Background: Neighborhood factors are known barriers to optimal diabetes outcomes; however, the pathways for these findings are not adequately understood. This study examined the direct and indirect pathways between neighborhood factors and glycemic control.

Methods: Data on 615 adults with type 2 diabetes was analyzed. Latent variables were created for neighborhood violence, neighborhood aesthetics, social cohesion, and access to healthy foods. Stress and HbA1c were entered as measured variables. Structured equation modeling (SEM) was used to investigate direct and indirect relationships between neighborhood factors, stress, and glycemic control.

Results: In the final model (Figure 1) (chi2 (158)= 406.97, p<0.001, RMSEA=0.05, p-close 0.38, CFI=0.97, TLI 0.96, CD=1.0), neighborhood violence (r=0.79, p=0.006), neighborhood aesthetics (r=0.74, p=0.02), and social cohesion (r=0.57, p=0.04) were significantly directly associated with stress. Stress was significantly directly associated with glycemic control (r=0.06, p=0.004). Neighborhood violence (r=0.05, p=0.05) and aesthetics (r=0.05, p=0.07) were marginally indirectly associated with glycemic control through stress.

Conclusions: The pathway between neighborhood factors and glycemic control is via chronic stress, therefore, interventions are needed to target chronic stress in adults with type 2 diabetes.


E. Mosley-Johnson: None. J.A. Campbell: None. R.J. Walker: None. L.E. Egede: None.


American Diabetes Association (1-19-JDF-075 to R.J.W.); National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861); National Institute on Minority Health and Health Disparities (R01MD013826)

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