Food Insecurity, Housing Instability, and Neighborhood Context: Pathways to Adolescent Mental Health.

PURPOSE: Adolescent mental health challenges in the United States have reached critical levels. This is a sensitive developmental period during which exposure to household-level hardships, such as food insecurity and housing instability, and adverse neighborhood environments may heighten vulnerability to mental, emotional, developmental, and behavioral health (MEDBH). This study examined the pathways through which household-level and neighborhood factors influence adolescent MEDBH. METHODS: Using cross-sectional data from the 2022 National Survey of Children's Health, logistic regression models assessed the independent associations of food insecurity, housing instability, and neighborhood factors (social cohesion, detractors, and amenities) with MEDBH outcomes. Generalized structural equation modeling was then used to evaluate direct and indirect pathways linking household-level hardship to MEDBH through neighborhood factors as mediators. RESULTS: Overall, 34.22% of adolescents experienced at least one MEDBH condition. Adjusted logistic regression analyses showed that food insecurity (adjusted odds ratio [aOR] = 1.50; 95% confidence interval [CI]: 1.29-1.74), housing instability (aOR = 1.54; 95% CI: 1.30-1.83), and neighborhood vandalism (aOR = 1.28; 95% CI: 1.09-1.50) were significantly associated with adverse MEDBH outcomes. Generalized structural equation modeling analyses demonstrated significant direct and indirect effects, with neighborhood factors mediating the associations between food insecurity (β = .024, p = .004), housing instability (β = .027, p = .004), and adolescent MEDBH. DISCUSSION: Food insecurity and housing instability as individual-level factors contribute to adolescent MEDBH, with flourishing neighborhood factors acting as a protective community-level mediator. This reinforces the need for multilevel interventions to address both household-level hardships and broader structural inequities.