Food access among people who inject drugs in West Virginia

Saba Rouhani,Sean T Allen,Allison O’Rourke,Rebecca Hamilton White,Susan G Sherman,Kristin E Schneider,Sara Whaley,Michael E Kilkenny,Brian W Weir

doi:10.1186/s12954-021-00536-x

Abstract

BackgroundThe substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. The objective of this study was to examine factors associated with adequate food access among PWID in a rural Appalachian community.MethodsCross-sectional surveys were used to collect data among PWID aged 18 and older in Cabell County, West Virginia. Frequency of hunger and sociodemographic, structural and drug use characteristics were measured. Adequate food access was defined as reporting ‘never’ going to bed hungry at night in the past six months. Pearson’s χ2 and t-tests and multivariable logistic regression were used to identify factors associated with food access.ResultsOnly 71 individuals (17%) reported never going to bed hungry at night in the past six months. Adjusted odds of having adequate food access were higher among PWID who completed high school (aOR 2.94; P = 0.010) and usually used drugs alone (aOR 1.97; P = 0.025), and lower among PWID who were female (aOR 0.51; P = 0.037), experienced homelessness (aOR 0.23, P < 0.001), were recently arrested (aOR 0.50 P = 0.047), and engaged in receptive sharing of injection equipment (aOR 0.52, P = 0.035).ConclusionsWe found extremely low food access in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions promoting food access are needed to improve the public health and wellbeing of people who inject drugs in Appalachia.

Highlights

The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, among people who inject drugs (PWID)
We examined factors associated with adequate food access among this population in order to inform potential actionable strategies to ensure the basic needs of rural PWID are met
Study design and recruitment Data were collected as part of the West Virginia COUNTS! Study which was conducted in June-July 2018 to estimate the number of PWID in Cabell County, West Virginia

Summary

Introduction

The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. People who use drugs are more likely to experience other adverse health outcomes, including HIV, viral hepatitis, cardiovascular disease, and diabetes [2, 3]. Experiencing even moderate food insecurity is associated with poorer mental health outcomes [13, 14] and barriers to healthcare, which result in lower uptake of prevention and treatment services for both HIV and substance use [15]. PWID struggling to access food are more likely to engage in behaviors (e.g., syringe sharing, condomless sex) that increase risks for HIV acquisition [15, 17,18,19,20]

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