在美国的一个有或有感染 HIV 风险的女性队列中，食物不安全与物质使用之间的纵向关联。
Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States.
机构信息
Newham University Hospital, Barts Health NHS Trust, London, UK.
Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
出版信息
Addiction. 2019 Jan;114(1):127-136. doi: 10.1111/add.14418. Epub 2018 Sep 25.
BACKGROUND AND AIMS
Few longitudinal studies have examined the relationship between food insecurity and substance use. We aimed to investigate this relationship using longitudinal data among women with or at risk for HIV in the United States.
DESIGN
Women's Interagency HIV Study (WIHS), a prospective cohort study.
SETTING
Nine sites across the United States.
PARTICIPANTS
A total of 2553 women with or at risk for HIV.
MEASUREMENTS
Semi-annual structured interviews were conducted during April 2013-March 2016. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. Outcomes were: any illicit substance use except cannabis; licit or illicit cannabis use; stimulant use (crack, cocaine, or methamphetamine); opioid use (heroin or methadone in a non-prescribed way); and prescription drug misuse (prescription narcotics, amphetamines, or tranquilizers in a non-prescribed way) since the last visit. We used multivariable logistic regression with random effects to examine longitudinal associations of current and previous FS with the outcomes simultaneously, adjusting for socio-demographic factors, HIV serostatus, physical health and health insurance.
FINDINGS
Average number of visits was 4.6. At baseline, 71% of participants were HIV-seropositive, 44% reported marginal, low, or very low FS, and 13% were using illicit substances. In adjusted analyses, current low and very low FS were significantly associated with 1.59 [95% confidence interval (CI) = 1.02, 2.46; P = 0.039] and 2.48 (95% CI = 1.52, 4.04; P < 0.001) higher odds of any illicit substance use, compared to high FS, and also with higher odds of cannabis, stimulant and opioid use, exhibiting a consistent dose-response relationship. Marginal, low, and very low FS at the previous visit were associated with 1.66 (95% CI = 1.08, 2.54; P = 0.020), 1.77 (95% CI = 1.14, 2.74; P = 0.011), and 2.28 (95% CI = 1.43, 3.64; P < 0.001) higher odds of current illicit substance use.
CONCLUSIONS
Food insecurity appears to be longitudinally associated with substance use among US women with or at risk for HIV.
背景和目的
很少有纵向研究探讨粮食不安全与物质使用之间的关系。我们旨在使用美国艾滋病毒感染者或高危妇女的纵向数据来研究这种关系。
设计
妇女艾滋病联合研究（WIHS），一项前瞻性队列研究。
地点
美国九个地点。
参与者
共有 2553 名艾滋病毒感染者或高危妇女。
测量
2013 年 4 月至 2016 年 3 月期间每半年进行一次结构访谈。粮食安全（FS）是主要预测指标，采用家庭粮食安全调查模块进行测量。结果是：除大麻外的任何非法物质使用；合法或非法大麻使用；兴奋剂使用（可卡因、可卡因或冰毒）；阿片类药物使用（未经处方使用海洛因或美沙酮）；以及未经处方滥用处方药物（麻醉剂、苯丙胺或安定）。我们使用具有随机效应的多变量逻辑回归来同时检查当前和以前的 FS 与结果之间的纵向关联，同时调整社会人口统计学因素、艾滋病毒血清状态、身体健康和健康保险。
结果
平均就诊次数为 4.6 次。在基线时，71%的参与者艾滋病毒呈阳性，44%报告边缘、低或极低的 FS，13%正在使用非法物质。在调整后的分析中，目前的低和极低 FS 与任何非法物质使用的几率分别增加 1.59（95%置信区间 [CI] = 1.02，2.46；P = 0.039）和 2.48（95% CI = 1.52，4.04；P < 0.001），与高 FS 相比，大麻、兴奋剂和阿片类药物使用的几率也更高，表现出一致的剂量反应关系。上一次就诊时的边缘、低和极低 FS 与当前非法物质使用的几率分别增加 1.66（95% CI = 1.08，2.54；P = 0.020）、1.77（95% CI = 1.14，2.74；P = 0.011）和 2.28（95% CI = 1.43，3.64；P < 0.001）。
结论
粮食不安全似乎与美国艾滋病毒感染者或高危妇女的物质使用呈纵向相关。
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