Food insecurity impacts healthy lifestyle practices and medication adherence among persons with hypertension in Colombia and Jamaica: Findings from a cross-sectional study.

Background: Adherence to medications and healthy lifestyles are important health behaviours for hypertension control and may be influenced by food insecurity and socioeconomic status (SES). We examined associations between food insecurity and SES with medication adherence and healthy lifestyle practices among patients with hypertension in Colombia and Jamaica. Methods: In a cross-sectional survey of hypertensive patients attending primary health centres in Colombia and Jamaica we collected self-reported demographic, education and employment information. Food insecurity was measured using two questions from the modified United States Department of Agriculture (USDA) food security instrument - was there sufficient money for 1) weekly food purchases and 2) healthy foods. Medication adherence was classified as high vs. low/medium using the IMPACTS-MAS questionnaire. Healthy lifestyle was scored using a 6-point scale as unfavourable (score ≤ 3) or favourable (score 4-6), 1 point each for eating less salt, exercising regularly, consuming ≥ 2 servings fruits and ≥ 3 servings vegetables daily, and reduced alcohol consumption or 2 points for abstinence. Multivariable logistic regression with medication adherence categories and lifestyle practice scores as dependent variables assessed associations with food insecurity and SES. Results: Of 576 participants (Colombia 288; Jamaica 288), Colombians were older (66.5 years vs. 62.5 years, p < 0.001), had higher education attainment and were less likely to be employed/retired. Colombians had less food insecurity (64.6% vs. 89.0% p < 0.001), higher medication adherence (88.2% vs 50.7% p < 0.001) and more favourable lifestyle practices (86.2% vs. 47.2% p < 0.001). Food insecurity in both countries was inversely related to education, having private health insurance, high medication adherence and healthy lifestyle practices. In multivariable models, food insecurity was associated with increased odds of unfavourable lifestyle practice scores, (OR = 2.4; 95% CI: 1.1, 5.2 p = 0.028) and poor medication adherence (OR = 1.9; 95% CI: (1.0, 3.7) p = 0.072), after adjusting for age, sex, country, marital status, education and employment and having ≥ 2 chronic illnesses. No associations with the other SES examined. Conclusion: Food insecure hypertensive patients had increased odds of unfavourable lifestyle practices and were twice as likely to have poor medication adherence. Strategies to address food insecurity may have a positive impact on hypertension control in low resource settings.