Food Insecurity and Substance Use From Birth to Emerging Adulthood: A Systematic Review

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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 (N¼1), ages 5 or under (N¼8), mid-childhood (N¼4), birth to 12 years (N¼1), adolescence (N¼21), emerging adulthood (N¼11), and adolescence to emerging adulthood (N¼2).Geographically, studies were conducted in North America (N¼28), South America (N¼2), Africa (N¼9), Asia-Pacific (N¼6), Europe (N¼2), 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 (N¼26), 54% found a positive association.For those examining whether SU predicted FI (N¼20), 65% indicated a positive association.Those examining bidirectional relationships (N¼2) 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.