Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Outcomes and Policy Research

Research Advisor

Shelley White-Means, Ph.D.


Lawrence Brown, Pharm.D., Ph.D. Samuel Dagogo-Jack, M.D. Simonne Nouer, M.D., Ph.D. Cynthia Russell, Ph.D.


Environment, Geographic Information Systems, Physical activity, Type 2 diabetes, Vulnerable populations


Obesity and type 2 diabetes are increasing health concerns in the United States, particularly among women and minorities. Generally, research has highlighted the health disparities that exist among African American women, especially as these disparities relate to obesity and type 2 diabetes. In Memphis, TN, the ZIP codes of 38106 and 38109 have the highest rates of diabetes hospitalizations in the city. Further, African American women in Memphis, TN have been identified as being most vulnerable to experiencing a potentially avoidable hospitalization due to chronic disease. The purpose of study was to identify factors that may impact African American overweight/obese women with type 2 diabetes in their attempts to lose weight and engage in physical activity, and to identify the specific environmental conditions of 38106 and 38109 that may promote or inhibit weight loss and physical activity efforts.

A mixed-methods approach was utilized, using a combination of individual interviews, objective quantification of ZIP code walkability, and field examinations of area resources that could impact health behaviors. Results showed that consistently positive influences found to impact women`s ability to effectively manage their diabetes through weight loss and physical activity included the presence of positive social support via neighbors and family, as well as how connected study participants` were to their community. Factors that contributed to difficulties in losing weight and engaging and regular physical activity were more frequently reported by study participants and included the presence of substantial generational diabetes, area crime, economic factors, nutrition modification difficulties, and various environmental factors including lack of sidewalks and blight. This study found that in the ZIP codes evaluated, the physical environment plays a crucial but secondary role to social capital and the social environment in encouraging weight loss and physical activity. Additionally, each ZIP code has associated unique aspects that may deter physical activity and adequate health maintenance.