Date of Conferral

10-30-2026

Date of Award

October 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Twanda Wadlington

Abstract

Food insecurity is a significant social determinant of health linked to negative health practices and health inequities. However, there is a need to examine its links with other substance use behaviors and the different links between income groups. A quantitative, cross-sectional study was used to explore relationships between food insecurity and substance use behaviors among underserved urban adults and to determine income differences. Secondary data were used from the National Health and Nutrition Examination Survey (NHANES) 2021–2023 (N = 8,153). The study was guided by the Health Belief Model (HBM) and the Biopsychosocial Model. Pearson chi-square tests were used to assess cigarette smoking, alcohol drinking frequency, alcohol consumption intensity, and binge drinking, with multinomial logistic regression and income-stratified analyses being performed to examine the relationship between each of these and income. Food insecurity was significantly associated with smoking, χ²(6, N = 2,928) = 276.06, p < .001; drinking frequency, χ²(30, N = 4,609) = 119.45, p < .001; alcohol consumption intensity, χ²(6, N = 3,798) = 50.45, p < .001; and binge drinking, χ²(6, N = 3,804) = 77.68, p < .001, suggesting that food insecurity was associated with all four substance use measures among the adults studied. Income-stratified analyses showed that smoking was associated with food insecurity across all income groups, while associations with alcohol consumption intensity and binge drinking differed among low-, middle-, and high-income groups. The results support integrating food insecurity screening and food assistance referrals into nutrition and behavioral health services to address health inequities for health care providers, policymakers, and community organizations.

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