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Background: It has been hypothesized that low access to healthy and nutritious food increases health disparities. Low-accessibility areas, called food deserts, are particularly commonplace in lower-income neighborhoods. The metrics for measuring the food environment's health, called food desert indices, are primarily based on decadal census data, limiting their frequency and geographical resolution to that of the census. We aimed to create a food desert index with finer geographic resolution than census data and better responsiveness to environmental changes. Materials and methods: We augmented decadal census data with real-time data from platforms such as Yelp and Google Maps and crowd-sourced answers to questionnaires by the Amazon Mechanical Turks to create a real-time, context-aware, and geographically refined food desert index. Finally, we used this refined index in a concept application that suggests alternative routes with similar ETAs between a source and destination in the Atlanta metropolitan area as an intervention to expose a traveler to better food environments. Results: We made 139,000 pull requests to Yelp, analyzing 15,000 unique food retailers in the metro Atlanta area. In addition, we performed 248,000 walking and driving route analyses on these retailers using Google Maps' API. As a result, we discovered that the metro Atlanta food environment creates a strong bias towards eating out rather than preparing a meal at home when access to vehicles is limited. Contrary to the food desert index that we started with, which changed values only at neighborhood boundaries, the food desert index that we built on top of it captured the changing exposure of a subject as they walked or drove through the city. This model was also sensitive to the changes in the environment that occurred after the census data was collected. Conclusions: Research on the environmental components of health disparities is flourishing. New machine learning models have the potential to augment various information sources and create fine-tuned models of the environment. This opens the way to better understanding the environment and its effects on health and suggesting better interventions. [ABSTRACT FROM AUTHOR]

Introduction: Poor quality neighborhood environments are independent risk factors for cardiovascular disease (CVD) but are understudied in Black adults, who face large CVD health disparities. Arterial stiffness, a marker of early vascular aging, precedes development of hypertension and adverse CVD events but the effect of neighborhood on arterial stiffness among Black adults remains unknown. Objective: We compared the association between neighborhood environment and arterial stiffness among Black adults in Jackson, MS and Atlanta, GA. Methods: We studied 1582 Black adults (mean age 53 ± 10, 35% male) living in Jackson, MS from the Jackson Heart Study (JHS) and 451 Black adults (mean age 53 ± 10, 39% male) living in Atlanta, GA from the Morehouse-Emory Cardiovascular Center for Health Equity (MECA) study, without known CVD. Neighborhood problems (includes measures of aesthetic quality, walking environment, food access), social cohesion (includes activity with neighbors), and violence/safety were assessed using validated questionnaires. Arterial stiffness was measured as pulse wave velocity (PWV) using magnetic resonance imaging in JHS and as PWV and augmentation index (AIx) using applanation tonometry (SphygmoCor, Inc.) in MECA. Multivariable linear regression models were used to examine the association between neighborhood characteristics and arterial stiffness, adjusting for potential confounders. Results: Improved social characteristics, measured as social cohesion in JHS (β = −0.32 [−0.63, −0.02], p = 0.04) and activity with neighbors (β = −0.23 [−0.40, −0.05], p = 0.01) in MECA, were associated with lower PWV in both cohorts and lower AIx (β = −1.74 [−2.92, − 0.56], p = 0.004) in MECA, after adjustment for CVD risk factors and income. Additionally, in MECA, better food access (β = −1.18 [−2.35, − 0.01], p = 0.05) was associated with lower AIx and, in JHS, lower neighborhood problems (β = −0.33 [−0.64, − 0.02], p = 0.04) and lower violence (β = −0.30 [−0.61, 0.002], p = 0.05) were associated with lower PWV. Conclusion: Neighborhood social characteristics show an independent association with the vascular health of Black adults, findings that were reproducible in two distinct American cities. [ABSTRACT FROM AUTHOR]

Arterial stiffness is a precursor for the development of hypertension and premature cardiovascular disease (CVD). Physical activity has been associated with lower arterial stiffness among largely White populations, but the types of activity required and whether these findings apply to Black adults remain unknown. We examined whether physical activity levels were associated with arterial stiffness among Black adults in two independent cohorts. In the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity, 378 Black adults (age 52.8 ± 10.3, 39.7% male) without known CVD living in Atlanta, GA were recruited. Arterial stiffness was measured as pulse wave velocity (PWV). Total and domain-specific physical activity were assessed by self-report. Multiple linear regression models were used to investigate differences across physical activity levels after adjusting for age, sex, CVD risk factors, and socioeconomic status. Findings were validated in an independent cohort of Black adults (n = 55, age 50.4 ± 9.2, 23.6% male). After adjustment for covariates, lower arterial stiffness was associated with higher self-reported levels of sport/exercise (6.92 ± 1.13 vs 7.75 ± 1.14, p < 0.001, highest vs lowest quartile) and home/life activities (7.34 ± 1.24 vs 7.73 ± 1.07, p = 0.04, highest vs lowest quartile), but not work, active living, or the overall physical activity scores. These findings were replicated in the independent cohort where higher levels of sport/exercise remained associated with lower arterial stiffness (6.66 ± 0.57 vs 8.21 ± 0.66, p < 0.001, highest vs lowest quartile). Higher levels of sport/exercise and home/life-related physical activities (in comparison to occupational physical activity) are associated with lower arterial stiffness in Black adults. [ABSTRACT FROM AUTHOR]

Purpose: Neighborhood environment is increasingly recognized as an important determinant of cardiovascular health (CVH) among Black adults. Most research to date has focused on negative aspects of the neighborhood environment, with little attention being paid to the specific positive features, in particular the social environment, that promote cardiovascular resilience among Black adults.We examined whether better neighborhood physical and social characteristics are associated with ideal CVH among Black adults, as measured by Life's Simple 7 (LS7) scores.Methods: We recruited 392 Black adults (age 53 ± 10 years, 39% men) without known CV disease living in Atlanta, GA. Seven neighborhood domains were assessed via questionnaire: asthetic quality, walking environment, safety, food access, social cohesion, activity with neighbors, and violence. CVH was determined by LS7 scores calculated from measured blood pressure; glucose; cholesterol; body mass index (BMI); and self-reported exercise, diet, and smoking, and categorized into poor (0-8), intermediate (9-10), and ideal (11-14). Multinomial logistic regression was used to examine the association between neighborhood characteristics and the odds of intermediate/ideal CVH categories compared with poor CVH after adjustment for age, gender, household income, education, marital status, and employment status.Results: Better scores in the neighborhood domains of social cohesion and activity with neighbors were significantly associated with higher adjusted odds of ideal LS7 scores (OR 2.02, 95% CI [1.36-3.01] and 1.71 [1.20-2.45] per 1 standard deviation [SD] increase in respective scores). These associations were stronger for both social cohesion (OR 2.61, 95% CI [1.48-4.61] vs. 1.40 [0.82-2.40]) and activity with neighbors (OR 1.82, 95% CI [1.15-2.86] vs. 1.53 [0.84-2.78]) in Black women than men. Specifically, better scores in social cohesion were associated with higher odds of ideal CVH in exercise (OR 1.73 [1.16-2.59]), diet (OR 1.90 [1.11-3.26]), and BMI (OR 1.52 [1.09-2.09]); better scores in activity with neighbors were also similarly associated with higher odds of ideal CVH in exercise (OR 1.48 [1.00-2.19]), diet (OR 2.15 [1.23-3.77]), and BMI (OR 1.45 [1.07-1.98]; per 1 SD in respective scores).Conclusions: More desirable neighborhood characteristics, particularly social cohesion and activity with neighbors, were associated with better CVH among Black adults. [ABSTRACT FROM AUTHOR]

Introduction: Intra-racial heterogeneity in cardiovascular health (CVH) among Blacks is understudied, and more research is needed to identify factors promoting CVH among Blacks. Neighborhood environment is increasingly recognized as an important determinant of CV risk and health, Yet whether specific features of neighborhood physical and social environments may promote CV resilience among Blacks has been underexplored. Hypothesis: Better neighborhood characteristics are associated with ideal CVH among Black adults, measured as Life's Simple 7 (LS7) scores. Methods: We recruited 392 Black adults (age 53 ± 10, 39% male) without known CV disease in Atlanta, GA, who resided in 199 residential neighborhood (defined as census tracts). Seven neighborhood domains were assessed via questionnaire: aesthetic quality, walking environment, safety, food access, social cohesion, activity with neighbors, and violence. CVH was determined by LS7 scores calculated from measured blood pressure, glucose, cholesterol, body mass index (BMI), and self-reported exercise, diet, and smoking, and categorized into poor (0-8), intermediate (9-10), and ideal (11-14). Multinomial logistic regression was used to examine the association between neighborhood characteristics and the odds of intermediate/ideal CVH categories compared to poor CVH after adjustment for age, gender, household income, education, marital status, and employment status. Results: A total of 53 (14%), 110 (28%), and 229 (58%) participants had ideal, intermediate, and poor LS7 scores, respectively. Better scores in the neighborhood domains of social cohesion and activity with neighbors were significantly associated with higher adjusted odds of ideal LS7 scores (OR 1.95, 95% CI [1.32 - 2.90] and 1.65 [1.16 - 2.35] per 1 standard deviation [SD] increase in respective scores). Specifically, better scores in social cohesion were associated with higher odds of ideal CVH in exercise (OR 1.73 [1.16 - 2.59]), diet (OR 1.99 [1.14 - 3.48]), and BMI (OR 1.51 [1.09 - 2.09]); better scores in activity with neighbors were also similarly associated with higher odds of ideal CVH in exercise (OR 1.47 [0.99 - 2.19]), diet (OR 2.37 [1.32 - 4.26]), and BMI (OR 1.44 [1.05 - 1.96]; per 1 SD in respective scores). Aesthetic quality, walking environment, safety, food access, and violence were not significantly associated with overall CVH categories in the adjusted models. Conclusion: More desirable neighborhood characteristics, particularly social cohesion and activity with neighbors, were associated with better CVH among Black adults. Further research is needed to investigate whether interventions to improve neighborhood qualities lead to better CVH in Blacks. [ABSTRACT FROM AUTHOR]

Introduction: Despite well-known inter-racial cardiovascular (CV) disparities, intra-racial heterogeneity within Blacks remains understudied. Factors promoting CV health among Blacks at neighborhood and individual levels warrant further investigation. Hypothesis: Resilience at neighborhood and individual levels is associated with better CV health in Blacks, measured as higher Life's Simple 7 (LS7) scores. Methods: We assessed LS7 scores in 308 Black adults (age 53 ± 10, 37% male) in Atlanta, GA. 'At risk' and 'resilient' census tracts were defined from high and low rates, respectively, of CV mortality, CV hospitalization, and CV emergency department visits for Blacks. Individual resilience factors were assessed with questionnaires on experience of discrimination, environmental mastery, purpose in life, optimism, resilient coping, and depressive symptoms. Linear mixed models were used to examine the association between LS7 scores and individual/neighborhood resilience. Results: Subjects living in resilient neighborhoods had higher LS7 scores than those living in 'at risk' neighborhoods after adjustment for age, sex, income, and education (β=0.71, P=0.03). Specifically, subjects from resilient neighborhoods had better blood pressure and glucose profiles than those from 'at risk' neighborhoods (OR=2.94, P=0.003; OR=2.24, P=0.03, respectively). Those with high (>median) scores of individual resilience factors (environmental mastery, purpose in life, and resilient coping) had higher LS7 scores than those with low (≤median) scores (β=0.80, 0.51, 0.55, respectively). Greater depressive symptoms (>median) were associated with lower LS7 scores (β=-0.63). There was an additive effect of neighborhood and individual resilience, with subjects living in 'at-risk' neighborhoods and with low individual resilience having the lowest LS7 scores and those with higher levels of individual and neighborhood resilience having the highest LS7 scores (β=1.63, P<0.001). Conclusions: Living in a resilient neighborhood with higher individual-level resilience was additively associated with better CV health in Blacks. Whether some of the adverse neighborhood factors can be mitigated by improving individual level resilience needs to be studied. [ABSTRACT FROM AUTHOR]