Food insecurity risk and alcohol use disorder in US young adults: Findings from the National Longitudinal Study of Adolescent to Adult Health

Intersectional discrimination and alcohol problems among transfeminine people of color: The moderating role of financial instability

This study examines the conditional indirect effect of discrimination on alcohol problems among transfeminine people of color, moderated by financial instability. An online cross-sectional survey (N = 80) was conducted from October 2021 to May 2022 with transfeminine adults of color with a history of alcohol problems. Using Hayes' PROCESS Macro, results showed that past-year discrimination was associated with higher drinking motives, greater alcohol use, and more alcohol-related problems. Among participants experiencing financial instability, past-year discrimination was associated with greater alcohol use and subsequent alcohol problems. Conversely, among financially stable participants, past-year discrimination was associated with less alcohol use and fewer alcohol problems. Findings highlight that economic deprivation amplifies the impact of discrimination-related stress on alcohol problems. Addressing basic needs is essential to mitigating these effects. This study underscores the importance of transgender inclusive policies while calling for further research on longitudinal outcomes.

Food insecurity and substance use among young adults in the United States

PURPOSE

The purpose of this study was to examine the association between food insecurity and substance use among young adults aged 18-25 in the U.S.

METHODS

A cross-sectional online survey was completed by a diverse sample of 1024 young adults (50.2 % female; 62 % non-white; m age = 21.7[SD = 2.26]) between January-April 2022. Logistic regression analyses were used to examine the association between food insecurity and current cigarette use, Electronic Nicotine Delivery System (ENDS) use, cannabis use, alcohol use, and binge drinking controlling for socio-demographic and economic factors, mental health, and experiences of discrimination.

RESULTS

Nearly 70 % of participants reported being food insecure over the past year. Substance use was also common: 45.9 % of participants reported current cigarette use, 50.9 % ENDS use, 57 % cannabis use, 65.9 % alcohol use, and 50.4 % engaged in binge drinking in the past two weeks. Being food insecure was associated with greater odds of cigarette use (OR = 2.49, 95 % CI = [1.77, 3.50]), ENDS use (OR = 2.18, 95 % CI = [1.58, 3.01]), cannabis use (OR = 1.73, 95 % CI = [1.26, 2.37]), alcohol use (OR = 1.60, 95 % CI = [1.16, 2.19]) and binge drinking (OR = 1.98, 95 % CI = [1.44, 2.72]), controlling for all other factors.

CONCLUSION

Food insecurity may serve as an important indicator of substance use among young adults. Practitioners should consider screening for food insecurity, providing information about food access, and developing interventions to address food insecurity among the young adults with whom they work. Future research should examine these associations prospectively to better understand how food insecurity may contribute to the initiation and/or escalation of substance use.

Hazardous alcohol use is associated with food insecurity in adults living alone: Findings from a nationwide study in Korea

Food insecurity has emerged as a major public health issue. This cross-sectional study explored the association between hazardous alcohol use and food insecurity and how this association varies according to household composition. A nationally representative sample of 31,971 adults from the two separate wave of the Korea National Health and Nutrition Examination Surveys was analyzed. Hazardous alcohol use was measured using the four-item version of the Alcohol Use Disorders Identification Test (AUDIT-4). The outcome variable was food insecurity, as measured using the 18-item Household Food Security Survey. Household composition was classified into three categories: single-person households (individuals living alone), multi-person households without children, and multi-person households with children. Logistic regression was employed to evaluate the association between a 1-standard deviation (SD) increase in AUDIT-4 scores and food insecurity, estimating the odds ratio (OR) and the corresponding 95% confidence interval (CI). Among the participants, 9.4% lived alone, 55.8% lived within multi-person households without children, and 34.8% lived within multi-person households with children. While hazardous alcohol use showed no clear association with food insecurity in the overall sample (OR: 1.01; 95% CI: 0.94-1.08), there was positive interaction between the AUDIT-4 and living alone an on the odds of experiencing food insecurity (P < 0.001). Hazardous alcohol use and a 1-SD increase in AUDIT-4 score were associated with 1.52-fold (95% CI: 1.13-2.05) and 1.22-fold (95% CI: 1.06-1.40) increases in the odds of food insecurity among those living alone. Additionally, consuming ≥10 drinks on a single occasion (OR: 1.93, 95% CI: 1.14-3.26) and experience of concerns by others about drinking (OR: 2.02, 95% CI: 1.28-3.19) were positively associated with food insecurity among those living alone. Hazardous alcohol use is associated with food insecurity, only among individuals living alone. Therefore, targeted policy efforts are necessary to mitigate hazardous alcohol use and food insecurity.

Unit-Based Correlates of Marginal Food Insecurity Among US Soldiers

OBJECTIVES

Although studies have addressed food insecurity among veterans, few have focused on active-duty soldiers or on variables associated with the military occupational context. We examined the link between marginal food insecurity (defined as anxiety over food sufficiency or shortage of food in the house) among US soldiers and demographic, behavioral health, and unit-related factors.

METHODS

We analyzed survey data from 6343 active-duty soldiers using χ2 tests, generalized linear mixed-effect models, and adjusted odds ratios (AORs) to identify significant differences between soldiers categorized as marginally food insecure versus those who were not.

RESULTS

In a fully adjusted model taking unit into account, marginal food insecurity was associated with preferring not to report gender (vs reporting being male) (AOR = 1.39; 95% CI, 1.08-1.78), being married/in a relationship (vs being single) (AOR = 1.22; 95% CI, 1.06-1.40), junior enlisted rank (vs noncommissioned officer: AOR = 0.45; 95% CI, 0.37-0.54; and vs officer: AOR = 0.13; 95% CI, 0.09-0.19), less time in unit (vs more time) (AOR = 0.99; 95% CI, 0.99-1.00), screening positive for depression (vs not) (AOR = 2.67; 95% CI, 2.30-3.11), screening positive for hazardous drinking (vs not) (AOR = 1.34; 95% CI, 1.11-1.63), and lack of reported unit-related social support (vs support) (AOR = 0.52; 95% CI, 0.45-0.59).

CONCLUSIONS

In this sample, more than 1 in 5 US soldiers reported marginal food insecurity. In addition to supporting households with financial and food assistance and targeting junior enlisted personnel, policy makers and leaders should prioritize soldiers who are married or in a relationship, who are new to their unit, and who screen positive for depression and hazardous drinking, and they should encourage units to take care of unit members who need support. Policy makers and leaders can use these study results to direct prevention and early intervention initiatives.

Translational science approaches for food insecurity research

Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.

Persistent and Changing Food Insecurity Among Students at a Midwestern University is Associated With Behavioral and Mental Health Outcomes

PURPOSE

To assess associations between persistent and changing food insecurity and behavioral and mental health outcomes in college students.

DESIGN

Online surveys conducted November 2018 and March 2019 (freshman year), and March 2020 (sophomore year) were used to assess food insecurity, which was then used to create 4 food security transitions: persistent food insecurity, emergent food insecurity, emergent food security, and persistent food security.

SETTING

Large Midwestern university.

SAMPLE

593 students completing all 3 surveys.

MEASURES

Dietary intake and behavioral and mental health outcomes (eating disorders, anxiety, depression, sleep quality) were assessed using validated instruments.

ANALYSIS

Associations between food security transitions and dietary intake, behavioral, and mental health outcomes were examined using generalized linear models.

RESULTS

Compared to persistent food security, emergent and persistent food insecurity was associated with lower (7% and 13% respectively) intake of fruits and vegetables combined; persistent food insecurity was associated with 17% lower intake of fruits, 6% lower intake of fiber and 10% higher intake of added sugar from beverages. Compared to persistent food secure students, eating disorder symptom risk was higher for emergent food insecure (OR = 7.61, 95% CI: 3.32, 17.48), and persistent food insecure (OR = 6.60, 95% CI: 2.60, 16.72) students; emergent (OR = 2.05, 95% CI: 1.14, 3.71) and persistent (OR = 2.55, 95% CI: 1.34, 4.87) food insecure students had higher odds of poor sleep quality, and persistent food insecure, emergent food insecure, and emergent food secure students had higher odds of anxiety and depression (OR range 2.35-2.85).

CONCLUSION

Food security transitions were associated with aspects of low diet quality and poorer behavioral and mental health outcomes among college students.

Longitudinal Associations Between Food Insecurity and Mental Health in Aging Adults in South Africa

OBJECTIVES

The aim of this study was to assess the longitudinal unidirectional and bidirectional associations between food insecurity and mental health among aging adults in South Africa.

METHODS

The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa (HAALSI) study.

RESULTS

The proportion of food insecurity was 20.2% in 2015, 24.1% in 2019 and 18.4% in 2021/2022. Food insecurity was positively associated depressive symptoms, poor life satisfaction, poor sleep quality, PTSD, loneliness, impaired cognition, and current tobacco use. Compared to without food insecurity in all three study waves, having food insecurity in one wave and/or two to three waves was positively associated with incident depressive symptoms, incident poor life satisfaction, incident poor sleep quality, incident PTSD, incident loneliness, incident current tobacco use, and incident current heavy alcohol use. PTSD, impaired cognition, current tobacco use and current heavy alcohol use were positively associated with incident food insecurity.

CONCLUSION

We found that food insecurity was unidirectionally associated with depressive symptoms, poor life satisfaction, poor sleep quality and loneliness, and bidirectionally associated with PTSD, impaired cognition, current tobacco use and current heavy alcohol use.

CLINICAL IMPLICATIONS

Enhanced screening and management of food insecurity may reduce mental ill-health in South Africa.

Food insecurity is associated with lower diet quality among dental students

PURPOSE

Food insecurity is associated with lower diet quality, adverse health outcomes, and academic difficulty among undergraduate students. The objective was to identify the relationship between food security status and diet quality in dental students.

METHODS

All dental students attending Howard University (n = 286) or the University of Iowa (n = 326) during the fall 2021 semester were invited to complete a cross-sectional survey designed to query demographics, food security status (i.e., United States Department of Agriculture's ten item Adult Food Security Module), and diet quality (i.e., short Healthy Eating Index). The survey was administered using the Qualtrics platform.

RESULTS

Response rates were similar for Howard (32.5%) and Iowa (29.4%). Students with food insecurity (46.0%) were slightly older and more likely to be Black or other, first generation professional/graduate students, and receive financial aid than peers with food security (p < 0.050). Food insecurity was associated with lower intakes of fruits and vegetables (p ≤ 0.005), higher intakes of added sugars (p < 0.001), and lower diet quality (p = 0.003). In linear regression analyses that controlled for other variables, food insecurity (p = 0.012), school site (p = 0.027), and gender (p = 0.039) were predictive of lower diet quality.

CONCLUSIONS

The inability to procure adequate and appropriate foods was associated with marginal dietary habits (i.e., less than ideal food choices and eating behaviors) and lower diet quality in dental students. Both marginal dietary habits and lower diet quality increase chronic disease risk and may present a barrier to academic success. Addressing food insecurity among dental students is necessary to ensure equitable opportunities for a healthy workforce in the future.

Increased alcohol use during the COVID-19 pandemic among people with HIV from racial/ethnic minority groups in South Florida

People with HIV (PWH) from racial/ethnic minority groups may be particularly vulnerable to the effects of the COVID-19 Pandemic. Exacerbated COVID-19-related stressors may lead to maladaptive coping mechanisms such as increased alcohol use. This study examined socioeconomic and psychosocial predictors of increased alcohol use during the first year of the COVID-19 Pandemic among PWH from racial/ethnic minority groups in South Florida. Data were collected from Ryan White Program clients during October 2020-January 2021 using a cross-sectional phone survey, and were analyzed using logistic regression modeling. Among 139 participants, 20% reported increased alcohol use. Findings showed that being unable to buy needed food (adjusted odds ratio [aOR]: 3.37; 95% confidence interval [CI]: 1.01-11.31) and spending more time caring for children (aOR: 5.22, 95% CI: 1.61-16.88) was associated with increased alcohol use during the Pandemic. Providing support to alleviate food insecurity and manage caregiving burden during public health crises like the COVID-19 Pandemic might help prevent increases in alcohol use among PWH.

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States

OBJECTIVE

Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample.

METHODS

Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents.

RESULTS

About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use.

CONCLUSION

Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

G, H.L. H, D. P, T. S, S.L. D, K. B, W.P. K, C.W. H, T.L. K. Disentangling the effects of Corticotrophin Releasing Factor and GABA release from the ventral bed nucleus of the stria terminalis on ethanol self-administration in mice

Excessive alcohol use causes a great deal of harm and negative health outcomes. Corticotrophin releasing factor (CRF), a stress-related neuropeptide, has been implicated in binge ethanol intake and ethanol dependence. CRF containing neurons in the bed nucleus of the stria terminalis (BNSTCRF) can control ethanol consumption. These BNSTCRF neurons also release GABA, raising the question, is it CRF or GABA release or both that is controlling alcohol consumption. Here, we used viral vectors to separate the effects of CRF and GABA release from BNSTCRF neurons on the escalation of ethanol intake in an operant self-administration paradigm in male and female mice. We found that CRF deletion in BNST neurons reduces ethanol intake in both sexes, with a stronger effect in males. For sucrose self-administration there was no effect of CRF deletion. Suppression of GABA release, via knockdown of vGAT, from BNSTCRF produced a transient increase in ethanol operant self-administration following in male mice, and reduced in motivation to work for sucrose on a progressive ratio schedule of reinforcement in a sex-dependent manner. Together, these results highlight how different signaling molecules from the same populations of neurons can bidirectionally control behavior. Moreover, they suggest that BNST CRF release is important for high intensity ethanol drinking that precedes dependence, whereas GABA release from these neurons may play a role in regulating motivation.

Latina mothers' perspectives on adverse experiences and protection of Latinx youth in an agricultural community

BACKGROUND

Adverse Childhood Experiences (ACEs) are a measure of childhood toxic stress that have a dose-dependent relationship with many adult health outcomes. While ACEs have been validated across diverse populations to measure neglect, abuse, and family dysfunction, they do not specifically assess trauma related to racism/xenophobia and immigration. 54% of Latinx youth in the United States are immigrants or children of immigrants and a large group with potentially unmeasured trauma. This study looks beyond ACEs to identify adverse and protective factors for healthy development among Latinx youth in an agricultural community through the perspectives of their mothers.

METHODS

Twenty mothers of adolescent participants in A Crecer: the Salinas Teen Health Study (a prospective cohort study of 599 adolescents) completed semi-structured interviews in Spanish. Interviews focused on mothers' perspectives on community resources, parenting strategies, parenting support systems, and their future aspirations for their children. Four coders completed iterative rounds of thematic coding drawing from published ACEs frameworks (original ACEs, community ACEs) and immigrant specific adverse events arising from the data.

RESULTS

Mothers in this study reported adverse experiences captured within community-level ACEs but also distinct experiences related to intergenerational trauma and immigrant-related adversities. The most cited community-level ACEs were housing instability and community violence. Immigrant related adversities included experiences of systemic racism with loss of resources, political instability limiting structural resources, and language-limited accessibility. These were exacerbated by the loss of family supports due to immigration related family-child separation including deportations and staggered parent-child migration. Having experienced intergenerational trauma and systemic oppression, mothers discussed their strategies for building family unity, instilling resilience in their children, and improving socioeconomic opportunities for their family.

CONCLUSIONS

Latina mothers shared the impacts of immigrant-related experiences on systemic inequities in the United States which are currently missing from the ACEs framework. Immigrant specific adverse events include language-limited accessibility, or family-child separations, and policies impacting structural resources for immigrant families. Mothers highlighted their capacity to build resilience in their children and buffer impacts of systemic racism. Community-tailored interventions can build on this foundation to reduce health disparities and promote health equity in this population.