Food Security is Associated with Higher Diet Quality Among Children of the US–Affiliated Pacific Region

Melanie Hingle, Eliza Short, Tanisha Aflague, Carol Boushey, Jean Butel, Patricia Coleman, Jonathan Deenik, Travis Fleming, Melissa Olfert, Leslie Shallcross, Lynne R. Wilkens, Rachel Novotny

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: The prevalence of food insecurity and its relationship to diet quality are factors impacting the health of persons living across the United States–affiliated Pacific region (USAP). Objectives: The aim of this study was to describe characterize the relationship between household food security status and diet quality of 2- to 8-y-old children across jurisdictions in the USAP. Methods: Baseline data from 2- to 8-y-olds (n = 3099) enrolled in the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, an obesity prevention study conducted in communities across Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawaii, and a concomitant prevalence study in communities across the Freely Associated States (FAS) (the Federated States of Micronesia: Kosrae, Pohnpei, Chuuk, Yap; Republic of Marshall Islands; Republic of Palau) were collected in 2012. Caregivers self-reported sociodemographic data and food insecurity. Assisted by their caregiver, children completed two dietary records on nonconsecutive, randomly assigned days. The Healthy Eating Index 2005 (HEI-2005) was used to assess the diet quality. Data were summarized overall and by jurisdiction. Differences in HEI-2005 and HEI component scores among jurisdictions and by household food security status were tested using 1-factor ANOVA. Results: Half or more of participants from American Samoa, Guam, CNMI, and FAS reported household food insecurity (n = 295, 59.7%; n = 292, 49.9%; n = 267, 54.6%; n = 572, 69.0%, respectively). HEI-2005 scores varied by jurisdiction (P < 0.001) and were significantly lower among FAS participants (54.7 ± 1.2) than among all other jurisdictions (P < 0.05). Total diet quality scores did not differ by food security status (59.9 ± 0.8 food secure compared with 58.3 ± 1.1 food insecure, P = 0.07); however, most diet quality adequacy component scores were significantly higher and moderation component scores significantly lower among participants in food secure households than those in food insecure households. Conclusions: Significant differences in children's diet quality and household food security existed across USAP jurisdictions.

Original languageEnglish (US)
Pages (from-to)848-856
Number of pages9
JournalJournal of Nutrition
Issue number3
StatePublished - Mar 2023


  • Healthy Eating Index
  • Pacific Islands
  • access to healthy foods
  • diet
  • food assistance
  • food security
  • healthy

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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