{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:05:40Z","timestamp":1790017540139,"version":"4.0.1"},"reference-count":20,"publisher":"American Diabetes Association","issue":"10","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"name":"Michigan Center for Diabetes and Translational Research"},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["P30DK092926"],"award-info":[{"award-number":["P30DK092926"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01 DK116715-01A1"],"award-info":[{"award-number":["R01 DK116715-01A1"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To assess the prevalence of housing instability and its associations with cost-related nonadherence and financial toxicity among adults with uncontrolled diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We analyzed baseline randomized controlled trial data from 600 adults with uncontrolled diabetes and cost-related barriers to care. Logistic and linear regression assessed associations of housing instability with cost-related nonadherence and financial toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Half (n = 298) reported housing instability, which was associated with greater odds of cost-related nonadherence (adjusted odds ratio 1.64; 95% CI 1.05, 2.56) and worse financial toxicity (B = \u22124.64; 95% CI \u22126.20, \u22123.09). Cost-related nonadherence was not significant after adjusting for diabetes distress and symptoms of depression and anxiety; financial toxicity remained significant. In sensitivity analyses, worry about housing costs, not housing or utility needs, was associated with financial toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Housing instability was associated with financial toxicity and, in primary models, with cost-related nonadherence. Findings should be validated in longitudinal, nationally representative samples.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-1152","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:16:42Z","timestamp":1786645002000},"page":"1877-1882","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Housing Instability Associated With Cost-Related Nonadherence and Financial Toxicity in People With Uncontrolled Diabetes"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7207-4629","authenticated-orcid":false,"given":"Victoria H.","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Health Behavior & Health Equity, University of Michigan School of Public Health , Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshanak","family":"Mehdipanah","sequence":"additional","affiliation":[{"name":"Department of Health Behavior & Health Equity, University of Michigan School of Public Health , Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minal R.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Health Behavior & Health Equity, University of Michigan School of Public Health , Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"2026092114524481800_B1","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1186\/s12889-023-15875-6","article-title":"Housing instability and cardiometabolic health in the United States: a narrative review of the literature","volume":"23","author":"Gu","year":"2023","journal-title":"BMC Public Health"},{"key":"2026092114524481800_B2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.socscimed.2017.11.051","article-title":"\"That wasn\u2019t really a place to worry about diabetes\": housing access and diabetes self-management among low-income adults","volume":"197","author":"Keene","year":"2018","journal-title":"Soc Sci Med"},{"key":"2026092114524481800_B3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s12913-022-07468-7","article-title":"Relationship between housing insecurity, diabetes processes of care, and self-care behaviors","volume":"22","author":"Mosley-Johnson","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2026092114524481800_B4","doi-asserted-by":"crossref","first-page":"933","DOI":"10.2337\/dc17-1812","article-title":"Unstable housing and diabetes-related emergency department visits and hospitalization: a nationally representative study of safety-net clinic patients","volume":"41","author":"Berkowitz","year":"2018","journal-title":"Diabetes Care"},{"key":"2026092114524481800_B5","doi-asserted-by":"crossref","first-page":"101475","DOI":"10.1016\/j.ehb.2025.101475","article-title":"Housing insecurity, financial hardship and mental health","volume":"57","author":"Ludlow","year":"2025","journal-title":"Econ Hum Biol"},{"key":"2026092114524481800_B6","doi-asserted-by":"crossref","first-page":"e2553617","DOI":"10.1001\/jamanetworkopen.2025.53617","article-title":"Housing instability following medical debt exposure among US adults, 2023 to 2025","volume":"9","author":"Moon","year":"2026","journal-title":"JAMA Netw Open"},{"key":"2026092114524481800_B7","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/j.1525-1497.2005.00278.x","article-title":"Housing instability and food insecurity as barriers to health care among low-income Americans","volume":"21","author":"Kushel","year":"2006","journal-title":"J Gen Intern Med"},{"key":"2026092114524481800_B8","doi-asserted-by":"crossref","first-page":"105933","DOI":"10.1016\/j.cct.2020.105933","article-title":"Study protocol: CareAvenue program to improve unmet social risk factors and diabetes outcomes- a randomized controlled trial","volume":"89","author":"Patel","year":"2020","journal-title":"Contemp Clin Trials"},{"key":"2026092114524481800_B9","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1007\/s11606-024-08708-8","article-title":"A randomized controlled trial to improve unmet social needs and clinical outcomes among adults with diabetes","volume":"39","author":"Patel","year":"2024","journal-title":"J Gen Intern Med"},{"key":"2026092114524481800_B10","doi-asserted-by":"crossref","first-page":"e297","DOI":"10.1371\/journal.pmed.0040297","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration","volume":"4","author":"Vandenbroucke","year":"2007","journal-title":"PLoS Med"},{"key":"2026092114524481800_B11","unstructured":"Billioux\n              A\n            , VerlanderK, AnthonyS, AlleyD.\n          Standardized screening for health-related social needs in clinical settings: the Accountable Health Communities Screening Tool. 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