Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity

Distinct patterns of cigarette smoking intensity and other substance use among women who experience housing instability

BACKGROUND

Recent insights into substance use cessation suggest that outcomes short of long-term abstinence are clinically meaningful and may offer more realistic incremental goals, particularly for highly vulnerable individuals. With the goal of informing tobacco treatment programs, we examined distinct patterns of cigarette smoking and their association with the ongoing use of other substances in women who experience housing instability.

METHODS

We recruited participants from a longitudinal study of women experiencing housing instability. Between June 2017 and January 2019, participants completed six monthly survey interviews regarding social conditions and the use of multiple substances. We examined associations between cigarette smoking intensity, including number of cigarettes smoked per day, heavy smoking, and an increase in number of cigarettes smoked from the previous 30-days, and other substance use in the past 7-days.

RESULTS

Of the 243 participants, 69 % were current smokers and 58 % were daily smokers. Number of cigarettes smoked per day (Adjusted odds ratio [AOR] 1.02, 95 % CI 1.00-1.03), heavy cigarette smoking, compared to none or light smoking (AOR 2.02, 95 % CI 1.46-2.79), and an increase in number of cigarettes smoked from the previous 30-days (AOR 1.06, 95 % CI 1.01-1.12) were all significantly associated with methamphetamine use in the past 7-days. Associations with other substance use were not as strong.

CONCLUSIONS

In a sample of unstably housed women, where almost half used multiple substances, methamphetamine use was associated with higher cigarette smoking intensity. Our findings highlight a potential role for integrating tobacco and methamphetamine use treatment to reduce tobacco use among unstably housed women.

Longitudinal experience of food insecurity & cigarette use in the early COVID-19 Pandemic, United States

Food insecurity is associated with cigarette smoking, yet little is known about how variability in the experience of food insecurity may relate to patterns of cigarette use. We sought to examine patterns of food insecurity and cigarette use during the COVID-19 pandemic (April 2020-March 2021). We analyzed longitudinal survey data from a nationally representative panel of adults in the United States (N = 7,880) from the Understanding Coronavirus in America Study. The primary independent variable was ten trajectories of food insecurity. Our dependent variable was past 7-day cigarette use (count of days used cigarettes). Poisson regression using generalized estimating equations was run controlling for key covariates. The prevalence of cigarette use on at least one day in the past week was lowest (17.5 %) for those who Remained Food Secure, and highest (57.9 %) among those who Became Fully Food Insecure, a group characterized by having high probability of becoming food insecure during the study period. Among those who reported at least one day of cigarette use in the past week, fewer than half (40.1 %) reported sustained use across all waves of the study. Those who Became Fully Food Insecure had an incidence rate ratio (IRR) of 1.73 (95 % CI: 1.18, 2.54) compared to those who Remained Food Secure with respect to number of smoking days. While different patterns of food insecurity are related to cigarette smoking at the population level, these results highlight that food insecurity, a key social need, may represent a novel strategy for informing reduction of tobacco use disparities.

Factors influencing implementation and sustainability of interventions to improve oral health and related health behaviours in adults experiencing severe and multiple disadvantage: a mixed-methods systematic review

OBJECTIVES

Among people experiencing severe and multiple disadvantage (SMD), poor oral health is common and linked to smoking, substance use and high sugar intake. Studies have explored interventions addressing oral health and related behaviours; however, factors related to the implementation of these interventions remain unclear. This mixed-methods systematic review aimed to synthesise evidence on the implementation and sustainability of interventions to improve oral health and related health behaviours among adults experiencing SMD.

METHODS

Bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, EBSCO, Scopus) and grey literature were searched from inception to February 2023. Studies meeting the inclusion criteria were screened and extracted independently by two researchers. Quality appraisal was undertaken, and results were synthesised using narrative and thematic analyses.

RESULTS

Seventeen papers were included (published between 1995 and 2022). Studies were mostly of moderate quality and included views from SMD groups and service providers. From the qualitative synthesis, most findings were related to aspects such as trust, resources and motivation levels of SMD groups and service providers. None of the studies reported on diet and none included repeated offending (one of the aspects of SMD). From the quantitative synthesis, no difference was observed in programme attendance between the interventions and usual care, although there was some indication of sustained improvements in participation in the intervention group.

CONCLUSION

This review provides some evidence that trust, adequate resources and motivation levels are potentially important in implementing interventions to improve oral health and substance use among SMD groups. Further research is needed from high quality studies and focusing on diet in this population.

PROSPERO REGISTRATION NUMBER

CRD42020202416.

Assessing the Feasibility of Conducting Smoking Cessation Outreach in Food Pantries: A Pilot Intervention Study

INTRODUCTION

Smoking prevalence is high among US adults with food insecurity. This study examined how food assistance settings, namely food pantries, can serve as a community-based venue to reach food insecure adults who smoke for smoking cessation.

METHODS

Partnering with a local hunger relief organization, we conducted surveys and focus groups of food pantry clients in Greater Cleveland, Ohio, followed by food pantry-based outreach events to connect people who smoke to the Ohio Tobacco Quit Line.

RESULTS

The survey included 132 participants who visited a food pantry (M age = 47; 74% women; 39% Black/African American), of whom 35% were using tobacco and 31% were smoking cigarettes. Among those currently smoking (M cigarettes/day = 9), 76% intended to quit in the next 6 months, and 82% had not used nor heard of the quitline. Informed by focus group themes, we conducted a total of 22 outreach events at four pantries. Among those interested in smoking cessation resources from the outreach events (n = 54), 78% were able to be subsequently contacted. Of them, 74% provided consent for quitline referral. The remainder either declined or were unable to participate.

CONCLUSIONS

While it was feasible to leverage food pantries for smoking cessation outreach, the overall reach was low. Despite high interest in quitting, there was limited effectiveness of outreach efforts without adaptations to each pantry setting and in recognition of the immediate food needs and with challenges related to the COVID-19 pandemic. There remains a critical need to address high rates of smoking among populations experiencing food insecurity.

IMPLICATIONS

Tobacco cessation services are increasingly recognizing the need to address food insecurity and other social needs that commonly occur in populations who use tobacco at higher rates. This research underscores both the value and the challenges related to leveraging food pantries as a community-based venue for smoking cessation outreach. In addition to improvements in outreach models, long-term investments in structural interventions are also needed to address underlying poverty and socioeconomic disadvantage that ultimately drive disparities in smoking and in food insecurity.

Social Risk and Smoking Among Women Smokers Early in the COVID-19 Pandemic: The Role of Mental Health

Background: We examined patterns of smoking in relation to health-related socioeconomic vulnerability (HRSV) among U.S. women early in the pandemic and whether mental health symptoms mediated these relationships. Materials and Methods: Data were obtained from the April 2020 National U.S. Women's Health COVID-19 Study (N = 3200). Among current smokers, adjusted odds of increased smoking since the start of the pandemic (vs. same or less) by incident and worsening HRSVs were modeled. Structural equation modeling was used to assess anxiety, depression, and traumatic stress symptoms as mediators of the relationship between six HRSVs (food insecurity; housing, utilities, and transportation difficulties; interpersonal violence; financial strain) and increased smoking early in the pandemic. Results: Nearly half (48%) of current smokers reported increased smoking since the pandemic started. Odds of increased smoking were higher among women with incident financial strain (aOR = 2.0, 95% CI 1.2-3.3), incident food insecurity (aOR = 2.9, 95% CI 1.7-5.1), any worsening HRSV (aOR = 2.2, 95% CI 1.5-3.0), and worsening food insecurity (aOR = 1.9, 95% CI 1.3-3.0). Anxiety symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (proportion mediated = 0.17, p = 0.001) and worsening food insecurity (0.19, p = 0.023), specifically. Depression symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (0.15, p = 0.004) and incident financial strain (0.19, p = 0.034). Traumatic stress was not a significant mediator of any tested relationship. Conclusions: Anxiety and depression symptoms partially explain the relationship between rising socioeconomic vulnerability and increased smoking among women early in the pandemic. Addressing HRSVs and mental health may help reduce increased smoking during a public health crisis.

Food insecurity is associated with an unhealthy lifestyle score in middle- and older-aged adults: findings from the EPIPorto cohort

The association of food insecurity with the combined effect of lifestyles is still limited. This study evaluated the association between food insecurity and a lifestyle score in middle- and older-aged adults. A cross-sectional study (2013-2016) was performed among 595 individuals (≥ 50 years) from the EPIPorto cohort (Porto, Portugal). Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Information on fruit and vegetable consumption (F&V), physical activity (PA) practice, tobacco smoking, and alcohol consumption were included in a lifestyle score. Those with F&V < five portions/day, < 150 min/week of moderate-intensity PA or < 75 min/week of vigorous-intensity PA, current smokers, consumers of > one drink of alcoholic beverages in women, and > two in men were assigned with one point; all the others had nil points. The score could range from 0 to 4, and was further categorised into three categories. Food insecurity was positively associated with an unhealthy lifestyle profile (OR = 2.272; 95%CI:1.079-4.782), independently of the adjustment variables. Analysing each lifestyle component, food insecurity was associated with low PA practice (OR = 2.365; 95%CI:1.020-5.485). Individuals from food insecure households were more likely to have an unhealthy lifestyle profile. Public health strategies should be developed among food insecure individuals to promote healthy lifestyles.

Determinants of cigarette smoking and smoking frequency among women of reproductive age in Nigeria: evidence from a nationwide cross-sectional survey

BACKGROUND

Smoking is a leading cause of avoidable deaths and attributable disability-adjusted life years globally. Yet, the determinants of smoking practices among women are understudied. This study assessed the determinants of smoking and smoking frequency among women of reproductive age in Nigeria.

METHODS AND MATERIALS

Data from the 2018 Nigeria Demographic and Health Survey (NDHS) were used in this study (n = 41,821). The data were adjusted for sampling weight, stratification, and cluster sampling design. The outcome variables were smoking status and smoking frequency (daily smoking and occasional smoking). The predictor variables included women's socio-demographic and household characteristics. Pearson's chi-squared test was used to evaluate the association between outcome and predictor variables. All variables significant in bivariate analyses were further analysed using complex sample logistics regression. Statistical significance was set at a p-value < 0.05.

RESULTS

The prevalence of smoking among women of reproductive age is 0.3%. The prevalence of smoking frequency is 0.1% (daily) and 0.2% (occasionally). Overall, women aged 25-34 (AOR = 2.13, 95%CI: 1.06-4.29, ρ = 0.034), residing in the South-south region (AOR = 9.45, 95%CI: 2.04-43.72, ρ <0.001), being formerly married (AOR = 3.75, 95%CI: 1.52-9.21, ρ = 0.004), in female-headed households (AOR = 2.56, 95%CI: 1.29-5.08, ρ = 0.007) and owning mobile phones (AOR = 2.10, 95%CI: 1.13-3.90, ρ = 0.020) were more likely to smoke. Whereas female-headed households (AOR = 4.34, 95%CI: 1.37-13.77, ρ = 0.013) and being formerly married (AOR = 6.37, 95%CI: 1.67-24.24, ρ = 0.007) predisposed to daily smoking, age 15-24 (AOR = 0.11, 95%CI: 0.02-0.64, ρ = 0.014) was protective of daily smoking among women. Owning mobile phones (AOR = 2.43, 95%CI: 1.17-5.06, ρ = 0.018) increased the odds of occasional smoking among women.

CONCLUSIONS

The prevalence rates of smoking and smoking frequency are low among women of reproductive age in Nigeria. Women-centred approaches to tobacco prevention and cessation must become evidence-informed by incorporating these determinants into interventions targeting women of reproductive age in Nigeria.

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.

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.

Financial Insecurity and Food Insecurity among U.S. Children with Secondhand and Thirdhand Smoke Exposure

Objectives: Smokers with financial and food insecurity may find it difficult to quit smoking and reduce their children’s tobacco smoke exposure (TSE). The objective was to examine the associations between child TSE and financial and food insecurity among U.S. school-aged children. Methods: We examined the 2018−2019 National Survey of Children’s Health data on 17,484 children 6−11 years old. Children were categorized into TSE groups: (1) No TSE: did not live with a smoker; (2) thirdhand smoke (THS) exposure alone: lived with a smoker who did not smoke inside the home; or (3) secondhand smoke (SHS) and THS exposure: lived with a smoker who smoked inside the home. We conducted weighted logistic, ordinal, and linear regression analyses to assess the relationships between child TSE status and financial and food insecurity, adjusting for covariates. Results: Overall, 13.1% and 1.8% of children had THS exposure alone and SHS and THS exposure, respectively. Compared to children with no TSE, children with THS exposure alone were at 2.17 increased odds (95% CI = 1.83, 2.58, p < 0.001) and children with SHS and THS exposure were at 2.24 increased odds (95% CI = 1.57, 3.19, p < 0.001) of having financial insecurity. Children with THS exposure alone were at 1.92 increased odds (95% CI = 1.58, 2.33, p < 0.001) and children with SHS and THS exposure were at 2.14 increased odds (95% CI = 1.45, 3.16, p < 0.001) of having food insecurity. Conclusions: Children with TSE are at increased risk of experiencing financial and food insecurity. When developing tobacco interventions, a holistic approach to tobacco control that addresses ways to decrease financial and food hardships may improve outcomes.

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.

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.

Ongoing tobacco use in women who experience homelessness and unstable housing: A prospective study to inform tobacco cessation interventions and policies

BACKGROUND

Tobacco use is common in people who experience homelessness. However, despite biological differences in use by sex and lower quit rates in women, research in homeless and unstably housed (HUH) women is sparse. We identified correlates of use specific to this population, with the goal of informing tobacco cessation programs tailored for HUH women.

METHODS

We conducted a prospective study among HUH women recruited from San Francisco homeless shelters, street encampments, free meal programs and low-income hotels. Between June 2016 and January 2019, study participants completed six monthly interviews to examine factors associated with tobacco use, defined as urinary cotinine >10 pg/mL or self-reported prior 30-day use.

RESULTS

Among 245 participants, 40% were Black, the median age was 53, 75% currently used tobacco and 89% had ≥one 24-hour quit attempt in the prior year. Tobacco use was more common in women with PTSD (66% vs. 48%) and depression (54% vs. 35%) compared to women without these conditions. Adjusted odds of tobacco use decreased significantly with increasing age (OR_{/5 yrs}: 0.81; 95% CI:0.68, 0.96) and increased with an increasing number of additional substances used (OR: 2.52; 95% CI: 1.88, 3.39).

CONCLUSION

Outside of a treatment setting and within a community-recruited sample population composed of HUH women, the number of additional substances used is a primary correlate of ongoing tobacco use. Tailored cessation interventions that prioritize the issue of multiple substance use, and public health policies that allocate funding to address it, may increase tobacco cessation in this population.

Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action

Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.

Relationship between food insecurity and smoking status among women living with and at risk for HIV in the USA: a cohort study

OBJECTIVES

People living with HIV (PLHIV) in the USA, particularly women, have a higher prevalence of food insecurity than the general population. Cigarette smoking among PLHIV is common (42%), and PLHIV are 6-13 times more likely to die from lung cancer than AIDS-related causes. This study sought to investigate the associations between food security status and smoking status and severity among a cohort of predominantly low-income women of colour living with and without HIV in the USA.

DESIGN

Women enrolled in an ongoing longitudinal cohort study from 2013 to 2015.

SETTING

Nine participating sites across the USA.

PARTICIPANTS

2553 participants enrolled in the Food Insecurity Sub-Study of the Women's Interagency HIV Study, a multisite cohort study of US women living with HIV and demographically similar HIV-seronegative women.

OUTCOMES

Current cigarette smoking status and intensity were self-reported. We used cross-sectional and longitudinal logistic and Tobit regressions to assess associations of food security status and changes in food security status with smoking status and intensity.

RESULTS

The median age was 48. Most respondents were African-American/black (72%) and living with HIV (71%). Over half had annual incomes ≤US$12 000 (52%). Food insecurity (44%) and cigarette smoking (42%) were prevalent. In analyses adjusting for common sociodemographic characteristics, all categories of food insecurity were associated with greater odds of current smoking compared with food-secure women. Changes in food insecurity were also associated with increased odds of smoking. Any food insecurity was associated with higher smoking intensity.

CONCLUSIONS

Food insecurity over time was associated with smoking in this cohort of predominantly low-income women of colour living with or at risk of HIV. Integrating alleviation of food insecurity into smoking cessation programmes may be an effective method to reduce the smoking prevalence and disproportionate lung cancer mortality rate particularly among PLHIV.

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.

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.

Household Food Security and Infant Adiposity

OBJECTIVES

Food insecurity has been associated with obesity, but previous studies are inconsistent and few included infants. We examined associations between household food security and infant adiposity and assessed the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) as effect modifiers. We hypothesized that infants from food-insecure households would have greater adiposity, with attenuation by WIC and SNAP.

METHODS

We repeatedly measured 666 infants from the southeastern United States in 2013-2017. We categorized households as high, marginal, low, or very low using the US Household Food Security Survey Module. Outcomes were BMI z score, subscapular and triceps skinfold-for-age z score, the sum of subscapular and triceps skinfolds, the ratio of subscapular and triceps skinfolds, and BMI z score ≥1 (at risk for overweight). We used covariate-adjusted repeated-measures linear and logistic regressions.

RESULTS

Of infants, 68.6% were Black and 60.5% had household incomes <$20 000. Interactions between food security and WIC and/or SNAP were not significant. Compared with infants from high food security households, infants from very low food security households had higher BMI z scores (0.18 U; 95% confidence interval [CI] 0.01 to 0.35), higher subscapular skinfold-for-age z scores (0.31 U; 95% CI 0.04 to 0.59), a higher sum of subscapular and triceps skinfolds (0.53 mm; 95% CI 0.002 to 1.07), and greater odds of being at risk for overweight (odds ratio 1.55; 95% CI 1.14 to 2.10). Infants from low food security households had greater odds of being at risk for overweight (odds ratio 1.72; 95% CI 1.17 to 2.10).

CONCLUSIONS

In larger and longer studies, researchers should examine food security and adiposity in young children.

Association of Problematic Alcohol Use and Food Insecurity among Homeless Men and Women

Food insecurity results from unreliable access to affordable and nutritious food. Homeless adults are particularly vulnerable to both food insecurity and problematic alcohol use. The current study examined the link between problematic alcohol use and food insecurity among homeless adults. Participants (N = 528; 62.7% men; M_age = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Problematic alcohol use was measured using the Alcohol Quantity and Frequency Questionnaire and the Patient Health Questionnaire. The latter used DSM-IV diagnostic criteria to assess probable alcohol use dependence/abuse. Heavy drinking was considered >7 drinks (women) and >14 drinks (men) per week. Food insecurity was measured with the USDA Food Security Scale-Short Form. The link between alcohol problems and food insecurity was examined with logistic regression analyses controlling for sex, age, education, income, and months homeless. Overall, 28.4% of the sample had probable alcohol dependence, 25% were heavy drinkers, and 78.4% were food insecure. Probable alcohol dependence and heavy drinking were correlated at 0.53 (p < 0.001). Results indicated that heavy drinking (OR = 2.12, CI_.95 = 1.21, 3.73) and probable alcohol dependence/abuse (OR = 2.72, CI_.95 = 1.55, 4.77) were each associated with increased odds of food insecurity. Food insecurity and problematic alcohol use are major issues among homeless populations; this study suggests they are associated. Future research is needed to shed light on potential causal mechanisms and on whether alcohol may take precedence over eating or food purchases.

Sociodemographic factors associated with food insecurity: data from the 2003-2014 New South Wales Population Health Survey

OBJECTIVE

To determine the prevalence and sociodemographic factors associated with food insecurity in the state of New South Wales (NSW), Australia.

DESIGN

Cross-sectional analysis of food insecurity data collected by the NSW Population Health Survey between 2003 and 2014. Multiple logistic regression was used to examine associations with key sociodemographic variables.

SETTING

NSW, Australia.

PARTICIPANTS

212 608 survey participants responded to the food insecurity survey question between 2003 and 2014. 150 767 of them were aged ≥16 years. The survey sample was randomly selected and weighted to be representative of the NSW population.

RESULTS

On average 6 % of adults aged ≥16 years experienced food insecurity in NSW. The odds of food insecurity appeared to increase from one survey year to the next by a factor of 1·05. Food insecurity was found to be independently associated with age, sex, marital status, household size, education, employment status, household income, smoking status, alcohol intake and self-rated health. The association with income, smoking status and self-rated health appeared to be the strongest among all covariates and showed a gradient effect. Food insecurity appeared to increase significantly between the age of 16 and 19 years.

CONCLUSIONS

The prevalence of food insecurity appears to be rising over time. Given the negative health consequences of food insecurity, more rigorous measurement and monitoring of food insecurity in NSW and nationally is strongly recommended. The findings provide support for interventions targeting low-income and younger population groups.

Capturing habitualness of drinking and smoking behavior in humans

BACKGROUND

Recent findings suggest that overreliance on habit may be common in individuals diagnosed with addiction. To advance our understanding of habit in clinical samples and from behavioral measures, this study examines the interrelations between self-reported habit index for smoking and drinking as well as behavioral measures of intraindividual variability in smoking and drinking.

METHODS

Treatment-seeking heavy drinking smokers (N = 416) completed the Self-Report Habit Index (SRHI) adapted for both smoking and drinking. "Behavioral habitualness" was computed from the degree of intraindividual variability in patterns of smoking and drinking over the past month. Using the 28-day Timeline-Follow Back (TLFB) interview, we derived two measures of intraindividual variability: interclass correlation (ICC) and autocorrelation [AR(7) coefficients].

RESULTS

Self-report measures of habit were robustly associated with clinical severity of drinking and smoking with higher habit scores indicating greater severity of drinking and smoking, respectively. ICC and AR(7) coefficients, the behavioral measure of "patterness" and putative habit, were not associated with SRHI scores. While ICC for smoking was associated with higher nicotine dependence scores, this pattern was not found for drinking ICC and alcohol problem severity.

CONCLUSIONS

These results support the construct validity of the self-report measures of habit for smoking and drinking, as well an initial evaluation of behavioral measure of smoking "patterness" as a potential proxy for habit smoking. Because habit represents a complex phenotype with limited clinical translation, additional studies capturing a wider range of substance use severity and coupled with brain-based validation methods are warranted.

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.

Cumulative Risk Factors Associated with Food Insecurity among Adults who Experience Homelessness

Introduction

There is a dearth of research on the determinants of food insecurity among adults who experience homelessness. According to cumulative risk theory, it is the accumulation of risk factors that places individuals in jeopardy for negative health consequences. Building on the cumulative risk theory, domain specific indices were created to examine the relationship between four cumulative risk factors and food insecurity among adults who experience homelessness.

Methods

Adult participants were recruited from six-area shelters in Oklahoma City (N = 565) during July - August 2016. Participants who affirmatively responded to two-six items of the six-item USDA Food Security Scale-Short form were categorized as food insecure. Four indices of cumulative risk were created based on affirmative survey responses: poor health & risky health behaviors index, personal and sexual victimization index, household disruption, and financial strain. Covariate-adjusted logistic regression models predicted the odds of adults experiencing food insecurity.

Results

Seventy-eight percent of the sample experienced food insecurity. Higher scores for the poor health and risky health behaviors index predicted higher odds of experiencing food insecurity (OR = 1.80, CI: 1.51 - 2.14). Higher scores for the personal and sexual victimization index predicted higher odds of experiencing food insecurity (OR = 1.57, CI: 1.20 - 2.04).

Conclusion

To facilitate food security among adults experiencing homelessness, shelters and community-based programs need to consider homelessness and food insecurity to be multi-faceted public health problems that are inter-related.

Use of Smoking Cessation Aids in a Convenience Sample of PLHIV in a Canadian Tertiary Care Clinic

Background:

Tobacco smoking is among the most significant predictors of cardiovascular disease and lung cancer in People Living with HIV (PLHIV). Smoking rates in this population are high, necessitating more effective smoking cessation strategies. We conducted a descriptive analysis of tobacco-related clinical and sociodemographic characteristics of smokers at a tertiary care HIV clinic in Montreal and an exploratory analysis of smoking cessation methods in order to identify potential areas of improvement in the clinic’s approach to smoking cessation.

Methods:

A convenience sample of patients completed a 10-minute questionnaire on tobacco-related behaviours and outcomes. Use of smoking cessation methods was compared using McNemar’s exact test with a Bonferroni correction for multiple testing (p<0.01 considered significant).

Results:

Seventy-two PLHIV participated. Two-thirds of our total participants were interested in quitting within six months, but the use of effective cessation strategies was low, particularly for counseling and oral therapy. Overall, oral therapy (e.g. varenicline) (16.7%) and counseling for cessation (5.6%) were used less than nicotine patches (50.0%) or ‘other’ methods (50.0%), which included abstinence and nicotine gum (p<0.001).

Conclusion:

Despite a small and potentially unrepresentative sample of HIV positive tobacco smokers at our clinic, this study could help guide further research aiming to determine and address barriers to smoking cessation and access to effective smoking cessation aids in PLHIV. Future studies might consider factors that affect motivation to quit, such as co-morbid mental health and substance use disorders, or the attitudes of HIV healthcare providers.

Changes in Food Insecurity and Smoking Status over Time: Analysis of the 2003 and 2015 Panel Study of Income Dynamics

PURPOSE

To examine whether food insecurity longitudinally affects smoking status.

DESIGN

Population-based prospective study.

SETTING

Data from the 2003 and 2015 Panel Study of Income Dynamics (PSID).

PARTICIPANTS

Four thousand five hundred sixty-three adults who were smokers and nonsmokers, participating in the 2003 (current study baseline) and 2015 (current study follow-up) waves of PSID.

MEASURES

Based on self-reported smoking status at baseline and follow-up, respondents were categorized as continued smoking, stopped smoking, started smoking, and continued nonsmoking. Similarly, respondents were categorized as stayed food secure, stayed food insecure, became food insecure, and became food secure based on responses to the Food Security Survey at baseline and follow-up.

ANALYSIS

Two logistic regression analyses to examine (1) among smokers at baseline the odds of stopping versus continuing smoking by follow-up and (2) among nonsmokers at baseline the odds of starting versus continuing nonsmoking by follow-up. In both models, change in food insecurity status was the primary independent variable, controlling for demographics including poverty.

RESULTS

Among smokers at baseline, becoming food insecure (vs staying food secure) was independently associated with lower likelihood of stopping smoking by follow-up (odds ratio [OR] = 0.66). Among nonsmokers at baseline, becoming food insecure (vs staying food secure) was independently associated with higher likelihood of starting smoking by follow-up (OR = 3.77).

CONCLUSIONS

Food insecurity is a risk factor for smoking, which has significant implications for developing interventions to reduce smoking prevalence, especially among low-income groups.

Smoking Predicts Food Insecurity Severity among Persons Living with HIV

Food insecurity is a key social and health issue among persons living with HIV (PLHIV). Food insecurity oftentimes co-occurs with substance use, but little is known about the relationship between tobacco use and food insecurity particularly among PLHIV. In this study, we prospectively examined the association of cigarette smoking with food insecurity in a cohort of 108 individuals seeking vocational rehabilitation services. Over the 12-month study period, smokers at baseline reported consistently higher levels of food insecurity compared to non-smokers. Smoking remained an independent risk factor for greater food insecurity, controlling for sociodemographic characteristics and known confounders (e.g., substance use, depression). Food insecurity is a key structural and socioeconomic barrier that may partially explain HIV-related health disparities observed among smokers. Further research is needed to characterize the bio-behavioral mechanisms linking smoking and food insecurity as well as test whether smoking cessation can reduce food insecurity in PLHIV who smoke.

Food Insecurity and Psychological Distress Among Former and Current Smokers With Low Income

PURPOSE

To examine how food insecurity and psychological distress interact in its association with smoking and to explore how food insecurity and psychological distress are associated with quitting smoking using quit ratio estimates.

DESIGN

Cross-sectional study.

SETTING

Data from the 2015 California Health Interview Survey.

PARTICIPANTS

A total of 3007 lower income adults who have ever smoked.

MEASURES

Ever smoking was defined as smoking 100+ cigarettes in the entire lifetime, with current smoking defined as smoking "every day" or "some days" and former smoking defined as smoking "not at all." Psychological distress and food insecurity were measured by the 6-item K6 Psychological Distress Scale and the 6-item Food Security Survey Short Form, respectively.

ANALYSIS

Multiple logistic regression analysis was used to examine correlates of smoking status. Quit ratios (percentage of ever smokers who have quit) were calculated across study variables.

RESULTS

Reporting food insecurity with psychological distress was independently associated with lower odds of being a former smoker, compared to reporting food security without psychological distress. The quit ratio was lower among ever smokers reporting food insecurity with distress (41%) compared to ever smokers reporting food security without distress (63%).

CONCLUSIONS

Specific conditions of impoverishment, such as food insecurity, interact with psychological distress in its association with continued smoking. Interventions to reduce socioeconomic disparities in smoking should consider the interacting role of food insecurity and psychological distress.