Date of Conferral

3-17-2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Manoj Sharma

Abstract

Food insecurity (FI) is a persistent public health challenge in the United States and disproportionately affects rural communities. Guided by syndemic theory, this quantitative cross-sectional study examined associations between FI and chronic disease outcomes among rural residents of Vermont and the Adirondack region of New York. Social determinants of health screenings and electronic medical records from 35 rural primary care sites were analyzed. Secondary data from n = 72,505 adults were used to evaluate these relationships. Binary logistic regression models assessed obesity, hypertension (HTN), and diabetes (DM), and a multinomial logistic regression model evaluated the combined presence of obesity and DM, obesity only, DM only, and neither condition. All models controlled for age, gender, insurance status, financial instability, and transportation barriers. FI was significantly associated with higher odds of DM (OR = 1.56, 95% CI [1.41, 1.73]), HTN (OR = 1.43, 95% CI [1.24, 1.65]), and obesity (OR = 1.36, 95% CI [1.25, 1.47]). In the multinomial model, FI increased the odds of belonging to each disease category relative to neither condition: both obesity and DM (OR = 1.74, 95% CI [1.52, 1.99]), obesity only (OR = 1.33, 95% CI [1.21, 1.47]), and DM only (OR = 1.63, 95% CI [1.42, 1.88]). Males had higher odds of diabetes (OR = 1.57, 95% CI [1.48, 1.67]) and the combined obesity–diabetes condition (OR = 1.34, 95% CI [1.26, 1.42]). Transportation barriers (OR = 1.30, 95% CI [1.22, 1.39]) and financial instability (OR = 1.54, 95% CI [1.46, 1.63]) were also significant predictors. Findings highlight how FI influences chronic disease risk and can inform rural food access initiatives and community-based prevention strategies promoting positive social change.

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