# Discrimination and vigilance as psychosocial pathways from food insecurity to cognitive difficulty among U.S. adults: a moderated mediation analysis

## TL;DR

This study shows that discrimination and vigilance partly explain how food insecurity leads to cognitive difficulties, especially among U.S.-born adults.

## Contribution

The study identifies psychosocial pathways linking food insecurity to cognitive difficulty and shows how these differ by nativity status.

## Key findings

- Food insecurity, discrimination, and vigilance are each linked to higher odds of cognitive difficulty.
- The sequential pathway through discrimination and vigilance explains 52% of the effect among U.S.-born adults and 39% among foreign-born adults.
- Nativity significantly moderates the strength of the psychosocial pathway from food insecurity to cognitive difficulty.

## Abstract

Food insecurity is a growing public health concern associated with adverse cognitive outcomes and shaped by structural barriers. However, the psychosocial mechanisms linking food insecurity to cognitive difficulty remain underexplored. This study examined whether perceived discrimination and vigilance help explain this relationship and whether these pathways differ by U.S. nativity status.

We used data from the 2023 National Health Interview Survey (NHIS) and analyzed 27,525 adults (23,000 U.S.-born and 4,525 foreign-born) aged 18 and older. Key variables included food insecurity, cognitive difficulty, perceived discrimination, and vigilance. We conducted moderated sequential mediation analyses, with discrimination and vigilance as mediators and nativity as a moderator. Models adjusted for age, sex, race/ethnicity, marital status, education, income, and self-rated health.

Food insecurity, discrimination, and vigilance were significantly associated with greater odds of cognitive difficulty. Among U.S.-born individuals, the sequential pathway from food insecurity through discrimination and vigilance was significant (β = 0.10, 95% CI: 0.08, 0.12), accounting for 52% of the total effect. Among foreign-born individuals, the pathway was also significant and fully mediated (β = 0.05, 95% CI: 0.03, 0.08), explaining 39% of the total effect. Nativity significantly moderated the full sequential pathway (β = -0.05, 95% CI: -0.07, -0.03), with stronger mediation observed among U.S.-born adults.

Discrimination and vigilance help explain how food insecurity affects cognitive difficulty. Addressing both material hardship and psychosocial stress may help prevent cognitive decline across diverse populations.

The online version contains supplementary material available at 10.1186/s12889-026-26226-6.