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

Food insecurity results from unreliable access to affordable and nutritious food. Homeless adults are particularly vulnerable to both food insecurity and problematic alcohol use. The current study examined the link between problematic alcohol use and food insecurity among homeless adults. Participants (N = 528; 62.7% men; Mage = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Problematic alcohol use was measured using the Alcohol Quantity and Frequency Questionnaire and the Patient Health Questionnaire. The latter used DSM-IV diagnostic criteria to assess probable alcohol use dependence/abuse. Heavy drinking was considered >7 drinks (women) and >14 drinks (men) per week. Food insecurity was measured with the USDA Food Security Scale-Short Form. The link between alcohol problems and food insecurity was examined with logistic regression analyses controlling for sex, age, education, income, and months homeless. Overall, 28.4% of the sample had probable alcohol dependence, 25% were heavy drinkers, and 78.4% were food insecure. Probable alcohol dependence and heavy drinking were correlated at 0.53 (p < 0.001). Results indicated that heavy drinking (OR = 2.12, CI.95 = 1.21, 3.73) and probable alcohol dependence/abuse (OR = 2.72, CI.95 = 1.55, 4.77) were each associated with increased odds of food insecurity. Food insecurity and problematic alcohol use are major issues among homeless populations; this study suggests they are associated. Future research is needed to shed light on potential causal mechanisms and on whether alcohol may take precedence over eating or food purchases.

[1]  Lawrence Busch,et al.  Food Security in the United States , 2021 .

[2]  Jennifer A. Pellowski.  National Institute on Alcohol Abuse and Alcoholism , 2020, Definitions.

[3]  K. Malecki,et al.  Cross-sectional associations of food insecurity with smoking cigarettes and heavy alcohol use in a population-based sample of adults. , 2019, Drug and alcohol dependence.

[4]  Thomas R. Kirchner,et al.  Reducing Drinking Among People Experiencing Homelessness: Protocol for the Development and Testing of a Just-in-Time Adaptive Intervention , 2019, JMIR research protocols.

[5]  D. Kendzor,et al.  Cumulative Risk Factors Associated with Food Insecurity among Adults who Experience Homelessness. , 2019, Health Behavior Research.

[6]  D. Kendzor,et al.  Modifiable Risk Factors and Readiness to Change among Homeless Adults. , 2019, American journal of health behavior.

[7]  D. Kendzor,et al.  Fruit and vegetable consumption and emotional distress tolerance as potential links between food insecurity and poor physical and mental health among homeless adults , 2019, Preventive medicine reports.

[8]  D. Kendzor,et al.  Characterizing Alcohol Use Behaviors among Homeless Men and Women. , 2019, American journal of health behavior.

[9]  E. Hébert,et al.  Understanding the link between contingency management and smoking cessation: The roles of sex and self-efficacy. , 2018, Addictive behaviors.

[10]  E. Cook,et al.  Mortality Among Unsheltered Homeless Adults in Boston, Massachusetts, 2000-2009 , 2018, JAMA internal medicine.

[11]  C. Beckwith,et al.  Food Insecurity, Morbidities, and Substance Use in Adults on Probation in Rhode Island , 2018, Journal of Urban Health.

[12]  J. Rotrosen,et al.  Substance use and homelessness among emergency department patients. , 2018, Drug and alcohol dependence.

[13]  N. Petry,et al.  A Randomized Trial of Contingency Management for Smoking Cessation in the Homeless , 2018, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[14]  V. Grazioli,et al.  Content Analysis of Advantages and Disadvantages of Drinking Among Individuals With the Lived Experience of Homelessness and Alcohol Use Disorders , 2018, Substance use & misuse.

[15]  Stephanie T. Lanza,et al.  Contemporary alcohol use patterns among a national sample of U.S. adult drinkers , 2017, Journal of addictive diseases.

[16]  J. Tsoh,et al.  Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity , 2017, Journal of Urban Health.

[17]  M. Businelle,et al.  Evaluation of a Shelter-Based Diet and Physical Activity Intervention for Homeless Adults. , 2017, Journal of physical activity & health.

[18]  D. Wetter,et al.  Smoking, Financial Strain, and Food Insecurity , 2017 .

[19]  M. Businelle,et al.  Health Risk Factors and Desire to Change among Homeless Adults. , 2016, American journal of health behavior.

[20]  D. Singer,et al.  Disparities in Cancer Incidence, Stage, and Mortality at Boston Health Care for the Homeless Program. , 2015, American journal of preventive medicine.

[21]  K. Gorman,et al.  Assessment of Food Intake, Obesity, and Health Risk among the Homeless in Rhode Island. , 2015, Public health nursing.

[22]  S. Torvaldsen,et al.  Is something better than nothing? Food insecurity and eating patterns of young people experiencing homelessness , 2015, Australian and New Zealand journal of public health.

[23]  Jin Huang,et al.  Unemployment and household food hardship in the economic recession , 2015, Public Health Nutrition.

[24]  D. Singer,et al.  Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston. , 2015, American journal of public health.

[25]  L. Fiellin,et al.  Food Insecurity and Health: Data from the Veterans Aging Cohort Study , 2015, Public health reports.

[26]  D. Kendzor,et al.  Characterizing Stressors and Modifiable Health Risk Factors Among Homeless Smokers , 2015, Health education & behavior : the official publication of the Society for Public Health Education.

[27]  K. Carey,et al.  Exploring the Relationships Among Food Insecurity, Alcohol Use, and Sexual Risk Taking Among Men and Women Living in South African Townships , 2014, The Journal of Primary Prevention.

[28]  D. Kendzor,et al.  Small financial incentives increase smoking cessation in homeless smokers: a pilot study. , 2014, Addictive behaviors.

[29]  M. Chopra,et al.  Food insecurity and its association with co-occurring postnatal depression, hazardous drinking, and suicidality among women in peri-urban South Africa. , 2013, Journal of affective disorders.

[30]  M. Barker,et al.  Food Choice And Nutrient Intake Amongst Homeless People , 2013, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[31]  W. Corbin,et al.  Relations among stress, coping strategies, coping motives, alcohol consumption and related problems: a mediated moderation model. , 2013, Addictive behaviors.

[32]  E John Orav,et al.  Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. , 2013, JAMA internal medicine.

[33]  R. Rosenheck,et al.  Obesity among Chronically Homeless Adults: Is it a Problem? , 2013, Public health reports.

[34]  N. Crepaz,et al.  Higher incidence of clear cell adenocarcinoma of the cervix and vagina among women born between 1947 and 1971 in the United States , 2011, Cancer Causes & Control.

[35]  Stephen W. Hwang,et al.  The assessment of food security in homeless individuals: a comparison of the Food Security Survey Module and the Household Food Insecurity Access Scale , 2011, Public Health Nutrition.

[36]  J. Helzer,et al.  Drinking and stress: an examination of sex and stressor differences using IVR-based daily data. , 2011, Drug and alcohol dependence.

[37]  Sowmya R. Rao,et al.  Food Insufficiency and Health Services Utilization in a National Sample of Homeless Adults , 2011, Journal of General Internal Medicine.

[38]  C. North,et al.  A prospective study of substance use and housing stability in a homeless population , 2010, Social Psychiatry and Psychiatric Epidemiology.

[39]  S. Kegeles,et al.  Food Insecurity Among Homeless and Marginally Housed Individuals Living with HIV/AIDS in San Francisco , 2009, AIDS and Behavior.

[40]  R. Isralowitz,et al.  Late Life Alcohol Use and Gender Differences Among Former Soviet Union Immigrants , 2009, Journal of ethnicity in substance abuse.

[41]  H. Doll,et al.  The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis , 2008, PLoS medicine.

[42]  M. Kivimäki,et al.  Employment trajectory as determinant of change in health-related lifestyle: the prospective HeSSup study. , 2008, European journal of public health.

[43]  K. Mossakowski.  Is the duration of poverty and unemployment a risk factor for heavy drinking? , 2008, Social science & medicine.

[44]  N. Weller,et al.  Dietary Intake of Homeless Women Residing at a Transitional Living Center , 2008, Journal of health care for the poor and underserved.

[45]  F. Bryant,et al.  Development and Validation of a Short-Form, Rapid Estimate of Adult Literacy in Medicine , 2007, Medical care.

[46]  R. Vuchinich,et al.  Meta-analysis of day treatment and contingency-management dismantling research: Birmingham Homeless Cocaine Studies (1990-2006). , 2007, Journal of consulting and clinical psychology.

[47]  T. Cargiulo.  Understanding the health impact of alcohol dependence. , 2007, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[48]  L. Trevena,et al.  Experiences of food insecurity among urban soup kitchen consumers: insights for improving nutrition and well-being. , 2006, Journal of the American Dietetic Association.

[49]  S. Booth.  Eating rough: food sources and acquisition practices of homeless young people in Adelaide, South Australia , 2006, Public Health Nutrition.

[50]  R. Hogg,et al.  Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. , 2005, The Journal of nutrition.

[51]  B. Grant,et al.  The 12-Month Prevalence and Trends in DSM–IV Alcohol Abuse and Dependence , 2004, Drug and alcohol dependence.

[52]  D. Hosmer,et al.  Homelessness and food insecurity , 2003 .

[53]  A. McCool,et al.  Dietary Intake and Nutritional Status of Older Adult Homeless Women , 2003, Journal of nutrition for the elderly.

[54]  V. Tarasuk,et al.  Homeless "squeegee kids": food insecurity and daily survival. , 2002, Social science & medicine.

[55]  G. Gmel,et al.  Defining alcohol-related fatal medical conditions for social-cost studies in western societies: an update of the epidemiological evidence. , 2001, Journal of substance abuse.

[56]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[57]  R. Briefel,et al.  The effectiveness of a short form of the Household Food Security Scale. , 1999, American journal of public health.

[58]  S. Morton,et al.  Utilization of mental health and substance abuse services among homeless adults in Los Angeles. , 1999, Medical care.

[59]  K. Silliman,et al.  Evidence of nutritional risk in a population of homeless adults in rural northern California. , 1998, Journal of the American Dietetic Association.

[60]  D. Dooley,et al.  Unemployment and alcohol disorder in 1910 and 1990: Drift versus social causation , 1992 .

[61]  J. Dwyer,et al.  Nutrition and health services needs among the homeless. , 1991, Public health reports.

[62]  E Luder,et al.  Health and nutrition survey in a group of urban homeless adults. , 1990, Journal of the American Dietetic Association.

[63]  E. Luder,et al.  Assessment of the nutritional status of urban homeless adults. , 1989, Public health reports.

[64]  N. Petry,et al.  Substance Abuse Treatment Patients in Housing Programs Respond to Contingency Management Interventions. , 2017, Journal of substance abuse treatment.

[65]  Vital signs: binge drinking prevalence, frequency, and intensity among adults - United States, 2010. , 2012, MMWR. Morbidity and mortality weekly report.

[66]  M. Trevisan,et al.  Alcohol-Related Morbidity and Mortality , 2003, Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.

[67]  M. Fichter,et al.  Alcoholism in homeless men in the mid-nineties: results from the Bavarian Public Health Study on homelessness , 1999, European Archives of Psychiatry and Clinical Neuroscience.

[68]  R. Room.  Measuring Alcohol Consumption in the United States , 1990 .