Of course we know that hunger exists in America – and that an estimated 15.3 million childrenin our country, or one in five, live in a household where there is a real risk they will go hungry.

Often studies of childhood hunger involve very young children – up to five years of age, for example, and the very real problems these children will experience later in life if deprived of food at an early age.

But what hasn’t been studied as much is the problem, and effect, of hunger on teenagers – and what teenagers will do to avoid it.

Until now.

Impossible Choices, a groundbreaking study conducted by the Urban Institute with support from Feeding America, finds that teens are exchanging sex for food, selling drugs, joining gangs, shoplifting, figuring out ways to be fed by friends’ families, and saving their school lunches so that they will have something to eat at night.

The study is qualitative, meaning the Urban Institute did not try to capture a numeric picture of teenage hunger in America, but rather an anecdotal one. Over a multi-year period, researchers created two focus groups – one male, one female – of teenagers in each of 10 lower-income communities across the U.S. The focus groups were located both in big cities such as Chicago, Los Angeles, and Washington, D.C., and in smaller communities, in rural North Carolina and eastern Oregon.

Their findings: teenagers in every community are missing meals and engaging in dangerous activities in order to eat, or to help their families eat. In all ten communities, focus groups described girls “selling their body” or “sex for money” as a strategy for making ends meet. Boys desperate for food were reported to engage in shoplifting and selling drugs in order to get by.

Susan Popkin, a senior fellow at the Urban Institute and the lead author of Impossible Choices, discussed the report in a lengthy write-up published by The Guardian.

“We heard the same story everywhere, a really disturbing picture about hunger and food insecurity affecting the wellbeing of some of the most vulnerable young people. The fact that we heard it everywhere from kids in the same way tells us there’s a problem out there that we should be paying attention to.”

Popkin told The Guardian she was surprised by the consistency of the researchers’ findings, across gender, race and geography.

“I wasn’t sure we would see it. Kids knew about all these strategies: hanging around your friend’s house and see if they’ll feed you, going hungry so that their younger brothers and sisters could eat, saving their school lunch so they could eat it at night so they could sleep at night.

“Everybody knew where you get the cheapest food and how you keep some emergency stuff in your house. It was just very matter-of-fact and very common, in the richest country in the world.”

In seven of the ten communities studied, teenagers told stories of girls exchanging sexual favors with strangers or stripping for money in abandoned houses, at flea markets and on the streets. In the communities with the highest poverty rates, both boys and girls steal food and other basics from local stores for themselves or their families, The Guardian reported. A male teenager in Chicago said, “I ain’t talking about robbing nobody. I’m just talking like going there and get what you need, just hurry up and walk out, which I do…They don’t even know. If you need to do that, that’s what you got to do, that’s what you got to do.”

Among the report’s findings:

• Teens feel a sense of shame around hunger and hide it. Many refuse to accept food or assistance in public settings or from people outside a trusted circle of friends and family.

• Food-insecure teens think about how to mitigate their hunger and make food last longer for the whole family. They go to friends’ or relatives’ houses to eat and save their school lunch for the weekend.

• Parents try to protect teens from hunger and from bearing responsibility for providing for themselves or others. However, teens routinely take on this role, going hungry so younger siblings can eat or finding ways to bring in food and money.

• Teens would overwhelmingly prefer to earn money through a formal job but prospects for youth employment are extremely limited.

• In a few communities, teens talked about going to jail or failing school as strategies for ensuring regular meals.

In the report, the Urban Institute’s recommendations include improving the federal Supplemental Nutrition Assistance Program; expanding access to school-based meals for teens in summer months and after classes; creating more and better youth job opportunities; establishing community projects, such as one that has proved successful in Portland; and helping rather than punishing girls who are sexually exploited.