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Association between e-cigarette use and food insecurity among low-income adults
  1. Dian Gu1,2,
  2. Wendy B Max1,
  3. Tingting Yao1,
  4. Yingning Wang1,
  5. Courtney Keeler3,
  6. Hai-Yen Sung1
  1. 1 Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
  2. 2 The Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
  3. 3 Department of Population Health Sciences, School of Nursing, University of San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Dian Gu, Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA; Dian.Gu{at}


Introduction Previous research quantifying the relationship between tobacco use and food insecurity has focused on cigarette smoking. E-cigarette use has become popular in recent years. Drawing on large, population-based survey data, this study augments the previous research, considering the association of e-cigarette use with food insecurity among low-income adults.

Methods We analysed data from the California Health Interview Survey in 2014–2019. The study sample consisted of 25 948 respondents aged 18–64 who lived in low-income (<200% of the Federal Poverty Level) households. Multivariable logistic regression models were estimated to examine the associations of e-cigarette use as well as dual use of e-cigarettes and cigarettes with food insecurity.

Results Of California low-income adults, 6.4% identified as current e-cigarette users (3.0% dual users of e-cigarettes and cigarettes, and 3.4% sole e-cigarette users) and 43.0% reported food insecurity. After controlling for confounding factors, food insecurity was significantly more likely to be reported among current e-cigarette users (adjusted OR (AOR)=1.67; 95% CI 1.25 to 2.23) compared with never e-cigarette users, and among dual users (AOR=2.21; 95% CI 1.63 to 3.00), current sole e-cigarette users (AOR=1.66; 95% CI 1.15 to 2.40), and current sole cigarette smokers (AOR=1.46; 95% CI 1.22 to 1.76) compared with never tobacco users. The odds of food insecurity among dual users were significantly greater than sole cigarette smokers but not statistically different from sole e-cigarette users.

Conclusions Using e-cigarette is an associated risk factor for food insecurity among low-income adults. Dual use of e-cigarettes and cigarettes has a significantly greater risk of food insecurity compared with smoking cigarettes alone.

  • Co-substance use
  • Electronic nicotine delivery devices
  • Non-cigarette tobacco products
  • Socioeconomic status
  • Addiction

Data availability statement

Data are available in a public, open access repository.

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  • Contributors H-YS conceived the idea for this study, and was responsible for designing the methodology and overseeing all aspects of this study. DG carried out all the data analyses and draft the initial manuscript. WBM, TY, YW and CK helped interpret the results and refine the analytic plan. All authors contributed to paper revision and have approved the final manuscript. H-YS obtained funding for the larger project.

  • Funding This research was funded by the California Tobacco-Related Disease Research Programme (TRDRP) under grant 28IR-0041 and National Cancer Institute Grant CA-113710.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.