Associations Between the Food Environment and Food Insecurity on Fruit, Vegetable, and Nutrient Intake, and Body Mass Index, Among Urban-Dwelling Latina Breast Cancer Survivors Participating in the ¡Mi Vida Saludable! Trial

<b>Background</b>: Socioeconomic disparities may drive cancer inequities in Hispanic/Latino populations. We examined associations of perceived access to healthy foods (AHF) and food insecurity (FI) with diet and body mass index (BMI) changes in Latina breast cancer (BC) survivors. <b>Methods</b>: Latina BC survivors in a 12-month intervention trial aiming to increase fruit/vegetable intake and physical activity were analyzed. AHF was from a modified, validated neighborhood environment scale and dichotomized (low-medium vs. high). FI was defined as eating less and/or going hungry due to a lack of money. AHF and FI surveys were self-reported. Outcomes included dietary intake, diet quality, and BMI. Fruit/vegetable intake was log-transformed. Relationships between AHF and FI and changes in diet and BMI were evaluated using generalized estimating equations. <b>Results</b>: Of women with AHF data (<i>n</i> = 86), 58% reported low-medium access and 42% reported high access. Fruit/vegetable (FV) intake declined overall from baseline to 12 months, with greater reductions among low-medium AHF women (-32%, 95% CI: -51%, -7%) compared with high AHF women (-17%, 95% CI: -40%, +13%). Statistically significant 12-month decreases in total calories, carbohydrates, sugars, and fat occurred in low-medium AHF women but not high AHF women, and changes in total energy density, carbohydrates, sugars, and BMI at 12 months were statistically significantly different between women with low-medium AHF and women with high AHF, <i>p</i> ≤ 0.05. Among 157 women, 23% reported FI. Reductions in fruit/vegetable intake were larger in women with FI (-39%, 95% CI: -57%, -14%) than in women without FI (-10% reductions, 95% CI: -25%, +8%) and between-group differences were significant at both 6 and 12 months, <i>p</i> ≤ 0.05. Most diet measures decreased for both FI and non-FI women, with greater decreases among those with FI. <b>Conclusions</b>: Latina BC survivors with FI or perceived limited AHF experienced greater declines in indicators of healthy diets including FV intake. Future interventions should integrate strategies to measure AHF and FI to address disparate access to healthy food options.