Do Neighborhood Characteristics Matter for Older Adults Living in Primarily Rural Neighborhoods, and If So, How and for Whom? Public Deposited

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  • March 21, 2019
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  • Kowitt, Sarah
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • Background. More than half of all adults in the United States—117 million people—have a chronic condition. In addition to accounting for most health care expenditures (86%), chronic disease is often associated with considerable decline in quality of life, increased risk of mortality, and decreased psychosocial and psychological functioning. Individual risk factors have been extensively linked to chronic disease and growing evidence now suggests that aspects of the neighborhood are associated with health and wellbeing. Methods. Accordingly, this dissertation includes two studies that examine the relationships among neighborhood characteristics and mental and physical functioning in older adults with knee osteoarthritis (Study 1) and the relationships with depression in a broader sample of older adults (Study 2). Specifically, Study 1 examined in multilevel, cross-sectional and longitudinal analyses if four neighborhood characteristics were a) associated with mental and physical functioning and b) interacted with key individual-level characteristics among older adults with knee osteoarthritis (n=656). Study 2 focused on older adults (91% of whom had at least one chronic condition, n=1558) and using structural equation modeling, examined if neighborhood characteristics were associated with depression, and if so, what factors (i.e., physical activity, social support, perceived individual control), selected from an a priori theoretical framework, mediated these relationships. For both studies, data came from a prospective cohort study in North Carolina designed to examine risk factors for osteoarthritis—the Johnston County Osteoarthritis Project. Results. Although few longitudinal associations were found, cross-sectional results from Study 1 suggested that perceived neighborhood social cohesion and perceived neighborhood resources for physical activity and walking were associated with less depression and greater physical functioning among older adults with knee osteoarthritis. Additionally, several interactions were found among neighborhood characteristics and race, disease severity, and presence of comorbidities. Study 2 again found relationships between neighborhood characteristics and depression. Further, mediation analysis indicated that these associations were mediated by physical activity, social support, and perceived individual control. Conclusions. Comprehensive approaches to chronic disease management should include attention to neighborhood context, in addition to targeting modifiable individual-level factors, such as physical activity, social support, and perceived individual control that mediate neighborhood influences.
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Advisor
  • Fisher, Edwin
  • Callahan, Leigh
  • Gottfredson, Nisha
  • Aiello, Allison
  • Muessig, Kathryn
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2018
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