August 4, 2016

A study from the UNC Gillings School of Global Public Health and RTI International has found that rates of food insecurity rose disproportionately among smokers between 1998 and 2011.

Paul Shafer

Paul Shafer

Paul Shafer, MA, doctoral student of health policy and management at the Gillings School and research economist in the Center for Health Policy Science and Tobacco Research at RTI International, is co-author of a new paper with these findings.

The full study, titled, “Comparing Trends Between Food Insecurity and Cigarette Smoking Among Adults in the United States, 1998 to 2011,” was published online August 4 by the American Journal of Health Promotion.

Previous studies have shown that cigarette smoking is associated with higher rates and severity of food insecurity, but have not examined how smoking prevalence changes in response to shifts in food security at the population level.

“Understanding this issue became even more important as food insecurity rose sharply during the Great Recession and has remained elevated ever since,” Shafer notes.

To investigate this disparity, Shafer and his co-author analyzed data from a representative sample of adults in the United States whose households had participated in both the Food Security Supplement and the Tobacco Use Supplement of the Current Population Survey during five overlapping time periods between 1998 and 2011.

Of these adults, ‘current smokers’ were defined as individuals who indicated that they smoked either on some days or every day at the time of the survey. Household food security was coded as either ‘secure’ or ‘insecure’ using a U.S. Department of Agriculture standard measure.

Between 1998 and 2011, the prevalence of food insecurity increased by 30 percent among adults overall and by 29 percent among nonsmokers, but rose nearly double that (54 percent) among current smokers. Most of these changes occurred during and after the economic recession of 2008 and 2009.

Over the same period, the prevalence of current smoking declined by 33 percent among food-secure adults, but only dropped by 14 percent among food-insecure adults.

“Drastically lower cessation rates among food-insecure smokers is very concerning,” Shafer adds, “especially as funding for food assistance programs like SNAP continues to be on the chopping block despite already being cut in recent years.”

Together, these trends reveal that food insecurity has increased more markedly among smokers than nonsmokers, and smoking prevalence has declined more slowly among adults in food-insecure households. This may be due, at least in part, to the difficult tradeoff that low-income smokers face between buying food and purchasing cigarettes.


Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or


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