Relationship between food insecurity and smoking status among women living with and at risk for HIV in the USA: a cohort study

Lila A Sheira; Edward A Frongillo; Judith Hahn; Kartika Palar; Elise D Riley; Tracey E Wilson; Adebola Adedimeji; Daniel Merenstein; Mardge Cohen; Eryka L Wentz; Adaora A Adimora; Ighovwerha Ofotokun; Lisa Metsch; Janet M Turan; Phyllis C Tien; Sheri D Weiser

doi:10.1136/bmjopen-2021-054903

Relationship between food insecurity and smoking status among women living with and at risk for HIV in the USA: a cohort study

BMJ Open. 2021 Sep 6;11(9):e054903. doi: 10.1136/bmjopen-2021-054903.

Authors

Lila A Sheira¹, Edward A Frongillo², Judith Hahn³, Kartika Palar³, Elise D Riley³, Tracey E Wilson⁴, Adebola Adedimeji⁵, Daniel Merenstein⁶, Mardge Cohen⁷, Eryka L Wentz⁸, Adaora A Adimora^{9

10}, Ighovwerha Ofotokun¹¹, Lisa Metsch¹², Janet M Turan¹³, Phyllis C Tien^{14

15}, Sheri D Weiser^{3

16}

Affiliations

¹ Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA lila.sheira@ucsf.edu.
² Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, South Carolina, USA.
³ Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
⁴ Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, New York, USA.
⁵ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
⁶ Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA.
⁷ Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA.
⁸ School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
⁹ School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁰ UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ School of Medicine, Emory University, Atlanta, Georgia, USA.
¹² Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA.
¹³ Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁴ Department of Medicine, University of California, San Francisco, California, USA.
¹⁵ Department of Veteran Affairs Medical Center, San Francisco, California, USA.
¹⁶ Center for AIDS Prevention Studies, University of California, San Francisco, California, USA.

Abstract

Objectives: People living with HIV (PLHIV) in the USA, particularly women, have a higher prevalence of food insecurity than the general population. Cigarette smoking among PLHIV is common (42%), and PLHIV are 6-13 times more likely to die from lung cancer than AIDS-related causes. This study sought to investigate the associations between food security status and smoking status and severity among a cohort of predominantly low-income women of colour living with and without HIV in the USA.

Design: Women enrolled in an ongoing longitudinal cohort study from 2013 to 2015.

Setting: Nine participating sites across the USA.

Participants: 2553 participants enrolled in the Food Insecurity Sub-Study of the Women's Interagency HIV Study, a multisite cohort study of US women living with HIV and demographically similar HIV-seronegative women.

Outcomes: Current cigarette smoking status and intensity were self-reported. We used cross-sectional and longitudinal logistic and Tobit regressions to assess associations of food security status and changes in food security status with smoking status and intensity.

Results: The median age was 48. Most respondents were African-American/black (72%) and living with HIV (71%). Over half had annual incomes ≤US$12 000 (52%). Food insecurity (44%) and cigarette smoking (42%) were prevalent. In analyses adjusting for common sociodemographic characteristics, all categories of food insecurity were associated with greater odds of current smoking compared with food-secure women. Changes in food insecurity were also associated with increased odds of smoking. Any food insecurity was associated with higher smoking intensity.

Conclusions: Food insecurity over time was associated with smoking in this cohort of predominantly low-income women of colour living with or at risk of HIV. Integrating alleviation of food insecurity into smoking cessation programmes may be an effective method to reduce the smoking prevalence and disproportionate lung cancer mortality rate particularly among PLHIV.

Keywords: HIV & AIDS; epidemiology; public health.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Cross-Sectional Studies
Female
Food Insecurity*
Food Supply
HIV Infections* / complications
HIV Infections* / epidemiology
Humans
Longitudinal Studies
Middle Aged
Smoking / epidemiology
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding