Search

Children residing in low-income neighborhoods are disproportionately affected by asthma morbidity and mortality. Neighborhood violence has been explored in relationship to child morbidity and health and developmental outcomes, but less is known about the relationship of violence to caregiver mental health. The purpose of this study was to examine the relationship of neighborhood violent crime victimization (objective and subjective measures), perceptions of community well-being and support, and depressive symptoms among a sample of primarily single female caregivers of children with uncontrolled asthma. This is a secondary analysis of baseline data obtained from a randomized controlled trial of a home-based environmental control intervention for children aged 3 to 12 years, who were primarily African American, and diagnosed with persistent, uncontrolled asthma. Results showed that both objective and subjective measures of crime, particularly in those with relatively low life stress (P < .001), limited education of the caregiver (P < .001), and fewer children (P < .01) in the household had direct associations with depressive symptoms in caregivers of children with uncontrolled asthma. Neighborhood perceptions of satisfaction and a sense of community, as well as perceptions of social support, were not associated with depressive symptoms. Our findings emphasize the need to screen for depressive symptoms, life stress, as well as both objective and subjective perceptions of neighborhood violence among caregivers of children with poorly controlled asthma. Furthermore, when providing holistic care to these caregivers, stress reduction and the provision of mental health resources are paramount.

To assess the influence of racial and economic residential segregation of home or hospital neighborhood on very preterm birth morbidity and mortality in neonates born very preterm.We constructed a retrospective cohort of n = 6461 infants born32 weeks using 2010-2014 New York City vital statistics-hospital data. We calculated racial and economic Index of Concentration at the Extremes for home and hospital neighborhoods. Neonatal mortality and morbidity was defined as death and/or severe neonatal morbidity. We estimated relative risks for Index of Concentration at the Extremes measures and neonatal mortality and morbidity using log binomial regression and the risk-adjusted contribution of delivery hospital using Fairlie decomposition.Infants whose mothers live in neighborhoods with the greatest relative concentration of Black residents had a 1.6 times greater risk of neonatal mortality and morbidity than those with the greatest relative concentration of White residents (95% CI 1.2-2.1). Delivery hospital explained more than one-half of neighborhood differences. Infants with both home and hospital in high-concentration Black neighborhoods had a 38% adjusted risk of neonatal mortality and morbidity compared with 25% of those with both home and hospital high-concentration White neighborhoods (P = .045).Structural racism influences very preterm birth neonatal mortality and morbidity through both the home and hospital neighborhood. Quality improvement interventions should incorporate a framework that includes neighborhood context.

OBJECTIVE To examine how neighborhood characteristics are associated with health outcomes among older adults with osteoarthritis. METHODS In multilevel, cross-sectional, and longitudinal analyses we examined whether 4 neighborhood characteristics were associated with depressive symptoms and reported knee impact scores, and whether the neighborhood characteristics interacted with race/ethnicity among older adults with radiographic knee osteoarthritis (n = 656 for cross-sectional analyses and n = 434 for longitudinal analyses). The data came from the Johnston County Osteoarthritis Project, a prospective cohort study in North Carolina designed to examine risk factors for osteoarthritis. RESULTS Although few longitudinal associations were found, cross-sectional results suggested that greater perceived neighborhood social cohesion (B = -0.04, P < 0.001) and perceived neighborhood resources for physical activity and walking (B = -0.03, P < 0.001) were associated with fewer depressive symptoms, and that greater perceived neighborhood resources for physical activity and walking were associated with higher (better) knee impact scores (B = 0.48, P = 0.008). We also observed 2 significant interactions among neighborhood characteristics and race/ethnicity related to depressive symptoms (P < 0.01); for African American adults, greater perceived neighborhood resources for physical activity and walking were associated with fewer depressive symptoms (B = -0.03, P < 0.001), but for White adults, greater perceived neighborhood safety was associated with fewer depressive symptoms (B = -0.04, P = 0.003). CONCLUSION In a sample of older adults with radiographic knee osteoarthritis, neighborhood context mattered, but in nuanced ways. Interventions aiming to improve mental and physical functioning of older adults with knee osteoarthritis can look to this study as evidence for the importance of neighborhood characteristics.

Opioid abuse has redefined drug problems in communities and shifted police activities to redress substance use. Changing neighborhood context around opioid issues may affect arrests and racial disparities in their imposition. This study presents a spatial analysis of arrests involving Blacks and Whites for possession of heroin, synthetic narcotics, and opium offenses. We identify the ecological conditions associated with opioid-related arrests using geographically weighted regression (GWR) methods that illuminate local patterns by allowing coefficients to vary across space. GWR models reveal spatial and racial differences in opioid-related possession arrest rates. Calls for police service for overdoses increase White arrests in more advantaged, rural communities. Economic disadvantage and racial diversity in neighborhoods more strongly elevate possession arrest rates among Blacks relative to Whites. Overdose calls predict Black arrests in poorer urban areas. Findings underscore police responsiveness to opioid problems and Black–White differences in how opioid users interact with the criminal justice system.

The aim of our study is to explore the relationships between neighborhood context, perceived social support, and parenting for low-income mothers with young infants. Data were collected during the first three time points from the Kids in Columbus Study, a 5-year longitudinal study on low-income families. Mother–child dyads (n = 228) were recruited from five Women, Infants, and Children Centers located in a Midwestern Metropolitan area. Data for the present study represents mother–child dyads that had completed time point 1 (infant age birth to 3-months), time point 2 (infant age 4 to 7 months), and 3 (infant age 9- to 12-months old). Social support and neighborhood quality were associated with both maternal perceptions and observed parenting outcomes. Social support positively predicted maternal perceptions of self-efficacy whereas neighborhood quality was positively related to parent involvement. Overall, social support and neighborhood quality were related to aspects of parenting in the first year of children’s lives. There was no evidence that the association between social support and parenting varied as a function of neighborhood quality. This finding suggests the neighborhood qualities captured in our study do not influence mothers’ ability to access social support during infancy.

As opioid addiction has risen in recent years, racial disparities in drug arrests may be changing in their size and sources. Neighborhood conditions, like economic disadvantage and racial composition, are powerful determinants of racial differences in arrests. Overdoses and police responses to these incidents may, however, alter the neighborhood context of drug arrests, especially those tied to heroin, synthetic narcotics, and related opium derivatives offenses. This study revisits the environmental correlates of arrest disparities by conducting a neighborhood-level analysis of Black–White differences in drug possession and selling arrests by substance type across the State of Delaware. Spatial model estimates suggest economic disadvantage and racial diversity in neighborhoods substantially increase Black arrest rates. Conversely, White arrest rates grow with more calls for service for overdose incidents, racial homogeneity, and to a lesser extent, economic disadvantage within a community. Disparities in arrest also vary by substance type, as heroin arrests for Whites are most correlated with higher overdose service calls relative to White arrests for marijuana, cocaine, and other substances or Black arrests for any substance. Results underscore the need to reexamine neighborhood conditions and arrest disparities due to emerging shifts in drug use and drug law enforcement.

The effects of place on human health and development have been extensively studied in recent years in the adult and adolescent populations, but minimal research has addressed neighborhood effects in early childhood. This analysis of the National Survey of Children's Health 2011/2012 cross-sectional survey examined relationships between risk for developmental disability in early childhood and neighborhood characteristics in a nationally-representative sample of children ages 0-5 years. Parents reported on their child's development using a well-validated parent report screening tool for developmental problems (the Parent's Evaluation of Developmental Status tool), and neighborhood and family characteristics. Multinomial logistic regression analyses were conducted for each of three neighborhood variables: physical disorder, safety, and isolation. After controlling for parental and child characteristics, the three neighborhood variables were each significantly associated with moderate (but not severe) risk versus low to no risk for developmental disabilities. When all neighborhood characteristics were included simultaneously in the same model, only physical disorder remained statistically significant [OR 1.44 (95% CI 1.09-1.91)], though modestly attenuated. These results suggest that neighborhoods may have effects on early childhood development, after controlling for individual child, parental, and family characteristics.

BackgroundMental health is a serious public health concern that is uniquely devastating for African American families.ObjectiveThis study systematically critiques the body of work documenting the mediating role of social support and neighborhood context on the psychological well-being of African American families.MethodsThis review used the PRISMA multistate process.FindingsSeveral important findings are drawn from this study: a) social support and neighborhood context shape psychological well-being, b) existing studies are limited in capacity to capture context despite having contextualized frameworks, c) African centered theory is missing.ConclusionsSocial support and neighborhood context matter. Future researchers must employ methods to capture this context and the link to mental health in African American communities where disproportionate risks exist.

Background: Short sleep duration (e.g., Methods: Participants (n=13,019) were from Waves I and II of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative multi-ethnic sample of adolescents and their health in adulthood. Sleep duration was self-reported in whole hours per day and categorized based on age-specific cut-offs for short sleep (6-12 years: Results: The sample was 4% Asian, 15% African American (AA), 2% American Indian (AI), 12% Hispanic, and 66% non-Hispanic White (NHW) and mean age 15 years (SD=.1). In SEM, AAs (β=.055, p Conclusion: Although household SES partially explained racial disparities, improving household SES conditions for racial/ethnic minority adolescents may not reduce disparities, given that higher household SES was positively associated with short sleep duration. Future studies should explore buffers for racial/ethnic minority adolescents in the context of SES to inform interventions and reduce disparities in sleep.

Background: Despite well-documented cardiovascular disparities between racial groups, within-race determinants of cardiovascular health among Black adults remain understudied. Factors promoting cardiovascular resilience among Black adults in particular warrant further investigation. Our objective was to examine whether individual psychosocial resilience and neighborhood-level cardiovascular resilience were associated with better cardiovascular health in Black adults, measured utilizing Life’s Simple 7 (LS7) scores. Methods: We assessed LS7 scores in 389 Black adults (mean age, 53±10 years; 39% men) living in Atlanta, Georgia. A composite score of individual psychosocial resilience was created by assessing environmental mastery, purpose in life, optimism, resilient coping, and depressive symptoms. Neighborhood-level cardiovascular resilience was separately determined by the census tract-level rates of cardiovascular mortality/morbidity events. Generalized linear mixed regression models were used to examine the association between individual psychosocial resilience, neighborhood cardiovascular resilience, and LS7 scores. Results: Higher individual psychosocial resilience was significantly associated with higher LS7 (β=0.38 [0.16–0.59] per 1 SD) after adjustment for sociodemographic factors. Similarly, higher neighborhood-level cardiovascular resilience was significantly associated with higher LS7 (β=0.23 [0.02–0.45] per 1 SD). When jointly examined, high individual psychosocial resilience (>median) was independently associated with higher LS7 (β=0.73 [0.31–1.17]), whereas living in high-resilience neighborhoods (>median) was not. The largest difference in LS7 score was between those with high and low psychosocial resilience living in low-resilience neighborhoods (8.38 [7.90–8.86] versus 7.42 [7.04–7.79]). Conclusions: Individual psychosocial resilience in Black adults is associated with better cardiovascular health.

OBJECTIVE: Individuals with serious mental illnesses are at risk of receiving inadequate outpatient mental health services, increasing the likelihood of medication non-adherence, readmissions, and self-harm. The purpose of this study was to identify individual- and neighborhood-level factors associated with outpatient mental health visits and explore the interaction between individual- and neighborhood-level factors in predicting mental health service utilization. METHODS: Data were derived from two randomized trials of patients with comorbid medical and serious mental illnesses across two different study sites between 2011 and 2017 (n=650). A total of 418 participants had valid addresses and were included in this study. Poisson regression assessed associations between individual- and neighborhood-level characteristics and number of visits to mental health providers. Known individual-level risk factors for outpatient follow-up were mutually adjusted in a model with neighborhood covariates added. RESULTS: Male gender, older age, unemployment, and lower education level were associated with less outpatient mental health service utilization. Neighborhood-level socioeconomic deprivation and residential instability were significantly associated with less mental health service visits. But only residential instability remained significant after controlling for other neighborhood-level and individual-level factors. CONCLUSIONS: Among individuals with comorbid medical and serious mental illnesses, living in neighborhoods with higher residential instability was associated with fewer visits to outpatient mental health providers. This finding suggests the importance of recognizing the social conditions that shape clinical interactions. Considering both individual and neighborhood characteristics may also allow for improved targeting of health services and more appropriate allocation of resources.

Our understanding of how community-level context impacts care of persons living with HIV (PLWH), including antiretroviral therapy (ART) adherence and retention in care, is limited. The objective of this study was to characterize the activity spaces of PLWH from an urban area in Southeastern U.S., where the epidemic is among the nation’s highest, and to examine how such activity spaces are associated with daily mood and health behaviors. In this small, pilot study, 11 participants were tracked with a global positioning system (GPS)-enabled application on their smartphones for 2 weeks. Activity spaces were created by connecting GPS points sequentially and adding buffers. Contextual exposure data (e.g., alcohol outlets) were connected to activity spaces. Participants also completed daily diary entry through texts 3 times per day regarding outcomes of substance use behaviors, mood, and medication adherence. This yielded a total of 18,007 GPS polyline records that we aggregated into 258 person-days that captured discrete occasions of exposure to contextual factors and subjects’ behaviors and moods. On average, the participants spent 19% of their time awake during the 2-week periods in their residential census tract. Exposure to social and built environment factors such as alcohol outlets was greater when participants were outside versus inside their residential census tract. Exposures on daily routes were also significantly associated with ART adherence, alcohol consumption, and mood. Findings suggest substantial differences between activity spaces and residential contexts. Activity spaces are relevant for PLWH and may impact HIV care and behavioral outcomes such as ART adherence and substance use.

Most residents in New York City (NYC) do not consume sufficient fruits and vegetables every day. Difficulties with access and high prices of fruits and vegetables in some neighborhoods contribute to different consumption patterns across NYC neighborhoods. We developed an agent-based model (ABM) to predict dietary behaviors of individuals at the borough and neighborhood levels. Model parameters were estimated from the 2014 NYC Community Health Survey, United States Census data, and the literature. We simulated six hypothetical interventions designed to improve access and reduce the price of fruits and vegetables. We found that all interventions would lead to increases in fruit and vegetable consumption but the results vary substantially across boroughs and neighborhoods. For example, a 10% increase in the number of fruit/vegetable vendors combined with a 10% decrease in the prices of fruits and vegetables would lead to a median increase of 2.28% (range: 0.65%-4.92%) in the consumption of fruits and vegetables, depending on neighborhood. We also found that the impact of increasing the number of vendors on fruit/vegetable consumption is more pronounced in unhealthier local food environments while the impact of reducing prices on fruits/vegetable consumption is more pronounced in neighborhoods with low levels of education. An agent-based model of dietary behaviors that takes into account neighborhood context has the potential to inform how fruit/vegetable access and pricing strategies may specifically work in tandem to increase the consumption of fruits and vegetables at the local level.

Neighborhood context, which may be impacted by urban growth or residential mobility, is associated with childhood physical activity. This secondary analysis examined associations of objectively measured neighborhood characteristics with young children’s moderate-to-vigorous physical activity (MVPA) and sedentary/rest time (SRT) over a period of rapid infrastructure change. Underserved preschoolers (n = 426) from a 36-month obesity prevention intervention were included in a secondary analysis (2019–2020). Based on household addresses, participants were coded as movers or non-movers and linked to four neighborhood variables: 1) distance to recreation sites, 2) annual crimes, 3) annual stray dogs, and 4) Gini index of income inequality. Accelerometry captured MVPA and SRT at baseline and 36 months. Baseline-to-follow-up neighborhood variables within moved and non-moved groups were compared. Multivariable regression assessed associations between follow-up MVPA/SRT and neighborhood variables. 45.3% of participants (n = 193) moved. Distance to the closest recreation site decreased significantly for non-movers (0.75 to 0.72 mi, p

Objective To assess the impact of Moving to Opportunity for Fair Housing Demonstration Program (MTO) implemented in 1994 in five U.S. cities (Baltimore, Boston, Chicago, Los Angeles, and New York City) on teen births. Methods We analyzed baseline and long-term evaluation data for youth (ages 13–20) and young adults (ages 21–30) (N = 7861) who were children or teens at baseline. We used regression analyses to estimate the impact of housing vouchers on having a teen birth. Results Overall, MTO had no significant effect on teen births. However, among young adults whose parent had a child before age 20, the proportion with a teen birth themselves was 21% lower among those offered housing vouchers to low-poverty neighborhoods with no restrictions compared to those not offered housing vouchers (p, Highlights • Moving to Opportunity (MTO) is a randomized study of housing vouchers. • MTO offers an opportunity to study the social determinants of reproductive health. • We examined childbearing among 13–30 year olds. • MTO had no effect on teen births for the youth sample (

Objective: Low perceived safety and security might have adverse health consequences, especially for chronically homeless individuals who are at high risk of victimization on the street. Permanent supportive housing (PSH) is an effective strategy to address chronic homelessness and improve residents’ health and well-being. However, it is unclear how formerly homeless individuals’ perceptions of safety and security reflect the objective neighborhood environment in which the PSH is located. This article presents a study of the perceived safety and security of formerly homeless individuals transitioned to PSH in and around Skid Row. Method: This mixed-method study examines the perceptions of safety and security of 24 PSH residents living in the Skid Row area of Los Angeles. Subsequent block-based neighborhood observations were conducted informed by these qualitative findings. Results: Although participants felt safer relative to when they were homeless, residents living within Skid Row felt less safe ...

Bullying is an important public health issue among adolescents. Few studies have examined how neighborhood context affects adolescent bullying. The purpose of this study was to examine the relationship between neighborhood collective efficacy and bullying perpetration and sought to determine whether future expectations mediated this relationship. A sample of 196 7th-grade students (60% female; 27% White) from a Midwestern school completed measures assessing past 30-day bullying perpetration, neighborhood collective efficacy, and future expectations. The effect of neighborhood collective efficacy on bullying was fully mediated by future expectations. Our findings suggest that neighborhood collective efficacy is associated with lower bullying perpetration by increasing adolescents’ expectations for the future. Strong social relationships increase adolescents’ perceptions of a positive future. Youth with more positive expectations of the future may be less likely to participate in bullying if they perceive the possible outcomes of bullying to be negative and an impediment to goals.

This study examined the relations of nativity, language, and neighborhood context to pregnancy norms among U.S. Hispanic teens. We used data from a sample of 972 Hispanic females and 960 Hispanic males from Waves I and II (1994-1996) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) collected in eighty high schools and fifty-two middle schools across the country. Results indicated that nativity, language, and neighborhood context were related to Hispanic teen pregnancy norms, although these relationships varied by gender. Specifically, foreign-born, non-English speaking females and those who lived in immigrant neighborhoods held stronger norms against unmarried teen pregnancies compared to English speakers and/or lived elsewhere. Yet, no relationship was demonstrated for males. The results of this study suggest an immigrant advantage related to female teen pregnancy norms, and that context matters in the formation of pregnancy norms for Hispanic females.

Neighborhoods are key socio-environmental contexts for marijuana use during emerging adulthood. This study examined the relationships between neighborhood context, traditional masculine norms (status, toughness, and anti-femininity), and marijuana use among 119 majority African American emerging adult men in a small urban community. Poisson regression models were used to determine the associations between neighborhood problems, social cohesion, and marijuana use. Moderator effects were examined to determine if masculinities modified these associations. Neighborhood problems and social cohesion were positively associated with marijuana use. Men who had a lower endorsement of some traditional masculine norms had greater marijuana use compared to men with a higher endorsement of these norms. These findings have implications for intervention strategies and policies.

Introduction: We have previously reported on the findings of a critical realist concurrent triangulated mixed method multilevel study that sought to identify and explain complex perinatal contextual social and psychosocial mechanisms that may influence the developmental origins of health and disease. That study used both Emergent and Construction Phases of a realist Explanatory Theory Building Method (1). The purpose here is to present The Thesis, Theoretical Framework, Propositions and Models explaining neighbourhood context, stress, depression and the developmental origins of health and disease. Theory/Methods: The analysis draws on an extensive extant literature; intensive (qualitative), extensive (quantitative) and multilevel studies used for phenomena detection, description, and emergent phase theory development; and the abductive and retroductive analysis undertaken for the theory construction phase. The theory construction methods used included: “1) defining stratified levels; 2) analytic resolution; 3) abductive reasoning; 4) comparative analysis (triangulation); 5) retroduction; 6) postulate and proposition development; 7) comparison and assessment of theories; and 8) conceptual frameworks and model development”. Results: Global, economic, social and cultural mechanisms were identified that explain maternal stress and depression within family and neighbourhood contexts. There is a complex intertwining of historical, spatial, cultural, material and relational elements that contribute to the experiences of loss and nurturing. Emerging are the centrality of social isolation and “expectation lost” as possible triggers of stress and depression not only for mothers but possibly also others who have their dreams shattered during life’s transitions. Discussion: The theoretical framework takes a critical realist perspective of perinatal social context, stress, depression and the developmental origins of health and disease and builds on the emerging literature on stress process, social isolation, social exclusion, social capital, segregation, acculturation, Globalisation, neighbourhood effects on health, perinatal adversity, and the developmental origins of health and disease. We draw on the philosopher Bhaskar’s (2) articulation of critical realism with its ontological stratification of reality. Such a stratified ontological perspective adds theoretical depth to the layered ecological models advanced by earlier social epidemiologists. Conclusions: The Thesis: In the neighbourhood spatial context, in keeping with critical realist ontology, global-economic, social and cultural level generative powers trigger and condition maternal psychological and biological level stress mechanisms resulting in the phenomenon of maternal depression and alteration of the infants’ developmental trajectory. Lessons learned: The meta-theory of critical realism is used here to generate and construct social epidemiological theory using stratified ontology and both abductive and retroductive analysis. The findings will be applied to the development of a middle range theory and subsequent programme theory for local perinatal child and family interventions. Limitations: The stratified levels of analysis in this study were predominantly social and psychological. The macro and meso levels were not fully analysed. Suggestions for future research: We will use the theories developed here for future confirmatory studies and realist programme theory development. References: 1. Eastwood JG, Kemp BA, Jalaludin BB. Realist theory construction for a mixed method multilevel study of neighbourhood context and postnatal depression. SpringerPlus. 2016;5:1081. 2. Bhaskar R. A Realist Theory of Science. Leeds: Leeds Books; 1975.

Objective: The current study extends research on Latino caregiving to describe the role of neighborhood-level factors and dementia severity for caregiver well-being. Method: Data are drawn from the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE 2010/2011, N = 343). We present regression analyses that describe the relationship between dementia severity in the older care recipient and neighborhood-level structural factors for caregiver mental health. Results: Mexican Americans providing care in neighborhoods characterized by a higher percent Latino report fewer depressive symptoms and greater life satisfaction. Percent Latino and percent Spanish speaking residing in the neighborhood are especially protective of caregiver depressive symptoms when care recipients display more severe dementia-related neuropsychiatric symptoms. Discussion: Neighborhood characteristics play an important role in the Latino caregiver well-being processes. Targeting neighborhoods, especially in regard to culturally competent dementia care education and services, should be the focus of intervention strategies for Mexican-origin caregivers.

Research on the effects of adolescent employment on primarily middle-class youth suggests that intense employment, working more than 15 or 20 hours during the school year, is associated with increased participation in risky behavior. Despite these findings, scholars who focus on the development of youth living in low-income urban areas often hypothesize that adolescent employment will have beneficial effects on this population. There is some evidence that adolescent employment is associated with increased educational achievement and adult employment for low-income urban youth. The impact of adolescent employment on future engagement in risky behavior across levels of neighborhood deprivation and employment intensity was investigated on a sample of 1,057 adolescents from the Project on Human Development in Chicago Neighborhoods, a longitudinal study of neighborhood effects on development. After controlling for individual characteristics, intense employment during adolescence did predict increased use of cigarettes and alcohol and having a greater number of sexual partners 2 years after employment was measured. There were no significant interactions between neighborhood SES and adolescent employment status on involvement in risky behavior. These findings suggest that intense adolescent employment is associated with detrimental developmental outcomes for youth regardless neighborhood context.

Prior research suggests that immigrant enclaves provide respiratory health benefits for US Hispanic residents. We test if immigrant enclaves provide differential respiratory health benefits for Hispanic children in El Paso (Texas) based on individual-level factors. Results reveal that higher neighborhood immigrant density is associated with reduced odds of wheezing, but that the protective immigrant enclave effect is modified by poverty, general health status, body mass index (BMI), and caretaker nativity. Higher immigrant density is significantly more protective for poor children and those with foreign-born caretakers; conversely, it is significantly less protective for children in worse health and those with higher BMI. These findings foster a novel understanding of how immigrant enclaves may be differentially protective for Hispanic children based on individual-level factors.

Background: Research consistently shows that breastfeeding behaviors vary according to individual-level sociodemographic characteristics, yet few studies examine contextual variations in breastfeeding. Objective: The purpose of this study is to examine the association between neighborhood context and breastfeeding among a sample of predominately unmarried urban mothers, a group with relatively low rates of breastfeeding. Methods: This study combines census tract information with data from 2 waves of the Fragile Families and Child Wellbeing Study (n = 4228) to predict the odds of initiating and sustaining breastfeeding. Results: Findings indicate that neighborhood socioeconomic composition, rather than racial or ethnic concentration, is associated with breastfeeding behaviors. More specifically, living in a highly educated neighborhood is associated with higher odds of initiating and sustaining breastfeeding. Conclusion: These results suggest that the breastfeeding behaviors of urban mothers vary according to neighborhood educational context. Understanding how breastfeeding behaviors are shaped by one’s neighborhood environment will allow public health initiatives to more effectively target vulnerable populations.

Spatial and locational dimensions of public health are attracting increasing attention among regional scientists whose analytic methods and frameworks can provide valuable insights into well-being challenges. Regional economic, demographic, and environmental processes are critically important to people’s health and access to health care. Such effects can be modeled and analyzed using spatial analytics and regional approaches. This chapter reviews contributions by regional scientists to public health research and intervention. Research challenges and opportunities are discussed in several broad areas of public health, including health disparities, environmental health, access to health services, and public health intervention.

OBJECTIVE: Neighborhood-level poverty and racial composition may contribute to racial disparities in hypertension outcomes. Little is known about how the effects of neighborhood social environments may differ by nativity status among diverse urban Black adults. We aimed to characterize the influence of neighborhood-level socio-demographic factors on hypertension outcomes among US- and foreign-born Black men with uncontrolled blood pressure. DESIGN: We conducted a cross-sectional analysis of baseline data from two large community-based trials of hypertensive Black men aged 50 and over linked with census tract data from the 2012 American Community Survey 5-year estimates. We defined census tracts with high racial segregation as those where 60 % or more self-identified as Black and high-poverty census tracts as those where 20 % or more lived below the poverty line. Multivariable general estimating equation models were used to measure associations between neighborhood characteristics and stage of hypertension, hypertension awareness, and treatment to yield adjusted prevalence ratios (aPR). Models were run separately for US- and foreign-born Black men. RESULTS: Over 64 % of the 1139 participants lived in a census tract with a high percentage of Black residents and over 71 % lived in high-poverty census tracts. Foreign-born Black men living in neighborhoods with a high concentration of Black residents were less likely to be treated for their high blood pressure (aPR 0.44, 95 % CI 0.22-0.88), but this result did not hold for US-born Black men. There were no significant associations between neighborhood poverty and hypertension outcomes. CONCLUSIONS: Neighborhood context may impact treatment for hypertension, one of the most important factors in hypertension control and decreasing hypertension-related mortality, particularly among foreign-born Black men.

The current study focuses on three dimensions of treatment neighborhood environments that may influence treatment retention: neighborhood disadvantage, stability, and concentrated immigration. We examined treatment outcomes for a total of 9,319 individuals who were admitted for initial treatment in 56 outpatient clinics in Cook County, Illinois. Census-tract-level data were used to measure facility neighborhood environment. We found that neighborhood disadvantage was unrelated to individual treatment completion. Immigrant concentration was found to increase the likelihood of substance abuse treatment completion, although it was attenuated after controlling for patient problem severity and referral sources. Neighborhood stability was found to be positively related to treatment completion. These results suggest that knowledge of neighborhood context should be an important consideration when making placement decisions of new treatment facilities. Knowledge of neighborhood impact on treatment attrition should also be considered essential information to be used for client placement, treatment program design, and discharge protocols.

Cardiovascular disease (CVD) continues to be the leading cause of death and a major source of health disparities in the Unites States and globally. Efforts to reduce CVD risk and eliminate cardiovascular health disparities have increasingly emphasized the importance of the social determinants of health. Neighborhood environments have emerged as a possible target for prevention and policy efforts. Hence there is a need to better understand the role of neighborhood environments in shaping cardiovascular risk. The MESA (Multi-Ethnic Study of Atherosclerosis) Neighborhood Study provided a unique opportunity to build a comprehensive place-based resource for investigations of associations between specific features of neighborhood physical and social environments and cardiovascular risk factors and outcomes. This review summarizes the approaches used to characterize residential neighborhood environments in the MESA cohort, provides an overview of key findings to date, and discusses challenges and opportunities in neighborhood health effects research. Results to date suggest that neighborhood physical and social environments are related to behavioral and biomedical risk factors for CVD and that cardiovascular prevention efforts may benefit from taking neighborhood context into account.HighlightsThere is a need for greater understanding of the role of neighborhood environments in shaping population levels of cardiovascular risk and disparities in cardiovascular risk.The MESA (Multi-Ethnic Study of Atherosclerosis) Neighborhood Study provides a unique opportunity to investigate the associations of specific features of neighborhood physical and social environments with cardiovascular risk factors and outcomes in a diverse population.Neighborhood physical and social environments have measurable impacts on cardiovascular disease risk.The consideration of environmental factors may improve policies to improve cardiovascular health and reduce disparities in cardiovascular health.

Social support has been recognized as a protective factor associated with reduced intimate partner violence (IPV). A question that few studies have examined, however, is whether the effectiveness of social support on IPV is conditioned by the neighborhood in which it occurs. This study investigated whether the separate effects of support from friends and family members on partner violence were conditioned by neighborhood disadvantage. Results indicated that social support from family significantly reduced the prevalence and frequency of IPV, whereas support from friends was associated with higher frequencies of partner violence. Importantly, the effects of social support were contextualized by neighborhood disadvantage, with the impact of both forms of social support on IPV being diminished in neighborhoods characterized by higher levels of disadvantage.

The bulk of “neighborhood effects” research examines the impact of neighborhood conditions cross-sectionally. However, it is critical to understand whether the effects of neighborhood context are situational and whether they endure over time. In this study, we take seriously the notion that there are enduring consequences of exposure to deleterious neighborhood conditions. Using a rich set of longitudinal data on adolescents from the Project on Human Development in Chicago Neighborhoods, we estimate the effect of exposure to violence on both internalizing (depression and anxiety) and externalizing problems (aggression). We find that exposure to violence has both an acute and enduring effect on aggression, yet no effect on anxiety-depression, net of individual, family, peer, and neighborhood influences. Part of the enduring effect of violence exposure is explained by changes in social cognitions brought on by the exposure, yet much of the relationship remains to be explained by other causal mechanisms.

This exploratory enquiry employs qualitative methods to advance knowledge and understanding of physical environmental attributes related to active living among residents of Australian retirement villages. Six focus groups ( n = 51 residents) were held and participants described how their current, and subsequently ideal, retirement village and neighborhood supported active lifestyles. Thematic analysis revealed three key environmental factors associated with active living: a positive social environment within the village; services and facilities provided in the village and wider neighborhood; and the presence of suitable pedestrian infrastructure. The unique discovery that environmental factors of both the retirement village and the surrounding neighborhood were associated with residents’ active living raises many questions for study. Findings informed the development of a survey instrument, and further understanding in this area has the potential to contribute to the design and siting practices of senior housing complexes within neighborhoods.

We used data from the 2002 National Survey of Family Growth to examine the influence of neighborhood characteristics on young males’ sexual and reproductive health (SRH). We linked census-tract data to construct a Neighborhood Disadvantage Scale for 1092 never-married males aged 15 to 19 years, and we examined the association of neighborhood disadvantage with 11 SRH behaviors for each male. We found significant associations between neighborhood disadvantage and measures of partnering and pregnancy. Public health research and policies must consider the role of neighborhood context when addressing health behaviors.

This study examined family and neighborhood influences relevant to low-income status to determine how they combine to predict the parenting behaviors of Mexican-American mothers and fathers. The study also examined the role of parenting as a mediator of these contextual influences on adolescent internalizing and externalizing symptoms. Study hypotheses were examined in a diverse sample of Mexican-American families in which 750 mothers and 467 fathers reported on their own levels of parental warmth and harsh parenting. Family economic hardship, neighborhood familism values, and neighborhood risk indicators were all uniquely associated with maternal and paternal warmth, and maternal warmth mediated the effects of these contextual influences on adolescent externalizing symptoms in prospective analyses. Parents' subjective perceptions of neighborhood danger interacted with objective indicators of neighborhood disadvantage to influence maternal and paternal warmth. Neighborhood familism values had unique direct effects on adolescent externalizing symptoms in prospective analyses, after accounting for all other context and parenting effects.

Children of immigrants in the United States often grow up in very different nutrition environments than their parents. As a result, parent-child concordance in diet may be particularly weak in immigrant families. Yet, little is known about parent-child dietary resemblance in immigrant families and how local contexts shape it. This study uses data from the 1999/2000-2009/2010 Continuous National Health and Nutrition Examination Survey to examine mother-child resemblance in dietary quality in Mexican-origin families in the United States. We investigate how immigrant generational status and neighborhood context shape the association between mothers' and children's dietary quality. We find that mother-child resemblance in dietary quality is weaker for first-generation children relative to third-generation children. However, residence in an immigrant enclave strengthens the mother-child association in dietary quality for first-generation children. Findings offer a unique within-family perspective of immigrant health. Results suggest that the healthy eating advantage of Mexican immigrant mothers may not be sustained across family generations and that Mexican immigrant mothers may face unique challenges in promoting healthy eating among their children.

Although a number of reviews of gender differences in conduct problems and delinquency exist, this paper fills a gap in reviewing neighborhood influences on gender differences in conduct problems and delinquency. These influences are known to be important for boys in childhood and adolescence, but cannot be assumed to be influential in the same manner for girls. The paper starts with several conceptualizations of the association between gender, neighborhoods and juvenile delinquency. It then addresses 4 key questions. Is residing in a disadvantaged neighborhood associated with problem behavior in girls? Are neighborhood effects independent of girls' age? Are girls in disadvantaged neighborhoods exposed to more risk factors than girls in advantaged neighborhoods? Can mediating risk factors explain gender differences in neighborhood effects on children's and adolescents' conduct problems and delinquent behavior? Answers to these questions are important to steer research and elucidate aspects of interventions that can be optimized for girls.

We used a preferences-and-constraints model to develop four hypotheses to explain why parents may choose self-care (an unsupervised arrangement) as the primary child care arrangement for their children over supervised alternatives and tested them in a multivariate framework using 1995 data from the Survey of Income and Program Participation. We found that the choice of self-care over supervised care alternatives is linked to the availability of parents’ time to care for children, the child’s level of responsibility and maturity, and the neighborhood context. However, we found no evidence that parents’ ability to pay for child care is related to the choice of self-care. The results also suggest that parents use different decision-making processes, depending on their children’s ages.

PURPOSE: To determine whether neighborhood characteristics are associated with self-rated health in older Mexican Americans. METHODS: Epidemiologic data on 3050 older Mexican Americans residing in the southwestern United States during 1993 and 1994 were merged with 1990 US Census data. All subjects were matched to one of 210 census tracts (neighborhoods). Multilevel ordinal logit models were used to examine relationships between self-rated health and individual- and neighborhood-level variables. RESULTS: After adjusting for individual characteristics, older Mexican Americans were more likely to rate their health poorer if they lived in neighborhoods that were economically disadvantaged, less populated by other Hispanics, or located within 50 miles of the US-Mexico border. In addition, residence in a border community moderated the relationship between self-rated health and neighborhood economic disadvantage. The effect of neighborhood economic disadvantage on poorer self-rated health was two to three times stronger for subjects living near the border region than subjects living further away from the border. CONCLUSIONS: This study demonstrates the importance of considering several dimensions of neighborhood context, especially for Mexican Americans. Residence in a border community and neighborhood economic disadvantage were important predictors of poorer self-rated health status. In addition, older Mexican Americans experience a health benefit from living in neighborhoods populated with other Hispanics.

While homeownership has been linked to positive health outcomes there is limited evidence regarding the conditions under which it may be health protective. We present a conceptual model linking homeownership to health, highlighting key potential pathways. Using the Detroit Metropolitan Area as a case study, and data from the American Community Survey (2009–2013; 5-years estimates) and Michigan Department of Community Health, we tested the following questions: (1) Is neighborhood percentage non-Hispanic Black (NHB) associated with homeownership? (2) Is neighborhood percentage NHB associated with health? (3) Is the association between percentage NHB and health mediated by homeownership? (4) Does neighborhood housing value modify associations between percentage NHB and health, or between homeownership and health? Percentage NHB was associated with homeownership and health outcomes; Associations between percentage NHB and mortality, but not disability, were partially mediated by neighborhood homeownership. Neighborhood housing value modified associations between neighborhood homeownership and both disability and mortality, but not between percentage NHB and health outcomes. Findings are consistent with the thesis that health-promoting effects of homeownership may be contingent upon house values. These results add to a limited body of evidence suggesting that variations in homeownership may contribute to persistent racial and socioeconomic health inequities.

To examine whether variation in neighborhood context is associated with preterm birth (PTB) outcomes and gestational age (GA) at delivery in Philadelphia, and to determine whether these associations might persist when considering relevant individual-level variables.We analyzed individual-level data collected for a prospective cohort study of singleton pregnancies with preterm labor. We merged block-group level data to each individual's home address. Unadjusted analyses were performed to determine the association between block-group variables and individual-level outcomes. Block-group variables identified as potential risk factors were incorporated into multivariable individual-level models to determine significance.We analyzed data for 817 women. The prevalence of PTB37 weeks was 41.5%. Although in unadjusted analyses several block-group variables were associated with PTB and GA at delivery, none retained significance in individual-level multivariable models.Block-group level data were not associated with PTB outcomes or GA at delivery in Philadelphia.

Researchers have speculated that negative life events are more common in troubled neighborhoods, amplifying adverse effects on health. Using a clustered representative sample of Chicago residents (2001–03; n = 3,105) from the Chicago Community Adult Health Survey, we provide the first documentation that negative life events are highly geographically clustered compared to health outcomes. Associations between neighborhood context and negative life events were also found to vary by event type. We then demonstrate the power of a contextualized approach by testing path models in which life events mediate the relation between neighborhood characteristics and health outcomes, including self-rated health, anxiety, and depression. The indirect paths between neighborhood conditions and health through negative life event exposure are highly significant and large compared to the direct paths from neighborhood conditions to health. Our results indicate that neighborhood conditions can have acute as well as chronic effects on health, and that negative life events are a powerful mechanism by which context may influence health.

Neighborhood context is recognized as an important predictor of individual-level behaviors and health outcomes (Pickett and Pearl 2001; Lee and Cubbin 2002; Sampson 2003). Neighborhoods, however, are difficult to define both in theory and in practice, and are often drawn to follow existing administrative boundaries or sampling schemes, or must be set arbitrarily due to a lack of sufficient data. Given the role of neighborhood context in influencing health outcomes, it is crucial that the area of influence surrounding the unit of analysis (be it a person, household, etc.) be properly defined. As already discussed in previous chapters, if we do not identify neighborhoods correctly, we cannot properly evaluate neighborhood effects. Defining neighborhoods is a challenge across the social sciences; investigations of the role of neighborhood context in decision making and shaping of individual-level outcomes are seen in public health, geography, demography, and sociology with no consistent approach to identifying and evaluating neighborhood effects. In this chapter, we outline several types of neighborhood definitions from the literature, and then, using data from the Women’s Health Study of Accra, implement a spatial model together with a simulation approach to examine how two alternative neighborhood definitions affect modeling of individual-level health outcomes.

Declines in case fatality post-myocardial infarction (MI) have been observed over the past 3 decades. Few studies report socioeconomic disparities in survival post-MI.We assessed 1-year case fatality among 9,116 incident MI patients included in the Atherosclerosis Risk in Communities community surveillance from 1992 to 2002. Addresses of hospitalized MI patients were geocoded by a commercial vendor and linked to year 2000 United States Census tract-level neighborhood income (nINC) data. We estimated case fatality odds ratios and 95% CIs with a multinomial logistic model to quantify the association between nINC tertile and case fatality, comparing short- (within 28 days) and long-term (29-365 days) case fatality to no death 1 year post-MI.Overall, 1-year age-adjusted case fatality rates were highest among MI patients living in low-nINC areas, followed by medium- and high-nINC areas, respectively. We found significant odds ratio modification by race (P.10) and formed race-nINC strata with high-nINC whites as the referent group. In multivariable models adjusting for age, gender, study community, and year of MI, low-nINC whites and low- and medium-nINC blacks had higher short-term case fatality than high-nINC whites. Low- and medium-nINC blacks had higher long-term case fatality compared with high-nINC whites.Differences in short- and long-term case fatality by neighborhood socioeconomic factors have not been systematically studied in the United States. Surveillance efforts can be expanded to incorporate measures of the neighborhood context to examine these associations over time.

Objective To examine the associations between parental perceptions of the neighborhood context and adolescent depression including potential gender differences in outcomes. Design and Sample Descriptive correlational study. A total of 32,499 parents of adolescents aged 12–17 years. Measures Descriptive and multivariate logistic and linear regression analyses of the 2007 National Survey of Children's Health. Neighborhood context was operationalized as physical disorder, social isolation, and lack of safety. Two depression outcomes (current depression diagnosis and current depression symptoms) were analyzed. Results Parental perceptions of neighborhood physical disorder were positively associated with adolescent depression diagnosis (AOR = 1.73, 95% CI = 1.07, 2.80) and an increase in depression symptoms (0.186, p

In this chapter, we provide a critical overview of research concerning the association between neighborhood context and mental health. Along the way, we address several fundamental questions. What is neighborhood context, and how is it measured and analyzed? What is the nature and extent of the association between neighborhood context and mental health? Why might neighborhood context contribute to mental health? Are certain groups of people more or less vulnerable to the psychological consequences of neighborhood context? To answer these questions, we describe common indicators of neighborhood context, note typical methods of analysis, summarize associations with a range of mental health outcomes, and discuss several viable mediation and moderation processes. Our primary mediation model suggests that the subjective neighborhood experience is essential to understanding the link between neighborhood context and mental health. We conclude by highlighting several important avenues for future research.

In recent decades there has been an increasing interest in understanding the role of social and physical contexts in influencing health behaviors and outcomes. This is especially true for weight, which is considered to be highly dependent on environmental factors. The evidence linking neighborhood characteristics to weight in the United States, however, is mixed. Many studies in this area are hampered by cross sectional designs and a limited scope, insofar as they investigate only one dimension of neighborhood context. It is also unclear to what extent neighborhood characteristics account for racial/ethnic disparities in weight. Using longitudinal data from the Los Angeles Family and Neighborhood Survey (L.A. FANS), we compare patterns of weight change between Hispanics and other racial and ethnic groups in order to evaluate whether we observe a pattern of unhealthy assimilation in weight among Hispanic immigrants and to identify differences in the rate at which different groups gain weight over time. We also explore the extent to which patterns of weight change are related to a wider range of community characteristics. We find that weight increases across all groups between the two study waves of L.A. FANS and that the increases are significant except for Asians/Pacific Islanders. With respect to differences in the pace of weight change, second and higher generation Hispanic women and black men gain weight more rapidly than their first generation Hispanic counterparts. Although the evidence presented indicates that first generation Hispanics gain weight, we do not find evidence for convergence in weight since the U.S.-born gain weight at a more rapid rate. The inclusion of community-level variables does not alter the relationships between the race, ethnicity, and immigrant generation categories and weight change. Of the six types of community characteristics considered, only collective efficacy is consistently and significantly associated with weight change, although the protective effect of neighborhood collective efficacy is seen only among women.

Although a health advantage in hypertension has been documented among Latinos, this advantage appears to be eroding. Of particular concern is the observation that Latinos are less likely to be screened and treated for hypertension and to having it controlled. Scholars have suggested that, above and beyond individual-level factors, neighborhood characteristics may be important predictors of health and health care. We analyzed 2001–2003 data from the Chicago Community Adult Health Study to examine (a) the relationship between the Latino and immigrant composition of neighborhoods in Chicago and several outcomes among Latinos: having hypertension, utilizing hypertension-related health care, and being treated for hypertension; and (b) whether there was a differential effect of neighborhood Latino/immigrant concentration by language of interview and nativity status. We controlled for additional neighborhood characteristics relevant to hypertension and to the availability and accessibility of health care resources. Neighborhoods with higher concentrations of immigrants and Latinos were associated with Latinos having lower odds of hypertension (OR = 0.60, p = 0.03). However, among those with hypertension, our results point to deleterious effects on hypertension care (OR = 0.55, p = 0.06) and treatment (OR = 0.54, p = 0.04) associated with living in neighborhoods with higher concentrations of immigrants and Latinos. We detected no significant interaction effects between immigrant/Latino neighborhood composition and language of interview or being an immigrant in this sample. These results suggest that improving access to care for Latinos with hypertension requires enhanced placement of community clinics and other safety-net health centers in neighborhoods with higher proportions of immigrants and Latinos.

The current study compared ethnic minority and European American clinically-referred anxious youth (N=686; 2-19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed.