title: The association between housing instability, food insecurity, and diabetes self-efficacy in low-income adults.
abstract: Limited data exist on whether structural factors associated with poverty such as inadequate housing and food insecurity affect diabetes care. In a sample of low-income participants with diabetes (N=711), we sought to determine if housing instability was associated with lower diabetes self-efficacy, and whether this relationship was mediated by food insecurity. We ordered housing from most to least stable. We observed a linear decrease in diabetes self-efficacy as housing instability increased (p<.01). After adjusting for age, sex, race/ethnicity, and alcohol or substance use, adults lacking a usual place to stay had lower self-efficacy than those who owned their own home (ß-coefficient -0.94, 95% CI -1.88, -0.01). Food insecurity mediated the association between housing instability and diabetes self-efficacy (ß-coefficient -0.64, 95% CI -1.57, 0.31). Our findings suggest that inadequate access to food lowers self-efficacy among adults with diabetes, and supports provision of food to unstably housed adults as part of diabetes care.
authors.affiliation: Division of General Internal Medicine/ San Francisco General Hospital at the University of California, San Francisco, San Francisco, CA 94143, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Vijayaraghavan
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jacobs
authors.forename: Hilary
authors.initials: H
authors.lastname: Seligman
authors.forename: Alicia
authors.initials: A
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D015190:Blood Glucose Self-Monitoring; D002140:California; D002641:Chicago; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology / Q000523:psychology*; D005260:Female; D005523:Food Supply / Q000191:economics* / Q000706:statistics & numerical data; D006798:Housing / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006815:Hunger / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D017058:Mexican Americans / Q000523:psychology; D008875:Middle Aged; D011203:Poverty / Q000208:ethnology; D012307:Risk Factors; D020377:Self Efficacy; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology; D016903:Drug Monitoring