Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States

Whittle, Henry J.; Sheira, Lila A; Frongillo, Edward A.; Palar, Kartika; Cohen, Jennifer; Merenstein, Daniel; Wilson, Tracey E.; Adedimeji, Adebola; Cohen, Mardge H.; Adimora, Adaora A.; Ofotokun, Ighovwerha; Metsch, Lisa R.; Turan, Janet M.; Wentz, Eryka L.; Tien, Phyllis C.; Weiser, Sheri D.

doi:10.1111/add.14418

Cited by 55 publications

(34 citation statements)

References 69 publications

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“…Although the link between food insecurity and mental health dis orders is well documented in Canada, 5,15,[18][19][20][21] our finding that severe food insecurity was associated with unintentional injuries and sui cides highlights the urgent need for more effective interventions. Given the prevalence of deaths related to drug poisoning in our sample (results not shown), our finding on unintentional injuries may partly reflect the link between food insecurity and substance use, 49,50 which is often complicated by the coexistence of HIV infec tion and depression. [51][52][53] The higher risk of death from suicides is consistent with Canadian studies documenting links between food insecurity and suicidal ideation and attempts.…”

Section: Discussionmentioning

confidence: 80%

Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study

Men

Gundersen

Urquía

et al. 2020

CMAJ

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F ood insecurity-inadequate access to food because of financial constraints-is a public health concern in Can ada. 1,2 In 2007/08, 11.3% of households experienced food insecurity; the figure rose to 12.4% by 2011/12. 1,2 Food insecurity is associated with negative health outcomes and higher health care spending in a graded fashion, with more severe food insecur ity corresponding to worse health and greater health care utiliza tion. 3-5 Food insecurity predicts higher incidence of chronic condi tions and poorer management of them. 6-14 Food insecurity is also associated with mental disorders, 15-18 suicidal thoughts 19,20 and suicide attempts. 21 Despite much evidence linking food insecurity to poor health, less is known about the association between food insecurity and mortality. A graded association between severity of food insecurity and all cause mortality risk was found among workingage adults in Ontario, Canada. 22 A study of the US adult population found very low food insecurity-equivalent to severe food insecurity in Canada-was associated with higher allcause mortality. 23 In addition, 2 small studies found food insecurity to be associated with higher mortality odds among HIVinfected adults. 24,25 However, none of these studies examined causes of death. More comprehensive, populationbased research is needed to advance our understanding of the health bur den associated with food insecurity. Linking vital statistics to multiple cycles of a national health sur vey, we conducted a populationbased retrospective cohort study to assess the association between household food insecurity status and Canadian adults' allcause and causespecific premature mortality. Methods Study sample

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Section: Discussionmentioning

confidence: 80%

Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study

Men

Gundersen

Urquía

et al. 2020

CMAJ

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“…19 Equally, food insecurity and food insufficiency are known risk factors for poor mental health, including depression and anxiety. 24,25,29 In addition to feelings such as hunger, exhaustion, worry, and frustration that may directly give rise to depressive and anxious symptoms, the experience of food insecurity in the U.S. is often characterized by salient stigma, shame, and self-blame. 47,48 Qualitative research has shown that these latter aspects of food insecurity often reflect a perceived failure of self-sufficiency and personal success among affected individuals, which is particularly damaging amid the individualist interpretations of wealth and achievement that are culturally prominent in the U.S. 47 In this respect, food insecurity is a profoundly relational experience that derives much of its potency from the context in which it occurs.…”

Section: Resultsmentioning

confidence: 99%

“…25,27 This finding has been shown in diverse geographical contexts and across a wide range of mental health outcomes. 25,[28][29][30][31] However, prior studies examining the association between food insecurity and mental health have not examined individual symptoms (in particular worrying and little interest, in addition to anxiety and depression). 32 Furthermore, there is a paucity of data on how receipt of food aid may modify the association between food insecurity and mental health.…”

Section: Introductionmentioning

confidence: 99%

Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic

Nagata

Ganson

Whittle

et al. 2021

American Journal of Preventive Medicine

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“…Qualitative studies in both PLWH and HIV-seronegative persons have identified feelings of helplessness, shame, and humiliation as central to the experience of FI. 16 Likewise, quantitative studies have confirmed an association of household FI with depression, anxiety, psychological distress, illicit substance use, 24 and worse overall mental health status. 9,13,25 Depression, poor mental health, and illicit substance use in turn predict ART nonadherence, higher viral loads, CD4 + T lymphocyte count decline, increased probability of AIDSdefining illness, and AIDS-related mortality.…”

Section: Mental Health Pathsmentioning

confidence: 95%

Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV

Weiser

Sheira

Palar

et al. 2020

AIDS Patient Care and STDs

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Food insecurity (FI) contributes to HIV-related morbidity and mortality, but the mechanisms whereby FI negatively impacts HIV health are untested. We tested the hypothesis that FI leads to poor HIV clinical outcomes through nutritional, mental health, and behavioral paths. We analyzed data from Women's Interagency HIV Study (WIHS) among 1803 women living with HIV (WLWH) (8225 person-visits) collected from 2013 to 2015 biannually from nine sites across the United States participating in the WIHS. FI was measured with the US Household Food Security Survey Module. Outcomes included HIV viral nonsuppression, CD4 cell counts, and physical health status (PHS). We used longitudinal logistic and linear regression models with random effects to examine associations adjusting for covariates and path analysis to test nutritional, mental health, and behavioral paths. Increasing severity of FI was associated with unsuppressed viral load, lower CD4 counts, and worse PHS (all p < 0.05). Report of FI 6 months earlier was independently associated with most outcomes after adjusting for concurrent FI. For viral nonsuppression, the nutritional and behavioral paths accounted for 2.09% and 30.66% of the total effect, with the mental health path operating via serial mediation through the behavioral path. For CD4 count, the mental health and behavioral paths accounted for 15.21% and 17.0% of the total effect, respectively. For PHS, depressive symptoms accounted for 60.2% of the total effect. In conclusion, FI is associated with poor health among WLWH through different paths depending on the outcome. Interventions should target FI and its behavioral and mental health mechanisms to improve HIV outcomes.

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Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States

Abstract: Food insecurity appears to be longitudinally associated with substance use among US women with or at risk for HIV.

Cited by 55 publications

References 69 publications

Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study

Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study

Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic

Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV

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