The primary independent variable is household food security. This variable is based on the USDA 10-item Adult Food Security Scale and previous literature [23 (link), 24 ]. The raw score was created by adding the affirmative answers to the following prompts:

“How often in the last 30 days has anyone in the household worried whether food would run out before getting money to buy more?” Score of 1 if responded ‘often’ or ‘sometimes’.

“How often in the last 30 days did the food purchased not last and the person/household didn't have money to get more?” Score of 1 if responded ‘often’ or ‘sometimes’.

“How often in the last 30 days could the person/household not afford to eat balanced meals?” Score of 1 if responded ‘often’ or ‘sometimes’.

“In the last 30 days, did the person/household reduce or skip meals because there wasn't enough money for food?” Score of 1 if responded ‘yes’.

“How many meals were skipped in the last 30 days?” Score of 1 if responded with 3 + days.

“In the last 30 days, did the person/household ever eat less because there wasn't enough money for food?” Score of 1 if responded ‘yes’.

“In the last 30 days, was the person/household ever hungry but didn't eat because there wasn't enough money for food?” Score of 1 if responded ‘yes’.

“In the last 30 days, did anyone in the household lose weight because there wasn't enough money for food?” Score of 1 if responded ‘yes’.

“In the last 30 days, did anyone in the household not eat for a whole day because there wasn't enough money for food?” Score of 1 if responded ‘yes’.

“How many days in the last 30 days did anyone in the household not eat for a whole day because there wasn't enough money for food?” Score of 1 if responded with 3 + days.

The score was adjusted so that those who answered 3 + days to, “how many meals were skipped in the last 30 days?” as well as to, “how many days in the last 30 days did anyone in the household not eat for a whole day because there wasn't enough money for food?” had an additional 1 added to their overall score. This addition is based on Dean et al. [23 (link)] to provide comparability with the USDA Economic Research Service guidelines by aligning the 30-day window in MEPS questions to the 12-month window in USDA questions [23 (link)]. The intent of this scoring is to appropriately capture the severity of food insecurity when skipping meals or not eating for an entire day occurs multiple times. Missing was defined as refusing to answer, responding with “I don’t know” or “Not ascertained” to all food insecurity questions. If an individual answered at least one of the questions, they had a score calculated using the items with a response in the dataset.
The raw score was grouped into 4 categories: high food security (score of 0), marginal food security (score of 1–2), low food security (score of 3–5), and very low food security (score of 6–11).
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