BACKGROUND: Food insecurity (FI) rates in the United States are particularly high among households with children. This research set aims to analyze if high school students experiencing FI had higher risk for mental health and suicidal behaviors. METHODS:Using combined data from 11 states that conducted the 2017 Youth Risk Behavior Survey, a total of 26,962 and 24,051 high school students were used to estimate race/ethnicity and sex-stratified prevalence ratios (PRs) from Poisson regression models. A single-question was used to measure the exposure of FI and outcomes of mental health and suicidal behaviors.RESULTS: Overall, 10.8% of students reported FI. Students experiencing FI had increased risk for all mental health and suicide behavior outcomes, regardless of their race/ethnicity or sex. PRs ranged from 1.9 (95% confidence interval [CI]:1.8, 2.0) to 3.1 (CI: 2.7, 3.6). Among males, PRs for the association between FI and all outcomes were highest among non-Hispanic black students (PRs ranged from 2.4 [CI: 1.7, 3.2] to 5.5 [CI: 2.3, 13.3]). Among females, PRs were highest among non-Hispanic white students (PRs ranged from 1.9 [CI:1.7, 2.1] to 3.6 [CI:2.9, 4.5]).CONCLUSIONS: FI is consistently associated with mental health and suicidal behaviors among different subgroups of students.

Childhood sexual abuse (CSA) has been shown to be more prevalent among populations living with HIV. Antiretroviral therapy (ART) adherence is crucial for populations living with HIV as it significantly increases the likelihood of attaining and maintaining viral suppression. Previous findings on the association between CSA and ART adherence have been mixed. The current mixed-methods systematic review aimed to identify quantitative and qualitative studies from CINAHL, PsycInfo, PubMed, and Web of Science examining the relationship between CSA and ART adherence. Authors were also contacted if relevant data were unpublished. Studies had to be published from January 1, 2000 to April 1, 2019, written in English, and examined CSA as an exposure and ART adherence as an outcome. Four domains were combined: 1) childhood sexual abuse; 2) child; 3) antiretroviral; and 4) adherence. Eight quantitative and two qualitative studies were retained. The results showed that four quantitative studies found no association while the other four found factors such as timing of victimization, mental health and gender influenced the association between CSA and ART adherence. Themes emerging from the qualitative studies included use of ART evoking memories of CSA; CSA impacting mental health; and mental health treatment improving ART adherence. Mixed insights included the intricate links between CSA and ART adherence and the role of external factors on the relationship. ART adherence intervention programs may be needed for people who have experienced CSA. However, future studies are needed that will examine the association between CSA and ART adherence and include subgroup analyses.

Household food insecurity (HFI) (or unavailability of nutritionally adequate and safe foods) is associated with unhealthy diet and increased risk of obesity and chronic diseases. Additionally, people with diabetes are at increased risk for depression. Although access to a regular and healthy diet is important to proper nutrition and to diabetes management, no studies have assessed how HFI is related to depression among youth and young adults (YYA) with type 1 diabetes (T1D) or type 2 diabetes (T2D). This study used cross-sectional data from the SEARCH for Diabetes in Youth study collected in 2015-2019 to evaluate associations between HFI and depression among YYA with T1D and T2D. HFI was categorized as a binary variable (food secure vs. food insecure) using the 18-item U.S. Department of Agriculture food security survey, where ≥3 affirmations indicated being food insecure. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to quantify depression symptoms as a continuous outcome (scores 0-60). Linear regression models were adjusted for age, sex, race/ethnicity, site, and diabetes duration. Models were analyzed separately for youth with T1D, young adults with T1D, and young adults with T2D. HFI and CES-D data were available for 335 T1D youth (10-17 years), 731 T1D young adults (18-35 years), and 272 T2D young adults (18-34 years). Of these, 18.8%, 17.5%, and 30.1%, respectively, reported being food insecure. Adjusted models showed that food insecure young adults with T1D had 7.4 higher scores on symptoms of depression (p<.0001) and those with T2D had 4.8 higher scores on symptoms of depression (p=0.0002), when compared to those that were food secure. Food insecure youth with T1D had 3.2 higher scores on symptoms of depression compared to food secure youth with T1D after adjustment for covariates (p=0.0031). Findings from this study suggest that living in a food insecure household is associated with increased depression symptomology among YYA with T1D or T2D. Disclosure A.D. Brown: None. J.A. Mendoza: None. K. Flory: None. B.A. Reboussin: None. C. Mercado: None. E.T. Jensen: None. L.M. Dolan: None. D. Dabelea: None. J.M. Lawrence: None. A.D. Liese: None. Funding SEARCH for Diabetes in Youth Cohort Study (1UC4DK108173); SEARCH Food Security Cohort Study (1R01DK117461-01); National Institute of General Medical Sciences (T32GM081740)

Household food insecurity (HFI) is the limited or uncertain availability of nutritionally adequate and safe foods and has been associated with decreased cognitive function in persons without diabetes. In persons with diabetes, little is known about the impact of HFI, but cognitive function is known to decline with diabetes duration and poorer glycemic control. We evaluated the cross-sectional association of HFI with cognitive function in youth and young adults (YYA) with type 1 diabetes (T1D), focusing on executive function as measured with the NIH Toolbox Cognition Battery (score range 39-146) and a potential interaction of HFI with glycemic control (high risk >9% vs. optimal/suboptimal ≤9% HbA1c). Age-adjusted composite fluid cognition score was modeled using multivariable linear regression, with HFI (≥3 affirmations on US Household Food Security Survey Module) as the predictor, controlling for covariates. Among 1,272 YYA with T1D (mean age 21, diabetes duration 11 years, 57% non-Hispanic white), 55% had high-risk glycemic control and 18% were food insecure. Food insecure T1D YYA had a 2.7 (SD=1.2) lower fluid cognition score than their food secure peers (93.7 vs. 96.4, p=0.03). Adjustment for sex, race/ethnicity, diabetes duration, site, and glycemic control attenuated this association (β=1.2, p=0.30). However, glycemic control turned out to modify the association of HFI with cognition (multiplicative interaction in adjusted model p<0.01). Among YYA with HbA1c ≤9%, food insecure individuals had a lower mean fluid cognition score than the food secure (99 vs. 104, p<0.02); for YYA with high-risk glycemic control, no association was observed. In this cross-sectional study, food insecurity has a detrimental relationship with cognition among T1D YYA, particularly among those with optimal/suboptimal glycemic control levels. Longitudinal research is needed to further delineate the temporal relationships between household food insecurity, glycemic control, and cognition. Disclosure A. D. Liese: None. B. A. Reboussin: None. A. S. Shah: None. S. M. Marcovina: None. L. M. Dolan: None. D. Dabelea: None. C. Pihoker: None. J. A. Mendoza: None. A. D. Brown: None. A. Shapiro: None. E. A. Frongillo: None. G. Wilkening: None. J. Fridriksson: None. A. Merchant: None. L. Henkin: None. E. T. Jensen: None. Funding National Institutes of Health (1R01DK117461, 1UC4DK108173)

We examined associations between adolescent self-reported hunger, health risk behaviors, and adverse experiences during the 2018–2019 school year. Youth Risk Behavior Survey data were pooled from 10 states. Prevalence ratios were calculated, and we assessed effect measure modification by sex. The prevalence of self-reported hunger was 13%. Self-reported hunger was associated with a higher prevalence of every health risk behavior/adverse experience analyzed, even after adjusting for sex, grade, and race/ethnicity. Sex did not modify associations. Findings underscore needs for longitudinal research with more robust measures of adolescent food insecurity to clarify the temporality of relationships.