Race/Ethnicity,Social Support,and Associations With Diabetes Self-Care and Clinical Outcomes in NHANES

Abstract

Purpose

The purpose of this study was to evaluate how social support and race/ethnicity were associated with diabetes self-care behaviors and clinical outcomes.

Methods

Using the cross-sectional 2005-2006 National Health and Nutrition Examination Survey (NHANES), the authors examined white, black, and Latino respondents who self-reported a diabetes diagnosis (n = 450), estimating the associations of social support on diabetes outcomes. The primary exposure was a social support index (0-5), which assessed the number of sources of support in one’s life. Outcomes were self-care behaviors (controlling weight, exercising, controlling fat/caloric intake, checking feet, and self-monitoring blood glucose) and intermediate clinical outcomes (hemoglobin A1C, diastolic blood pressure, and low-density lipoprotein [LDL]).

Results

There were no differences in social support by race/ethnicity. The authors observed several significant race/ethnicity by social support interactions in adjusted models, controlling for age, gender, education, self-reported health, depression, functional disability, insurance status, and insulin use. Among blacks, social support was associated with controlling weight (odds ratio [OR] = 1.55, P = .03), exercising (OR = 1.38, P = .03), controlling fat/ calories (OR = 1.84, P = .03), and lower diastolic blood pressure (β = -3.07, P = .02). Among whites, social support was associated with lower LDL (β = -9.45, P = .01). No significant effects were noted for Latinos.

Conclusions

The relationship of social support with diabetes management differed by race/ethnicity, with the strongest findings among blacks. Social support may be influential for maintaining self-care behaviors among blacks and controlling lipid levels among whites.

Get full access to this article

View all access options for this article.

References

Fisher EB

Brownson CA

O’Toole ML

Shetty G.

Anwuri VV

Glasgow RE

Ecological approaches to self-management: The case of diabetes. Am J Public Health. 2005;95:1523-1535.

Berkman L.

Glass T.

Social integration, social networks, social support, and health. In:

Berkman L

Kawachi I

, eds. Social Epidemiology. New York, NY: Oxford University Press; 2000:137-173.

Gallant MP

The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav. 2003;30:170-95.

van Dam HA

van der Horst FG

Knoops L.

Ryckman RM

Crebolder HF

van den Borne BH

Social support in diabetes: a systematic review of controlled intervention studies. Patient Educ Couns. 2005;59:1-12.

Keyserling TC

Samuel-Hodge CD

Ammerman AS

, et al. A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity. Diabetes Care. 2002;25:1576-1583.

Gilliland SS

Azen SP

Perez GE

Carter JS

Strong in body and spirit: lifestyle intervention for Native American adults with diabetes in New Mexico. Diabetes Care. 2002;25:78-83.

Wen LK

Shepherd MD

Parchman ML

Family support, diet, and exercise among older Mexican Americans with type 2 diabetes. Diabetes Educ. 2004;30:980-993.

Carranza SN

LeBaron S.

Adherence among Mexican Americans with type 2 diabetes: behavioral attribution, social support, and poverty. Fam Med. 2004 ;36:539-540.

El-Kebbi IM

Bacha GA

Ziemer DC

, et al. Diabetes in urban African Americans. V. Use of discussion groups to identify barriers to dietary therapy among low-income individuals with non-insulin-dependent diabetes mellitus. Diabetes Educ. 1996;22:488-492.

10.

Maillet NA

D’Eramo Melkus G.

Spollett G.

Using focus groups to characterize the health beliefs and practices of black women with non-insulin-dependent diabetes. Diabetes Educ. 1996;22:39-46.

11.

McDonald PE

Wykle ML

Misra R.

Suwonnaroop N.

Burant CJ

Predictors of social support, acceptance, health-promoting behaviors, and glycemic control in African-Americans with type 2 diabetes. J Natl Black Nurses Assoc. 2002;13:23-30.

12.

Bailey BJ

Lherisson-Cedeno D.

Diabetes outcomes and practices: comparison of African Americans and Caucasians . J Natl Black Nurses Assoc. 1997;9:66-75.

13.

Fitzgerald JT

Anderson RM

Funnell MM

, et al. Differences in the impact of dietary restrictions on African Americans and Caucasians with NIDDM. Diabetes Educ. 1997;23:41-47.

14.

Gleeson-Kreig J.

Bernal H.

Woolley S.

The role of social support in the self-management of diabetes mellitus among a Hispanic population. Public Health Nurs. 2002;19:215-222.

15.

Chlebowy DO

Garvin BJ

Social support, self-efficacy, and outcome expectations: impact on self-care behaviors and glycemic control in Caucasian and African American adults with type 2 diabetes. Diabetes Educ. 2006;32:777-786.

16.

Mulvaney-Day NE

Alegria M.

Sribney W.

Social cohesion, social support, and health among Latinos in the United States. Soc Sci Med. 2007;64:477-495.

17.

Ford ME

Tilley BC

McDonald PE

Social support among African-American adults with diabetes, part 2: a review . J Natl Med Assoc. 1998;90:425-432.

18.

Barnes LL

Mendes de Leon CF

Bienias JL

Evans DA

A longitudinal study of black-white differences in social resources. J Gerontol B Psychol Sci Soc Sci. 2004;59:S146-S153.

19.

Taylor SE

Welch WT

Kim HS

Sherman DK

Cultural differences in the impact of social support on psychological and biological stress responses. Psychol Sci. 2007;18:831-837.

20.

National Center for Health Statistics.

Analytic and Reporting Guidelines: The National Health and Nutrition Examination Survey (NHANES). Hyattsville, MD: Centers for Disease Control and Prevention; 2006.

21.

Ford ES

Loucks EB

Berkman LF

Social integration and concentrations of C-reactive protein among US adults . Ann Epidemiol. 2006;16:78-84.

22.

Seeman TE

Lusignolo TM

Albert M.

Berkman L.

Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. Health Psychol. 2001;20:243-255.

23.

Berkman LF

Syme SL

Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol. 1979;109:186-204.

24.

Katz S.

Ford AB

Moskowitz RW

Jackson BA

Jaffe MW

Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914-919.

25.

DeCoster VA

The emotions of adults with diabetes: a comparison across race. Soc Work Health Care. 2003;36:79-99.

26.

Ciechanowski PS

Katon WJ

Russo JE

Hirsch IB

The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. Gen Hosp Psychiatry. 2003;25:246-252.

27.

Kroenke K.

Spitzer RL

Williams JB

The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-613.

28.

Lumley T.

Diehr P.

Emerson S.

Chen L.

The importance of the normality assumption in large public health data sets . Annu Rev Public Health. 2002;23:151-169.

29.

Xu J.

Long JS

Confidence intervals for predicted outcomes in regression models for categorical outcomes. Stata Journal. 2005;5:537-559.

30.

Ong KL

Cheung BM

Wong LY

Wat NM

Tan KC

Lam KS

Prevalence, treatment, and control of diagnosed diabetes in the US National Health and Nutrition Examination Survey 1999-2004. Ann Epidemiol . 2008;18:222-229.

31.

Kirk JK

D’Agostino RB

Bell RA

, et al. Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care . 2006;29:2130-2136.

32.

Karter AJ

Ferrara A.

Darbinian JA

Ackerson LM

Selby JV

Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care. 2000; 23:477-483.

33.

Brown AF

Gerzoff RB

Karter AJ

, et al. Health behaviors and quality of care among Latinos with diabetes in managed care. Am J Public Health. 2003;93:1694-1698.

34.

Nwasuruba C.

Khan M.

Egede LE

Racial/ethnic differences in multiple self-care behaviors in adults with diabetes. J Gen Intern Med. 2007;22:115-120.

35.

Bertera EM

Psychosocial factors and ethnic disparities in diabetes diagnosis and treatment among older adults. Health Soc Work. 2003;28:33-42.

36.

Babbie ER

Chapter 6: Indexes, scales, and typologies. In: The Practice of Social Research. 11th ed. Florence, KY: Cengage Learning; 2006.

37.

Sherbourne CD

Stewart AL

The MOS social support survey. Soc Sci Med. 1991;32:705-714.

38.

Toobert DJ

Hampson SE

Glasgow RE

The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943-950.

39.

Rothman KJ

No adjustments are needed for multiple comparisons. Epidemiology . 1990;1:43-46.