The Association of Food Insecurity, Mental Health, and Healthcare Access and Use Among Lesbian, Gay, and Bisexual Adults in the United States: Results From the 2021 National Health Interview Survey

Purpose: We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. Design and Setting: We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. Sample: The study sample was restricted to LGB adults >= 18 years (N = 1178) from the 2021 NHIS survey. Measures: Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. Analysis: Descriptive statistics and linear and generalized linear regressions. Results: The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as gay or lesbian. Eleven percent were food insecure. Sexual orientation, income-to-poverty ratio, and health insurance were significant correlates of food insecurity. In multivariable analyses, food insecurity was significantly associated with mental illness (including depression, anxiety, and serious psychological distress), limited health care access and use (including inability to pay medical bills, delay in getting medical and mental health care, and going without needed medical and mental health care), and medication nonadherence (including skipping medication, taking less medication, delay filling prescription, and going without needed prescription). Conclusion: Food insecurity is a constant predictor of adverse mental health and low medical and mental health care use rates among LGB adults in the United States. Achieving food security in LGB people requires improving their financial and nonfinancial resources to obtain food.