Overview: ​

 

Food insecurity refers to the limited or uncertain access to or ability to acquire safe, nutritionally adequate, and affordable food in socially acceptable ways (Andersen, 1990; USDA Economic Research Service [ERS], 2025). This issue affects over 18 million individuals across the United States as of 2024 (USDA, Economic Research Service, 2025). Food insecurity is especially prevalent in communities with low incomes and/or low access to nutritious food sources (i.e., grocery stores), with 38% of households experiencing poverty also fitting the criteria of being food insecure (Rabbitt et al., 2024). Food insecurity is deeply interconnected with stress, poor diet quality, and negative mental health outcomes, which can lead to long-term health challenges. Specifically, research finds that individuals experiencing food insecurity have higher levels of perceived stress and experience isolation based in shame and stigma that exacerbate their situation and tend to culminate in negative dietary behaviors leading to poor nutrition (Cain et al., 2022; Becker et al., 2019). Individuals facing food insecurity often have lower quality diets (Leung et al., 2014) as well as higher intake of hyperpalatable foods, particularly those that are high in sugar and fat (Chiu et al., 2024), due to their limited food access. This underscores the importance of advancing the emerging theme of nutrition security, which emphasizes access not only to sufficient calories but to healthful, nourishing foods that support a healthful lifestyle (Mozaffarian, 2023). There is an urgent need to address systemic barriers to achieving food security. Illuminating the relationship between food insecurity and psychological distress is essential to mitigate the negative impacts on both physical and mental health.

 

Background:

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Key Statistics

In 2024, over 18.3 million households across the United States experienced food insecurity, including: children in nearly 1 in 5 households (representing 14 million children), older adults (11% of households with seniors), and individuals with disabilities (34%) (Rabbitt et al., 2025; Hales 2024; Feeding America, 2025). Food insecurity has the greatest impact on financially insecure populations and those that rely on others for their nutrition, such as children, those with chronic disease or disabilities, and older adults (Myers, 2020). While food unavailability is inherently stressful, this stress is often driven and intensified by intersecting social determinants of health, including poverty, racism, trauma, and adverse childhood experiences (Butler et. al., 2024). While people with limited incomes are already facing increased rates of unemployment, poverty, and lower average income (Feeding America, 2025), the lowest income quintile (earning less than $16,171 annually) spend about 33% of their income on food alone, along with rising housing costs that often exceed another 33% of their total expenditures (USDA ERS, 2025). Within these populations, there is an added level of difficulty due to limited transportation, fixed incomes, and higher healthcare costs (Reed-Jones, 2023). This financial strain increases stress and encourages reliance on lower-cost foods, contributing to dietary patterns that are less aligned with national dietary guidelines (Jandaghian-Bidgoli et al., 2024). Food insecurity is associated with lower diet quality, higher stress levels, and negative mental health outcomes (Jandaghian-Bidgoli et. al., 2024).

 

Low Resource Environments & Access

Food insecure neighborhoods are defined by average neighborhood income, distance to a large grocery store or healthy food source, and environmental resource indicators like public transportation access (USDA, 2025). Previously referred to as food deserts, the USDA now refers to these areas as ‘low income and low access’ (USDA, 2025). Low income is defined as an annual household income at or below $31,200 for a family of four, meeting 80% of a defined area’s average income. Among varying definitions for low access, the USDA Economic Research Service’s Food Access Research Atlas most stringent definition for a ‘low access’ area is a household that is more than 0.5 miles from a large grocery store in an urban area and/or more than 10 miles away in a rural area (US Hunger, 2022). More recent scholarship emphasizes the role of structural factors and systemic barriers to this state (Odoms-Young et al., 2024), coining the term “food apartheid” to refer to the segregation of people of color from access to fresh and affordable food (Zurawski, 2023; Karpyn et al., 2019).

 

Limited access to transportation heavily impacts access to food as 8% of U.S. households, representing over 10.5 million households, do not have a vehicle and rely on public transit (Rhone, 2025; U.S. Census Bureau, 2025). In a survey conducted by U.S. Hunger, a national nonprofit addressing food insecurity, 43% of individuals experiencing food insecurity reported they do not have access to transportation (2022). Individuals without vehicle access reported higher stress when obtaining food, especially in neighborhoods perceived as unsafe (Feeding America, 2025). The availability of nutritious foods nearby is an important factor influencing an individual’s diet. In food-insecure areas without vehicle access, convenience stores are often the most reliable food source, typically offering affordable but more highly processed options. (Ma et al., 2017). Greater reliance on calorie-dense and nutrient-poor options provides a direct connection between dietary behaviors, physiological stress responses, and the cycle that can ensue, detailed in the Stress Measurement Network’s Nutrition entry (Stress Measurement Network, 2025). Considering the environmental context with respect to stress and diet can better capture the full cycle of food insecurity and its impact on health.

 

Connection to Stress

Individuals experiencing food insecurity are significantly associated with higher levels of perceived stress with the uncertainty of acquiring sufficient nutritious food, provoking feelings of anxiety and depression (Cain et. al., 2022). Specifically, parents report an added layer of stress from the need to shield their children from food insecurity, oftentimes by sacrificing their own nutrition, and discuss how this uncertainty and cognitive load to manage insufficient resources is a stress inducing experience (Cain et. al., 2022). Chronic stress felt by people experiencing food insecurity can change their biological and psychological reactions to food and how their bodies metabolize nutrients, leading to worsened physical and mental health outcomes (Lee et. al., 2023). Chronic food insecurity serves as a systemic stressor, maintaining activation of the hypothalamic-pituitary-adrenal axis (the main stress response system in the body) leading to elevated cortisol levels and a bidirectional cycle of psychological distress and emotional dysregulation with poor dietary habit impacts. This feedback loop cycles stress and poor nutrition behaviors that worsen physical and mental health. This can lead to cravings for hyperpalatable foods, high stress, anxiety and burnout, as studied in diverse populations ranging from college students to healthcare professionals (Sustainability Directory, 2025; AMA, 2026; Brown et al., 2025). These health challenges often lead to social isolation, making it harder for individuals to access support systems and food assistance programs, ultimately trapping them in a continuous cycle of food insecurity and chronic stress, emphasizing the importance of measuring food security-related stress in clinical and community programming. Food insecurity impacts both diet and psychological distress. Overall, this contributes to negative health impacts and disease aggravation (Jandaghian-Bidgoli et. al., 2024).

 

In addition to lack of availability of foods and nutrients, dietary behaviors related to food insecurity-related stress and shame can play a role as well. In school-aged children, this food insecurity-associated shame and stress appear to have a significant effect on learning and productivity behaviors and mental health concerns, which may contribute to adverse health outcomes later in life (Ke & Ford-Jones, 2015). Studies have linked skipping meals with students feeling sad and hopeless; in more extreme cases, food insecurity, diet, and stress may lead to depression and suicidal ideation in late adolescence and young adulthood (Michael et al., 2020; Ke & Ford-Jones, 2015).

 

The lack of choice that accompanies food insecurity can also lead to restrictive eating habits, resulting in disordered eating, especially in parents. Becker et al. (2019) used the Eating Disorders Examination-Questionnaire (EDE-Q) and found that many individuals did not recognize their eating behaviors as disordered and instead believed their stress-induced dietary actions were justified. Participants explained that their restricted food intake was an effort to make the food last longer or opted to eat less to ensure their children were fed appropriately (Becker et al., 2019). Those experiencing food insecurity described their lack of time, tight finances, feelings of procrastination, lethargy, and decision fatigue contributing to making less healthy choices, which lowered their mood (Lee et al., 2023). Oftentimes, individuals struggling with food insecurity feel isolated from peers or others in their community due to feeling embarrassed about their inability to access food or their use of food assistance programs (Lee et. al., 2023).

 

Diet Quality- Nutrition Security

Individuals with food insecurity have been found to have diets of lower diet quality (Leung et al., 2014) as well as higher intakes of high fat and high sugar (dessert-type) hyperpalatable foods (Chiu et al., 2024) and ultra-processed foods (Leung et al., 2022). As a result, individuals who are food insecure often face malnutrition in the forms of both undernutrition and overnutrition (obesity) due to negative impact on diet quality (Myers, 2020). When food access is limited to SNAP-authorized convenience stores, dietary options often do not support healthy eating and are associated with stress-related consumption of hyperpalatable and sugary foods. (Yau & Potenza, 2013). Pairing socioeconomic data with community asset maps illustrates the density and proximity of food retailers in food insecure areas (Figure 1), highlighting barriers to consistent access to culturally and nutritionally appropriate foods. Recent efforts to address food security have increasingly focused on nutrition security, defined as consistent access to health-promoting food, to ensure available options are not limited to ultra-processed foods, but instead nutrient-rich food that will support an active, healthy lifestyle.

 

Figure 1: Comparative Access to SNAP-Authorized Convenience Stores vs. Full-Service Grocers in Southern Nevada

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Figure 1 illustrates the disparity in food access and nutrition security through the Southern Nevada Healthy Food Access Map. The areas are densely populated by light green points representing SNAP-authorized outlets with limited fresh food from convenience stores. In contrast, the dark green points represent SNAP-authorized large grocery stores and are notably sparse within the shaded Low Income and Low Access (LILA) regions.

 

Collection and Measurement: 

 

Hunger Vital Signs​

The Hunger Vital Signs is a 2-item screening tool used to identify households at risk of food insecurity. The questions are: 1) Within the past 12 months, we worried whether our food would run out before we got money to buy more, 2) Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more. Households at risk for food insecurity would answer “often true” or “sometimes true” to one or both questions (CHW, 2025).

 

Household Food Security Survey Module (HFSSM)​

The U.S. Household Food Security Scale is a survey tool previously used by the United States Department of Agriculture to assess food security or insecurity in households until 2025. There are two versions of this scale, the 18-item version used for detailed studies and the 6-item version for quicker assessments. It measures an individual’s worry about running out of food, their inability to afford nutritious foods, cutting meal sizes or skipping meals, and any other experiences they may face due to food insecurity. Results provide ranking on the severity of food insecurity using USDA definitions of “low” or “very low” food security. The longer scales are able to determine the severity of food insecurity (i.e., low food security equates to reduced quality and variety of diet, but very low food insecurity shows disrupted eating patterns and reduced food intake) (USDA, 2025). These scales are still available online for use at the state or local level.

 

USDA Food Access Research Atlas Low Income and Low Access (LILA)​

The USDA Economic Research Service’s Food Access Research Atlas is a census-tract-level diagnostic tool used to identify “low income and low access” areas (LILA). Due to geographic barriers that vary significantly by region, the atlas offers multiple LILA definitions based on different distance thresholds to the nearest large grocery store. These benchmarks include 0.5 mile and 1 mile markers for urban areas, as well as the 10 mile and 20 mile markers for rural areas, allowing researchers to select the definition that most accurately reflects the food environment of their specific study population (US Hunger, 2022; Rhone, 2025).

 

Abbreviated Child and Adult Food Security Scale (ACAFSS)​

The ACAFSS is an 8-item scale that measures the presence and severity of food insecurity in households with children. This is an alternative to the more extensive module, HFSSM. This scale was designed to quickly identify food insecurity levels, monitor changes, and guide interventions (Poblacion et al., 2023).

 

Disaster Food Security Scale (DFSS)​

The Disaster Food Security Scale is a 15-item self-report survey used to assess food insecurity during disaster or emergency situations. It evaluates multiple dimensions of disruption, including food availability, access, affordability, quality, safety, dietary adequacy, and worry about food supply. Respondents indicate whether each statement was “Never True,” “Sometimes True,” or “Often True” during or after a disaster. Responses are summed to produce a total score, with higher scores indicating greater severity of disaster-related food insecurity (Clay et al., 2023).

 

United Nations Food and Agriculture Organization

 

Access Food Insecurity Experience Scale (FIES)​

The Food Insecurity Experience Scale is an 8-item experience-based scale that asks questions about an individual’s or family’s access to adequate food. It measures the severity of food insecurity based on questions that are self-reported food-related behaviors including mild, moderate and severe food insecurity. Mild food insecurity describes those who have adequate access but feel uncertain about future availability. Moderate food insecurity involves individuals forced to lower the quality or quantity of their food due to resource constraints. Severe food insecurity characterizes those who have run out of food and may go entire days without eating. This scale provides a standardized global measure of the psychological (referring to anxiety and uncertainty regarding food supply) and physical barriers to food access (FAO, 2025).

 

Household Consumption and Expenditure Surveys (HCES)​

The Household Consumption and Expenditure Surveys are multi-component data collection tools that typically utilize a food list of approximately 100 to 125 items, a range recommended by the Food and Agriculture Organization and World Bank (2018) to ensure data quality by capturing the majority of a population’s intake without causing respondent fatigue. These surveys collect data at the household level to provide national and subnational estimates on food quantities acquired through purchase, home production, or gifts and the monetary value on those items. By tracking the cost and economic access to food, these surveys allow researchers to calculate the percentage of a household’s budget spent on food. This serves as a proxy for financial stress and nutritional vulnerability (FAO, 2025).

 

Prevalence of Undernourishment (PoU)​

The Prevalence of Undernourishment is a model-based statistical measure. It provides critical estimates of the proportion of a population that is persistently consuming an insufficient amount of food to meet minimum dietary energy requirements. This tool tracks general trends and changes in hunger over time; the FAO has published global and regional estimates since 1974 and specific country estimates since 1999. This method estimates the percentage of those within a population who are at risk of not having sufficient food by calculating the probability that a randomly selected individual’s calorie intake falls below a minimum threshold (FAO, 2021). This provides a global tool for comparison and source for hunger data.

 

National Health and Nutrition Examination Survey (NHANES)​

The National Health and Nutrition Examination Survey (NHANES) is a nationally representative program in the United States designed to evaluate the health and nutritional status of the population. It integrates interview data with standardized physical examinations and laboratory testing to provide comprehensive information on diet, health conditions, and biomarkers. NHANES includes detailed dietary and food security assessment methods, such as 24-hour dietary recalls, along with anthropometric and clinical measures. NHANES also includes depression screeners for mental health, allowing researchers to investigate both nutritional intake and physical and mental health outcomes across diverse population groups (Williams et al., 2025).

 

Map the Meal Gap (MMG)​

Map the Meal Gap is a statistical modeling tool created and used by Feeding America to estimate food insecurity at the local level. It utilizes a four-variable model that analyzes food insecurity on the local level stratified by age, income, race and ethnicity as well as eligibility for federal programs such as SNAP. Beyond demographics, the model quantifies the food budget shortfall and the average meal cost based on the spending of food secure households (Feeding America, 2025).

 

Nutrition Security Screener (NSS)​

The Nutrition Security Screener is a 2-item tool to measure access to health-promoting foods. It assesses the difficulty of obtaining foods (such as fruits, vegetables, and whole grains) over a 12-month period. The first item categorizes nutrition security into levels including High, Low, or Very Low. The second item identifies thirteen specific barriers, such as cost, transportation, and limited cooking equipment. This tool is significant for its ability to identify individuals who may be food secure but remain nutrition insecure, and it has been independently linked to higher risks of chronic conditions like diabetes and hypertension (Tufts Food is Medicine Institute, 2025).

 

Associated Measures: Scales that track eating behaviors and diet quality linked to food insecurity due to inconsistent access to food leading to chronic meal cutting, restrictive eating out of need, and episodes of binge eating.

 

Three-Factor Eating Questionnaire​

The Three-Factor Eating Questionnaire or Eating Inventory is a self-report measurement to evaluate three dimensions of eating behavior: cognitive restraint, uncontrolled eating, and perceived hunger or emotional eating. The 18-item questionnaire is rated on a scale of “definitely true (4), mostly true (3), mostly false (2), and definitely false (1);” the higher the score, the more dependent on cognition, stress, or emotional eating patterns (de Lauzon et al., 2004). 

 

Eating Disorders Examination-Questionnaire (EDE-Q)​

The Eating Disorders Examination Questionnaire is a self-reported measure that consists of 28 questions that are concerned with eating habits and behaviors in the past 28 days. This examination goes deeper into the personal emotions individuals may face with their eating habits and behaviors. These questions range from personal emotions, body image, and portion sizes. It is ranked on a 7-point scale: no days, 1-5 days, 6-12 days, 13-15 days, 16-22 days, 23-27 days, and every day. It is scored on 4 subscales: restraint, eating concern, shape concern, and weight concern. This form of measurement is highly accurate when discriminating between individuals with and without an eating disorder (Mond et al., 2006).

 

Hyperpalatable Foods Intake​

Hyperpalatable Food Intake is a measurement used to identify the consumption of foods to be highly rewarding through specific combinations of fat, sugar, and sodium. This is measured by applying a standardized quantitative definition to food items to determine if they meet specific thresholds, 1) Fat and sodium, 2) Fat and sugar, or 3) Carbohydrates. Researchers use these criteria to calculate the percentage of an individual’s total caloric intake that comes from these high-reward foods to assess their impact on eating behaviors and metabolic health (Fazzino et al., 2019).

 

Comprehensive Emotional Eating Scale (CEES)​

The Comprehensive Emotional Eating Scale is a 40-item self-report questionnaire developed to assess emotional eating behavior across four dimensions: positive and negative emotional over- and under-eating. Respondents indicate how often emotional states influence their eating. Higher scores reflect greater frequency of emotional eating responses, including tendencies toward overeating or undereating in response to affective states such as stress, which are relevant to food insecurity and disrupted eating patterns (Hooper et al., 2025).

 

Strengths and weaknesses:

 

The most commonly used measures for food insecurity, nutrition security and related dietary intakes provide essential insights into peoples’ lived experiences, behaviors, and emotional well-being, but they differ in depth, focus, and limitations (FAO, 2025; USDA, 2025; Feeding America, 2025; Tufts Food is Medicine Institute, 2025; Williams et al., 2025). These tools are designed to assess the availability, accessibility, and adequacy of food often through experience-based questions that capture worry about food supply, reduced quality or quantity of intake and coping strategies in response to resource constraints (FAO, 2025; Poblacion et al. 2023; CHW, 2025; Clay et al., 2023; USDA, 2025). Some instruments are more comprehensive, distinguishing between levels of severity and capturing disrupted eating patterns, nutritional compromise and trade-offs, while others prioritize brevity and are intended for rapid screening in clinical or community settings (USDA, 2025; CHW, 2025; Poblacion et al., 2023; Clay et al., 2023; Tufts Food is Medicine Institute, 2025). These tools provide important information regarding participant food insecurity by capturing disrupted eating patterns, nutritional compromise, such as any trade-offs in food quality made due to limited resources (FAO, 2025; USDA, 2025).

 

These self-reported surveys can be useful for identifying trends of behavior but are subject to unreliability due to self-reporting practices of individuals. While these tools are useful for identifying at-risk populations, monitoring trends and guiding interventions, they rely heavily on self-reported data, including experience-based scales and behavioral questionnaires, making them susceptible to information bias (such as underreporting due to stigma or misunderstanding of terminology) and recall bias, especially when participants are asked to reflect on food experiences over an extended period (Clay et al., 023; FAO, 2025; Williams et al., 2025; Mond et al., 2006; de Lauzon et al., 2004; Hooper et al., 2025). In addition, shorter tools may not capture the full complexity of food and nutrition insecurity including emotional, cultural, environmental and structural dimensions that shape individuals' experiences, and may overlook dietary quality or consumption patterns measured through economic and intake-based approaches (Tufts Food is Medicine Institute, 2025; Hooper et al., 2025; Fazzino et al., 2019; FAO, 2025). Differences in context may also affect how questions are interpreted, which can limit generalizability across populations without appropriate adaptation, particularly when applying global, national, and geographically modeled measures across diverse settings (FAO, 2025; Rhone, 2025; US Hunger, 2022; Feeding America, 2025). These tools serve as valuable resources, but their accuracy and relevance depend on the population being assessed, the timing of administration, and the sensitivity of the questions used (FAO, 2025; USDA, 2025; Feeding America, 2025; Williams et al., 2025). The majority of these tools also do not measure mental health outcomes directly. Despite the reported connections between food insecurity and mental health, namely stress, in the literature, the lack of a fully integrated measurement tool poses a barrier to comprehensive analysis.

 

Author(s) and Reviewer(s): Prepared by Sabina Malik, PhD, Dorothy Chiu, PhD, Danielle Lee, RD, Rachel Tang, Jazmine Perez, and Annie Roe, PhD, RD. Reviewed by the Mental Health Nutrition Network Evaluation leadership team. If you have any comments on these measures, email smalik@unr.edu.

 

Version date: September 2026.

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