Dynamics of syndemic theory-based multilevel empowerment in food pantry users with diabetes

Background: Type 2 diabetes and obesity are synergetic epidemics rapidly advancing without adequate biopsychosocial and/or behavioral health interventions to meaningfully slow or reverse the trend. By 2030 more than half of the United States’ population is expected to be obese and by 2060 the prevalence of type 2 diabetes is expected to triple. The highest burden of obesity and type 2 diabetes occurs among people exposed to structural violence, including people with low income and minoritized racial groups. Structural violence is a multilevel (i.e., individual, interpersonal, organization, community, and societal) social determinant of health that includes factors such as social exclusion and low neighborhood social capital. Structural violence is posited to synergistically promote worse obesity and type 2 diabetes outcomes (e.g., increased risk, worse disease management, complications) among marginalized groups through mechanisms of systematic disenfranchisement and disempowerment. This three-manuscript dissertation explores the deleterious synergy between obesity, type 2 diabetes, and structural violence, and mechanisms to counteract this synergy in the food pantry context. Methods: As the preliminary phase of the multi-phase optimization strategy, this three-manuscript dissertation seeks to develop a clear theoretical/conceptual framework and identify points for intervention. As such, the first is a scoping review of multilevel interventions in type 2 diabetes prevention and management. The multilevel interventions included two or more levels (i.e., individual, interpersonal, organization, community, and/or society), and clinical outcomes (e.g., weight, glucose regulation). Three large psychosocial health databases were searched yielding 10 intervention studies for qualitative content analysis. The themes and their frequency were reported. The second manuscript examines synergy between obesity, type 2 diabetes, and economic social exclusion in a nationally representative sample. Disease clustering was assessed across the full sample (N = 238,099,023). Then synergy factor analysis and relative excess risk due to interaction were implemented with a subsample of Black and Hispanic women (n = 33,597,035) with low income and high rates of disease clustering. The third manuscript uses structural equation modeling to test a theoretically driven conceptual model of multilevel empowerment for food pantry users with type 2 diabetes. Eighty-seven food pantry users from central Illinois completed surveys on multilevel challenges (e.g., financial distress), multilevel empowerment, and multidimensional wellbeing. Results: Among the multilevel interventions for review in the first manuscript, 4 achieved significant results in lowering weight and glucose levels. Findings of the second manuscript demonstrated obesity, type 2 diabetes, and economic social exclusion synergistically interacted to promote poorer health outcomes (e.g., higher disease prevalence) among Black and Hispanic women with low income. The DOSE syndemic may be a potent contributor to metabolic health inequities experienced by Black and Hispanic women with low income (SF = 1.55, p < 0.01). In the final manuscript, there was insufficient power for structural equation modeling, however, mean differences in multilevel empowerment were found (t = -2.38, p < 0.05). Food pantry users with diabetes experienced lower multilevel empowerment in comparison to their peers. Implications: Together these studies address important gaps in the literature: 1) multilevel factors (e.g., economic social exclusion) on metabolic disorder sequelae and 2) multilevel interventions that promote positive clinical outcomes in type 2 diabetes prevention and management. Results will inform the preparation of a multilevel intervention to address metabolic health inequities among marginalized groups.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Social Work

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2024

Author dc:creator

• Campbell, Jeanna Marie

Contributors dc:contributor

• Windsor, Liliane
• Andrade, Flávia
• Gao, Xiaotian
• Bulled, Nicola

• Type 2 Diabetes
• Obesity
• Structural Violence
• Syndemics
• Multi-phase Optimization Strategy

Statement dc:rights

• Copyright 2024 Jeanna M. Campbell

Language dc:language

en, eng

Handle dc:identifier

https://hdl.handle.net/2142/127497

OAI record oai:identifier

https://www.ideals.illinois.edu/oai-pmh?verb=GetRecord&metadataPrefix=etdms&identifier=oai%3Awww.ideals.illinois.edu%3A2142%2F127497