UC San Diego

ABSTRACT OF THE DISSERTATION

Psychosocial, Sociocultural, and Biobehavioral Correlates of Glycemic Control among Individuals with Diabetes in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

by

Rebeca Espinoza Giacinto

Doctor of Philosophy in Public Health (Global Health)

University of California, San Diego, 2016

San Diego State University, 2016

Professor Gregory A. Talavera, Chair

Background: Individuals with uncontrolled diabetes are at higher risk for developing cardiovascular disease, dyslipidemia, hypertension and retinopathy. While there is evidence for poor diabetes management among high risk populations, such as Hispanic/Latinos, specific self-care and lifestyle practices that influence glycemic regulation remain poorly understood.

Aims: This dissertation will examine psychosocial, sociocultural, and biobehavioral correlates of glycemic control among diverse Hispanic/Latinos with diabetes in the US through the following aims: (1) to examine psychosocial and sociocultural correlates of glycemic status; (2) to examine the role of sleep duration and glycemic status; and (3) to examine the reported use of conventional and complimentary medicine and types of care accessed and its related influence on glycemic regulation status.

Methods: Chapters 2-4 employ data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Data were collected as part of the HCHS/SOL study which included 16,415 self-identified Hispanic/Latinos ages 18-75 recruited between March 2008 and June 2011. Analyses for the current study involved a subset of individuals with diabetes.

Results: As presented in Chapter 2, older age, shorter duration of US residence, annual doctor visits, and better dietary quality were independently associated with improved glycemic control. No other variables, including those for psychosocial and sociocultural factors, were significantly associated with glycemic control. As presented in Chapter 3, individuals with long sleep duration (>9 hrs.) had suboptimal glycemic control status, compared to those who reported average sleep duration (6< 9hrs.). As described in Chapter 4, individuals with poor glycemic status were more likely to report being prescribed diabetes medication as well as reporting concomitant use of diabetes medication and botanical/herbal use compared to those who reported use of neither prescribed diabetes medications or supplement use.

Conclusion: Addressing social and structural barriers such as routine care, particularly among younger Hispanic/Latinos and those with longer residence in the US may aid in improving glycemic control status and preventing complications related to suboptimal diabetes management. Further research is needed to examine acculturative processes and glycemic control which may offer greater insights into specific correlates of diabetes management among ethnically diverse Hispanic/Latinos in the US.