Food Insecurity, Health, and Socioeconomic Status: Results from the University of the Basque Country, Spain

Background/Objectives: Food insecurity (FI) is the 'limited or uncertain availability of nutritionally adequate and safe foods'. Although the literature suggests a strong association between FI, socioeconomic status (SES), and health, the nature of their relationship is not well specified in vulnerable population groups such as university students. To address this gap, this study aimed to assess the prevalence of FI among university students, examine its association with various health outcomes, and explore the potential mediating effect of SES. Methods: This cross-sectional survey included a convenience sample of 394 participants from the University of the Basque Country UPV/EHU (Spain). Data on SES, demographic and lifestyle factors, and health outcomes were collected between December 2021 and January 2022, using a questionnaire developed by the Food Insecurity among European University Students during the COVID-19 Pandemic (FINESCOP) consortium. Internal consistency of the questionnaire was assessed at the UPV/EHU using Cronbach's α. FI was measured using the Food Insecurity Experience Scale (FIES) from the FAO, which was validated through testing of Rasch model assumptions. Results: Overall, 19% of university students were food insecure, with 2.5% experiencing moderate and 0.8% experiencing severe FI. Adjusted linear regression models showed that FI was associated with a higher body mass index (BMI), poorer self-rated health, and worsening health during the pandemic. SES mediated the relationship between FI and health outcomes, with the strongest mediation observed for BMI (indirect association: B = 0.25, 95% CI = -0.17-0.75; total association: B = 1.85, 95% CI = 0.14-3.56; 15.3% of mediation). Conclusions: FI is prevalent among UPV/EHU students, and it is associated with multiple negative health outcomes, partly explained by SES. To effectively address FI, higher education institutions should consider implementing comprehensive strategies. For future research, longitudinal studies would be recommended to systematically monitor FI and examine causal relationships.