Re-defining vulnerability to diabetes in an urban setting

Objective: Concern over the rate of increase in Type 2 diabetes in the U.S. has shifted attention to primary prevention. Conducted in the city of Houston, the aim of our study was to identify and characterize vulnerability to... [ view full abstract ]

Objective: Concern over the rate of increase in Type 2 diabetes in the U.S. has shifted attention to primary prevention. Conducted in the city of Houston, the aim of our study was to identify and characterize vulnerability to this disease among individuals who do not yet show the familiar clinical signs and risk factors. Special attention was paid to local social and cultural factors that might contribute to such vulnerability.

Methods: Three study neighborhoods were selected and 125 adult participants without a diabetes diagnosis were recruited for face-to-face interviews. Transcriptions from recorded interviews were coded and analyzed using NVivo software. Salient social and cultural factors plausibly linked to vulnerability were identified. Participants were arranged by economic disadvantage and by biological risk factors into 4 groups and modal frequencies of those social and cultural factors were computed within each group to assign factor priorities.

Results: Ten social and cultural factors linked to vulnerability in the 4 groups were identified. Each group was then assigned a profile derived from the relative priority among its social and cultural factors. We refer to these as Isolated Skeptics -- reluctance to trust healthcare; Concerned Seniors -- heightened uncertainty over their health; Financially Pressured Caregivers -- diminished capacity to act; and Time-Pressured Young -- diminished opportunity for well-being. Relevant factors among the participants included the experience of change and transition in their neighborhoods, adherence to food traditions, being time poor, having low health literacy, and being influenced by peer appearance.

Conclusions: Vulnerability to diabetes can be shaped by social and cultural risk factors that extend beyond traditional notions of biological risk and economic disadvantage. Consideration of these factors should inform the design of public health interventions since they mediate both opportunities for and barriers to health-related practices.