Adolescents living in households with limited or uncertain availability of nutritious food are more than twice as likely as other kids to have emotional problems or conduct problems, according to a new study.

"These findings add to our growing understanding of food insecurity and its implications, and demonstrate that food insecurity is an independent risk factor for mental health problems among adolescents," said lead author Dr. Elizabeth Poole-Di Salvo of Weill Cornell Medical Center in New York.

"According to the most recent data, food insecurity affects nearly 20 percent of U.S. households with children under the age of 18 years," Poole-Di Salvo told Reuters Health by email.

The researchers used data from a 2007 study of about 8,600 kids ages 12 to 16 years. In most cases a parent, usually the teen's mother, was interviewed by phone.

The parents answered questions about economically-based difficulties in meeting food needs over the past 12 months and completed a 25-item measure of their child's emotional symptoms conduct problems, hyperactivity, peer problems and social fit.

According to the results in Academic Pediatrics, 10 percent of kids in the sample lived in food insecure households, and 11 percent had parent-reported problems with mental health.

Factors like the teens' grade level, poverty status, household income below the poverty threshold, unmarried parents, level of parent education, poor parent health, parent depression, unsafe school and unsafe neighborhood were all associated with both food insecurity and mental health risk.

But after adjusting for these and other factors, teens with food insecurity were 2.3 times as likely to have parent-reported mental health problems compared to those without food insecurity.

Almost 29 percent of teens with food insecurity had mental health problems, researchers found, compared to 9 percent of other kids. This pattern held across subtypes of mental health issues - for instance, more than 26 percent of kids with food insecurity had conduct problems, compared to more than 11 percent of other kids. Similarly, 22 percent of food insecure kids had hyperactivity compared to 11 percent of other kids, and 20 percent of food insecure kids had peer problems compared to less than 9 percent of other kids.

Having access to free or reduced-price school lunch programs did not change these results, the researchers note.

"While we cannot infer causality from this study, we suspect that exposure to food insecurity during adolescence, a period of rapid brain growth and development, may lead to suboptimal nutrition as well as increased psychological stress for the family and adolescent, and may adversely impact adolescent mental health," Poole-Di Salvo said.

Teens dealing with food insecurity may be experiencing stress from the uncertainty of not knowing where their next meal is coming from, from being hungry or from deficiencies in specific nutrients, added senior study author Dr. Ruth E. K. Stein of Albert Einstein College of Medicine and The Children's Hospital at Montefiore in Bronx, New York.

"We cannot definitively rule out that mental health problems also cause household food insecurity, but that seems less likely, especially since we controlled for stressful life events and maternal mental health," Stein told Reuters Health by email.

Adults and children alike feel health-related results from the most severe economic stress, said Christian Gregory, an economist specializing in diet, safety and health economics at the U.S. Department of Agriculture Economic Research Service who was not part of the new study.

"As someone who really knows well the literature and research about the Supplemental Nutrition Assistance Program (SNAP), our primary policy intervention against food insecurity, giving people access to food or resources to food is really important" Gregory told Reuters Health by phone.

"Early identification of risk factors for both food insecurity and mental health problems are critical, and pediatricians can be instrumental in connecting families to available resources in their communities," Poole-Di Salvo said.

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