Access to urban food outlets as a predictor of diabetes
Item
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Title
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Access to urban food outlets as a predictor of diabetes
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Identifier
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d_2009_2013:2a567546068d:11144
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identifier
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11480
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Creator
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Amstislavski, Philippe,
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Contributor
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Juliana A. Maantay | Yehuda Klein
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Date
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2012
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Language
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English
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Publisher
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City University of New York.
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Subject
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Geographic information science and geodesy | Environmental justice | Statistics | Diabetes | Energy Balance | Food Access | Multi-level Analysis | Socio-Economic Environment
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Abstract
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Background and problem statement. There is an unprecedented rise in diabetes in urban populations worldwide. A relationship between spatial concentration of other metabolic diseases and poor access to healthy foods in some underserved urban neighborhoods have been reported. Concurrently, a relationship between increased risk of developing diabetes and consumption of unhealthy foods and has been shown to exist. Neighborhood food contexts hypothesized to lead to developing diabetes need to be studied.;Study goals. The main hypothesis of this study is that the degree of access to food outlets near residences influences the outcome of diabetes. Covariates include individual-level variables of age and gender of the subjects, and neighborhood-level variables of educational attainment, percent of residents in poverty, of housing units without vehicles, and of female-headed households with children.;Methods. Address, demographic, and health data extracted from medical records of black visitors to hospital emergency department were linked to geo-referenced socio-economic and food outlet data for the visitors. Census Tract (CT) of residence. Hierarchical linear modeling was used to consider the effect of variation in food and socio-economic environments on diabetes among the subjects. A cross-sectional study was designed and a multilevel logistic regression analysis was performed.;Results. Spatial access to food outlets was not a significant predictor of diabetes in this study. However, subjects living in the socio-economically deprived neighborhoods had a higher probability of having diabetes. For every unit decrease in the neighborhood.s socio-economic index constructed from the census variables, the subjects were 7 percent more likely to have diabetes (CI 1.03-1.12, p-value 0.0024). Female gender and older age were strongly associated with odds of having diabetes.;Conclusions. Socio-economic context of neighborhood was shown to affect probability of having diabetes, while local food outlet access did not. The results indicate that there may be a critical difference between economic and spatial access to foods and the actual choices individuals make about their diets. These choices may be driven by individual cultural and social preferences. More research is needed to study these individual biosocial factors and to analyze how they affect diet and diabetes outcome.;Keywords. Socio-Economic Environment, Diabetes, Energy Balance, Food Access, Multi-level Analysis.
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Type
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dissertation
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Source
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2009_2013.csv
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degree
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Ph.D.
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Program
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Earth & Environmental Sciences
