Access to Care and Health Outcomes Among Women Veterans Using Veterans Administration Health Care: Association With Food Insufficiency

Emerging trends and the clinical impact of food insecurity in patients with diabetes

“…16 Prior studies have established an association between food insecurity and depression that is present in many subgroups, especially in gender and racial minority populations. [17][18][19] Becerra and colleagues used data from the California Health Interview Survey (CHIS) during years 2007, 2009, 2011, and 2012 to investigate food security status and psychological distress in impoverished Hispanic adults. Serious psychological distress was measured with the Kessler-6 scale, a validated survey measuring anxiety and depressive symptoms.…”

“…Not only is depression more prevalent in adults with food insecurity, but food insecurity is also a risk factor for depression and worsened depressive symptoms . Prior studies have established an association between food insecurity and depression that is present in many subgroups, especially in gender and racial minority populations . Becerra and colleagues used data from the California Health Interview Survey (CHIS) during years 2007, 2009, 2011, and 2012 to investigate food security status and psychological distress in impoverished Hispanic adults.…”

Food Insecurity in US Military Veterans

“…67 Findings from one study were based on data from a survey of California state residents. 68 In contrast, 7 publications reported on surveys specifically designed for veterans such as the Veterans Aging Cohort Study (VACS), 69,70 the Women Veterans Health Utilization and Experience Survey (WV-HUES), 71,72 the Northstar Survey, 73,74 and the Weight and Veterans’ Environments Study 75 —all involved users of Department of Veterans Affairs (VA) health care. Two studies piloted approaches to examining FI in veterans, 76,77 while another qualitatively examined FI and related issues using focus group methods.…”

“…Eight central themes were dominant (Figure 1): (1) FI prevalence in veterans (n = 4), 64,67,70,73 (2) health status (n = 7), 60,66,69,70,74,75,79 (3) dietary practices/service-related dietary experiences (n = 2), 68,78 (4) health care utilization (n = 2), 71,72 (5) economic instability (n = 2), 61,63 (6) homelessness/housing instability (n = 1), 76 (7) federal food program participation (n = 1), 62 and (8) community and emergency preparedness factors (n = 5). 65,75,77,79,80 Health status was the most dominant domain, while food program participation and homelessness/housing instability were the least dominant (Figure 2).…”

“…Two studies examined responses about health care access and food insufficiency in women VHA health care users as part of the WV-HUES. 71,72 “Food insufficiency” was used as an index of FI and was defined from the screener question of the USDA HFSSM: “Which of these statements best describes the food eaten in your household in the past 12 months?—enough but not always the kinds of food we want, sometimes not enough to eat, or often not enough to eat.” 47 In one study, 71 food insufficiency was significantly ( P << .05) associated with health care access (eg, delayed or missed health care). Patient activation, a component of patient engagement associated with health care utilization, 81 was assessed in a second study based on WV-HUES, 72 concluding that food insufficiency may be a barrier to patient activation.…”