Older Age Is Significantly Associated With Increased Food Security Among Pantry Clients in Baltimore

Objectives: Food insecurity (FI) and substance use (SU) have been linked in young people but, to-date, there has been no large-scale consideration of FI-SU across development.This systematic review considered evidence of bidirectional associations of FI and SU from childhood to emerging adulthood.Methods: A systematic literature search of PubMed, MEDLINE, CINAHL, and PsycINFO considered papers published up until 2024.Inclusion criteria were English language; human studies between 0 and 25 years; and examined associations between FI and SU.Study quality was assessed by 2 reviewers using the Cochrane Risk of Bias Tool, adapted for observational studies.Results: Of 6754 identified articles, 48 met the inclusion criteria.This included articles focused on maternal outcomes (N1), ages 5 or under (N8), mid-childhood (N4), birth to 12 years (N1), adolescence (N21), emerging adulthood (N11), and adolescence to emerging adulthood (N2).Geographically, studies were conducted in North America (N28), South America (N2), Africa (N9), Asia-Pacific (N6), Europe (N2), and a global study with data from 26 countries.Most studies were cross-sectional (75%), although some were longitudinal (13%), cohort-based (8%), or case-control (4%).SU types included illicit drugs (56%), alcohol (50%), nicotine (44%), and all 3 (15%).Of those articles examining whether FI predicted SU (N26), 54% found a positive association.For those examining whether SU predicted FI (N20), 65% indicated a positive association.Those examining bidirectional relationships (N2) all reported significant positive associations.Most studies (90%) provided moderate to high certainty of evidence within observational designs.Conclusions: This review suggests a significant bidirectional association between FI and SU across development.Future studies should focus on the precise mechanisms underlying this association.Public health efforts targeting either FI or SU should address both factors.