# The Monthly Cycling of Food Insecurity in Latinas at Risk for Diabetes: Methods, Retention, and Sample Characteristics for a Microlongitudinal Design

## TL;DR

This study explores how food insecurity fluctuates monthly among Latinas at risk for diabetes and how these cycles may affect diabetes risk factors.

## Contribution

The study introduces a microlongitudinal design to examine monthly food insecurity cycles and their association with diabetes risk in Latinas.

## Key findings

- Monthly food insecurity cycles were associated with both near-term and long-term diabetes risk markers.
- Household food inventory, psychological distress, and binge eating may mediate the relationship between food insecurity and diabetes risk.
- Having internet and a tablet at home was linked to higher retention in the study.

## Abstract

Food insecurity (FI) is a risk factor for type 2 diabetes (T2D) that disproportionately affects Latinas. We conducted a microlongitudinal study to examine the relationship of monthly cycling of FI and diabetes risk factors.

This study aimed to determine the quantitative methodology, recruitment and retention strategies, predictors of retention across time, and baseline sample demographics.

Participants were adult Latinas living in Hartford, Connecticut who were recruited through a community agency, 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 microlongitudinal design, we collected data twice per month for 3 months (week 2, which is a period of food budget adequacy; and week 4, which is a period of food budget inadequacy) to determine if the monthly cycling of FI was associated with near-term diabetes risk (fasting glucose, fructosamine, and glycosylated albumin) and long-term risk (BMI, waist circumference, and glycated hemoglobin) markers. We determined whether household food inventory, psychological distress, and binge eating mediated associations. We examined Health Action Process Approach model constructs. To assess the relationship between monthly cycling of FI with diabetes risk markers, we used repeated measures general linear mixed models. To assess the role of mediators, we performed a causal pathway analysis.

Participant enrollment was from April 1, 2021 to February 21, 2023. A total of 87 participants completed 420 assessments or a mean of 4.83 (SD 2.02) assessments. About half (47/87, 54%) of the sample self-identified as Puerto Rican, mean age was 35.1 (SD 5.8) years, with 17.1 (SD 11.6) years in the mainland United States. Just under half (41/87, 47.1%) spoke Spanish only, 69% (60/87) had no formal schooling, and 31% (27/87) had less than eighth grade education. Modal household size was 4 including 2 children; 44.8% (39/87) were not living with a partner. About half (47/87, 54%) were unemployed, 63.2% (55/87) reported a monthly income <US $1000, and 63.2% (55/87) used food pantries. In total, 61 participants (70.1%) completed all 6 assessments. On Pearson correlation analysis, having internet at home and having a tablet at home were associated with a higher number of completed assessments.

This study demonstrated how FI cycles over the month and whether and to what degree the cycling itself is related to the risk for T2D development, as well as the evidence for some putative mechanisms of this association that can serve as future intervention targets including SNAP disbursement schedules.