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Food Insecurity, Food Deserts, and Waist-to-Height Ratio: Variation by Sex and Race/Ethnicity


The purpose of this study is to investigate the association between two food-related hardships—food insecurity and living in a food desert—on waist-to-height ratio (WHtR). Data on participants from waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed. The association between food-related hardships and waist-to-height ratio were examined using logistic regression. Models were stratified by sex and race/ethnicity to examine potential moderating effects. Study results suggest food insecurity has a positive association with WHtR among female respondents (OR = 1.360, p = .017). Living in a food desert has a positive association with WHtR among both females (OR = 1.247, p = .026) and males (OR = 1.245, p = .024). In models stratified by race/ethnicity living in a food desert is positively associated with WHtR among White respondents (OR = 1.279, p = .003). Given the link between food-related hardships and obesity, targeted interventions that alleviate food insecurity and inadequate access to healthy food retailers could be effective in reducing obesity.

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This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by Grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website ( No direct support was received from Grant P01-HD31921 for this analysis.

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Correspondence to Alexander Testa.

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Testa, A., Jackson, D.B. Food Insecurity, Food Deserts, and Waist-to-Height Ratio: Variation by Sex and Race/Ethnicity. J Community Health 44, 444–450 (2019).

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  • Food insecurity
  • Food desert
  • Nutrition
  • Waist-to-height ratio
  • Obesity