Date of Conferral



Doctor of Public Health (DrPH)


Health Services


Shirley Gerrior


The purpose of this research was to examine food security for people with prediabetes participating in the Supplemental Nutrition Assistance Program (SNAP), focusing on their food choice decisions and coping strategies over a 30-day benefit cycle that potentially increases the risk of Type 2 diabetes. A cross-sectional, quantitative design based on food choice process model constructs was used. SNAP participants (n = 36) with prediabetes, aged 21-70 years, were recruited as outpatients from Bronx Lebanon Hospital and completed self-reported questionnaires on demographics and health, food security, and food frequency. Descriptive statistics, Pearson chi square tests, and regression analysis were performed using SPSS. Also, independent t test, and Levene's test were used for ad hoc analysis to assess variation of food choice decisions over 30 days. Of the sample, 5% had low and 95% very low food secure status. Food security status did not predict coping strategies (p = .724); however, food security status and type of coping strategy had a moderate relationship (p < 0.01; r =.60). Food choices of 11 food categories changed over a 30-day cycle with greatest variation for Week 1, compared to Weeks 2-4 (p < .005). Use of coping strategies to minimize hunger was limited. Very low food security associated with certain coping strategies disrupted eating patterns. Disrupted eating patterns affect food variation over time, increasing the intake of non-nutrient-dense foods and the risk of obesity and Type 2 diabetes. The implications for positive social change include the potential to change SNAP's benefit allotments, make nutrition education mandatory, and create a nutrition package, thereby lowering food insecurity and the risk of Type 2 diabetes.