People in low socioeconomic status groups are at increased risk for diabetes mellitus, a group of diseases associated with high levels of blood glucose. High rates of depression have been found in people with diabetes. The study examined the relationship between stress, depression, and glycemic control in low-income type 2 diabetes patients. Participants were recruited at two community health centers that provide free medical care. The following hypotheses were examined: (1) experiencing stressful life events is positively correlated with blood glucose level; (2) negative stressful events have a greater association with glucose level than positive stressful events; (3) depression mediates the relationship between negative stressful events and glucose level (mediation model); (4) the effect of experiencing both negative stressful events and depression is predictive of glucose level (additive model); (5) the interaction between negative stressful events and depression is predictive of glucose level (interactive model); and (6) perceptions of control moderates the relationship between stress and depression.Stressful life events and depression were not related to blood glucose levels in bivariate correlations. The data did not support any of the three models of the relationship between stress, depression, and glycemic control. The strongest predictor of glycemic control was Hispanic ethnicity, however, income and education appear to confound this relationship.Depression was positively correlated with the total number of stressful events and negative stressful events and negatively correlated with perceptions of control. Participants in the study with less than a high school education had the highest amount of depression. In post-hoc analyses, four variables (education, perceptions of control, stressful life events, blood glucose) predicted 58% of the variance in depression, and education and perceptions of control were the strongest predictors. Per ceptions of control was a significant partial mediator of the relationship between education and depression and also partially mediated the relationship between stress and depression.The results of the study indicate that decreasing stressful life events and increasing perceptions of control is important in reducing low-income diabetes patients' level of depression.

This thesis analyses research into the evolution and adaptation of the communities in Rotorua and Kaikoura by using a complex systems perspective. This perspective requires that the analyst look beyond the obvious impacts of tourism such as employment, crowding, and congestion, to the processes that underlie the experiences of local people in relation to tourism. The configuration of the destination, the flows of people in the area, the visitor types and the ratio of hosts to guests all influence a community's interactions with tourists. In small destinations, the effect of host interactions with guests is potentially much greater than is the case in larger destinations. However, in using a complex systems perspective to analyse the effects of tourism on these two destinations, it becomes clear that the impacts of tourism are more than just the impacts of tourists. The impacts of tourism are intertwined with the processes of trust, leadership and decision making occurring both within the community and within the wider regional and national socio-economic systems. As such, local perceptions of tourism are associated with history, geography, local politics and local social processes. As concepts, the meanings of both 'tourism' and 'community' emerge from the experiences people have, and the associations that they make with the two terms. Thus, the meaning of both 'tourism' and 'community' are idiosyncratic and locally defined. Each term means different things to residents in Rotorua and Kaikoura, and each affects how residents perceive tourism in their respective towns. For example, the associations that people make between historical events and processes such as restructuring are quite different in each of the two communities. In Rotorua, tourism is seen as a source of stability, as a phenomenon that confers a higher level of perceived control on the community. In Kaikoura, tourism is seen as a source of change and it confers a lesser sense of perceived control on the community overall. Likewise, the relationship between the local council and the community underlies the sense of security people feel about local decision making processes. This relationship is mediated by a range of processes including the effort that the council put into communicating with community members, the leadership shown by the council, the way in which they facilitate community visioning processes, which then provide a basis for both leadership and decision making. Underlying these processes are community processes of rivalry, competition, cooperation, labelling and stereotyping that all affect the levels of trust that the community have in those around them. Community cohesion (which is not the same as community agreement) underlies a community's ability to work together to manage tourism. Thus using a complex systems approach to analyse the impacts of tourism in two destinations has shown that there is much more to tourism than the impacts of tourists and their activities. Instead, the way the community system interacts with the tourism system gives rise to the impacts of tourism. Tourism can be usefully conceptualised as a process that is inextricably interwoven with history, politics and community interaction processes at the destination level. Perceptions of tourism reflect these processes and the understanding that local people have of them, and the level of control that they feel they have over tourism development. With little trust in local decision making processes, people have a low sense of control over how tourism development affects them. In tourism planning, therefore, it may be more effective to focus primarily on the processes by which tourism development and management occurs in the local area and to look at mitigating the effects of tourists only after building community capacity to adaptively manage tourism in their area. Communities need a sense of control over their world, and this is only undermined when experts and institutions try to advise courses of action without involving a range of community players in the process of managing tourism. Thus, government and other organisations and institutions at local level must focus on working with communities to build local capacity to manage tourism, without imposing on those communities to convince them to 'treat tourists well' or to manage their environment better, so they become more attractive as a destination.