Relationship Between Food Security and Walking for Transportation: Findings by Region and Rurality

PURPOSE: Lack of transportation increases the risk of food insecurity. However, little is known about how food security relates to active transportation when considering rurality and the US region of the country. A better understanding could lead to active transportation interventions that connect individuals with low food security to high-quality food access points. METHODS: To examine the relationship between food security and days per week of transport walking, we employed a negative binomial regression analysis with survey weights using data from the 2022 National Health Interview Survey (N = 27,651). To test whether region or rural-urban status modifies relationships, we included interaction terms in the model. Covariates include age, sex, education, race/ethnicity, self-rated health, urban-rural status, and US region. FINDINGS: Food security has a significant relationship with transport walking in rural and urban communities. This association did not significantly differ between rural and urban communities (second difference = 0.084; p > 0.369). Food security was significantly associated with transport walking across all regions, and the relationship strength did not significantly differ by region (all second differences p > 0.25). In the fully adjusted model, food insecurity was significantly associated with greater transport walking (b = 0.37, 95% CI: 0.24, 0.49, p < 0.001). CONCLUSIONS: Regardless of rural-urban status or region of US residency, individuals experiencing food insecurity walk for transportation more than persons with food security. Special consideration needs to be given to transport walking infrastructure that facilitates access to food across the United States, including rural communities.