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Perception of Neighborhood Problems, Health Behaviors, and Diabetes Outcomes Among Adults With Diabetes in Managed Care

The Translating Research Into Action for Diabetes (TRIAD) Study

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
² Deep South Center on Effectiveness at Birmingham VA Medical Center and Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
³ Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia
⁴ Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
⁵ Division of Research, Kaiser Permanente, Oakland, California

Address correspondence and reprint requests to Tiffany L. Gary, PhD, 615 N. Wolfe St., Rm E6531, Baltimore, MD 21205. E-mail: tgary{at}jhsph.edu

OBJECTIVE—Recent data suggest that residential environment may influence health behaviors and outcomes. We assessed whether perception of neighborhood problems was associated with diabetes behaviors and outcomes.

RESEARCH DESIGN AND METHODS—This cross-sectional analysis included 7,830 diabetic adults enrolled in Translating Research Into Action for Diabetes, a study of diabetes care and outcomes in managed care settings. Perception of neighborhood problems was measured using a summary score of participants’ ratings of crime, trash, litter, lighting at night, and access to exercise facilities, transportation, and supermarkets. Outcomes included health behaviors and clinical outcomes. Hierarchical regression models were used to account for clustering of patients within neighborhoods and to adjust for objective neighborhood socioeconomic status (percentage living in poverty) and potential individual-level confounders (age, sex, race/ethnicity, education, income, comorbidity index, and duration of diabetes).

RESULTS—After adjustment, residents of neighborhoods in the lowest tertile (most perceived problems) reported higher rates of current smoking (15 vs. 11%) than those in the highest tertile and had slightly lower participation in any weekly physical activity (95 vs. 96%). In addition, their blood pressure control was worse (25 vs. 31% <130/80 mmHg), and their Short Form 12 scores were slightly lower (44 vs. 46 units for emotional well-being and 43 vs. 44 units for physical well-being); all P < 0.01.

CONCLUSIONS—Neighborhood problems were most strongly associated with more smoking and higher blood pressure, both of which have significant implications for cardiovascular risk. Potential mechanisms that explain these associations should be further explored in longitudinal studies.

Abbreviations: DBP, diastolic blood pressure • SBP, systolic blood pressure • SES, socioeconomic status • SF-12, Short Form 12 • SMBG, self-monitoring of blood glucose • TRIAD, Translating Research into Action for Diabetes

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