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Open Access Publications from the University of California

Scholarly Works (4 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2014)

Incidence and prevalence of chronic diseases such as diabetes are increasing in the U.S. Effective diabetes management is essential to ensure healthy outcomes and avoid severe diabetes sequelae including blindness, myocardial infarction, and early mortality. Research and interventions on diabetes management have primarily targeted changes in individual level risk factors related to physical activity, diet, and medication adherence. Features of neighborhoods, such as neighborhood safety may also be risk factors for poor diabetic management. Research has associated neighborhoods with diabetes incidence and prevalence but few studies focus diabetic populations. To this end, the overall goal of these analyses is to examine how neighborhood safety is associated with diabetic health.

Methods: Chapter 1 provides an introduction and overview to the diabetes and neighborhood safety literature. Three analyses investigating research aims related to neighborhood safety and diabetic management and health will be conducted over three chapters, as follows: Chapter 2: Perceived Neighborhood Safety and Crime in Relation to Cardiometabolic Risk Factors among type II diabetics, Chapter 3: Examining associations between police recorded crime and stress among type II diabetics, and Chapter 4: Examining associations between police recorded crime and obesity among type II diabetics. Chapter 5 provides a summary of findings, implications, and recommendations.

This study will use data from the Diabetes Study of Northern California (DISTANCE), one of the largest, racially and ethnically diverse U.S. cohorts of diabetics followed in a managed care health system. This cohort was established to study social determinants of diabetes and is ideally suited to explore how neighborhood safety, using measures of perceived and objective crime, influence stress and cardiometabolic risk factors such as glycemic control and body mass index.

Discussion and Significance: Diabetics are at risk for a multitude of diabetic complications and early mortality. Understanding how neighborhood level risk factors affect diabetic health may help alleviate diabetes sequelae. Contextual risk factors such as neighborhood crime and safety may be amenable to policy changes and may lead to additional effective interventions for diabetics.

    Cover page: Neighborhood Safety and Diabetic Health: Examining the Associations between Neighborhood Safety and Cardiometabolic Risk Factors
    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2016)
    Little is known about how neighborhood crime may relate to health in diabetes patients. We examined associations between individuals' perceptions of neighborhood safety or violent crime and stress, physical activity, body mass index (BMI) or hemoglobin A1c (HbA1c) in a sample (n=721) of adults (mean age:63) with diabetes. Self-reported neighborhood safety, violent crime, physical activity, and stress were collected and linked to clinical measures of BMI and HbA1c. Approximately 54% and 15% of patients reported neighborhood safety concerns and violent crimes, respectively. Any neighborhood safety concerns (β=1.14, 95% C.I. 0.04-2.24) and violent crime (β=2.04, 95% C.I. 0.34-3.73) were associated with BMI in adjusted analysis. Any violent crime was associated with class II-III obesity (BMI≥35) (OR=1.34, 95% C.I.: 1.02, 1.75). There were no significant associations between neighborhood safety concerns or violent crime with stress, physical activity, or HbA1c. Neighborhood safety is associated with BMI and obesity. Further studies, including longitudinal designs, are needed to study how people with diabetes may be influenced by a sense of poor personal safety in their neighborhoods.
      Cover page: Associations of perceived neighborhood safety and crime with cardiometabolic risk factors among a population with type 2 diabetes
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2016)
      While stress has been linked to poor health outcomes, little is known about the impact of objective measures of neighborhood crime on stress in patients with chronic disease. Using the Kaiser Permanente Diabetes Study of Northern California (DISTANCE), we examined associations between police-recorded crime (2005-2007) and stress (Perceived Stress Scale-4) in four large Northern California cities (Oakland, Sacramento, San Francisco, and San Jose). We performed stratified analysis by gender and race/ethnicity using generalized linear regression models. In our study sample (n = 3188, mean age 59, range 30-77), 10 % reported high stress. In adjusted analyses, higher neighborhood all crimes rate was associated with modest increase in high stress for African-American (OR = 1.10; 95 % CI 1.02-1.22) and Latina women (OR = 1.36; 95 % CI 1.10-1.67) and property crime showed similar associations with stress for these groups of women. Visible crime was associated with stress only for Latina women (OR = 1.43; 95 % CI 1.14-1.78). We found no association between crime and stress among men or other racial/ethnic groups of women. High crime levels may disproportionately impact health among certain subpopulations. Studies using additional measures of stress are necessary to differentiate the health impact of crime-related stress from other forms of stressors among individuals living with diabetes.
        Cover page: Police-Recorded Crime and Perceived Stress among Patients with Type 2 Diabetes: the Diabetes Study of Northern California (DISTANCE).
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2015)

        Background

        In previous research, neighborhood deprivation was positively associated with body mass index (BMI) among adults with diabetes. We assessed whether the association between neighborhood deprivation and BMI is attributable, in part, to geographic variation in the availability of healthful and unhealthful food vendors.

        Methods

        Subjects were 16,634 participants of the Diabetes Study of Northern California, a multiethnic cohort of adults living with diabetes. Neighborhood deprivation and healthful (supermarket and produce) and unhealthful (fast food outlets and convenience stores) food vendor kernel density were calculated at each participant's residential block centroid. We estimated the total effect, controlled direct effect, natural direct effect, and natural indirect effect of neighborhood deprivation on BMI. Mediation effects were estimated using G-computation, a maximum likelihood substitution estimator of the G-formula that allows for complex data relations such as multiple mediators and sequential causal pathways.

        Results

        We estimated that if neighborhood deprivation was reduced from the most deprived to the least deprived quartile, average BMI would change by -0.73 units (95% confidence interval: -1.05, -0.32); however, we did not detect evidence of mediation by food vendor density. In contrast to previous findings, a simulated reduction in neighborhood deprivation from the most deprived to the least deprived quartile was associated with dramatic declines in both healthful and unhealthful food vendor density.

        Conclusions

        Availability of food vendors, both healthful and unhealthful, did not appear to explain the association between neighborhood deprivation and BMI in this population of adults with diabetes.
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