Date of Award

Spring 2023

Document Type

Open Access Dissertation


Epidemiology and Biostatistics

First Advisor

Angela D. Liese


Given the life-long impact of diabetes(1-5), it is important to engage in behaviors that promote health and wellness to delay or prevent negative health outcomes(3, 6-10). Despite this, youth and young adults with diabetes generally do not adhere to nutritional(11-17) or physical activity(18, 19) recommendations. In households experiencing financial difficulties, especially those who are having difficulty providing sufficient food to all of its members, adhering to recommendations may be even more difficult.

The purpose of this dissertation is to better understand and contextualize food insecurity among youth and young adults (YYA) with youth-onset T1DM and T2DM. The first aim addresses this by estimating the prevalence of food insecurity by diabetes type and age group. The second aim extends this by analyzing the effect of food insecurity on lifestyle behaviors, namely dietary quality and electronic media use.

In this population of YYA with T1DM and T2DM, 21.4% experienced food insecurity, including 7.6% reporting very low food security (Table 4.1). This is higher than comparable population-based estimates for both food insecurity (United States - US: 12.7%; South Carolina – SC: 13.2%; Washington – WA: 12.9%) and very low food security (US: 5.4%; SC: 4.6%; WA: 4.8%)(20). Food insecurity was more common among participants with T2DM (36.8%; 95% CI: 26.9-48.1) compared to those with T1DM (17.2%; 95% CI: 13.2-22.1; Table 4.2), and the proportion of participants experiencing very low food security was almost double (T2DM: 11.8%; T1DM: 6.5%; Table 4.1). While there is some evidence to suggest that there might be age-related trends (Table 4.2; T1DM: <17 years: 14.4%, 18+ years: 19.0%; T2DM: <17 years old: 39.3%, ≥18 years: 35.4%), these were not statistically significant, likely due to the small sample size and the relationship between diabetes type and age.

With respect to the two lifestyle outcomes, there was limited support for a relationship between food security and either dietary quality (Tables 4.4-4.9) or electronic media use (Tables 4.11-4.13). The findings do suggest the possibility of an underlying relationship, specifically the relationship between food insecurity and high-level electronic media use outcomes (Table 4.13).

Due to the nature of diabetes and diabetes management strategies, food security is especially important in this population. However, the findings suggest that the increased budgetary demands associated with the management chronic diseases, such as diabetes, are having negative effects within these households. These findings suggest that an intervention, e.g., providing financial, food, medication, or other related assistance, may be especially effective among YYA with diabetes. The disparities in food insecurity by diabetes type and the trends related to age, although not statistically significant, are concerning. The overarchingly poor dietary intake quality and electronic media habits is especially troubling, given the role of healthful behaviors in effective diabetes management.

In conclusion, in this cohort of youth and young adults with diabetes, almost 1 in 3 YYA with diabetes (32.4%) was living in a household that had some level of concern about having enough money for food and more than 1 in 5 participants (21.4%) experienced food insecurity. More than double the participants with T2DM (36.8%; 95% CI: 26.9-48.1) reported experiencing food insecurity compared to participants with T1DM (17.2%; 95% CI: 13.2-22.1), trends that were similar regardless of age group. Although findings related to behavioral outcomes are inconsistent, there is some evidence to suggest that there are trends in both dietary quality and electronic media use. Given the important downstream implications, it is exceptionally important to work toward supportive interventions that reduce food insecurity among YYA with T1DM and T2DM.


© 2023, Lauren Helene Martini

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Epidemiology Commons