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Food insecurity among people who inject drugs in Los Angeles and San Francisco

  • Jane Schmitz (a1), Alex H Kral (a2), Daniel Chu (a1), Lynn D Wenger (a2) and Ricky N Bluthenthal (a1)...

We estimated the prevalence of food insecurity among people who inject drugs (PWID) in Los Angeles and San Francisco and explored correlates of food insecurity.


A cross-sectional study that measured 30 d food insecurity using the US Adult Food Security Survey ten-item Module developed by the US Department of Agriculture. Food insecurity was defined as including low and very low food security.


Two cities in the state of California, USA.


Male and female active PWID (n 777).


Among participants, 58 % reported food insecurity and 41 % reported very low food security. Food-insecure PWID were more likely to report being homeless (prevalence ratio (PR)=1·20; 95 % CI 1·05, 1·37), chest pain in the past 12 months (PR=1·19; CI 1·06, 1·35), acquiring syringes from someone who goes to a syringe exchange programme (PR=1·27; 95 % CI 1·13, 1·43) and feeling at risk for arrest for possession of drug paraphernalia (PR=1·30; 95 % CI 1·15, 1·46).


Current food insecurity was common among PWID in these two cities, yet few factors were independently associated with food insecurity. These data suggest that broad strategies to improve food access for this high-risk population are urgently needed.

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1. Coleman-Jensen, A, Nord, M & Singh, A (2013) Household Food Security in the United States in 2012. Economic Research Report no. ERR-155. Washington, DC: US Department of Agriculture, Ecconomic Research Service.
2. Chaparro, MP, Langellier, B, Birnbach, K et al. (2012) Nearly Four Million Californians are Food Insecure. Los Angeles, CA: UCLA Center for Health Policy Research.
3. Scrimshaw, NS & SanGiovanni, JP (1997) Synergism of nutrition, infection, and immunity: an overview. Am J Clin Nutr 66, issue 2, 464S477S.
4. Stuff, JE, Casey, PH, Szeto, KL et al. (2004) Household food insecurity is associated with adult health status. J Nutr 134, 23302335.
5. Palar, K, Kushel, M, Frongillo, EA et al. (2015) Food insecurity is longitudinally associated with depressive symptoms among homeless and marginally-housed individuals living with HIV. AIDS Behav 19, 15271534.
6. Kushel, MB, Gupta, R, Gee, L et al. (2006) Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med 21, 7177.
7. Mathers, BM, Degenhardt, L, Phillips, B et al. (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 372, 17331745.
8. Hendricks, K & Gorbach, S (2009) Nutrition issues in chronic drug users living with HIV infection. Addict Sci Clin Pract 5, 1623.
9. Anema, A, Wood, E, Weiser, SD et al. (2010) Hunger and associated harms among injection drug users in an urban Canadian setting. Subst Abuse Treat Prev Policy 5, 20.
10. Vogenthaler, NS, Hadley, C, Rodriguez, AE et al. (2011) Depressive symptoms and food insufficiency among HIV-infected crack users in Atlanta and Miami. AIDS Behav 15, 15201526.
11. Shannon, K, Kerr, T, Milloy, MJ et al. (2011) Severe food insecurity is associated with elevated unprotected sex among HIV-seropositive injection drug users independent of HAART use. AIDS 25, 20372042.
12. Strike, C, Rudzinski, K, Patterson, J et al. (2012) Frequent food insecurity among injection drug users: correlates and concerns. BMC Public Health 12, 1058.
13. National Research Council (2006) Food Insecurity and Hunger in the United States: An Assessment of the Measure . Washington, DC: National Academy of Science.
14. Watters, J & Biernacki, P (1989) Targeted sampling: options for the study of hidden populations. Soc Probl 36, 416430.
15. Bluthenthal, RN & Watters, JK (1995) Multimethod research from targeted sampling to HIV risk environments. NIDA Res Monogr 157, 212230.
16. Green, TC, Bluthenthal, RN, Singer, M et al. (2010) Prevalence and predictors of transitions to and away from syringe exchange use over time in 3 US cities with varied syringe dispensing policies. Drug Alcohol Depend 111, 7481.
17. Bickel, G, Nord, M, Price, C et al. (2000) Guide to Measuring Household Food Security. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service.
18. Weiser, SD, Bangsberg, DR, Kegeles, S et al. (2009) Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav 13, 841848.
19. Himmelgreen, DA, Perez-Escamilla, R, Segura-Millan, S et al. (1998) A comparison of the nutritional status and food security of drug-using and non-drug-using Hispanic women in Hartford, Connecticut. Am J Phys Anthropol 107, 351361.
20. Romero-Daza, N, Himmelgreen, DA, Perez-Escamilla, R et al. (1999) Food habits of drug-using Peurto Rican women in inner-city Hartford. Med Anthropol 18, 281298.
21. Furness, BW, Simon, PA, Wold, CM et al. (2004) Prevalence and predictors of food insecurity among low-income households in Los Angeles County. Public Health Nutr 7, 791794.
22. Normen, L, Chan, K, Braitstein, P et al. (2005) Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. J Nutr 135, 820825.
23. US Census Bureau (2013) Poverty: Poverty thresholds by Size of Family and Number of Children. (accessed February 2016).
24. Wagner, KD, Simon-Freeman, R & Bluthenthal, RN (2013) The association between law enforcement encounters and syringe sharing among IDUs on skid row: a mixed methods analysis. AIDS Behav 17, 26372643.
25. Bluthenthal, RN, Kral, AH, Erringer, EA et al. (1999) Drug paraphernalia laws and injection-related infectious disease risk among drug injectors. J Drug Issues 29, 116.
26. Bluthenthal, RN, Lorvick, J, Kral, AH et al. (1999) Collateral damage in the war on drugs: HIV risk behaviors among injection drug users. Int J Drug Policy 10, 2538.
27. Karpel, JP (2013) Overview of pulmonary disease in injection drug users. (accessed February 2016).
28. McCord, J, Jneid, H, Hollander, JE et al. (2008) Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation 117, 18971907.
29. Chermack, ST & Blow, FC (2002) Violence among individuals in substance abuse treatment: the role of alcohol and cocaine consumption. Drug Alcohol Depend 66, 2937.
30. Chilton, M & Booth, S (2007) Hunger of the body and hunger of the mind: African American women’s perceptions of food insecurity, health and violence. J Nutr Educ Behav 39, 116125.
31. Chilton, MM, Rabinowich, JR & Woolf, NH (2014) Very low food security in the USA is linked with exposure to violence. Public Health Nutr 17, 7382.
32. Montgomery, BE, Rompalo, A, Hughes, J et al. (2015) Violence against women in selected areas of the United States. Am J Public Health 105, 21562166.
33. Wong, MD, Sarkisian, CA, Davis, C et al. (2007) The association between life chaos, health care use, and health status among HIV-infected persons. J Gen Intern Med 22, 12861291.
34. Aday, LA & Cornelius, LJ (2006) Designing and Conducting Health Surveys: A Comprehensive Guide, 3rd ed. San Francisco, CA: Jossey-Bass.
35. Riley, ED, Vlahov, D, Huettner, S et al. (2002) Characteristics of injection drug users who utilize tuberculosis services at sites of the Baltimore city needle exchange program. J Urban Health 79, 113127.
36. Bluthenthal, RN, Heinzerling, KG, Anderson, R et al. (2008) Approval of syringe exchange programs in California: results from a local approach to HIV prevention. Am J Public Health 98, 278283.
37. Parker, J, Jackson, L, Dykeman, M et al. (2012) Access to harm reduction services in Atlantic Canada: implications for non-urban residents who inject drugs. Health Place 18, 152162.
38. Centers for Disease Control and Prevention (2010) Syringe exchange programs – United States, 2008. MMWR Morb Mortal Wkly Rep 59, 14881491.
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Public Health Nutrition
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