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Dulin A, Risica PM, Mello J, Ahmed R, Carey KB, Cardel M, Howe CJ, Nadimpalli S, Gans KM. Examining neighborhood and interpersonal norms and social support on fruit and vegetable intake in low-income communities. BMC Public Health 2018; 18:455. [PMID: 29621989 PMCID: PMC5887203 DOI: 10.1186/s12889-018-5356-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 03/22/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We examined whether neighborhood-, friend-, and family- norms and social support for consumption and purchase of fruits and vegetables (F&V) were associated with F&V intake among low-income residents in subsidized housing communities. We examined baseline data from a study ancillary to the Live Well/Viva Bien intervention. Participants included 290 residents in four low-income subsidized housing sites who were ≥ 18 years of age, English and/or Spanish speaking, and without medical conditions that prevented consumption of F&V. METHODS Linear regression models examined associations of norms and social support with F&V intake after adjustments for sociodemographic characteristics. RESULTS In the analysis, neighborhood social support for F&V was associated with a 0.31 cup increase in F&V intake (95% CI = 0.05, 0.57). The family norm for eating F&V and family social support for eating F&V were associated with a 0.32 cup (95% CI = 0.13, 0.52) and 0.42 cup (95% CI = 0.19, 0.64) increase in F&V intake, respectively. CONCLUSIONS To our knowledge, no other studies have examined neighborhood, family, and peer norms and social support simultaneously and in relation to F&V intake. These findings may inform neighborhood interventions and community-level policies to reduce neighborhood disparities in F&V consumption.
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Affiliation(s)
- Akilah Dulin
- Behavioral and Social Sciences, Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Patricia M Risica
- Behavioral and Social Sciences, Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Rashid Ahmed
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Kate B Carey
- Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912, USA
| | - Michelle Cardel
- Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 2197 Mowry Road, 132, PO Box 100177, Gainsville, FL, 32610, USA
| | - Chanelle J Howe
- Epidemiology, Brown University School of Public Health, Box G-S121-2, Providence, RI, 02912, USA
| | - Sarah Nadimpalli
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Kim M Gans
- Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, Unit 1058, Room 320, Storrs, CT, 06269, USA
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McClure E, Feinstein L, Ferrando-Martínez S, Leal M, Galea S, Aiello AE. The Great Recession and Immune Function. THE RUSSELL SAGE FOUNDATION JOURNAL OF THE SOCIAL SCIENCES : RSF 2018; 4:62-81. [PMID: 30288397 PMCID: PMC6168205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Great Recession precipitated unprecedented home foreclosures increases, but documentation of related neighborhood changes and population health is scant. Using the Detroit Neighborhood Health Study (N = 277), we examined associations between neighborhood-level recession indicators and thymic function, a life course immunological health indicator. In covariate-adjusted multilevel models, each 10 percentage point increase in abandoned home prevalence and 1 percentage point increase in 2009 home foreclosures was associated with 1.7-year and 3.3-year increases in thymic aging, respectively. Associations attenuated after adjustment for neighborhood-level social cohesion, suggesting community ties may buffer recession-related immune aging. Effects of neighborhood stressors were strongest in middle-income households, supporting theory of excess vulnerability in this group. Future research should assess whether ongoing foreclosure and blight reduction efforts improve health for residents of recession impacted neighborhoods.
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Affiliation(s)
- Elizabeth McClure
- The Carolina Population Center and Department of Epidemiology, University of North Carolina at Chapel Hill
| | | | | | - Manuel Leal
- The Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocio University Hospital, Seville, Spain
| | | | - Allison E Aiello
- The Carolina Population Center and Department of Epidemiology, University of North Carolina at Chapel Hill
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Prescott SL, Logan AC. Each meal matters in the exposome: Biological and community considerations in fast-food-socioeconomic associations. ECONOMICS AND HUMAN BIOLOGY 2017; 27:328-335. [PMID: 29107462 DOI: 10.1016/j.ehb.2017.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 06/07/2023]
Abstract
Advances in omics and microbiome technology have transformed the ways in which the biological consequences of life in the 'ecological theatre' can be visualized. Exposome science examines the total accumulated environmental exposures (both detrimental and beneficial) as a means to understand the response of the 'total organism to the total environment' over time. The repetitive stimulation of compensatory physiological responses (immune, cardiovascular, neuroendocrine) in response to stress - including sources of stress highly relevant to socioeconomic disadvantage - may lead to metabolic dysregulation and cellular damage, ultimately influencing behavior and disease. The collective toll of physiological wear and tear, known as allostatic load, is not paid equally throughout developed societies. It is paid in excess by the disadvantaged. In the context of fast-food, human and experimental research demonstrates that the biological response to a single fast-food-style meal - especially as mediated by the microbiome- is a product of the person's total lived experience, including the ability to buffer the fast-food meal-induced promotion of inflammation and oxidative stress. Emerging research indicates that each meal and its nutritional context matters. As we discuss, equal weekly visits to major fast-food outlets by the affluent and deprived do not translate into biological equivalency. Hence, debate concerning reducing fast-food outlets through policy - especially in disadvantaged neighborhoods where they are prevalent - requires a biological context. The fast-food establishment and fast-food meal - as they represent matters of food justice and press upon non-communicable disease risk - are far more than physical structures and collections of carbohydrate, fat, sugar and sodium.
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Affiliation(s)
- Susan L Prescott
- School of Medicine, University of Western Australia, PO Box D184, Princess Margaret Hospital, Perth, WA, 6001, Australia; International Inflammation (in-FLAME) Network, Research Group of the Worldwide Universities Network (WUN), 6010 Park Ave, Suite #4081, West New York, NJ, 07093, United States.
| | - Alan C Logan
- International Inflammation (in-FLAME) Network, Research Group of the Worldwide Universities Network (WUN), 6010 Park Ave, Suite #4081, West New York, NJ, 07093, United States
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Lippert AM, Evans CR, Razak F, Subramanian SV. Associations of Continuity and Change in Early Neighborhood Poverty With Adult Cardiometabolic Biomarkers in the United States: Results From the National Longitudinal Study of Adolescent to Adult Health, 1995-2008. Am J Epidemiol 2017; 185:765-776. [PMID: 28379315 PMCID: PMC5860310 DOI: 10.1093/aje/kww206] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 07/01/2016] [Accepted: 07/12/2016] [Indexed: 02/07/2023] Open
Abstract
Limitations of extant research on neighborhood disadvantage and health include general reliance on point-in-time neighborhood measures and sensitivity to residential self-selection. Using data from the US Census and the 1995-2008 National Longitudinal Study of Adolescent to Adult Health, we applied conventional methods and coarsened exact matching to assess how cardiometabolic health varies among those entering, exiting, or remaining in poor and nonpoor neighborhoods. Within the full sample (n = 11,767), we found significantly higher systolic and diastolic blood pressures among those who entered or consistently lived in poor neighborhoods relative to those who never lived in poor neighborhoods. Obesity was similarly more common among those who originated from poor neighborhoods than among those who originated from nonpoor neighborhoods. Having exited poor neighborhoods was associated with lower systolic blood pressure than was consistent residence in low-income communities. Among the matched sample (n = 9,727), results adjusted for confounders and residential self-selection revealed fewer significant contrasts. Compared with peers who had no neighborhood poverty exposure, those who consistently lived in poor neighborhoods had 46% and 52% higher odds of being obese or hypertensive, respectively. Those who exited neighborhood poverty had significantly higher diastolic blood pressures than those who had never lived in poor neighborhoods. These findings underscore the importance of past as well as current residential circumstances for cardiometabolic health.
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Affiliation(s)
- Adam M. Lippert
- Correspondence to Dr. Adam M. Lippert, University of Colorado Denver, 1380 Lawrence Street, Suite 420, Denver, CO 80204 (e-mail: )
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Howard VJ, McClure LA, Kleindorfer DO, Cunningham SA, Thrift AG, Diez Roux AV, Howard G. Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites. Neurology 2016; 87:2340-2347. [PMID: 27742815 DOI: 10.1212/wnl.0000000000003299] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/19/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the relationship between neighborhood socioeconomic characteristics and incident stroke in a national cohort of black and white participants. METHODS The study comprised black (n = 10,274, 41%) and white (n = 14,601) stroke-free participants, aged 45 and older, enrolled in 2003-2007 in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort. A neighborhood socioeconomic score (nSES) was constructed using 6 neighborhood variables. Incident stroke was defined as first occurrence of stroke over an average 7.5 (SD 3.0) years of follow-up. Proportional hazards models were used to estimate associations between nSES score and incident stroke, adjusted for demographics (age, race, sex, region), individual socioeconomic status (SES) (education, household income), and other risk factors for stroke. RESULTS After adjustment for demographics, compared to the highest nSES quartile, stroke incidence increased with each decreasing nSES quartile. The hazard ratio (95% confidence interval) ranged from 1.28 (1.05-1.56) in quartile 3 to 1.38 (1.13-1.68) in quartile 2 to 1.56 (1.26-1.92) in quartile 1 (p < 0.0001 for linear trend). After adjustment for individual SES, the trend remained marginally significant (p = 0.085). Although there was no evidence of a differential effect by race or sex, adjustment for stroke risk factors attenuated the association between nSES and stroke in both black and white participants, with greater attenuation in black participants. CONCLUSIONS Risk of incident stroke increased with decreasing nSES but the effect of nSES is attenuated through individual SES and stroke risk factors. The effect of neighborhood socioeconomic characteristics that contribute to increased stroke risk is similar in black and white participants.
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Affiliation(s)
- Virginia J Howard
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia.
| | - Leslie A McClure
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - Dawn O Kleindorfer
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - Solveig A Cunningham
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - Amanda G Thrift
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - Ana V Diez Roux
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
| | - George Howard
- From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia
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Puckrein GA, Egan BM, Howard G. Social and Medical Determinants of Cardiometabolic Health: The Big Picture. Ethn Dis 2015; 25:521-4. [PMID: 26673674 DOI: 10.18865/ed.25.4.521] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cardiometabolic diseases, including diabetes and heart disease, account for >12 million years of life lost annually among Black adults in the United States. Health disparities are geographically localized, with ~80% of health disparities occurring within ~6000 (16%) of all 38,000 US ZIP codes. Socio-economic status (SES), behavioral and environmental factors (social determinants) account for ~80% of variance in health outcomes and cluster geographically. Neighborhood SES is inversely associated with prevalent diabetes and hypertension, and Blacks are four times more likely than Whites to live in lowest SES neighborhoods. In ZIP code 48235 (Detroit, 97% Black, 16.2% unemployed, income/capita $18,343, 23.6% poverty), 1082 Medicare fee-for service (FFS) beneficiaries received care for type 2 diabetes (T2D) and coronary artery disease (CAD) in 2012. Collectively, these beneficiaries had 1082 inpatient admissions and 839 emergency department visits, mean cost $27,759/beneficiary and mortality 2.7%. Nationally in 2011, 236,222 Black Medicare FFS beneficiaries had 213,715 inpatient admissions, 191,346 emergency department visits, mean cost $25,580/beneficiary and 2.4% mortality. In addition to more prevalent hypertension and T2D, Blacks appear more susceptible to clinical complications of risk factors than Whites, including hypertension as a contributor to stroke. Cardiometabolic health equity in African Americans requires interventions on social determinants to reduce excess risk prevalence of risk factors. Social-medical interventions to promote timely access to, delivery of and adherence with evidence-based medicine are needed to counterbalance greater disease susceptibility. Place-based interventions on social and medical determinants of health could reduce the burden of life lost to cardiometabolic diseases in Blacks.
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Affiliation(s)
| | - Brent M Egan
- 2. Care Coordination Institute, Greenville Health System, University of South Carolina School of Medicine, Greenville, South Carolina
| | - George Howard
- 3. University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama
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Dulin-Keita A, Clay O, Whittaker S, Hannon L, Adams IK, Rogers M, Gans K. The influence of HOPE VI neighborhood revitalization on neighborhood-based physical activity: A mixed-methods approach. Soc Sci Med 2015; 139:90-9. [PMID: 26164364 DOI: 10.1016/j.socscimed.2015.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study uses a mixed methods approach to 1) identify surrounding residents' perceived expectations for Housing Opportunities for People Everywhere (HOPE VI) policy on physical activity outcomes and to 2) quantitatively examine the odds of neighborhood-based physical activity pre-/post-HOPE VI in a low socioeconomic status, predominantly African American community in Birmingham, Alabama. METHODS To address aim one, we used group concept mapping which is a structured approach for data collection and analyses that produces pictures/maps of ideas. Fifty-eight residents developed statements about potential influences of HOPE VI on neighborhood-based physical activity. In the quantitative study, we examined whether these potential influences increased the odds of neighborhood walking/jogging. We computed block entry logistic regression models with a larger cohort of residents at baseline (n = 184) and six-months (n = 142, 77% retention; n = 120 for all informative variables). We examined perceived neighborhood disorder (perceived neighborhood disorder scale), walkability and aesthetics (Neighborhood Environment Walkability Scale) and HOPE VI-related community safety and safety for physical activity as predictors. RESULTS During concept mapping, residents generated statements that clustered into three distinct concepts, "Increased Leisure Physical Activity," "Safe Play Areas," and "Generating Health Promoting Resources." The quantitative analyses indicated that changes in neighborhood walkability increased the odds of neighborhood-based physical activity (p = 0.04). When HOPE VI-related safety for physical activity was entered into the model, it was associated with increased odds of physical activity (p = 0.04). Walkability was no longer statistically significant. CONCLUSIONS These results suggest that housing policies that create walkable neighborhoods and that improve perceptions of safety for physical activity may increase neighborhood-based physical activity. However, the longer term impacts of neighborhood-level policies on physical activity require more longitudinal evidence to determine whether increased participation in physical activity is sustained.
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Affiliation(s)
- Akilah Dulin-Keita
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Olivio Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Shannon Whittaker
- Institute for Community Health Promotion, Department of Behavioral and Social Sciences, Brown University, Box G-S121-2, Providence, RI 02912, USA.
| | - Lonnie Hannon
- Department of Sociology, Tuskegee University, Tuskegee, AL 36088, USA.
| | - Ingrid K Adams
- School of Human Environmental Sciences, University of Kentucky, Lexington, KY 40506, USA.
| | - Michelle Rogers
- College of Computing and Informatics, Drexel University, Philadelphia, PA 19104, USA.
| | - Kim Gans
- Center for Health, Intervention and Prevention, Department of Human Development & Family Studies, 348 Mansfield Road, Unit 1058 Room 330, University of Connecticut, Storrs, CT 06269, USA.
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Logan AC. Dysbiotic drift: mental health, environmental grey space, and microbiota. J Physiol Anthropol 2015; 34:23. [PMID: 25947328 PMCID: PMC4438628 DOI: 10.1186/s40101-015-0061-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/23/2015] [Indexed: 02/07/2023] Open
Abstract
Advances in research concerning the mental health implications of dietary patterns and select nutrients have been remarkable. At the same time, there have been rapid increases in the understanding of the ways in which non-pathogenic microbes can potentially influence many aspects of human health, including those in the mental realm. Discussions of nutrition and microbiota are often overlapping. A separate, yet equally connected, avenue of research is that related to natural (for example, green space) and built environments, and in particular, how they are connected to human cognition and behaviors. It is argued here that in Western industrial nations a ‘disparity of microbiota’ might be expected among the socioeconomically disadvantaged, those whom face more profound environmental forces. Many of the environmental forces pushing against the vulnerable are at the neighborhood level. Matching the developing microbiome research with existing environmental justice research suggests that grey space may promote dysbiosis by default. In addition, the influence of Westernized lifestyle patterns, and the marketing forces that drive unhealthy behaviors in deprived communities, might allow dysbiosis to be the norm rather than the exception in those already at high risk of depression, subthreshold (subsyndromal) conditions, and subpar mental health. If microbiota are indeed at the intersection of nutrition, environmental health, and lifestyle medicine (as these avenues pertain to mental health), then perhaps the rapidly evolving gut-brain-microbiota conversation needs to operate through a wider lens. In contrast to the more narrowly defined psychobiotic, the term eco-psychotropic is introduced.
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Affiliation(s)
- Alan C Logan
- CAMNR, 23679 Calabasas Road Suite 542, Calabasas, CA, 91302, USA.
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