ArticleJournal of general internal medicine2019
Differential Impact of Food Insecurity, Distress, and Stress on Self-care Behaviors and Glycemic Control Using Path Analysis.
Article in Journal of general internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Focusing attention on the important association between food insecurity and psychological distress: a systematic review and meta-analysis.BMC nutrition · 2024Pooled it
- Senior food insecurity in the USA: a systematic literature review.Public health nutrition · 2023Pooled it
- Longitudinal Effect of Diabetes Fatalism on Clinical Outcomes and Health-Related Quality of Life in African Americans with Type 2 Diabetes.Journal of general internal medicine · 2026Trial
- Food Security and Cardio-Metabolic Risk in Individuals with Metabolic Syndrome.International journal of environmental research and public health · 2024Trial
- Development and Psychometric Properties of the 5-Item Diabetes Fatalism Scale Short Form (DFS-SF).Journal of general internal medicine · 2026Article
- Food insecurity, epigenetic age acceleration, and depression in middle-aged and older adults: a longitudinal cohort study.Frontiers in nutrition · 2026Article
- Blue-green spaces, heat stress, and health-supportive public-space use under urban stress: machine learning and SEM evidence from jogging flow in Fuzhou, China.Frontiers in public health · 2026Article
- Understanding type 2 diabetes self-management in the Marshall Islands: A mixed-methods exploration of sociocultural and structural barriers.PLOS global public health · 2026Article
- Food insecurity patterns and mental health among youth and young adults with diabetes.BMJ open diabetes research & care · 2025Article
- Exploring Drivers of Binge Eating in Individuals With Food Insecurity and Recurrent Binge Eating: A Qualitative Analysis.The International journal of eating disorders · 2025Article
- Exploring Food Insecurity and Perceived Stress on Daytime Sleepiness among Older Adults in New York City.Foods (Basel, Switzerland) · 2024Article
- Associations Between Social Determinants of Health and Outcomes of Chronic Medical Conditions.Cureus · 2024Article
- Association of food insecurity with successful aging among older Indians: study based on LASI.European journal of nutrition · 2024Article
- Economic insecurities and patient-reported outcomes in patients with systemic lupus erythematosus in the USA: a cross-sectional analysis of data from the California Lupus Epidemiology Study.The Lancet. Rheumatology · 2024Article
- Diabetes distress in a Medicaid sample: The role of psychosocial and health-related factors.Journal of diabetes and its complications · 2023Article
- Diet and Food and Nutrition Insecurity and Cardiometabolic Disease.Circulation research · 2023Review
- Food is medicine intervention shows promise for engaging patients attending a safety-net hospital in the Southeast United States.Frontiers in public health · 2023Article
- Food Stress and Diabetes-Related Psychosocial Outcomes in American Indian Communities: A Mixed Methods Approach.Journal of nutrition education and behavior · 2022Article
- Equity in Psychosocial Outcomes and Care for Racial and Ethnic Minorities and Socioeconomically Disadvantaged People With Diabetes.Diabetes spectrum : a publication of the American Diabetes Association · 2022Article
- Self-care practices and correlates among patients with type 2 diabetes in Eastern Ethiopia: A hospital-based cross-sectional study.SAGE open medicine · 2022Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundThe aim of this study was to investigate the direct and indirect pathways through which food insecurity influences glycemic control and self-care behaviors.
methodsUsing data collected from 615 adults with type 2 diabetes, we investigated pathways between food insecurity and diabetes outcomes using path analysis. We included measures of perceived stress, diabetes distress, diabetes fatalism, and depression as psychosocial factors in the pathway. Self-care behaviors included general diet, specific diet, exercise, blood sugar testing, foot care, and medication adherence. Analyses were conducted using Stata v14, to include both direct and indirect effects, with standardized estimates to allow comparison of paths.
resultsFood insecurity was directly associated with stress (r = 0.43, p < 0.001), depression (r = 0.34, p < 0.001), fatalism (r = 0.09, p = 0.03), and distress (r = 0.36, p < 0.001). The type of stress, however, was differentially associated with outcomes, with distress associated with HbA1c (r = 0.25, p < 0.001), general and specific diet (r = - 0.28 and - 0.17, respectively, p = 0.001), and medication adherence (r = - 0.26, p < 0.001), while stress was associated with specific diet (r = - 0.14, p = 0.005) and medication adherence (r = - 0.15, p < 0.001) and depression was associated with exercise (r = - 0.06, p = 0.007). Food insecurity was indirectly associated with HbA1c (r = 0.08, p = 0.001), and four self-care behaviors (general diet, specific diet, exercise, and medication adherence).
conclusionsFood insecurity influences self-care behaviors indirectly via multiple psychosocial factors, and glycemic control indirectly through diabetes distress, supporting the hypothesis that stress is an important mechanism. Programs to improve access to resources and manage psychosocial concerns should be combined with food-based programs for food insecure populations with diabetes.
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