Perceived Stress and Associations Between Food Insecurity, Diet Quality, and Eating Behaviors: Evidence from Two Cross-Sectional Studies in U.S. Samples

Background/Objectives: The present investigation examined whether perceived stress statistically mediated the association between food insecurity and diet quality, as well as maladaptive eating behaviors (i.e., reward-based eating, comfort eating). Methods: Study 1 used cross-sectional data from the National Heart, Lung, and Blood Institute Growth and Health Study (N = 624), in which Black and white women completed self-report measures of food security, perceived stress, diet quality, and reward-based eating. Study 2 used cross-sectional data from a census-matched U.S. sample by age, gender, income, race/ethnicity, and census region (N = 1993), with self-report measures of food security, perceived stress, and comfort eating. Mediation analyses tested the indirect effect of perceived stress on associations between food insecurity and diet quality, reward-based eating, and comfort eating, controlling for sociodemographic factors. Results: In Study 1, food insecurity was positively correlated with perceived stress (r = 0.30) and negatively correlated with diet quality (r = −0.11). Perceived stress mediated the relationship between food insecurity and higher reward-based eating (indirect effect = 0.14, 95% CI 0.08, 0.22) but did not mediate the association between food insecurity and diet quality (indirect effect = −0.04, 95% CI −0.11, 0.03). In Study 2, food insecurity was positively correlated with perceived stress (r = 0.42) and comfort eating (r = 0.19). Using a two-part mediation model, perceived stress mediated the association between food insecurity and the frequency of comfort eating among individuals who reported at least one day of comfort eating, with the strongest indirect effect observed among food-insecure individuals (conditional indirect effect = 0.75, 95% CI 0.49, 1.13). Conclusions: Across two cross-sectional studies, higher perceived stress statistically mediated the relationship between food insecurity and two forms of maladaptive eating behaviors, suggesting that perceived stress is an important correlate of these relationships. Future work is needed to further evaluate the causal relationships between these constructs.