Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Vasileios Margaritis


Diabetes is a chronic condition affecting more than 30 million adults living in the United States. Diabetes self-management (DSM) can prevent or delay the complications of diabetes and improve clinical outcomes; however, data show that low-income, food insecurity, female gender, and race contribute to challenges performing effective DSM. The health belief model was the theoretical framework for this cross-sectional study, which examined how food insecurity, low-income, and race affect DSM activities in women with diabetes. The sample population from the 2017 Behavioral Risk Factor Surveillance System survey consisted of 1,842 women with diabetes who were 18 years of age or older, had an annual income of less than $50,000, and were food insecure. Results of the chi square analyses indicated a significant association between food insecurity and DSM activities (χ2 = 48.99, p < 0.0001); however, results showed no significant association between low-income or race (p > 0.05). Results of a binary logistic regression model revealed that food secure and younger women had 1.618 and .584 times the odds of having effective DSM activities than food-insecure and older women (OR=1.618, 95% CI=1.282 - 2.041, p < 0.001; OR=.584, 95% CI=.465 - .733, p < 0.001, respectively). These results might provide researchers with guidance regarding food insecure and younger women with diabetes who might require additional support for their diabetes management. Tailored public health interventions might lead to positive social change by increasing food stability and nutrition knowledge, potentiating improvements in hemoglobin A1C, a 90-day measure of glucose control, which could reduce risk of diabetes-related morbidity and mortality.