Electronic Theses and Dissertations

Date

2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Social & Behavioral Sciences

Committee Chair

Kenneth Ward

Committee Member

Brook Harmon

Committee Member

Yu (Joyce) Jiang

Committee Member

Kristoffer Berlin

Abstract

Type 2 Diabetes (T2D) is an important public health concern that is associated with excess morbidity and mortality in the US. Understanding factors that influence T2D self-management and clinical outcomes is important for improving T2D-related outcomes. This dissertation used the Healthy Eating and Active Living in the Spirit (HEALS) study baseline data to examine the associations between number of comorbidities, psychosocial well-being (depressive symptoms, discrimination stress), fatalism, T2D-related health behaviors (diet, physical activity), and clinical outcomes (hemoglobin A1C [A1C], C-reactive protein [CRP], interleukin-6 [IL-6]), and the buffering effect of social support in these relationships in a sample of 106 African American adults with T2D. Moderated mediation analyses revealed that at different levels of social support, there was no significant indirect association between number of comorbidities and fatalism through psychosocial well-being, and no significant direct association between psychosocial well-being and fatalism. At different levels of social support, there was no significant indirect association between psychosocial well-being and health behaviors through fatalism, and no significant direct association between fatalism and health behaviors. There was no significant indirect association of fatalism and clinical outcomes through health behaviors at different levels of social support. There also was no significant direct association between physical activity and clinical outcomes at different levels of social support. However, greater social support was directly associated with lower CRP (b = -61.338, p = 0.029) and lower IL-6 (b = -15.705, p = 0.040). A more pro-inflammatory diet was also associated elevated IL-6 only for individuals with low (b = 0.247, p = 0.034) and moderate (b = 0.220, p = 0.049) social support but not for individuals with high level of social support (b = 0.193, p = 0.098). Findings suggest improving dietary behaviors should be considered within the context of social support, as this appears to be a modifying factor for IL-6. Future studies should examine the impact of different types of social support (i.e., informal vs. formal social support; emotional support, instrumental support, informational support; positive vs. negative support, religiosity as a source of support) in these associations.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest

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