According to a report by the U.S. Department of Agriculture, 49 million people in the United States lived in households struggling to find enough food to eat. Nearly 16 million are children, who are far more likely to have limited access to sufficient food than the general population. While 15.9% of Americans lived in food-insecure households, 21.6% of children had uncertain access to food.

Feeding America — the largest hunger relief charity and network of food banks in the U.S. — created Map the Meal Gap, a study measuring food-insecurity among the general population and children at the state and county levels. While hunger remains a problem nationally, some areas of the country had nearly double the national rate. Food-insecurity rates among children were as high as 41% in Zavala County, Texas. At the state level, New Mexico led the nation with 29.2% of children living in food-insecure households.

According to Ross Fraser, Director of Media Relations at Feeding America, children are of course more vulnerable to poverty and food-insecurity because they can’t work. “You have a lot of people with large families who live in poverty, and children can’t change their financial circumstances,” he said.

The situation may also be considerably worse than it seems. Benefits from the Supplemental Nutrition Assistance Program (SNAP) have been sharply reduced since November 2013, after the data for the report was collected. Prior to the cut, 45% of all SNAP beneficiaries were children, according to Feeding America.

The states with the highest child food-insecurity rates are clustered in particular regions, and tend to be sparsely populated. These include states along the Mexican border, such as Texas, New Mexico, Arizona, as well as states like Mississippi. In general, they have fewer highways, less public transportation.

It is relatively easy to get on a bus and get to a food bank in a big city, explained Fraser. However, it’s different “if you’re living in the middle of nowhere in Wyoming, where there is no public transportation and you might be a hundred miles from the nearest food pantry, and you don’t have a working car, and there’s not a grocery store within miles and miles.”

Not surprisingly, states where children have limited access to adequate meals had high poverty and unemployment rates. The 10 states with the highest child food-insecurity rates identified by Feed America had poverty rates, as well as child poverty rates, in excess of the national rate. In Mississippi the poverty rate for children was 35%, well above the national rate of 23%. Eight of the 10 states had unemployment rates exceeding the national rate of 6.6% in 2012.

According to Feeding America, prevalence of a number of chronic illnesses is higher among people living in food-insecure households. When it is difficult to find adequate meals on a regular basis, the chances of negative health outcomes go up. Fraser explained that “you have to have a healthy and nutritious diet in order to have a healthy active lifestyle — whenever that’s compromised, you put that at risk.” The problem can be even more severe for children. “The lack of adequate nutrition can literally change the architecture of a child’s brain,” Fraser pointed out.

Incidence of diabetes and obesity was especially high in the states with high rates of food-insecurity. “People who live in homes that are food-insecure have twice the rate of type 2 diabetes,” said Fraser. Five states with the highest food-insecurity among children — Mississippi, Georgia, Arkansas, Texas, and North Carolina — had obesity rates above the national rate of 27.1%.

To identify the states with the highest rates of child food-insecurity, 24/7 Wall St. relied on Feeding America’s report on state, county and congressional district level food-insecurity in the United States. The report measured limited access to adequate food based on a model incorporating factors such as food costs, unemployment, and poverty rates. For children, the model included eligibility for various school lunch programs. The model relied on 2012 data from the USDA, Bureau of Labor Statistics and U.S. Census Bureau. We also considered 2012 data from the U.S. Census Bureau, and the Bureau of Labor Statistics. Data from the Gallup-Healthways Well-Being Index is from 2012 and 2013.

These are the states where the most children go hungry.

10. North Carolina
> Child food-insecurity: 26.7%
> Child poverty rate: 26.0% (10th highest)
> 2012 Unemployment rate: 9.2% (tied-5th highest)
> Pct. with SNAP benefits: 15.3% (17th highest)

Like many of the states with high food-insecurity among children, smaller, rural communities were more likely to struggle to limited access to food. More than 20% of individuals living in Hyde County, for example, had uncertain or inadequate access to food in 2012, among the highest rates of any county in the U.S. Poor food-security also placed people at a greater risk of negative health outcomes. In a recent Gallup poll, more than 13.2% of North Carolina residents reported that they had been diagnosed with diabetes, among the nation’s highest rates. North Carolina had among the worst poverty rates in 2012, with 18% of residents living below the poverty level, compared to 15.9% nationwide. The unemployment rate was also particularly bad, at 9.2% in 2012, worse than all but a handful of states.

9. Oregon
> Child food-insecurity: 27.3%
> Child poverty rate: 23.0% (20th highest)
> 2012 Unemployment rate: 8.8% (tied-11th highest)
> Pct. with SNAP benefits: 20.1% (the highest)

More than one in five Oregon residents relied on food stamps in 2012, the highest rate in the nation. Given the importance of government assistance for families in the state, the high rate of child food-insecurity, 27.3%, may not be surprising. Some have argued that historically high housing costs — Oregon’s median home price was $223,900 in 2012, compared with just $171,900 nationwide — have driven up the homeless rate in the state. According to Children First for Oregon, a non-profit, nearly 4% of Oregon public school students were homeless in recent years, nearly the highest rate nationwide. Unlike many of the states with high food-insecurity, residents tended to be in good health. Obesity, diabetes and hypertension were all below the national rate.

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8. Texas
> Child food-insecurity: 27.4%
> Child poverty rate: 25.8% (11th highest)
> 2012 Unemployment rate: 6.8% (16th lowest)
> Pct. with SNAP benefits: 14.3% (23rd highest)

There were nearly seven million children living in Texas in 2012, more than any state except California. Of that number, more than 27%, or 1.9 million, had difficulty finding adequate meals over the course of the year. The problem was even worse in some small rural communities. More than 40% of children living in Zavala County, were considered food-insecure — by far the worst rate nationwide. While smaller communities tend to be more vulnerable, residents of larger communities often struggled with food-security as well. Of 15 counties with at least 100,000 food-insecure children, four were in Texas. More than one fifth of the under-18 population struggled to find adequate meals in each of these four counties. Limited access to crucial needs was hardly limited to food in Texas. No state had a greater percentage of its residents living without health insurance — 22.5% in 2012.

7. Florida
> Child food-insecurity: 27.6%
> Child poverty rate: 25.4% (13th highest)
> 2012 Unemployment rate: 8.8% (tied-11th highest)
> Pct. with SNAP benefits: 15.2% (18th highest)

Miami-Dade County was one of just 15 counties nationwide where more than 100,000 children suffered from food-insecurity. Florida had a relatively high unemployment rate in 2012 — 8.8%, compared with a 8.1% national rate in 2012. Household income, on the other hand, was just $45,040 in 2012, considerably lower than the national median of $51,371. Like Texas, Florida residents had among the lowest rates of health insurance — 20.1% of residents were uninsured in 2012. Low health insurance coverage only makes matters worse when limited access to food is already producing poor health outcomes. Floridians were more likely to have been diagnosed with diabetes and to have previously suffered a heart attack than Americans in most other states.

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6. Arkansas
> Child food-insecurity: 27.7%
> Child poverty rate: 28.5% (3rd highest)
> 2012 Unemployment rate: 7.5% (22nd lowest)
> Pct. with SNAP benefits: 15.5% (14th highest)

Like several states with poor food-security for children, Arkansas struggles with low median incomes and high poverty rates. A typical household in the state earned just over $40,000 in 2012. One in five state residents was living in poverty that year, higher than all but a handful of states. Poverty was even worse among children. Nearly 30% of residents under age 18 were living in poverty that year, third-highest nationally. Poor food-security can lead to poor health outcomes, such as obesity. More than 32% of Arkansas residents were obese last year, among the highest rates nationwide.

5. Nevada
> Child food-insecurity: 28.1% (tied-4th highest)
> Child poverty rate: 24.0% (17th highest)
> 2012 Unemployment rate: 11.5% (the highest)
> Pct. with SNAP benefits: 12.6% (19th lowest)

Food-insecurity among children is often reflected by participation in various school lunch programs. At least half of Nevada children were eligible for reduced lunch programs, actually lower than the nation rate — 80% of American children are eligible nationally. However, Nevada’s state government has recognized that at least 20 rural schools did not know about these programs or were unable to participate due to lack of resources. Among the larger counties where data was available, Clark County, which includes the city of Las Vegas, was home to 124,600 children living in food-insecure households, among the highest figures for all U.S. counties. A poor job market may also have contributed to food-insecurity. The unemployment rate in Nevada was 11.5% in 2012, the worst rate in the country.

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4. Georgia
> Child food-insecurity: 28.1% (tied-4th highest)
> Child poverty rate: 27.2% (6th highest)
> 2012 Unemployment rate: 9.0% (8th highest)
> Pct. with SNAP benefits: 16.5% (tied-9th highest)

Like many states where child food-insecurity was prevalent, Georgia struggles with high poverty rates. Nearly one in five individuals in the state lived below the poverty line in 2012, including 27% of children, both among the worst rates nationwide. Residents also relied more heavily on food stamps than in most other states, with 16.5% collecting SNAP benefits in 2012, compared with 13.6% nationwide. Health outcomes were also poor in the state, with diabetes and obesity rates both higher than the national rate. The unemployment rate was also quite high, at 9% in 2012, worse than all but a handful of states. Muscogee and Fulton counties had unemployment above 9% and food-insecurity rates of roughly 20%.

3. Arizona
> Child food-insecurity: 28.2%
> Child poverty rate: 27.0% (7th highest)
> 2012 Unemployment rate: 8.3% (14th highest)
> Pct. with SNAP benefits: 14.5% (22nd highest)

Nearly 250,000 children lived in food-insecure households in Maricopa County, which includes Phoenix, more than in all but a few counties nationwide. The food-insecurity rate in the county was 24.6%, actually lower than the statewide rate, which was more than 28% in 2012. Like most states suffering from food-insecurity, Arizona struggles with high poverty rates and a relatively high unemployment rate. The child poverty rate was 27% that year, and 8.3% of the workforce was unemployed, both among the worst nationwide.

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2. Mississippi
> Child food-insecurity: 28.7%
> Child poverty rate: 34.7% (the highest)
> 2012 Unemployment rate: 9.2% (tied-5th highest)
> Pct. with SNAP benefits: 19.4% (2nd highest)

Mississippi was home to the county with the highest food-insecurity rate in the nation, Humphreys County, where 33% of all residents were unable to reliably find three adequate meals a day. Mississippi continued to lead the nation with a poverty rate of more than 24.2% in 2012. The poverty rate for children was even higher, at 35% — the highest rate nationwide. Low incomes in the state help explain the high poverty rates. A typical Mississippi household made less than $37,095 in 2012, a lower median income than any other state. Mississippi had the highest obesity rate of any state in 2012, and residents were more likely to be diagnosed with diabetes and have previously had a heart attack than the vast majority of Americans.

1. New Mexico
> Child food-insecurity: 29.2%
> Child poverty rate: 29.3% (2nd highest)
> 2012 Unemployment rate: 7.1% (22nd lowest)
> Pct. with SNAP benefits: 16.5% (tied-9th highest)

Nearly 30% of children were living in food-insecure households in New Mexico, the highest rate in the country. While unemployment was actually lower than the national rate, at 7.1% in 2012, the state has struggled with a low median income and high poverty rates. More than 20% of all individuals, and nearly 30% of children, lived below the poverty line in 2012, both second-worst in the nation. New Mexico’s poverty problem is among the nation’s oldest and most severe. According to the USDA, the state is designated as an area of “persistent poverty” with the problem extending back to at least the 1970 Census.

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