Though diabetes prevalence has increased nationally, geographic disparities have widened with higher diabetes-related mortality in rural regions than in urban areas. Evidence suggests that an unhealthy food environment increases diabetes risk in urban areas, but crude measures of the food environment may not capture the risk of rural diabetes. Therefore, robust analyses of the food environment and rural diabetes must measure exposures at the correct geographic scale and quantify how certain food purchases can increase diabetes risk. The hazards of the food environment not only include an unhealthy imbalance of macronutrients, but also dietary chemical exposures such as bisphenols and phthalates. These chemicals are now recognized as endocrine disruptors that may promote insulin resistance and diabetes. Though previous studies of diabetes risk have explored poor diet quality and dietary contaminants in isolation of each other, this study seeks to compare the combined impact of both hazards on diabetes risk among rural residents. To accomplish this goal, the study will obtain detailed dietary data through food frequency questionnaires and receipts of food purchases, measure estimated daily intake and urinary levels of bisphenols and phthalates, and use point-of- care HbA1c testing to identify key risk factors associated with rural diabetes. The study setting will be Sullivan County, New York, a rural county with the second-to-worst health ranking and rate of premature death in New York State, and also a high burden of diabetes. Though not representative of all rural regions, the impoverished, predominately White rural population of Sullivan County is an understudied group at high risk for poor diabetic outcomes. Therefore, the specific aims of this study will be to: 1) determine whether the diet quality of rural residents is influenced by their geographic locations and characteristics of their local food environment, 2) calculate estimated daily intake of bisphenols and phthalates based on the food consumption patterns of rural residents and compare results to urinary levels of these chemicals, and 3) use point-of-care HbA1c tests to identify how poor diet quality and dietary contaminants affect glycemic control among rural residents without a prior diagnosis of diabetes.
Rural residents experience substantial barriers in accessing healthy foods, but may also be exposed to other hazards of their local food environment through chemical contaminants ingested from dietary sources. This study will perform geographically detailed surveillance in rural Sullivan County, New York to identify how diet quality and dietary contaminants may interact to increase diabetes risk in rural communities. Findings will inform strategies to improve dietary behavior, reduce dietary chemical exposures, and prevent diabetes among rural residents.