Food insecurity, cigarette smoking, and acculturation among Latinos: data from NHANES 1999-2008

Food insecurity and use of electronic vapor products among high school students

Background: Studies have shown that food insecurity is associated with electronic vapor products (EVP) use in adults; however, an understanding of this relationship in adolescents is needed to inform prevention efforts in this age group. Aim: Examine the relationship of food insecurity with EVP use patterns, frequency and source of acquisition in high school students. Methods: This cross-sectional study used Youth Risk Behavior Survey (YRBS) 2019 data from states that incorporated the YRBS' optional food insecurity question. The data included 42,154 high school students with complete information on food insecurity and two EVP-related questions. Responses to EVP-related questions identified "ever users," "current users," "former users," "current dual EVP-cigarette users," and assessed "frequency of EVP use among current users" and "source of EVP acquisition." Logistic regression examined associations of food insecurity with EVP-related outcomes. Results: The proportion of high school students who ever used EVP was 48.3% and the proportion of food-insecure students was about 12%. Food security status significantly differed by race/ethnicity of students, such that the proportion of food insecure students classified as "non-Hispanic White" was lower than the proportion of food secure students classified as "non-Hispanic White." Food insecurity was significantly associated with greater odds of ever EVP use (odds ratio (OR) = 1.75; 95% confidence interval (CI) = (1.55, 1.96)), current EVP use (OR = 2.07; 95% CI = (1.80, 2.37); using never users as reference category) and current dual use of EVP and cigarettes (OR = 2.91; 95% CI = (2.38, 3.55)). Food insecurity also was associated with greater odds of current EVP use (OR = 1.54; 95% CI = (1.28, 1.84)) when former users were used as reference category. In current users, food insecurity was related to greater odds of daily EVP use (OR = 1.40; 95% CI = (1.14, 1.70)) compared to occasional use. Conclusions: Study findings imply that efforts targeting prevention/cessation of EVP use should consider reducing food insecurity in high school students.

Investigating psychological distress and peer influence in the longitudinal path linking food insecurity to adolescent substance use: a nationwide low-income cohort study

Food insecurity (FI), defined as the limited or uncertain availability of nutritionally adequate and safe foods, remains a major life concern among many poor subpopulations. Few investigations have been made into the mechanism underlying its impact on adolescent substance use. This study aimed to examine the longitudinal relationship between FI and cigarette and alcohol use among economically disadvantaged adolescents and then explore the role of psychological distress and peer substance use in the aforementioned association. Data of 1,243 adolescents (Mage = 13.3 years; 645 males) were obtained from a nationwide cohort study on Taiwanese adolescents from low-income families. Multiple hierarchical regression analyses based on generalized linear mixed-effects models with binomial distribution found that FI was consistently associated with cigarette smoking (β = 0.458, p < 0.001) but not alcohol drinking (β = 0.142, p = 0.143) when both psychological distress and peer substance use were adjusted. In the moderated mediation analysis based on bootstrap methods, we observed that psychological distress mediated the association between food insecurity and alcohol drinking (β = 0.036, 95% CI = 0.015-0.063) but not cigarette smoking (β = 0.018, 95% CI =-0.001-0.037). Furthermore, the indirect effects varied by peer drinking status (index of moderated mediation = 0.04, 95% CI 0.015-0.072). Clinical and public health attention should be given to evaluating food-insecure adolescents' psychological well-being and peer influence when counseling their substance use issues.

Mediation analysis of mental health characteristics linking social needs to life satisfaction among immigrants

Background

Life satisfaction contributes to improved long and healthy lives, enhanced biological function, better mental health, and decreased mortality risks. Social needs (e.g., food security, employment, healthcare utilization) are important determinants of mental health and life satisfaction among immigrants. However, there is limited literature on how social needs influence mental health, which, in turn, affects life satisfaction among immigrants. We examined whether mental health influences the mechanisms of the relationship between social needs and life satisfaction among immigrants.

Methods

We used the 2021 cross-sectional National Health Interview Survey data on U.S. immigrants (n = 4320) aged ≥18 years. We conducted weighted mediation analyses with multiple linear regression. Life satisfaction (scores 0-10; ≥1 as higher life satisfaction) was the dependent variable; independent variables were food security, employment, and healthcare utilization; and the mediator, serious psychological distress (SPD: scores 0-24; ≥1 as higher SPD).

Results

The total effect (not accounting for SPD) of food insecurity (vs. secure) on life satisfaction was negative (β = -0.61, p < 0.001); the direct effect (after accounting for SPD) was not statistically significant (β = -0.21, p = 0.153), while the indirect effect (food insecurity's effect explained by SPD) was negative (β = -0.40, p < 0.001). The total (β = 0.32, p < 0.001), direct (β = 0.24, p = 0.004), and indirect (β = 0.09, p = 0.006) effects of being employed (vs. unemployed) on life satisfaction were positive. The total (β = -0.12, p = 0.116) and direct (β = -0.03, p = 0.683) effects of healthcare utilization within the past year (vs. more than a year) on life satisfaction were not statistically significant, whereas the indirect effect was negative (β = -0.09, p < 0.001).

Conclusions

SPD mediates the effect of food security, healthcare utilization, and employment on life satisfaction, suggesting the need to improve social needs and mental health among immigrants.

Low-Income Asian Americans: High Levels Of Food Insecurity And Low Participation In The CalFresh Nutrition Program

Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40 percent). Food insecurity by severity was also heterogenous; very low food security affected 2 percent of Chinese adults but 9 percent and 10 percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11 percent and 12 percent among Korean and Chinese adults, respectively, to 20 percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.

Association between e-cigarette use and food insecurity among low-income adults

INTRODUCTION

Previous research quantifying the relationship between tobacco use and food insecurity has focused on cigarette smoking. E-cigarette use has become popular in recent years. Drawing on large, population-based survey data, this study augments the previous research, considering the association of e-cigarette use with food insecurity among low-income adults.

METHODS

We analysed data from the California Health Interview Survey in 2014-2019. The study sample consisted of 25 948 respondents aged 18-64 who lived in low-income (<200% of the Federal Poverty Level) households. Multivariable logistic regression models were estimated to examine the associations of e-cigarette use as well as dual use of e-cigarettes and cigarettes with food insecurity.

RESULTS

Of California low-income adults, 6.4% identified as current e-cigarette users (3.0% dual users of e-cigarettes and cigarettes, and 3.4% sole e-cigarette users) and 43.0% reported food insecurity. After controlling for confounding factors, food insecurity was significantly more likely to be reported among current e-cigarette users (adjusted OR (AOR)=1.67; 95% CI 1.25 to 2.23) compared with never e-cigarette users, and among dual users (AOR=2.21; 95% CI 1.63 to 3.00), current sole e-cigarette users (AOR=1.66; 95% CI 1.15 to 2.40), and current sole cigarette smokers (AOR=1.46; 95% CI 1.22 to 1.76) compared with never tobacco users. The odds of food insecurity among dual users were significantly greater than sole cigarette smokers but not statistically different from sole e-cigarette users.

CONCLUSIONS

Using e-cigarette is an associated risk factor for food insecurity among low-income adults. Dual use of e-cigarettes and cigarettes has a significantly greater risk of food insecurity compared with smoking cigarettes alone.

Sexual Orientation and Food Hardship: National Survey of Family Growth, 2011-2019

OBJECTIVE

Given the high rates of poverty observed among sexual minority groups and their social vulnerability, we examined the prevalence and correlation of food hardship, measured as food insecurity, receipt of free or reduced-cost food, and Supplemental Nutrition Assistance Program (SNAP) participation among low-income sexual minority and heterosexual adults using population-level health surveillance data.

METHODS

We used 4 waves of pooled data (2011-2019) from the National Survey of Family Growth for adults aged 18-44 years. We compared the sexual orientation subgroups and used logistic regression to predict the likelihood of food hardship.

RESULTS

Among men, gay and bisexual men had higher odds of experiencing food insecurity than their heterosexual counterparts (adjusted odds ratio [aOR] = 1.97 and 1.83, respectively). Compared with heterosexual men, bisexual men had significantly higher odds of receiving free or reduced-cost food, but gay men did not. The odds of participating in SNAP did not differ significantly among gay, bisexual, and heterosexual men. Among women, only bisexual women were more prone to experiencing food insecurity than their heterosexual counterparts (aOR = 1.81). The odds of receiving free or reduced-cost food did not differ significantly among heterosexual, bisexual, and lesbian women. However, compared with heterosexual women, lesbian women had significantly lower odds (aOR = 0.62) and bisexual women had significantly higher odds (aOR = 1.24) of participating in SNAP.

CONCLUSION

Our findings contribute to the limited literature examining trends in food hardship among sexual minority groups and suggest potentially different patterns of food insecurity, food assistance, and SNAP participation among sexual orientation subgroups, which may call for group-specific, nuanced approaches for lessening food hardship.

Impact of smoking cessation on household food security

PURPOSE

Smokers can spend a substantial amount on cigarettes, potentially constraining their ability to purchase food. We tested the association of smoking cessation and household food security.

METHODS

Using the Current Population Survey (2001-2019), we longitudinally linked the Tobacco Use Supplement and the Food Security Supplement (n = 71,278). Among adult smokers (n = 13,144), we used modified Poisson regression to model household food insecurity as a function of quit status (continuing smokers vs. recent quitters), adjusting for sex, age, household size, children in the household, and other household smokers. We also used multinomial logistic regression to examine more detailed food security status (high, marginal, low, very low).

RESULTS

The adjusted probability of household food insecurity at follow-up was 11% (95% CI: 8.7%-13%) for recent quitters and 20% (95% CI: 19%-21%) for continuing smokers. Continuing smokers had a lower adjusted probability of high food security (69% vs. 80%) and a higher adjusted probability of marginal (11% vs. 9.8%), low (12% vs. 7%), and very low food security (7.8% vs. 3.6%) compared to recent quitters.

CONCLUSIONS

Cigarette cessation is associated with a lower risk of household food insecurity. Therefore, promoting tobacco cessation alongside food assistance and poverty reduction policies may help alleviate food insecurity.

Reprint of: Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Association Between the Use of Tobacco Products and Food Insecurity Among South Korean Adults

Objectives: Food insecurity is the most basic form of human deprivation; thus, strategies to eradicate poverty should include policies to improve food insecurity. This study investigated the association between the use of tobacco products and food insecurity.

Methods: We analyzed 21,063 adults from the Korea National Health and Nutrition Examination Survey, 2013–2015, 2019. The OR and 95% CI for food insecurity was calculated in each category of the status of tobacco products use and sociodemographic characteristics using multivariable logistic regression analysis.

Results: Of 21,063 participants, 7.3% belonged to the food insecurity group. The OR (95% CI) for food insecurity was 1.34 (1.08–1.65) among current users of any tobacco products compared with those who had never used any tobacco product. The odds for food insecurity were higher among those with secondhand smoke exposure, younger participants, those with lower household income, lower levels of education, manual workers or people without occupation, and separated/widowed/divorced participants.

Conclusion: Use of any tobacco products was associated with food insecurity among South Korean adults. Tobacco control could improve food insecurity.

Food Insecurity and Mental Well-Being in Immigrants: A Global Analysis

INTRODUCTION

This study estimates the prevalence of food insecurity, mental well-being, and their associations among immigrants and compares the food insecurity-mental well-being associations with nonimmigrants globally and by region.

METHODS

The Gallup World Poll data from 2014 to 2019 were analyzed in 2021. A total of 36,313 immigrants and 705,913 nonimmigrants were included. Food insecurity was measured by the Food Insecurity Experience Scale. Mental well-being was assessed using the Negative Experience Index and Positive Experience Index. A community attachment index was used to measure the living environment. Multilevel mixed-effect linear models were used to examine how the Negative Experience Index/Positive Experience Index was associated with food insecurity and the community attachment index in immigrants and nonimmigrants, adjusting for sociodemographic characteristics, survey years, and country fixed effects. The modifying effects of immigration status on food insecurity-mental well-being associations were tested.

RESULTS

The weighted proportion of food insecurity among global immigrants was 38.6% during 2014-2019. In the pooled adjusted model, food insecurity was dose-responsively associated with greater Negative Experience Index and lower Positive Experience Index than the food-secure ref (p<0.001 for trend). Similar dose-response associations were observed in nonimmigrants and in region-specific analyses. Community attachment marginally affected the food insecurity-mental well-being associations (all p≤0.001 for interaction). Immigration status significantly modified the food insecurity-mental well-being associations in all analyses (all p=0.01 for interaction), and immigrants experienced poorer mental well-being than nonimmigrants at the same level of community attachment and food insecurity.

CONCLUSIONS

Food insecurity is prevalent and is associated with poor mental well-being in immigrants worldwide. Future interventions are needed to alleviate food insecurity and promote community attachment to improve mental health among immigrants, especially in Asian and Pacific countries.

Does Food Insecurity in Early Life Make People More Depressed?—Evidence from CHARLS

Based on the China Health and Retirement Longitudinal Study (CHARLS) data, this paper estimates the long-term association between food insecurity and later adult health and health behaviors with the Probit model. The results show that food insecurity in early life significantly increases adults’ depression likelihood (measured by the CES-D scale). The food insecurity experience is also negatively and significantly associated with individual self-rated health status, memory, sleep quality, and life satisfaction. The negative association between food insecurity and cognitive ability and sleep hours is larger for females.

Mental distress and food insecurity in pregnancy

Abstract Food insecurity is a source of daily stress, especially in women. The aim was to investigate the association between mental distress and food insecurity in pregnant women. Cross-sectional study with pregnant women from the public health service, regardless risk stratification, or gestational trimester in Colombo-PR, Brazil. Poisson regression models were progressively adjusted for exposure variables. Results: Among the participating pregnant women (N=513) the prevalence of mental distress was 50.1%; associated with mild food insecurity (PR 1.34, 95%CI 1.12; 1.61) and moderate/severe food insecurity (PR 1.70, 95%CI 1.33; 2.19). The variable that most changed the association between the outcome and mild food insecurity was income (-4.48%) and, for moderate/severe food insecurity, education (-7.60%). For mild and moderate/severe food insecurity, the greatest reduction occurred with socioeconomic variables 4.5% (PR 1.27, 95%CI 1.05; 1.53) and 8.0% (PR 1.50, 95% CI 1.17; 1.93), respectively. The association between food insecurity and mental distress was consistent, and increased with the degree of food insecurity, with a greater reduction for socioeconomic variables.

Household food insecurity and in-utero and early life smoke exposure: Data from NHANES 2003-2016

In-utero, postnatal, and childhood smoke exposure are associated with adverse health consequences, and examining factors related to smoke exposure during these vulnerable periods are critical to inform efforts that promote maternal and child health. This study included pregnant and postpartum women aged 20-44 years and children aged 3-12 years from National Health and Nutrition and Examination Survey (NHANES) 2003-2016 cycles. Logistic regression examined association of household food insecurity with firsthand (FHS) and secondhand (SHS) exposure among pregnant and postpartum women, and SHS exposure among children, based on serum cotinine and respondent-reports. Very low household food security was significantly associated with increased odds of cotinine-based FHS exposure among pregnant (OR(95%CI) = 5.19 (1.75, 15.39)) and postpartum women (OR(95%CI) = 4.75(1.66, 13.57)). Non-smoking, postpartum women from very low food secure households also had significantly greater odds of cotinine-based SHS exposure (OR(95%CI) = 7.40 (2.08, 26.37)) than those from food secure households. Using respondent-reported smoking status, low food security in pregnant and postpartum women was significantly related to increased odds of FHS exposure (OR(95% CI) = 3.75(1.52, 9.23)). Further, children from marginal, low and very low food secure households had significantly higher odds of SHS exposure compared to those from food secure households. Results imply the co-occurrence food insecurity and in-utero and early life smoke exposure.

Food insecurity among immigrants and refugees of diverse origins living in metropolitan Atlanta: the roles of acculturation and social connectedness

Little is known about the prevalence and correlates of food insecurity among immigrants and refugees. Acculturation and social connectedness may influence food insecurity (lack of access at all times to enough food for an active, healthy life) by affecting a person's ability to access and use governmental and charitable food assistance programs, as well as other community-based or informal food-related resources. We explored associations of acculturation and social connectedness with food insecurity among diverse immigrants and refugees living in metropolitan Atlanta, a major destination for these populations in recent years. From 2017 to 2018, we surveyed 162 adults attending health fairs or programs hosted by two community-based organizations serving immigrants and refugees. Food insecurity within the past year was assessed using the American Academy of Pediatrics' two-item questionnaire. Acculturation indicators included heritage culture and American acculturation scores (Vancouver Acculturation Index), English fluency, heritage language fluency, and percentage of lifetime in the USA. Social connectedness was operationalized using measures of religious attendance and social isolation. We conducted a multivariable logistic regression controlling for age, sex, education, household income, employment status, and household size. In the sample, 51.9% identified as Vietnamese, 16.0% Hispanic, 15.4% Burmese, 14.8% Bhutanese or Nepali, and 1.8% other. The average age was 39.10 (standard deviation [SD] =13.83), 34.0% were male, 73.8% had below a Bachelor's degree, and 49.7% were unemployed. Average scores for American acculturation (mean [M] = 3.26, SD = 1.05, range 1-5) were lower than heritage acculturation (M = 4.34, SD = 0.68, range 1-5). Additionally, 43.4% were fluent in English. Average percentage of life in the USA was 40.59% (SD = 33.48). Regarding social connectedness, 55.9% regularly attended religious services. Average social isolation scores were 3.93 (SD = 1.34, range 3-9). Overall, past-year food insecurity was reported by 17.3% (34.6% in Hispanics, 24.0% in Burmese, 13.1% in Vietnamese, and 8.3% in Bhutanese or Nepali). In adjusted models, food insecurity was associated with English fluency (adjusted odds ratio [aOR] = 0.36, p = .03) and social isolation (aOR = 2.29, p < .001) but not other measures of acculturation or religious attendance. Limited English proficiency may make it more difficult to navigate or use governmental and charitable food assistance programs. Social isolation may hinder individuals from obtaining information about food assistance programs, receiving aid for services navigation, and sharing or borrowing food from family, friends, and neighbors. Interventions should seek to improve access to English language and literacy services, enhance the linguistic and cultural competency of service providers, and build social connectedness among immigrants and refugees.

The impact of childhood experience of starvations on the health of older adults: Evidence from China

This paper used pooled cross-sectional data from the Chinese Longitudinal Healthy Longevity Survey to comprehensively investigate how childhood experiences of starvation affect the health of older Chinese adults. The study found that the childhood experience of starvation was negatively correlated with self-rated health, functional health and cognitive health among older adults. After using the model and variable substitution methods to address the endogeneity problems caused by omitted variables, the negative effects of childhood experiences of starvation on the health of older adults were still present. The Karlson-Holm-Breen decomposition method was used to test the mediation effects, and it was found that childhood experiences of starvation had adverse effects on the health of older adults through endowment insurance, household income, education and nutrition. Consequently, the government should strengthen nutrition or other related health interventions for children and make longer-term plans for improving the health of older adults.

The Intersection of Food Insecurity and Tobacco Use: A Scoping Review

Cigarette smoking is increasingly concentrated in socioeconomically disadvantaged groups, and food insecurity also disproportionately affects lower-income groups. Recent studies have suggested that smoking and food insecurity operate as risk factors for one another, but there is limited understanding of their intersection. This scoping review aimed to synthesize the published literature on the association between food insecurity and tobacco use across population groups in the United States and Canada. We searched PubMed, Web of Science, and PsycINFO using key words. Studies included were published in English between 2008 and 2018, reported empirical findings, measured both tobacco use and food insecurity, and considered either variable as a study outcome. Nineteen articles were identified; 6 examined tobacco use as an outcome variable and 13 examined food insecurity as an outcome variable. Most articles were of studies using cross-sectional designs. Study samples ranged from general populations, clinical samples, and underserved populations. For each article, we extracted information including specific findings related to the association between food insecurity and tobacco use. We synthesized the current research by formulating a model by which food insecurity and tobacco use are bidirectionally associated. This scoping review concludes that the co-occurrence of food insecurity and tobacco use exists across populations in the United States and Canada. As the evidence is largely from cross-sectional investigations, there is a need for longer term, comprehensive assessments of relationships between tobacco use and food insecurity. Such investigations can inform policies and interventions aimed toward addressing the inequitable burden of tobacco use and of food insecurity among disadvantaged populations.

Latino Resident Fathers' Early Involvement with Infants

Despite the growing number of Latino families in the United States (Passel et al., 2011), Latino fathers are an understudied segment of the population. We examined a subsample of Latino residential fathers (n = 859) from the Fragile Families and Child Wellbeing Study. Measures of fathers' generational status and fathering beliefs, including adherence to traditional gender roles and fathering identity salience, were collected at child's birth; father involvement was collected at infant age one year. We tested longitudinal mediations between fathers' generational status, fathering beliefs, and involvement using structural equation modeling. Fathers' generational status impacted the amount of time fathers spend with their children in tasks relating to direct caregiving, but not necessarily cognitive engagement. Findings highlight the importance of considering cultural context in early Latino father involvement.

Does the duration of childhood starvation affect life at age 45 or older in China? The mediating role of socioeconomic and health statuses

This study investigated the impact of the duration of childhood starvation experience on life satisfaction among Chinese people and examined whether and how socioeconomic and health statuses mediated this association. Data were derived from the China Health and Retirement Longitudinal Study, a nationwide social survey project that was conducted among Chinese individuals aged 45 or older in 2014. The results show that the duration of childhood starvation experience was significantly negatively associated with life satisfaction, and socioeconomic and health statuses mediated this relationship. The findings suggested that more interventions should be conducted among people who have experienced childhood starvation.

Cross-sectional associations of food insecurity with smoking cigarettes and heavy alcohol use in a population-based sample of adults

BACKGROUND

Smoking, alcohol abuse and dual substance use represent significant public health problems and are thought to contribute to significant disparities in morbidity and mortality in the United States. Associations of food insecurity with these substances are poorly characterized, particularly concerning heavy alcohol consumption and dual substance use. Additionally, demographic factors may moderate these associations.

METHODS

In a cross-sectional, representative sample of Wisconsin adults (n = 1616), logistic regression was used to examine whether food insecurity was associated with cigarette smoking, heavy alcohol use and dual substance use. Interactions of food insecurity with gender, marital status and age group tested moderation by demographic factors.

PRINCIPAL FINDINGS

Food insecurity was associated with cigarette smoking in men and women (odds ratio (OR) = 3.0, 95% confidence interval (CI) = 2.1-4.4); however, only among men was food insecurity associated with heavy alcohol use (OR = 1.5; 95% CI = 1.0-2.2) and dual substance use (OR = 5.2; 95% CI = 1.5-18.6). Marital status and age group did not moderate associations of food insecurity with substance use.

CONCLUSIONS

Food insecurity and substance use are highly correlated. Heavy alcohol consumption and dual use were positively correlated with food insecurity among men, but not among women. Longitudinal analyses are needed to disentangle temporality and underlying pathways of observed associations. Additionally, future work should determine whether interventions and policies targeting food insecurity can simultaneously reduce cigarette and alcohol use.

Tobacco use increases risk of food insecurity: An analysis of continuous NHANES data from 1999 to 2014

Tobacco use is a major health disparities issue in the United States; it is much more common in less-educated and lower-income groups. These groups also experience a higher prevalence of food insecurity. Previous studies analyzing the association between tobacco use and food insecurity have focused on only cigarettes. We assessed the relationship between food insecurity and use of cigarettes, alternative tobacco products (cigars, electronic cigarettes, smokeless tobacco), any tobacco product, and multiple tobacco products. Using National Health and Nutrition Examination Survey data from 1999 to 2014, we built multinomial logistic regression models predicting degree of food security (i.e., food security, low food security, very low food security) for use of different tobacco product types, any product, and multiple products. After adjustment, use of any product, relative to no use, was significantly associated with increased odds of both food insecurity outcomes: low (adjusted odds ratio (AOR) = 1.2, 95% confidence interval (CI): 1.0-1.4) and very low (AOR = 1.8, 95% CI: 1.6-2.2) food security. In a separate model, single product use, relative to no use, was significantly associated with increased odds of low (AOR = 1.5, 95% CI: 1.3-1.7) and very low (AOR = 2.2, 95% CI: 1.9-2.6) food security. For multiple product use the magnitude of association was higher for very low food security (AOR = 2.7, 95% CI: 1.8-4.0). The significant associations identified here can inform researchers and policymakers developing interventions to prevent tobacco- and food insecurity-related diseases. To be effective in reducing either health risk, interventions may need to target both tobacco use and food insecurity.

Addressing Food Insecurity and Overweight/Obesity in Hospitalized Low-Income Latino Patients

Food insecurity (FI), the limited or unreliable availability of safe and nutritious food, is a pressing public health concern affecting millions of U.S. citizens. Unfortunately, FI tends to impact those who are most vulnerable (e.g., low-income minorities) and potentially increases obesity risks, diet-sensitive disease risks (e.g., hypertension and type 2 diabetes), and hospital utilization. Low-income Latino patients may be particularly sensitive to adverse outcomes based on unaddressed socioeconomic needs. Nurses are in a prime position to assess and address FI in these patients. Our article will discuss how nurses can be advocates in combating FI in Latino patients with overweight/obesity.

Tobacco Use as a Health Disparity: What Can Pediatric Clinicians Do?

Tobacco use is a global health crisis, and has a tremendous and negative impact on health and wellbeing. Tobacco use disproportionately affects members of vulnerable populations, and by acting on multiple socioecological levels, serves to perpetuate and reinforce cycles of poverty. Members of the pediatric medical community can play a key role in interrupting cycles of tobacco use. Providers can serve as powerful allies to vulnerable communities by treating tobacco use in caregivers, counseling youth against using tobacco products, protecting children from the impact of secondhand smoke exposure, and advocating for economic, social, and health policies to disrupt intergenerational smoking.

Food security of food recipients of a food pantry and soup kitchen

Objective

To discern the impact of food donations provided by a food pantry and soup kitchen on food security.

Design

In this cross-sectional study, participants completed a demographic questionnaire, core food security module, FFQ and list of food donations. The FFQ was utilized to assess diet quality as estimated via the 2010 Healthy Eating Index.

Setting

Clients were selected randomly from a food pantry and soup kitchen in Central Texas, USA.

Participants

A total of 222 adults.

Results

Approximately 73 % of participants lacked food security. Compared with the food secure, the food insecure consisted of 61 % men, 42 % Caucasians, 56 % single and 67 % homeless. Also, of the food insecure, 60 % were soup kitchen clients and 64 % had an annual income <$US 1000 (P<0·01). The probability of food insecurity was reduced by ≥1·17-fold when the total dietary intake included the food donations, as these were rich in fruits, total vegetables and grains, dairy and protein foods (P<0·05).

Conclusions

Food insecurity was quite prevalent in this sample of individuals who visited food pantries and soup kitchens. The addition of food donations improved the quality of the participants’ total diet and had a positive influence on food security. Thus, community organizations should financially support these food assistance agencies and strive to offer a variety of healthy and tasty foods in adequate quantities to provide optimum diet quality.

Food insecure cancer survivors continue to smoke after their diagnosis despite not having enough to eat: implications for policy and clinical interventions

PURPOSE

This cross-sectional study examined whether food insecurity among cancer survivors is associated with smoking status and quit attempt.

METHODS

Data from the 2015 behavioral risk factor surveillance system, social context module on 6,481 adult cancer survivors, were used in this study. Outcome variables were smoking status and quit attempt. Key independent variable was food insecurity. We estimated adjusted odds ratios (AOR) and 95% confidence intervals (CI) using weighted multivariable logistic regression models while controlling for individual-level demographic, socioeconomic, clinical, and behavioral characteristics.

RESULTS

About 19.0% of cancer survivors were current smokers, out of whom 60.4% made attempt to quit smoking in the past 12 months, and 26.2% reported experiencing food insecurity in the past 12 months. Food insecurity was significantly associated with smoking status and quit attempt after controlling for individual-level characteristics. The odds of being a current smoker, [AOR 1.45 (95% CI 1.10-2.02)], and making quit attempt, [AOR 1.74 (95% CI 1.10, 2.83)], were higher for food insecure cancer survivors compared to food secure cancer survivors.

CONCLUSIONS

Food insecurity, in addition to smoking, may hinder the progress of care and treatment, requiring the development of new policies for routine food insecurity screening among cancer survivors. Efforts should be focused on identifying food insecure cancer survivors, targeting their smoking behavior, and offering them appropriate nutritional and smoking cessation interventions.

Acculturation and Food Insecurity Among Puerto Ricans Living in Boston

OBJECTIVE

To examine the associations among acculturation, food environment, and food insecurity among Puerto Ricans in Boston.

METHODS

The researchers used data from the second wave of the Boston Puerto Rican Health Study. The sample included 719 Puerto Rican adults in Boston. The researchers used logistic regression to examine the associations between psychological and language acculturation and food insecurity.

RESULTS

Individuals with medium psychological acculturation were more likely to be food insecure than were those with low or high psychological acculturation (P = .01). The association between language acculturation and food insecurity differed by distance of residence from primary shopping location (P = .02).

CONCLUSIONS AND IMPLICATIONS

This study extends the understanding of acculturation and food insecurity by investigating the impact of psychological and language acculturation. The findings highlight biculturalism, indicated by medium psychological acculturation, as a risk factor for food insecurity. People with low language acculturation who live far from food shopping locations had the highest prevalence of food insecurity.

Social and Structural Determinants of Smoking Status and Quit Attempts Among Adults Living in 12 US States, 2015

PURPOSE

This study examined the relationships among intermediary determinants, structural determinants, and adult smoking status and quit attempts.

DESIGN

Secondary data analysis of cross-sectional data.

SETTING

Data come from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), Social Context module. A national, representative sample from 12 US states (Alabama, Arkansas, Delaware, District of Columbia, Georgia, Louisiana, Minnesota, Mississippi, Missouri, Rhode Island, Tennessee, and Utah).

PARTICIPANTS

A total of 64 053 noninstitutionalized US adults aged ≥18 years.

MEASURES

Smoking status and quit attempts were outcome variables. Individual-level structural determinants (age, sex, race/ethnicity, marital status, education, and employment status) and intermediary determinants (housing insecurity, food insecurity, health insurance, binge drinking, and general health mental health) from BRFSS.

ANALYSIS

Weighted multivariate, multinomial logistic regression.

RESULTS

Current smoking was greater among men, respondents aged between 35 to 64 and 55 to 64, adults who reported food insecurity, housing insecurity, frequent mental distress, binge drinking, and who were unemployed. Current smokers had higher odds of making quit attempts in the past 12 months if they were non-Hispanic Black, graduated college, and reported food and housing insecurity.

CONCLUSION

Multifaceted smoking cessation interventions that address food and housing needs also incorporate screening for potential comorbidities such as mental distress and/or hazardous alcohol use and may be needed to enhance smoking cessation rates among racially diverse adults.

Characterizing Cardiovascular Health and Evaluating a Low-Intensity Intervention to Promote Smoking Cessation in a Food-Assistance Population

Food assistance recipients are at higher risk for poor cardiovascular health given their propensity to poor dietary intake and tobacco use. This study sought to evaluate the cardiovascular health status, and determine the impact of a low-intensity smoking cessation education intervention that connected mobile food pantry participants to state quit-smoking resources. A pre-post design with a 6-week follow-up was used to evaluate the impact of a 10-12 min smoking cessation education session implemented in five food pantries in Delaware. Baseline cardiovascular health, smoking behaviors and food security status were assessed. Smoking cessation knowledge, intention to quit and use of the state quit line were also assessed at follow-up. Of the 144 participants 72.3% reported having hypertension, 34.3% had diabetes, 13.9% had had a stroke. 50.0% were current smokers. The low-intensity intervention significantly increased smoking cessation knowledge but not intention to quit at follow-up. Seven percent of current smokers reported calling the quit line. Current tobacco use was five times more likely in food insecure versus food secure adults (OR 4.98; p = 0.006), even after adjustment for demographic factors. Systems based approaches to address tobacco use and cardiovascular health in low-income populations are needed. The extent to which smoking cessation could reduce food insecurity and risk for cardiovascular disease in this population warrants investigation.

Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States

It is the position of the Academy of Nutrition and Dietetics that systematic and sustained action is needed to achieve food and nutrition security in the United States. To achieve food security, effective interventions are needed, along with adequate funding for, and increased utilization of, food and nutrition assistance programs; inclusion of nutrition education in such programs; strategies to support individual and household economic stability; and research to measure impact on food insecurity- and health-related outcomes. Millions of individuals living in the United States experience food insecurity. Negative nutritional and non-nutritional outcomes are associated with food insecurity across the lifespan, including substandard academic achievement, inadequate intake of key nutrients, increased risk for chronic disease, and poor psychological and cognitive functioning. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, play key roles in addressing food insecurity and are uniquely positioned to make valuable contributions through competent and collaborative practice, provision of comprehensive food and nutrition education and training, innovative research related to all aspects of food insecurity, and advocacy efforts at the local, state, regional, and national levels.

Food Insecurity and Cardiometabolic Risk Factors in Adolescents

Introduction

Food insecurity is associated with poor cardiometabolic health in adults. The extent to which this relationship exists in adolescents has yet to be defined. The objective of this study was to examine the relationship between food insecurity and cardiometabolic risk factors in adolescents.

Methods

We evaluated the association between food insecurity and several cardiometabolic risk factors by using data collected from the Youth Risk Behavior Survey at the state and city levels. Logistic regression models adjusted for sex, race/ethnicity, grade, and neighborhood safety were used to determine the association between food insecurity and cardiometabolic risk factors among a weighted sample of 495,509 adolescents.

Results

Of the sample studied, 12.8% reported being food insecure. Food-insecure adolescents had more than a twofold increased odds of not eating breakfast on all 7 days (adjusted odds ratio [AOR] = 2.27; 95% confidence interval [CI], 1.61–3.21; P < .001), a 60% increased odds of reporting less than 8 hours per day of sleep (AOR = 1.60; 95% CI, 1.15–2.23; P = .006), a 65% increased odds of reporting current cigarette smoking (AOR = 1.65; 95% CI, 1.16–2.36; P = .006), and a 65 % increased odds of current alcohol consumption (AOR = 1.36; CI, 1.01–1.84; P = .04), compared with food-secure adolescents.

Conclusion

Among adolescents, in adjusted models, food insecurity was significantly associated with not consuming breakfast daily, getting less than 8 hours of sleep per day, currently smoking, and currently drinking alcohol. Food insecurity in adolescents may serve as an important precursor to poor cardiometabolic health.

Association Between Food Distress and Smoking Among Racially and Ethnically Diverse Adults, Schenectady, New York, 2013-2014

Introduction

Smoking and poor nutrition are 2 leading preventable causes of death. This study investigated associations between smoking and indicators of individual- and neighborhood-level food distress among racially and ethnically diverse urban adults.

Methods

We analyzed data from a health interview survey and a food environment assessment collected in 2013 and 2014 in Schenectady, New York. We constructed logistic regression models for current smoking with 6 indicators of food distress as exposure variables and sociodemographic characteristics, depression, anxiety, perceived stress, alcohol binge drinking, and disability as covariates.

Results

The analytic sample consisted of 1,917 adults; 59.4% were female, more than half were racial/ethnic minorities (26.2% non-Hispanic black, 10.3% Hispanic, 10.9% Guyanese, 4.0% multiracial and other), and 37.1% were current smokers. All indicators of food distress remained in the parsimonious final model: consuming 0 or 1 serving of fruits and vegetables daily more than doubled the odds of smoking, compared with consuming 5 or more servings (odds ratio [OR], 2.05). Food insecurity (OR, 1.77), receiving Supplemental Nutrition Assistance Program benefits (OR, 1.79), using a food pantry (OR, 1.41), living in a neighborhood with low access to healthy food (OR, 1.40), and shopping for food often at a store with limited healthy food choices (OR, 1.38) were also associated with significantly higher odds of smoking.

Conclusion

Recognizing that smoking and food distress are independently associated would lead to innovative public health intervention strategies. We suggest stronger collaboration between tobacco and nutrition public health professionals to synergistically reduce tobacco use and improve nutrition behavior and food environments in communities.

Tobacco cessation and household spending on non-tobacco goods: results from the US Consumer Expenditure Surveys

Objectives

To estimate the impact of tobacco cessation on household spending on non-tobacco goods in the USA.

Methods

Using 2006–2015 Consumer Expenditure Survey data, 9130 tobacco-consuming households were followed for four quarters. Households were categorised during the fourth quarter as having: (1) recent tobacco cessation, (2) long-term cessation, (3) relapsed cessation or (4) no cessation. Generalised linear models were used to compare fourth quarter expenditures on alcohol, food at home, food away from home, housing, healthcare, transportation, entertainment and other goods between the no-cessation households and those with recent, long-term or relapsed cessation. The full sample was analysed, and then analysed by income quartile.

Results

In the full sample, households with long-term and recent cessation had lower spending on alcohol, food, entertainment and transportation (p<0.001). Recent cessation was further associated with reduced spending on food at home (p<0.001), whereas relapsed cessation was associated with higher spending on healthcare and food away from home (p<0.001). In the highest income quartile, long-term and recent cessations were associated with reduced alcohol spending only (p<0.001), whereas in the lowest income quartile, long-term and recent cessations were associated with lower spending on alcohol, food at home, transportation and entertainment (p<0.001).

Conclusions

Households that quit tobacco spend less in areas that enable or complement their tobacco cessation, most of which may be motivated by financial strain. The most robust association between tobacco cessation and spending was the significantly lower spending on alcohol.

Food Insecurity Associated with Self-Efficacy and Acculturation

Food insecurity is a significant public health issue that affects the physical and mental health of people of all ages. Higher levels of self-efficacy may reduce levels of food insecurity. In addition, acculturation is potentially an important factor for food insecurity among immigrant populations. The purpose of this study is to examine food insecurity associated with self-efficacy and acculturation among low-income primary care patients in the United States. A self-administered survey was administered in May and June 2015 to uninsured primary care patients (N = 551) utilizing a free clinic that provides free primary care services to low-income uninsured individuals and families in the United States. On average, participants reported low food security. Higher levels of self-efficacy were associated with lower levels of food insecurity. Higher levels of heritage language proficiency were related to lower levels of food insecurity. US-born English speakers, women, and unmarried individuals potentially have higher risks of food insecurity and may need interventions to meet their specific needs. Self-efficacy should be included in nutrition education programs to reduce the levels of food insecurity. Future studies should further examine why these groups have a high risk to better understand needs for interventions.

Hunger and Behavioral Risk Factors for Noncommunicable Diseases in School-Going Adolescents in Bolivia, 2012

Hunger may play a role in noncommunicable disease (NCD) risk. This study used the 2012 Global School-based Student Health Survey from Bolivia to determine the association between hunger and risk factors for NCDs among adolescents. Hunger was associated with increased odds of nondaily fruit and vegetable consumption (adjusted odds ratio [AOR] = 1.21; P < .001), inadequate physical activity (AOR = 1.21; P = .001), and current tobacco use (hunger sometimes [AOR = 1.83; P < .001] or most of the time/always [AOR = 2.12; P < .001]). Interventions to reduce the burden of NCDs in Bolivia should address hunger, in addition to traditional behavioral risk factors.

Associations between smoking behaviors and financial stress among low-income smokers

OBJECTIVE

Many American households struggle to bring in sufficient income to meet basic needs related to nutrition, housing, and healthcare. Nicotine addiction and consequent expenditures on cigarettes may impose extra financial strain on low-income households. We examine how cigarette use behaviors relate to self-reported financial stress/strain among low-income smokers.

METHODS

At baseline in 2011/12, OPT-IN recruited adult smokers age 18-64 from the administrative databases of the state-subsidized Minnesota Health Care Programs (N = 2406). We tested whether nicotine dependency, type of cigarettes used, and smoking intensity were associated with self-reported difficulty affording food, healthcare, housing, and living within one's income. All regression models were adjusted for race, education, income, age, and gender.

RESULTS

Difficulty living on one's income (77.4%), paying for healthcare (33.6%), paying for housing (38.4%), and paying for food (40.8%) were common conditions in this population. Time to first cigarette and cigarettes smoked per day predicted financial stress related to affording food, housing, and living within one's income (all p < 0.05). For instance, those whose time to first cigarette was greater than 60 minutes had about half the odds of reporting difficulty paying for housing compared to those who had their first cigarette within five minutes of waking (adjusted odds ratio = 0.55 [95% CI: 0.41, 0.73]). Type of cigarette used was not associated with any type of financial stress/strain.

CONCLUSIONS

Smoking and particularly heavy smoking may contribute in an important way to the struggles that low-income households with smokers face in paying for necessities.

Food Insecurity: A Concept Analysis

AIM

To report an analysis of the concept of food insecurity in order to (a) propose a theoretical model of food insecurity useful to nursing; and (b) discuss its implications for nursing practice, nursing research, and health promotion.

BACKGROUND

A total of 48 million Americans are food insecure. As food insecurity is associated with multiple negative health effects, nursing intervention is warranted.

DESIGN

Concept analysis.

DATA SOURCES

A literature search was conducted in May 2014 in Scopus and MEDLINE using the exploded term "food insecur*." No year limit was placed. Government websites and popular media were searched to ensure a full understanding of the concept.

REVIEW METHODS

Iterative analysis, using the Walker and Avant method.

RESULTS

Food insecurity is defined by uncertain ability or inability to procure food, inability to procure enough food, being unable to live a healthy life, and feeling unsatisfied. A proposed theoretical model of food insecurity, adapted from the Socio-Ecological Model, identifies three layers of food insecurity (individual, community, society), with potential for nursing impact at each level.

CONCLUSION

Nurses must work to fight food insecurity. There exists a potential for nursing impact that is currently unrealized. Nursing impact can be guided by a new conceptual model, Food Insecurity Within the Nursing Paradigm.

Associations between food insecurity and healthy behaviors among Korean adults

BACKGROUND/OBJECTIVES

Food insecurity has been suggested as being negatively associated with healthy behaviors and health status. This study was performed to identify the associations between food insecurity and healthy behaviors among Korean adults.

SUBJECTS/METHODS

The data used were the 2011 Community Health Survey, cross-sectional representative samples of 253 communities in Korea. Food insecurity was defined as when participants reported that their family sometimes or often did not get enough food to eat in the past year. Healthy behaviors were considered as non-smoking, non-high risk drinking, participation in physical activities, eating a regular breakfast, and maintaining a normal weight. Multiple logistic regression and multinomial logistic regression analyses were used to identify the association between food insecurity and healthy behaviors.

RESULTS

The prevalence of food insecurity was 4.4% (men 3.9%, women 4.9%). Men with food insecurity had lower odds ratios (ORs) for non-smoking, 0.75 (95% CI: 0.68-0.82), participation in physical activities, 0.82 (95% CI: 0.76-0.90), and eating a regular breakfast, 0.66 (95% CI: 0.59-0.74), whereas they had a higher OR for maintaining a normal weight, 1.19 (95% CI: 1.09-1.30), than men with food security. Women with food insecurity had lower ORs for non-smoking, 0.77 (95% CI: 0.66-0.89), and eating a regular breakfast, 0.79 (95% CI: 0.72-0.88). For men, ORs for obesity were 0.78 (95% CI: 0.70-0.87) for overweight and 0.56 (95% CI: 0.39-0.82) for mild obesity. For women, the OR for moderate obesity was 2.04 (95% CI: 1.14-3.63) as compared with normal weight.

CONCLUSIONS

Food insecurity has a different impact on healthy behaviors. Provision of coping strategies for food insecurity might be critical to improve healthy behaviors among the population.

Concentration of tobacco advertisements at SNAP and WIC stores, Philadelphia, Pennsylvania, 2012

Introduction

Tobacco advertising is widespread in urban areas with racial/ethnic minority and low-income households that participate in nutrition assistance programs. Tobacco sales and advertising are linked to smoking behavior, which may complicate matters for low-income families struggling with disparate health risks relating to nutrition and chronic disease. We investigated the relationship between the amount and type of tobacco advertisements on tobacco outlets and the outlet type and location.

Methods

By using field visits and online images, we inspected all licensed tobacco retail outlets in Philadelphia (N = 4,639). Point pattern analyses were used to identify significant clustering of tobacco outlets and outlets with exterior tobacco advertisements. Logistic regression was used to analyze the relationship between the outlet’s acceptance of Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the presence of tobacco advertisements.

Results

Tobacco outlets with exterior tobacco advertisements were significantly clustered in several high-poverty areas. Controlling for racial/ethnic and income composition and land use, SNAP and WIC vendors were significantly more likely to have exterior (SNAP odds ratio [OR], 2.11; WIC OR, 1.59) and interior (SNAP OR, 3.43; WIC OR, 1.69) tobacco advertisements than other types of tobacco outlets.

Conclusion

Tobacco advertising is widespread at retail outlets, particularly in low-income and racial/ethnic minority neighborhoods. Policy makers may be able to mitigate the effects of this disparate exposure through tobacco retail licensing, local sign control rules, and SNAP and WIC authorization.