Neighborhoods and the Management of Chronic Conditions

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DESCRIPTION (provided by applicant): Dr. Brown is a general internist seeking further training in multilevel modeling, geographic information systems methods, and community-based interventions in order to better assess and reduce socioeconomic and racial disparities in health for older adults. Her main area of interest is in the relationship between the neighborhood or community context and health, whether these associations vary for persons with chronic conditions and with aging, and ways to systematically incorporate the community context into evidence based interventions to improve outcomes among older persons with chronic conditions. Her project proposes to study these relationships in a representative sample of neighborhoods in Los Angeles County and to use these findings in combination with prior research to develop an intervention that integrates evidence-based clinical and behavioral strategies with an understanding of the ways in which neighborhood context may influence the ability to adhere to recommended treatments and implement behavior change for persons with chronic conditions. The study's aims are to: 1) assess the relationship between the neighborhood environment and current health behaviors and clinical outcomes in a longitudinal cohort of English-and Spanish-speaking persons in the Los Angeles Family and Neighborhood Study and to determine whether these relationships differ by age and chronic condition; 2) evaluate psychosocial mediators and moderators of the relationship between the socioeconomic, resource, and physical environments and health related behaviors and outcomes; and 3) develop a practice-based intervention that uses clinic and community partners to increase access to information about neighborhood resources that can be used to enhance self-management strategies, mitigate the negative influences of the physical and social environment on health, and ultimately improve clinical outcomes among middle-aged and older adults with chronic conditions.