Association of food insecurity with the use of tobacco products and urine cotinine-measured smoking intensity: evidence from a population-based study in South Korea, 2019-2021.

Introduction: This study explored the association between food insecurity and tobacco product use and urine cotinine-measured smoking intensity.

Methods: This cross-sectional study included 13 705 adults representative of the Korean population. The 18-item Household Food Security Survey Module was administered to the primary food managers in households with the scores applied to household members. The use of three tobacco products-combustible cigarettes, heated tobacco products and electronic cigarettes (e-cigarettes)-was assessed. Based on the urine cotinine level, the smoking status of each participant was classified into one of three groups: non-smoker, low-intensity smoker and high-intensity smoker. Logistic regression analysis was used to determine the association between food insecurity and tobacco product use and urine cotinine-measured smoking intensity. ORs and 95% CIs were estimated.

Results: Among the survey participants, 3.2% had mild food insecurity and 0.7% had moderate-to-severe food insecurity. Those with mild food insecurity (23.5%, OR: 1.38, 95% CI: 1.01 to 1.89) and those with moderate-to-severe food insecurity (45.1%, OR: 3.36, 95% CI: 1.87 to 6.03) compared with those with non-food insecurity (18.4%) were positively associated with combustible cigarette use. Those with moderate-to-severe food insecurity was positively associated with e-cigarette use (5.5%, OR: 3.49, 95% CI: 1.31 to 9.28). Compared with those with non-food security (7.9%), those with mild food insecurity (14.3%, OR: 1.61, 95% CI: 1.09 to 2.38) and moderate-to-severe food insecurity (22.1%, OR: 2.25, 95% CI: 1.04 to 4.86) were associated with high-intensity smoking.

Conclusion: Food insecurity is associated with both combustible and e-cigarette use. Those with food insecurity are associated with engagement in high-intensity smoking.