Current measurement of food insecurity in the US has largely focused the USDA scales. However, these scales do not capture multidimensional risk associated with food insecurity, account for stigma associated with being considered food insecure, or adequately capture the idea of nutrition security which is particularly important for individuals with diabetes. We aimed to create a more comprehensive set of questions allowing identification of an individual as being food insecure without reliance on questions only focused on food quantity and cost. We used data collected from 614 adults with type 2 diabetes recruited for a cross-sectional study on social determinants of health in Milwaukee, Wisconsin. The mean age of the sample was 55 years with mean duration of diabetes diagnosis of 9 years. The 6-item USDA food insecurity scale was used as the outcome with a variety of questions capturing social risk used to create a risk score for food insecurity. A series of questions were tested with the final risk score ranging from 0-7 based on questions including:

  • 1) income less than $25,000,

  • 2) going without food, clothing, or housing due to needing funds for medical care,

  • 3) being worried or stressed about paying rent or mortgage,

  • 4) being worried or stressed about money to buy nutritious meals,

  • 5) not seeing a doctor due to cost,

  • 6) not filling prescriptions due to cost, and

  • 7) neighborhood being unsafe due to crime.

In the full sample of adults with diabetes, those indicating 2 risks were 3.5 times more likely to be food insecure, those indicating 3 risks were 10.8 times more likely to be food insecure, and those indicating 4+ items were 54.2 times more likely to be food insecure. Use of this tool can identify food insecure adults in a way that captures food and nutrition security while being inclusive of individuals who may feel stigma associated with food insecurity. In addition, it can identify levels of risk capturing multiple facets of the underlying issue of poverty to screen more comprehensively.


L.E.Egede: None. R.J.Walker: None.


American Diabetes Association (1-19-JDF-075) ; National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede) , the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker)

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