The relationship between food insecurity and tobacco or alcohol use in Great Britain: A representative population-based survey.

Introduction: Tobacco and alcohol use are linked to health disparities. In recent years, food insecurity, an indicator of disparities, has increased in Great Britain. This study examined the associations between food insecurity and tobacco or alcohol use. Methods: Data were drawn from a representative cross-sectional study of people aged ≥16 years in Great Britain (N = 4,056), conducted in January‒February 2025. Food insecurity was measured with the 6-item Household Food Security Scale, divided into high/marginal, low, or very low food security. Logistic regression models with food insecurity (combining low and very low food insecurity) as the outcome and adjusted for age, gender, nation of residence, socioeconomic position, financial hardship and smoking or alcohol consumption (measured using AUDIT-C score), were used to derive odds ratios (ORadj). Results: Overall, 7.9 % (95 % CI: 6.9, 8.9) reported low and 9.6 % (8.6, 10.7) very low food security. Smoking was associated with food insecurity (ORadj = 1.75; 95 % CI: 1.32, 2.31). People who abstained from alcohol were more likely to be food insecure compared with those who drank at increasing (AUDIT-C 5: ORadj = 0.62; 0.41, 0.93) or higher risks of harm (AUDIT-C 8: ORadj = 0.63; 0.40, 0.97); however, this relationship was moderated by psychological distress. Conclusion: Food insecurity was associated with higher smoking prevalence. Among people experiencing distress, those abstaining from alcohol and at risk of dependence appeared more likely to experience food insecurity than those drinking at other levels. These findings suggest the need for interventions that offer support for smoking, alcohol and which address underlying stressors of food insecurity.