High Risk, the Community Nutrition Environment, and Food Insecurity: The Role of Cumulative Risk, and Food Store Accessibility and Availability in Predicting the Likelihood of Family Food Insecurity in Baltimore City

Background: Food insecurity has short and long-term health, social, behavioral, educational, and developmental outcomes for children and adults. Many families experience multiple risks for being food insecure. Families at highest risk for food insecurity often live in communities with low supermarket access and high corner and convenience store access, where food is more costly. As food represents a larger portion of a low income family's budget in comparison to middle and upper income families, it is important to consider how greater access to corner and convenience stores and lower access to supermarkets relate to food security.;Purpose: To determine if cumulative risk, community nutrition environment accessibility and availability, and food insecurity are related among a high risk population in an urban setting.;Method: Secondary data from the Challenge! Study was connected to food store data using ArcMap GIS. Logistic regression analysis was used to examine if cumulative risk and accessibility and availability of stores were associated with food insecurity.;Results: Higher cumulative risk was related to higher odds of being food insecure. Neither accessibility nor availability of food stores was associated with higher odds of food insecurity; however, cumulative risk moderated the relationship between accessibility of food stores and likelihood of food insecurity. Families who had higher risk and lived farther from corner stores had higher odds of being food insecure and those who were low risk and living farther from the nearest corner store had lower odds of food insecurity.;Conclusion: Cumulative risk is associated with likelihood of food insecurity. At first glance, the community nutrition environment is not associated with the likelihood of food insecurity in this setting. However, cumulative risk moderates this relationship. High risk families may experience greater reliance on corner stores to protect them from food insecurity due to barriers in accessing other store types, such as transportation. Corner stores may be protective for high risk families. Low risk families may have access to greater resources that take them outside of their community, providing greater selection of stores. Efforts to reduce food insecurity should focus on those who experience the greatest level of cumulative risk.