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Title: Neighborhood socioeconomic status, depression, and health status in the Look AHEAD (Action for health in diabetes) study

item GARY-WEBB, TIFFANY - Columbia University - New York
item BAPTISTE-ROBERTS, KESHA - Johns Hopkins School Of Public Health
item PHAM, LUU - Johns Hopkins School Of Public Health
item WESCHE-THOBABEN, JACQUELINE - University Of Pittsburgh
item PATRICIO, JENNIFER - St Luke'S-Roosevelt Hospital
item PI-SUNYER, F - St Luke'S-Roosevelt Hospital
item BROWN, ARLEEN - Geffen School Of Medicine
item JONES-CORNEILLE, LASHANDA - University Of Pennsylvania
item BRANCATI, FREDERICK - Johns Hopkins School Of Public Health
item FOREYT, JOHN - Children'S Nutrition Research Center (CNRC)

Submitted to: BioMed Central(BMC) Public Health
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/1/2012
Publication Date: 5/1/2012
Citation: Gary-Webb, T.L., Baptiste-Roberts, K., Pham, L., Wesche-Thobaben, J., Patricio, J., Pi-Sunyer, F.X., Brown, A.F., Jones-Corneille, L., Brancati, F.L., Look AHEAD Research Group. 2012. Neighborhood socioeconomic status, depression, and health status in the Look AHEAD (Action for health in diabetes) study. BioMed Central(BMC) Public Health. 11(1):349.

Interpretive Summary: Diabetes is often associated with depression and diminished health status among those individuals with the condition. While depression and poor health may be associated with diabetes, the impact and association of the socio-economic environment of the diabetic individual and its effects on health and depression has only briefly been addressed. Considering the ill health effects and stress that comes with living in lower socio-economic environments, it is imperative to determine what these effects have on preexisting conditions such as diabetes. The study found that diabetic subjects living in areas of higher poverty, as compared to those living areas of lower poverty, had significantly lower scores for overall physical and mental health as well as role-limitations both physically, emotionally, and socially. These findings help further illustrate the negative effects and overall poorer health status that can result from living under lower SES conditions. Given these findings, it is imperative that factors, such as socio economic status (SES) be taken into consideration when dealing with conditions like diabetes and when designing and when evaluating a weight loss management program. How these SES conditions may affect weight management still requires further investigation, evidence suggest that lower SES may be related to increases in weight.

Technical Abstract: Depression and diminished health status are common in adults with diabetes, but few studies have investigated associations with socio-economic environment. The objective of this manuscript was to evaluate the relationship between neighborhood-level SES and health status and depression. Individual-level data on 1010 participants at baseline in Look AHEAD (Action for Health in Diabetes), a trial of long-term weight loss among adults with type 2 diabetes, were linked to neighborhood-level SES (percentage living below poverty) from the 2000 US Census (tracts). Dependent variables included depression (Beck Inventory), and health status (Medical Outcomes Study (SF-36) scale). Multi-level regression models were used to account simultaneously for individual-level age, sex, race, education, personal yearly income and neighborhood-level SES. Overall, the percentage living in poverty in the participants' neighborhoods varied, mean =11% (range 0-67%). Compared to their counterparts in the lowest tertile of neighborhood poverty (least poverty), those in the highest tertile (most poverty) had significantly lower scores on the role-limitations(physical), role limitations(emotional), physical functioning, social functioning, mental health, and vitality sub-scales of the SF-36 scale. When evaluating SF-36 composite scores, those living in neighborhoods with more poverty had significantly lower scores on the physical health (beta-coefficient [beta]= -1.90 units, 95% CI: -3.40,-0.039), mental health (beta= -2.92 units, -4.31,-1.53) and global health (beta= -2.77 units, -4.21,-1.33) composite scores. In this selected group of weight loss trial participants, lower neighborhood SES was significantly associated with poorer health status. Whether these associations might influence response to the Look AHEAD weight loss intervention requires further investigation.