Exploring regional inequities in food safety practices and food security in Italy: A cross-sectional study

Objective This study examined regional disparities in food security and food safety knowledge and behavior among Italian adults. Methods Between January and June 2024, we conducted a cross-sectional anonymous online survey targeting Italian residents aged ≥18. The sample size was calculated a priori assuming a 50% prevalence, 95% confidence, and 3% margin of error, yielding a target of 1067 participants. Validated Italian versions of the Food Security Survey Module (It-FSSM) and the Food Safety Knowledge and Behavior Questionnaire (It-FSKB) were employed to assess participants’ knowledge and behaviors. Sociodemographic data, including age, sex, body mass index (BMI), educational level, physical activity, smoking habits, and food apps usage, were collected. Multinomial logistic regression—adjusted for age, sex, BMI, and educational level—was used to evaluate regional differences. Results Among 1752 participants (70.4% women; mean age: 36.01 ± 13.84 y), those in the South area and Islands were significantly less likely to report high food safety knowledge (relative risk ratio [RRR] = 0.66; 95% confidence interval [CI]: 0.54–0.82; P = 0.000) and high food safety behaviors (RRR = 0.64; 95% CI: 0.52–0.79; P < 0.001), and more likely to experience moderate food insecurity (RRR = 1.64; 95% CI: 1.00–2.69; P = 0.048) compared to participants to the North. Participants in the Center were over twice likely than those in the North to report high food security versus very low (RRR = 2.72; 95% CI: 1.15–6.43; P = 0.023) and were also 30% less likely to use food delivery apps rarely rather than not at all (RRR = 0.70; 95% CI: 0.50–0.97; P = 0.034). Conclusions This study highlights significant regional disparities, with the South area and Islands facing the greatest challenges. These findings provide evidence to guide targeted public health interventions and policies promoting food safety and security across Italy.