title: Food insecurity and low self-efficacy are associated with increased healthcare utilization among adults with type II diabetes mellitus.
abstract: Food insecurity has been shown to negatively impact health outcomes, disease management and hospitalizations. Despite the increasing burden of type II diabetes mellitus (T2DM) in the United States, little research exists on the role of food insecurity and its association to T2DM-related healthcare utilization. The purpose of our study was to address such a gap in the literature by evaluating the role of food insecurity and T2DM-related past 12-month hospitalization or emergency department (ED) admission among adults with healthcare professional diagnosed T2DM.
  
  
  
  We utilized the California Health Interview Survey (CHIS), 2009, 2011/2012 data to select CHIS participants who were aged 18 or older and reported doctor diagnosis of T2DM; resulting in a total of 8252 participants. Food insecurity was defined as: living at or above 200% federal poverty level (FPL), living below 200% FPL but food secure, living below 200% FPL and food insecure. A secondary exposure variable of interest was self-efficacy, based on the CHIS-provided variable of confidence to manage T2DM. All analyses were survey weighted with alpha less than .05 noting significance.
  
  
  
  Those with low food security (12.96%) and low-self efficacy (15.14%), reported significantly higher prevalence of T2DM-related healthcare utilization, as compared to their counterparts. Both living with low food security and having low self-efficacy were also associated with over two-fold increase in healthcare utilization.
  
  
  
  Our results demonstrate the cumulative need for community-based resources to improve the continuum of care and ensure that such at-risk populations have adequate resources for disease management.
authors.affiliation: Department of Health Science and Human Ecology, California State University, San Bernardino, CA, United States. Electronic address: mbecerra@csusb.edu.
authors.forename: Monideepa B
authors.initials: MB
authors.lastname: Becerra
authors.affiliation: California State University, San Bernardino, CA, United States.
authors.forename: Nickolas L
authors.initials: NL
authors.lastname: Allen
authors.affiliation: School of Allied Health Professions, Loma Linda University, Loma Linda, CA, United States.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Becerra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005523:Food Supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty; D020377:Self Efficacy; D055815:Young Adult
keywords: California Health Interview Survey; Diabetes; Emergency department; Food security; Hospitalization; Self-efficacy