Moderating effect of loneliness on the relationship of housing instability and food insecurity with smoking behavior

ABSTRACT

Loneliness is a public health concern associated with individuals adopting various coping mechanisms to counter stressors. Stressors like social determinants of health (SDoH) risks (housing, food) have been associated with smoking. This study examines the role of loneliness on the relationship of SDoH risks with smoking. A cross-sectional study utilizing 2019 Ohio Medicaid Assessment Survey data was conducted. Multiple weighted logistic regressions were conducted to analyze the associations of loneliness and SDoH risks with smoking. Also, two models tested for the independent moderating effect of loneliness with food insecurity and housing instability on smoking. Of the 29,495 individuals who completed the loneliness questionnaire, 18% were identified as being lonely. Also, 20% and 16% of respondents reported food insecurity and housing instability respectively. Food insecurity (OR=2.10; CI=1.87–2.35), housing instability (OR=1.50; OR=1.33–1.68), and loneliness (OR=1.43; CI=1.27–1.60) were associated with greater odds of smoking. Loneliness buffered the relationship between housing instability and smoking behavior (ORinteraction=1.37; CI=1.06–1.78). In conclusion, SDoH risks and loneliness are associated with smoking. Loneliness has a moderating effect on the relationship between housing instability and smoking. These findings highlight the complex relationship of factors associated with smoking. A multi-faceted approach involving providers, health systems, local organizations, and payers is necessary.

KEYWORDS:

• Loneliness
• social determinants of health
• smoking
• food insecurity
• housing instability

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contribution

PP and SS conceptualized and designed the study. PP and OC acquired the data and conducted the analyses. All authors were involved in the interpretation of data, drafting of manuscript, and revision of manuscript.

Additional information

Funding

No funding was received for this study

Notes on contributors

Pranav M. Patel

Pranav M. Patel is a pharmacist trained in health outcomes research. His research interests range from health economics and outcomes research, social determinants of health, affordability, access, and health equity.

Omar Chaker

Omar Chaker, PharmD, is a Drug Information Resident at Duke University Hospital and a Medical Information Resident at GlaxoSmithKline in Durham, USA. He received his Doctor of Pharmacy from the University of Toledo. His practice interests include medical information in the therapeutic area of immunology and formulary management. His research interests include impact of medication policy on clinical outcomes, psychiatric experimental therapeutics in animal models, and medication use impact on public health.

Shipra Singh

Dr. Shipra Singh is an Associate Professor and the Program Director for the Health Education doctoral program at the School of Population Health. She is the Director of the Health Equity Research Center (HERC) at the College of Health and Human Services. She is also a key faculty at the School for the Advancement for Interprofessional Education (IPE) at the University of Toledo. The primary focus of Dr. Singh's work is at the intersection of medicine and public health, with an emphasis on social determinants of health, health disparities and interprofessional education.