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The persistence of the black health disadvantage has been a puzzling component of health in the United States in spite of general declines in rates of morbidity and mortality over the past century. Studies that have focused on well-established individual-level determinants of health such as socio-economic status and health behaviors have been unable to fully explain these disparities. Recent research has begun to focus on other factors such as racism, discrimination, and segregation. Variation in neighborhood context-socio-demographic composition, social aspects, and built environment-has been postulated as an additional explanation for racial disparities, but few attempts have been made to quantify its overall contribution to the black/white health gap. This analysis is an attempt to generate an estimate of place effects on explaining health disparities by utilizing data from the U.S. National Health Interview Survey (NHIS) (1989-1994), combined with a methodology for identifying residents of the same blocks both within and across NHIS survey cross-sections. Our results indicate that controlling for a single point-in-time measure of residential context results in a roughly 15-76% reduction of the black/white disparities in self-rated health that were previously unaccounted for by individual-level controls. The contribution of residential context toward explaining the black/white self-rated health gap varies by both age and gender such that contextual explanations of disparities decline with age and appear to be smaller among females. [ABSTRACT FROM AUTHOR]

Cross-sectional studies of neighborhood context and health are subject to upward bias due to unobserved heterogeneity and to downward bias due to overadjustment for potential mediators in the pathway between neighborhood context and health. In this study, the authors employed two strategies that addressed these two sources of bias. First, to mitigate overadjustment of mediators, they adjusted for baseline characteristics observed just prior to the measurement of neighborhood context, using a combined propensity score and regression strategy. Second, to mitigate underadjustment of unmeasured confounders, they employed a fixed-effects modeling strategy to account for unobserved non-time-varying heterogeneity. Analyses were based on a nationally representative sample of the nonimmigrant US population from the Panel Study of Income Dynamics (1980-1997) in which respondent-rated health was regressed on neighborhood poverty. The samples consisted of approximately 6,000 respondents for the propensity score/regression models and 45,000 person-years for the fixed-effects models. Both modeling strategies yielded significant estimates of neighborhood poverty and supported a causal link between neighborhood context and health. [ABSTRACT FROM AUTHOR]

Objective: To examine whether socioeconomic status (SES) gradients emerge in health outcomes as early as birth and to examine the magnitude, potential sources, and explanations of any observed SES gradients.Data Sources: The National Maternal and Infant Health Survey conducted in 1988.Study Design: A multinomial logistic regression of trichotomized birth-weight categories was conducted for normal birth-weight (2,500-5,500 grams), low birth-weight (LBWT; < 2,500 grams), and heavy birth-weight (> 5,500 grams). Key variables included income, education, occupational grade, state-level income inequality, and length of participation in Women-Infants-Children (WIC) for pregnant mothers.Principal Findings: A socioeconomic gradient for low birth-weight was discovered for an adjusted household income measure, net of all covariates in the unrestricted models. A gross effect of maternal education was explained by maternal smoking behaviors, while no effect of occupational grade was observed, net of household income. There were no significant state-level income inequality effects (Gini coefficient) for any of the models. In addition, participation in WIC was discovered to substantially flatten income gradients for short-term participants and virtually eliminate an income gradient among long-term participants.Conclusions: Although a materialist explanation for early-life SES gradients seems the most plausible (vis-à-vis psychosocial and occupational explanations), more research is needed to discover potential interventions. In addition, the notion of a monotonic gradient in which income is salutary across the full range of the distribution is challenged by these data such that income may cease to be beneficial after a given threshold. Finally, the success of WIC participation in flattening SES gradients argues for either: (a) the experimental efficacy of WIC, or (b) the biasing selection characteristics of WIC participants; either conclusion suggests that interventions or characteristics of participants deserves further study as a potential remedy for socioeconomic disparities in early-life health outcomes such as LBWT. [ABSTRACT FROM AUTHOR]

We test whether or not labor market frustration is associated with clinical alcohol abuse/dependence diagnoses among labor migrants living in California. Our sample consists of 1576 Mexican labor migrants in Fresno, CA, who migrated for the purpose of seeking employment. Using clinical criterion (DSM-III-R), we find that frustrating experiences resulting from labor market exclusion and discrimination are significantly related to past-year alcohol abuse/dependence. Similarly, although high levels of social support are salutary, they are not protective among those who experience moderate/high levels of employment frustration. Since Mexican-origin immigrants have low rates of health insurance coverage and lower propensities for formal help-seeking, community outreach programs that target labor migrants are essential to this population's mental health maintenance. [ABSTRACT FROM AUTHOR]

This study looks at the effect of social support mechanisms as potential moderators and mediators of the relationship between stressful acculturation experiences and self-ratings of physical health. Data are from a sample of 3012 Mexican-origin adults aged 18-59 sampled under a probabilistic, stratified, cluster sampling design in Fresno County, California. While acculturation stressors (i.e., discrimination, legal status, and language conflict) all had a gross positive effect on the likelihood of rating oneself in fair/poor health, only legal status stress had a net effect. In addition, greater numbers of peers and family members in the United States, and a higher reliance on religious support mechanisms decreased the likelihood of reporting fair/poor health. However, levels of both instrumental social support and religious support seeking moderated the (nonsignificant, main) effects of discrimination on physical health. This study indicates that physical health is negatively associated with acculturation stressors and positively associated with social support; discrimination is only associated with poorer physical health among those for whom social support is lacking. [ABSTRACT FROM AUTHOR]

Most analyses of prenatal substance use focus on individual level correlates and ignore community level variables and the effect of the dependency of respondents within communities. This analysis uses multilevel logistic regression models to more accurately assess the correlates of perinatal substance use in California. Statistical results indicate that a significant portion of substance use can be attributed to neighborhood heterogeneity, and that traditional models of substance use may inaccurately attribute this variation to individual level regression coefficients. Substantive results indicate that levels of neighborhood public assistance had an independent, significant effect on the prevalence of all substances tested for except alcohol. Black women had higher predicted prevalence risks for alcohol and cocaine while White women had higher predicted risks for tobacco, marijuana and amphetamines. Racial contrasts were non-significant for the overall illicit drug category and opiates, after controlling for neighborhood public assistance. Finally, individual level variables, with the exception of age, were not moderated by levels of neighborhood public assistance. [ABSTRACT FROM AUTHOR]

This event history analysis of the Perinatal Substance Exposure Study investigates individual and community level correlates of the timing of first prenatal care among pregnant women in California. Data were collected anonymously at the time of delivery and include demographic information from hospital records and urine samples which were tested for a battery of substances. Zip-code level data from the 1990 census were appended to each record to assess absolute community effects. A discrete-time hazard rate was estimated for each trimester in six nested models using logistic regression. Results suggest that: poor, non-White, younger, native born, Spanish-speaking, substance-using women in poorer neighborhoods were least likely to receive prenatal care. While a positive urine test for alcohol was not associated with prenatal care initiation; overall drug positives and tobacco positives (self-report) were. The optimal model, with interactions, estimates that women in poorer communities were less likely to receive prenatal care in the first trimester, but more likely to receive care in the third trimester. This pattern is similar for most of the time-varying covariates in that non-Whites, English speakers and younger women were less likely to receive first trimester care, but more likely to receive second and third trimester care. [ABSTRACT FROM AUTHOR]

Objective: Alcohol use is common in older adults and linked to poor health and aging outcomes. Studies have demonstrated genetic and environmental contributions to the quantity of alcohol consumption in mid-to-late life, but less is known about whether these influences are moderated by sociodemographic factors such as age, sex, and educational attainment. This study sought to better understand sociodemographic trends in alcohol consumption across the second half of the life course and their underlying genetic and environmental influences., Method: Primary analyses were based on 64,140 middle-aged or older adult twins (40-102 years) from 14 studies in the Interplay of Genes and Environment Across Multiple Studies consortium. We harmonized a measure of weekly alcohol consumption (in grams of ethanol per week) across all studies., Results: Older age was associated with lower alcohol consumption, primarily for adults over age 75, for individuals with higher education, and for males. Trends were similar across birth cohorts and after excluding current abstainers. At mean age 56, alcohol use was moderately heritable in females (.34, 95% CI [.26, .41]) and more heritable in males (.42, 95% CI [.38, .45]). Heritability was lower in older aged adults and in females with higher education., Conclusions: This study represents the largest twin study of alcohol consumption in middle-aged and older adults. Results highlight that genetic and environmental factors influence alcohol consumption differently across age, sex, and educational attainment and that intervention efforts may need to be tailored based on individuals' backgrounds. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Polygenic scores (PGS) are broadly misconstrued as reflecting direct causal genetic effects on their respective phenotypes. While this assumption might be accurate for some anthropometric traits like height, more complex traits such as educational attainment show very large indirect effects that stem from many sources. One unexplored source of confounding is the possibility of evocative gene-environment correlation (rGE). Using data from the National Longitudinal Study of Adolescent to Adult Health, we examine the relationship between interviewer assessments of respondent appearance as a function of education PGS. We show a bivariate association between educational PGS and 1) perceived grooming, 2) physical attractiveness, and 3) personality. We then regress years of education on the educational PGS and show that very little of the association (~1-2%) is mediated by attractiveness or personality but 7.5% of the baseline association is confounded with how others may perceive grooming. These results highlight the importance of social-behavioral mechanisms that may link specific genotypes to successful transitions through high school and college and continue to bridge research from the social and biological sciences.

There is inconsistent evidence as to whether gentrification, the increase of affluent residents into low-income neighborhoods, is detrimental to health. To date, there is no systematic evidence on how gentrification may matter for a range of birth outcomes across cities with varying characteristics. We utilize California's Birth Cohort File (2009-2012), Decennial Census data, and the American Community Survey (2008-2012) to investigate the relationship of gentrification to: preterm birth, low birthweight, and small-for-gestational-age across California. We find that socioeconomic gentrification is uniformly associated with better birth outcomes. Notably, however, we find that only places specifically experiencing increases in non-White gentrification had this positive impact. These associations vary somewhat by maternal characteristics and by type of gentrification measure utilized; discrepancies between alternative measurement strategies are explored. This study provides evidence that socioeconomic gentrification is positively related to birth outcomes and the race-ethnic character of gentrification matters, emphasizing the continued need to examine how gentrification may impact a range of health and social outcomes.

Introduction: In the United States, each state sets its own standards for its death investigation system. These may require independent medical examiners and coroners or allow for the sheriff to assume the role of coroner. Motivated by the well-established fact that counts of officer-involved homicides in official data sets grossly undercount the number of these incidents, we examine the possibility that different death investigation systems may lead to different death classification outcomes., Methods: To examine the potential differences in officer-involved homicide underreporting by presence of sheriff-coroner and violent death type (gunshot, intentional use of force, pursuit, or other vehicle accident), we compare ratios of incidents from both the Federal Bureau of Investigation's Supplementary Homicide Reports and the restricted Multiple-Cause of Death files from the National Vital Statistics System to the Fatal Encounters data across coroner contexts in California between 2000 and 2018; we quantify differences descriptively and examine bivariate tests of means., Results: We find significantly greater underreporting of officer-involved deaths in sheriff-coroner counties in both official data sets for all incidents compared with non-sheriff-coroner counties, independently of the period considered. These underreporting differences in the National Vital Statistics System are robust to restricting to gunshot and intentional use of force deaths, the type of incident expected to be less prone to misclassification in that data set., Conclusions: Officer-involved death underreporting in sheriff-coroner counties necessitates further scrutiny. Disparities in officer-involved death reporting suggest political pressure may play a role in classifying deaths., Competing Interests: The authors, reviewers, editors, and publication staff do not report any relevant conflicts of interest., (© The Author(s) 2022.)

Purpose: Ethnic disparities in childhood cancer survivor (CCS) mental health have been identified, although prior survivorship research has focused predominantly on non-Hispanic/Latinx (H/L) white survivors. Methods: This study examined the association of acculturation with depressive symptoms and wellbeing among 582 young adult H/L CCS recruited to a population-based study of CCS in Southern California. Results: In multivariable regression models adjusted for covariates, greater identification with both the Hispanic and Anglo cultures was positively associated with wellbeing ( p  = 0.007 and p  < 0.0001, respectively), and Hispanic cultural identification was associated with fewer depressive symptoms ( p  = 0.04). Conclusions: Greater understanding of unique protective factors among minority CCS may inform tailored interventions promoting mental health.

Introduction: The most widely used data set for studying police homicides-the Supplementary Homicide Reports (SHR) kept by the Federal Bureau of Investigation-is collected from a voluntary sample., Materials and Methods: Using a journalist-curated database of police-related deaths, we find the SHR police homicide data to be substantially incomplete. This is due to both non-reporting and substantial under-reporting by agencies. Further, our inquiry discloses a pattern of error in identifying "victims" and "offenders" in the data, and finds that investigating agencies are often incorrectly listed as the responsible agency, which seriously jeopardizes police department-level analyses. Finally, there is evidence of sample bias such that the SHR data system is not representative of all police departments, nor is it representative of large police departments., Conclusions: We conclude that the SHR data is of dubious value for assessing correlates of police homicides in the United States, as all analyses using it will reflect these widespread biases and significant undercounts. Analysis of SHR data for these purposes should cease.

Data from the Interplay of Genes and Environment across Multiple Studies (IGEMS) consortium were used to examine predictions of different models of gene-by-environment interaction to understand how genetic variance in self-rated health (SRH) varies at different levels of financial strain. A total of 11,359 individuals from 10 twin studies in Australia, Sweden, and the United States contributed relevant data, including 2,074 monozygotic and 2,623 dizygotic twin pairs. Age ranged from 22 to 98 years, with a mean age of 61.05 (SD = 13.24). A factor model was used to create a harmonized measure of financial strain across studies and items. Twin analyses of genetic and environmental variance for SRH incorporating age, age 2 , sex, and financial strain moderators indicated significant financial strain moderation of genetic influences on self-rated health. Moderation results did not differ across sex or country. Genetic variance for SRH increased as financial strain increased, matching the predictions of the diathesis-stress and social comparison models for components of variance. Under these models, environmental improvements would be expected to reduce genetically based health disparities.

Gang violence remains an ongoing crisis in many communities in the United States. This paper assesses the potential association of gang-occupied neighborhoods with birth outcomes. Adverse birth outcomes serve as a "barometer" of population health, denoting both poor conditions for human development and portending future public health concerns. We draw upon (1) Los Angeles County Vital Statistics Birth Records (2008-2012), (2) GIS information on gang territory boundaries, (3) LA city geo-coded crime data, and (4) the 2010 U.S. Census and 2006-2010 American Community Survey. We find an association between gang-occupied neighborhoods and adverse birth outcomes; however, this association is largely explained by other neighborhood socio-demographic characteristics, crime notwithstanding. We also find that gangland neighborhoods tend to exacerbate the effects of crime for all birth outcomes, but only significantly so for small for gestational age births. Lastly, gang co-residence, crime, and other neighborhood demographics explain a substantial portion of socioeconomic and racial/ethnic disparities in adverse birth outcomes. Gangland neighborhoods appear to be a novel contributor to both population health and health disparities. Future studies should address these relationships in a broad range of metropolitan settings, paying careful attention to causal linkages and moderating effects of gangs and crime.

While lower educational attainment is associated with worse health status, education may also affect one's ability to identify need for urgent care. Using data from the 2010 Medicare CAHPS survey, we estimated multivariate logistic models to test the relationship between self-reported educational attainment and the perceived need for urgent care, controlling for health status and other factors. As expected, lower educational attainment was associated with greater reported need for urgent care in bivariate analyses because of poorer health. However, lower educational attainment was associated with less perceived need for urgent care after controlling for health status, particularly for those in poor health. These findings suggest the need for interventions to improve the likelihood that people with less education recognize the need for urgent care, particularly those in poor health and in most need of urgent care.

Introduction: This study examines COVID-19-associated discrimination regardless of infection status. It evaluates the contribution of various risk factors (e.g., race/ethnicity and wearing a face mask) and the relationship with mental distress among U.S. adults in March and April 2020, when the pandemic escalated across the country., Methods: Participants consisted of a probability-based, nationally representative sample of U.S. residents aged ≥18 years who completed COVID-19-related surveys online in March and April (n=3,665). Multivariable logistic regression was used to predict the probability of a person perceiving COVID-19-associated discrimination. Linear regression was used to analyze the association between discrimination and mental distress. Analyses were conducted in May 2020., Results: Perception of COVID-19-associated discrimination increased from March (4%) to April (10%). Non-Hispanic Black (absolute risk from 0.09 to 0.15 across months) and Asians (absolute risk from 0.11 to 0.17) were more likely to perceive discrimination than other racial/ethnic groups (absolute risk from 0.03 to 0.11). Individuals who wore face masks (absolute risk from 0.11 to 0.14) also perceived more discrimination than those who did not (absolute risk from 0.04 to 0.11). Perceiving discrimination was subsequently associated with increased mental distress (from 0.77 to 1.01 points on the 4-item Patient Health Questionnaire score)., Conclusions: Perception of COVID-19-associated discrimination was relatively low but increased with time. Perceived discrimination was associated with race/ethnicity and wearing face masks and may contribute to greater mental distress during early stages of the pandemic. The long-term implications of this novel form of discrimination should be monitored., (Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To analyze the spatial variation of sociodemographic factors associated with the geographic distribution of new patient visits to otolaryngologists., Study Design: Retrospective cross-sectional analysis., Setting: United States., Subject and Methods: Medicare new patient visits pooled from 2012 to 2016 to otolaryngology providers were obtained from the Centers for Medicare and Medicaid Services, and county-level sociodemographic data were obtained from the 2012-2016 American Community Survey. The mean number of new patient visits per otolaryngology provider by county was calculated. The spatial variation was analyzed with negative binomial and geographically weighted regression. Predictors included various neighborhood characteristics., Results: There were 7,199,129 Medicare new patient visits to otolaryngology providers from 2012 to 2016. A 41.7-fold difference in new patient evaluation rates was observed across US counties (range, 11-458.8 per otolaryngology provider). On multivariable regression analysis, median age, sex, work commute time, percentage insured, and the advantage index of a county were predictors for the rate of new patient visits to otolaryngology providers. However, geographically weighted regression demonstrated that the association of a county's disadvantage index, advantage index, percentage insured, and work commute times with new patient visits per provider varied across space., Conclusions: There are wide geographic differences in the number of new Medicare patients seen by otolaryngologists, and the influence of county sociodemographic factors varied regionally. Further research to analyze the variations in practice patterns of otolaryngologists is warranted to predict future public health needs.

The Interplay of Genes and Environment across Multiple Studies (IGEMS) is a consortium of 18 twin studies from 5 different countries (Sweden, Denmark, Finland, United States, and Australia) established to explore the nature of gene-environment (GE) interplay in functioning across the adult lifespan. Fifteen of the studies are longitudinal, with follow-up as long as 59 years after baseline. The combined data from over 76,000 participants aged 14-103 at intake (including over 10,000 monozygotic and over 17,000 dizygotic twin pairs) support two primary research emphases: (1) investigation of models of GE interplay of early life adversity, and social factors at micro and macro environmental levels and with diverse outcomes, including mortality, physical functioning and psychological functioning; and (2) improved understanding of risk and protective factors for dementia by incorporating unmeasured and measured genetic factors with a wide range of exposures measured in young adulthood, midlife and later life.

Adverse childhood experiences (ACEs) have powerful consequences for health and well-being throughout the life course. We draw on evidence that exposure to ACEs shapes developmental processes central to emotional regulation, impulsivity, and the formation of secure intimate ties to posit that ACEs shape the timing and context of childbearing, which in turn partially mediate the well-established effect of ACEs on women's later-life health. Analysis of 25 years of nationally representative panel data from the National Longitudinal Study of Youth (NLSY79; n = 3,893) indicates that adverse childhood experiences predict earlier age at first birth and greater odds of having a nonmarital first birth. Age and marital status at first birth partially mediate the effect of ACEs on women's health at midlife. Implications for public health and family policy aimed at improving maternal and child well-being are discussed.

Objectives: Prior studies of the health effects of recessions have shown mixed results. Ecological studies often report a positive relationship between economic downturns and population health while individual-level studies often show that conditions related to recessions are deleterious. Our study examines the spatially and temporally heterogenous effects of the Great Recession (TGR) on adverse birth outcomes, a contemporaneous measure of population health that is highly responsive to changing social conditions., Methods: We use restricted birth cohort data from California (2004-2012) merged with both county- and tract-level socio-demographic data, to explore birth selectivity and temporal and unemployment effects during TGR on adverse birth outcomes., Results: We find that gestational exposure - more specifically, second trimester exposure - during or adjacent to the months of TGR was generally deleterious for birth outcomes, more so, in some cases, for mothers with lower levels of education, and that increases in county-level unemployment were generally deleterious for birth outcomes., Conclusions: Although recessionary effects on population health are problematic and may have far-reaching effects, it appears that these effects may be largely universal, even given potential selective fertility favoring advantaged groups., (© 2019 The Authors.)

Background: Previous studies demonstrated a positive association between perceived discrimination and mental health problems among immigrants in countries that traditionally host immigrants. Recent trends in international migration show that there has been a significant increase in immigrant populations in East Asian countries. These newer host countries have different social contexts from traditional ones, yet mental health among these immigrants and its relationship to discrimination are under-researched. Thus, this study aimed to examine the association between perceived discrimination and depressive symptoms among immigrants in one of the newer host countries, South Korea. Moreover, we investigated if differentiated social support (ethnic, host or other support) serves as a moderator of discrimination for depressive symptoms., Methods: This study used survey data from the 2012 Korean Social Survey on Foreign Residents (N = 1068), restricted to adults 20 years or older. Multiple linear regression models were conducted to estimate the association between perceived discrimination, social support, and depressive symptoms among immigrants in South Korea., Results: Perceived discrimination showed a strong positive association with depressive symptoms among immigrants, and ethnic and host support was directly positively associated with depressive symptoms. Furthermore, ethnic support moderated the effects of perceived discrimination on depressive symptoms., Conclusion: Community-level interventions providing immigrants opportunities to increase social networking members from the same country as well as the native-born in a host country may be helpful resources for improving mental health among immigrants in South Korea. Also, raising awareness of racial discrimination among members in South Korea would be crucial.

Objectives: We evaluated the Fatal Encounters (FE) database as an open-source surveillance system for tracking police-related deaths (PRDs)., Methods: We compared the coverage of FE data to several known government sources of police-related deaths and police homicide data. We also replicated incident selection from a recent review of the National Violent Death Reporting System., Results: FE collected data on n = 23,578 PRDs from 2000-2017. A pilot study and ongoing data integration suggest greater coverage than extant data sets. Advantages of the FE data include circumstance of death specificity, incident geo-locations, identification of involved police-agencies, and near immediate availability of data. Disadvantages include a high rate of missingness for decedent race/ethnicity, potentially higher rates of missing incidents in older data, and the exclusion of more comprehensive police use-of-force and nonlethal use-of-force data-a critique applicable to all extant data sets., Conclusions: FE is the largest collection of PRDs in the United States and remains as the most likely source for historical trend comparisons and police-department level analyses of the causes of PRDs., Competing Interests: This project is funded by NICHD grant R01HD093382. All co-authors are at least partially supported by funds from this grant.

We examined whether attained socioeconomic status (SES) moderated genetic and environmental sources of individual differences in cognitive performance using pooled data from 9 adult twin studies. Prior work concerning SES moderation of cognitive performance has focused on rearing SES. The current adult sample of 12,196 individuals (aged 27-98 years) allowed for the examination of common sources of individual differences between attained SES and cognitive performance (signaling potential gene-environment correlation mechanisms, rGE), as well as sources of individual differences unique to cognitive performance (signaling potential gene-environment interaction mechanisms, G × E). Attained SES moderated sources of individual differences in 4 cognitive domains, assessed via performance on 5 cognitive tests ranging 2,149 to 8,722 participants. Attained SES moderated common sources of influences for 3 domains and influences unique to cognition in all 4 domains. The net effect was that genetic influences on the common pathway tended to be relatively more important at the upper end of attained SES indicating possible active rGE, whereas, genetic influences for the unique pathway were proportionally stable or less important at the upper end of attained SES. As a noted exception, at the upper end of attained SES, genetic influences unique to perceptual speed were amplified and genetic influences on the common pathway were dampened. Accounting for rearing SES did not alter attained SES moderation effects on cognitive performance, suggesting mechanisms germane to adulthood. Our findings suggest the importance of gene-environment mechanisms through which attained SES moderates sources of individual differences in cognitive performance. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background: Although evidence has shown that U.S. late-life disability has been declining, studies have also suggested that there has been an increase in chronic diseases between 1984 and 2007., Objectives: To further illuminate these potentially contradictory trends, we explicate how the contribution of chronic conditions changes across four common types of disability (ADL, IADL, mobility disability, and functional limitations) by age (A), period (P), and birth cohorts (C) among adults aged 20 and above., Methods: Our data came from seven cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES). We utilize a cross-classified random effect model (CCREM) to simultaneously estimate age, period, and cohort trends for each disability. Each chronic condition was sequentially then simultaneously added to our base models (sociodemographics only). Reductions in predicted probability from the base model were then calculated for each chronic condition by each temporal dimension (A/P/C) to assess the contribution of each chronic condition., Results: There was increasing age-based contribution of chronic conditions to all disabilities. The period-based contribution remained quite stagnant across years while cohort-based contributions showed a continual decline for recent cohorts. Arthritis showed the greatest contribution to disability of all types which was followed by obesity. Cancer was the least important contributor to disabilities., Conclusion: Although chronic conditions are becoming less disabling across recent cohorts, other competing risk factors might suggest prevailing causes of disability., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Infant mental health is an interdisciplinary professional field of inquiry, practice, and policy that is concerned with alleviating suffering and enhancing the social and emotional competence of young children. The focus of this field of practice is supporting the relationships between infants and toddlers and their primary caregivers to ensure healthy social and emotional development. Notably, the connection between early life experiences and lifelong health has been well established in the scientific literature. Without appropriate regulation from a supportive caregiver, exposure to extreme stressors in early childhood can result in wide-ranging physiological disruptions, including alterations to the developing brain and immune, metabolic, and cardiovascular systems. As part of this interdisciplinary team, pediatric primary care clinicians are in a unique position to incorporate infant mental health practice tenets during their frequent office visits with infants and toddlers. This article provides pediatric primary care clinicians with an overview of infant mental health practice and suggestions for the conscious promotion of positive early relationships as an integral component of well-child care., (Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Black-white differences in U.S. adult mortality have narrowed over the past five decades, but whether this narrowing unfolded on a period or cohort basis is unclear. The distinction has important implications for understanding the socioeconomic, public health, lifestyle, and medical mechanisms responsible for this narrowing. We use data from 1959 to 2009 and age-period-cohort (APC) models to examine period- and cohort-based changes in adult mortality for U.S. blacks and whites. We do so for all-cause mortality among persons aged 15-74 as well as for several underlying causes of death more pertinent for specific age groups. We find clear patterns of cohort-based reductions in mortality for both black men and women and white men and women. Recent cohort-based reductions in heart disease, stroke, lung cancer, female breast cancer, and other cancer mortality have been substantial and, save for breast cancer, have been especially pronounced for blacks. Period-based changes have also occurred and are especially pronounced for some causes of death. Period-based reductions in blacks' and whites' heart disease and stroke mortality are particularly impressive, as are recent period-based reductions in young men's and women's mortality from infectious diseases and homicide. These recent period changes are more pronounced among blacks. The substantial cohort-based trends in chronic disease mortality and recent period-based reductions for some causes of death suggest a continuing slow closure of the black-white mortality gap. However, we also uncover troubling signs of recent cohort-based increases in heart disease mortality for both blacks and whites.

Objectives: This study delineates activities of daily living (ADL) and instrumental activities of daily living (IADL) black-white disparity trends by age, period, and cohort (APC) and explores sociodemographic contributors of cohort-based disparity trends., Method: We utilized multiple cross-sectional waves of National Health Interview Survey data (1982-2009) to describe APC trends of ADL and IADL disparities using a cross-classified random effect model. Further, we decomposed the cohort-based disparity trends using Fairlie's decomposition method for nonlinear outcomes., Results: The crossover ADL and IADL disparities (whites > blacks) occurring at age 75 increased with age and reached a plateau at age of 80, whereas period-based ADL and IADL disparities remained constant for the past 3 decades. The cohort disparity trends for both disabilities showed a decline with each successive cohort except for ADL disparity among women., Discussion: We examined the role of aging on racial disparity in disability and found support for the racial crossover effect. Further, the racial disparity in disability will disappear should the observed pattern of declining cohort-based ADL and IADL disparities persist. Although education, income, and marital status are important sociodemographic contributors to cohort disparity trends, future studies should investigate individual behavioral health determinants and cohort-specific characteristics that explain the cohort-based racial difference in ADL and IADL disabilities., (© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This paper uses data from the U.S. National Health Interview Surveys (N = 1,513,097) to describe and explain temporal patterns in black-white health disparities with models that simultaneously consider the unique effects of age, period, and cohort. First, we employ cross-classified random effects age-period-cohort (APC) models to document black-white disparities in self-rated health across temporal dimensions. Second, we use decomposition techniques to shed light on the extent to which socio-economic shifts in cohort composition explain the age and period adjusted racial health disparities across successive birth cohorts. Third, we examine the extent to which exogenous conditions at the time of birth help explain the racial disparities across successive cohorts. Results show that black-white disparities are wider among the pre-1935 cohorts for women, falling thereafter; disparities for men exhibit a similar pattern but exhibit narrowing among cohorts born earlier in the century. Differences in socioeconomic composition consistently contribute to racial health disparities across cohorts; notably, marital status differences by race emerge as an increasingly important explanatory factor in more recent cohorts for women whereas employment differences by race emerge as increasingly salient in more recent cohorts for men. Finally, our cohort characteristics models suggest that cohort economic conditions at the time of birth (percent large family, farm or Southern birth) help explain racial disparities in health for both men and women., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma-operationalized as living in communities with high levels of anti-gay prejudice-increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR] = 3.03, 95% Confidence Interval [CI] = 1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

While a growing literature has documented a link between neighborhood context and health outcomes, little is known about the relationship between neighborhood characteristics and height. Using individual data from the 1999-2004 U.S. National Health and Nutrition Examination Survey merged with tract-level data from the U.S. Census, we investigate several neighborhood characteristics, including neighborhood socioeconomic status (NSES), education index of concentration at the extremes (ICE), and population density, as potential predictors of height. Employing a series of two-level random intercept models, we find a one standard deviation increase in NSES to be associated with a 0.6-1.4 cm height advantage for white and foreign-born Mexican-American females and for U.S. born Mexican-American males, net of individual-level controls. Similarly, a 10 point increase in neighborhood education ICE was associated with 0.23-0.32 cm greater height for white and foreign-born Mexican-American females and U.S. born Mexican-American males. Population density was nominally negatively associated with height for foreign-born Mexican-American females. Our findings reveal that lower physical stature for some ethnic and gender groups is clustered within neighborhoods of low SES and education, suggesting that contextual factors may play a role in influencing height above individual-level attributes., (Published by Elsevier B.V.)

Objectives: We elucidated how US late-life disability prevalence has changed over the past 3 decades., Methods: We examined activities of daily living (ADL) and instrumental activities of daily living (IADL) disability trends by using age-period-cohort (APC) models among older adults aged 70 years or older who responded to the National Health Interview Survey between 1982 and 2009. We fitted logistic regressions for ADL and IADL disabilities and for each of the 3 APC trends with 2 models: unadjusted and fully adjusted for age, period, cohort, and sociodemographic variables., Results: The unadjusted and adjusted period trends showed a substantial decline in IADL disability, and ADL disability remained stable across time. Unadjusted cohort trends for both outcomes also showed continual declines across successive cohorts; however, increasing cohort trends were evident in the adjusted models., Conclusions: More recent cohorts of US older adults are becoming more disabled, net of aging and period effects. The net upward cohort trends in ADL and IADL disabilities remain unexplained. Further studies should explore cohort-specific determinants contributing to the increase of cohort-based disability among US older adults.

Studies of racial health gaps often find that disparities persist even after adjusting for socioeconomic status (SES). We contend that the persistent residual variation may, in part, be the result of conceptual and methodological problems in the operationalization of SES. These include inadequate attention to the content validity of SES measures and insufficient adjustments for SES differences across racial groups. Using data from the 1997-2007 U.S. Panel Study of Income Dynamics (N = 9932), we use longitudinal and multi-level measures of SES and apply a propensity score adjustment strategy to examine the black/white disparity in self-rated health. Compared to conventional regression estimates that yield unexplained racial health gaps, propensity score adjustment accounts for the entire racial disparity in self-rated health. Results suggest that previous studies may have inadequately adjusted for differences in SES across racial groups, that social factors should be carefully and conscientiously considered, and that acknowledgment of the possibility of incomplete SES adjustments should be weighed before any inferences to non-SES etiology can be made., (Published by Elsevier Ltd.)

Little research has been conducted on how differing spatial resolutions or classification techniques affect image-driven identification and categorization of slum neighborhoods in developing nations. This study assesses the correlation between satellite-derived land cover and census-derived socioeconomic variables in Accra, Ghana to determine whether the relationship between these variables is altered with a change in spatial resolution or scale. ASTER and Landsat TM satellite images are each used to classify land cover using spectral mixture analysis (SMA), and land cover proportions are summarized across Enumeration Areas in Accra and compared to socioeconomic data for the same areas. Correlation and regression analyses compare the SMA results with a Slum Index created from various socio-economic data taken from the Census of Ghana, as well as to data derived from a "hard" per-pixel classification of a 2.4 m Quickbird image. Results show that the vegetation fraction is significantly correlated with the Slum Index (Pearson's r ranges from -0.33 to -0.51 depending on which image-derived product is compared), and the use of a spatial error model improves results (multivariate model pseudo- R 2 ranges from 0.37 to 0.40 by image product). We also find that SMA products derived from ASTER are a sufficient substitute for classification products derived from higher spatial resolution QB data when using land cover fractions as a proxy for slum presence, suggesting that SMA might be more cost-effective for deriving land cover fractions than the use of high-resolution imagery for this type of demographic analysis.

This study explores socio-economic gradients in height (stature-for-age) among a nationally representative sample of 2-6 year old children in the United States. We use NHANES III (1988-1994) Youth data linked with a special Natality Data supplement which contains information from birth certificates among sampled NHANES III Youth who are < 7 years of age. Our results indicate significant socio-economic gradients for both maternal education and family income, net of controls for confounders, including: birth weight, gestational age, family size, and parental heights. These results are in stark contrast to those from other developed countries that seem to indicate diminished or eliminated socio-economic disparities, net of known confounders. In the United States, it appears that socio-economic gradients have an effect on birth outcomes, and continue to have an additional direct and independent effect on height, even in early childhood., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Neighborhood social ecologies may have protective effects on depression in Latinos, after adjusting for demographic risk factors, such as nativity and length of stay in the US. This study examines the effects of neighborhood collective efficacy and linguistic isolation on depression in a heterogeneous urban Latino population from 1,468 adult respondents in Los Angeles County. We used multilevel models to analyze how major depression is associated with socioeconomic background, length of stay in the U.S., neighborhood collective efficacy and linguistic isolation among Latinos. A significant cross-level interaction effect was found between collective efficacy and foreign-born Latinos who resided in the US ≥ 15 years. We report cross-level interaction effects between linguistic isolation and nativity for U.S.-born and nativity and duration of residence for foreign-born Latinos who had lived in the U.S. at least 15 years. The moderating effects reported in this study suggest that the benefits of neighborhood collective efficacy and linguistic isolation vary by Latino subgroup and are conceptually discrete forms of social capital and offer insights for community based interventions.

Objective: To assess whether neighbourhood socioeconomic status (NSES) is independently associated with disparities in biological 'wear and tear' measured by allostatic load in a nationally representative sample of US adults., Design: Cross-sectional study., Setting: Population-based US survey, the Third National Health and Nutrition Examination Survey (NHANES III), merged with US census data describing respondents' neighbourhoods., Participants: 13,184 adults from 83 counties and 1805 census tracts who completed NHANES III interviews and medical examinations and whose residential addresses could be reliably geocoded to census tracts., Main Outcome Measures: A summary measure of biological risk, incorporating nine biomarkers that together represent allostatic load across metabolic, cardiovascular and inflammatory subindices., Results: Being male, older, having lower income, less education, being Mexican-American and being both black and female were all independently associated with a worse allostatic load. After adjusting for these characteristics, living in a lower NSES was associated with a worse allostatic load (coefficient -0.46; CI -0.079 to -0.012). The relationship between NSES and allostatic load did not vary significantly by gender or race/ethnicity., Conclusions: Living in a lower NSES in the USA is associated with significantly greater biological wear and tear as measured by the allostatic load, and this relationship is independent of individual SES characteristics. Our findings show that where one lives is independently associated with allostatic load, thereby suggesting that policies that improve NSES may also yield health returns.

We investigate an alternative conceptualization of neighborhood context and its association with health. Using an index that measures a continuum of concentrated advantage and disadvantage, we examine whether the relationship between neighborhood conditions and health varies by socio-economic status. Using NHANES III data geocoded to census tracts, we find that while largely uneducated neighborhoods are universally deleterious, individuals with more education benefit from living in highly educated neighborhoods to a greater degree than individuals with lower levels of education., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Background: Insomnia is the most commonly reported sleep disorder, characterized by trouble falling asleep, staying asleep, or waking up too early. Previous epidemiological data reveal that women are more likely than men to suffer from insomnia symptoms. We investigate the role that mental health history plays in explaining the gender disparity in insomnia symptoms., Methods: Using logistic regression, we analyze National Health and Nutritional Examination Survey (NHANES) III interview and laboratory data, merged with data on sociodemographic characteristics of the residential census tract of respondents. Our sample includes 5469 young adults (ages 20-39) from 1429 census tracts., Results: Consistent with previous research, we find that women are more likely to report insomnia symptoms compared to men (16.7% vs. 9.2%). However, in contrast to previous work, we show that the difference between women's and men's odds of insomnia becomes statistically insignificant after adjusting for history of mental health conditions (OR=1.08, p>.05)., Conclusions: The gender disparity in insomnia symptoms may be driven by higher prevalence of affective disorders among women. This finding has implications for clinical treatment of both insomnia and depression, especially among women.

Objective: Single-year estimates of health disparities in small racial/ethnic groups are often insufficiently precise to guide policy, whereas estimates that are pooled over multiple years may not accurately describe current conditions. While collecting additional data is costly, innovative analytic approaches may improve the accuracy and utility of existing data. We developed an application of the Kalman filter in order to make more efficient use of extant data., Data Source: We used 1997-2004 National Health Interview Survey data on the prevalence of health outcomes for two racial/ethnic subgroups: American Indians/Alaska Natives and Chinese Americans., Study Design: We modified the Kalman filter to generate more accurate current-year prevalence estimates for small racial/ethnic groups by efficiently aggregating past years of cross-sectional survey data within racial/ethnic groups. We compared these new estimates and their accuracy to simple current-year prevalence estimates., Principal Findings: For 18 of 19 outcomes, the modified Kalman filter approach reduced the error of current-year estimates for each of the two groups by 20-35 percent-equivalent to increasing current-year sample sizes for these groups by 56-135 percent., Conclusions: This approach could increase the accuracy of health measures for small groups using extant data, with virtually no additional cost other than those related to analytical processes.

Most national health surveys do not permit precise measurement of the health of racial/ethnic subgroups that comprise <1 per cent of the U.S. population. We identify three potentially promising sample design strategies for increasing the accuracy of national health estimates for a small target subgroup when used to supplement a small probability sample of that group and apply these strategies to American Indians/Alaska Natives (AI/AN) and Chinese using National Health Interview Survey data. These sample design strategies include (1) complete sampling of targets within households, (2) oversampling selected macrogeographic units, and (3) oversampling from an incomplete list frame. Stage (1) is promising for Chinese and AI/AN; (2) works for both groups, but it would be more cost-effective for AI/AN because of their greater residential concentration; (3) is somewhat effective for groups like Chinese with viable surname lists, but not for AI/AN. Both (2) and (3) efficiently improve measurement precision when the supplement is the same size as the existing core sample, with diminishing additional returns as the supplement grows relative to the core sample, especially for (3). To avoid large design effects, the oversampled geographic areas or lists must have good coverage of the target population. To reduce costs, oversampled geographic tracts and lists must consist primarily of targets. These techniques can be used simultaneously to substantially increase effective sample sizes (ESSs). For example, (1) and (2) in combination can be used to multiply the nominal sample size of AI/AN or Chinese by 8 and the ESS by 4.

Background: Socioeconomic and racial-ethnic disparities in health status across the United States are large and persistent. Obesity rates are rising faster in black and Hispanic populations than in white populations, and they foreshadow even greater disparities in chronic illnesses such as diabetes and cardiovascular disease in years to come. Factors that influence dietary intake of fruit and vegetables in these populations are only partly understood., Objectives: We examined associations between fruit and vegetable intake and neighborhood socioeconomic status (SES), analyzed whether neighborhood SES explains racial differences in intake, and explored the extent to which neighborhood SES has differential effects by race-ethnicity of US adults., Design: Using geocoded residential addresses from the Third National Health and Nutrition Examination Survey, we merged individual-level data with county and census tract-level US Census data. We estimated 3-level hierarchical models predicting fruit and vegetable intake with individual characteristics and an index of neighborhood SES as explanatory variables., Results: Neighborhood SES was positively associated with fruit and vegetable intake: a 1-SD increase in the neighborhood SES index was associated with consumption of nearly 2 additional servings of fruit and vegetables per week. Neighborhood SES explained some of the black-white disparity in fruit and vegetable intake and was differentially associated with fruit and vegetable intake among whites, blacks, and Mexican Americans., Conclusions: The positive association of neighborhood SES with fruit and vegetable intake is one important pathway through which the social environment of neighborhoods affects population health and nutrition for whites, blacks, and Hispanics in the United States.

In prior research, neighborhood effects have often been weak or inconsistent in predicting specific causes of mortality and morbidity. To determine whether residential neighborhood effects are suppressed by exposure to other environments, we examined the effect on adult self-rated health of non-residential environments that figure in individuals' daily routines. We linked the 2000 US Census data with the Los Angeles Family and Neighborhood Study (L.A.FANS) database, which consists of 3323 adults sampled from neighborhoods in LA County. Characteristics of census tracts where respondents lived, worked, shopped, sought medical care, worshipped and spent "other" time were obtained from the 2000 US Census. Weighted multilevel linear and clustered generalized ordered logistic regressions were used to estimate associations between self-rated health and non-residential neighborhood exposures after adjustment for individual-level factors and exposure to residential neighborhoods. We found that residence in disadvantaged neighborhoods was associated with worse self-rated health. In a dose-response fashion, the greater the exposure to less disadvantaged non-residential neighborhoods in the course of routine activities, the greater the magnitude in improved self-rated health. Models including non-residential neighborhood exposure increase the magnitude and significance of the association between residential neighborhoods and health. In conclusion, individuals' exposure to non-residential neighborhoods confounds and suppresses the association of residential neighborhoods with health and could explain why previous studies may not have found robust associations between residential neighborhood predictors and health.

A growing body of literature has documented a link between neighborhood context and health outcomes. However, little is known about the relationship between neighborhood context and body mass index (BMI) or whether the association between neighborhood context and BMI differs by ethnicity. This paper investigates several neighborhood characteristics as potential explanatory factors for the variation of BMI across the United States; further, this paper explores to what extent segregation and the concentration of disadvantage across neighborhoods help explain ethnic disparities in BMI. Using data geo-coded at the census tract-level and linked with individual-level data from the Third National Health and Examination Survey in the United States (U.S.), we find significant variation in BMI across U.S. neighborhoods. In addition, neighborhood characteristics have a significant association with body mass and partially explain ethnic disparities in BMI, net of individual-level adjustments. These data also reveal evidence that ethnic enclaves are not in fact advantageous for the body mass index of Hispanics-a relationship counter to what has been documented for other health outcomes.

Objective: To determine how Hispanic residential concentration moderates the relationship between neighborhood collective efficacy and teenage birth rates., Design: Cross-sectional analysis of census tract level survey data and birth records., Setting: Sixty-five Los Angeles (California) County census tracts in 2000 and 2001., Participants: Measures of neighborhood collective efficacy from 2600 adults from the Los Angeles Family and Neighborhood Study (LAFANS) survey were linked with demographic information from the US 2000 Census and Los Angeles County birth records for 10- through 19-year-old mothers., Main Exposures: Collective efficacy and Hispanic residential concentration., Main Outcome Measures: Married and unmarried teenage birth rates., Results: In census tracts with less than a 50% Hispanic population, a 1-SD increase in collective efficacy was associated with a 5.07 births per 1000 decrease in the unmarried teenage birth rate (P<.05). In census tracts with a 50% or greater Hispanic population, a 1-SD increase in collective efficacy was not statistically related to unmarried rates, but it was associated with a 3.43 increase in the married teenage birth rate (P<.05)., Conclusions: Collective efficacy may help reduce adolescent childbearing in some, but not all, neighborhoods. An interaction between collective efficacy and Hispanic population concentration suggests cultural variation may play a role in how collective efficacy influences adolescent fertility. Possible explanations for the positive relationship between collective efficacy and married birth rates found in segregated Hispanic neighborhoods include profertility orientations and availability of childrearing networks for young parents. To help harness social capital to improve public health outcome, we suggest future studies examine the role of community cultural variation.

Background: Residents in poor neighborhoods have higher body mass index (BMI) and eat less healthfully. One possible reason might be the quality of available foods in their area. Location of grocery stores where individuals shop and its association with BMI were examined., Methods: The 2000 U.S. Census data were linked with the Los Angeles Family and Neighborhood Study (L.A.FANS) database, which consists of 2620 adults sampled from 65 neighborhoods in Los Angeles County between 2000 and 2002. In 2005, multilevel linear regressions were used to estimate the associations between BMI and socioeconomic characteristics of grocery store locations after adjustment for individual-level factors and socioeconomic characteristics of residential neighborhoods., Results: Individuals have higher BMI if they reside in disadvantaged areas and in areas where the average person frequents grocery stores located in more disadvantaged neighborhoods. Those who own cars and travel farther to their grocery stores also have higher BMI. When controlling for grocery store census tract socioeconomic status (SES), the association between residential census tract SES and BMI becomes stronger., Conclusions: Where people shop for groceries and distance traveled to grocery stores are independently associated with BMI. Exposure to grocery store mediates and suppresses the association of residential neighborhoods with BMI and could explain why previous studies may not have found robust associations between residential neighborhood predictors and BMI.

Social determinants have been identified as a fundamental cause of health and disease in most industrialized countries. However, much less is known about which characteristics of communities may lead to disparities in health outcomes. Collective efficacy--the willingness of community members to look out for each other and intervene when trouble arises--is a social factor shown to be associated with outcomes related to obesity, including premature mortality and cardiovascular disease. The objective of this study is to determine whether neighborhood collective efficacy is associated with individual measures of body mass index (BMI) in adolescents. We use a multi-level, cross-sectional survey in Los Angeles County, involving 807 adolescents in 684 households in 65 neighborhoods in addition to a sample of 3000 adult respondents. The main outcomes measures are BMI, at risk of overweight, and overweight status. Using a two-level model, we find significant relationships between collective efficacy and all three outcomes, net of levels of neighborhood disadvantage. The associations between BMI and collective efficacy could potentially be explained by several factors, including a metabolic pathway, neighborhood differences in the physical and social environments, or a combination of these two. If group-level collective efficacy is indeed important in the regulation of individual-level net energy balance, it suggests that future interventions to control weight by addressing the social environment at the community level may be promising.