Food Insecurity and Mental Health Among High School Students: Evidence From National and Virginia Youth Risk Behavior Surveillance Data

BACKGROUND: Youth mental health problems are rising nationally. Virginia ranks among the lowest states in youth mental health access and has concentrated pockets of food insecurity (FI), underscoring the urgency of policy responses. FI is a known risk factor, yet surveillance often relies on single-item measures. We introduce a multidimensional Food Insecurity Index (FII) to examine associations with adolescent mental health. METHODS: We analyzed 2023 Youth Risk Behavior Surveillance System data from Virginia (n = 1866) and the United States (n = 10,724). The FII combined five indicators capturing acute scarcity and chronic dietary compromise. Survey-weighted logistic regression estimated adjusted odds ratios (AORs) for persistent sadness or hopelessness. RESULTS: Each 1-point increase in FII was associated with higher odds of persistent sadness or hopelessness in Virginia (AOR = 1.066, 95% CI: 1.005-1.130) and nationally (AOR = 1.087, 95% CI: 1.062-1.112). Female students had higher odds than males, and bullying was a strong correlate. A dose-response pattern was observed. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Integrating FI screening with nutrition and behavioral health supports may help identify and address overlapping risks. CONCLUSIONS: Multidimensional FI is consistently associated with poorer mental health among high school students.