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Arnold School of Public Health

Health promotion, education, and behavior researchers lead two new projects focusing on food insecurity

November 6, 2020 | Erin Bluvas,

Edward Frongillo, a professor in the Department of Health Promotion, Education, and Behavior, and collaborators have been awarded two R01 grants from the National Institutes of Health. With $2 million in funding from the National Institute of Diabetes and Digestive and Kidney Diseases, Frongillo and co-investigator Brie Turner-McGrievy will assess whether a specific six-month intervention yields better health outcomes and reduced disparities for individuals with diabetes*. For the second project, Frongillo is one of three principal investigators to lead a five-year, $4 million (National Heart, Lung, and Blood Institute) study aimed at reducing HIV and cardiovascular disease health disparities**.

A common thread between these projects, besides Frongillo himself, is his long-term work related to food insecurity (i.e., limited or uncertain access to safe, nutritious food). Frongillo conducts global research focusing on the measurement, determinants, and consequences of household, adult and child food insecurity with a long-term aim of advancing policy and programs for improving nutrition and development.

In the diabetes project, Frongillo and Turner-McGrievy will extend their food insecurity research by leading the UofSC component of a randomized control trial. Partnering with Project Open Hand, a non-profit nutrition agency that provides food support to vulnerable residents with chronic illness in the San Francisco and Oakland, California areas, the team will assess the effectiveness of the intervention, Changing Health through Food Support for Diabetes.

“Low-income communities are disproportionately represented among the 29 million people who have type 2 diabetes and the 40 million people who are food insecure in the United States,” Frongillo says. “Food insecurity is strongly associated with developing type 2 diabetes and contributes to higher rates of diabetes-related health problems and mortality.”

This six-month intervention will provide supplemental food support that meets 75 percent of the nutritional needs for a diabetes-tailored diet and offer nutritional education by registered dieticians from Project Open Hand. The researchers will measure the impact of the intervention on health outcomes (e.g., glycemic control) for 400 low-income adults with type 2 diabetes compared to participants who receive standard care.

In the HIV and cardiovascular health project, Frongillo and the multidisciplinary team will build on existing food insecurity research to understand the effects of intersecting material-need insecurities (i.e., food, housing, financial, healthcare) on HIV and cardiovascular disease outcomes among 3,000 men and women who are living with or are at risk for HIV. These insecurities encompass absolute insufficiency of resources (e.g., hunger, homelessness, inadequate finances, no health insurance), poor quality of resources (e.g., poor diets, inadequate healthcare coverage), uncertainty of consistently meeting future needs, and having to engage in socially unacceptable means to meet needs.

“When people lack the means to consistently meet their material needs for food, housing, finances, and healthcare, their health suffers, particularly for those already managing chronic diseases such as HIV,” Frongillo says. “This study will allow us to better understand how these unmet material needs work together to harm HIV and cardiovascular disease health with the ultimate goal of reducing disparities in these conditions.”

Previous studies have examined how individual insecurities affect various health outcomes, but none have used comprehensive measures to assess the relationships among intersecting insecurities and HIV and cardiovascular disease outcomes. Using an intersectional perspective allows the researchers to examine how different combinations of these insecurities affect health and may lead to more effective interventions that target co-occurring needs simultaneously. It will also enable the researchers to identify individuals at risk for worse outcomes more accurately compared to separate effects.

*Principal Investigators on the Food is Medicine: Randomized Trial of Medically-Tailored Food Support for Diabetes Health project are Sheri Weiser (University of California at San Francisco) and Kartika Palar (University of California at San Francisco).

**Principal Investigators on the Intersection of Material-Need Insecurities and HIV and Cardiovascular Health project are Sheri Weiser (University of California at San Francisco), Bulent Turan (University of Alabama at Birmingham), and Edward Frongillo (University of South Carolina).


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