PROJECT SUMMARY/ABSTRACT Food insecurity is paradoxically associated with elevated risk of adolescent obesity in the United States. The mechanisms underlying this excess risk are not well understood, and such knowledge is essential for informing obesity prevention efforts for adolescents from under-resourced backgrounds. Thus, aligned with the need emphasized by the Strategic Plan for NIH Obesity Research to identify the reasons contributing to increased risk for obesity among economically marginalized populations, research is critically needed to elucidate modifiable mechanisms to target in obesity prevention efforts among food-insecure adolescents. In the proposed project, Dr. Hazzard, a registered dietitian and public health researcher, will examine binge eating as a potential mechanism to explain the association between food insecurity and elevated risk for adolescent obesity. With the exceptional mentorship team she has assembled and the resources available to her through the University of Minnesota, this Pathway to Independence Award will support Dr. Hazzard in filling critical training gaps and conducting the research necessary to launch her career as an independent investigator conducting intervention work to promote food security and healthy weight among adolescents experiencing food insecurity. To prepare her for this role, a multifaceted training plan including coursework, mentorship, and research is proposed in: (1) qualitative and mixed methods, (2) advanced statistical methods, with a focus on machine learning and causal mediation analysis, and (3) intervention design, development, and dissemination, with an emphasis on human- centered design. The expertise Dr. Hazzard develops through this training plan will be essential for conducting the proposed research. During the mentored K99 phase, she will elucidate the etiology of binge eating in the context of food insecurity during adolescence using a mixed-methods approach that involves (a) conducting qualitative interviews in food-insecure adolescents who report binge eating and (b) leveraging existing data from an NIH-funded observational cohort to employ tree-based machine learning techniques (Aim 1). In the independent R00 phase, Dr. Hazzard will recruit 175 adolescents into a new, independent cohort that she will follow for 18 months to quantify the extent to which binge eating mediates the longitudinal association between food insecurity and weight gain during adolescence (Aim 2). Finally, using a human-centered design approach, she will develop vignettes describing potential school-based interventions to improve food security and prevent excess weight gain among food-insecure adolescents and assess perceived acceptability of the potential interventions using these vignettes in semi-structured interviews with adolescents who have experienced food insecurity (Aim 3). Findings from this project will lay the groundwork for the development and implementation of a school-based intervention to promote food security and healthy weight among adolescents experiencing food insecurity and, in turn, promote Dr. Hazzard’s successful transition to an independent research career. 1

PROJECT NARRATIVE Households with children are disproportionately affected by food insecurity, and in food-insecure households, adolescents are more vulnerable to experiencing disrupted eating patterns than younger children. Food-insecure adolescents face elevated risk for obesity in the United States, which is a significant public health concern due to its wide-ranging physical and mental health consequences, yet the reasons underlying this increased risk are not clear. By examining binge eating as a novel mechanism to explain the increased risk for adolescent obesity associated with food insecurity and evaluating potential approaches for promote food security and healthy weight among adolescents affected by food insecurity, findings from the proposed project will inform interventions to mitigate obesity risk in youth from under-resourced backgrounds. 1