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

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.

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.

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.

Food deserts and cardiovascular health among young adults

OBJECTIVE

This study assesses the association between living in a food desert and cardiovascular health risk among young adults in the USA, as well as evaluates whether personal and area socioeconomic status moderates this relationship.

DESIGN

A cross-sectional analysis was performed using data from Wave I (1993-1994) and Wave IV (2008) from the National Longitudinal Study of Adolescent to Adult Health. Ordinary least squares regression models assessing the association between living in a food desert and cardiovascular health were performed. Mediation and moderation analyses assessed the degree to which this association was conditioned by area and personal socioeconomic status.

SETTING

Sample of respondents living in urban census tracts in the USA in 2008.

PARTICIPANTS

Young adults (n 8896) aged 24-34 years.

RESULTS

Net of covariates living in a food desert had a statistically significant association with cardiovascular health risk (range 0-14) (β = 0·048, P < 0·01). This association was partially mediated by area and personal socioeconomic status. Further analyses demonstrate that the adverse association between living in a food desert and cardiovascular health is concentrated among low socioeconomic status respondents.

CONCLUSIONS

The findings from this study suggest a complex interplay between food deserts and economic conditions for the cardiovascular health of young adults. Developing interventions that aim to improve health behaviour among lower-income populations may yield benefits for preventing the development of cardiovascular health problems.

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.

Emerging trends and the clinical impact of food insecurity in patients with diabetes

Food insecurity is a major public health concern in the United States affecting 15 million households according to data in 2017 from the US Department of Agriculture. Food insecurity, or the inability to consistently obtain nutritious food, disproportionately affects socioeconomically disadvantaged households, as well as those with chronic diseases including diabetes mellitus (DM). This review article explores the literature over the past 10 years pertaining to the complex relationship between food insecurity, social determinants of health, and chronic disease with an emphasis on diabetes and glycemic control. Those with diabetes and food insecurity together have been shown to have worse glycemic control compared to those who are food secure, but it remains unclear exactly how food insecurity affects glycemic control. Prior interventional studies have targeted aspects of food insecurity in patients with diabetes but have reported variable outcomes with respect to improvement in glycemic control despite effectively reducing rates of food insecurity. Additionally, few data exist regarding long-term outcomes and diabetes-related complications in this population. It is likely that many factors at both the community and individual levels impact glycemic control outcomes in the setting of food insecurity. Further studies are needed to better understand these factors and to create multifaceted targets for future interventional studies aimed at improving glycemic control in this population.

Unreliable and Difficult-to-Access Food for Those in Need: A Qualitative and Quantitative Study of Urban Food Pantries

For individuals who are food insecure, food pantries can be a vital resource to improve access to adequate food. Access to adequate food may be conceptualized within five dimensions: availability (item variety), accessibility (e.g., hours of operation), accommodation (e.g., cultural sensitivity), affordability (costs, monetary or otherwise), and acceptability (e.g., as related to quality). This study examined the five dimensions of access in a convenience sample of 50 food pantries in the Bronx, NY. The design was cross-sectional. Qualitative data included researcher observations and field notes from unstructured interviews with pantry workers. Quantitative data included frequencies for aspects of food access, organized by the five access dimensions. Inductive analysis of quantitative and qualitative data revealed three main inter-related findings: (1) Pantries were not reliably open: only 50% of pantries were open during hours listed in an online directory (several had had prolonged or indefinite closures); (2) Even when pantries were open, all five access dimensions showed deficiencies (e.g., limited inventory, few hours, pre-selected handouts without consideration of preferences, opportunity costs, and inferior-quality items); (3) Open pantries frequently had insufficient food supply to meet client demand. To deal with mismatch between supply and demand, pantries developed rules for food provision. Rules could break down in cases of pantries receiving food deliveries, leading to workarounds, and in cases of compelling client need, leading to exceptions. Adherence to rules, versus implementation of workarounds and/or exceptions, was worker- and situation-dependent and, thus, unpredictable. Overall, pantry food provision was unreliable. Future research should explore clients' perception of pantry access considering multiple access dimensions. Future research should also investigate drivers of mismatched supply and demand to create more predictable, reliable, and adequate food provision.

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.

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.

The association between food deserts and short sleep duration among young adults in the United States: variation by race and ethnicity

BACKGROUND

Both food deserts and short sleep duration are serious public health problems that affect the lives of millions of Americans. Although recent research has begun to link community characteristics to sleep problems, the relationship between living in a food desert and sleep behavior has gone largely unexplored.

METHODS

Using data from the National Longitudinal Study from Adolescent to Adult Health and data on food retailers from the Modified Retail Food Environment Index, this study applies multivariable logistic regression to assess the association between living in a food desert and short sleep duration. Models were stratified by race and ethnicity to examine potential moderating effects. Supplemental analyses are conducted where the comparison category is restricted to respondents who live in census tracts with low access to healthy food retailers but do not live in food deserts.

RESULTS

In adjusted logistic regression models, living in a food desert is not associated with short sleep duration. When the sample is stratified, living in a food desert has a positive and significant association with short sleep duration among Hispanic respondents in both the main analysis (odds ratio = 1.7; 95% confidence interval = 1.0-2.7) and supplemental models (odds ratio = 1.9; 95% confidence interval = 1.2-3.2).

CONCLUSIONS

Living in a food desert is not associated with short sleep duration among young adults. Study results indicate that living in a food desert is associated with increased odds for short sleep duration among Hispanics. Potential explanations for this finding are discussed in the context of extant research.

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.