Diabetes is increasing at an alarming rate. Between 1980 and 2004, as obesity increased, the number of Americans with diabetes more than doubled. Individuals from minority, low-income and low education populations are disproportionately affected by diabetes (and by complication of diabetes), and these socioeconomic disparities may be growing. Health disparities are often attributed to differences in medical care or self-care, but data suggest that these individual level factors explain few of the existing disparities. Neighborhood environments are increasingly recognized as exerting influence on diet, on physical activity and on outcomes of chronic disease. The present proposal is based on the theory that the immediate neighborhood environment of a person living with diabetes may influence decisions and actions related to food procurement, weight status, diabetes self-care behaviors and cardiometabolic markers and, ultimately, on incidence of complications of diabetes. The proposed research project will assess neighborhood-level influences on health such as accessibility to supermarkets, the ratio of fast food and convenience store to supermarkets and produce vendors, and household food security, by collecting a broad range of data on participants'communities in an ongoing study of ethnic disparities in diabetes outcomes. Neighborhood- level data will be collected and linked to a vast array of detailed individual-level socio-demographic, behavioral, cardiometabolic and complications data existing on this cohort. The project's specific aims are: 1) to create a longitudinal database of neighborhood characteristics;2) to assess the effect of the neighborhood food environement on cardiometabolic markers of risk among persons with diabetes;and, 3) to determine individual- and neighborhood-level factors on the causal pathway between the neighborhood food environment and cardiometabolic markers of risk among persons with diabetes. This study involves data collection and analysis of compositional (e.g., census), contextual (e.g., food resources), and spatially derived data (e.g., access to food resource) on health behaviors and cardiometabolic risk factors among persons with diabetes. Accomplishing the aims of this proposal will expand current understanding of the neighborhood food, physical activity and social environments that contribute to good health, and will inform further study of alternative strategies for measurement and analysis of environmental influences on health.

Public Health Relevance

The proposed study aims to assess neighborhood-level factors that are associated with weight status, diabetes self-care behaviors and cardiometabolic risk factors in a cohort of adult diabetics. We will add neighborhood data, such as neighborhood socioeconomic status, location of supermarkets, fast food restaurants, alcohol outlets, and parks, to the ongoing Kaiser Permanente Division of Research """"""""Distance Study"""""""". We will model the influence of neighborhood factors on weight status, diet, physical activity, glycemic control, lipid levels and blood pressure. We will identify modifiable individual- and neighborhood-level factors that may have public health program and policy implications.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Hunter, Christine
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University of California Berkeley
Schools of Public Health
United States
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Tamayo, Aracely; Mujahid, Mahasin S; Laraia, Barbara et al. (2016) Police-Recorded Crime and Perceived Stress among Patients with Type 2 Diabetes: the Diabetes Study of Northern California (DISTANCE). J Urban Health 93:745-757
Tamayo, Aracely; Karter, Andrew J; Mujahid, Mahasin S et al. (2016) Associations of perceived neighborhood safety and crime with cardiometabolic risk factors among a population with type 2 diabetes. Health Place 39:116-21
Downing, Janelle; Karter, Andrew; Rodriguez, Hector et al. (2016) No Spillover Effect of the Foreclosure Crisis on Weight Change: The Diabetes Study of Northern California (DISTANCE). PLoS One 11:e0151334
Zhang, Y Tara; Laraia, Barbara A; Mujahid, Mahasin S et al. (2016) Is a reduction in distance to nearest supermarket associated with BMI change among type 2 diabetes patients? Health Place 40:15-20
Zhang, Y Tara; Laraia, Barbara A; Mujahid, Mahasin S et al. (2015) Does food vendor density mediate the association between neighborhood deprivation and BMI?: a G-computation mediation analysis. Epidemiology 26:344-52
Laraia, Barbara A; Blanchard, Samuel D; Karter, Andrew J et al. (2014) Spatial pattern of body mass index among adults in the diabetes study of Northern California (DISTANCE). Int J Health Geogr 13:48
Moffet, Howard H; Warton, E Margaret; Parker, Melissa M et al. (2014) The DISTANCE model for collaborative research: distributing analytic effort using scrambled data sets. Inf Secur Comput Fraud 2:33-38
Laraia, Barbara A (2013) Food insecurity and chronic disease. Adv Nutr 4:203-12
Jones-Smith, Jessica C; Karter, Andrew J; Warton, E Margaret et al. (2013) Obesity and the food environment: income and ethnicity differences among people with diabetes: the Diabetes Study of Northern California (DISTANCE). Diabetes Care 36:2697-705
Stoddard, Pamela J; Laraia, Barbara A; Warton, E Margaret et al. (2013) Neighborhood deprivation and change in BMI among adults with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE). Diabetes Care 36:1200-8

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