Food Insecurity and Positive Eating Disorder Screens Among US College Students: Disparities, Dose‐Response, and Differential Item Functioning Across Multiple Survey Cohorts

OBJECTIVE: Food insecurity (FI) is associated with eating-related psychopathology, but its dose-response relationship with eating disorder screening remains poorly characterized. This study examined this association across multiple cohorts of US college students, including its persistence after adjustment and variation across social identity groups. METHOD: Repeated cross-sectional data from the Healthy Minds Study were analyzed. FI worry was assessed as never/sometimes/often and eating disorder screening status using the SCOFF (≥ 2; SCOFF+). Dose-response analyses examined SCOFF+ across levels of FI. Multilevel logistic regression models with institution-level random intercepts examined the FI-SCOFF+ association before (M1) and after covariate adjustment (M2 and M3). Exploratory analyses examined social identity subgroups and differential item functioning (DIF) across race/ethnicity groups. RESULTS: Among students with FI data (N = 395,713), 29.1% reported FI sometimes or often. SCOFF+ increased from 26.5% among students reporting no FI to 37.7% among those reporting FI sometimes (OR = 1.66 [1.63, 1.69]) and 42.7% among those reporting it often (OR = 2.08 [2.02, 2.14]). In the multilevel association, FI was associated with higher odds of SCOFF+ (M1 OR = 1.51 [1.50, 1.53]; M2 OR = 1.14 [1.12, 1.15]; M3 OR = 1.10 [1.08, 1.12]). Associations were positive across social identity groups. DIF effects were negligible. DISCUSSION: FI showed a graded dose-response association with SCOFF+ across multiple cohorts. Screening prevalence increased across each level of FI, whereas substantial attenuation after adjustment indicates considerable overlap with affective and socioeconomic factors. These findings highlight the relevance of food access to research and prevention of eating disorders.