Decades of research have demonstrated that diabetes affects racial and ethnic minority and low-income adult populations in the U.S. disproportionately, with relatively intractable patterns seen in these populations’ higher risk of diabetes and rates of diabetes complications and mortality (1). With a health care shift toward greater emphasis on population health outcomes and value-based care, social determinants of health (SDOH) have risen to the forefront as essential intervention targets to achieve health equity (2–4). Most recently, the COVID-19 pandemic has highlighted unequal vulnerabilities borne by racial and ethnic minority groups and by disadvantaged communities. In the wake of concurrent pandemic and racial injustice events in the U.S., the American College of Physicians, American Academy of Pediatrics, Society of General Internal Medicine, National Academy of Medicine, and other professional organizations have published statements on SDOH (5–8), and calls to action focus on amelioration of these determinants at individual, organizational, and policy levels (9–11).

In diabetes, understanding and mitigating the impact of SDOH are priorities due to disease prevalence, economic costs, and disproportionate population burden (12–14). In 2013, the American Diabetes Association (ADA) published a scientific statement on socioecological determinants of prediabetes and type 2 diabetes (15). Toward the goal ofunderstanding and advancing opportunities for health improvement among the population with diabetes through addressing SDOH, ADA convened the current SDOH and diabetes writing committee, prepandemic, to review the literature on 1 ) associations of SDOH with diabetes risk and outcomes and 2 ) impact of interventions targeting amelioration of SDOH on diabetes outcomes. This article begins with an overview of key definitions and SDOH frameworks. The literature review focuses primarily on U.S.-based studies of adults with diabetes and on five SDOH: socioeconomic status (education, income, occupation); neighborhood and physical environment (housing, built environment, toxic environmental …

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Social Determinants of Health and Diabetes: A Scientific Review.

The COVID-19 pandemic has disrupted many aspects of daily life. The purpose of this study was to identify how health behaviors, level of stress, financial and food security have been impacted by the pandemic among Canadian families with young children. Parents (mothers, n = 235 and fathers, n = 126) from 254 families participating in an ongoing study completed an online survey that included close and open-ended questions. Descriptive statistics were used to summarize the quantitative data and qualitative responses were analyzed using thematic analysis. More than half of our sample reported that their eating and meal routines have changed since COVID-19; most commonly reported changes were eating more snack foods and spending more time cooking. Screen time increased among 74% of mothers, 61% of fathers, and 87% of children and physical activity decreased among 59% of mothers, 52% of fathers, and 52% of children. Key factors influencing family stress include balancing work with childcare/homeschooling and financial instability. While some unhealthful behaviors appeared to have been exacerbated, other more healthful behaviors also emerged since COVID-19. Research is needed to determine the longer-term impact of the pandemic on behaviors and to identify effective strategies to support families in the post-COVID-19 context.

The Impact of COVID-19 on Health Behavior, Stress, Financial and Food Security among Middle to High Income Canadian Families with Young Children.

BACKGROUND/OBJECTIVES: Physical distancing during the COVID-19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to investigate (1) experiences of social isolation and loneliness during shelter-in-place orders, and (2) unmet health needs related to changes in social interactions. DESIGN: Mixed-methods longitudinal phone-based survey administered every 2 weeks. SETTING: Two community sites and an academic geriatrics outpatient clinical practice. PARTICIPANTS: A total of 151 community-dwelling older adults. MEASUREMENTS: We measured social isolation using a six-item modified Duke Social Support Index, social interaction subscale, that included assessments of video-based and Internet-based socializing. Measures of loneliness included self-reported worsened loneliness due to the COVID-19 pandemic and loneliness severity based on the three-item University of California, Los Angeles (UCLA) Loneliness Scale. Participants were invited to share open-ended comments about their social experiences. RESULTS: Participants were on average aged 75 years (standard deviation = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% had difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video-based socializing, and 42% minimal Internet-based socializing. Socially isolated participants reported difficulty finding help with functional needs including bathing (20% vs 55%; P = .04). More than half (54%) of the participants reported worsened loneliness due to COVID-19 that was associated with worsened depression (62% vs 9%; P < .001) and anxiety (57% vs 9%; P < .001). Rates of loneliness improved on average by time since shelter-in-place orders (4-6 weeks: 46% vs 13-15 weeks: 27%; P = .009), however, loneliness persisted or worsened for a subgroup of participants. Open-ended responses revealed challenges faced by the subgroup experiencing persistent loneliness including poor emotional coping and discomfort with new technologies. CONCLUSION: Many older adults are adjusting to COVID-19 restrictions since the start of shelter-in-place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology-based social interaction.

Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During the COVID-19 Shelter-in-Place Orders.

This report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond by focusing on the integration of social care into the delivery of health care

https://jamanetwork.com/journals/jama/articlepdf/2752359/jama_bibbinsdomingo_2019_vp_190135.pdf

Integrating Social Care Into the Delivery of Health Care

Food insecurity is now recognized as a major health crisis in the United States. This is due to the size of the problem—more than 42 million persons were food insecure in 2015—as well as the multiple negative health outcomes and higher health care costs attributable to food insecurity. An extensive body of literature from multiple fields has examined the causes and consequences of food insecurity and the efficacy of food assistance programs—especially the Supplemental Nutrition Assistance Program. We review this literature and provide suggestions for future research directions. We suggest examining the distribution of food insecurity within households, the impact of the food distribution system on food insecurity, the coping mechanisms of low-income food secure families, food insecurity among American Indians, the effects of charitable food assistance, the causal relationship between food insecurity and health outcomes, the declining age gradient in food insecurity among Seniors, the effects of labor force participation and the Great Recession on food insecurity, and the long-term consequences of food insecurity. In addition, the impact of two recent policy recommendations on food insecurity – the minimum wage and the Affordable Care – Act should be considered.

Food Insecurity Research in the United States: Where We Have Been and Where We Need to Go

For a decade, Feeding America's Map the Meal Gap (MMG) has provided sub-state-level estimates of food insecurity for both the full-population and for children. Along with being extensively used by food banks, it is widely used by state- and local-governments to help plan responses to food insecurity in their communities. In this paper, we describe the methods underpinning MMG, detail the approach Feeding America has used to make projections about the geography of food insecurity in 2020, and how food insecurity rates may have changed due to COVID-19 since 2018. We project an increase of 17 million Americans who are food insecure in 2020 but this aggregate increase masks substantial geographic variation found in MMG.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/aepp.13100

Food Insecurity during COVID-19.

Author(s): Gundersen, Craig; Engelhard, Emily E; Crumbaugh, Amy S; Seligman, Hilary K | Abstract: ObjectiveTo facilitate the introduction of food insecurity screening into clinical settings, we examined the test performance of two-item screening questions for food insecurity against the US Department of Agriculture's Core Food Security Module.DesignWe examined sensitivity, specificity and accuracy of various two-item combinations of questions assessing food insecurity in the general population and high-risk population subgroups.Setting2013 Current Population Survey December Supplement, a population-based US survey.SubjectsAll survey participants from the general population and high-risk subgroups.ResultsThe test characteristics of multiple two-item combinations of questions assessing food insecurity had adequate sensitivity (g97 %) and specificity (g70 %) for widespread adoption as clinical screening measures.ConclusionsWe recommend two specific items for clinical screening programmes based on their widespread current use and high sensitivity for detecting food insecurity. These items query how often the household 'worried whether food would run out before we got money to buy more' and how often 'the food that we bought just didn't last and we didn't have money to get more'. The recommended items have sensitivity across high-risk population subgroups of ≥97 % and a specificity of ≥74 % for food insecurity.

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Brief assessment of food insecurity accurately identifies high-risk US adults.

The burgeoning food insecurity literature in the United States has pro- vided a portrait of the causes and consequences of food insecurity. One underex- plored aspect is the spatial diversity in food insecurity across the United States. In response, Feeding America has been releasing annual county-level food insecurity estimates since 2010. In this article, we describe the methods underlying these esti- mates, followed by answers to the following: What are the state-level determinants of food insecurity? What is the distribution of food insecurity across counties in the United States? How do the county-level food insecurity estimates generated in Map the Meal Gap compare with other sources?

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Map the Meal Gap: Exploring Food Insecurity at the Local Level

The Determinants of Food Insecurity among Food Bank Clients in the United States

An extensive literature has described U.S. food insecurity and its determinants, but there has been little work on the geographic distribution of food insecurity and no work on the distribution of private food assistance by geography. To study the former, we use data from the Map the Meal Gap (MMG) project, which is broken down by Rural-Urban Continuum Codes. For the latter, we combine MMG data with data from the Hunger in America 2014 (HIA 2014) survey to determine the geographic distribution of charitable food assistance. At the national level, we find few differences across the rural-urban interface, but we do find differences within and across regions. We also find that regardless of how it is measured, the distribution of charitable food assistance is directed more toward counties with smaller populations—a finding that holds even after controlling for factors that influence the distribution of charitable assistance.

Emily Engelhard

Papers

Food Insecurity during COVID-19.

Brief assessment of food insecurity accurately identifies high-risk US adults.

Map the Meal Gap: Exploring Food Insecurity at the Local Level

The Determinants of Food Insecurity among Food Bank Clients in the United States

Food Insecurity across the Rural-Urban Divide: Are Counties in Need Being Reached by Charitable Food Assistance?: