Food insecurity among Latina women in Idaho and Washington: structural vulnerability, psychosocial factors, and cardiometabolic risk.

Introduction: Latina women in the United States face overlapping nutritional, social, and cardiometabolic vulnerability, yet how food insecurity, excess weight, and cardiometabolic risk co-occur in underrepresented communities remains insufficiently characterized. We examined food insecurity among Latina women in Idaho and Washington as a marker of vulnerability and situated it within a broader context of excess weight, prediabetes risk, and structural and psychosocial disadvantage. Methods: Cross-sectional survey data were collected from 199 self-identified Latina women recruited through a stratified, address-based sampling design together with community outreach. Food insecurity was assessed using the Hunger Vital Sign; the cardiometabolic profile by body mass index, overweight or obesity, and the Bang prediabetes risk score; and dietary quality using the Mini-EAT. Structural and psychosocial factors included farmworker household status, education, age, social support, discrimination, depressive symptoms, and adverse childhood experiences, with an exploratory analysis of acculturative stress among immigrant participants. Data analysis included modified Poisson regression (prevalence ratios, PR) and proportional-odds ordinal regression. Results: Food insecurity was common (43.3%), and overweight or obesity was highly prevalent (78.9%). In the final model, food insecurity was more prevalent among women in farmworker households (PR 1.65, 95% CI 1.07-2.55) and those with less than a high-school education, though this estimate was based on few women (PR 1.87, 95% CI 1.10-3.19), and less prevalent among women with higher social support (PR 0.99 per point, 95% CI 0.98-1.00). A higher burden of adverse childhood experiences was associated with greater food-insecurity severity (cumulative OR 1.18, 95% CI 1.01-1.38). Among immigrant women, acculturative stress was associated with food insecurity (PR 1.61, 95% CI 1.28-2.03). Dietary quality was broadly suboptimal, and its association with food-insecurity status was modest and did not establish directionality, and food insecurity was not clearly associated with prediabetes risk. Discussion: These findings illustrate the food insecurity-obesity paradox in an understudied regional population, in which a high prevalence of food insecurity coexists with a high prevalence of overweight and obesity.