Food insecurity among injection drug users in los angeles and san francisco

Injection drug users (IDUs) likely experience a higher prevalence of food insecurity than the general adult population due to their risk environment. This study aimed to estimate the prevalence of food insecurity and identify demographic and behavioral risk factors. We recruited IDUs from Los Angeles (n=279) and San Francisco (n=273) using community outreach and targeted sampling between April 2011 and April 2012. Participants responded to questions about demographics, drug use, health status, sexual activity and a 10-item subset of the U.S. Department of Agriculture Food Security Questionnaire. Food insecurity was defined as affirmative answers to ≥3 items. Adjusted prevalence rate ratios (PRRs) were estimated using generalized linear models. The sample was predominately male, impoverished, and non-white. The prevalence of food insecurity was 50.5% overall, with similar estimates in each city. After excluding variables that were not associated with food insecurity in bivariate or fully adjusted models, seven variables were significantly associated with food insecurity. Compared to their peers who were food secure, food insecure IDUs were more likely to be homeless (PRR 1.28; 95% Confidence Interval 1.06-1.56), report recycling as an income source (1.22; 1.02-1.46), engage in risky needle sharing (1.45; 1.19-1.77) and acquisition (1.50; 1.17-1.94) practices, have been injected by others (1.25; 1.05-1.48), be HIV positive (1.41; 1.08-1.84) and feel at risk for arrest (1.25; 1.05-1.46). The level of food insecurity is exceptionally high among all identified IDU subgroups. Coordinated efforts are required to improve food security among IDUs, irrespective of additional risk factors.