Cross-sectional associations of food insecurity with smoking cigarettes and heavy alcohol use in a population-based sample of adults

•Associations of food insecurity with smoking, heavy alcohol use, dual use tested.•Effect modification by gender, marital status and age group were also examined.•Data came from a cross-sectional, representative sample of Wisconsin adults.•Food insecurity was associated with smoking.•Food insecurity associated with heavy alcohol use and dual use in men but not women. Smoking, alcohol abuse and dual substance use represent significant public health problems and are thought to contribute to significant disparities in morbidity and mortality in the United States. Associations of food insecurity with these substances are poorly characterized, particularly concerning heavy alcohol consumption and dual substance use. Additionally, demographic factors may moderate these associations. In a cross-sectional, representative sample of Wisconsin adults (n = 1616), logistic regression was used to examine whether food insecurity was associated with cigarette smoking, heavy alcohol use and dual substance use. Interactions of food insecurity with gender, marital status and age group tested moderation by demographic factors. Food insecurity was associated with cigarette smoking in men and women (odds ratio (OR) = 3.0, 95% confidence interval (CI) = 2.1–4.4); however, only among men was food insecurity associated with heavy alcohol use (OR = 1.5; 95% CI = 1.0–2.2) and dual substance use (OR = 5.2; 95% CI = 1.5–18.6). Marital status and age group did not moderate associations of food insecurity with substance use. Food insecurity and substance use are highly correlated. Heavy alcohol consumption and dual use were positively correlated with food insecurity among men, but not among women. Longitudinal analyses are needed to disentangle temporality and underlying pathways of observed associations. Additionally, future work should determine whether interventions and policies targeting food insecurity can simultaneously reduce cigarette and alcohol use.