1
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Malik FS, Liese AD, Reboussin BA, Sauder KA, Frongillo EA, Lawrence JM, Bellatorre A, Pihoker C, Loots B, Dabelea D, Mayer-Davis E, Jensen E, Turley C, Mendoza JA. Prevalence and Predictors of Household Food Insecurity and Supplemental Nutrition Assistance Program Use in Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2023; 46:278-285. [PMID: 34799431 PMCID: PMC9887610 DOI: 10.2337/dc21-0790] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence of household food insecurity (HFI) and Supplemental Nutrition Assistance Program (SNAP) participation among youth and young adults (YYA) with diabetes overall and by type, and sociodemographic characteristics. RESEARCH DESIGN AND METHODS The study included participants with youth-onset type 1 diabetes and type 2 diabetes from the SEARCH for Diabetes in Youth study. HFI was assessed using the 18-item U.S. Household Food Security Survey Module (HFSSM) administered from 2016 to 2019; three or more affirmations on the HFSSM were considered indicative of HFI. Participants were asked about SNAP participation. We used χ2 tests to assess whether the prevalence of HFI and SNAP participation differed by diabetes type. Multivariable logistic regression models were used to examine differences in HFI by participant characteristics. RESULTS Of 2,561 respondents (age range, 10-35 years; 79.6% ≤25 years), 2,177 had type 1 diabetes (mean age, 21.0 years; 71.8% non-Hispanic White, 11.8% non-Hispanic Black, 13.3% Hispanic, and 3.1% other) and 384 had type 2 diabetes (mean age, 24.7 years; 18.8% non-Hispanic White, 45.8% non-Hispanic Black, 23.7% Hispanic, and 18.7% other). The overall prevalence of HFI was 19.7% (95% CI 18.1, 21.2). HFI was more prevalent in type 2 diabetes than type 1 diabetes (30.7% vs. 17.7%; P < 0.01). In multivariable regression models, YYA receiving Medicaid or Medicare or without insurance, whose parents had lower levels of education, and with lower household income had greater odds of experiencing HFI. SNAP participation was 14.1% (95% CI 12.7, 15.5), with greater participation among those with type 2 diabetes compared with those with type 1 diabetes (34.8% vs. 10.7%; P < 0.001). CONCLUSIONS Almost one in three YYA with type 2 diabetes and more than one in six with type 1 diabetes reported HFI in the past year-a significantly higher prevalence than in the general U.S. population.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Katherine A. Sauder
- Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO
| | - Edward A. Frongillo
- Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | | | - Anna Bellatorre
- Department of Epidemiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
| | - Beth Loots
- Seattle Children’s Research Institute, Seattle, WA
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado Denver School of Medicine, Aurora, CO
| | | | - Elizabeth Jensen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christine Turley
- Department of Pediatrics, University of South Carolina, Columbia, SC
| | - Jason A. Mendoza
- Department of Pediatrics, University of Washington, Seattle, WA
- Seattle Children’s Research Institute, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
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2
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Herman WH, Bullock A, Boltri JM, Conlin PR, Greenlee MC, Lopata AM, Powell C, Tracer H, Schillinger D. The National Clinical Care Commission Report to Congress: Background, Methods, and Foundational Recommendations. Diabetes Care 2023; 46:e14-e23. [PMID: 36701594 PMCID: PMC9887619 DOI: 10.2337/dc22-0611] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/01/2022] [Indexed: 01/27/2023]
Abstract
Since the first Federal Commission on Diabetes issued its report in 1975, the diabetes epidemic in the U.S. has accelerated, and efforts to translate advances in diabetes treatment into routine clinical practice have stalled. In 2021, the National Clinical Care Commission (NCCC) delivered a report to Congress that provided recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. In the five articles in this series, we present the NCCC's evidence-based recommendations to 1) reduce diabetes-related risks, prevent type 2 diabetes, and avert diabetes complications through changes in federal policies and programs affecting the general population; 2) prevent type 2 diabetes in at-risk individuals through targeted lifestyle and medication interventions; and 3) improve the treatment of diabetes and its complications to improve the health outcomes of people with diabetes. In this first article, we review the successes and limitations of previous federal efforts to combat diabetes. We then describe the establishment of and charge to the NCCC. We discuss the development of a hybrid conceptual model that guided the NCCC's novel all-of-government approach to address diabetes as both a societal and medical problem. We then review the procedures used by the NCCC to gather information from federal agencies, stakeholders, key informants, and the public and to conduct literature reviews. Finally, we review the NCCC's three foundational recommendations: 1) improve the coordination of non-health-related and health-related federal agencies to address the social and environmental conditions that are accelerating the diabetes epidemic; 2) ensure that all Americans at risk for and with diabetes have health insurance and access to health care; and 3) ensure that all federal policies and programs promote health equity in diabetes.
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Affiliation(s)
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | | | - Paul R. Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Clydette Powell
- School of Medicine and Health Services, George Washington University, Washington, DC
| | - Howard Tracer
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD
| | - Dean Schillinger
- University of California San Francisco School of Medicine and San Francisco General Hospital, San Francisco, CA
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3
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Abstract
Medication nonadherence in individuals with diabetes can lead to adverse health outcomes. Young and middle-aged adults are more likely to have low food security than other age groups. However, little research has focused on the relationship between food security and medication adherence in this population. The objective of this study was to examine the relationship between food security and medication adherence among young and middle-aged adults with diabetes. This study used 2019 National Health Interview Survey data. Persons were included if they were aged less than 50 and had a diabetes diagnosis. Individuals were categorized as nonadherent to medication if they answered "yes" to one question indicating nonadherence. Food security status was categorized as food secure, low food security, and very low food security. Among adults under age 50 with diabetes, nearly a fifth were categorized as having low or very low food security. Approximately a quarter of the participants were not adherent. Respondents with low food security and very low food security were significantly more likely to be nonadherent to medication than those who were food secure. People with diabetes under the age of 50 who have low or very low food security are at an increased risk for nonadherence to medication.
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Affiliation(s)
- Brittany E Imel
- Department of Public Health, College of Health Sciences, Arcadia University
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4
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Osborn B, Albrecht SS, Fleischer NL, Ro A. Food insecurity, diabetes, and perceived diabetes self-management among Latinos in California: Differences by nativity and duration of residence. Prev Med Rep 2022; 28:101856. [PMID: 35711286 PMCID: PMC9194646 DOI: 10.1016/j.pmedr.2022.101856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/14/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
We examined associations between food security (FS) status and type 2 diabetes (T2D) prevalence and perceived T2D self-management by nativity and US duration of residence among Latinos living in California. We used the California Health Interview Survey (2012-2017) and included Latinos who lived below 200% of the federal poverty line (n = 16,254) and for our management outcome, those with T2D (n = 2284). Latinos with low FS (OR = 1.44, 95% CI 1.14-1.83) or very low FS (OR = 1.87, 95% CI 1.33-2.61) had a higher odds of T2D compared to their food-secure counterparts. When stratified by nativity/duration in the US, US-born Latinos and Latino immigrants with >10 years duration had a higher odds of T2D if they reported low FS (US-born: OR = 1.60, 95% CI 1.02-2.52; >10 yrs: OR = 1.48, 95% CI 1.12-1.97) or very low FS (US-born: OR = 2.37, 95% CI 1.45-3.86; >10 yrs: OR = 1.78, 95% CI 1.15-2.76) compared to their food-secure counterparts. There was no association among immigrants with <10 years duration. For perceived T2D self-management, those with low or very low FS had lower odds of reporting proper management (OR = 0.56, 95% CI 0.36-0.86; OR = 0.46, 95% CI 0.26-0.83) compared to their food-secure counterparts. When stratified by nativity, the US-born did not differ in their perceived self-management by FS status, while immigrants with low or very FS had lower odds of perceived self-management (OR = 0.54, 95% CI 0.34-0.86; OR = 0.36, 95% CI 0.17-0.74), compared to their food-secure counterparts. Food insecurity may be an important contributor to T2D prevalence and perceived T2D self-management for Latino immigrants.
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Affiliation(s)
- Brandon Osborn
- Program in Public Health, University of California, Irvine, Anteater Instruction and Research Building (AIRB), Room 2030, 653 E. Peltason Road, Irvine, CA 92697-3957, United States
| | - Sandra S. Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 703, New York, NY 10032, United States
| | - Nancy L. Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States
| | - Annie Ro
- Program in Public Health, University of California, Irvine, Anteater Instruction and Research Building (AIRB), Room 2030, 653 E. Peltason Road, Irvine, CA 92697-3957, United States
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Learnihan V, Schroers RD, Coote P, Blake M, Coffee NT, Daniel M. Geographic variation in and contextual factors related to biguanide adherence amongst medicaid enrolees with type 2 Diabetes Mellitus. SSM Popul Health 2022; 17:101013. [PMID: 35106360 PMCID: PMC8784336 DOI: 10.1016/j.ssmph.2021.101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/30/2022] Open
Abstract
Much is known about the adverse impacts on diabetes outcomes of non-adherence to diabetes medication. Less is known about how adherence to diabetes medication varies geographically, and the correspondence of this variation to social and contextual factors. Using pharmacy claims data over a two-year period, this study analysed non-adherence to biguanide medication for N=24,387 adult Medicaid enrolees diagnosed with Type 2 Diabetes Mellitus (T2DM) and residing in Ohio. Spatial analysis was used to detect clusters of census tract level rates of non-adherence, defined as the proportion of patients below the Proportion Days Covered (PDC) threshold of 80%, the level at which patients have a reasonable likelihood of achieving most clinical benefit from their medication. Multilevel models were used to understand associations between medication non-adherence and contextual factors including social vulnerability, urbanicity and distance to utilised pharmacy, with adjustment for individual-level covariates. These findings indicate that contextual factors are associated with medication non-adherence in Medicaid clients with T2DM. They suggest a need for spatially specific, multifaceted intervention programmes that target and/or account for the features of residential settings beyond individual and health system-level factors alone. While “environmental” considerations are often acknowledged, few intervention initiatives are predicated on explicit knowledge of spatially variable influences that can be targeted to enable and support medication adherence. Medication adherence is a problem amongst Type 2 Diabetes patients on Medicaid. Social and contextual factors' influence on medication adherence is underexplored. Higher social vulnerability is associated with non-adherence to biguanides. Adopting spatial analysis techniques enables geographic targeting of health risk.
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Affiliation(s)
- Vincent Learnihan
- Health Research Institute, University of Canberra, Australia
- Corresponding author. MPH Health Research Institute, University of Canberra, Building 23 Office B32, University Drive, Bruce, ACT, 2617, Australia.
| | | | - Philip Coote
- Health Research Institute, University of Canberra, Australia
| | - Marcus Blake
- Health Research Institute, University of Canberra, Australia
| | - Neil T. Coffee
- Health Research Institute, University of Canberra, Australia
| | - Mark Daniel
- Health Research Institute, University of Canberra, Australia
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia
- South Australian Health & Medical Research Institute, Australia
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7
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Ding A, Dixon SW, Ferries EA, Shrank WH. The role of integrated medical and prescription drug plans in addressing racial and ethnic disparities in medication adherence. J Manag Care Spec Pharm 2022; 28:379-386. [PMID: 35199574 PMCID: PMC10372970 DOI: 10.18553/jmcp.2022.28.3.379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medication nonadherence in the United States contributes to 125,000 deaths and 10% of hospitalizations annually. The pain of preventable deaths and the personal costs of nonadherence are borne disproportionately by Black, Latino, and other minority groups because nonadherence is higher in these groups due to a variety of factors. These factors include socioeconomic challenges, issues with prescription affordability and convenience of filling and refilling them, lack of access to pharmacies and primary care services, difficulty taking advantage of patient engagement opportunities, health literacy limitations, and lack of trust due to historical and structural discrimination outside of and within the medical system. Solutions to address the drivers of lower medication adherence, specifically in minority populations, are needed to improve population outcomes and reduce inequities. While various solutions have shown some traction, these solutions have tended to be challenging to scale for wider impact. We propose that integrated medical and pharmacy plans are well positioned to address racial and ethnic health disparities related to medication adherence. DISCLOSURES: This study was not supported by any funding sources other than employment of all authors by Humana Inc. Humana products and programs are referred to in this article.
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8
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Wilder ME, Kulie P, Jensen C, Levett P, Blanchard J, Dominguez LW, Portela M, Srivastava A, Li Y, McCarthy ML. The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med 2021; 36:1359-1370. [PMID: 33515188 PMCID: PMC8131473 DOI: 10.1007/s11606-020-06447-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication adherence (MA) is critical to successful chronic disease management. It is not clear how social determinants of health (SDH) impact MA. We conducted a systematic review and meta-analysis to summarize the evidence on the relationship between SDH and MA. METHODS We conducted a systematic review of the literature using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) format. A literature search was performed using three databases: PubMed, Scopus, and Cochrane Clinical Trials Register in December of 2018. Included studies were completed in the USA, included adults aged 18 years and older, measured at least one social determinant of health, and medication adherence was the primary outcome measure. Data from included full texts were independently extracted using a standardized data extraction form. We then conducted a meta-analysis and pooled the odds ratios from the included studies for each social determinant as well as for all SDH factors collectively. RESULTS A total of 3137 unduplicated abstracts were identified from our database searches. A total of 173 were selected for full text review after evaluating the abstract. A total of 29 articles were included for this systematic review. Economic-related SDH factors and MA were mostly commonly examined. The meta-analysis revealed a significant relationship between food insecurity (aOR = 0.56; 95% CI 0.42-0.7), housing instability (aOR = 0.64; 95% CI 0.44-0.93), and social determinants overall (aOR = 0.75; 95% CI 0.65-0.88) and medication adherence. DISCUSSION Food insecurity and housing instability most consistently impacted medication adherence. Although included studies were heterogenous and varied widely in SDH and MA measurements, adverse social determinants overall were significantly associated with lower MA. The relationship between SDH and MA warrants more attention and research by health care providers and policymakers.
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Affiliation(s)
- Marcee E Wilder
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA.
| | - Paige Kulie
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Caroline Jensen
- Anesthesiology Residency Program, Columbia University, New York, NY, USA
| | - Paul Levett
- Himmelfarb Health Sciences Library, George Washington University, Washington, DC, USA
| | - Janice Blanchard
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Luis W Dominguez
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Maria Portela
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Aneil Srivastava
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA
| | - Yixuan Li
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Melissa L McCarthy
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, DC, USA.,Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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9
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Papajorgji-Taylor D, Francisco M, Schneider JL, Vaughn K, Lindberg N, Smith N, Fitzpatrick SL. Bridge to Health/ Puente a la Salud: Rationale and design of a pilot feasibility randomized trial to address diabetes self-management and unmet basic needs among racial/ethnic minority and low-income patients. Contemp Clin Trials Commun 2021; 22:100779. [PMID: 34013093 PMCID: PMC8114052 DOI: 10.1016/j.conctc.2021.100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Racial/ethnic and socioeconomic disparities in diabetes prevalence and management persist. Unmet basic needs such as food insecurity and unstable housing interfere with optimal diabetes self-management. Bridge to Health/Puente a la Salud is a randomized pilot trial designed to examine the feasibility of testing the effectiveness of addressing unmet basic needs via navigation services versus navigation plus diabetes self-management support (DSMS) on improving diabetes-related outcomes among racial/ethnic minority and low-income patients with uncontrolled diabetes. Material and methods We recruited and randomized 110 African American, Hispanic, and Medicaid patients (any race/ethnicity) with diabetes and recent hemoglobin A1C ≥ 8% to one of two 6-month interventions: 1) Navigation only; or 2) Navigation + DSMS. In both arms, practice-embedded patient navigators help participants navigate social services and community-based resources to address unmet basic needs. In Navigation + DSMS, participants are also assigned to a community health worker (CHW) embedded in a local community-based organization who provides additional navigation support and delivers DSMS. A1C and unmet basic needs data are collected via routine lab and survey, respectively, at baseline and 6-month follow-up. Qualitative interviews with participants, health system leaders, CHWs, and patient navigators are conducted to explore intervention acceptability and determinants of implementation in a health care setting. Discussion Findings from this pilot feasibility study will enhance understanding about acceptability, preliminary clinical effectiveness, and facilitators and barriers to implementation of the Navigation only and Navigation + DSMS interventions and inform refinements of the overall study design for the larger, randomized clinical trial.
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Affiliation(s)
- Dea Papajorgji-Taylor
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Melanie Francisco
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Jennifer L Schneider
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Katie Vaughn
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Nangel Lindberg
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Ning Smith
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Stephanie L Fitzpatrick
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
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Fitzpatrick SL, Banegas MP, Kimes TM, Papajorgji-Taylor D, Fuoco MJ. Prevalence of Unmet Basic Needs and Association with Diabetes Control and Care Utilization Among Insured Persons with Diabetes. Popul Health Manag 2021; 24:463-469. [PMID: 33535008 DOI: 10.1089/pop.2020.0236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Unmet basic needs (eg, food insecurity, inadequate housing) are major barriers to diabetes self-management. The purpose of this study was to identify the prevalence of unmet basic needs and examine the association with diabetes control and care utilization among insured persons with diabetes. A total of 4043 adult patients with diabetes were screened for unmet basic needs using Your Current Life Situation, a screener for unmet basic needs, during a clinical encounter or as an online survey, during the study period (January 1, 2016-August 31, 2017). Hemoglobin A1c and care utilization (outpatient, emergency department [ED], hospitalization, diabetes-related prescription refills) were extracted from the electronic health record 12 months prior to screening. The authors compared patients with unmet basic needs to those with no needs on poor diabetes control (ie, A1c ≥8%) and care utilization using multivariable regression models. Of the 4043 patients screened, 25% endorsed ≥1 unmet basic need. In adjusted analyses, the presence of unmet basic needs was associated with an increased likelihood of having an A1c ≥8% (OR = 1.77; 95% CI 1.47, 2.13), more outpatient visits (incidence rate ratio [IRR] = 1.3; 1.2, 1.4), more ED visits (IRR = 2.3; 2.0, 2.6), more hospitalizations (IRR = 1.8; 1.5, 2.2), and more delays in refilling diabetes medication (IRR = 1.21; 1.13, 1.30). Findings indicate that unmet basic needs are highly prevalent, even among an insured patient population, and are associated with poor diabetes-related clinical outcomes and excess utilization. Future studies to determine best strategies to integrate this information into treatment planning are warranted.
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Affiliation(s)
| | | | - Teresa M Kimes
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
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11
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Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, Thornton PL, Haire-Joshu D. Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care 2020; 44:dci200053. [PMID: 33139407 PMCID: PMC7783927 DOI: 10.2337/dci20-0053] [Citation(s) in RCA: 578] [Impact Index Per Article: 144.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Felicia Hill-Briggs
- Department of Medicine, Johns Hopkins University, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Nancy E Adler
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Tiffany L Gary-Webb
- Departments of Epidemiology and Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | - Pamela L Thornton
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, St. Louis, MO
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12
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Cummer E, Loyola Amador C, Montez K, Skelton JA, Ramirez B, Best S, Zimmer R, Palakshappa D. What a city eats: Examining the dietary preferences of families living in communities at high risk for food insecurity. J Clin Transl Sci 2020; 5:e55. [PMID: 33948276 PMCID: PMC8057380 DOI: 10.1017/cts.2020.549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Food insecurity (FI) is the lack of consistent access to enough food for an active and healthy life. Community-based hunger relief programs often serve as emergency food sources for families with FI. However, these programs may not provide foods that diverse populations of people prefer. We sought to evaluate the dietary patterns and preferences of families living in food-insecure neighborhoods and utilizing a community-based hunger relief program, in order to improve the utilization of local nutritional programs. METHODS We examined the Help Our People Eat (HOPE) community-based mobile meal program. Free-listing interviews (n = 63) were conducted with English-(66%) and Spanish-speaking (34%) participants of the program. Participants were asked about FI risk, food preferences, and dietary behaviors at home. RESULTS The majority of participants (90%) had children in the household. About 60% reported not being able to afford the type of food they enjoyed. Most participants reported using stoves for cooking (80%). Participants overwhelmingly cooked with chicken, beef, and pork. The most common side dishes included potatoes, rice, and salad. Most participants reported no interest in cooking differently or learning new recipes. CONCLUSIONS A common theme throughout interviews was that families prefer similar meals, but may prepare them differently based on the language spoken. Food preferences consisted of a high intake of carbohydrate-rich meals, perhaps because these foods may be cheaper and easier to access. Notably, new recipes and cooking methods were not a priority for these families, possibly due to the time and effort needed to learn them.
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Affiliation(s)
- Elaina Cummer
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Brenda Ramirez
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott Best
- Help Our People Eat (HOPE) of Winston-Salem, Winston-Salem, NC, USA
| | - Rachel Zimmer
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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13
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Psychological Distress among College Students: Role of Food Insecurity and Other Social Determinants of Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114118. [PMID: 32526990 PMCID: PMC7312727 DOI: 10.3390/ijerph17114118] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022]
Abstract
Food insecurity is a major social determinant of health and an assessment of how it may impact college students' mental health is imperative, as well as differential associations by self-identified gender. A cross-sectional survey was used among college students of a mid-size minority-serving institution with a final sample size of 302 participants aged 18 years or above. Descriptive, bivariate, and multivariable regressions were conducted, by gender, to assess the role of food insecurity (United States Department of Agriculture (USDA) six-item questionnaire), on mental health outcomes (Kessler-6 scale and self-perception). All the statistical analyses were conducted in SPSS version 24 (IBM, Corp.; Armonk, NY, USA) with an alpha less than 0.05 used to denote significance. Among those with food insecurity, the odds of reporting psychological distress (odds ratio (OR) = 3.645, p < 0.05) and an average to very poor self-perceived mental health status (OR = 2.687, p <0.05) were higher compared to their food-secure counterparts, with the results consistent in a gender-specific analysis as well. Compared to men, however, women had higher odds of psychological distress (OR = 2.280, p < 0.05), as well as reporting average to very poor self-perceived mental health statuses (OR = 2.700, p < 0.05). Among women, any alcohol use in the past 12 months (OR = 2.505, p < 0.05) and a low self-perceived physical health status (OR = 3.601, p < 0.05) were associated with an average to very poor self-perceived mental health status. Among men, a low perceived physical health status was associated with higher odds of psychological distress (OR = 3.477, p < 0.05). The results of our study highlight that food insecurity should be considered a social determinant of mental health wellbeing. In addition, gender-specific trends in mental health highlight the need for targeted interventions for prevention and treatment.
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14
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Walker RJ, Garacci E, Campbell JA, Harris M, Mosley-Johnson E, Egede LE. Relationship Between Multiple Measures of Financial Hardship and Glycemic Control in Older Adults With Diabetes. J Appl Gerontol 2020; 40:162-169. [PMID: 32167406 DOI: 10.1177/0733464820911545] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: To examine the relationship between multiple measures of financial hardship and glycemic control in older adults with diabetes. Methods: Using data from Health and Retirement Study (HRS), we investigated four measures of financial hardship: difficulty paying bills, ongoing financial strain, decreasing food intake due to money, and taking less medication due to cost. Using linear regression models, we investigated the relationship between each measure, and a cumulative score of hardships per person, on glycemic control (HbA1c). Results: After adjustment, a significant relationship existed with each increasing number of hardships associated with increasing HbA1c (0.09, [95%CI 0.04, 0.14]). Difficulty paying bills (0.25, [95%CI 0.14, 0.35]) and decreased medication usage due to cost (0.17, [95%CI 0.03, 0.31]) remained significantly associated with HbA1c. Conclusion: In older adults, difficulty paying bills and cost-related medication nonadherence is associated with glycemic control, and every additional financial hardship was associated with an increased HbA1c by nearly 0.1%.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Melissa Harris
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Elise Mosley-Johnson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
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15
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Flint KL, Davis GM, Umpierrez GE. Emerging trends and the clinical impact of food insecurity in patients with diabetes. J Diabetes 2020; 12:187-196. [PMID: 31596548 DOI: 10.1111/1753-0407.12992] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 11/28/2022] Open
Abstract
Food insecurity is a major public health concern in the United States affecting 15 million households according to data in 2017 from the US Department of Agriculture. Food insecurity, or the inability to consistently obtain nutritious food, disproportionately affects socioeconomically disadvantaged households, as well as those with chronic diseases including diabetes mellitus (DM). This review article explores the literature over the past 10 years pertaining to the complex relationship between food insecurity, social determinants of health, and chronic disease with an emphasis on diabetes and glycemic control. Those with diabetes and food insecurity together have been shown to have worse glycemic control compared to those who are food secure, but it remains unclear exactly how food insecurity affects glycemic control. Prior interventional studies have targeted aspects of food insecurity in patients with diabetes but have reported variable outcomes with respect to improvement in glycemic control despite effectively reducing rates of food insecurity. Additionally, few data exist regarding long-term outcomes and diabetes-related complications in this population. It is likely that many factors at both the community and individual levels impact glycemic control outcomes in the setting of food insecurity. Further studies are needed to better understand these factors and to create multifaceted targets for future interventional studies aimed at improving glycemic control in this population.
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16
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Becerra MB, Avina RM, Jackson M, Becerra BJ. Role of food insecurity in prescription delay among adults with asthma: results from the California health interview survey. J Asthma 2019; 58:248-252. [PMID: 31578120 DOI: 10.1080/02770903.2019.1676435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Food insecurity remains a major public health concern in the United States. Studies have noted that food insecurity can lead to lower healthcare utilization and poorer health status. Despite the continuous burden of asthma, little research has shown whether food insecurity serves as a social determinant to poor asthma care. In this study, we specifically focused on whether food insecurity can lead to delay in prescription medication for adults with asthma in California.Methods: We utilized the California Health Interview Survey. Survey weighted descriptive, univariate, and multivariable logistic regression analyses were conducted. A total of 11,645 observations, representing an average annual population size of 1,085,481 was included in this study.Results: Nearly 15% and 8% of participants were food insecure and had current asthma, respectively. Based on adjusted odds ratio, food insecure adults were 148% more likely to report delay in asthma prescription, as compared to those who were food secure (adjusted odds ratio =2.48; 95% CI: 1.58, 3.89).Conclusions: Given the delay in prescription, and thus appropriate health care, demonstrated in our study, targeted measures at point of care should be implemented to identify such at-risk patients early and provide resources for food aid to ensure optimal health outcomes.
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Affiliation(s)
- Monideepa B Becerra
- Department of Health Science and Human Ecology, California State University, San Bernardino, CA, USA
| | - Robert M Avina
- Department of Health Science and Human Ecology, California State University, San Bernardino, CA, USA
| | - Maylen Jackson
- Department of Health Science and Human Ecology, California State University, San Bernardino, CA, USA
| | - Benjamin J Becerra
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
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17
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Parikh TJ, Helfrich CD, Quiñones AR, Marshall-Fabien GL, Makaroun LK, Black MA, Thielke SM. Cost-related delay in filling prescriptions and health care ratings among medicare advantage recipients. Medicine (Baltimore) 2019; 98:e16469. [PMID: 31374008 PMCID: PMC6708951 DOI: 10.1097/md.0000000000016469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Despite higher health care needs, older adults often have limited and fixed income. Approximately a quarter of them report not filling or delaying prescription medications due to cost (cost-related prescription delay, CRPD). To ascertain the association between CRPD and satisfaction with health care, secondary analysis of the 2012 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Advantage Survey was performed.Regression models quantified the association between CRPD and rating of personal doctor, specialist, and overall health care. Models were adjusted for demographic, health-related, and socioeconomic characteristics. 274,996 Medicare Advantage enrollees were mailed the CAHPS survey, of which 101,910 (36.8%) returned a survey that had responses to all the items we analyzed. CRPD was assessed by self-report of delay in filling prescriptions due to cost. Health care ratings were on a 0-10 scale. A score ≤ 5 was considered a poor rating of care.In unadjusted models, CRPD more than doubled the relative risk (RR) for poor ratings of personal doctor (RR 2.34), specialist (RR 2.14), and overall health care (RR 2.40). Adjusting for demographics and health status slightly reduced the RRs to 1.9, but adjusting for low-income subsidy and lack of insurance for medications did not make a difference.CRPD is independently associated with poor ratings of medical care, regardless of health, financial or insurance status. Providers might reduce patients' financial stress and improve patient satisfaction by explicitly discussing prescription cost and incorporating patient priorities when recommending treatments.
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Affiliation(s)
- Toral J Parikh
- Department of Gerontology and Geriatric Medicine, University of Washington, Health Services Research and Development, VA Puget Sound Health Care System
| | - Christian D Helfrich
- Department of Health Services, University of Washington, Health Services Research and Development, VA Puget Sound Health Care System
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University
| | | | - Lena K Makaroun
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | | | - Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System
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18
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Schroeder EB, Zeng C, Sterrett AT, Kimpo TK, Paolino AR, Steiner JF. The longitudinal relationship between food insecurity in older adults with diabetes and emergency department visits, hospitalizations, hemoglobin A1c, and medication adherence. J Diabetes Complications 2019; 33:289-295. [PMID: 30717893 PMCID: PMC6660013 DOI: 10.1016/j.jdiacomp.2018.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 11/16/2022]
Abstract
AIMS To examine the relationship between food insecurity and emergency department (ED) visits, hospitalizations, A1c, and diabetes medication adherence over one year of follow-up among individuals >65 years with diabetes mellitus. METHODS We conducted a longitudinal cohort study of adults >65 years with diabetes who did (n = 742) or did not (n = 2226) report food insecurity at baseline. We used conditional logistic regression for the ED visits or hospitalization outcomes, and mixed effects models for A1c and non-insulin diabetes medication adherence. RESULTS In bivariate analyses, individuals with food insecurity were more likely to have an ED visit (OR = 1.40, 95% CI 1.15-1.72) or hospitalization (OR = 1.41, 95% CI 1.11-1.78) in the year after the food security assessment. In addition, A1c was higher (7.5% vs. 7.2%, p < 0.001). There was no difference in medication adherence. These differences persisted with adjustment for basic demographic and clinical characteristics, but were attenuated with further adjustment for socioeconomic status. CONCLUSIONS Differences in diabetes outcomes by food insecurity status were attenuated by adjustment for socioeconomic status. Adverse outcomes in individuals with diabetes and food insecurity may be driven by effects of food insecurity per se or be mediated by a constellation of basic resource needs or lower socioeconomic status.
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Affiliation(s)
- Emily B Schroeder
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Chan Zeng
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - Andrew T Sterrett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - Tina K Kimpo
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - Andrea R Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States
| | - John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, United States; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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19
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Mullin B, Cervantes BS, Billimek J. Material Need Insecurity and Its Concurrent Barriers to Diabetes Management Among Low-Income Latino Adults Receiving Medical Care. Diabetes Care 2019; 42:e31-e33. [PMID: 30674549 PMCID: PMC6463549 DOI: 10.2337/dc18-1583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/19/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Briga Mullin
- Program in Medical Education for the Latino Community (PRIME-LC), School of Medicine, University of California, Irvine, Irvine, CA
| | - Brett S Cervantes
- Program in Medical Education for the Latino Community (PRIME-LC), School of Medicine, University of California, Irvine, Irvine, CA
- Health Policy Research Institute, University of California, Irvine, Irvine, CA
| | - John Billimek
- Program in Medical Education for the Latino Community (PRIME-LC), School of Medicine, University of California, Irvine, Irvine, CA
- Health Policy Research Institute, University of California, Irvine, Irvine, CA
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20
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Berkowitz SA, Karter AJ, Corbie-Smith G, Seligman HK, Ackroyd SA, Barnard LS, Atlas SJ, Wexler DJ. Food Insecurity, Food "Deserts," and Glycemic Control in Patients With Diabetes: A Longitudinal Analysis. Diabetes Care 2018; 41:1188-1195. [PMID: 29555650 PMCID: PMC5961388 DOI: 10.2337/dc17-1981] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/27/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Both food insecurity (limited food access owing to cost) and living in areas with low physical access to nutritious foods are public health concerns, but their relative contribution to diabetes management is poorly understood. RESEARCH DESIGN AND METHODS This was a prospective cohort study. A random sample of patients with diabetes in a primary care network completed food insecurity assessment in 2013. Low physical food access at the census tract level was defined as no supermarket within 1 mile in urban areas and 10 miles in rural areas. HbA1c measurements were obtained from electronic health records through November 2016. The relationship among food insecurity, low physical food access, and glycemic control (as defined by HbA1c) was analyzed using hierarchical linear mixed models. RESULTS Three hundred and ninety-one participants were followed for a mean of 37 months. Twenty percent of respondents reported food insecurity, and 31% resided in an area of low physical food access. In adjusted models, food insecurity was associated with higher HbA1c (difference of 0.6% [6.6 mmol/mol], 95% CI 0.4-0.8 [4.4-8.7], P < 0.0001), which did not improve over time (P = 0.50). Living in an area with low physical food access was not associated with a difference in HbA1c (difference 0.2% [2.2 mmol/mol], 95% CI -0.2 to 0.5 [-2.2 to 5.6], P = 0.33) or with change over time (P = 0.07). CONCLUSIONS Food insecurity is associated with higher HbA1c, but living in an area with low physical food access is not. Food insecurity screening and interventions may help improve glycemic control for vulnerable patients.
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Affiliation(s)
- Seth A Berkowitz
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA .,Diabetes Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Giselle Corbie-Smith
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.,Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA.,Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Sarah A Ackroyd
- Department of Obstetrics, Gynecology & Reproductive Sciences, Temple University Hospital, Philadelphia, PA
| | - Lily S Barnard
- University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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21
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Avilés-Santa ML, Colón-Ramos U, Lindberg NM, Mattei J, Pasquel FJ, Pérez CM. From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America. Front Endocrinol (Lausanne) 2017; 8:298. [PMID: 29176960 PMCID: PMC5687125 DOI: 10.3389/fendo.2017.00298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Abstract
The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.
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Affiliation(s)
- M. Larissa Avilés-Santa
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, United States
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Nangel M. Lindberg
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Francisco J. Pasquel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Cynthia M. Pérez
- University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
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22
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Bhargava V, Lee JS. Food Insecurity and Health Care Utilization Among Older Adults in the United States. J Nutr Gerontol Geriatr 2017; 35:177-92. [PMID: 27559853 DOI: 10.1080/21551197.2016.1200334] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the relationships between food insecurity and utilization of four health services among older Americans: office visits, inpatient hospital nights, emergency department visits, and home health care. Nationally representative data from the 2011 and 2012 National Health Interview Survey were used (N = 13,589). Nearly 83.0% of the sample had two or more office visits, 17.0% reported at least one hospital night, 23.0% had at least one emergency room visit, and 8.1% used home health care during the past 12 months. Adjusting for confounders, food-insecure older adults had higher odds of using more office visits, inpatient hospital nights, and emergency department visits than food-secure older adults, but similar odds of home health care utilization. The findings of this study suggest that programs and policies aimed at reducing food insecurity among older adults may have a potential to reduce utilization of health care services.
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Affiliation(s)
- Vibha Bhargava
- a Department of Financial Planning, Housing and Consumer Economics , University of Georgia , Athens , Georgia , USA
| | - Jung Sun Lee
- b Department of Foods and Nutrition , University of Georgia , Athens , Georgia , USA
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23
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Social vulnerability and hypoglycemia among patients with diabetes. ACTA ACUST UNITED AC 2017; 64:92-99. [PMID: 28440783 DOI: 10.1016/j.endinu.2016.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 11/25/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022]
Abstract
Lower-income populations are hit harder by the diabetes epidemic as regards both prevalence and the risk of complications. Food Insecurity is one of the mechanisms through which poverty may predispose people with low socio-economic status to poorer control and higher complication rates. The United Nations Food and Agriculture Organization defined food security as "the right to have access to sufficient nutritional and culturally acceptable food choices." Adults suffering from diabetes with limited income have a 40% greater chance of having food insecurity and an inadequate blood glucose control. Such patients have a two-fold greater risk of developing severe hypoglycemia. In addition, several studies have shown that social vulnerability resulting from food insecurity, low socioeconomic status, low educational levels, and poor health education is an independent risk factor for hypoglycemia, even after conventional predictors are controlled. This review analyzes the literature available on social vulnerability as a non-conventional risk factor for development of hypoglycemia in diabetic subjects.
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24
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Abstract
In this longitudinal study, we applied structural equation modeling (SEM) to examine the historical, predisposing, enabling/barrier, and need factors as related to the underuse of medical services during early midlife. We gathered longitudinal data on a prospective cohort of community-dwelling men and women (N = 548) followed from adolescence to early midlife. The findings supported a mediational model: A mutually affectionate parent-child relationship in early adolescence was inversely related to underuse of medical services in early midlife via the mediational roles played by later predisposing factors (i.e., depressive mood and cigarette smoking), need factor (i.e., physical health problems), barriers (i.e., financial difficulty), and enabling factors (i.e., social support for health services in early midlife). In addition, satisfaction with medical services in the neighborhood had an association with less underuse of medical services in early midlife. Family therapy focused on an increase in the affectionate relationship between the adolescents and his/her parents and cognitive-behavioral treatment of depressive mood may lead to a decrease in the underuse of medical services.
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Affiliation(s)
- Chenshu Zhang
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY, 10016, USA
| | - Judith S Brook
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY, 10016, USA.
| | - Carl G Leukefeld
- Department of Behavioral Sciences, University of Kentucky, Lexington, KY, USA
| | - David W Brook
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave., 15th Floor, New York, NY, 10016, USA
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25
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Knight CK, Probst JC, Liese AD, Sercye E, Jones SJ. Household food insecurity and medication "scrimping" among US adults with diabetes. Prev Med 2016; 83:41-5. [PMID: 26656403 DOI: 10.1016/j.ypmed.2015.11.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/27/2015] [Accepted: 11/29/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Our research examined the prevalence of food insecurity among adults with self-reported diabetes and whether food insecurity was associated with cutting back ("scrimping") on prescribed medications because of financial constraints. METHODS We conducted a cross-sectional analysis of data from the 2011 National Health Interview Survey (NHIS). Adults completing this survey were considered to have diabetes if they reported current use of insulin or "diabetic pills" (n=3,242). Food insecurity was determined with a 10-item scale; respondents were categorized as food secure (FS), marginally food secure (MFS) or food insecure (FI). RESULTS Approximately one in six adults in NHIS with diabetes reported food insecurity (17.0%), and an additional 8.8% were marginally FS. An individual was considered to be scrimping on medications if he/she gave a "yes" response to at least one of four questions pertaining to reduced, delayed or avoided medication use. Overall, 18.9% of respondents with diabetes reported one or more type of medication scrimping: 11.7% of FS individuals, 27.7% of MFS individuals and 45.6% of FI individuals. In adjusted analyses, marginal food security and food insecurity remained strongly associated with scrimping. CONCLUSIONS One-quarter of adults with diabetes may have difficulty obtaining foods appropriate for a diabetic diet; a substantial number of these individuals also fail to obtain or take medications. Practitioners may miss either problem unless targeted questions are included in clinical encounters. Clinicians should consider referring FI and MFS diabetic patients to community food resources.
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Affiliation(s)
- Chadwick K Knight
- South Carolina Department of Health and Environmental Control, United States.
| | - Janice C Probst
- Department of Health Services Policy and Management, Arnold School of Public Health, 915 Greene Street, Room 355, University of South Carolina, Columbia, SC 29208, United States
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 915 Greene Street, Room 461, University of South Carolina, Columbia, SC 29208, United States
| | - Erica Sercye
- Cancer Prevention and Control Program, Arnold School of Public Health, 915 Greene Street, Room 249, University of South Carolina, Columbia, SC 29208, United States
| | - Sonya J Jones
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, 915 Greene Street, Room 435B, University of South Carolina, Columbia, SC 29208, United States
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Bhargava V, Lee JS. Food Insecurity and Health Care Utilization Among Older Adults. J Appl Gerontol 2016; 36:1415-1432. [PMID: 26912734 DOI: 10.1177/0733464815625835] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the relationship between food insecurity and health care utilization (physician, inpatient, emergency room, and home health visits) among older adults. Survey data collected from Georgia Advanced Performance Outcomes Measures Project 6 linked to the Centers for Medicare and Medicaid Services (GA Advanced POMP6-CMS) data 2008 ( N = 957) were analyzed. Nearly one half of the sample (48.3%) was food insecure. Food insecure individuals were significantly less likely than food secure individuals to have any physician (69.7% vs. 80.2%) and home health visits (24.9% vs. 32.3%) during 2008. However, there were no significant differences in levels of health care utilization by food secure and food insecure older adults. Food secure and food insecure older adults utilized comparable levels of health care services. Public assistance programs such as Medicare and meal services targeted toward older adults may enable economically constrained, food insecure older adults to access needed health care services.
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Smalls BL, Gregory CM, Zoller JS, Egede LE. Assessing the relationship between neighborhood factors and diabetes related health outcomes and self-care behaviors. BMC Health Serv Res 2015; 15:445. [PMID: 26428459 PMCID: PMC4589943 DOI: 10.1186/s12913-015-1086-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that community and neighborhood characteristics can impact health outcomes of those with chronic illness, including T2DM. Factors, such as crime, violence, and lack of resources have been shown to be barriers to optimal health outcomes in diabetes. Thus, the objective of this study is to assess the effects of neighborhood factors on diabetes-related health outcomes and self-care behaviors. METHODS Adult patients (N = 615) with type 2 diabetes mellitus (T2DM) were recruited from an academic medical center and a Veterans Affairs medical center in the southeastern United States. Validated scales and indices were used to assess neighborhood factors and diabetes-related self-care behaviors. The most recent HbA1c, blood pressure, and LDL cholesterol were abstracted from each patients' electronic medical record. RESULTS In the fully adjusted model, significant associations were between neighborhood aesthetics and diabetes knowledge (β = 0.141) and general diet (β = -0.093); neighborhood comparison and diabetes knowledge (β = 0.452); neighborhood activities and general diet (β = -0.072), exercise (β = -0.104), and foot care (β = -0.114); food insecurity and medication adherence (β = -0.147), general diet (β = -0.125), and blood sugar testing (β = -0.172); and social support and medication adherence (β = 0.009), foot care (β = 0.010), and general diet (β = 0.016). Significant associations were also found between neighborhood violence and LDL Cholesterol (β = 4.04), walking environment and exercise (β = -0.040), and social cohesion and HbA1c (β = -0.086). DISCUSSION We found that neighborhood violence, aesthetics, walking environment, activities, food insecurity, neighborhood comparison, social cohesion and social support have statistically significant associations with self-care behaviors and outcomes to varying degrees. However, the key neighborhood factors that had independent associations with multiple self-care behaviors and outcomes were food insecurity, neighborhood activities and social support. CONCLUSION This study suggests that food insecurity, neighborhood activities, aesthetics, and social support may be important targets for interventions in individuals with T2DM.
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Affiliation(s)
- Brittany L Smalls
- Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA.
| | - Chris M Gregory
- Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA.
| | - James S Zoller
- Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA. .,Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA.
| | - Leonard E Egede
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Room 280, MSC 593, Charleston, SC, 29425, USA. .,Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, RT 12th Floor, P.O. Box 250591, Charleston, SC, 29425, USA.
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Abstract
AbstractObjectiveTo examine the relationship between food insecurity and coping strategies (actions taken to manage economic stress) hypothesized to worsen glucose control in patients with diabetes.DesignUsing a cross-sectional telephone survey and clinical data, we compared food-insecure and food-secure individuals in their use of coping strategies. Using logistic regression models, we then examined the association between poor glucose control (glycated Hb, HbA1c≥8·0 %), food insecurity and coping strategies.SettingAn urban medical centre, between June and December 2013.SubjectsFour hundred and seven adults likely to be low income (receiving Medicaid or uninsured and/or residing in a zip code with >30 % of the population below the federal poverty level) with type 2 diabetes.ResultsOf respondents, 40·5 % were food insecure. A significantly higher percentage of the food-insecure group reported use of most examined coping strategies, including foregone medical care, participation in the Supplemental Nutrition Assistance Program (SNAP)) and use of emergency food programmes. Food insecurity was associated with poor glucose control (OR=2·23; 95 % CI 1·22, 4·10); coping strategies that were more common among the food insecure were not associated with poor glucose control. Among the food insecure, receipt of SNAP was associated with lower risk of poor glucose control (OR=0·27; 95 % CI 0·09, 0·80).ConclusionsWhile food insecurity was associated with poor glucose control, most examined coping strategies did not explain this relationship. However, receipt of SNAP among food-insecure individuals was associated with better diabetes control, suggesting that such programmes may play a role in improving health.
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Food insecurity, coping strategies and glucose control in low-income patients with diabetes. Public Health Nutr 2015; 19:1103-11. [DOI: 10.1017/s1368980015002323] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo examine the relationship between food insecurity and coping strategies (actions taken to manage economic stress) hypothesized to worsen glucose control in patients with diabetes.DesignUsing a cross-sectional telephone survey and clinical data, we compared food-insecure and food-secure individuals in their use of coping strategies. Using logistic regression models, we then examined the association between poor glucose control (glycated Hb, HbA1c≥8·0 %), food insecurity and coping strategies.SettingAn urban medical centre, between June and December 2013.SubjectsFour hundred and seven adults likely to be low income (receiving Medicaid or uninsured and/or residing in a zip code with >30 % of the population below the federal poverty level) with type 2 diabetes.ResultsOf respondents, 40·5 % were food insecure. A significantly higher percentage of the food-insecure group reported use of most examined coping strategies, including foregone medical care, participation in the Supplemental Nutrition Assistance Program (SNAP)) and use of emergency food programmes. Food insecurity was associated with poor glucose control (OR=2·23; 95 % CI 1·22, 4·10); coping strategies that were more common among the food insecure were not associated with poor glucose control. Among the food insecure, receipt of SNAP was associated with lower risk of poor glucose control (OR=0·27; 95 % CI 0·09, 0·80).ConclusionsWhile food insecurity was associated with poor glucose control, most examined coping strategies did not explain this relationship. However, receipt of SNAP among food-insecure individuals was associated with better diabetes control, suggesting that such programmes may play a role in improving health.
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Spratt SE, Feinglos MN, Willis JM. Barriers to care for patients with diabetes in Durham, North Carolina, why are we withholding life-sustaining medications from the patients who need them the most? Expert Rev Endocrinol Metab 2015; 10:459-461. [PMID: 30298767 DOI: 10.1586/17446651.2015.1069704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The diabetes epidemic and its complications disproportionately affect minorities and the poor. Medical treatments that can prevent or delay diabetes complications are widely available but poverty underlies much of why there are disparities in diabetes care and outcomes. Lack of access to care, food insecurity and inability to pay for medications prevents adherence to a medication and lifestyle regimen that can be life-sustaining. At the very least, US policies should be changed to provide life-sustaining medications that prevent costly complications to patients who cannot afford them. Adopting value-based insurance design would benefit patients with diabetes who cannot afford to pay for medications but would also reduce healthcare costs in the long run.
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Affiliation(s)
- Susan E Spratt
- a 1 Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Durham, NC 27710, USA
| | - Mark N Feinglos
- a 1 Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Durham, NC 27710, USA
| | - Janese M Willis
- b 2 Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Higashi RT, Craddock Lee SJ, Leonard T, Cuate EL, Cole J, Pruitt SL. Multiple Comorbidities and Interest in Research Participation Among Clients of a Nonprofit Food Distribution Site. Clin Transl Sci 2015; 8:584-90. [PMID: 26277918 DOI: 10.1111/cts.12325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Persons accessing food from nonprofit distribution sites face numerous challenges and typically have significant unmet health needs. However, given limited and intermittent healthcare system engagement, this vulnerable population is underrepresented in clinical research. We sought to better understand the health needs of a nonclinical population to inform future research and interventions. METHODS Focus groups were conducted in English (n = 4) and Spanish (n = 4) with clients of Crossroads Community Services (CCS), the largest distributor of North Texas Food Bank. Discussions probed participants' health status, healthcare utilization, understanding and utilization of mammography, and attitudes toward participation in research. RESULTS Participants included 42 CCS clients, primarily Hispanic or African American women. Participants reported multiple comorbid conditions among household members, yet utilization of health services was often limited by cost. The majority expressed interest in participating in research to communicate their health concerns and obtain emotional support. CONCLUSION CCS clients represent a high-need, under-reached population willing to engage in health-related research that affords them opportunity to connect with peers in group settings and obtain information to improve management of daily life challenges. The Community Assistance Research (CARe) Initiative, a community-academic collaboration, establishes a much-needed opportunity for ongoing clinical research and intervention among this underserved population.
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Affiliation(s)
- Robin T Higashi
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Simon J Craddock Lee
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, Dallas, Texas, USA
| | - Tammy Leonard
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Economics Department, University of Dallas, Dallas, Texas, USA
| | - Erica L Cuate
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jay Cole
- Crossroads Community Services, Dallas, Texas, USA
| | - Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, Dallas, Texas, USA
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Sattler ELP, Lee JS, Bhargava V. Food insecurity and medication adherence in low-income older Medicare beneficiaries with type 2 diabetes. J Nutr Gerontol Geriatr 2015; 33:401-17. [PMID: 25424513 DOI: 10.1080/21551197.2014.959680] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Little is known about diabetes management among low-income older Americans. This study used statewide self-administered survey and Medicare claims data to examine the relationships of food insecurity and medication (re)fill adherence in a sample of Medicare Part D beneficiaries with type 2 diabetes in need of food assistance in Georgia in 2008 (n = 243, mean age 74.2 ± 7.8 years, 27.2% African American, 77.4% female). (Re)fill adherence to oral hypoglycemics was measured as Proportion of Days Covered. Food insecurity was assessed using a six-item validated standard measure. About 54% of the sample were food insecure. About 28% of the diabetic sample did not (re)fill any diabetes medication and over 80% had at least one diabetes complication. Food insecure participants showed comparable (re)fill adherence to food secure participants. However, 57% of food insecure participants were nonadherent to oral hypoglycemics. Underlying basic needs must be addressed to improve diabetes management in this population.
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Herman D, Afulani P, Coleman-Jensen A, Harrison GG. Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample. Am J Public Health 2015; 105:e48-59. [PMID: 26270308 DOI: 10.2105/ajph.2015.302712] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We investigated whether nonelderly US adults (aged 18-64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. METHODS We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ(2) test and multivariate logistic regression with interaction terms. RESULTS Bivariate and multivariate analyses showed a dose-response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. CONCLUSIONS Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households.
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Affiliation(s)
- Dena Herman
- Dena Herman is with the Department of Family and Consumer Sciences, California State University Northridge, Northridge, CA. Patience Afulani and Gail G. Harrison are with the Fielding School of Public Health, University of California, Los Angeles. Alisha Coleman-Jensen is with Economic Research Service, US Department of Agriculture, Washington, DC
| | - Patience Afulani
- Dena Herman is with the Department of Family and Consumer Sciences, California State University Northridge, Northridge, CA. Patience Afulani and Gail G. Harrison are with the Fielding School of Public Health, University of California, Los Angeles. Alisha Coleman-Jensen is with Economic Research Service, US Department of Agriculture, Washington, DC
| | - Alisha Coleman-Jensen
- Dena Herman is with the Department of Family and Consumer Sciences, California State University Northridge, Northridge, CA. Patience Afulani and Gail G. Harrison are with the Fielding School of Public Health, University of California, Los Angeles. Alisha Coleman-Jensen is with Economic Research Service, US Department of Agriculture, Washington, DC
| | - Gail G Harrison
- Dena Herman is with the Department of Family and Consumer Sciences, California State University Northridge, Northridge, CA. Patience Afulani and Gail G. Harrison are with the Fielding School of Public Health, University of California, Los Angeles. Alisha Coleman-Jensen is with Economic Research Service, US Department of Agriculture, Washington, DC
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Abstract
BACKGROUND Latinos from agricultural communities have a high prevalence of food insecurity and are at increased risk of obesity and diabetes, yet little is known about the associations between food insecurity and diabetes outcomes. OBJECTIVE To examine the associations between food insecurity and diabetes outcomes among rural Latinos. METHODS Cross-sectional survey with medical chart abstraction of 250 Latinos with diabetes. Primary outcomes are the control of 3 intermediate diabetes outcomes (hemoglobin A1C ≤8.0%, LDL-cholesterol ≤100 mg/dL, and blood pressure ≤140/90 mm Hg), a composite of control of the 3, and receipt of 6 processes of care. Secondary outcomes are cost-related medication underuse and participation in self-care activities. RESULTS Fifty-two percent of patients reported food insecurity and 1-in-4 reported cost-related medication underuse. Patients with food insecurity were more likely to report cost-related medication underuse [adjusted odds ratio (AOR)=2.49; 95% confidence intervals (CI), 1.30, 4.98; P=0.003], less likely to meet the composite measure for control of the 3 intermediate outcomes (AOR=0.24; 95% CI, 0.07, 0.84; P<0.05), and less likely to receive a dilated eye examination (AOR=0.37; 95% CI, 0.18, 0.77; P<0.05) and annual foot examinations (AOR=0.42; 95% CI, 0.20, 0.84; P<0.05) compared with those who were food secure. CONCLUSIONS Among this rural Latino population, food insecurity was independently associated with not having control of the intermediate diabetes outcomes captured in the composite measure, not receiving dilated eye and foot examinations, and with self-reporting cost-related medication underuse.
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August KJ, Billimek J. A theoretical model of how neighborhood factors contribute to medication nonadherence among disadvantaged chronically ill adults. J Health Psychol 2015; 21:2923-2933. [PMID: 26089191 DOI: 10.1177/1359105315589391] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In addition to individual-level socioeconomic and psychological factors, the neighborhood environment has been found to be related to medication nonadherence, particularly among low-income, minority populations managing a chronic disease. In this article, we synthesize the relevant literature on how neighborhood factors contribute to engagement in health behaviors and reasons for medication nonadherence among this population. We propose a theoretical framework for understanding the mediating and moderating mechanisms whereby the neighborhood environment may impact medication nonadherence among individuals most at risk for adverse disease outcomes. Guided by this model, we provide recommendations for future research, practice, and policy.
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Billimek J, Guzman H, Angulo MA. Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial. Trials 2015; 16:145. [PMID: 25873349 PMCID: PMC4409752 DOI: 10.1186/s13063-015-0672-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called “EMPATHy” that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor. Methods/Design The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be “coaches” to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a “contextualized plan of care” (i.e., a plan of care that addresses a barrier to medication adherence in the patient’s daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints. Discussion The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications. Trial registration ClinicalTrials.gov NCT02324036 Registered 16 December 2014.
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Affiliation(s)
- John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Herlinda Guzman
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Marco A Angulo
- Department of Family Medicine, School of Medicine, University of California, Irvine, 101 The City Drive South, Building 200, Suite 835, Orange, CA, 92868, USA.
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Billimek J, Guzman H, Angulo MA. Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial. Trials 2015; 16:145. [PMID: 25873349 PMCID: PMC4409752 DOI: 10.1186/s13063-015-0672-7 10.1186/s13063-015-0672-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called "EMPATHy" that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor. METHODS/DESIGN The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be "coaches" to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a "contextualized plan of care" (i.e., a plan of care that addresses a barrier to medication adherence in the patient's daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints. DISCUSSION The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications. TRIAL REGISTRATION ClinicalTrials.gov NCT02324036 Registered 16 December 2014.
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Affiliation(s)
- John Billimek
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Herlinda Guzman
- Health Policy Research Institute and Division of General Internal Medicine, School of Medicine, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA.
| | - Marco A Angulo
- Department of Family Medicine, School of Medicine, University of California, Irvine, 101 The City Drive South, Building 200, Suite 835, Orange, CA, 92868, USA.
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Afulani P, Herman D, Coleman-Jensen A, Harrison GG. Food Insecurity and Health Outcomes Among Older Adults: The Role of Cost-Related Medication Underuse. J Nutr Gerontol Geriatr 2015; 34:319-342. [PMID: 26267444 DOI: 10.1080/21551197.2015.1054575] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study is to examine the relationship between food security and cost-related medication underuse among older adults (persons aged 65 years and older) in the United States; and to determine if this relationship differs by sex, chronic disease status, and type of health insurance. Data are from a combined sample of older adults in the 2011 and 2012 National Health Interview Survey (N = 10,401). Both bivariate and multivariate analyses show a dose-response relationship between food insecurity and cost-related medication underuse among the elderly--increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < 0.001). This association is not conditional on sex, chronic disease status, or type of health insurance. However, females and those with a chronic condition are more likely to report cost-related medication underuse than males and those without a chronic condition respectively; and older adults with Medicare and Medicaid or other public insurance are less likely to report cost-related medication underuse than older adults with only Medicare.
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Affiliation(s)
- Patience Afulani
- a Community Health Sciences , UCLA Fielding School of Public Health , Los Angeles , California , USA
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The impact of the 2008 financial crisis on food security and food expenditures in Mexico: a disproportionate effect on the vulnerable. Public Health Nutr 2014; 18:2934-42. [PMID: 25428800 DOI: 10.1017/s1368980014002493] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present paper investigated the impact of the 2008 financial crisis on food security in Mexico and how it disproportionally affected vulnerable households. DESIGN A generalized ordered logistic regression was estimated to assess the impact of the crisis on households' food security status. An ordinary least squares and a quantile regression were estimated to evaluate the effect of the financial crisis on a continuous proxy measure of food security defined as the share of a household's current income devoted to food expenditures. Setting Both analyses were performed using pooled cross-sectional data from the Mexican National Household Income and Expenditure Survey 2008 and 2010. SUBJECTS The analytical sample included 29,468 households in 2008 and 27,654 in 2010. RESULTS The generalized ordered logistic model showed that the financial crisis significantly (P<0·05) decreased the probability of being food secure, mildly or moderately food insecure, compared with being severely food insecure (OR=0·74). A similar but smaller effect was found when comparing severely and moderately food-insecure households with mildly food-insecure and food-secure households (OR=0·81). The ordinary least squares model showed that the crisis significantly (P<0·05) increased the share of total income spent on food (β coefficient of 0·02). The quantile regression confirmed the findings suggested by the generalized ordered logistic model, showing that the effects of the crisis were more profound among poorer households. CONCLUSIONS The results suggest that households that were more vulnerable before the financial crisis saw a worsened effect in terms of food insecurity with the crisis. Findings were consistent with both measures of food security--one based on self-reported experience and the other based on food spending.
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Mayberry LS, Egede LE, Wagner JA, Osborn CY. Stress, depression and medication nonadherence in diabetes: test of the exacerbating and buffering effects of family support. J Behav Med 2014; 38:363-71. [PMID: 25420694 DOI: 10.1007/s10865-014-9611-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/12/2014] [Indexed: 11/29/2022]
Abstract
Stressors and depressive symptoms have been associated with medication nonadherence among adults with type 2 diabetes (T2DM). We tested whether these associations were exacerbated by obstructive family behaviors or buffered by supportive family behaviors in a sample of 192 adults with T2DM and low socioeconomic status using unadjusted and adjusted regression models. We found support for the exacerbating hypothesis. Stressors and nonadherence were only associated at higher levels of obstructive family behaviors (interaction AOR = 1.12, p = .002). Similarly, depressive symptoms and nonadherence were only associated at higher levels of obstructive family behaviors (interaction AOR = 3.31, p = .002). When participants reported few obstructive family behaviors, neither stressors nor depressive symptoms were associated with nonadherence. We did not find support for the buffering hypothesis; stressors and depressive symptoms were associated with nonadherence regardless of supportive family behaviors. Nonadherent patients experiencing stressors and/or major depressive symptoms may benefit from interventions that reduce obstructive family behaviors.
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Gucciardi E, Vahabi M, Norris N, Del Monte JP, Farnum C. The Intersection between Food Insecurity and Diabetes: A Review. Curr Nutr Rep 2014; 3:324-332. [PMID: 25383254 PMCID: PMC4218969 DOI: 10.1007/s13668-014-0104-4] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Access to sufficient, safe, and nutritious food not only affects the health of people who experience food insecurity, but also their ability to manage health conditions, such as diabetes. When people find it difficult to access sufficient food, tailoring their food selection to a diabetes regimen is even more difficult. Food insecurity in North America is consistently more prevalent among households with a person living with diabetes, and similarly, diabetes is also more prevalent in food-insecure households. Diabetes management can be stressful due to the many required responsibilities; when compounded with food insecurity, it becomes an even greater challenge. As a result, many food-insecure diabetics find themselves caught between competing priorities such as procuring food, prescribed medications and supplies for diabetes, and managing other living expenses, potentially worsening their condition and overall health. Healthcare providers should be aware and informed about the significant role that food security can play in the prevention and management of diabetes.
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Affiliation(s)
- Enza Gucciardi
- School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 Canada
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 Canada
| | - Nicole Norris
- School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 Canada
| | - John Paul Del Monte
- School of Nutrition, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 Canada
| | - Cecile Farnum
- Library and Archives, Ryerson University , 350 Victoria Street, L272-F, Toronto, Ontario M5B 2K3 Canada
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Guerrero N, Walsh MC, Malecki KC, Nieto FJ. Urban-rural and regional variability in the prevalence of food insecurity: the survey of the health of Wisconsin. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2014; 113:133-138. [PMID: 25211799 PMCID: PMC4245074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Food insecurity is a public health concern estimated to affect 18 million American households nationally, which can result in chronic nutritional deficiencies and other health risks. The relationships between food insecurity and specific demographic and geographic factors in Wisconsin are not well documented. The goals of this paper are to investigate sociodemographic and geographic features associated with food insecurity in a representative sample of Wisconsin adults. METHODS This study used data from the Survey of the Health of Wisconsin (SHOW). SHOW annually collects health-related data on a representative sample of Wisconsin residents. Between 2008-2012, 2,947 participants were enrolled in the SHOW study. The presence of food insecurity was defined based on the participant's affirmative answer to the question "In the last 12 months, have you been concerned about having enough food for you or your family?" RESULTS After adjustment for age, race, and gender, 13.2% (95% CI, 10.8%-15.1%) of participants reported food insecurity, 56.7% (95% CI, 50.6%-62.7%) of whom were female. Food insecurity did not statistically differ by region (P = 0.30). The adjusted prevalence of food insecurity in the urban core, other urban, and rural areas was 14.1%, 6.5%, and 10.5%, respectively. These differences were not statistically significant (P = 0.13) and, for urban core and rural areas, persisted even when accounting for level of economic hardship in the community. CONCLUSIONS The prevalence of food insecurity is substantial, affecting an estimated 740,000 or more Wisconsin residents. The prevalence was similarly high in all urbanicity levels and across all state public health regions in Wisconsin. Food insecurity is a common problem with potentially serious health consequences affecting populations across the entire state.
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Affiliation(s)
- Natalie Guerrero
- Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health
| | - Matthew C Walsh
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison
| | - Kristen C Malecki
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison
| | - F Javier Nieto
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison
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Treat or eat: food insecurity, cost-related medication underuse, and unmet needs. Am J Med 2014; 127:303-310.e3. [PMID: 24440543 DOI: 10.1016/j.amjmed.2014.01.002] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/02/2014] [Accepted: 01/02/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adults with chronic disease are often unable to meet medication and food needs, but no study has examined the relationship between cost-related medication underuse and food insecurity in a nationally representative sample. We examined which groups most commonly face unmet food and medication needs. METHODS Cross-sectional analysis of data from chronically ill participants (self-report of arthritis, diabetes mellitus, cancer, asthma, chronic obstructive pulmonary disease, stroke, hypertension, coronary heart disease, or presence of a "psychiatric problem") aged ≥20 years, in the 2011 National Health Interview Survey. We fit logistic regression models to identify factors associated with food insecurity, cost-related medication underuse, or both. RESULTS There were 9696 adult National Health Interview Survey (NHIS) participants who reported chronic illness; 23.4% reported cost-related medication underuse; 18.8% reported food insecurity; and 11% reported both. Adults who reported food insecurity were significantly more likely to report cost-related medication underuse (adjusted odds ratio [aOR] 4.03). Participants with both cost-related medication underuse and food insecurity were more likely to be Hispanic (aOR 1.58), non-Hispanic black (aOR 1.58), and have more chronic conditions (aOR per additional chronic condition 1.56) than patients reporting neither. They also were less likely to have public, non-Medicare insurance (aOR 0.70) and report participation in the Special Supplemental Nutrition Assistance Program for Woman, Infants, and Children (aOR 0.39). CONCLUSIONS Approximately 1 in 3 chronically ill NHIS participants are unable to afford food, medications, or both. WIC and public health insurance participation are associated with less food insecurity and cost-related medication underuse.
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Osborn CY, Mayberry LS, Wagner JA, Welch GW. Stressors may compromise medication adherence among adults with diabetes and low socioeconomic status. West J Nurs Res 2014; 36:1091-110. [PMID: 24569697 DOI: 10.1177/0193945914524639] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Studies examining the impact of stressors on diabetes self-care have focused on a single stressor or have been largely qualitative. Therefore, we assessed the stressors experienced by a high-risk population with type 2 diabetes, and tested whether having more stressors was associated with less adherence to multiple self-care behaviors. Participants were recruited from a Federally Qualified Health Center and 192 completed a stressors checklist. Experiencing more stressors was associated with less adherence to diet recommendations and medications among participants who were trying to be adherent, but was not associated with adherence to other self-care behaviors. Because having more stressors was also associated with more depressive symptoms, we further adjusted for depressive symptoms. Stressors remained associated with less adherence to medications, but not to diet recommendations. For adults engaged in adherence, experiencing an accumulation of stressors presents barriers to adherence that are distinct from associated depressive symptoms.
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Affiliation(s)
| | | | - Julie A Wagner
- University of Connecticut Health Center, Farmington, CT, USA
| | - Garry W Welch
- Tufts University School of Medicine, Boston, MA, USA Baystate Medical Center, Springfield, MA, USA
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