For women with or at risk for HIV in the United States, lower food security is associated with an increased risk for substance use, according to results published in Addiction.
Future research should explore whether this relationship is bidirectional and what mechanisms act in either direction.
The study included women with or at risk for HIV (n=2553). The researchers conducted semistructured interviews between April 2013 and March 2016. They measured food security using the Household Food Security Survey Module. Study outcomes included any illicit substance use except cannabis, licit or illicit cannabis use, stimulant use (crack/cocaine/methamphetamine), opioid use (heroin/methadone in a nonprescribed way), and prescription drug misuse (prescription narcotics/amphetamines/tranquilizers in a nonprescribed way) since the last visit.
The researchers used multivariable logistic regression with random effects to examine longitudinal associations of current and previous food security with outcomes, adjusting for sociodemographic factors, HIV serostatus, physical health, and health insurance.
The average number of visits was 4.6. At baseline, 71% of participants were HIV-positive; 44% reported marginal, low, or very low food security; and 13% were using illicit substances.
After adjusted analyses, the researchers found that current low and very low food security were significantly associated with a 1.6 (95% CI, 1.0-2.5; P <.05) and 2.5 (95% CI, 1.5-4.0; P <.001) higher odds of any illicit substance use, respectively, compared with high food security. Low and very low food security were also associated with higher odds of cannabis, stimulant, and opioid use with a consistent dose-response relationship.
The researchers found that marginal, low, and very low food security at the previous visit were associated with 1.7 (95% CI, 1.1-2.5; P <.05), 1.8 (95% CI, 1.1-2.7; P <.05), and 2.3 (95% CI, 1.4-3.6; P <.001) higher odds of current illicit substance use, respectively.
“Political focus is needed on the social, structural, and public health dimensions of substance use in the US, of which [food insecurity] is a component,” the researchers wrote. “This is especially true in the context of mutually reinforcing HIV and substance use epidemics with unique implications for women.”
Whittle HJ, Sheira LA, Frongillo EA, et al. Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States [published online August 14, 2018]. Addiction. doi: 10.1111/add.14418