Moderating effect of loneliness on the relationship of housing instability and food insecurity with smoking behavior

Loneliness is a public health concern associated with individuals adopting various coping mechanisms to counter stressors. Stressors like social determinants of health (SDoH) risks (housing, food) have been associated with smoking. This study examines the role of loneliness on the relationship of SDoH risks with smoking. A cross-sectional study utilizing 2019 Ohio Medicaid Assessment Survey data was conducted. Multiple weighted logistic regressions were conducted to analyze the associations of loneliness and SDoH risks with smoking. Also, two models tested for the independent moderating effect of loneliness with food insecurity and housing instability on smoking. Of the 29,495 individuals who completed the loneliness questionnaire, 18% were identified as being lonely. Also, 20% and 16% of respondents reported food insecurity and housing instability respectively. Food insecurity (OR=2.10; CI=1.87-2.35), housing instability (OR=1.50; OR=1.33-1.68), and loneliness (OR=1.43; CI=1.27-1.60) were associated with greater odds of smoking. Loneliness buffered the relationship between housing instability and smoking behavior (ORinteraction=1.37; CI=1.06-1.78). In conclusion, SDoH risks and loneliness are associated with smoking. Loneliness has a moderating effect on the relationship between housing instability and smoking. These findings highlight the complex relationship of factors associated with smoking. A multi-faceted approach involving providers, health systems, local organizations, and payers is necessary.