Hunger is Health: The Association Between Food Insecurity and Diabetes in the Primary Care Center (PCC) at Grady Hospital in Atlanta, GA Open Access

Girovich, Bella A. (2017)

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With a prevalence of 48.1 million people in 2014 living in food-insecure households in the United States (Alisha Coleman-Jensen, 2015), food insecurity is one of the largest public health issues of our time. Similarly, a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data from 1999-2002 showed a statistically significant increased prevalence of diabetes among mildly food insecure and severely food insecure at 10.0% and 16.1%, respectively (Seligman, Laraia, & Kushel, 2010). Given the data that the prevalence of diabetes is associated with food insecurity, there is a need for further research on the prevalence of food insecurity among diabetic populations.


The goals of this thesis were to (1) estimate the prevalence of food insecurity among diabetics at Grady, (2) determine if there is an association between food security and diabetes status, (3) emphasize the need to address socio-contextual determinants of health, and (4) ascertain if it is appropriate to incorporate food security measures into electronic medical records.


The study was conducted through a cross-sectional design. 323 patients were included into the sample. Patients were given a questionnaire that included questions regarding age, sex, race, household income, number of people in the household, zip code, diabetes status, the USDA 2-item food security screener, and SNAP utilization. The primary outcome was a combined variable of prediabetes and type 2 diabetes. Patients that screened positive for food insecurity were given resources to help them access food in Atlanta.


The overall prevalence of food insecurity among the patient population surveyed was 53.5%. Among diabetic patients (those with both prediabetes and type two diabetes), the prevalence of food insecurity was 62.5%. In multivariable logistic regression analyses, the odds of having diabetes was 2.6 times greater (95%CI 1.7-4.1) among food insecure compared to food secure patients. The effect remained statistically significant after controlling for sex, race, and income [2.6 (95%CI 1.5-4.4)]. Gender significantly modified the association between food insecurity and diabetes with greater odds of diabetes among men with food insecurity (5.1 95%CI 2.5-9.8) compared to women (1.5 95%CI 0.8-2.8)].


The associations between food insecurity and diabetes as well as the high prevalence of both conditions give evidence that food insecurity should be addressed in clinical settings. This study makes the case that electronic medical records should include measures of food insecurity for appropriate referral. More research, especially longitudinal, is necessary to continue to examining this association.

Table of Contents

List of Tables and Figures

Chapter 1: Introduction

Chapter 2: Review of the Literature

Chapter 3: Methodology

Chapter 4: Results

Chapter 5: Discussion, Recommendations, and Conclusion



Appendix A: Grady Health System Community Assets

Appendix B: Infographic Distributed to Survey Participants

Appendix C: Food Security Screening Tool

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