Smoking and Food Insecurity

Nov 14, 2008
Children and adults living with adult smokers appear less likely to have daily access to enough healthy food compared with those living with non-smoking adults, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals1.

About 13 million U.S. children live in food-insecure households, according to background information in the article. “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.” Studies have shown that food insecurity is strongly associated with household income. Since families with at least one smoker spend 2 percent to 20 percent of their income on tobacco, it is likely that smokers are affecting the financial resources needed to provide adequate food.

Cynthia Cutler-Triggs, M.D., of the New York University School of Medicine and Bellevue Hospital Center, and colleagues analyzed 8,817 households with children age 17 and younger from 1999 to 2002 to see if the presence or absence of adult smokers in the household affected the food security of those living in the home. Age, sex, race of the child and poverty index ratios were also noted.

At least one smoker lived in 23 percent of the children’s households “and 32 percent of children in low-income households lived with a smoker compared with 15 percent of those in more affluent households.” Fifteen percent of adults and 11 percent of children reported having experienced food insecurity within the last year, with 6 percent of adults and 1 percent of children experiencing severe food insecurity.

“Food insecurity was more common and severe in children and adults in households with smokers,” the authors write. “Of children in households with smokers, 17 percent were food insecure vs. 8.7 percent in households without smokers,” with rates of severe child food insecurity at 3.2 percent and 0.9 percent, respectively. “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.” The highest rates of food insecurity were in children living in low-income households with smokers. Additionally, compared with white families, black and Hispanic families had higher rates of child food insecurity in both smoking and non-smoking homes.

“These data also demonstrate how pervasive this combination of child health risks is in low-income families,” the authors conclude. “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.”

Aside from spending resources on cigarettes instead of healthy foods, cigarette smoking also contributes to “lost productivity resulting from diseases caused by smoking,” further lowering incomes and raising the likelihood of food insecurity, writes Frank J. Chaloupka, Ph.D., of the University of Illinois at Chicago, in an accompanying editorial2.

“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,” Dr. Chaloupka continues.

“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. ”


1. Arch Pediatr Adolesc Med. 2008;162[11]:1056-1062.

2. Arch Pediatr Adolesc Med. 2008;162[11]:1096-1097.