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Diabetes Journal Club November 17, 2011

Diabetes Journal Club November 17, 2011. Margaux Añel -Tiangco, MD. Background. Observational studies have shown that neighborhood attributes like poverty and racial segregation are associated with increased risks of obesity and diabetes. How neighborhoods might affect health.

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Diabetes Journal Club November 17, 2011

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  1. Diabetes Journal ClubNovember 17, 2011 MargauxAñel-Tiangco, MD

  2. Background • Observational studies have shown that neighborhood attributes like poverty and racial segregation are associated with increased risks of obesity and diabetes

  3. How neighborhoods might affect health • Changes in built environment • Grocery stores • Spaces where residents can exercise • Proximity to health care providers • Neighborhood safety might affect • Exercise level • Diet • Level of stress • Social norms might affect health-related behaviors

  4. Methods • Moving to Opportunity (MTO) • Project of the Dept of Housing and Urban Development • 5 cities: Baltimore, Boston, Chicago, LA, New York • Eligibility: Families with children younger than 18 y/o who live in selected public housing developments in census tracts with poverty rates ≥40% in 1990 • Families were given vouchers from 1994-1998 • Outcomes data collected from one woman from each family (usually the household head) from 2008-2010 (~10 yrs after randomization)

  5. Interventions • Low-poverty voucher • Given rent-subsidy voucher - required to use in a low poverty rate census tract (<10% poverty rate) • Received short-term counseling for housing search • After 1 year, can move to a different tract regardless of poverty rate in that tract • Traditional voucher group • Given rent-subsidy voucher with no restrictions on where to live; no housing counseling • Control group – not given voucher

  6. Results 48% used voucher 63% used voucher

  7. Baseline characteristics

  8. Baseline characteristics

  9. Census-Tract Poverty Rate According to Study Group 50% 33% 33% median 28%

  10. No difference 13% 19% 22% p = 0.05

  11. Why is there a difference in health outcomes? • Testing for nonlinear relationships between neighborhood attributes and health outcomes had low statistical power

  12. Census tract characteristics

  13. Census tract characteristics

  14. Study critiques • Only half of participants used the vouchers and many of the families in the control moved to lower poverty areas • Participants volunteered – Hawthorne effect

  15. Take home points • Moving to a neighborhood with a low poverty rate is associated with improvements in BMI and A1c • Mechanisms remain unclear • Further research needed to look into clinical or public health interventions that ameliorate the effects of neighborhood environment on obesity and diabetes

  16. Questions?

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