measure can be used to monitor nutrition security in national surveys. Comprehensive measures of the food environment are needed to understand its relationship with nutrition security and to guide targeted policy interventions.