Date of Completion


Embargo Period



Angela Bermudez-Millan, Amanda J. Durante, Julie Wagner

Field of Study

Public Health


Master of Public Health

Open Access

Open Access



Refugee survivors of starvation and trauma during the Khmer Rouge rule of Cambodia suffer myriad poor health outcomes, 30 years after the genocide. Having high rates of food insecurity, depression, and the highest rate of type 2 diabetes mellitus for an Asian subgroup complicates nutritional health outcomes.


(1) To document household food insecurity of Cambodian Americans who were alive during the Pol Pot era, with depression and elevated diabetes risk in New England; (2) To document the dietary behaviors of Cambodian Americans; and (3) To explore preliminary associations between household food insecurity, dietary behaviors and diabetes risk markers (waist circumference, hemoglobin A1c (A1c), and cholesterol).


We analyzed cross-sectional baseline data from the Diabetes Risk Reduction through Eat, Walk, Sleep And Medication Therapy Management for Depressed Cambodians (DREAM) study, an ongoing diabetes prevention trial. Cambodian Americans (n=45) that met the eligibility requirements which included age 35-70, Khmer speaking, >=3 risk factors for diabetes and either anti-depressant medication or elevated depression symptoms on the Hopkins Symptom Checklist were enrolled in the study. Participants completed the 6-item validated Khmer language, version of the U.S. Household Food Security Survey Module and subjects were classified as food insecure or not, based on the finding. The participants completed a Semi-Quantitative Food Frequency Questionnaire (FFQ). Waist circumference measurement was taken in triplicate and the mean was used for analyses. Fasting blood samples were collected and assayed centrally at Quest Diagnostics to assess A1c and total cholesterol.


Respondents’ mean age was 57 years old, 84% (n=32) were female, 82% (n=32) were not working, and 46% (n=21) were married. Fifty percent (n=22) were enrolled in the Supplemental Nutrition Assistance Program (SNAP). Fifty-three percent (n=23) were classified as food secure and forty-six percent (n=20) as food insecure. There were no significant differences in food security status on age, gender, employment status, number of people in the household, or marital status. Overall, 94.7% (n=36) of the respondents consumed white rice. However, participants who consume white rice daily were more likely to be food insecure (60%, n=17), (p=.05).


Household food insecurity was prevalent among Cambodians. Household food insecurity was significantly associated with daily white rice consumption. Future multivariate analyses should control for depressive and trauma symptoms to further establish these associations.

Major Advisor

Angela Bermúdez-Millán PhD, MPH