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ABSTRACT: OBJECTIVE: While behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence. DESIGN AND METHODS: Data came from 4,008 adults aged 45-84 at baseline who participated in a neighborhood ancillary study of the Multi-Ethnic Study of Atherosclerosis. Participants were enrolled at six study sites at baseline (2000-2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a 1-mile buffer area. Obesity was defined as BMI ≥ 30 kg/m(2) . Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression. RESULTS: Among 4,008 nonobese participants, 406 new obesity cases occurred during 5 years of follow-up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per s.d. increase in neighborhood score. The association persisted after adjustment for baseline BMI and individual-level covariates (hazard ratio (HR) 0.88, 95% confidence interval (CI): 0.79, 0.97), and for correlated features of the walking environment but CIs widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI: 0.84, 1.15). CONCLUSIONS: Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.
Obesity 03/2013; 21(3):621-628. · 4.28 Impact Factor
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Jennifer J Griggs,
Sarah T Hawley,
John J Graff,
Ann S Hamilton,
Reshma Jagsi,
Nancy K Janz, Mahasin S Mujahid,
Christopher R Friese,
Barbara Salem,
Paul H Abrahamse,
Steven J Katz
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ABSTRACT: Disparities in receipt of adjuvant chemotherapy may contribute to higher breast cancer fatality rates among black and Hispanic women compared with non-Hispanic whites. We investigated factors associated with receipt of chemotherapy in a diverse population-based sample.
Women diagnosed with breast cancer between August 2005 and May 2007 (N = 3,252) and reported to the Detroit, Michigan, or Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registry were recruited to complete a survey. Multivariable analyses examined factors associated with chemotherapy receipt.
The survey was sent to 3,133 patients; 2,290 completed a survey (73.1%), and 1,403 of these patients were included in the analytic sample. In multivariable models, disease characteristics were significantly associated with the likelihood of receiving chemotherapy. Low-acculturated Hispanics were more likely to receive chemotherapy than non-Hispanic whites (odds ratio [OR], 2.00; 95% CI, 1.31 to 3.04), as were high-acculturated Hispanics (OR, 1.43; 95% CI, 1.03 to 1.98). Black women were less likely to receive chemotherapy than non-Hispanic whites, but the difference was not significant (OR, 0.83; 95% CI, 0.64 to 1.08). Increasing age (even in women age < 50 years) and Medicaid insurance were associated with lower rates of chemotherapy receipt.
In this population-based sample, disease characteristics were strongly associated with receipt of chemotherapy, indicating that clinical benefit guides most treatment decisions. We found no compelling evidence that black women and Hispanics receive chemotherapy at lower rates. Interventions that address chemotherapy use rates according to age and insurance status may improve quality of systemic treatment.
Journal of Clinical Oncology 08/2012; 30(25):3058-64. · 18.37 Impact Factor
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ABSTRACT: Psychosocial stress is a significant risk factor for smoking, and Blacks experience higher levels of psychosocial stress relative to other racial/ethnic groups. Limited research has comprehensively examined psychosocial stressors in relation to smoking among Blacks.
We examined psychosocial stressors in relation to smoking status (current, previous, and never) in middle-aged Blacks (34-85 years, n = 592) from Milwaukee, Wisconsin, a subset of the Midlife in the United States Study II (2004-2006). Eleven stressor domains were assessed, including psychological and physical work stress, work-family conflict, perceived inequality, relationship stress, neighborhood stress, discrimination, financial stress, recent problems, stressful events, and childhood adversity. We also calculated a cumulative score. Multinomial models were adjusted for age, gender, education, and income.
Seven of the 11 stressors and the cumulative score were associated with higher odds of being a current smoker compared with a never-smoker: neighborhood, financial, relationship, and psychological work stress, perceived inequality, stressful events, childhood adversity (p values <.05; ORs ranged from 1.28 to 1.77). Three stressors and the cumulative score were associated with higher odds of being a previous smoker versus a never-smoker (p < .05). Individuals who scored in the top quartile on 5 or more stressors were 3.74 (95% CI = 2.09-6.71) times as likely to be current smokers, and more than twice as likely to be previous smokers, compared with individuals with no high stressors. Conclusions: These results demonstrate a strong relationship between stress and smoking among urban middle-aged Blacks and suggest that cessation programs should address modifiable individual and community-level stressors.
Nicotine & Tobacco Research 02/2012; 14(10):1161-9. · 2.58 Impact Factor
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ABSTRACT: Few studies have examined geographic variation in hypertension disparities, but studies of other health outcomes indicate that racial residential segregation may help to explain these variations. The authors used data from 8,071 black and white participants in the National Health and Nutrition Examination Survey (1999-2006) who were aged 25 years or older to investigate whether black-white hypertension disparities varied by level of metropolitan-level racial residential segregation and whether this was explained by race differences in neighborhood poverty. Racial segregation was measured by using the black isolation index. After adjustment for demographics and individual-level socioeconomic position, blacks had 2.74 times higher odds of hypertension than whites (95% confidence interval (CI): 2.32, 3.25). However, race differences were significantly smaller in low- than in high-segregation areas (P(interaction) = 0.006). Race differences in neighborhood poverty did not explain this heterogeneity, but poverty further modified race disparities: Race differences were largest in segregated, low-poverty areas (odds ratio = 4.14, 95% CI: 3.18, 5.38) and smallest in nonsegregated, high-poverty areas (odds ratio = 1.24, 95% CI: 0.77, 2.01). These findings suggest that racial disparities in hypertension are not invariant and are modified by contextual levels of racial segregation and neighborhood poverty, highlighting the role of environmental factors in the genesis of disparities.
American journal of epidemiology 06/2011; 174(5):537-45. · 5.59 Impact Factor
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ABSTRACT: Worry about recurrence (worry) is a persistent concern of breast cancer survivors. Little is known about whether race/ethnicity or healthcare experiences are associated with worry.
Women with nonmetastatic breast cancer diagnosed from June 2005 to February 2007 and reported to Detroit or Los Angeles Surveillance, Epidemiology, and End Results registries were surveyed (mean 9 months postdiagnosis); 2290 responded (73%). Latinas and African Americans were oversampled. A worry scale was constructed as the mean score of 3 items (on 5-point Likert, higher = more worry): worry about cancer returning to the same breast, occurring in the other breast, or spreading to other parts of the body. Race/ethnicity categories were white, African American, and Latina (categorized into low vs high acculturation). The worry scale was regressed on sociodemographics, clinical/treatment, and healthcare experience factors (eg, care coordination collapsed into low, medium, high).
Low acculturated Latinas reported more worry and African Americans less worry than whites (P < .001). Other factors independently associated with more worry were younger age, being employed, more pain and fatigue, and radiation (Ps < .05). With all factors in the model, less worry was associated (all Ps < .05) with greater ease of understanding information (2.89, 2.99, 2.81 for low, medium, high), better symptom management (3.19, 2.89, 2.87 for low, medium, high), and more coordinated care (3.36, 2.94, 2.82 for low, medium, high). Race/ethnicity remained significant controlling for all factors (P < .001).
Less acculturated Latina breast cancer patients are vulnerable to high levels of worry. Interventions that improve information exchange, symptom management, and coordinating care hold promise in reducing worry.
Cancer 03/2011; 117(9):1827-36. · 4.77 Impact Factor
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ABSTRACT: The reasons for racial/ethnic disparities in hypertension (HTN) prevalence in the United States are poorly understood.
Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether individual- and neighborhood-level chronic stressors contribute to these disparities in cross-sectional analyses. The sample consisted of 2,679 MESA participants (45-84 years) residing in Baltimore, New York, and North Carolina. HTN was defined as systolic or diastolic blood pressure ≥140 or 90 mm Hg, or taking antihypertensive medications. Individual-level chronic stress was measured by self-reported chronic burden and perceived major and everyday discrimination. A measure of neighborhood (census tract) chronic stressors (i.e., physical disorder, violence) was developed using data from a telephone survey conducted with other residents of MESA neighborhoods. Binomial regression was used to estimate associations between HTN and race/ethnicity before and after adjustment for individual and neighborhood stressors.
The prevalence of HTN was 59.5% in African Americans (AAs), 43.9% in Hispanics, and 42.0% in whites. Age- and sex-adjusted relative prevalences of HTN (compared to whites) were 1.30 (95% confidence interval (CI): 1.22-1.38) for AA and 1.16 (95% CI: 1.04-1.31) for Hispanics. Adjustment for neighborhood stressors reduced these to 1.17 (95% CI: 1.11-1.22) and 1.09 (95% CI: 1.00-1.18), respectively. Additional adjustment for individual-level stressors, acculturation, income, education, and other neighborhood features only slightly reduced these associations.
Neighborhood chronic stressors may contribute to race/ethnic differences in HTN prevalence in the United States.
American Journal of Hypertension 02/2011; 24(2):187-93. · 3.18 Impact Factor
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ABSTRACT: We examined race/ethnic differences in treatment-related job loss and the financial impact of treatment-related job loss, in a population-based sample of women diagnosed with breast cancer.
Three thousand two hundred fifty two women with non-metastatic breast cancer diagnosed (August 2005-February 2007) within the Los Angeles County and Detroit Metropolitan Surveillance Epidemiology and End Results registries, were identified and asked to complete a survey (mean time from diagnosis = 8.9 months). Latina and African American women were over-sampled (n = 2268, eligible response rate 72.1%).
One thousand one hundred eleven women (69.6%) of working age (<65 years) were working for pay at time of diagnosis. Of these women, 10.4% (24.1% Latina, 10.1% African American, 6.9% White, p < 0.001) reported that they lost or quit their job since diagnosis due to breast cancer or its treatment (defined as job loss). Latina women were more likely to experience job loss compared to White women (OR = 2.0, p = 0.013)), independent of sociodemographic factors. There were no significant differences in job loss between African American and White women, independent of sociodemographic factors. Additional adjustments for clinical and treatment factors revealed a significant interaction between race/ethnicity and chemotherapy (p = 0.007). Among women who received chemotherapy, Latina women were more likely to lose their job compared to White women (OR = 3.2, p < 0.001), however, there were no significant differences between Latina and White women among those who did not receive chemotherapy. Women who lost their job were more likely to experience financial strain (e.g. difficulty paying bills 27% vs. 11%, p < 0.001).
Job loss is a serious consequence of treatment for women with breast cancer. Clinicians and staff need to be aware of aspects of treatment course that place women at higher risk for job loss, especially ethnic minorities receiving chemotherapy.
Journal of Cancer Survivorship 10/2010; 5(1):102-11. · 2.63 Impact Factor
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ABSTRACT: To determine whether early life adversity (ELA) was predictive of inflammatory markers and to determine the consistency of these associations across racial groups.
We analyzed data from 177 African Americans and 822 whites aged 35 to 86 years from two preliminary subsamples of the Midlife in the United States biomarker study. ELA was measured via retrospective self-report. We used multivariate linear regression models to examine the associations between ELA and C-reactive protein, interleukin-6, fibrinogen, endothelial leukocyte adhesion molecule-1, and soluble intercellular adhesion molecule-1, independent of age, gender, and medications. We extended race-stratified models to test three potential mechanisms for the observed associations.
Significant interactions between ELA and race were observed for all five biomarkers. Models stratified by race revealed that ELA predicted higher levels of log interleukin-6, fibrinogen, endothelial leukocyte adhesion molecule-1, and soluble intercellular adhesion molecule-1 among African Americans (p < .05), but not among whites. Some, but not all, of these associations were attenuated after adjustment for health behaviors and body mass index, adult stressors, and depressive symptoms.
ELA was predictive of high concentrations of inflammatory markers at midlife for African Americans, but not whites. This pattern may be explained by an accelerated course of age-related disease development for African Americans.
Psychosomatic Medicine 09/2010; 72(7):694-701. · 3.97 Impact Factor
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ABSTRACT: Despite increasing interest in the extent to which features of residential environments contribute to incidence of type 2 diabetes mellitus, no multisite prospective studies have investigated this question. We hypothesized that neighborhood resources supporting physical activity and healthy diets are associated with a lower incidence of type 2 diabetes.
Person-level data came from 3 sites of the Multi-Ethnic Study of Atherosclerosis, a population-based, prospective study of adults aged 45 to 84 years at baseline. Neighborhood data were derived from a population-based residential survey. Type 2 diabetes was defined as a fasting glucose level of 126 mg/dL or higher (> or =7 mmol/L) or taking insulin or oral hypoglycemic agents. We estimated the hazard ratio of type 2 diabetes incidence associated with neighborhood (US Census tract) resources.
Among 2285 participants, 233 new type 2 diabetes cases occurred during a median of 5 follow-up years. Better neighborhood resources, determined by a combined score for physical activity and healthy foods, were associated with a 38% lower incidence of type 2 diabetes (hazard ratio corresponding to a difference between the 90th and 10th percentiles for resource distribution, 0.62; 95% confidence interval, 0.43-0.88 adjusted for age, sex, family history of diabetes, race/ethnicity, income, assets, educational level, alcohol use, and smoking status). The association remained statistically significant after further adjustment for individual dietary factors, physical activity level, and body mass index.
Better neighborhood resources were associated with lower incidence of type 2 diabetes, which suggests that improving environmental features may be a viable population-level strategy for addressing this disease.
Archives of internal medicine 10/2009; 169(18):1698-704. · 11.46 Impact Factor
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ABSTRACT: There is concern that minority women have limited access to breast reconstruction. We described patterns of use, experiences with clinicians, and patients' satisfaction with treatment decisions for women of different race/ethnicities.
A total of 3,252 patients with breast cancer from Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries were surveyed near the time of diagnosis (n = 2,260, response rate 72.2%). The primary outcomes were receipt of reconstruction, access to information about reconstruction, and decisional satisfaction. The primary independent variable was race/ethnicity (white, African American [AA], highly acculturated Latina [Latina-high], and less acculturated Latina [Latina-low]). Control variables included other sociodemographic and clinical factors. chi(2) and multivariate logistic regression were used for the analyses.
Receipt of reconstruction varied significantly by patient race/ethnicity-40.9% of whites, 33.5% of AAs, 41.2% of Latina-high, and only 13.5% of Latina-low (P < .001)-and persisted when we controlled for demographic and clinical factors. Minority women were significantly less likely than whites to see a plastic surgeon before initial surgery and were more likely to desire more information about reconstruction (17.0% of whites v 27.0% of AAs, 30.0% of Latina-high, and 55.9% of Latina-low; P < .001). Decisional satisfaction was lowest among minority women without reconstruction (P < .001).
Minority women, particularly less acculturated Latinas, had low receipt of breast reconstruction, which may be related to limited information about the procedure and less access to plastic surgeons. Greater desire for information and lower satisfaction with surgical decisions among these patients motivate greater attention to treatment support for these patients.
Journal of Clinical Oncology 10/2009; 27(32):5325-30. · 18.37 Impact Factor
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ABSTRACT: : The goal of this study was to investigate cross-sectional associations between features of neighborhoods and hypertension and to examine the sensitivity of results to various methods of estimating neighborhood conditions.
: We used data from the Multi-Ethnic Study of Atherosclerosis on 2612 individuals 45-85 years of age. Hypertension was defined as systolic blood pressure above 140 mm Hg, diastolic pressure above 90 mm Hg, or use of antihypertensive medications. Neighborhood (census tract) conditions potentially related to hypertension (walking environment, availability of healthy foods, safety, social cohesion) were measured using information from a separate phone survey conducted in the study neighborhoods. For each neighborhood we estimated scale scores by aggregating residents' responses using simple aggregation (crude means) and empirical Bayes estimation (unconditional, conditional, and spatial). These estimates of neighborhood conditions were linked to each study participant based on the census tract of residence. Two-level binomial regression methods were used to estimate adjusted associations between neighborhood conditions and hypertension.
: Residents of neighborhoods with better walkability, availability of healthy foods, greater safety, and more social cohesion were less likely to be hypertensive (relative prevalence [95% confidence interval] for 90th vs. 10th percentile of conditional empirical Bayes estimate = 0.75 [0.64-0.88], 0.72 [0.61-0.85], 0.74 [0.63-0.86], and 0.69 [0.57-0.83]), respectively, after adjusting for site, age, sex, income, and education. Associations were attenuated and often disappeared after additional adjustments for race/ethnicity.
: Neighborhood walkability, food availability, safety, and social cohesion may be mechanisms that link neighborhoods to hypertension.
Epidemiology (Cambridge, Mass.) 08/2008; 19(4):590-8. · 5.51 Impact Factor
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ABSTRACT: Providing breast cancer patients with needed information and support is an essential component of quality care. This study investigated racial/ethnic variations in the information received and in the availability of peer support.
In total, 1766 women who were diagnosed with nonmetastatic breast cancer and reported to the Los Angeles County Surveillance, Epidemiology, and End Results registry from June 2005 to May 2006 were mailed a survey after initial treatment. Among accrued cases, 96.2% met eligibility criteria (n = 1698), and 72% completed the survey. Race/ethnicity categories were white, African American, and Latinas (2 categories indicating low or high acculturation, which was determined by using the Short Acculturation Scale for Hispanics). Outcomes included receipt and need for treatment-related and survivorship-related information, difficulty understanding information, and support from women with breast cancer.
More women reported receiving treatment-related information than survivorship-related information. After adjusting for sociodemographic, clinical, and treatment factors, a higher percentage of low acculturated Latina women desired more information on treatment-related and survivorship-related issues (P < .001). Significantly more Latina low acculturated women than white women reported difficulty understanding written materials, with 74.5% requiring help from others. A higher percentage of all minority groups compared with whites reported no contact with other women with breast cancer (P < .05) and reported less contact through family/friends (P < .05). Women rated the benefit of talking to other women high, particularly with emotional issues.
Continued efforts to provide culturally appropriate information and support needs to women with breast cancer are necessary to achieve quality care. Latinas with low acculturation reported more unmet information and care support needs than women in other racial/ethnic groups.
Cancer 07/2008; 113(5):1058-67. · 4.77 Impact Factor
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ABSTRACT: This study investigated associations between neighborhood physical and social environments and body mass index in 2,865 participants of the Multi-Ethnic Study of Atherosclerosis (MESA) aged 45-84 years and residing in Maryland, New York, and North Carolina. Neighborhood (census tract) environments were measured in non-MESA participants residing in MESA neighborhoods (2000-2002). The neighborhood physical environment score combined measures of a better walking environment and greater availability of healthy foods. The neighborhood social environment score combined measures of greater aesthetic quality, safety, and social cohesion and less violent crime. Marginal maximum likelihood was used to estimate associations between neighborhood environments and body mass index (kg/m(2)) before and after adjustment for individual-level covariates. MESA residents of neighborhoods with better physical environments had lower body mass index (mean difference per standard deviation higher neighborhood measure = -2.38 (95% confidence interval (CI): -3.38, -1.38) kg/m(2) for women and -1.20 (95% CI: -1.84, -0.57) kg/m(2) for men), independent of age, race/ethnicity, education, and income. Attenuation of these associations after adjustment for diet and physical activity suggests a mediating role of these behaviors. In men, the mean body mass index was higher in areas with better social environments (mean difference = 0.52 (95% CI: 0.07, 0.97) kg/m(2)). Improvement in the neighborhood physical environment should be considered for its contribution to reducing obesity.
American journal of epidemiology 07/2008; 167(11):1349-57. · 5.59 Impact Factor
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ABSTRACT: Most studies examining the relation between residential environment and health have used census-derived measures of neighborhood socioeconomic position (SEP). There is a need to identify specific features of neighborhoods relevant to disease risk, but few measures of these features exist, and their measurement properties are understudied. In this paper, the authors 1) develop measures (scales) of neighborhood environment that are important in cardiovascular disease risk, 2) assess the psychometric and ecometric properties of these measures, and 3) examine individual- and neighborhood-level predictors of these measures. In 2004, data on neighborhood conditions were collected from a telephone survey of 5,988 residents at three US study sites (Baltimore, Maryland; Forsyth County, North Carolina; and New York, New York). Information collected covered seven dimensions of neighborhood environment (aesthetic quality, walking environment, availability of healthy foods, safety, violence, social cohesion, and activities with neighbors). Neighborhoods were defined as census tracts or census clusters. Cronbach's alpha coefficient ranged from 0.73 to 0.83, with test-retest reliabilities of 0.60-0.88. Intraneighborhood correlations were 0.28-0.51, and neighborhood reliabilities were 0.64-0.78 for census tracts for most scales. The neighborhood scales were strongly associated with neighborhood SEP but also provided information distinct from neighborhood SEP. These results illustrate a methodological approach for assessing the measurement properties of neighborhood-level constructs and show that these constructs can be measured reliably.
American Journal of Epidemiology 05/2007; 165(8):858-67. · 5.22 Impact Factor
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ABSTRACT: To examine cross sectional and longitudinal associations of socioeconomic position and neighborhood environments with BMI in a middle-aged and bi-ethnic cohort.
Analyses were based on 13,167 subjects (45 to 64 years) who participated in the Atherosclerosis Risk in Communities Study, a population-based study. Census block groups were used as proxies for neighborhoods and were characterized using a summary socioeconomic score. BMI was measured at baseline and at three follow-up visits over a 9-year period.
Individual and neighborhood socioeconomic characteristics were independently and inversely associated with BMI at baseline in women [mean difference in kilograms per meter squared per unit increase in socioeconomic category (SE) for white and black women respectively; -1.56 (0.14), -1.59 (0.19) for education; -1.07 (0.10), -1.18 (0.18) for income; and -1.04 (0.09), -0.77 (0.18) for neighborhood characteristics]. Results for men were not as consistent. Baseline BMI was negatively associated with income in white men but was positively associated with education, income, and neighborhood characteristics in black men. BMI increased over time regardless of gender or race and in most age groups. In whites, there were no consistently patterned differences in longitudinal trends in BMI by individual or neighborhood socioeconomic characteristics. However, in blacks, there was some evidence of greater increases in the higher socioeconomic status groups.
Socioeconomic factors are inversely associated with BMI in middle-aged women, possibly reflecting socially patterned exposures occurring in childhood and adolescence. However, recent increases over time in BMI are either not clearly patterned by socioeconomic factors or are greater in the higher socioeconomic status groups.
Obesity research 09/2005; 13(8):1412-21. · 4.95 Impact Factor
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ABSTRACT: Background
Despite increasing interest in the extent to which features of residential environments contribute to incidence of type 2 diabetes mellitus, no multisite prospective studies have investigated this question. We hypothesized that neighborhood resources supporting physical activity and healthy diets are associated with a lower incidence of type 2 diabetes.Methods
Person-level data came from 3 sites of the Multi-Ethnic Study of Atherosclerosis, a population-based, prospective study of adults aged 45 to 84 years at baseline. Neighborhood data were derived from a population-based residential survey. Type 2 diabetes was defined as a fasting glucose level of 126 mg/dL or higher (≥7 mmol/L) or taking insulin or oral hypoglycemic agents. We estimated the hazard ratio of type 2 diabetes incidence associated with neighborhood (US Census tract) resources.Results
Among 2285 participants, 233 new type 2 diabetes cases occurred during a median of 5 follow-up years. Better neighborhood resources, determined by a combined score for physical activity and healthy foods, were associated with a 38% lower incidence of type 2 diabetes (hazard ratio corresponding to a difference between the 90th and 10th percentiles for resource distribution, 0.62; 95% confidence interval, 0.43-0.88 adjusted for age, sex, family history of diabetes, race/ethnicity, income, assets, educational level, alcohol use, and smoking status). The association remained statistically significant after further adjustment for individual dietary factors, physical activity level, and body mass index.Conclusion
Better neighborhood resources were associated with lower incidence of type 2 diabetes, which suggests that improving environmental features may be a viable population-level strategy for addressing this disease.
The worldwide epidemic of type 2 diabetes mellitus is largely driven by the combined rise in obesity, intake of energy-dense or nutrient-poor foods, and physical inactivity. Individual-based approaches to reverse this epidemic, including surgical treatment, medication, and behavior modification, have yielded mixed results.1- 2 Meanwhile, community trends in diabetes incidence continue to worsen.3 It has been argued that large-scale behavioral change is necessary to forestall the epidemic, but behavioral change is often difficult and is not sustainable in unsupportive environments. There is growing recognition that population-level environmental interventions have the potential to alter sociocultural norms in health behaviors.4 The presence of resources that support physical activity and a healthy diet are environmental features that could affect the development of type 2 diabetes.
Cross-sectional evidence exists that neighborhood resources are associated with precursors to type 2 diabetes, as measured by body mass index (BMI)5- 6 (calculated as weight in kilograms divided by height in meters squared) and insulin resistance.7- 9 Yet, to our knowledge, only 2 longitudinal studies have examined whether neighborhood characteristics are associated with type 2 diabetes, and both included limited measures of the relevant environmental features and were limited to small or restricted single-site samples.10- 11 No longitudinal study, to our knowledge, has examined whether neighborhood resources, specifically for physical activity and healthy foods, are associated with incident type 2 diabetes in a large, multisite population sample. The identification of an effect of neighborhood features on the development of type 2 diabetes would support prevention efforts that target environmental features.
We examined whether neighborhood resources that support being physically active and having a healthy diet are associated with incidence of type 2 diabetes during 5 years of follow-up in a large and diverse population-based sample. We hypothesized that the incidence of type 2 diabetes was inversely associated with these 2 neighborhood features.
Archives of Internal Medicine 169(18):1698-1704. · 11.46 Impact Factor
