title: Assessing the relationship between neighborhood factors and diabetes related health outcomes and self-care behaviors.
abstract: BACKGROUND
  Studies have shown that community and neighborhood characteristics can impact health outcomes of those with chronic illness, including T2DM. Factors, such as crime, violence, and lack of resources have been shown to be barriers to optimal health outcomes in diabetes. Thus, the objective of this study is to assess the effects of neighborhood factors on diabetes-related health outcomes and self-care behaviors.
  
  
  METHODS
  Adult patients (N = 615) with type 2 diabetes mellitus (T2DM) were recruited from an academic medical center and a Veterans Affairs medical center in the southeastern United States. Validated scales and indices were used to assess neighborhood factors and diabetes-related self-care behaviors. The most recent HbA1c, blood pressure, and LDL cholesterol were abstracted from each patients' electronic medical record.
  
  
  RESULTS
  In the fully adjusted model, significant associations were between neighborhood aesthetics and diabetes knowledge (β = 0.141) and general diet (β = -0.093); neighborhood comparison and diabetes knowledge (β = 0.452); neighborhood activities and general diet (β = -0.072), exercise (β = -0.104), and foot care (β = -0.114); food insecurity and medication adherence (β = -0.147), general diet (β = -0.125), and blood sugar testing (β = -0.172); and social support and medication adherence (β = 0.009), foot care (β = 0.010), and general diet (β = 0.016). Significant associations were also found between neighborhood violence and LDL Cholesterol (β = 4.04), walking environment and exercise (β = -0.040), and social cohesion and HbA1c (β = -0.086).
  
  
  CONCLUSIONS
  We found that neighborhood violence, aesthetics, walking environment, activities, food insecurity, neighborhood comparison, social cohesion and social support have statistically significant associations with self-care behaviors and outcomes to varying degrees. However, the key neighborhood factors that had independent associations with multiple self-care behaviors and outcomes were food insecurity, neighborhood activities and social support.
  
  
  CONCLUSIONS
  This study suggests that food insecurity, neighborhood activities, aesthetics, and social support may be important targets for interventions in individuals with T2DM.
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA. Bsmalls@partners.org.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Smalls
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA. Gregoryc@musc.edu.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gregory
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA. zollerjs@musc.edu.|Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA. zollerjs@musc.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Zoller
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Room 280, MSC 593, Charleston, SC, 29425, USA. egedel@musc.edu.|Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, RT 12th Floor, P.O. Box 250591, Charleston, SC, 29425, USA. egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D008078:Cholesterol, LDL / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D015444:Exercise / Q000502:physiology; D005260:Female; D005523:Food Supply; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012648:Self Care; D012944:Social Support; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin