Prevalence and Associations between Food Insecurity and Overweight/Obesity among Native Hawaiian and Pacific Islander Adolescents

Abstract Objective: This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores sociodemographic factors which might have a moderation effect on the association. Design: Cross-sectional study using 2014 NHPI-National Health Interview Survey (NHIS) data reported by a parent or guardian. Family-level food security was assessed by the United States (US) Department of Agriculture 10-item questionnaire. BMI for age and sex >=85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria. Setting: The US, including all 50 states and the District of Columbia. Participants: 383 NHPI adolescents aged 12-17 in the US. Results: A third (33.5%) of NHPI adolescents aged 12-17 were overweight (19.1%) or obese (14.4%); 8.1% had low food security; and 8.5% had very low food security. Mean family food security score was 1.06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77% lower for adolescents in families participating in SNAP (OR: 0.23, 95% CI: 0.08-0.64, p=0.007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food insecure families. Conclusions: The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents’ health outcomes.