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

Focusing attention on the important association between food insecurity and psychological distress: a systematic review and meta-analysis

BACKGROUND

Food insecurity has involved more than 750 million individuals worldwide. The association of food insecurity with socio-economic factors is also undeniable demand more consideration. Food insecurity will become a global priority by 2030. This systematic review and meta-analysis examined current literature concerning the association between food insecurity and psychological distress.

METHODS

Relevant researches were identified by searching databases including PubMed, EMBASE, Scopus, and Web of Science, ProQuest, and Cochrane Library up to June 2024 without language limitation. Then a snowball search was conducted in the eligible studies. The quality assessment was made through Newcastle-Ottawa Scale.

RESULTS

Data were available from 44 cross-sectional articles for systematic review and 17 eligible articles for meta-analysis with 2,267,012 and 1,953,636 participants, respectively. Findings support the growing segment of literature on the association between food insecurity and psychological distress. The highly represented groups were households with low income. Psychological and diabetic distress was directly associated with food insecurity as it increased the odds of distress to 329% (OR: 3.29; 95% CI: 2.46-4.40). Sleep problems, anxiety, depression, lower life satisfaction, obesity, and a higher rate of smoking were among the secondary outcomes.

CONCLUSION

Food insecurity was a common stressor that can have a negative impact on psychological well-being and even physical health. The findings should be considered in the public health and making policy-making process.

Food insecurity, social needs, and smoking status among patients in a county hospital system

Tobacco use in the U.S. is increasingly concentrated among populations with socioeconomic disadvantages such as food insecurity. Building on prior studies showing that food insecurity increases odds of cigarette smoking, the current study sought to examine how food insecurity and other social needs, particularly financial strain, transportation barriers, and housing/utility insecurity, were associated with smoking status among adult patients seen in a county hospital system. We analyzed data from the electronic health record of patients from The MetroHealth System (Cleveland, Ohio, USA), covering a two-year period since implementation of social determinants of health assessments (2019-2021; N = 45,151 patients). Logistic regression analyses were used to examine associations with smoking status. Compared to the overall smoking prevalence (21 %), smoking was higher among patients screening for transportation barriers (41 %), financial strain (39 %), food insecurity (34 %), and housing/utility insecurity (27 %). Each of these social needs was independently associated with increased odds of current smoking (all p < 0.05). Smoking prevalence increased sequentially as the number of social needs increased; with each addition of a social need, there was a dose-response association with higher odds of current smoking (adjusted ORs ranged from 1.56 to 3.76, all p < 0.001), and current smoking specifically among ever smoking patients (adjusted ORs ranged from 1.39 to 3.01, all p < 0.001). There was substantial overlap among several social needs and smoking status. Alongside improving access to evidence-based cessation treatments and services, the findings raise the possibility that addressing social needs might reduce barriers to quitting and thereby reduce tobacco use disparities.

Addressing tobacco use in the context of complex social needs: A new conceptual framework and approach to address smoking cessation in community health centers

Objective

This article presents a new conceptual framework “Connection to Health for Smokers” (CTHS), its application to address smoking cessation, and its acceptability in community health centers (CHCs).

Methods

CTHS, an online interactive patient educational tool comprehensively implements the “5 A's” (ask, advise, assess, assist, and arrange) within the context of patients' social and behavioral health needs. Semi-structured interviews were conducted with five health educators (nurses) who administered CTHS with 62 patients to evaluate the acceptability of the program. Thematic analyses were conducted with interview transcripts.

Results

CHC health educators viewed CTHS has enhanced patient-centered communication, was able to identify patients' needs beyond tobacco use, and individualize action planning to integrate social and behavioral health needs.

Conclusion

CTHS received enthusiasm from CHC health educators as a helpful tool to address tobacco use among their patients. Comprehensive on-site smoking cessation programs at CHCs that provide a structured evidence-based approach informed by an understanding of each patient's coexisting social and behavioral health needs may play an important role in reducing tobacco use disparities in the United States.

Innovation

CTHS offers a new promising framework to comprehensively integrate the 5A's within the context of social and behavioral determinants of health for smoking cessation.

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Social and behavioral health challenges may interfere smoking cessation

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CTHS implements “5A's” while addressing coexisting social and behavioral needs

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Integrate patients' needs in tobacco treatment optimizes cessation outcomes

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Nurses viewed addressing complex needs helpful to motivate smokers to quit smoking

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Comprehensive patient-centered approach may reduce tobacco use disparities

Examining Reciprocal Effects of Cigarette Smoking, Food Insecurity, and Psychological Distress in the U.S

In the U.S., cigarette smoking is increasingly concentrated in disadvantaged and vulnerable populations, such as populations with lower income and with mental health needs. Food insecurity is linked with psychological distress and is an independent risk factor for smoking. We prospectively examined how cigarette smoking, food insecurity, and psychological distress operate as risk factors for one another in a 2-year longitudinal analysis of U.S. adults from the 2015 and 2017 Panel Study of Income Dynamics, a nationally representative household survey (N = 7946). Using cross-lagged panel analysis, cross-lagged regression coefficients were estimated simultaneously with direct-effect paths, controlling for covariates. Results showed significant bidirectional associations between smoking and food insecurity: 2015 smoking predicted 2017 food insecurity, and 2015 food insecurity predicted 2017 smoking. Food insecurity and psychological distress also had significant bidirectional associations. However, the association between smoking and psychological distress was unidirectional: 2015 psychological distress predicted 2017 smoking, but not vice versa. The findings suggest a cyclical possibility that smoking exacerbates food insecurity, food insecurity exacerbates psychological distress, and psychological distress exacerbates smoking. There is a need to replicate with more timepoints, but our results highlight the importance of examining the overlapping health burdens of smoking, food insecurity, and psychological distress.

Confronting the Post-ACA American Health Crisis: Designing Health Care for Value and Equity

The United States is in the midst of a health crisis marked by unprecedented 3-year declines in life expectancy. Addressing this national crisis requires alignment of public policies, public health policies, and health care policies, with the overarching aim of improving national health and health equity. Aligning national polices to support human needs provides a foundation for implementing post-Affordable Care Act national health care reform. Reform should start with the twin goals of improving health care value and equity. A focus on value, that is, outcomes and processes desired by patients, is critical to ensuring that resources are judiciously deployed to optimize individual and population health. A focus on health care equity ensures that the health care system is intentionally designed to minimize inequities in health care processes and outcomes, particularly for member of socially disadvantaged groups. All sectors related to the health care system-from policies and payment mechanisms to delivery design, measurement, patient engagement/democratization, training, and research-should be tightly aligned with improving health care value and equity during this next era of health care reform.

Sociodemographic Correlates of Food Insecurity Among New York City Tobacco Users

PURPOSE

To identify rates and sociodemographic correlates of food insecurity among low-income smokers.

DESIGN

Cross-sectional analysis of baseline survey data from a randomized controlled trial (N = 403) testing a smoking cessation intervention for low-income smokers.

SETTING

Two safety-net hospitals in New York City.

SAMPLE

Current smokers with annual household income <200% of the federal poverty level.

MEASURES

Food insecurity was measured using the United States Department of Agriculture 6-item food security module. Participant sociodemographics were assessed by self-reported survey responses.

ANALYSIS

We used frequencies to calculate the proportion of smokers experiencing food insecurity and multivariable logistic regression to identify factors associated with being food insecure.

RESULTS

Fifty-eight percent of participants were food insecure, with 29% reporting very high food insecurity. Compared to married participants, separated, widowed, or divorced participants were more likely to be food insecure (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [CI]: 1.25-4.33), as were never married participants (AOR = 2.81, 95% CI: 1.54-5.14).

CONCLUSIONS

Health promotion approaches that target multiple health risks (eg, smoking and food access) may be needed for low-income populations. Interventions which seek to alleviate food insecurity may benefit from targeting socially isolated smokers.

Psychological distress and cigarette smoking among U.S. households by income: Considering the role of food insecurity

Psychological distress and tobacco use are known to co-occur for many reasons, including vulnerabilities associated with socioeconomic disadvantage. Food insecurity-a stressful condition due to inconsistent food access-is linked with increased psychological distress and is also an independent risk factor for smoking. We investigated the association between psychological distress and cigarette smoking, examining distress occurring with or without food insecurity, and variations in the associations by socioeconomic status. We analyzed data from the 2015 U.S. Panel Study of Income Dynamics (n = 9048). A four-category variable was constructed based on responses to validated measures of psychological distress and of food insecurity: no distress and no food insecurity; food insecurity without distress; distress without food insecurity; and distress with food insecurity. Weighted, robust Poisson regression analysis examined associations with current smoking, with analyses stratified by socioeconomic status. Smoking prevalence was highest among respondents experiencing psychological distress with food insecurity (39%). Results showed that respondents with food insecurity alone had higher smoking prevalence (33%) than respondents with psychological distress alone (20%). Only among respondents above poverty, psychological distress without food insecurity was significantly associated with current smoking (prevalence ratio = 1.44; 95% CI [1.25, 1.65]). For respondents at/below poverty, psychological distress without food insecurity was not significantly associated with current smoking. Further examining how socioeconomic stressors, such as food insecurity, intersect with psychological distress is needed to address continued socioeconomic disparities in cigarette smoking and develop effective population-based interventions.