Rebekah J Walker1,2, Jennifer A Campbell3,4,5, Leonard E Egede3,4,5. 1. Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226-3596, USA. rebwalker@mcw.edu. 2. Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA. rebwalker@mcw.edu. 3. Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226-3596, USA. 4. Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA. 5. University of Wisconsin, Milwaukee, Joseph Zilber School of Public Health, Milwaukee, WI, 53205, USA.
Abstract
BACKGROUND: The aim of this study was to investigate the direct and indirect pathways through which food insecurity influences glycemic control and self-care behaviors. METHODS: Using data collected from 615 adults with type 2 diabetes, we investigated pathways between food insecurity and diabetes outcomes using path analysis. We included measures of perceived stress, diabetes distress, diabetes fatalism, and depression as psychosocial factors in the pathway. Self-care behaviors included general diet, specific diet, exercise, blood sugar testing, foot care, and medication adherence. Analyses were conducted using Stata v14, to include both direct and indirect effects, with standardized estimates to allow comparison of paths. RESULTS: Food insecurity was directly associated with stress (r = 0.43, p < 0.001), depression (r = 0.34, p < 0.001), fatalism (r = 0.09, p = 0.03), and distress (r = 0.36, p < 0.001). The type of stress, however, was differentially associated with outcomes, with distress associated with HbA1c (r = 0.25, p < 0.001), general and specific diet (r = - 0.28 and - 0.17, respectively, p = 0.001), and medication adherence (r = - 0.26, p < 0.001), while stress was associated with specific diet (r = - 0.14, p = 0.005) and medication adherence (r = - 0.15, p < 0.001) and depression was associated with exercise (r = - 0.06, p = 0.007). Food insecurity was indirectly associated with HbA1c (r = 0.08, p = 0.001), and four self-care behaviors (general diet, specific diet, exercise, and medication adherence). CONCLUSIONS: Food insecurity influences self-care behaviors indirectly via multiple psychosocial factors, and glycemic control indirectly through diabetes distress, supporting the hypothesis that stress is an important mechanism. Programs to improve access to resources and manage psychosocial concerns should be combined with food-based programs for food insecure populations with diabetes.
BACKGROUND: The aim of this study was to investigate the direct and indirect pathways through which food insecurity influences glycemic control and self-care behaviors. METHODS: Using data collected from 615 adults with type 2 diabetes, we investigated pathways between food insecurity and diabetes outcomes using path analysis. We included measures of perceived stress, diabetes distress, diabetes fatalism, and depression as psychosocial factors in the pathway. Self-care behaviors included general diet, specific diet, exercise, blood sugar testing, foot care, and medication adherence. Analyses were conducted using Stata v14, to include both direct and indirect effects, with standardized estimates to allow comparison of paths. RESULTS: Food insecurity was directly associated with stress (r = 0.43, p < 0.001), depression (r = 0.34, p < 0.001), fatalism (r = 0.09, p = 0.03), and distress (r = 0.36, p < 0.001). The type of stress, however, was differentially associated with outcomes, with distress associated with HbA1c (r = 0.25, p < 0.001), general and specific diet (r = - 0.28 and - 0.17, respectively, p = 0.001), and medication adherence (r = - 0.26, p < 0.001), while stress was associated with specific diet (r = - 0.14, p = 0.005) and medication adherence (r = - 0.15, p < 0.001) and depression was associated with exercise (r = - 0.06, p = 0.007). Food insecurity was indirectly associated with HbA1c (r = 0.08, p = 0.001), and four self-care behaviors (general diet, specific diet, exercise, and medication adherence). CONCLUSIONS: Food insecurity influences self-care behaviors indirectly via multiple psychosocial factors, and glycemic control indirectly through diabetes distress, supporting the hypothesis that stress is an important mechanism. Programs to improve access to resources and manage psychosocial concerns should be combined with food-based programs for food insecure populations with diabetes.
Authors: Hilary K Seligman; Andrew B Bindman; Eric Vittinghoff; Alka M Kanaya; Margot B Kushel Journal: J Gen Intern Med Date: 2007-04-11 Impact factor: 5.128
Authors: Seth A Berkowitz; James B Meigs; Darren DeWalt; Hilary K Seligman; Lily S Barnard; Oliver-John M Bright; Marie Schow; Steven J Atlas; Deborah J Wexler Journal: JAMA Intern Med Date: 2015-02 Impact factor: 21.873
Authors: Matthew M Ippolito; Courtney R Lyles; Kimberly Prendergast; Michelle Berger Marshall; Elaine Waxman; Hilary Kessler Seligman Journal: Public Health Nutr Date: 2016-07-13 Impact factor: 4.539