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Background  The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. The objective of this study was to examine factors associated with adequate food access among PWID in a rural Appalachian community.    Methods  Cross-sectional surveys were used to collect data among PWID aged 18 and older in Cabell County, West Virginia. Frequency of hunger and sociodemographic, structural and drug use characteristics were measured. Adequate food access was defined as reporting ‘never’ going to bed hungry at night in the past six months. Pearson’s  χ  2  and  t -tests and multivariable logistic regression were used to identify factors associated with food access.    Results  Only 71 individuals (17%) reported never going to bed hungry at night in the past six months. Adjusted odds of having adequate food access were higher among PWID who completed high school (aOR 2.94;  P  = 0.010) and usually used drugs alone (aOR 1.97;  P  = 0.025), and lower among PWID who were female (aOR 0.51;  P  = 0.037), experienced homelessness (aOR 0.23,  P  < 0.001), were recently arrested (aOR 0.50  P  = 0.047), and engaged in receptive sharing of injection equipment (aOR 0.52,  P  = 0.035).    Conclusions  We found extremely low food access in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions promoting food access are needed to improve the public health and wellbeing of people who inject drugs in Appalachia.

Food access among people who inject drugs in West Virginia