Date of Completion


Embargo Period



Stacey L. Brown, Angela Bermúdez-Millán, and Julie Wagner

Field of Study

Public Health


Master of Public Health

Open Access

Open Access



Cambodian refugees who experienced famine and trauma from the Khmer Rouge genocide are disproportionately at high risk of type 2 diabetes. This risk is exacerbated when this vulnerable population experiences a high prevalence of food insecurity upon resettlement in the U.S. As a result, refugee dietary intake and nutrition uniquely contribute to the rise of often long-term health consequences and pose an unexpected burden on the U.S. healthcare system.


(1) To describe household food security status of Cambodians refugees (2) To examine the association between food security status and socioeconomic status (SES) of Cambodian refugees; (3) To describe dietary patterns, especially rice and sugar-sweetened beverages consumption of this population; (4) To examine the association between household food insecurity and diabetes risk marker (Hemoglobin A1c, HbA1c); (5) To examine preliminary associations between household food insecurity, dietary patterns and HbA1c.


The preliminary cross-sectional baseline data was collected from the Diabetes Risk Reduction through Eat, Walk, Sleep and Medication Therapy Management for Depressed Cambodians (DREAM) study. Cambodian participants (n=205) were enrolled who met the inclusion criteria including age 35-70, Khmer speaking, scored >=3 on the ADA Diabetes Risk Test, self-reported anti-depressant medication or indicated elevated depressive symptoms on the Khmer version of the depression subscale of the Hopkins Symptom Checklist. Household food security status for the past 12 months was assessed using the 6-item, validated Khmer language version of the U.S. Household Food Security Survey Module. Dietary patterns were assessed using a short semi-quantitative Food Frequency Questionnaire (FFQ). Hemoglobin A1c (HbA1c) levels were assessed by centrally collecting and assaying fasting blood samples at a clinical laboratory.


Participants’ mean age was 55 years old, 77% (n=145) were female, 50% (n=93) were married, 68% (n=128) were unemployed, 41% (n=76) were Supplemental Nutritional Assistance Program (SNAP) recipients, and 56% (n=104) earned between $30,000- above $40,000. Out of a total 189 participants, 72% (n=148) were found food secure and 19% (n=39) were food insecure. There were statistically significant differences in food security status on marital status, income, employment status, SNAP status and communication barrier (p-value


Food insecurity was significantly associated with elevated diabetic risk marker (HbA1c). Although dietary patterns didn’t show any association with food insecurity or HbA1c levels, future studies need to consider a more robust mediation model and control for mental illnesses to further explore the association.

Major Advisor

Stacey L. Brown