"You Gotta Eat It to Survive": A Mixed-Methods Study of the Perceived Food Environment and Food Choice Among Youth Experiencing Homelessness.

Background/Objectives: This study aimed to examine how the perceived food environment influences food choice among youth experiencing homelessness. Methods: A convergent parallel mixed-methods design was used with 14 youth experiencing homelessness (aged 18-23 years; 64% Black/African American; 57% male) in Columbus, Ohio, United States. Data were collected through semi-structured interviews, surveys, and site observations between August 2022 and February 2023. Interviews and surveys assessed participants' perceptions of their food environment and food choices. Interviews were audio-recorded, transcribed verbatim and analyzed by inductive thematic approaches to identify patterns, categories, and relationships. To quantify the physical food environment, observations were conducted at food acquisitions sites identified during interviews and analyzed descriptively. Qualitative and quantitative data were collected concurrently, analyzed separately, and subsequently integrated to examine areas of convergence and divergence. Results: Participants obtained food primarily from fast-food restaurants and a drop-in center, whereas grocery and corner stores were used less frequently. Although food was available through multiple sources within participants' food environment, they were perceived as unaffordable, inaccessible, or unappetizing. Specifically, foods from grocery stores were perceived as unaffordable and inaccessible, while foods provided by the drop-in center and fast-food restaurants were viewed as unappetizing, unhealthy, and sometimes inaccessible. Observational data also showed variability in access to healthy food options across the various settings. Despite the availability of food within their environments, all participants experienced food insecurity. Conclusions: The food environment and food choice for youth experiencing homelessness is shaped not only by the mere availability of food but also its perceived affordability, accessibility, and desirability. Interventions need to extend beyond increasing food availability to ensure that available foods are affordable, accessible, and of high quality. Tailored education in nutrition, food safety, and food resource management may further enhance youths' ability to identify, select, and prepare available foods in ways that increase their perceived desirability.