A new study published in the CDC journal Preventing Chronic Diseases, titled “Association Between Food Distress and Smoking Among Racially and Ethnically Diverse Adults, Schenectady, New York, 2013–2014,” has found that food distress, or the lack of access to healthy and affordable food, is significantly associated with smoking in racially and ethnically diverse urban adults. The study, conducted by Akiko S. Hosler, PhD and Isaac H. Michaels, MPH, analyzed data collected in 2013 and 2014 in Schenectady, New York and found that six indicators of food distress were associated with higher odds of smoking, including consuming less than five servings of fruits and vegetables daily, food insecurity, receiving Supplemental Nutrition Assistance Program (SNAP) benefits, using a food pantry, living in a neighborhood with low access to healthy food, and shopping for food at a store with limited healthy options.
The study found that each of the six indicators of food distress were significantly associated with current smoking, even when controlling for sociodemographic, health, and behavioral variables. The relationship between food insecurity and smoking, as well as the link between low rates of consumption of fruits and vegetables and smoking, have been previously reported, and this study confirms these findings in a diverse sample of adults in Schenectady, New York. The study also found that participation in SNAP, use of a food pantry, living in a neighborhood with low access to healthy food, and shopping for food often at a store with limited healthy food choices were all independently associated with smoking.
There is a lack of research on the mechanism linking smoking and food distress, but one explanation is the “opportunity cost” argument, which suggests that smokers spend a large portion of their expendable income on cigarettes, leaving less money to spend on food. Smokers may also have less of an appetite for food due to altered palate and hunger-satiety sensations, and food-insecure individuals may smoke to suppress hunger. In turn, chronic hunger, imbalanced diet, and economic difficulties in obtaining adequate food can cause stress and anxiety and increase dependence on nicotine.
The study also found that living in a neighborhood with low access to healthy food was independently associated with smoking, possibly due to additional sources of stress, anxiety, and hunger that could intensify nicotine addiction, or as a manifestation of poor dietary behavior and low demand for healthy food among residents. Shopping for food often at stores with limited healthy options and pro-tobacco environments, such as corner stores, dollar stores, or drug stores, was also associated with smoking. These stores had the most limited healthy food choices and the most pro-tobacco in-store environments, including high levels of tobacco products and tobacco advertising.
Recognizing the independent associations between food distress and smoking has implications for public health practice, as addressing both issues can lead to innovative strategies for smoking prevention, cessation, and policy development. The study authors, Akiko S. Hosler, PhD and Isaac H. Michaels, MPH, suggest stronger collaboration between tobacco and nutrition public health professionals to reduce tobacco use and improve nutrition behaviors and food environments in communities.
Hosler AS, Michaels IH. Association between food distress and smoking among racially and ethnically diverse adults, schenectady, new york, 2013-2014. Prev Chronic Dis. 2017;14:E71. https://www.cdc.gov/pcd/issues/2017/16_0548.htm