Neighborhoods and the Management of Chronic Conditions

描述(申请人提供)：布朗博士是一名普通内科医生，正在寻求在多层次建模、地理信息系统方法和社区干预方面的进一步培训，以更好地评估和减少老年人在健康方面的社会经济和种族差异。她感兴趣的主要领域是社区或社区环境与健康之间的关系，这些关系对于患有慢性病和老年病的人是否有所不同，以及如何将社区环境系统地纳入基于证据的干预措施，以改善患有慢性病的老年人的结果。她的项目建议在洛杉矶县具有代表性的社区样本中研究这些关系，并将这些发现与之前的研究结合起来，开发一种干预措施，将基于证据的临床和行为策略与理解社区环境可能影响慢性病患者坚持推荐治疗和实施行为改变的能力的方式相结合。这项研究的目的是：1)在洛杉矶家庭和社区研究中评估社区环境与当前健康行为和临床结果之间的关系，并确定这些关系是否因年龄和慢性病而不同；2)评估社会经济、资源和物理环境与健康相关行为和结果之间关系的心理社会调节因素和调节因素；以及3)开发以实践为基础的干预措施，利用诊所和社区合作伙伴增加获得社区资源信息的机会，这些信息可用于加强自我管理战略，减轻物理和社会环境对健康的负面影响，并最终改善患有慢性病的中老年患者的临床结果。

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.