Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-26226-6.