Food security – or “access by all people at all times to enough food for an active, healthy life” – is a leading determinant of health. Food insecure adults (i.e., those without access to adequate food) experience poor nutrition, obesity, and chronic inflammation. Perhaps, unsurprisingly, food insecurity is associated with leading causes of death and disability—including cancer, chronic obstructive pulmonary disease, stroke, and diabetes.

Women disproportionately experience food insecurity, and sexual minority women (i.e., lesbian, bisexual, and heterosexual women reporting same-sex behavior; SMW) may be at greater risk. SMW experience discrimination due to their minority gender and sexual orientation that depletes their access to employment, living wages, and social supports. The systematic disruption of these economic resources may place SMW at greater risk for experiencing economic instability and related concerns, including food insecurity.

Several solutions exist to alleviate food insecurity in the general population. In the United States (U.S.), the Supplemental Nutrition Assistance Program (formerly, “food stamps”; SNAP) is a means-based program that provides financial assistance to participating low- and no- income households. SNAP participation reduces food insecurity in the general population, and may be an effective tool to reduce food insecurity in SMW. At the local level, emergency food assistance (e.g., food pantries, soup kitchens) are provided by non-profit and religious organizations to provide in-kind nutrition assistance to individuals and families in need, regardless of income. However, emergency food assistance is not associated with long-term reductions in food insecurity. Few studies have investigated differences in SNAP use and emergency food assistance by sexual orientation; as such, it is not known how these resources may be leveraged to address food insecurity in SMW.

Our study

We used publicly available data from the 2005-2014 National Health and Nutrition Examination Survey (NHANES) to investigate the prevalence of food insecurity and food assistance (SNAP use and emergency food assistance) in women, by sexual orientation. Data collected from 7,279 women was weighted to derive U.S. population-representative estimates. Of all respondents, 90.4% identified as exclusively heterosexual, 5.1% identified as heterosexual but also reported having sex with women, 3.4% identified as bisexual, and 1.2% identified as lesbian.

Food insecurity

Bisexual women reported the highest prevalence of food insecurity

Over 25% of SMW experienced food insecurity over the past 12-months (vs 13.1% of exclusively heterosexual women). Bisexual women reported the highest prevalence of food insecurity (27.3%) followed by lesbian women (25.5%). Alarmingly, compared to exclusively heterosexual women, SMW were 50-84% more likely to experience at least one period during the past 12-months where eating patterns were disrupted and food intake was reduced due to lack of money or other resources.

Food assistance

Over 20% of SMW reported using the federal Supplemental Nutrition Assistance Program (SNAP, formerly referred to as “food stamps”) in the past 12-months; however, in fully adjusted models, the prevalence rate of women using SNAP did not differ by sexual orientation. This finding is in contrast to prior studies that have found differences in SNAP use by sexual orientation.

Lesbians reported highest prevalence of emergency food assistance (17.5%), and they were 89% more likely to use emergency food assistance than exclusively heterosexual women

Emergency food participation has not been explored in previous population-based studies of food insecurity in sexual minority populations. In our study, lesbians reported highest prevalence of emergency food assistance (17.5%), and they were 89% more likely to use emergency food assistance than exclusively heterosexual women. However, heterosexual women reporting same-sex behavior were also 43% more likely to report past 12-month use of emergency food assistance than exclusively heterosexual women.

Reducing disparities

This study is among the first to document disparities in food insecurity and emergency food assistance in SMW. Our results highlight inequities faced by SMW in accessing adequate and nutritious food. This is especially concerning as SMW’s increased rates of food insecurity may contribute to chronic disease disparities—including cancer and diabetes—seen in this population.

Results suggest a need for culturally-specific interventions to reduce food insecurity disparities. One solution is to increase SNAP participation by SMW. By partnering with lesbian, gay, bisexual and transgender (LGBT) organizations, public health departments may use targeted marketing and outreach to increase awareness of SNAP requirements and enrollment among food insecure SMW. For SMW who do not qualify for SNAP, local solutions may include increasing access to LGBT-specific food pantries sponsored by community-based organizations and improving the variety, amount, and nutrition of food distributed by these resources.

Research reported in the referenced publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number T32CA229114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.