title: Neighborhood perceptions and health-related outcomes among Latinos with diabetes from a rural agricultural community.
abstract: Little is known about how neighborhood perceptions are related to diabetes outcomes among Latinos living in rural agricultural communities. Our objective was to examine the association between perceived neighborhood problems and diabetes outcomes. This is a cross-sectional survey study with medical record reviews of a random sample of 250 adult Latinos with type 2 diabetes. The predictor was a rating of patient ratings of neighborhood problems (crime, trash and litter, lighting at night, and access to exercise facilities, transportation, and supermarkets). The primary outcomes were the control of three intermediate outcomes [LDL-cholesterol (LDL-c) < 100 mg/dl, AlC < 9.0 %, and blood pressure (BP) < 140/80 mmHg], and body mass index (BMI) < 30 kg/m(2). Secondary outcomes were participation in self-care activities (physical activity, healthy eating, medication adherence, foot checks, and glucose checks). We used regression analysis and adjusted for age, gender, education, income, years with diabetes, insulin use, depressive symptoms, and co-morbidities. Forty-eight percent of patients perceived at least one neighborhood problem and out of the six problem areas, crime was most commonly perceived as a problem. Perception of neighborhood problems was independently associated with not having a BP < 140/80 [Adjusted odds ratio (AOR) = 0.45; 95 % CI 0.22, 0.92], and BMI < 30 (AOR = 0.43; 95 % CI 0.24, 0.77), after controlling for covariates. Receipt of recommended processes of care was not associated with perception of neighborhood. Perception of neighborhood problems among low-income rural Latinos with diabetes was independently associated with a higher BMI and BP.
authors.affiliation: Department of Family Medicine, UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA, gemoreno@mednet.ucla.edu.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Moreno
authors.forename: Leo S
authors.initials: LS
authors.lastname: Morales
authors.forename: Fatima
authors.initials: F
authors.lastname: Nuñez de Jaimes
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Marilu
authors.initials: M
authors.lastname: Isiordia
authors.forename: Christine
authors.initials: C
authors.lastname: Noguera
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000383:Agriculture; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012424:Rural Population; D055815:Young Adult