Impact of food affordability on diabetes-related preventable hospitalization.

OBJECTIVES: This study aims to estimate the burden of food affordability on diabetes-related preventable hospitalizations among Medicaid enrollees in the United States. STUDY DESIGN: This study used a retrospective observational design with Medicaid administrative claims data from 17 states from 2014. METHODS: Data were linked with county-level social determinants of health (SDOH) from the American Community Survey. The rate of diabetes-related preventable hospitalizations was measured using the Agency for Healthcare Research and Quality's Prevention Quality Diabetes Composite, which includes hospitalization for short-term complications, long-term complications, lower extremity amputations, and uncontrolled diabetes. Multivariable logistic regression was used to predict the occurrence of diabetes-related preventable hospitalization. RESULTS: Among the 16 million eligible individuals, diabetes-related preventable hospitalizations were identified at the rate of 1.91 per 1000 individuals and contributed to more than $160 million in charges. Rates were higher among men compared with women (0.25% vs 0.15%; P < .001) and among Black adults compared with White adults (0.29% vs 0.18%; P < .001). Compared with individuals residing in counties with low food affordability, those residing in counties with high (odds ratio [OR], 0.84; 95% CI, 0.78-0.91; P < .001) or medium (OR, 0.85; 95% CI, 0.81-0.90; P < .001) food affordability had lower odds of hospitalization. CONCLUSIONS: This study provides real-world evidence about the impact of SDOH on diabetes-related preventable hospitalizations. Federal and state policies that can help improve accessibility of healthy foods are needed to ameliorate the burden of diabetes on society.

Influences on Body Size Perceptions Among Black Women in the Mississippi Delta.

PURPOSE: To identify factors that influence Black women's body size perceptions. DESIGN: Interviews (cognitive mapping exercise) with 25 women; focus group with 7 additional women. SETTING: Mississippi Delta. PARTICIPANTS: Thirty-two black women. MEASURES: Influences on body size perceptions, body mass index, and body satisfaction. ANALYSIS: Interviewee maps were combined and condensed, using matrix addition and qualitative aggregation, to create a social map. The social map was presented to a focus group. A paired sample t test and descriptive statistics were run to assess weight perception accuracy and body satisfaction. RESULTS: The initial social map contained 27 variables. Male preferences (87.5%) and appearance (64%) were believed by most participants to influence perceptions of body size. The focus group identified lack of encouragement, stress, and substance use as factors worth adding to the map. A statistically significant proportion of interviewees possessed an inaccurate weight perception, t(24) = 2.741, P < .05. Furthermore, 76% were dissatisfied with their current weight status and 80% desired a healthy body size. CONCLUSION: These findings provide practitioners with leverage points, beyond diet and physical activity, that may improve the efficacy of weight reduction interventions among black women. Considering the paucity of research regarding influences on body size perceptions, this study also provides researchers with participant-defined variables worthy of further examination.