Food insecurity partially mediates the association between drug use and depressive symptoms among men who have sex with men in Los Angeles, California

Abstract

Objective: To understand the relationship between drug use, food insecurity (FI), and mental health among men who have sex with men (MSM). Design: Cohort study (2014-2019) with at least one follow-up. Setting: Visits at 6-month intervals included self-assessment for FI and depressive symptoms. Urine testing results confirmed drug use. Factors associated with FI were assessed using multiple logistic regression with random effects for repeated measures. General structural equation modeling tested whether FI mediates the relationship between drug use and depressive symptoms. Participants: Data were from HIV-positive and high-risk HIV negative MSM in Los Angeles, CA (n=431; 1,192 visits). Results: At baseline, FI was reported by 50.8% of participants, depressive symptoms in 36.7%, and 52.7% of urine screening tests were positive for drugs (i.e., marijuana, opioids, methamphetamine, cocaine, ecstasy). A positive drug test was associated with a 96% increase in the odds of being food insecure (95% CI: 1.26-3.07). Compared to those with high food security, individuals with very low food security have a nearly 7-fold increase in the odds of reporting depressive symptoms (95% CI: 3.71-11.92). Findings showed 14.9% of the association between drug use (exposure) and depressive symptoms (outcome) can be explained by FI (mediator). Conclusion: The prevalence of FI among this cohort of HIV-positive and high-risk HIV-negative MSM was high; the association between drug use and depressive symptoms was partially mediated by FI. Findings suggest that enhancing access to food and nutrition may improve mood in the context of drug use, especially among MSM at risk for HIV-transmission.

Food Insecurity, Neighborhood Food Environment, and Health Disparities: State of the Science, Research Gaps and Opportunities

“…Although not highlighted in the workshop, evidence is emerging regarding the need to apply a broader lens to identify populations at higher risk for food insecurity, drivers/determinants of food insecurity, and effective approaches to prevent and alleviate the burden of food insecurity. For example, several studies indicate that sexual and gender minorities, including individuals who identify as lesbian, gay, bisexual, transgender, Two-Spirit, and queer, are at greater risk for food insecurity as compared with the general population [ [84] , [85] , [86] , [87] ]. However, research regarding the prevalence, drivers, and consequences of food insecurity in this population is limited.…”