Association for Public Policy Analysis & Management

Background: Food Insecurity is still a major challenge in the United States. In 2016, 12.3 percent of households in the United States were food insecure and essentially there has not been significant change from 12.7 percent in 2015. Equally, the percentage of households with very high food insecurity have remained the same at 5 percent since 2015. Studies show that food insecurity is associated with poor health outcomes and increased health care costs and expenditures. As such, food insecurity creates stressful circumstances that can potentially lead to anxiety and risky health behaviors such as alcohol use, transactional sex, and smoking as coping mechanisms. However, little is known about the association of food insecurity with smoking and alcohol use in the general population.

Methods: The sample comprised of 189,000 adults aged 18-64 years. Three cycles of the National Health Interview Survey (NHIS) data from 2014-2016 were used for analysis. Alcohol use is measured by the frequency of drinking per week during the past year (12 months before the date the survey was conducted). Alcoholic beverages include liquor, beer, wine, and any other type of alcoholic beverage. Smoking is measured by the individual’s frequency of smoking, if an individual smoke every day, some days, or not at all. Food security is measured using an indicator of the family's food security status based on their food security raw-score (FSRAWSCORE) in the 30-day food security scale. The score is calculated based on 10 questions about the family’s food security status ranging from affordability, quantity, and quality of food. The status for food security is ranked as food secure, low food secure, very low food secure. NHIS measures food insecurity on a scale raw-score that ranges from 0-10, with a score of 0-2 as food secure, 3-5 low food secure, and 6-10 as very low food secure. Descriptive statistics and multinomial logistic regression models were used in analysis.

Results: The prevalence of food insecurity in the general population was 11.27 percent, with 6.48 percent low food secure and 4.79 percent very low food secure. Low food secure individuals had 1.1 times risk of smoking everyday compared to food secure individuals. The risk was much higher for very low food secure individual at 1.5 times risk of smoking every day compared to food secure individuals. Number of day in a week for alcohol use was negatively associated with low food security

Conclusion: Food insecurity is associated with increased frequency of smoking but alcohol use was negatively associated with food insecurity.