Proximity to Food Outlets and Diabetes-Related Health Outcomes: A Cross-Sectional Study in Robeson County, NC

Type 2 diabetes is a growing epidemic in the United States, and already affects 25.8 million Americans (8.3%) in 2011. The prevalence of type 2 diabetes has nearly tripled from 1990 to 2010 and is projected to increase. If this pattern continues, the Centers for Disease Control and Prevention (CDC) estimates that one-third of Americans will have type 2 diabetes by 2050. In North Carolina, this problem is particularly acute; the state has the 13th highest prevalence of diabetes at 9.8% of the general population. Robeson County—a rural area with a large American Indian population of Lumbee descent—has shown dramatically higher diabetes prevalence than the rest of the state, at 13.7%. The high prevalence of diabetes in Robeson County raises significant concerns about the long-term health status its residents. Research has shown that lifestyle modifications, including dietary changes, can reduce the development of diabetes, as well as the need for treatment of existing diabetes. Unfortunately, rural areas tend to have a dearth of healthy food retailers, such as supermarkets, while boasting a plethora of fast food options. Due to various barriers—such as distance to, and price of, healthy food options—low-income and minority groups living in rural areas are even less likely to have consistent access to healthy, affordable food. Without a healthy diet, it can be challenging for individuals to achieve optimal control over diabetes risk factors, such as A1c level, blood pressure level, and body mass index (BMI). Over time, poor eating behaviors can heighten one’s risk for developing diabetes, or experiencing diabetes-related complications such as kidney failure, amputation, or blindness. It is important to evaluate access to healthy food options in Robeson County to inform future intervention and policy action to reverse diabetes trends in this area. While many individuals living in rural areas lack access to healthy food options and are subsequently at risk for developing diabetes, low-income and minority groups face even higher risk for diabetes morbidity and mortality. Minority groups are disproportionately represented among the poor, and low socioeconomic status is often associated with limited access to affordable, healthy food. Robeson County, with nearly 30% of individuals in poverty, and nearly 40% of individuals of American Indian descent, has many residents that are particularly vulnerable to the risk factors that cause diabetes. At present, little is known about the specific interaction between geographic access to healthy foods and diabetes in a predominantly rural, low-income, and minority area, such as Robeson County. Researchers have begun using Geographic Information Systems (GIS) mapping technology to explore the food environment, as it offers the benefit of visually determining ‘food activity spaces,’ the geographic locations and variety of food outlets at which individuals shop. The impetus for using GIS in Robeson County came from the CEO of Robeson Health Care Corporation (RHCC), a federally qualified health center with four clinics serving patients in Robeson County. This research aims to use GIS to better understand the relationship between food access and various diabetes-related risk factors in Robeson County, North Carolina in order to ultimately inform community policy changes.Bachelor of Science in Public Healt