{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T20:44:16Z","timestamp":1789677856235,"version":"4.0.1"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Nutrition security is increasingly recognized as a critical but underexamined driver of health. Identifying barriers to nutrition security is essential for developing effective interventions.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine associations among barriers to healthy eating, their prevalence by sociodemographics, and their associations with health conditions.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this cross-sectional study, a population-based survey was conducted between February and April 2023 among English-speaking US adults aged 18 years or older recruited and surveyed through the Qualtrics panel service, with oversampling among people with annual household incomes less than $50\u202f000. Data were analyzed from March 18 to November 9, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Nutrition security status and barriers to nutrition security, assessed through the Nutrition Security Screener.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were health conditions: type 2 diabetes, obesity, heart disease, high blood pressure, high cholesterol, stroke, and cancer. Independent variables were nutrition security barriers. Covariates included age, gender, race, ethnicity, educational attainment, annual household income, and food security status. Multivariable regressions with health condition outcomes were stratified by nutrition security status.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analyses (1518 [50.6%] were female; 1983 [66.1%] were between ages 18 and 49 years). A mean (SD) of 7.8 (3.0) barriers were reported among participants with nutrition insecurity compared with 4.4 (3.2) among those who had nutrition security. Most barriers were only modestly intercorrelated (mean [SD]\n r<\/jats:italic>\n \u2009=\u20090.45 [0.13]), with the highest correlation (\n r<\/jats:italic>\n \u2009=\u20090.86) between insufficient time to shop and to cook. Barriers clustered into 2 factors that explained 61.4% of the variance. Black adults had higher odds of transportation barriers (adjusted odds ratio [AOR], 1.56 [95% CI, 1.17-2.08]) than White adults, whereas Hispanic\/Latinx adults had higher odds of nutrition assistance barriers (AOR, 1.65 [95% CI, 1.26-2.17]) than those who were non-Hispanic\/Latinx. A higher number of barriers (per unit increase [range, 0-13]) was associated with higher prevalence of diabetes (AOR, 1.10 [95% CI, 1.04-1.16]), heart disease (AOR, 1.16 [95% CI, 1.07-1.24]), and obesity (AOR, 1.09 [95% CI, 1.04-1.14]) among adults with nutrition security and of heart disease (AOR, 1.12 [95% CI, 1.03-1.22]) and stroke (AOR, 1.12 [95% CI, 1.02-1.25]) among those with nutrition insecurity.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study among US adults, barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions. These findings provide new insights into how barriers to healthy eating can be assessed, informing more targeted clinical, public health, and policy initiatives.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.20264","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:57:37Z","timestamp":1782845857000},"page":"e2620264","source":"Crossref","is-referenced-by-count":3,"title":["Barriers to Nutrition Security in the US"],"prefix":"10.1001","volume":"9","author":[{"given":"Caroline E.","family":"Owens","sequence":"first","affiliation":[{"name":"Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts"},{"name":"Department of Anthropology, University of North Carolina Wilmington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronit","family":"Ridberg","sequence":"additional","affiliation":[{"name":"Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Reedy","family":"Sharib","sequence":"additional","affiliation":[{"name":"Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hope C.","family":"Craig","sequence":"additional","affiliation":[{"name":"Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dariush","family":"Mozaffarian","sequence":"additional","affiliation":[{"name":"Food Is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts"},{"name":"Division of Cardiology, Tufts Medical Center, Boston, Massachusetts"},{"name":"School of Medicine, Tufts University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"issue":"3","key":"zoi260566r2","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1093\/jn\/121.3.408","article-title":"Food insecurity: a nutritional outcome or a predictor variable?","volume":"121","author":"Campbell","year":"1991","journal-title":"J Nutr"},{"issue":"6A","key":"zoi260566r3","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1079\/PHN2002385","article-title":"Measurement of household food security in the USA and other industrialised countries.","volume":"5","author":"Radimer","year":"2002","journal-title":"Public Health Nutr"},{"issue":"5","key":"zoi260566r4","doi-asserted-by":"publisher","first-page":"481","DOI":"10.3945\/an.113.004119","article-title":"What are we assessing when we measure food security? a compendium and review of current metrics.","volume":"4","author":"Jones","year":"2013","journal-title":"Adv Nutr"},{"issue":"5","key":"zoi260566r5","doi-asserted-by":"publisher","first-page":"1404S","DOI":"10.1093\/jn\/136.5.1404S","article-title":"Measuring household food insecurity: why it\u2019s so important and yet so difficult to do.","volume":"136","author":"Webb","year":"2006","journal-title":"J Nutr"},{"issue":"10","key":"zoi260566r6","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.1016\/j.jand.2018.10.011","article-title":"The association between food insecurity and diet quality varies by race\/ethnicity: an analysis of National Health and Nutrition Examination Survey 2011-2014 results.","volume":"119","author":"Leung","year":"2019","journal-title":"J Acad Nutr Diet"},{"issue":"12","key":"zoi260566r7","doi-asserted-by":"publisher","first-page":"1943","DOI":"10.1016\/j.jand.2014.06.353","article-title":"Food insecurity is inversely associated with diet quality of lower-income adults.","volume":"114","author":"Leung","year":"2014","journal-title":"J Acad Nutr Diet"},{"issue":"12","key":"zoi260566r8","doi-asserted-by":"publisher","first-page":"1692","DOI":"10.1161\/CIRCRESAHA.123.322065","article-title":"Diet and food and nutrition insecurity and cardiometabolic disease.","volume":"132","author":"Brandt","year":"2023","journal-title":"Circ Res"},{"issue":"4","key":"zoi260566r9","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1377\/hlthaff.2024.01346","article-title":"A new approach to guide research and policy at the intersection of income, food, nutrition, and health.","volume":"44","author":"Berkowitz","year":"2025","journal-title":"Health Aff (Millwood)"},{"issue":"16","key":"zoi260566r10","doi-asserted-by":"publisher","first-page":"1605","DOI":"10.1001\/jama.2021.1915","article-title":"Prioritizing nutrition security in the US.","volume":"325","author":"Mozaffarian","year":"2021","journal-title":"JAMA"},{"key":"zoi260566r11","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1146\/annurev-nutr-062222-023359","article-title":"Assessing and monitoring nutrition security to promote healthy dietary intake and outcomes in the United States.","volume":"43","author":"Seligman","year":"2023","journal-title":"Annu Rev Nutr"},{"issue":"3","key":"zoi260566r12","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.jneb.2024.11.004","article-title":"A meta-ethnography to determine critical constructs of nutrition security.","volume":"57","author":"Faul","year":"2025","journal-title":"J Nutr Educ Behav"},{"issue":"6","key":"zoi260566r13","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.16406","article-title":"Association of socioeconomic and geographic factors with diet quality in US adults.","volume":"5","author":"McCullough","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"6","key":"zoi260566r15","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1016\/j.ajcnut.2025.08.017","article-title":"Development and validation of a brief Nutrition Security Screener (NSS) for clinical and public health settings.","volume":"122","author":"Craig","year":"2025","journal-title":"Am J Clin Nutr"},{"issue":"4","key":"zoi260566r16","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1377\/hlthaff.2024.00585","article-title":"\u201cFood Is Medicine\u201d in the US: a national survey of public perceptions of care, practices, and policies.","volume":"44","author":"Ridberg","year":"2025","journal-title":"Health Aff (Millwood)"},{"issue":"4","key":"zoi260566r17","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1089\/pop.2020.0123","article-title":"Trends in food insecurity in the United States from 2011-2017: disparities by age, sex, race\/ethnicity, and income.","volume":"24","author":"Walker","year":"2021","journal-title":"Popul Health Manag"},{"issue":"1","key":"zoi260566r18","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.1542\/peds.2009-3146","article-title":"Development and validity of a 2-item screen to identify families at risk for food insecurity.","volume":"126","author":"Hager","year":"2010","journal-title":"Pediatrics"},{"key":"zoi260566r19","doi-asserted-by":"publisher","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of Cronbach\u2019s alpha.","volume":"2","author":"Tavakol","year":"2011","journal-title":"Int J Med Educ"},{"issue":"1","key":"zoi260566r20","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing.","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc B Stat Methodol"},{"key":"zoi260566r21","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1097\/FCH.0000000000000183","article-title":"Examining the impact of structural racism on food insecurity: implications for addressing racial\/ethnic disparities.","volume":"41","author":"Odoms-Young","year":"2018","journal-title":"Fam Community Health"},{"key":"zoi260566r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2020.100655","article-title":"Disparities in food insecurity at the intersection of race and sexual orientation: a population-based study of adult women in the United States.","volume":"12","author":"Patterson","year":"2020","journal-title":"SSM Popul Health"},{"issue":"4","key":"zoi260566r23","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1177\/109019810102800405","article-title":"Managing healthy eating: definitions, classifications, and strategies.","volume":"28","author":"Falk","year":"2001","journal-title":"Health Educ Behav"},{"issue":"4","key":"zoi260566r24","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.jneb.2011.11.009","article-title":"How people interpret healthy eating: contributions of qualitative research.","volume":"44","author":"Bisogni","year":"2012","journal-title":"J Nutr Educ Behav"},{"issue":"11","key":"zoi260566r25","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1093\/aje\/kwad145","article-title":"A driver in health outcomes: developing discrete categories of transportation insecurity.","volume":"192","author":"McDonald-Lopez","year":"2023","journal-title":"Am J Epidemiol"},{"issue":"3","key":"zoi260566r26","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1007\/s10900-019-00765-z","article-title":"The nutrition benefits participation gap: barriers to uptake of SNAP and WIC among Latinx American immigrant families.","volume":"45","author":"Pelto","year":"2020","journal-title":"J Community Health"},{"issue":"8","key":"zoi260566r27","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1093\/tbm\/ibae037","article-title":"Benefits of using both the Hunger Vital Sign and brief Nutrition Security Screener in health-related social needs screening.","volume":"14","author":"Calloway","year":"2024","journal-title":"Transl Behav Med"},{"key":"zoi260566r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.appet.2022.106288","article-title":"Development of new measures to assess household nutrition security, and choice in dietary characteristics.","volume":"179","author":"Calloway","year":"2022","journal-title":"Appetite"},{"key":"zoi260566r1","unstructured":"The Rockefeller Foundation. True cost of food: measuring what matters to transform the US food system. 2021. Accessed November 9, 2025. https:\/\/www.rockefellerfoundation.org\/reports\/true-cost-of-food-measuring-what-matters-to-transform-the-u-s-food-system\/"},{"key":"zoi260566r14","unstructured":"The White House. Biden-Harris Administration national strategy on hunger, nutrition, and health. September 2022. Accessed November 9, 2025. https:\/\/bidenwhitehouse.archives.gov\/wp-content\/uploads\/2022\/09\/White-House-National-Strategy-on-Hunger-Nutrition-and-Health-FINAL.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2850963\/owens_2026_oi_260566_1782829154.96382.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:57:45Z","timestamp":1782845865000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2850963"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":28,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.20264","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]}}}