Sexual orientation disparities in food insecurity and food assistance resource use in U.S. adult women: National Health and Nutrition Examination Survey, 2005-2014

Abstract

Background. Nearly 40 million American adults report past year food insecurity. This is concerning, as food insecurity is associated with chronic disease morbidity and premature mortality. Women disproportionately experience food insecurity, and sexual minority women (i.e., lesbian, bisexual, and heterosexual women reporting same-sex behavior) may be at greater risk for experiencing food insecurity disparities. The purpose of this study was to investigate patterns and prevalence of food insecurity and food assistance resource use in sexual minority and exclusively heterosexual women using population-level health surveillance data. Methods. We pooled 2004-2014 National Health and Nutrition Examination Survey data. Women were classified by sexual identity and lifetime same-sex behavior to create subgroups of lesbian, bisexual, heterosexual women reporting same-sex behavior (heterosexual WSW), and exclusively heterosexual women. We compared groups on past 12-month food insecurity, severe food insecurity, Supplemental Nutrition Assistance Program (SNAP) and emergency food assistance resource use using multivariable Poisson regression models to estimate weighted prevalence ratios. Results. Lesbian, bisexual, and heterosexual WSW were more likely to report past 12-month food insecurity and severe food insecurity than exclusively heterosexual women: prevalence ratios (PR) ranged from 1.37 (95% confidence interval [CI] = 1.07,1.75) to 1.77 (95% CI = 1.08-2.91). No differences were found in SNAP participation by sexual orientation, but more lesbians and heterosexual WSW reported using emergency food assistance in the past 12-months (PR = 1.96; 95% CI = 1.34, 2.88 and PR = 1.47; 95% CI = 1.05, 2.06 respectively). Conclusions. Food insecurity—including disrupted eating patterns and reduced food intake—is overrepresented in sexual minority women. Lesbians and heterosexual WSW are also more likely to rely on emergency food assistance. This is problematic as SNAP use may reduce food insecurity over time, but emergency food resources (e.g., food pantries) do not. More evidence is needed to understand the multilevel factors driving food insecurity in this population, with to develop policy and community-based efforts to increase SNAP participation and decrease food insecurity.