Food insecurity is an important issue in public health even in developed societies, particularly for vulnerable populations. Food insecurity refers to the uncertain or limited access to adequate and safe foods. Emerging evidence shows an association between food insecurity, type 2 diabetes risk factors, and management of type 1 and type 2 diabetes. A review of the current literature describing the association between food insecurity and diabetes reveals possible mechanisms and pathophysiologic pathways. There is less evidence for effective interventions, and much of the current literature is limited to cross-sectional studies. Future work should evaluate longitudinal associations and ways to help vulnerable patients with diabetes access adequate food for effective diabetes management.
Background: Medically-tailored meal programs that provide home-delivered medically-appropriate food are an emerging intervention when type 2 diabetes co-occurs with food insecurity (limited or uncertain access to nutritious food owing to cost). We sought to understand the experiences of medically-tailored meal program participants. Methods: We conducted semi-structured interviews with participants in a randomized trial of medically-tailored meals (NCT02426138) until reaching content saturation. Participants were adults (age > 20 years) with type 2 diabetes in eastern Massachusetts, and the interviews were conducted from April to July 2017. Interviews were transcribed verbatim and coded by two independent reviewers. We determined emergent themes using content analysis. Results: Twenty individuals were interviewed. Their mean age was 58 (SD: 13) years, 60.0% were women, 20.0% were non-Hispanic black, and 15.0% were Hispanic. Key themes were 1) satisfaction and experience with medicallytailored meals 2) food preferences and cultural appropriateness, 3) diabetes management and awareness, and 4) suggestions for improvement and co-interventions. Within these themes, participants were generally satisfied with medically-tailored meals and emphasized the importance of receiving culturally appropriate food. Participants reported several positive effects of medically-tailored meals, including improved quality of life and ability to manage diabetes, and stress reduction. Participants suggested combining medically-tailored meals with diabetes self-management education or lifestyle interventions. Conclusions: Individuals with diabetes and food insecurity expressed satisfaction with the medically-tailored meal program, and reported that participation reduced stress and the burden of diabetes management. Suggestions to help ensure the success of medically-tailored meal programs included a strong emphasis on culturally acceptability and accommodating taste preferences for provided foods, and combining medically-tailored meals with diabetes education or lifestyle intervention. Trial registration: ClinicalTrials.gov NCT02426138.
In the past 40 years, there has been a significant increase in Black students’ enrollment at predominantly White institutions (PWIs). Meanwhile, research shows that Black students often experience difficulty with transitioning and adjusting to PWIs. Previous research has effectively documented the challenges facing a significant number of Black students at PWIs; however, less is known about the experiences of Black women in particular. This study examined stress from racial tension experienced among 129 Black undergraduate women at PWIs in the Northeast region of the United States, as well as the potential moderating factors of the theorized Strong Black Woman concept and the Africultural coping theory. Hierarchical regression analyses indicated a significant positive association between racial tension experienced on campus and stress. Results also indicated that only Africultural coping was a significant moderator of this relationship, such that there was a weaker relationship between racial tension and stress among the participants who engaged more in Africultural coping. Policy implications for improving the campus racial climate and the academic experiences of Black college women at PWIs are discussed.
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