Abstract TU166: Food Insecurity, Food Assistance, and Cardiovascular Disease Risk Factors Among U.S. Adults

Background: Food insecurity (FI) is defined as limited or uncertain access to adequate food and remains a critical public health concern in the US. National rates of FI have continued to rise, coinciding with persistent disparities in cardiovascular disease (CVD) risk. While participation in food assistance programs aims to alleviate FI, its interaction with FI on CVD risk factors remains unclear. This study examined the association between FI and clustering of CVD risk factors among US adults and its potential moderation by participation in the Supplemental Nutrition Assistance Program (SNAP). Methods: We analyzed 143,820 adults aged ≥18 years from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) dataset. FI was ascertained by affirming the “food ran out in the past 12 months due to lack of money” question. Six CVD risk factors, namely BMI >25 kg/m 2 , self-reported diabetes diagnosis, hypertension, smoking, lack of physical activity, and elevated cholesterol, were examined. Each factor was scored as 1 (risk present) and summed to a risk factor score (range 0-6). Weighted multivariable linear regression models were applied to estimate associations between FI and the CVD risk factor score, adjusting for sociodemographic and alcohol use. Results: Approximately 11.4% of participants reported FI and 9.2% participated in SNAP. The percentages of participants with 0, 1, 2, and 3 or more risk factors were, respectively, 9.6%, 24.4%, 26.8%, and 39.1%. FI was significantly associated with higher CVD risk factor score. Participants with FI had a 0.49 and 0.32 higher CVD risk factor score than those without FI, in unadjusted and adjusted models (standard error 0.0001, 0.0001, all p < 0.0001), respectively. Participation in SNAP did not moderate the association between FI and CVD risk factor score (p=0.27). Conclusions: FI was associated with greater clustering of CVD risk factors among U.S. adults, regardless of SNAP participation. The findings highlight the need for integrated public health strategies addressing not only food access but also dietary patterns, behavioral risk modification, and chronic disease prevention.