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.
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.
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