Investigating psychological distress and peer influence in the longitudinal path linking food insecurity to adolescent substance use: a nationwide low-income cohort study

ABSTRACT

Food insecurity (FI), defined as the limited or uncertain availability of nutritionally adequate and safe foods, remains a major life concern among many poor subpopulations. Few investigations have been made into the mechanism underlying its impact on adolescent substance use. This study aimed to examine the longitudinal relationship between FI and cigarette and alcohol use among economically disadvantaged adolescents and then explore the role of psychological distress and peer substance use in the aforementioned association. Data of 1,243 adolescents (Mage = 13.3 years; 645 males) were obtained from a nationwide cohort study on Taiwanese adolescents from low-income families. Multiple hierarchical regression analyses based on generalized linear mixed-effects models with binomial distribution found that FI was consistently associated with cigarette smoking (β = 0.458, p < 0.001) but not alcohol drinking (β = 0.142, p = 0.143) when both psychological distress and peer substance use were adjusted. In the moderated mediation analysis based on bootstrap methods, we observed that psychological distress mediated the association between food insecurity and alcohol drinking (β = 0.036, 95% CI = 0.015–0.063) but not cigarette smoking (β = 0.018, 95% CI =−0.001–0.037). Furthermore, the indirect effects varied by peer drinking status (index of moderated mediation = 0.04, 95% CI 0.015–0.072). Clinical and public health attention should be given to evaluating food-insecure adolescents’ psychological well-being and peer influence when counseling their substance use issues.

KEYWORDS:

• Food insecurity
• cigarette smoking
• alcohol use
• psychological distress
• peer influence

Ethical standards disclosure

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the Institutional Review Board of National Cheng Kung University Hospital (B-ER-106-232). Written informed consent was obtained from all subjects.

Disclosure statement

The authors have no conflicts of interest to declare.

Financial support

The study was funded by research grants from the Ministry of Science and Technology, Taiwan awarded to Lee CT (MOST-109-2635-B-006-002) and Tsai MC (MOST-107-2629-B-006-001).

Authorship

Lee C. T. conceived the study, acquired the funding, cleaned the dataset, interpreted the results, and drafted the manuscript. Pramukti I. conducted the statistical analysis, interpreted the results, and drafted the manuscript. Ubeda Herrera J. J. reviewed the literature and drafted the manuscript. Tsai M. C. conceived the study, acquired the funding, obtained the dataset, oversaw the statistical analysis, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13548506.2023.2263681

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The work was supported by the Ministry of Science and Technology, Taiwan [MOST-107-2629-B-006-001,MOST-109-2635-B-006-002].