Addictive behaviors reports · 2026
Food insecurity and elevated nicotine exposure among U.S. tobacco users: Evidence from NHANES.
СтатьяНазвание и аннотация: Перевод в очереди
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Roulette Casey Jordan
Аннотация
BACKGROUND: Tobacco use and food insecurity (FI) frequently co-occur and may influence each other bidirectionally. Most prior research has emphasized tobacco use as a driver of FI, typically relying on self-reported measures. This study examined associations between FI and serum cotinine, a biomarker of nicotine exposure, and evaluated potential mediating and moderating factors.
METHODS: Data from the 2015-2018 National Health and Nutrition Examination Survey were analyzed for 2,149 adult tobacco users. Cotinine concentrations were log-transformed and modeled with survey-weighted generalized linear models, adjusted for sociodemographic covariates, depression, and body mass index. Mediation was tested with causal mediation analysis and structural equation modeling, and moderation with interaction terms.
RESULTS: Each unit increase in FI severity was associated with an ∼ 10% increase in cotinine after adjustment (p = 0.018). Depression neither mediated nor moderated the FI-cotinine association. Poverty-income ratio significantly moderated the relationship (p = 0.009): the positive FI-cotinine slope was strongest at higher incomes, while at or below the poverty line FI was not significantly associated with cotinine. In smoker subsamples, FI also moderated the smoking frequency-cotinine slope, with the most food-insecure participants showing the shallowest dose-response relationships.
CONCLUSIONS: FI is associated with elevated cotinine concentrations, but effects depend on household economic resources and how smoking behavior translates into nicotine uptake. Stabilizing food security may be critical for reducing tobacco-related health disparities.
METHODS: Data from the 2015-2018 National Health and Nutrition Examination Survey were analyzed for 2,149 adult tobacco users. Cotinine concentrations were log-transformed and modeled with survey-weighted generalized linear models, adjusted for sociodemographic covariates, depression, and body mass index. Mediation was tested with causal mediation analysis and structural equation modeling, and moderation with interaction terms.
RESULTS: Each unit increase in FI severity was associated with an ∼ 10% increase in cotinine after adjustment (p = 0.018). Depression neither mediated nor moderated the FI-cotinine association. Poverty-income ratio significantly moderated the relationship (p = 0.009): the positive FI-cotinine slope was strongest at higher incomes, while at or below the poverty line FI was not significantly associated with cotinine. In smoker subsamples, FI also moderated the smoking frequency-cotinine slope, with the most food-insecure participants showing the shallowest dose-response relationships.
CONCLUSIONS: FI is associated with elevated cotinine concentrations, but effects depend on household economic resources and how smoking behavior translates into nicotine uptake. Stabilizing food security may be critical for reducing tobacco-related health disparities.