Food insecurity and 24-hour movement behaviors in adolescents: associations with guideline adherence and behavioral combinations

Food insecurity is an important social determinant of health that may be associated with adolescents’ daily movement behaviors. However, existing research has primarily focused on individual behaviors, with limited attention to adherence to integrated 24-hour movement guidelines and their behavioral combinations. This study examined the associations between food insecurity and adherence to the 24-hour movement guidelines, as well as specific combinations of movement behaviors among adolescents. Data were drawn from the 2019 Youth Risk Behavior Survey (YRBS), a large sample of 45,571 students in grades 9–12. Multinomial logistic regression models were used to examine the associations between food insecurity and (1) the number of 24-hour movement guidelines met and (2) specific combinations of movement behaviors. Adolescents who met none of the guidelines were treated as the reference group. Results are presented as relative risk ratios (RRRs) with 95% confidence intervals (CIs), adjusting for covariates. Overall, food insecurity was associated with a lower likelihood of meeting the 24-hour movement guidelines, showing a clear gradient pattern. Compared with adolescents without food insecurity, those experiencing food insecurity were less likely to meet one (RRR = 0.83, 95% CI: 0.74–0.93), two (RRR = 0.69, 95% CI: 0.58–0.83), and all three guidelines (RRR = 0.47, 95% CI: 0.29–0.76). In analyses of behavioral combinations, food insecurity was consistently associated with a lower likelihood of engaging in favorable movement patterns. Stronger associations were observed for combinations involving sleep, including sleep only (RRR = 0.70, 95% CI: 0.57–0.87), MVPA + sleep (RRR = 0.56, 95% CI: 0.41–0.75), and screen time + sleep (RRR = 0.69, 95% CI: 0.52–0.92), whereas no significant association was found for MVPA alone. Food insecurity is associated with lower adherence to the 24-hour movement guidelines and less favorable combinations of movement behaviors among adolescents. These findings highlight the importance of addressing social determinants alongside integrated behavior patterns to promote adolescent health.