Urban-rural and regional variability in the prevalence of food insecurity: the survey of the health of Wisconsin.

Food insecurity is a complex economic and public health issue. Defined as “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways,”1 food insecurity has a variety of health implications. It is associated with chronic diseases and poor metabolic control,2,3 decreased mental health and cognitive performance,4-6 medication underuse and cost-related non-adherence,7,8 and less healthful eating. 9 Food insecurity is a public health concern nationally and across different regions of the United States. It is estimated that 18 million American households have experienced food insecurity.10 According to 1999-2006 estimates from the National Health and Nutrition Examination Survey (NHANES), about 21.5% of Americans were characterized as having marginal, low, or very low food security.11 The relationships between food insecurity and specific demographic and geographic factors in Wisconsin have not yet been investigated. In order to take on a focused research effort on these issues in Wisconsin, it is important to first investigate characteristics of the state's food insecure population and the prevalence of food insecurity in different geographic areas and urbanicity levels across the state. We used data from the 2008-2012 waves of the Survey of the Health of Wisconsin (SHOW) to investigate socio-demographic and regional differences in food insecurity. We hypothesized that the prevalence of food insecurity would be similar across state public health regions and would be different across various levels of urbanicity within the state (i.e., higher in urban areas). No previous study, of which we are aware, has directly investigated differences in food insecurity between areas of varying urbanicity and geography within a particular state, and such results could be key components in future attempts to develop targeted policies and address food insecurity in Wisconsin.