Hypotheses

This study seeks to determine whether the built environment and neighborhood

composition influence diabetes prevalence. As stated in the introduction, this study will attempt to answer two predominant questions. I have grouped the hypotheses based on which

overarching question each attempts to answer. First, how does neighborhood composition affect one’s built environment? The first three hypotheses address this first question. I hypothesize that, for the state of Georgia, the built environment will vary based on the racial makeup of the

residents who live there. I predict that areas of higher minority concentration will have lower access to healthful facilities and a higher access to harmful facilities (such as alcohol outlets and fast food restaurants). Secondly, I hypothesize that the built environment will vary based on the income makeup of the residents. I predict that areas of lower income will have a less desirable built environment, in terms of access and availability of healthful facilities. Third, I hypothesize that the built environment will vary based on the geographic density of the areas where people live.

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Table 4.1. Hypotheses Tested.

1. How does neighborhood composition influence the built environment? a. The built environment will decline as African-American presence in a

county increases.

i. The proportion of positive food outlets will decrease as African- American presence increases.

ii. The proportion of negative food outlets will increase as African- American presence increases.

iii. The proportion of healthcare facilities will decrease as African- American presence increases.

iv. The proportion of physical activity facilities will decrease as African-American presence increases.

v. The proportion of public administration facilities will decrease as African-American presence increases.

b. The built environment will improve as the neighborhood disadvantage scale decreases at the county level.

i. The proportion of positive food outlets will increase as neighborhood disadvantage scale decreases.

ii. The proportion of negative food outlets will decrease as neighborhood disadvantage scale decreases.

iii. The proportion of healthcare facilities will increase as neighborhood disadvantage scale decreases.

iv. The proportion of physical activity facilities will increase as neighborhood disadvantage scale decreases.

v. The proportion of public administration facilities will increase as median household income increases.

c. The built environment will be better in urban areas and worse in rural areas at the county level.

i. The proportion of positive food outlets will be greater in urban areas than in rural areas.

ii. The proportion of negative food outlets will be lesser in urban areas than in rural areas.

iii. The proportion of healthcare facilities will be greater in urban areas than in rural areas.

iv. The proportion of physical activity facilities will be greater in urban areas than in rural areas.

v. The proportion of public administration facilities will be greater in urban areas than in rural areas.

2. How do neighborhood composition and built environment together influence diabetes prevalence?

a. Areas of higher African-American presence will have lower access to healthful facilities and a higher prevalence of diabetes.

i. Areas of higher African-American presence will have lower access to positive food outlets and a higher prevalence of diabetes.

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ii. Areas of higher African-American presence will have higher access to negative food outlets and a higher prevalence of diabetes.

iii. Areas of higher African-American presence will have lower access to healthcare facilities and a higher prevalence of diabetes.

iv. Areas of higher African-American presence will have lower access to physical activity facilities and a higher prevalence of diabetes. v. Areas of higher African-American presence will have lower access

to public administration facilities and a higher prevalence of diabetes.

b. Areas that are poorer will have lower access to healthful facilities and a higher prevalence of diabetes.

i. Areas that are poorer will have lower access to positive food outlets and a higher prevalence of diabetes.

ii. Areas that are poorer will have higher access to negative food outlets and a higher prevalence of diabetes.

iii. Areas that are poorer will have lower access to healthcare facilities and a higher prevalence of diabetes.

iv. Areas that are poorer will have lower access to physical activity facilities and a higher prevalence of diabetes.

v. Areas that are poorer will have lower access to public

administration facilities and a higher prevalence of diabetes.

c. Areas that are rural will have lower access to healthful facilities, which will be associated with a higher prevalence of diabetes.

i. Areas that are rural will have lower access to positive food outlets, which will be associated with a higher prevalence of diabetes. ii. Areas that are rural will have higher access to negative food outlets,

which will be associated with a higher prevalence of diabetes. iii. Areas that are rural will have lower access to healthcare facilities,

which will be associated with a higher prevalence of diabetes. iv. Areas that are rural will have lower access to physical activity

facilities, which will be associated with a higher prevalence of diabetes.

v. Areas that are rural will have lower access to public administration facilities, which will be associated with a higher prevalence of diabetes.

How do neighborhood composition and built environment combined affect diabetes prevalence? The second overarching question will encompass the last three hypotheses. I predict that access to healthful opportunities will be limited in low-income, high minority areas. I also

69 predict that urban areas will have greater access to healthful facilities, such as supermarkets, physician’s offices, and parks than rural areas. As access to healthful opportunities increases, the prevalence of diabetes decreases. Further, access to unhealthful options will be abundant in low- income, high minority areas, and as access to these facilities increases, the prevalence of diabetes will increase as well. Fourth, I hypothesize that areas of higher minority racial residential

segregation will have lower access to healthful facilities and a higher prevalence of diabetes. Fifth, I predict that areas that are poorer will have lower access to healthful facilities and a higher prevalence of diabetes. Finally, I hypothesize that areas that are more rural will have lower access to healthful facilities, which will be associated with a higher prevalence of diabetes.

I will examine these hypotheses through the theoretical framework of fundamental causes and through the pathway shown in Figure 4.2. Based on the literature, the composition of

neighborhoods, whether they are subject to residential segregation and/or urban or rural location, influence the availability of healthful facilities, such as supermarkets, parks, recreation facilities, and healthcare facilities. This accessibility to facilities affects residents’ diets, physical activity, and propensity to visit doctors’ offices. Finally, these health behaviors affect diabetes

prevalence. I argue that differential composition of neighborhoods, in this way, leads to differential access to facilities, leading to differential health behaviors, which leads to diabetes disparities.

Racial disparities exist in diabetes prevalence throughout the United States (LaViest et al., 2009). However, very little research has focused on the potential effect that one’s physical environment may have on the prevalence of diabetes in the community. In recent years though, there has been an increasing popularity and availability of methods especially suited to the study

70 of neighborhood health effects (Diez-Roux, 2003b). Specifically, the use of geographic

information systems (GIS) and spatial analysis techniques has become more popular in the last couple of decades (Diez-Roux, 2007).

Figure 4.2. Pathway by which the Composition of Neighborhoods affects Diabetes Prevalence.

In the next section, I describe the ways that I will examine the relationship between one’s built environment and access to resources and the prevalence of diabetes. To do so, I will

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