Perceived Stress as a Pathway for the Relationship Between Neighborhood Factors and Glycemic Control in Adults With Diabetes

Abstract

Purpose Neighborhood factors such as crime, discrimination, and violence are increasingly recognized as correlates of poor glycemic control. However, pathways for these relationships are unclear. This study examined stress and self-efficacy as potential pathways for the relationship between neighborhood factors and glycemic control in adults with type 2 diabetes. Design Cross-sectional study. Setting Two primary care clinics in southeastern US. Participants 615 adults aged 18 years and older. Measures Validated measures were used to capture neighborhood factors, stress, and self-efficacy, while hemoglobin A1c (HbA1c) was abstracted from the electronic health record. Analysis Path analysis was used to investigate direct and indirect relationships between neighborhood factors, stress, self-efficacy, and glycemic control. Results In the final model, violence (r = .17, P = .024), discrimination (r = .46, P < .001), and crime (r = .36, P = .046) were directly associated with higher perceived stress. Stress (r = −.5, P < .001) was directly associated with lower self-efficacy. Self-efficacy was directly associated with better general diet (r = .12, P < .001), better specific diet (r = .04, P < .001), more exercise (r = .08, P < .001), and lower HbA1c (r = −.11, P < .001). Stress (r = .05, P < .001), crime (r = .20, P < .001), and discrimination (r = .08, P < .001) were indirectly associated with higher HbA1c. Conclusion Stress and self-efficacy are potential pathways for the relationship between neighborhood factors like violence, discrimination, and crime and glycemic control. Interventions aimed at mitigating stress and improving self-efficacy may improve self-care behaviors and glycemic control.

An Integrative Review of Social Determinants of Glycemic Targets Achievement in Adults with Type 2 Diabetes in the United States

“…The association between neighborhood and the built environment and glycemic target achievement has been addressed in nine included studies (20%) (Campbell et al, 2021; Carpio & Stewart, 2016; Egede et al, 2022; Hu et al, 2022; Levy et al, 2022; Smalls et al, 2015; Tabaei et al, 2018; Walker et al, 2015; Zahedi-Spung et al, 2022). The results indicate that various factors in deprived neighborhoods were associated with not achieving glycemic targets.…”

“…The results indicate that various factors in deprived neighborhoods were associated with not achieving glycemic targets. These factors include high neighborhood problems (Hu et al, 2022), the presence of only one store or lack of stores in the neighborhood (Levy et al, 2022), neighborhood violence and social cohesion (Smalls et al, 2015), lower social support (Walker et al, 2015), deprived neighborhoods (Tabaei et al, 2018; Zahedi-Spung et al, 2022), and neighborhood crime and violence (Egede et al, 2022). However, one of the included studies found that a lower-income neighborhood and the built environment were not significantly associated with poor glycemic target achievement in adults (Campbell et al, 2021).…”

“…A total of seven included studies (15.6%) have reported the association between social and community context and glycemic target achievement (Campbell et al, 2021; Carpio & Stewart, 2016; Egede et al, 2022; Hu et al, 2022; Levy et al, 2022; Smalls et al, 2015; Wilson, 2021). However, only five studies demonstrated a significant association between social and community contexts and higher glycemia.…”

“…However, only five studies demonstrated a significant association between social and community contexts and higher glycemia. These contexts include poorer social connections (Carpio & Stewart, 2016; Levy et al, 2022), higher perceived discrimination (Egede et al, 2022; Hu et al, 2022), and higher social vulnerability (Wilson, 2021). Two studies found insignificant associations between measured social and community contexts and glycemic levels (Campbell et al, 2021; Smalls et al, 2015).…”

Neighborhood-level social vulnerability and individual-level cognitive and motor functioning over time in older non-Latino Black and Latino adults

“…These cardio-health conditions are known to negatively impact cognition (Gorelick et al, 2017) including episodic memory (Gonzales et al, 2017), and thought to increase health disparities in cognition (De Anda-Duran et al, 2022) and motor functions (e.g., gait; Niermeyer, 2018 for a systematic review). Additionally, a recent study found that adverse neighborhood conditions are directly related to participantlevel psychosocial stress-levels of which negatively impact the Hypothalamic-Pituitary-Adrenal axis in humans (Gerritsen et al, 2010) as well as microglia-dependent mechanisms in rodents (Garvin and Bolton, 2022)-and this stress was in turn related to negative health outcomes (Egede et al, 2022). Thus, it would seem that neighborhood-level social vulnerability gets "under the skin" and "into the brain" of older adults to influence both cognitive and motor outcomes.…”