JMIR Publications

ABSTRACT

Background:

Food insecurity (FI) is a risk factor for type 2 diabetes (T2D) that disproportionately affects Latinas. We propose that FI cycles over the course of a month according to disbursement of food assistance benefits and seek to understand whether this cycling is related to diabetes risk. We conducted a micro-longitudinal study to examine the relationship of monthly cycling of FI and diabetes risk factors.

Objective:

This paper reports the quantitative methodology, describes our recruitment and retention strategies, examines predictors of retention across time, and reports baseline demogrraphics of the sample.

Methods:

Participants were adult Latinas living in Hartford CT, a small state capital city in northeastern, USA. They were recruited through a community agency in Hartford, CT and were invited to participate if they were receiving Supplementary Nutrition Assistance Program (SNAP) benefits, screened positive for FI using the 2-item Hunger Vital Sign Screener, and had elevated risk factors for T2D using the American Diabetes Association risk factor test. Using a micro-longitudinal design, we collected data twice per month for 3 months (week two which is a period of food budget adequacy and week four which is a period of food budget inadequacy). We will determine if the monthly cycling of FI using the US Household Food Security Survey Module is associated with near-term diabetes risk (fasting glucose, fructosamine, glycosylated albumin) and long-term risk (body mass index, waist circumference, and HbA1c). We will determine whether household food inventory, psychological distress, and binge eating mediate associations. We will also examine Health Action Process Approach (HAPA) model constructs. To assess the relationship between monthly cycling of FI with diabetes risk markers, we will use repeated measures general linear mixed models (GLMMs). To assess the role of mediators, we will perform a causal pathway analysis.

Results:

Recruitment was through the Women, Infants and Children (WIC) program, health fairs, mobile markets, community health agencies, local convenience stores, local daycare centers and local food pantries Participant enrollment was from April 1, 2021, to February 21, 2023. Eighty-seven participants completed 420 assessments or mean=4.83 (SD=2.02) assessments.; 70.1% (n=61) completed all 6 assessments. About half (54.0%) of the sample self-identified as Puerto Rican, mean age was 35.1 ± 5.8 years, with 17.1 ± 11.6 years in the mainland U.S. Just under half (47.1%) spoke Spanish only, 69.0% had no formal schooling and 31.0% had <8th grade education. Modal household size was 4 including 2 children, and 44.5% were not living with a partner. About half (54.0%) were unemployed, 63.2% reported a monthly income <$1,000 and 63.2% used food pantries. Sixty-one participants (70.1%) completed all 6 assessments. In Pearson’s correlations, having internet at home and having a tablet at home were associated with a higher number of completed assessments. Novelty of the study includes the micro-longitudinal design and the bio-psycho-social-contextual framework.

Conclusions:

This study will demonstrate how FI cycles over the course of the month, as well as whether and to what degree the cycling itself is related to risk for developing T2D. Further, the study will provide evidence for some putative mechanisms of this association that can serve as future intervention targets including SNAP disbursement schedules. Clinical Trial: Not applicable. The study is not a clinical trial.