exercise by the former (Summerson, Konen, and Dignan, 1992). Barriers to exercise were reported by women from all ethnic communities, though income level affected the frequency with which specific barriers were mentioned. For example, women from low-income areas were more likely to report difficulties in finding a safe and appropriate place to exercise and an inability to afford child care. Pain and distress from exercise are commonly expressed barriers among older, female respondents, who are most susceptible to diabetes and its complications (Leventhal et al., 2001). The negative perception of exercise by Hispanic respondents—that exercise posed the danger of rapid declines in blood sugar levels and symptoms of hypoglycemia—represents another barrier that is likely based on direct observation either of other persons or personal experience. Thus, perceived features of the environment and experienced somatic effects, such as pain, appear to be the main barriers to exercise, or at least are reported to be.

Hopelessness and Personal, Medical, and Social Support for Diabetes Control

The prescription for lifestyle changes in diet and exercise for diabetes prevention and control gives the at-risk individual two complex behavioral tasks that are difficult to initiate and more difficult to sustain. The difficulties in changing behaviors that are the major targets of prevention programs are consistent with data showing a high level of fatalism and hopelessness regarding diabetes prevention. African-American respondents are reported to experience a nearly overwhelming sense of powerlessness and lack of control over the development and management of their diabetes, a feeling made more extreme for respondents experiencing one or more complications of diabetes (Blanchard et al., 1999). Powerlessness was felt by African-American and Native American participants in the Minnesota program, and by low-income Mexican Americans (Schwab, Meyer, and Merrell, 1994). Hispanic respondents expressed their sense of powerlessness in different ways. Some attributed diabetes to prior and unchangeable life traumas



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