LAUSR

Objectives Tobacco use and diseases related to poor diet rank among the top two causes of premature death in the U.S. Existing research suggests smoking and obesity are each associated with food insecurity (FI), but few studies have documented their co-occurrence in the context of FI. The purpose of this study was to describe the prevalence and correlates of FI with a particular focus on the co-occurrence of obesity and smoking among those who are FI in a nationally representative sample. Methods 5364 non-pregnant adults aged 20+ were selected for analysis from the 2013-2014 NHANES survey cycle. Height and weight were measured. BMI weight class was defined as normal weight (BMI > 18.5 and < 25), overweight (BMI > 25 and < 30) and obese (BMI > 30). Adult food insecurity (yes/no) was defined as full/marginal food security v. low/very low. Rao-Scott chi-square tests were used to compare prevalence rates. A logistic regression model was set up with FI as the dependent variable and demographics (age, race, education, gender, and poverty income ratio), smoking status, and BMI class as independent variables. Analyses were performed according to NHANES analytical guidelines to create nationally representative values. Results The overall prevalence of food insecurity, smoking, and obesity was 14.4% (n = 971), 19.6% (n = 1082), and 38.5% (n = 2060), respectively. The co-occurrence of obesity and smoking in the overall sample was 7.0% (n = 377). Among those who were FI, the prevalence of smoking was 36.6% (v. not FI 16.6%, P < 0.001), obesity was 47.1% (v. not FI 37.0%, P < 0.001), and the co-occurrence of smoking and obesity was 14.4% (v. not FI 5.7%, P < 0.001). In the logistic regression model, significant predictors of FI included: younger age (P = 0.007), lower poverty income ratio (P < 0.001), having a high school education or less (P = 0.002), smoking (P = 0.01) and obesity (P = 0.004). Conclusions Obesity and smoking were independent predictors of FI. Further, among those who were FI, the prevalence of co-occurring smoking and obesity was more than double that of those in the U.S. population without FI. Overall, these findings suggest food insecurity should be considered when developing obesity and smoking cessation-related interventions. Funding Sources None.