Structural Analysis of the Relationship of Food Insufficiency to Cardiovascular Disease Risk and Outcomes Among Adults From the Southern Region of NHANES III

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Nutrition and Food Systems

First Advisor

Kathy Yadrick

Advisor Department

Nutrition and Food Systems


In 1991, Cathy Campbell at Cornell University proposed a conceptual framework for risk factors and consequences of food insufficiency, which indicated that food insufficiency could be both an outcome as well as a predictor of other outcomes such as poor health. Over the past decade, research has provided evidence for the relationship between food insufficiency and each construct proposed by Campbell, but has not demonstrated inter-relationships among all model components simultaneously. Higher than national average rates of cardiovascular disease (CVD) in the southern region of the U.S. combined with high rates of food insufficiency indicated a need to investigate inter-relationships among food insufficiency, diet quality, health behaviors, CVD risks and outcomes. Therefore the purpose of this study was to develop and test a model for relationships among food insufficiency, diet quality, CVD risks, and outcomes among adults residing in the southern region and participating in the Third National Health and Nutrition Examination Survey (NHANES III). The model was derived from Campbell's conceptual framework of the risk factors for and consequences of food insufficiency. The study design was descriptive correlational. Subjects were non-pregnant, non-lactating adults aged 18 and older who participated in NHANES III, had complete data for all study variables, and resided in the southern region of the U.S. Structural equation modeling (SEM) was used to determine relationships between the indicator variables and latent constructs (measurement models) as well as among latent constructs and among predictor variables simultaneously (structural model). Results indicated those with low income, those with low edlevel, non-white and female would be more likely to report food insufficiency than those of opposite demographic and economic characteristics. Evaluation of the measurement models indicated reasonably good fit of the latent constructs and their indicator variables. However, SEM indicated less than good fit of the structural model. Correlations among the indicator variables may have caused the misfit observed in the structural model. Future research should focus on assessing correlations among the indicator variables to better define future structural models of relationships of food insufficiency to cardiovascular disease risks and outcomes.