Evaluating Community and Individual-Level Psychosocial Factors to Improve Chronic Disease-Related Dietary Behaviors: A Case Study of Los Angeles County

This dissertation applied two theoretical perspectives, the Biopsychosocial Model and Environmental Affordances Model, to conduct a case study of potential community- and individual-level psychosocial factors that can be addressed to reduce the burden of chronic disease in a large racially/ethnically diverse urban jurisdiction undergoing major transformations in how physical and mental health services are delivered locally.The first study, Examining the relationships between psychosocial community characteristics, food choice factors, and dietary behaviors in a racially/ethnically diverse urban population, sought to better understand the linkages between diet and the social and psychological dynamics of communities, as well as how other psychosocial food choice factors shape this relationship. These factors were operationalized as psychosocial community characteristics (PCCs) and other food choice factors (FCFs). Multivariable regression analyses indicated that certain PCCs, including perceived neighborhood violence and social cohesion, are predictive of diet, although racial/ethnic differences exist. Findings also suggest that FCFs may explain and moderate the relationship between PCCs and diet.The second study, Examining the role of psychological well-being in the relationship between community characteristics and dietary behaviors in a racially/ethnically diverse urban population, built upon the first dissertation study to assess the potential intervening role that psychological well-being (i.e., a measure of mental health) plays on the relationship between PCCs and diet. Results from multivariable regression analyses found evidence that PWB explains and moderates the relationship between PCCs and diet. The third study, A geo-spatial assessment of community-based psychosocial risk factors associated with chronic disease-related dietary behaviors in Los Angeles County, examined the regional distribution of structural and psychosocial factors that have the potential to influence chronic disease. These included dietary behaviors, community-level economic hardship, density of restaurant retail food establishments, psychological well-being, and density of available of mental health counseling services. Disparities in diet-related chronic disease risk were observed in Los Angeles County, both in terms of their exposure of adverse community environments which may negatively impact individuals’ food choice decisions and in terms of individuals’ access to structural resources that may help them better deal with these negative community environments