Date of Award

Fall 2026

Abstract

Food insecurity is a significant public health concern associated with reduced dietary quality and increased chronic disease risk. Despite growing evidence linking food insecurity to poor nutritional outcomes, gaps remain in understanding how food assistance program access, perceived barriers to participation, and food security status relate to objectively measured dietary quality and glycemic health. This cross-sectional study examined these associations across three aims in a sample of 81 New Hampshire adults at risk of food insecurity, recruited from Gather Pantry Market. Food security status was assessed using the USDA 18-item Household Food Security Survey Module (HFSSM) and modeled as a continuous variable. Self-reported fruit and vegetable (FV) intake was measured using Dietary Screener Questionnaire (DSQ). Skin carotenoids, an objective biomarker of FV intake, were measured via pressure-mediated reflection spectroscopy (Veggie Meter™), and glycosylated hemoglobin (HbA1c) was assessed via point-of-care fingerstick analysis. Perceived SNAP barriers and SNAP participation status were collected via the SNAP Attitudes Questionnaire. Aims were analyzed using analysis of covariance (ANCOVA) and multiple linear regression models, adjusting for relevant demographic and anthropometric covariates. Aim 1 investigated associations between SNAP participation status, perceived SNAP barriers, and three outcomes: self-reported FV intake, skin carotenoid scores, and Hba1c. SNAP participation was significantly associated with lower self-reported FV intake; no significant associations were detected for skin carotenoids or HbA1c. Perceived SNAP barriers were not significantly associated with any outcome. Aim 2 examined whether food security status predicted the same three outcomes. Food insecurity was significantly and independently associated with lower skin carotenoid scores across all adjusted models but was not significantly associated with self-reported FV intake or HbA1c. Aim 3 assessed whether FV intake, across six self-reported measures and the skin carotenoid biomarker, predicted HbA1c. No significant associations were detected across any dietary exposure or adjusted model. Age was the most consistent predictor of HbA1c across all aims. Collectively, these findings demonstrate that food insecurity is associated with objectively measured lower FV intake, a relationship not captured by self-report. The discordance between self-reported intake and skin carotenoid scores may reflect known limitations of self-reported dietary assessment, including recall error and social desirability bias, as well as the possibility that self-reported intake included fruits and vegetables low in carotenoids and therefore insensitive to detection by reflection spectroscopy. Findings support the continued development of SNAP access initiatives and underscore the value of incorporating objective dietary biomarkers into food security research.

Document Type

Master's Thesis

First Advisor

Carlota Dao

Second Advisor

Noereem Mena

Third Advisor

Sherman Bigornia

Department or Program

Animal and Nutritional Sciences

Degree Name

Master of Science

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