Hazardous alcohol use is associated with food insecurity in adults living alone: Findings from a nationwide study in Korea

Food insecurity has emerged as a major public health issue. This cross-sectional study explored the association between hazardous alcohol use and food insecurity and how this association varies according to household composition. A nationally representative sample of 31,971 adults from the two separate wave of the Korea National Health and Nutrition Examination Surveys was analyzed. Hazardous alcohol use was measured using the four-item version of the Alcohol Use Disorders Identification Test (AUDIT-4). The outcome variable was food insecurity, as measured using the 18-item Household Food Security Survey. Household composition was classified into three categories: single-person households (individuals living alone), multi-person households without children, and multi-person households with children. Logistic regression was employed to evaluate the association between a 1-standard deviation (SD) increase in AUDIT-4 scores and food insecurity, estimating the odds ratio (OR) and the corresponding 95% confidence interval (CI). Among the participants, 9.4% lived alone, 55.8% lived within multi-person households without children, and 34.8% lived within multi-person households with children. While hazardous alcohol use showed no clear association with food insecurity in the overall sample (OR: 1.01; 95% CI: 0.94–1.08), there was positive interaction between the AUDIT-4 and living alone an on the odds of experiencing food insecurity (P < 0.001). Hazardous alcohol use and a 1-SD increase in AUDIT-4 score were associated with 1.52-fold (95% CI: 1.13–2.05) and 1.22-fold (95% CI: 1.06–1.40) increases in the odds of food insecurity among those living alone. Additionally, consuming ≥10 drinks on a single occasion (OR: 1.93, 95% CI: 1.14–3.26) and experience of concerns by others about drinking (OR: 2.02, 95% CI: 1.28–3.19) were positively associated with food insecurity among those living alone. Hazardous alcohol use is associated with food insecurity, only among individuals living alone. Therefore, targeted policy efforts are necessary to mitigate hazardous alcohol use and food insecurity.