Association of Problematic Alcohol Use and Food Insecurity among Homeless Men and Women

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.

Household food insecurity, sociodemographic and lifestyle risk factors associated with high blood pressure among women in farming communities in Ghana

BACKGROUND

Hypertension remains a primary contributor to avoidable mortality and impairment. This study aimed to examine the association between household food insecurity (HFI), another public health concern, and hypertension among women farmers in peri-urban and rural communities in Ghana.

METHODS

Self-reported hypertension status, blood pressure measurement, and HFI were assessed using data on 430 women from a cross-sectional survey. We examined the odds of hypertension in women experiencing different categories of food insecurity while controlling for other known factors.

RESULTS

Close to 74% (n = 319) of respondents belonged to households that were food-secure with 26% (n = 111) in food-insecure households. At the time of the survey, about a fifth of the participants (19%) reported to have ever been diagnosed with hypertension and 22% were living with high blood pressure (i.e., systolic: 140 mm Hg or higher and diastolic: 90 mm Hg or higher). Living in a rural community compared to a peri-urban community was associated with lower odds of living with high blood pressure. Older women were more likely than younger women to report having known hypertension and living with high blood pressure. Dangbe women were less likely to have high blood pressure than women from other ethnic groups. An increase in physical/morbidity activity was associated with a decreased likelihood of high blood pressure among food-insecure women.

CONCLUSIONS

This study buttresses the importance of hypertension awareness among older women, particularly, in urbanizing communities, and the need to explore mediating factors through which ethnicity may influence living with high blood pressure.

Food Insecurity Is Increasing and Is More Common Among Persons with Chronic Liver Disease

BACKGROUND

Effective interventions for metabolic liver disease include optimized nutritional intake. It is increasingly clear, however, that many patients with metabolic liver disease lack the resources to execute nutritional advice. Data on the trends of food insecurity are needed to prioritize public health strategies to address the burden of liver disease.

METHODS

Cross-sectional analysis of six waves of data from 24,847 adults aged > 20 years from the 2017-2018 National Health and Nutrition Examination Survey. Food security was measured using the US Department of Agriculture's Core Food Security Module. Liver disease was defined as elevated liver enzymes and a risk factor: elevated BMI, diabetes, and/or excess alcohol consumption. Advanced liver disease was estimated using FIB-4 > 2.67.Additional covariates included age, sex, race/ethnicity, education, marital status, poverty-income ratio, alcohol intake, body mass index, diabetes, and participation in the Supplemental Nutrition Assistance Program (SNAP).

RESULTS

The overall prevalence of liver disease was 24.6%, ranging from 21.1% (2017-2018) to 28.3% (2015-2016) (P-trend = 0.85). 3.4% of participants had possible advanced liver disease, ranging from 1.9% (2007-2008) to 4.2% (2015-2016)(P-trend = 0.07). Among those with liver disease, the prevalence of food insecurity was 13.6% in 2007-2008, which rose steadily to 21.6% in 2015-2016, before declining to 18.0% in 2017-2018 (P-trend = 0.0004). Food insecurity rose more sharply for adults aged < 50 years (2007-2008: 17.6%, 2015-2016: 28.0%, P-trend = 0.004) compared to adults aged ≥ 50 years (2007-2008: 9.5%, 2015-2016: 16.5%, P-trend < 0.0001). Similarly among those with liver disease, significant predictors of food insecurity included Hispanic ethnicity, low educational attainment, and participating in SNAP.

CONCLUSION

Food insecurity is increasingly common among those with liver disease.

A Meta-analysis of the Prevalence of Food Insecurity Among People Experiencing Housing Insecurity and Homelessness in the United States

OBJECTIVES

Studies suggest that people experiencing housing insecurity and homelessness (HIH) have varying experiences with food insecurity. We estimated the prevalence of food insecurity and identified the factors associated with it among people experiencing HIH in the United States.

METHODS

We conducted a meta-analysis of the prevalence of food insecurity among people experiencing HIH and a systematic review of associated factors through a comprehensive search of 8 academic databases. We identified 3398 unique articles and included 40 studies in the review that met the following criteria: included observational or experimental data on the prevalence of food insecurity among people experiencing HIH, conducted in the United States, and written in English.

RESULTS

The overall prevalence of food insecurity was 57% (95% CI, 48%-65%). Most people experiencing HIH had food insecurity, and our estimated prevalence among people experiencing HIH was >4 times higher than the prevalence in the US population. Experiencing symptoms of a mental health condition (eg, depression, posttraumatic stress disorder, anxiety) in addition to HIH was most frequently (7 datasets) associated with increased odds of food insecurity. Social and institutional support was most frequently (5 datasets) associated with decreased odds of food insecurity.

CONCLUSION

Our findings suggest that multisector coordination is needed to address individual- and system-level factors associated with food insecurity and HIH.

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.

Addressing food insecurity: what is the role of healthcare?

Food insecurity - when individuals or households have difficulty accessing sufficient, safe, culturally appropriate and nutritious food due to lack of money or other resources - is a global public health concern. Levels of food insecurity have increased across the UK in recent years, due in part to a decade of austerity, widespread loss of income during the COVID-19 pandemic and the more recent cost-of-living crisis, leading to rising use of food banks. The stress of living with uncertain access to food and going periods without food is damaging to physical and mental health. Food insecurity is linked to both obesity and malnutrition, as often the most readily available foods are processed, high in fats, sugars and salt, but low in essential nutrients for health. While recognising that many of the drivers of food insecurity, and health inequalities more broadly (i.e. the social determinants of health) lie outside the health service, it is increasingly acknowledged that the National Health Service - and primary care in particular - has a key role to play in mitigating health inequalities. This review considers the potential role of healthcare in mitigating food insecurity, with a focus on primary care settings. Recent initiatives in Scotland, such as community links workers and general practitioner practice-attached financial advice workers, have shown promise as part of a more community-oriented approach to primary care, which can mitigate the effects of food insecurity. However, a more 'upstream' response is required, including 'cash first' interventions as part of broader national strategies to end the need for food banks.

Food Insecurity is Increasing and is More Common Among Persons with Chronic Liver Disease

Background

Effective interventions for metabolic liver disease include optimized nutritional intake. It is increasingly clear, however, that many patients with metabolic liver disease lack the resources to execute nutritional advice. Data on the trends of food insecurity are needed to prioritize public health strategies to address the burden of liver disease.

Methods

Cross-sectional analysis of six waves of data from the 2007-2018, 24,847 subjects aged ≥20 years from the 2017-2018 National Health and Nutrition Examination Survey. Food security was measured using the US Department of Agriculture's Core Food Security Module. Liver disease was defined as elevated liver enzymes and a risk factor: elevated BMI, diabetes, and/or excess alcohol consumption. Models were adjusted using age, sex, race/ethnicity, education, poverty-income ratio, smoking, physical activity, alcohol intake, sugary beverage intake, Healthy Eating Inex-2015 score. Advanced liver disease was estimated using FIB-4 >2.67.

Results

The overall prevalence of liver disease was 24.6%, ranging from 21.1% (2017-2018) to 28.3% (2015-2016) (P-trend=0.85). 3.4% of participants had possible advanced liver disease, ranging from 1.9% (2007-2008) to 4.2% (2015-2016)(P-trend=0.07). Among those with liver disease, the prevalence of food insecurity was 13.6% in 2007-2008, which rose steadily to 21.6% in 2015-2016, before declining to 18.0% in 2017-2018 (P-trend=0.0004). Food insecurity rose more sharply for adults aged <50 years (2007-2008: 17.6%, 2015-2016: 28.0%, P-trend=0.004) compared to adults aged ≥50 years (2007-2008: 9.5%, 2015-2016: 16.5%, P-trend<0.0001). Food insecurity was more common among women, those with high BMI, and those with diabetes.

Conclusion

Food insecurity is increasingly common among those with liver disease.

Association between religiosity/spirituality and substance use among homeless individuals

BACKGROUND

Alcohol and illicit drug use are prevalent among homeless people. Religiosity and spirituality (RS) have been widely associated with lower consumption of substances. However, evidence of this relationship among homeless people is still scarce.

AIMS

To evaluate the associations between RS and alcohol and illicit drug consumption among homeless people in a large Brazilian urban center.

METHOD

This cross-sectional study was carried out in São Paulo city, Brazil. Aspects such as spirituality (FACIT-Sp12), religiosity (DUREL), spiritual-religious coping (Brief-RCOPE), and self-report questions concerning the current substance use (alcohol and illicit substances) were evaluated. Adjusted logistic regression models were used to assess the impact of RS beliefs on alcohol and illicit drug consumption.

RESULTS

A total of 456 homeless people were included, of an average age of 44.5 (SD = 12.6) years. More than half of the participants consumed alcohol (55.7%) weekly and 34.2% used illicit drugs weekly. Adjusted logistic regression models identified that aspects of RS were associated with lower likelihood factors for alcohol and illicit drug use; conversely, negative spiritual religious coping (SRC) strategies were associated with a higher likelihood to use both.

CONCLUSION

The prevalence of alcohol and illicit drug use among participants was high. RS and positive SRC were important protective factors for lower consumption of these substances. Conversely, negative SRC strategies were associated with risk factors.

Alcohol misuse as a social determinant of food insecurity among smallholder farmers

The availability and affordability of alcohol in smallholder communities have surged the misuse of alcohol. Misusing alcohol has dire health and nutrition consequences in smallholder communities. Alcohol misuse can divert household resources from essential household needs such as food and also hinder local food production. In the context of multiple stressors on smallholder farmers' livelihoods, it is crucial to assess the relationship between alcohol consumption and smallholder farmers' experience of hunger. Therefore, we used data from a cross-sectional survey involving 1100 smallholder farmers in the Upper West region of Ghana to examine the association between alcohol consumption and household food insecurity. Results showed that daily (OR = 3.81; p ≤ 0.001) and weekly/frequent (OR = 2.32; p ≤ 0.001) consumption of alcohol was significantly associated with higher odds of household food insecurity compared to no consumption. The relationship between alcohol and food insecurity was bidirectional. The experience of food insecurity was also significantly associated with higher odds of occasional or frequent alcohol consumption. While alcohol misuse can transition smallholder households into food insecurity, the household heads of food insecure households may resort to alcohol to cope with underlying stressors such as climate change and food insecurity. This calls for policy interventions to mitigate alcohol misuse through regulations, surveillance, economic disincentives and improving the social mechanisms of resilience to climate change and food insecurity in smallholder communities. However, policy approaches must be cautious not to disrupt the livelihoods of vulnerable smallholder farmers.

Sexual Orientation and Food Hardship: National Survey of Family Growth, 2011-2019

OBJECTIVE

Given the high rates of poverty observed among sexual minority groups and their social vulnerability, we examined the prevalence and correlation of food hardship, measured as food insecurity, receipt of free or reduced-cost food, and Supplemental Nutrition Assistance Program (SNAP) participation among low-income sexual minority and heterosexual adults using population-level health surveillance data.

METHODS

We used 4 waves of pooled data (2011-2019) from the National Survey of Family Growth for adults aged 18-44 years. We compared the sexual orientation subgroups and used logistic regression to predict the likelihood of food hardship.

RESULTS

Among men, gay and bisexual men had higher odds of experiencing food insecurity than their heterosexual counterparts (adjusted odds ratio [aOR] = 1.97 and 1.83, respectively). Compared with heterosexual men, bisexual men had significantly higher odds of receiving free or reduced-cost food, but gay men did not. The odds of participating in SNAP did not differ significantly among gay, bisexual, and heterosexual men. Among women, only bisexual women were more prone to experiencing food insecurity than their heterosexual counterparts (aOR = 1.81). The odds of receiving free or reduced-cost food did not differ significantly among heterosexual, bisexual, and lesbian women. However, compared with heterosexual women, lesbian women had significantly lower odds (aOR = 0.62) and bisexual women had significantly higher odds (aOR = 1.24) of participating in SNAP.

CONCLUSION

Our findings contribute to the limited literature examining trends in food hardship among sexual minority groups and suggest potentially different patterns of food insecurity, food assistance, and SNAP participation among sexual orientation subgroups, which may call for group-specific, nuanced approaches for lessening food hardship.

Food insecurity is associated with an unhealthy lifestyle score in middle- and older-aged adults: findings from the EPIPorto cohort

The association of food insecurity with the combined effect of lifestyles is still limited. This study evaluated the association between food insecurity and a lifestyle score in middle- and older-aged adults. A cross-sectional study (2013-2016) was performed among 595 individuals (≥ 50 years) from the EPIPorto cohort (Porto, Portugal). Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Information on fruit and vegetable consumption (F&V), physical activity (PA) practice, tobacco smoking, and alcohol consumption were included in a lifestyle score. Those with F&V < five portions/day, < 150 min/week of moderate-intensity PA or < 75 min/week of vigorous-intensity PA, current smokers, consumers of > one drink of alcoholic beverages in women, and > two in men were assigned with one point; all the others had nil points. The score could range from 0 to 4, and was further categorised into three categories. Food insecurity was positively associated with an unhealthy lifestyle profile (OR = 2.272; 95%CI:1.079-4.782), independently of the adjustment variables. Analysing each lifestyle component, food insecurity was associated with low PA practice (OR = 2.365; 95%CI:1.020-5.485). Individuals from food insecure households were more likely to have an unhealthy lifestyle profile. Public health strategies should be developed among food insecure individuals to promote healthy lifestyles.

Development and preliminary effectiveness of a smartphone-based, just-in-time adaptive intervention for adults with alcohol misuse who are experiencing homelessness

BACKGROUND

Adults experiencing homelessness have much higher rates of alcohol misuse than housed individuals. This study describes the development and preliminary effectiveness of a smartphone-based, just-in-time adaptive intervention (JITAI) to reduce alcohol use among adults experiencing homelessness.

METHODS

We conducted a pilot trial (N = 41; mean age [SD] = 45.2 [11.5]; 19.5% women) of the Smart-T Alcohol JITAI where participants completed brief ecological momentary assessments (EMAs) each day, received personalized treatment messages following each EMA, and accessed on-demand intervention content for 4 weeks. The prediction algorithm and treatment messages were developed based on an independent but similar sample as part of the trial. We examined three drinking outcomes: daily drinking (yes/no), drinks per day, and heavy episodic drinking, controlling for scores on the Alcohol Use Disorders Identification Test (AUDIT) at baseline, age, and sex using quadratic growth curve models.

RESULTS

Over the 4-week period, participants showed a decline in all alcohol use outcomes. Participants also reported high levels of satisfaction with the JITAI.

CONCLUSIONS

Use of the Smart-T Alcohol JITAI was well received and provided encouraging evidence that it may reduce any drinking, drinks per day, and heavy episodic drinking among adults experiencing homelessness.

Evaluation of General Health Status of Persons Living in Socio-Economically Disadvantaged Neighborhoods in a Large European Metropolitan City

Background: Living in socio-economically disadvantaged neighborhoods can predispose persons to numerous health conditions. The purpose of this study was to report the general health conditions of persons living in disadvantaged neighborhoods in Rome, Italy, a large European metropolitan city. Participants were reached through the mobile facilities of the primary care services of the Dicastery for the Charity Services, Vatican City. Methods: People living in disadvantaged neighborhoods were reached with mobile medical units by doctors, nurses, and paramedics. Demographic characteristics, degree of social integration, housing conditions, and history of smoking and/or alcohol use were investigated. Unstructured interviews and general health assessments were performed to investigate common acute and/or chronic diseases, and history of positivity to COVID-19. Basic health parameters were measured; data were collected and analyzed. Results: Over a 10-month period, 436 individuals aged 18–95 years were enrolled in the study. Most lived in dormitories, whereas a few lived in unsheltered settings. Most participants (76%) were unemployed. Smoking and drinking habits were comparable to the general population. The most common pathological conditions were cardiovascular diseases in 103 subjects (23.39%), diabetes in 65 (14.9%), followed by musculoskeletal system disorders (11.7%), eye diseases (10.5%), psychiatric conditions such as anxiety and depression (9.2%), and chronic respiratory conditions (8.7%). Conclusions: Subjects in our sample showed several pathologic conditions that may be related to their living conditions, thus encouraging the development of more efficient and effective strategies for a population-tailored diagnosis and treatment.

Association of food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from low- and middle-income countries

BACKGROUND

The aim of the present study was to investigate associations between food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from six low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the World Health Organisation's Study on Global Aging and Adult Health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts was collected. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the association between food insecurity and suicidal ideation or suicide attempts.

RESULTS

The final analytical sample included 34,129 individuals aged ≥50 years [mean (SD) age 62.4 (16.0) years; 52.1% females]. Compared to no food insecurity, severe food insecurity was associated with a significant 2.78 (95%CI = 1.73-4.45) times higher odds for suicidal ideation, while moderate and severe food insecurity were associated with 2.59 (95%CI = 1.35-4.97) and 5.15 (95%CI = 2.52-10.53) times higher odds for suicide attempts, respectively.

LIMITATIONS

The cross-sectional design, the use of self-reported wish to die as a measure of suicide ideation, and that suicidal ideation and suicide attempts were only assessed among those who had depressive symptoms, could be considered limitations of our study.

CONCLUSIONS

Food insecurity was positively associated with suicidal ideation and suicide attempts. Targeting food insecurity among older adults in LMICs may lead to reduction in suicidal ideation and suicide attempts, although future longitudinal studies are warranted to confirm this.

Association of food security with cardiometabolic health during young adulthood: cross-sectional comparison of American Indian adults with other racial/ethnic groups

OBJECTIVES

Our aim was to assess the cross-sectional associations between food insecurity and cardiometabolic health indicators in American Indian young adults compared with non-Hispanic white, black, Asian or Pacific Islander and Hispanic young adults.

DESIGN

Data from the fourth wave of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were used. Variables included a self-assessed measure of risk of food insecurity, indicators of cardiometabolic health (body mass index, haemoglobin A1c, blood pressure) and sociodemographic characteristics. Multivariable regression models were used to assess the association of risk of food insecurity with cardiometabolic health, while controlling for sociodemographic variables. All analyses were weighted and accounted for the complex survey design.

PARTICIPANTS

The analytical sample of n=12 799 included mostly non-Hispanic white respondents (n=7900), followed by n=2666 black, n=442 American Indian, n=848 Asian or Pacific Islander and n=943 Hispanic.

RESULTS

Risk of food insecurity was more common among respondents who were female, Black, American Indian, had lower educational attainment, and were classified as having obesity or diabetes. In unadjusted models, risk of food insecurity was significantly associated with greater odds of obesity (OR=1.39; 95% CI 1.20 to 1.60) and diabetes (OR=1.61; 95% CI 1.23 to 2.11). After adjusting for sociodemographic factors (age, sex, education, income, household size, tobacco smoking, alcohol intake and race/ethnicity), only the association between risk of food insecurity and obesity remained (OR=1.19; 95% CI 1.03 to 1.38). Relationships among risk of food insecurity, sociodemographic characteristics and diabetes varied across models stratified by race and ethnicity.

CONCLUSIONS

Results suggest that elevated risk of food insecurity is present in young American Indian adults, but its relationship with cardiometabolic health is unclear. Future work should capitalise on longitudinal data and the US Department of Agriculture's Food Security Survey Modules.

Guest Support for Outdoor Smoke-Free Policies within a Homeless Shelter

Roughly 70-80% of adults experiencing homelessness smoke cigarettes. Smoke-free living/workplace policies are an empirically-supported tobacco control intervention. However, homeless shelters may be reluctant to implement smoke-free policies due to fears of it discouraging current/potential shelter guests from taking refuge there. The current study was meant to characterize guest support for on-property smoke-free policies within a homeless shelter with an extant indoor tobacco use ban amongst never smokers, former smokers, and current smokers to provide data on this point. Participants comprised a convenience sample of adult guests of a homeless shelter in Texas (N = 394, 28.2% women; 10.2% former; and 75.9% current smokers). Participant sociodemographics, smoking status, behavioral health diagnoses, and support for two versions of an on-property outdoor courtyard smoke-free policy (one partial, one complete) were assessed. Data were collected in two waves in a repeated cross-sectional design. Overall, 64.0% of participants supported a partial, and 32.0% a full smoking ban. Logistic regressions, controlling for wave of data collection, age, sex, and any additional significant predictors from a semi-adjusted model, examined associations between participant characteristics and policy support. Older participants (OR = 1.024, CI_0.95 = 1.005-1.044), non-veterans (OR = 2.523, CI_0.95 = 1.156-5.506), former smokers (OR = 2.730, CI_0.95 = 1.191-6.258), and those without severe mental illness (OR = 1.731, CI_0.95 = 1.061-2.824) had significantly greater odds of supporting a partial smoking ban. Relative to current smokers, never smokers (OR = 3.902, CI_0.95 = 2.133-7.137) and former smokers (OR = 8.257, CI_0.95 = 3.951-17.258) had significantly greater odds of supporting a complete smoking ban. The implementation of smoke-free living/workplace policies in homeless shelters may enjoy more support from guests-specifically, non-smokers-than anticipated by shelter administrators. Aside from reducing ambient smoke exposure for never and former smokers, these policies can help to reduce ubiquitous smoking cues for those who may want to quit, are undergoing a quit attempt, or are trying to maintain abstinence. Interventionists might partner with shelter guests, particularly smokers, to inform the roll-out of such policies for maximal acceptance and adoption.

Homelessness and Public Health: A Focus on Strategies and Solutions

On any given night, hundreds of thousands of people are homeless in the United States and Canada [...].

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

BACKGROUND AND OBJECTIVES

The relationship between food insecurity and alcohol use disorder remains unknown. The aim of this study was to determine the association between food insecurity risk and alcohol use disorder in a nationally representative sample of young adults.

METHODS

Cross-sectional nationally representative data of 14,786 US young adults aged 24-32 years old from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed to assess a single-item measure of food insecurity risk and Diagnostic and Statistical Manual, 5th Edition (DSM-5) alcohol use disorder.

RESULTS

Among young adults, 12% were found to be at risk for food insecurity. Young adults with food insecurity risk had greater odds of moderate (adjusted odds ratio [AOR]: 1.34, 95% confidence interval [CI]: 1.13-1.58) and severe (AOR: 1.67, 95% CI: 1.34-2.07) threshold alcohol use disorder than food-secure young adults, adjusting for age, sex, race/ethnicity, education, income, receipt of public assistance, household size, and smoking. Food insecurity risk was also associated with a 23% higher (95% CI: 11%-37%) number of problematic alcohol use behaviors (e.g., risky behaviors, continued alcohol use despite emotional or physical health problems).

DISCUSSION AND CONCLUSIONS

Food insecurity risk is associated with problematic patterns of alcohol use. Health care providers should screen for food insecurity and problematic alcohol use in young adults and provide referrals for further resources and treatment when appropriate.

SCIENTIFIC SIGNIFICANCE

This nationally representative study of US young adults is the first to find an association between food insecurity risk and alcohol use disorder using DSM-5 criteria.

Perceived Social Support Attenuates the Association between Stress and Health-Related Quality of Life among Adults Experiencing Homelessness

Health-related quality of life (HRQoL) is defined as a multidimensional subjective assessment of one’s physical and mental health. Homelessness is associated with numerous stressors that can reduce HRQoL. Social support is defined as the availability of individuals, or resources provided by individuals, to cope with stress. Interpersonal social support may be important in buffering HRQoL from the negative implications of stress. Here, we examine this association in a marginalized group known for high rates of physical and mental health comorbidities: adults experiencing homelessness. Participants (N = 581; 63.7% men; M_age = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Social support was measured with the 12-item Interpersonal Support Evaluation List (ISEL). HRQoL was measured by the Behavioral Risk Factor Surveillance System (BRFSS) survey using self-rated health, the number of poor mental and poor physical health days over the preceding 30 days, as well as the number of limited activity days as the result of poor mental and/or physical health. Perceived stress was assessed using the 4-item Perceived Stress Scale (PSS). The potential moderation effect of social support was examined by assessing the interaction term of social support and stress in a series of linear regression analyses, controlling for sex, age, months homeless, race, education, health insurance status, serious mental illness diagnosis, and recruitment agency/site. There was a significant interaction effect of social support and stress on the prediction of days of poor physical health, days of poor mental health, and days of limited activity (p in all cases ≤ 0.05). Results add to a growing literature on the potentially protective benefits of social support for HRQoL, extend them to a large sample of adults experiencing homelessness in the South, and demonstrate the significance of this moderating effect of social support over and above the influence of several prominent sociodemographic and diagnostic variables. Future work should determine if interventions designed to enhance social support can buffer HRQoL from the deleterious effects of stress among this vulnerable population.

'Joining the Dots': Individual, Sociocultural and Environmental Links between Alcohol Consumption, Dietary Intake and Body Weight-A Narrative Review

Alcohol is energy-dense, elicits weak satiety responses relative to solid food, inhibits dietary fat oxidation, and may stimulate food intake. It has, therefore, been proposed as a contributor to weight gain and obesity. The aim of this narrative review was to consolidate and critically appraise the evidence on the relationship of alcohol consumption with dietary intake and body weight, within mainstream (non-treatment) populations. Publications were identified from a PubMed keyword search using the terms 'alcohol', 'food', 'eating', 'weight', 'body mass index', 'obesity', 'food reward', 'inhibition', 'attentional bias', 'appetite', 'culture', 'social'. A snowball method and citation searches were used to identify additional relevant publications. Reference lists of relevant publications were also consulted. While limited by statistical heterogeneity, pooled results of experimental studies showed a relatively robust association between acute alcohol intake and greater food and total energy intake. This appears to occur via metabolic and psychological mechanisms that have not yet been fully elucidated. Evidence on the relationship between alcohol intake and weight is equivocal. Most evidence was derived from cross-sectional survey data which does not allow for a cause-effect relationship to be established. Observational research evidence was limited by heterogeneity and methodological issues, reducing the certainty of the evidence. We found very little qualitative work regarding the social, cultural, and environmental links between concurrent alcohol intake and eating behaviours. That the evidence of alcohol intake and body weight remains uncertain despite no shortage of research over the years, indicates that more innovative research methodologies and nuanced analyses are needed to capture what is clearly a complex and dynamic relationship. Also, given synergies between 'Big Food' and 'Big Alcohol' industries, effective policy solutions are likely to overlap and a unified approach to policy change may be more effective than isolated efforts. However, joint action may not occur until stronger evidence on the relationship between alcohol intake, food intake and weight is established.

Ecological Momentary Assessment of Alcohol Consumption and Its Concordance with Transdermal Alcohol Detection and Timeline Follow-Back Self-report Among Adults Experiencing Homelessness

Background

Studies of alcohol use presume valid assessment measures. To evaluate this presumption, we examined the concordance of alcohol use as measured by ecological momentary assessment (EMA) self‐reports, transdermal alcohol concentration readings via the Secure Continuous Remote Alcohol Monitor (SCRAM), and retrospective self‐reports via the Timeline Follow‐Back (TLFB) among adults experiencing homelessness.

Methods

Forty‐nine adults who reported alcohol misuse (mean age = 47, SD = 9; 57% Black; 82% men) were recruited from a homeless shelter. For 4 weeks, alcohol use was assessed: (i) 5 times or more per day by EMA, (ii) every 30 minutes by a SCRAM device worn on the ankle, and (iii) by TLFB for the past month at the end of the study period. There were 1,389 days of observations of alcohol use and alcohol use intensity for 49 participants.

Results

EMA and SCRAM alcohol use data agreed on 73% of days, with an interrater agreement Kappa = 0.46. A multilevel analysis of concordance of 3 measures for alcohol use yielded statistically significant correlations of 0.40 (day level) and 0.63 (person level) between EMA and SCRAM. Alcohol use was detected on 49, 38, and 33% of days by EMA, SCRAM, and TLFB, respectively. For alcohol use intensity, EMA and SCRAM resulted in statistically significant correlations of 0.46 (day level) and 0.78 (person level). The concordance of TLFB with either EMA or SCRAM was weak, especially at the day level.

Conclusions

This is the first study to examine concordance of alcohol use estimates using EMA, SCRAM, and TLFB methods in adults experiencing homelessness. EMA is a valid approach to quantifying alcohol use, especially given its relatively low cost, low participant burden, and ease of use. Furthermore, any stigma associated with wearing the SCRAM or reporting alcohol use in person may be attenuated by using EMA, which may be appealing for use in studies of stigmatized and underserved populations.

Mental Illness and Youth-Onset Homelessness: A Retrospective Study among Adults Experiencing Homelessness

Financial challenges, social and material instability, familial problems, living conditions, structural issues, and mental health problems have been shown to contribute to youth homelessness. Based on the paucity of literature on mental illness as a reason for youth homelessness, the current study retrospectively evaluated the association between the timing of homelessness onset (youth versus adult) and mental illness as a reason for homelessness among homeless adults living in homeless shelters and/or receiving services from homeless-serving agencies. Homeless participants (N = 919; 67.3% men) were recruited within two independent studies from Dallas and Oklahoma. Covariate-adjusted logistic regressions were used to measure associations between homelessness onset and mental illness as a reason for current homelessness, history of specific mental illnesses, the historical presence of severe mental illness, and severe mental illness comorbidity. Overall, 29.5% of the sample reported youth-onset homelessness and 24.4% reported mental illness as the reason for current homelessness. Results indicated that mental illness as a reason for current homelessness (AOR = 1.62, 95% CI = 1.12–2.34), history of specific mental illnesses (Bipolar disorder–AOR = 1.75, 95% CI = 1.24–2.45, and Schizophrenia/schizoaffective disorder–AOR = 1.83, 95% CI = 1.22–2.74), history of severe mental illness (AOR = 1.48, 95% CI = 1.04–2.10), and severe mental illness comorbidities (AOR = 1.30, 95% CI: 1.11–1.52) were each associated with increased odds of youth-onset homelessness. A better understanding of these relationships could inform needs for early interventions and/or better prepare agencies that serve at-risk youth to address precursors to youth homelessness.

Differences in Utilization of Medical and Dental Services among Homeless People in South Korea

(1) Background: Homelessness contributes to both needs for care and barriers to access. This study aimed to explore the utilization of medical or dental services using Andersen's model for a vulnerable population of homeless in South Korea. (2) Methods: The data were applied from the first national survey for homeless people in South Korea, 2016. Totally 2032 persons participated in the interview survey. This study team requested the raw data through the public portal and analyzed them. (3) Results: The participants who were homeless for more than ten years, staying in small rooming house or shelter, non-employed, earning less than 500,000 won per month, and having a medical condition showed a significantly higher chance of using Medicaid. The use of outreach programs had a significant relationship with gender, duration of homelessness, and monthly income. Among dental patients, the homeless who did not consume alcohol, stayed in a shelter, and were employed had higher chances of using dental service. (4) Conclusions: Medicaid service was strongly related to enabling factors but outreach programs with predisposing factors. Dental service showed strong relationships with the enabling domain, but the pattern was opposite: the jobless had less chance to avail it. The policymakers need to consider these domains of service utilization to provide equitable access to healthcare services.