EXAMINING NEIGHBORHOOD SOCIOECONOMIC CHARACTERISTICS AND ACCESS TO THE NATIONAL DIABETES PREVENTION PROGRAM: A MARYLAND PERSPECTIVE

Abstract

Despite substantial federal and state investments made to promote the National Diabetes Prevention Program (NDPP) as a population health strategy for diabetes prevention it remains underutilized. Research has pointed to a variety of factors that have contributed to low uptake of this evidence-based lifestyle change program. However, the role neighborhood socioeconomic disadvantage plays in NDPP access and use has been underexplored. The state of Maryland is an ideal setting to investigate how neighborhood socioeconomic disadvantage impacts various dimensions of NDPP access due to the significant investments in primary care transformation and NDPP. This dissertation examines: (1) the relationship between neighborhood socioeconomic disadvantage and potential access to the NDPP using primary care providers geographic proximity to the NDPP sites in Maryland, (2) the relationship between neighborhood socioeconomic disadvantage and potential access to the NDPP based on geographic proximity of individuals with prediabetes to the nearest NDPP site in Maryland, and (3) the relationship between neighborhood socioeconomic disadvantage and utilization of diabetes prevention intervention such as NDPP, metformin, or both among individuals with prediabetes in Maryland. Findings from this work underscore how targeted statewide public health and health care initiatives can enhance NDPP access and utilization in neighborhoods with higher levels of socioeconomic disadvantage.