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Perception of Neighborhood Problems, Health Behaviors, and Diabetes Outcomes for 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, MD
² Deep South Center on Effectiveness at Birmingham VA Medical Center and Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
³ Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, GA
⁴ Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
⁵ Division of Research, Kaiser Permanente, Oakland, CA

tgary{at}jhsph.edu

ABSTRACT

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

Methods: This cross-sectional analysis included 7,830 diabetic adults enrolled in Translating Research Into Action for Diabetes (TRIAD), 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 and 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 SES (% living in poverty) and potential individual-level confounders (age, sex, race/ethnicity, education, income, co-morbidity index, 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 BP control was worse (25% vs. 31%, were <130/80 mmHg), and their SF-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.

Conclusion: Neighborhood problems were mostly strongly associated with more smoking and higher BP, both of which have significant implications for cardiovascular risk. Potential mechanisms that explain these associations should be further explored in longitudinal studies.

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