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

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.