Daily access to healthy food is decreased in children and adults who live with smoking adults in comparison to those living with non-smoking adults, according to an article released on November 3, 2008 in the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The article defines food insecurity as follows: “Food insecurity is the inability to access enough food in a socially acceptable way for every day of the year. In households with the most severe food insecurity, there are multiple involuntary reductions in food intake and disruptions of usual eating patterns.” The authors state that approximately 13 million U.S. children live in food-insecure households. Previously, it has been shown that this insecurity is strongly associated with household income — and families with at least one smoker spend between two and twenty percent of their incomes on tobacco. As a result, the authors suspect that smokers, by affecting financial means, also affect the means for adequate food provisions.

To investigate the link between smoking status in families and food insecurity, Cynthia Cutler-Triggs, M.D., of the New York University School of Medicine and Bellevue Hospital Center, and colleagues examined 8,817 households with children 17 years old and younger between the years of 1999 and 2002. These groups were monitored to see if the presence or absense of adult smokers affected food security of those living in the same home. The groups were also examined in terms of age, sex, race of the child, and poverty index. Food insecurity was evaluated using the US Department of Agriculture Food Security Survey Module.

In examining the factors and outcomes, the authors found that at least one smoker was present in 23% of children’s households. In stratifying these children, they said: “32 percent of children in low-income households lived with a smoker compared with 15 percent of those in more affluent households.” A total 15% of adults and 11% of children reported that they had experienced food insecurity within the last years. Severe food insecurity was experienced by a total 6% of adults and 1% of children.

The authors note that trends were apparent in the data. “Food insecurity was more common and severe in children and adults in households with smokers,” they write. “Of children in households with smokers, 17 percent were food insecure vs. 8.7 percent in households without smokers.” This indicated a rate of severe child food insecurity of 3.2% in households with smokers and 0.9% in those without smokers. The trend was similar for adults in these households: “For adults, 25.7 percent in households with smokers and 11.6 percent in households without smokers were food insecure, and rates of severe food insecurity were 11.8 percent and 3.9 percent, respectively.”

Food insecurity rates were highest in children living in low-income households with smokers. In comparison with white families, black and Hispanic families had higher rates of child food insecurity in the smoking and non-smoking strata.

The authors conclude that smoking status should be noted when determining child health risk factors: “These data also demonstrate how pervasive this combination of child health risks is in low-income families,” they write. “The burden of food insecurity is a previously unrecognized danger of adult tobacco use to be added to the ever-growing list of negative effects of adult tobacco use on children in the United States.”

In an accompanying editorial, Frank J. Chaloupka, Ph.D., of the University of Illinois at Chicago, emphasizes the importance of this work. According to him, in addition to the reallocation of resources towards cigarettes instead of health foods, cigarette smoking also adds to “lost productivity resulting from diseases caused by smoking.” This further lowers incomes, raising the likelihood of food insecurity. 

He further advocates action: “Comprehensive tobacco control policies and programs are effective in reducing this burden, with higher taxes on cigarettes and other tobacco products being particularly effective in promoting cessation and reducing tobacco use in low-income populations.”

“However, the potential for higher taxes to exacerbate food insecurity in households that continue to smoke makes it critical that at least some of the new revenues generated by higher tobacco taxes be used to support programs targeting low-income households, including those that further reduce the health and economic burden caused by smoking on this particularly vulnerable population. “

Increased Rates and Severity of Child and Adult Food Insecurity in Households With Adult Smokers
Cynthia Cutler-Triggs, MD; George E. Fryer, PhD; Thomas J. Miyoshi, MSW; Michael Weitzman, MD
Arch Pediatr Adolesc Med. 2008;162(11):1056-1062.
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Smoking, Food Insecurity, and Tobacco Control
Frank J. Chaloupka, PhD
Arch Pediatr Adolesc Med. 2008;162(11):1096-1098.
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Written by Anna Sophia McKenney