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. [More Details…] The proposed research project will assess neighborhood–level influences on health—such as accessibility to supermarkets, fast food restaurants and recreational facilities, and public services and amenities—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 neighborhood-level factors on cardiometabolic markers of risk among persons with diabetes; and, 3) to determine individual- and neighborhood-level factors on the causal pathway between neighborhood 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.
PI: Barbara Laraia
Co-Investigators: Nancy Adler, Andy Karter (Kaiser Division of Research), Will Dow (UCB), Maggi Kelly (UCB) and Michael Jerrett (UCB)
Funding: NIH/NIDDK
Link to: OurSpace: Neighborhood Database Initiative
Specific Aims:
Specific Aim 1: To create a longitudinal database of neighborhood characteristics and derive spatial measures of accessibility to food, physical activity and social resources
Specific Aim 2: To assess the effect of neighborhood-level factors on cardiometabolic markers of risk among persons with diabetes, with particular attention to racial/ethnic disparities for the full cohort (n = 20,000)
Specific Aim 3: To determine individual- and neighborhood-level factors on the causal pathway between neighborhood environment and cardiometabolic markers of risk among persons with diabetes among a sub-sample of the cohort (n = 2,500)
Publications:
Moffet HM, Adler N, Schillinger D, Ahmed AT, Laraia B, Selby JV, Neugebauer R, Liu JY, Parker MM, Warton M, Karter AJ. Cohort Profile: The Diabetes Study of Northern California (DISTANCE) Objectives and design of a survey follow-up study of social health disparities in a managed care population. International Journal of Epidemiology, (in press).