Associations of neighborhood problems and neighborhood social cohesion with mental health and health behaviors: The Multi-Ethnic Study of Atherosclerosis

Collective efficacy, alcohol outlet density, and young men's alcohol use in rural South Africa

Alcohol use contributes to morbidity and mortality in developing countries by increasing the risk of trauma and disease, including alcohol dependence. Limited research addresses determinants of alcohol use beyond the individual level in sub-Saharan Africa. We test the association of community collective efficacy and alcohol outlet density with young men's drinking in a cross-sectional, locally representative survey conducted in rural northeast South Africa. Informal social control and cohesion show protective associations with men's heavy drinking, while alcohol outlet density is associated with more potential problem drinking. These findings provide initial support for intervening at the community level to promote alcohol reduction.

The influence of parental nativity, neighborhood disadvantage and the built environment on physical activity behaviors in Latino youth

Little evidence exists examining if parental nativity, neighborhood disadvantage and built environment features are associated with physical activity behaviors in Latino youth. We used a representative sample of Latino youth (n = 616) living in New Jersey to examine parental nativity associations with active transport to school, active use of sidewalks, use of local neighborhood parks, and use of neighborhood physical activity facilities. We estimated prevalence ratios (PR) that accounted for the complex survey design. Latino youth with foreign-born parents were generally more active than their US-born peers, and those with parents in the US 10 years or less were more likely to engage in active transport to school (PR = 1.51, 95% CI 1.04-2.21), after adjusting for census-based neighborhood disadvantage, self-reported neighborhood measures, and geocoded distance to school. Parental nativity status should be considered in policies or interventions designed to increase physical activity among Latino youth.

Transnational, social, and neighborhood ties and smoking among Latino immigrants: does gender matter?

OBJECTIVES

We examined whether transnational ties, social ties, and neighborhood ties were independently associated with current smoking status among Latino immigrants. We also tested interactions to determine whether these associations were moderated by gender.

METHODS

We conducted a series of weighted logistic regression analyses (i.e., economic remittances, number of return visits, friend support, family support, and neighborhood cohesion) using the Latino immigrant subsample (n = 1629) of the National Latino and Asian American Study in 2002 and 2003.

RESULTS

The number of past-year return visits to the country-of-origin was positively associated with current smoker status. Gender moderated the association between economic remittances, friend support, and smoking. Remittance behavior had a protective association with smoking, and this association was particularly pronounced for Latino immigrant women. Friendship support lowered the odds of smoking among men, but not women.

CONCLUSIONS

Our results underscore the growing importance of transnational networks for understanding Latino immigrant health and the gendered patterns of the associations between social ties, transnational ties, and health risk behaviors.

Effectiveness of a walking group intervention to promote physical activity and cardiovascular health in predominantly non-Hispanic black and Hispanic urban neighborhoods: findings from the walk your heart to health intervention

OBJECTIVES

The purpose of this study was to evaluate the effectiveness of the Walk Your Heart to Health (WYHH) intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk among non-Hispanic Black and Hispanic residents of Detroit, Michigan. The study was designed and implemented using a community-based participatory research approach that actively engaged community residents, health service providers and academic researchers. It was implemented between 2009 and 2012.

METHOD

WYHH was a 32-week community health promoter-facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45 to 90 minutes (increasing over time). The study used a cluster randomized control design to evaluate effectiveness of WYHH, with participants randomized into intervention or lagged intervention (control) groups. Psychosocial, clinical, and anthropometric data were collected at baseline, 8, and 32 weeks, and pedometer step data tracked using uploadable peisoelectric pedometers.

RESULTS

Participants in the intervention group increased steps significantly more during the initial 8-week intervention period, compared with the control group (β = 2004.5, p = .000). Increases in physical activity were associated with reductions in systolic blood pressure, fasting blood glucose, total cholesterol, waist circumference and body mass index at 8 weeks, and maintained at 32 weeks.

CONCLUSION

The WYHH community health promoter-facilitated walking group intervention was associated with significant reductions in multiple indicators of cardiovascular risk among predominantly Hispanic and non-Hispanic Black participants in a low-to-moderate income urban community. Such interventions can contribute to reductions in racial, ethnic, and socioeconomic inequities in cardiovascular mortality.

Change in neighborhood environments and depressive symptoms in New York City: the Multi-Ethnic Study of Atherosclerosis

Physical and social features of neighborhoods, such as esthetic environments and social cohesion, change over time. The extent to which changes in neighborhood conditions are associated with changes in mental health outcomes has not been well-established. Using data from the MultiEthnic Study of Atherosclerosis, this study investigated the degree to which neighborhood social cohesion, stress, violence, safety and/or the esthetic environment changed between 2002 and 2007 in 103 New York City Census tracts and the associations of these changes with changes in depressive symptoms. Neighborhoods became less stressful, more socially cohesive, safer, and less violent. White, wealthy, highly educated individuals tended to live in neighborhoods with greater decreasing violence and stress and increasing social cohesion. Individuals living in neighborhoods with adverse changes were more likely to have increased CES-D scores, although due to limited sample size associations were imprecisely estimated (P>0.05). Changes in specific features of the neighborhood environment may be associated with changes in level of depressive symptoms among residents.

Social engagement and chronic disease risk behaviors: the Multi-Ethnic Study of Atherosclerosis

OBJECTIVE

Although engagement in social networks is important to health, multiple different dimensions exist. This study identifies which dimensions are associated with chronic disease risk behaviors.

METHODS

Cross-sectional data on social support, loneliness, and neighborhood social cohesion from 5381 participants, aged 45-84 from the Multi-Ethnic Study of Atherosclerosis was used.

RESULTS

After adjusting for individual characteristics and all social engagement variables, social support was associated with lower smoking prevalence (PR=0.88, 95% CI: 0.82, 0.94), higher probability of having quit (PR=1.03, 95% CI: 1.01, 1.06) and a slightly higher probability of achieving physical activity recommendations (PR=1.03, 95% CI: 1.01, 1.06). Neighborhood social cohesion was associated with very slightly higher probability of achieving recommended (PR=1.03, 95% CI: 1.01, 1.05) or any regular (PR=1.0, 95% CI: 1.01, 1.04) physical activity, and a higher probability of consuming at least five daily fruit and vegetable servings (PR=1.05, 95% CI: 1.01, 1.09).

CONCLUSIONS

Both social support and neighborhood social cohesion, a less commonly considered aspect of social engagement, appear to be important for chronic disease prevention interventions and likely act via separate pathways.

Neighborhood environment perceptions and the likelihood of smoking and alcohol use

Neighborhood characteristics are important correlates for a variety of health outcomes. Among several health risk behaviors, smoking and alcohol use have significant consequences. Perceptions of neighborhood problems are associated with depressive symptoms, lower physical activity, and lower quality of life. However, it is unclear which perceived aspects of neighborhoods might be related to smoking and drinking. We examined whether perceived neighborhood characteristics were associated with smoking and drinking patterns using data from US metropolitan Midwestern area adults. Participants completed surveys including sociodemographic characteristics, neighborhood perceptions, behavioral and psychological health. For men, negative perceptions of neighborhood infrastructures were significant predictors for smoking and binge drinking. Among women, no perceived environmental factors were associated with smoking or drinking. However, education was a significant negative predictor for smoking. As age increased, the likelihood of using cigarettes, heavy and binge drinking in women decreased significantly. Depression was a positive predictor for smoking and heavy drinking in men and women, respectively. These findings indicate that the perceived neighborhood infrastructure was predictive of health behaviors among men, even after adjusting for key confounders. Closer attention may need to be paid to the role of neighborhood environmental characteristics along with individual-level characteristics in influencing unhealthy behaviors.

The association of individual and neighborhood social cohesion, stressors, and crime on smoking status among African-American women in southeastern US subsidized housing neighborhoods

The purpose of this study was to examine the associations between individual and neighborhood social contextual factors and smoking prevalence among African-American women in subsidized neighborhoods. We randomly sampled 663 adult women in 17 subsidized neighborhoods in two Southeastern US states. The smoking prevalence among participants was 37.6%, with an estimated neighborhood household prevalence ranging from 30 to 68%. Smokers were more likely to be older, have lower incomes, have lower BMI, and live with other smokers. Women with high social cohesion were less likely to smoke, although living in neighborhoods with higher social cohesion was not associated with smoking prevalence. Women with higher social cohesion were more likely to be older and had lived in the neighborhood longer. Women with high stress (related to violence and disorder) and who lived in neighborhoods with higher stress were more likely to smoke. Younger women were more likely to have higher stress than older women. There were no statistically significant associations with objective neighborhood crime data in any model. This is the first study to examine both individual and neighborhood social contextual correlates among African-American women in subsidized neighborhoods. This study extends findings about smoking behaviors and neighborhood social contexts in this high-risk, urban population. Future research is needed to explore age and residential stability differences and perceptions of social cohesion, neighborhood disorder, and perceived violence in subsidized housing. Further research is also warranted on African-American women, subsidized housing, smoking, social context, health disparities' effective strategies to address these individual and contextual factors to better inform future ecological-based multilevel prevention, and cessation intervention strategies.

A global study on the influence of neighborhood contextual factors on adolescent health

PURPOSE

This study uses data collected as part of the Well-Being of Adolescents in Vulnerable Environments study to (1) compare the perceptions of neighborhood-level factors among adolescents across five different urban sites; (2) examine the associations between factors within the physical and social environments; and (3) examine the influence of neighborhood-level factors on two different health outcomes-violence victimization in the past 12 months and ever smoked.

METHODS

Across five urban sites (Baltimore, New Delhi, Johannesburg, Ibadan, and Shanghai), 2,320 adolescents aged 15-19 years completed a survey using audio computer-assisted self-interview technology. To recruit adolescents, each site used a respondent-driven sampling method, which consisted of selecting adolescents as "seeds" to serve as the initial contacts for recruiting the entire adolescent sample. All analyses were conducted with Stata 13.1 statistical software, using complex survey design procedures. To examine associations between neighborhood-level factors and among our two outcomes, violence victimization and ever smoked, bivariate and multivariate analyses were conducted.

RESULTS

Across sites, there was great variability in how adolescents perceived their neighborhoods. Overall, adolescents from Ibadan and Shanghai held the most positive perceptions about their neighborhoods, whereas adolescents from Baltimore and Johannesburg held the poorest. In New Delhi, despite females having positive perceptions about their safety and sense of social cohesion, they had the highest sense of fear and the poorest perceptions about their physical environment. The study also found that one of the most consistent neighborhood-level factors across sites and outcomes was witnessing community violence, which was significantly associated with smoking among adolescents in New Delhi and Johannesburg and with violence victimization across nearly every site except Baltimore. No other neighborhood-level factor exerted greater influence.

CONCLUSIONS

This study confirms the important associations between perceptions of a neighborhood and adolescent health. At the same time, it demonstrates that not all neighborhood-level factors are associated with adolescent health outcomes in the same way across different urban contexts. Further longitudinal research is needed to examine the direction of causation between adolescent health neighborhood contexts and health outcomes and the reasons for why different urban contexts may exert varying levels of influence on the health of adolescents.

Collective efficacy and depressive symptoms in Brazilian elderly

The objective was to investigate the association between depressive symptoms and collective efficacy among the elderly in a municipality in southern Brazil. A cross-sectional population-based design was carried out. Structured interviews were held at the homes of 1007 elderly individuals. The presence of depressive symptoms was measured using the Geriatric Depression Scale, exposures were a standard 8-item collective efficacy scale and a single item about elderly participation in groups. Data were analyzed using Poisson regression to obtain the crude and adjusted prevalence ratios (PRs). The sample consisted mostly of female (63%), white (96%) and married (64%) elderly individuals. The mean age, income and educational level were, respectively: 73 years (SD=4), R$ 1836 (SD=2170) and 5 years of education (SD=4). After controlling for demographic, socioeconomic, behavioral and health-related variables, participants who reported low collective efficacy at the places where they lived presented a prevalence of depressive symptoms that was twice as high as the prevalence among those who reported high collective efficacy. In the same way, elderly individuals who did not participate in groups presented prevalence of the outcome around 64% higher than among those who took part in one or more groups. The study suggests that creation of and participation in social networks and community groups may be an important strategy for promoting mental health among the elderly.

Neighborhood stressors, mastery, and depressive symptoms: racial and ethnic differences in an ecological model of the stress process in Chicago

Neighborhood stressors are associated with depressive symptoms and are more likely to be experienced in poor, non-White neighborhoods. Neighborhood stress process theory suggests that neighborhood stressor affect mental health through personal coping resources, such as mastery. Mastery is thought to be both a pathway and a buffer of the ill effects of neighborhood stressors. This research examines the neighborhood stress process with a focus on racial and ethnic differences in the relationship between neighborhood stressors, mastery, and depressive symptoms in a multi-ethnic sample of Chicago residents. Findings suggest race-specific effects on depressive symptoms. Mastery is found to be a pathway from neighborhood stressors to depressive symptoms but not a buffer against neighborhood stressors. Mastery is most beneficial to Whites and those living in low stress neighborhoods.

Assessing the environmental characteristics of cycling routes to school: a study on the reliability and validity of a Google Street View-based audit

Background

Google Street View provides a valuable and efficient alternative to observe the physical environment compared to on-site fieldwork. However, studies on the use, reliability and validity of Google Street View in a cycling-to-school context are lacking. We aimed to study the intra-, inter-rater reliability and criterion validity of EGA-Cycling (Environmental Google Street View Based Audit - Cycling to school), a newly developed audit using Google Street View to assess the physical environment along cycling routes to school.

Methods

Parents (n = 52) of 11-to-12-year old Flemish children, who mostly cycled to school, completed a questionnaire and identified their child’s cycling route to school on a street map. Fifty cycling routes of 11-to-12-year olds were identified and physical environmental characteristics along the identified routes were rated with EGA-Cycling (5 subscales; 37 items), based on Google Street View. To assess reliability, two researchers performed the audit. Criterion validity of the audit was examined by comparing the ratings based on Google Street View with ratings through on-site assessments.

Results

Intra-rater reliability was high (kappa range 0.47-1.00). Large variations in the inter-rater reliability (kappa range -0.03-1.00) and criterion validity scores (kappa range -0.06-1.00) were reported, with acceptable inter-rater reliability values for 43% of all items and acceptable criterion validity for 54% of all items.

Conclusions

EGA-Cycling can be used to assess physical environmental characteristics along cycling routes to school. However, to assess the micro-environment specifically related to cycling, on-site assessments have to be added.

Assessment of neighborhood context in a nationally representative study

OBJECTIVES

This paper introduces new measures of neighborhood context that are included in the second wave of the National Social Life, Health, and Aging Project (NSHAP). We describe the use of field interviewer ratings of respondents' neighborhood conditions, as well as the adaptation of existing measures for the assessment of neighborhood social context among urban and nonurban older adults.

METHOD

We construct scales of neighborhood problems, neighborhood social cohesion, neighborhood social ties, and perceived neighborhood danger, and assess their reliability and validity. We then calculate descriptive statistics for measures of neighborhood context across respondent age, gender, and racial/ethnic background, and across low-, moderate-, and high-density residential blocks.

RESULTS

We find that older women report greater neighborhood cohesion and more neighborhood ties than older men, but women also perceive more neighborhood danger. Black and Hispanic older adults reside in neighborhoods with more problems, lower cohesion, fewer social ties, and greater perceived danger. Neighborhood characteristics also vary across residential densities. Neighborhood problems and perceived danger increase with block-level density, but neighborhood social cohesion and social ties were lowest among residents of moderate-density blocks.

DISCUSSION

The inclusion of neighborhood context measures in the second wave of NSHAP provides a unique opportunity to explore associations among neighborhood context, social connectedness, and indicators of health and function among older adults. We discuss limitations of the measures and provide recommendations for their use.

The relation between social cohesion and smoking cessation among Black smokers, and the potential role of psychosocial mediators

BACKGROUND

Social cohesion, the self-reported trust and connectedness between neighbors, may affect health behaviors via psychosocial mechanisms.

PURPOSE

Relations between individual perceptions of social cohesion and smoking cessation were examined among 397 Black treatment-seeking smokers.

METHODS

Continuation ratio logit models examined the relation of social cohesion and biochemically verified continuous smoking abstinence through 6 months post-quit. Indirect effects were examined in single mediator models using a nonparametric bootstrapping procedure. All analyses controlled for sociodemographics, tobacco dependence, and treatment.

RESULTS

The total effect of social cohesion on continuous abstinence was non-significant (β = 0.05, p = 0.10). However, social cohesion was associated with social support, positive affect, negative affect, and stress, which, in turn, were each associated with abstinence in adjusted models (ps < 0.05).

CONCLUSIONS

Results suggest that social cohesion may facilitate smoking cessation among Black smokers through desirable effects on psychosocial mechanisms that can result from living in a community with strong interpersonal connections.

Neighborhoods and mental health: exploring ethnic density, poverty, and social cohesion among Asian Americans and Latinos

This study examines the associations of neighborhood ethnic density and poverty with social cohesion and self-rated mental health among Asian Americans and Latinos. Path analysis is employed to analyze data from the 2002-2003 National Latino and Asian American Study (NLAAS) and the 2000 U.S. Census (N = 2095 Asian Americans living in N = 259 neighborhoods; N = 2554 Latinos living in N = 317 neighborhoods). Findings reveal that neighborhood ethnic density relates to poor mental health in both groups. Social cohesion partially mediates that structural relationship, but is positively related to ethnic density among Latinos and negatively related to ethnic density among Asian Americans. Although higher neighborhood poverty is negatively associated with mental health for both groups, the relationship does not hold in the path models after accounting for social cohesion and covariates. Furthermore, social cohesion fully mediates the association between neighborhood poverty and mental health among Latinos. This study highlights the necessity of reconceptualizing existing theories of social relationships to reflect complex and nuanced mechanisms linking neighborhood structure and mental health for diverse racial and ethnic groups.

Validation of French and German versions of a Perceived Neighborhood Social Cohesion Questionnaire among young Swiss males, and its relationship with substance use

This study main purpose was the validation of both French and German versions of a Perceived Neighborhood Social Cohesion Questionnaire. The sample group comprised 5065 Swiss men from the “Cohort Study on Substance Use Risk Factors.” Multigroup Confirmatory factor analysis showed that a three-factor model fits the data well, which substantiates the generalizability of Perceived Neighborhood Social Cohesion Questionnaire factor structure, regardless of the language. The Perceived Neighborhood Social Cohesion Questionnaire demonstrated excellent homogeneity ( α = 95) and split-half reliability ( r = .96). The Perceived Neighborhood Social Cohesion Questionnaire was sensitive to community size and participants’ financial situation, confirming that it also measures real social conditions. Finally, weak but frequent correlations between Perceived Neighborhood Social Cohesion Questionnaire and alcohol, cigarette, and cannabis dependence were measured.

A multilevel perspective on gender differences in the relationship between poverty status and depression among older adults in the United States

Despite a large body of literature on depression, previous studies have focused on either intra- or interpersonal factors but not multilevel influences, which potentially could buffer depression in late life. The intent of this study was to identify whether the impact of poverty might be moderated by multilevel factors such as sense of control, social support, and neighborhood environment. The results showed that the elderly poor, especially older women, were more likely to be depressed. Support from friends significantly moderated the association between depression and poverty among older women. Implications for critical feminist gerontology and for practice are discussed.

The onset of depression during the great recession: foreclosure and older adult mental health

OBJECTIVES

We examined neighborhood-level foreclosure rates and their association with onset of depressive symptoms in older adults.

METHODS

We linked data from the National Social Life, Health, and Aging Project (2005-2006 and 2010-2011 waves), a longitudinal, nationally representative survey, to data on zip code-level foreclosure rates, and predicted the onset of depressive symptoms using logit-linked regression.

RESULTS

Multiple stages of the foreclosure process predicted the onset of depressive symptoms, with adjustment for demographic characteristics and changes in household assets, neighborhood poverty, and visible neighborhood disorder. A large increase in the number of notices of default (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.14, 2.67) and properties returning to ownership by the bank (OR = 1.62; 95% CI = 1.06, 2.47) were associated with depressive symptoms. A large increase in properties going to auction was suggestive of such an association (OR = 1.45; 95% CI = 0.96, 2.19). Age, fewer years of education, and functional limitations also were predictive.

CONCLUSIONS

Increases in neighborhood-level foreclosure represent an important risk factor for depression in older adults. These results accord with previous studies suggesting that the effects of economic crises are typically first experienced through deficits in emotional well-being.

The relationship between physical activity and the living environment: a multi-level analyses focusing on changes over time in environmental factors

There is limited evidence on the causality of previously observed associations between neighborhood characteristics and physical activity (PA). We aimed to assess whether individual-level PA was associated with changes in fear of crime, social cohesion, green spaces, parking facilities, social disorder, and physical disorder that occurred over the past 3 years. In general, in neighborhoods where residents had more favorable perceptions of the environment in 2006, residents were more likely to be physically active in 2009. In addition, improvements between 2006 and 2009 with respect to perceived social cohesion, green spaces, social disorder, and physical disorder were associated with increased odds of being active in 2009. For both the levels in 2006 and trends in the period 2006-2009, the associations were somewhat stronger among women than among men, but associations did not vary by age or length of residence. For several environmental factors, we observed that not only the levels at a certain point in time, but also recent improvements over time were related to PA. These results provide new support for a causal relationship between these environmental factors and PA.

Social cohesion and self-rated health: The moderating effect of neighborhood physical disorder

Using data from the Los Angeles Family and Neighborhood Survey and its companion datasets, we examined how neighborhood disorder, perceived danger and both individually perceived and contextually measured neighborhood social cohesion are associated with self-rated health. Results indicate that neighborhood disorder is negatively associated with health and the relationship is explained by perceived cohesion and danger, which are both also significant predictors of health. Further, individually perceived cohesion emerges as a more important explanation of self-rated health than neighborhood-level social cohesion. Finally, neighborhood disorder and perceived cohesion interact to influence health, such that cohesion is especially beneficial when residents live in neighborhoods characterized by low to moderate disorder; once disorder is at high levels, cohesion no longer offers protection against poor health. We interpret our findings as they relate to prior research on neighborhoods, psychosocial processes, and health, and discuss their implications for intervention efforts that address disorder in urban communities.

Gender differences in the social pathways linking neighborhood disadvantage to depressive symptoms in adults

Depression debilitates the lives of millions and is projected to be the second leading disease burden worldwide by 2020. At the population level, the causes of depression are found in the everyday social and physical environments in which people live. Research has shown that men and women often experience neighbourhood environments differently and that these variations are often reflected in health outcomes. The current study examines whether social and environmental correlates of depression are similar in men and women. This study examines whether (i) there are gender differences in the association between neighbourhood disadvantage and depressive symptoms, and (ii) dimensions of social capital and cohesion mediate these associations. Data come from the Montreal Neighbourhood Networks and Healthy Aging Study, which consists of a cluster stratified sample of Montreal census tracts (n_ct = 300) and individuals within those tracts (n_i = 2707). Depressive symptoms and social capital were measured with a questionnaire. Neighbourhood disadvantage was measured at the census tract level using data from the 2006 Canada Census. Multilevel logistic regression stratified by gender and a three-step mediation analysis procedure were used. Final sample size for these analyses was 2574 adults. Depressive symptoms had a prevalence of 17.3% in the overall sample. Disadvantage was associated with depressive symptoms in women only (OR = 1.25, 95% CI = 1.01–1.55). Perceived neighbourhood cohesion was shown to mediate the association of disadvantage and depressive symptoms in women (ab = 0.02; 95% CI = 0.003–0.04, p<0.05). Other socio-relational variables, specifically generalized trust and trust in neighbours were associated with depression in women but did not act as mediating variables. Health promotion initiatives meant to combat depression may wish to consider gender differences in the design and implementation of neighbourhood or peer-based programs.

Developing Behavioral Theory With the Systematic Integration of Community Social Capital Concepts

Health behavior theories state that social environments influence health behaviors, but theories of how this occurs are relatively underdeveloped. This article systematically surveys community social capital concepts in health behavior literature and proposes a conceptual framework that integrates these concepts into existing behavioral theory. Fifty-three studies tested associations between community social capital concepts and physical activity (38 studies), smoking (19 studies), and diet (2 studies). Trustworthiness of community members was consistently associated with more health-promoting and less disease-promoting behaviors in 19 studies. Neighborly reciprocity showed mixed results in 10 studies. Reporting a good sense of community was associated with more physical activity in only 5 of 16 studies. Neighborhood collective efficacy, which includes social cohesion and informal social control, was inconsistently associated with behaviors in 22 studies. Behavioral social norms were associated with smoking and physical activity in 2 of 6 studies, and neighborhood modeling of physical activity was associated with increased activity in 12 of 17 studies, with 1 opposing result. This review identifies several community social capital-related concepts that are, at times, associated with both health-promoting and disease-promoting behaviors and often have no associations. Theory explains these findings by describing the relationships and interactions among these concepts. Using these findings, this article proposes a conceptual framework that integrates community social capital concepts into existing behavioral theory. Iterative empirically based theory development is needed to address these concepts, which affect behaviors. These results can also inform theoretically based community-based and socially tailored interventions.

Concurrent trajectories of BMI and mental health patterns in emerging adulthood

Affective disorders and weight status have been consistently linked in childhood and adult research, and this comorbidity has synergistic effects leading to more severe health consequences. We map the co-development of these developmental processes in the U.S. National Longitudinal Survey of Youth - 1997 (NLSY97) cohort ages 15 to 27 to inform the targeting of public health interventions. We estimate profiles of youth mental health and weight status through parallel process growth mixture modeling within a person-centered framework controlling for race/ethnicity, gender, and poverty status. Fit statistics indicate a 5-class parallel process model for the concurrent trajectories of BMI and mental health. The concurrent trajectories model reveals latent class trajectories of "stable normal weight, stable good mental health" (82.2%); "consistently obese, stable good mental health" (6.8%); "overweight becoming obese, declining mental health" (5.6%); "stable normal weight, improving mental health" (3.3%); and "morbid obesity, stable good mental health" (2.1%). The risk of developmental trajectories of poor mental health and BMI outcomes is greater for females, blacks, Hispanics, and individuals living below the poverty line. These results should help public health professionals to better target subpopulations approaching or already experiencing developmental pathways of risk for poor mental health and weight comorbidities. Multilevel investigation of lifestyle and contextual factors will foster further refinement of public health interventions.

Mechanisms linking socioeconomic disadvantage and BMI in smokers

OBJECTIVES

To evaluate a conceptual model of the psychosocial pathways linking socioeconomic status and body mass index (BMI) among smokers.

METHODS

A latent variable modeling approach was used to evaluate the interrelationships among socioeconomic status, perceived neighborhood disadvantage, social support, negative affect, and BMI among smokers recruited from the Houston metropolitan area (N = 424).

RESULTS

A total of 42.4% of participants were obese, with the highest prevalence of obesity among Latinos followed by African Americans. Across all racial/ethnic groups, perceived neighborhood disadvantage, social support, and negative affect functioned as pathways linking socioeconomic status and BMI.

CONCLUSIONS

Findings indicate the need for interventions that target obesity among socioeconomically disadvantaged smokers and provide potential intervention targets for the prevention and treatment of obesity.

Adaptacao transcultural e confiabilidade de medidas de caracteristicas autorreferidas de vizinhanca no ELSA-Brasil

OBJETIVO: Descrever o processo de adaptação de escalas de medida de características de vizinhança para o português brasileiro. MÉTODOS: As dimensões abordadas foram coesão social, ambiente propício para atividade física, disponibilidade de alimentos saudáveis, segurança em relação a crimes, violência percebida e vitimização. No processo de adaptação foram avaliados aspectos de equivalência entre as escalas originais e respectivas versões para o português. A confiabilidade teste-reteste foi avaliada em submostra de 261 participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) que responderam ao mesmo questionário em dois momentos distintos em um intervalo de tempo de sete a 14 dias entre as duas aplicações. RESULTADOS: Os aspectos de equivalência avaliados mostraram-se adequados. O coeficiente de correlação intraclasse variou entre 0,83 (IC95% 0,78;0,87) para Coesão Social e 0,90 (IC95% 0,87;0,92) para Ambiente para Atividade Física. As escalas apresentaram consistência interna (alfa de Cronbach) que variaram entre 0,60 e 0,84. CONCLUSÕES: As medidas autorreferidas de características de vizinhança tiveram reprodutibilidade muito boa e boa consistência interna. Os resultados sugerem que essas escalas podem ser utilizadas em estudos com população brasileira que apresente características similares àquelas do ELSA-Brasil.

Changes in smoking, sports participation and overweight: does neighborhood prevalence matter?

We investigated whether the prevalence of health-related behaviors and overweight in neighborhoods is associated with changes in smoking, sports participation and overweight over 13 years of follow-up in Dutch adults residing in 86 neighborhoods of Eindhoven in 1991. We showed that living in neighborhoods with a high prevalence of non-smoking, no sports participation and overweight increased the odds of quitting smoking, quitting sports and becoming overweight. After adjustments for age, gender, education and neighborhood deprivation this association remained significant for becoming overweight. Neighborhood prevalence of health-related behaviors and overweight appears to be a currently neglected but relevant determinant of changes in health-related behaviors.

Assessing the psychometric and ecometric properties of neighborhood scales in developing countries: Saúde em Beagá Study, Belo Horizonte, Brazil, 2008-2009

Although specific measurement instruments are necessary to better understand the relationship between features of neighborhoods and health, very few studies have developed instruments to measure neighborhood features in developing countries. The objective of the study was to develop valid and reliable measures of neighborhood context useful in a Latin American urban context, assess their psychometric and ecometric properties, and examine individual and neighborhood-level predictors of these measures. We analyzed data from a multistage household survey (2008-2009) conducted in Belo Horizonte City by the Observatory for Urban Health. One adult in each household was selected to answer a questionnaire that included scales to measure neighborhood domains. Census tracts were used to proxy neighborhoods. Internal consistency was evaluated by Cronbach's alpha, and multilevel models were used to estimate ecometric properties and to estimate associations of neighborhood measures with socioeconomic indicators. The final sample comprised 4048 survey respondents representing 149 census tracts. We assessed ten neighborhood environment dimensions: public services, aesthetic quality, walking environment, safety, violence, social cohesion, neighborhood participation, neighborhood physical disorder, neighborhood social disorder, and neighborhood problems. Cronbach's alpha coefficients ranged from 0.53 to 0.83; intraneighborhood correlations ranged from 0.02 to 0.53, and neighborhood reliability varied from 0.76 to 0.99. Most scales were associated with individual and neighborhood socioeconomic predictors. Questionnaires can be used to reliably measure neighborhood contexts in developing countries.

Companionship in the neighborhood context: older adults' living arrangements and perceptions of social cohesion

This study investigated the impact of neighborhood social cohesion on the perceived companionship of nearly 1,500 community-dwelling older adults from the Neighborhood, Organization, Aging and Health project (NOAH), a Chicago-based study of older adult well-being in the neighborhood context. We hypothesized that the relationship between neighborhood-level social cohesion and individual residents' reports of companionship would be more pronounced among those who lived alone than those who resided with others. Controlling for age, gender, education, race, marital status, length of neighborhood residence, and self-rated health, neighborhood social cohesion predicted companionship among those who lived alone; for a one-unit increase in neighborhood social cohesion, the odds of reporting companionship increased by half. In contrast, social cohesion did not predict the companionship of those who resided with others. The results suggest that older adults who live alone particularly profit from the benefits of socially cohesive neighborhood environments.

Facilitators of home and community-based service use by urban African American elders

OBJECTIVE

To examine the factors associated with urban African American elders' utilization of home and community-based services and explore whether these factors differ by category of service.

METHODS

Data came from a representative sample of 1,099 African American older adults living in Detroit. Logistic regression models were used to explore the predisposing, enabling, and need factors associated with any service use and five categories of service use: in-home care, household services, functional care, out-of-home services, and financial/legal services.

RESULTS

Findings suggest that previous studies using the Andersen model may not be generalizable to an urban African American population. Service use was related primarily to enabling resources, particularly in terms of financial resources, not driving a car, and social resources and support. Future research should further examine the facilitators and barriers to service use by urban African Americans to improve their access to care.

The social environment and walking behavior among low-income housing residents

Walking, both for leisure and for travel/errands, counts toward meeting physical activity recommendations. Both social and physical neighborhood environmental features may encourage or inhibit walking. This study examined social capital, perceived safety, and disorder in relation to walking behavior among a population of low-income housing residents. Social and physical disorder were assessed by systematic social observation in the area surrounding 20 low-income housing sites in greater Boston. A cross-sectional survey of 828 residents of these housing sites provided data on walking behavior, socio-demographics, and individual-level social capital and perceived safety of the areas in and around the housing site. Community social capital and safety were calculated by aggregating individual scores to the level of the housing site. Generalized estimating equations were used to estimate prevalence rate ratios for walking less than 10 min per day for a) travel/errands, b) leisure and c) both travel/errands and leisure. 21.8% of participants walked for travel/errands less than 10 min per day, 34.8% for leisure, and 16.8% for both kinds of walking. In fully adjusted models, those who reported low individual-level social capital and safety also reported less overall walking and less walking for travel/errands. Unexpectedly, those who reported low social disorder also reported less walking for leisure, and those who reported high community social capital also walked less for all outcomes. Physical disorder and community safety were not associated with walking behavior. For low-income housing residents, neighborhood social environmental variables are unlikely the most important factors in determining walking behavior. Researchers should carefully weigh the respective limitations of subjective and objective measures of the social environment when linking them to health outcomes.

Age-Friendly Environments and Self-Rated Health:

While a number of organizations and government entities have encouraged the development of more “age-friendly” environments, to date there has been limited research linking these environment features to elder outcomes. Using a representative sample of older adults living in Detroit, this study examined the association between age-friendly environment factors and self-rated health. Results indicated that access to health care, social support, and community engagement were each associated with better self-rated health, while neighborhood problems were associated with poorer self-rated health. Moreover, individual-level income and education no longer predicted self-rated health once age-friendly environment factors were taken into account. These findings highlight the need for more research documenting the effects of age-friendly environments, particularly across diverse contexts and populations.

Neighborhood social cohesion and posttraumatic stress disorder in a community-based sample: findings from the Detroit Neighborhood Health Study

PURPOSE

Posttraumatic stress disorder (PTSD) is common and debilitating. Although research has identified individual-level risk factors for PTSD, the role of macro-social factors in PTSD etiology remains unknown. This study tests whether perceived neighborhood social cohesion (NSC), measured at the both the individual and neighborhood levels, plays a role in determining past-year risk of PTSD among those exposed to trauma.

METHODS

Data (n = 1,221) were obtained from an ongoing prospective epidemiologic study in the city of Detroit. Assessment of traumatic event exposure and PTSD was consistent with DSM-IV criteria. Generalized estimating equations (GEE) and logistic regression models were used to estimate the association of neighborhood-level perceived NSC with the risk of PTSD, adjusting for individual-level perceptions of NSC and other covariates.

RESULTS

The odds of past-year PTSD were significantly higher among those residing in a neighborhood with low social cohesion compared to high (OR = 2.44, 95 % CI: 1.58, 3.78), independent of individual sociodemographic characteristics, number of traumas, and individual-level perceptions of NSC. The odds of past-year PTSD were not significantly associated with individual-level perceptions of NSC.

CONCLUSIONS

These results demonstrate that social context shapes risk of PTSD and suggest that changing the social context may shift vulnerability to this disorder.

Perception of environmental problems and common mental disorders (CMD)

BACKGROUND

In the past few years, there has been increasing interest in studying the association between problems in the neighbourhood environment and health indicators. The objective of this study is to examine the relationship between the perception of environmental problems by individuals and the prevalence of common mental disorders (CMD) in Spain.

METHODS

A cross-sectional study using data from a large scale national representative survey of households (the 2006 Spanish National Health Survey). Participants included in the study were aged between 16 and 64 years (n = 23,760). The dependent variable was common mental disorders assessed with the General Health Questionnaire (GHQ-12). The independent variable was the individual's perception of environmental problems. Raw and adjusted Odds Ratios and their confidence intervals (95%) were calculated by fitting logistic regression models adjusting for age, marital status, work situation, social class, rural or urban area, country of origin, restrictions in carrying out activities of daily life due to a health problem and social support.

RESULTS

The individuals who reported environmental problems had a higher prevalence of CMD. There was a clear increasing gradient in CMD prevalence with the increase in the number of environmental problems mentioned. Among the subjects who reported to have 1 or no environmental problem the prevalence of CMD was 11.8% (men) and 18.7% (women), and among those who mentioned 6 or more problems, the prevalence increased to 20.8% (men) and 35.4% (women). After adjusting for all the co-variables, there is an association between environmental problems and CMD (men OR 1.44, 95% CI 1.08-1.66; women OR 1.46, 95% CI 1.27-1.67). The environmental problems most strongly associated with the prevalence of CMD are noise, bad smell, air pollution, and lack of green areas.

CONCLUSIONS

Our findings show that individuals who perceive environmental problems in their neighbourhood have a higher prevalence of CMD, even after adjusting for all co-variables. In addition, there is a clear increasing gradient in the prevalence of CMD with the increase in the number of environmental problems. Efforts to reduce the prevalence of CMD must be directed to improve individual and contextual risks.

Geographic variation in participation for physically disabled adults: the contribution of area economic factors to employment after spinal cord injury

This study investigates the role of area economic characteristics in predicting employment-a key aspect of social participation for adults with physical disabilities-using data from a national registry of persons with spinal cord injury (SCI). SCI results in chronic impairment and most commonly occurs during young adulthood when working is a key aspect of the adult social role. Geocoded data were collected from two of the 14 SCI Model Systems (SCIMS) centers involved in the National SCIMS database and used to link individual-level data with area-level measures extracted from the 2000 US Census. The analysis included participants of working-age (18-64 years) and living in the community (N=1013). Hierarchical generalized linear modeling was used to estimate area-level variation in participation and the relative contribution of area-level economic indicators, adjusted for individual-level health, functioning, and background characteristics. The likelihood of employment for adults with SCI varied by area and was associated with area SES and urbanicity, but not area unemployment. These findings suggest that variation in area economic conditions may affect the feasibility of employment for persons who experience chronic physical disability during adulthood, thus limiting full participation in society.

Perceptual quality of neighbourhood design and feelings of unsafety

This paper takes the quality of life in the neighbourhood as a starting point and appeals to the framework of Age-friendly Cities to gain insights in how ‘the neighbourhood as a physical surrounding’ can either promote or hinder feelings of unsafety in later life. It examines the impact of the perceived design of the neighbourhood on feelings of unsafety in later life. Literature on the relationship between feelings of unsafety and the neighbourhood mainly concentrates on incivilities and disorder. Other physical-spatial features of the neighbourhood are rarely taken into consideration. Using data generated from the Belgian Ageing Studies (N=25,980) multivariate analyses indicate that a neighbourhood which is perceived to be physically adapted to the needs of older people (in terms of accessibility and distance to services) heightens feelings of safety. The findings demonstrate the need to reduce behaviour constraints by redesigning fear-related physical features. This conclusion raises practical implications and formulates a number of policy recommendations to tackle feelings of unsafety in an ageing society.

Neighborhood deprivation and clinical outcomes among head and neck cancer patients

The unique effects of neighborhood-level economic deprivation on survival, recurrence, and second primary malignancy development were examined using adjusted Cox proportional hazards regression models among 1151 incident squamous cell carcinomas of the head and neck patients. Cancer site was examined as a potential moderator. Main analyses yielded null results; however, interaction analyses indicated poorer overall survival [HR=1.59 (1.00-2.53)] and greater second primary malignancy development [HR=2.99 (1.46-6.11)] among oropharyngeal cancer patients from highly deprived neighborhoods relative to less deprived neighborhoods. Results suggest a dual focus on individual and neighborhood risk factors could help improve clinical outcomes among oropharyngeal cancer patients.

Health behaviors among Baby Boomer informal caregivers

PURPOSE OF THE STUDY

This study examines health-risk behaviors among "Baby Boomer" caregivers and non-caregivers.

DESIGN AND METHODS

Data from the 2009 California Health Interview Survey of the state's non-institutionalized population provided individual-level, caregiving, and health behavior characteristics for 5,688 informal caregivers and 12,941 non-caregivers. Logistic regression models were estimated separately for four individual health-risk behaviors-smoking, sedentary behavior, and regular soda and fast-food consumption-as well as a global health-risk measure.

RESULTS

Controlling for psychological distress and personal characteristics and social resources such as age, gender, income and education, work and marital status, and neighborhood safety, caregivers had greater odds than non-caregivers of overall negative health behavior and of smoking and regular soda and fast-food consumption. We did not observe significant differences in odds of negative behavior related to stress for spousal caregivers and caregivers in the role for longer periods of time or those providing more hours of weekly care compared with other caregivers.

IMPLICATIONS

Our study found evidence that Baby Boomer caregivers engage in poor health behaviors that are associated with exposure to caregiving. Baby Boomer caregivers may be at risk for certain behavioral factors that are associated with disability and chronic illness.

More than culture: structural racism, intersectionality theory, and immigrant health

Explanations for immigrant health outcomes often invoke culture through the use of the concept of acculturation. The over reliance on cultural explanations for immigrant health outcomes has been the topic of growing debate, with the critics' main concern being that such explanations obscure the impact of structural factors on immigrant health disparities. In this paper, we highlight the shortcomings of cultural explanations as currently employed in the health literature, and argue for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes. Based on our review of the literature, we suggest specific lines of inquiry regarding immigrants' experiences with day-to-day discrimination, as well as on the roles that place and immigration policies play in shaping immigrant health outcomes. The paper concludes with suggestions for integrating intersectionality theory in future research on immigrant health.

Neighborhood perceptions are associated with tobacco dependence among African American smokers

INTRODUCTION

The animal and human research literatures suggest that deprived environmental conditions may be associated with drug dependence, but the relation of neighborhood perceptions with a multidimensional measure of tobacco dependence has not been previously studied. The purpose of this study was to examine the associations between neighborhood perceptions (neighborhood problems and neighborhood vigilance) and tobacco dependence among smokers as measured by the Wisconsin Inventory of Smoking Dependence Motives-68 (WISDM).

METHODS

Participants were 384 African American smokers (49% men, 80% < $30,000 annual household income) enrolled in a randomized clinical trial of a smoking cessation intervention. A series of regression models were conducted to examine the associations between neighborhood perceptions and tobacco dependence using a generalized estimating equation approach, which accounted for potential correlation in tobacco dependence between participants from the same neighborhood.

RESULTS

Results indicated that more self-reported neighborhood problems and greater neighborhood vigilance were significantly associated with tobacco dependence as measured by the WISDM total score in analyses adjusted for age, gender, income, education, employment status, and partner status (p ≤ .002). Neighborhood perceptions were related to both primary and secondary dependence motives (p ≤ .005).

CONCLUSIONS

Results suggest that the neighborhood context is associated with dependence on tobacco among African American smokers but longitudinal studies are needed to assess causation. Future research should also explore the mechanisms that account for the associations between neighborhood perceptions and tobacco dependence to better inform intervention development.

Neighbourhood crime and smoking: the role of objective and perceived crime measures

Background

Smoking is a major public health problem worldwide. Research has shown that neighbourhood of residence is independently associated with the likelihood of individuals' smoking. However, a fine comprehension of which neighbourhood characteristics are involved and how remains limited. In this study we examine the relative contribution of objective (police-recorded) and subjective (resident-perceived) measures of neighbourhood crime on residents' smoking behaviours.

Methods

Data from 2,418 men and women participating in the 2007/8 sweep of the West of Scotland Twenty-07 Study were analyzed. Smoking status and perceived crime were collected through face-to-face interviews with participants. Police-recorded crime rates were obtained from the Scottish Neighbourhood Statistics website at the datazone scale. Adjusted odds ratios and 95% confidence intervals were estimated for the likelihood of current smoking using logistic regression models. Adjusted mean daily amount smoked and F statistics were calculated using general linear models. Analyses were conducted for all respondents and stratified by sex and age cohort.

Results

Compared to individuals living in low crime areas, those residing in an area characterized by high police-recorded crime rates or those perceiving high crime in their neighbourhood were more likely to be current smokers, after controlling for individual characteristics. The association with smoking was somewhat stronger for police-recorded crime than for perceived crime. Associations were only slightly attenuated when adjusting for either the objective or subjective crime measures, suggesting that these indicators may exert an independent influence on the risk of smoking. Stronger effects were observed for women compared to men. Police-recorded crime rates were more strongly related to smoking status among older respondents than among the younger cohort, whereas the strongest effect for perceived crime was observed among younger participants.

Conclusions

Our findings highlight the relevance of paying attention to both objective and perceived neighbourhood crime measures when aiming to prevent smoking.

The role of empowerment in youth development: a study of sociopolitical control as mediator of ecological systems' influence on developmental outcomes

Empowerment has become an influential concept and theoretical framework for social policy and practice. Still, relatively little is known about the roles that empowerment plays in the ecology of human development, particularly among young people. This article reports results of a study of psychological empowerment among young people, using data from 629 high school students (65.8% female; 96.5% non-white). Using a path analysis, we examined the role of perceived sociopolitical control--an indicator of the intrapersonal component of psychological empowerment--as a mediator between ecological support systems and developmental outcomes. Findings confirmed that social support in family, peer, and school settings, and family cohesion positively predict self-esteem and perceived school importance, which, in turn, have protective effects on psychological symptoms, violent behaviors and substance use. Sociopolitical control was found to mediate the relationships between ecological supports and risk factors and developmental outcomes, leading to the conclusion that perceived efficacy in the sociopolitical domain, and youth empowerment, more generally, should be considered as core elements of the ecology of human development. Policy and practice aimed at promoting positive developmental outcomes and preventing risk behaviors should take their relationship to sociopolitical control into account.

The role of daily mobility in mental health inequalities: the interactive influence of activity space and neighbourhood of residence on depression

The literature reports an association between neighbourhood deprivation and individual depression after adjustment for individual factors. The present paper investigates whether vulnerability to neighbourhood features is influenced by individual "activity space" (i.e., the space within which people move about or travel in the course of their daily activities). It can be assumed that a deprived residential environment can exert a stronger influence on the mental health of people whose activity space is limited to their neighbourhood of residence, since their exposure to their neighbourhood would be greater. Moreover, we studied the relationship between activity space size and depression. A limited activity space could indeed reflect spatial and social confinement and thus be associated with a higher risk of being depressed, or, conversely, it could be linked to a deep attachment to the neighbourhood of residence and thus be associated with a lower risk of being depressed. Multilevel logistic regression analyses of a representative sample consisting of 3011 inhabitants surveyed in 2005 in the Paris, France metropolitan area and nested within 50 census blocks showed, after adjusting for individual-level variables, that people living in deprived neighbourhoods were significantly more depressed that those living in more advantaged neighbourhoods. We also observed a statistically significant cross-level interaction between activity space and neighbourhood deprivation, as they relate to depression. Living in a deprived neighbourhood had a stronger and statistically significant effect on depression in people whose activity space was limited to their neighbourhood than in those whose daily travels extended beyond it. In addition, a limited activity space appeared to be a protective factor with regard to depression for people living in advantaged neighbourhoods and a risk factor for those living in deprived neighbourhoods. It could therefore be useful to take activity space into consideration more often when studying the social and spatial determinants of depression.

Health is Power: an ecological, theory-based health intervention for women of color

OBJECTIVE

Physical inactivity and poor dietary habits plague Americans as health challenges, with women of color most vulnerable to their detrimental effects. Individually focused interventions have not demonstrated lasting success, possibly due to the lack of focus on sustainable social and physical environment factors. This manuscript describes the rationale, design and methodology of Health Is Power (HIP), a transcultural, community based, randomized controlled trial that investigated the effectiveness of a group cohesion intervention to increase physical activity and improve dietary habits in African American and Hispanic or Latina women in Houston and Austin, Texas.

METHODS

The intervention development was guided by group dynamics principles anchored within an ecologic model.

RESULTS

Women participated in three health assessments and a six month face to face intervention that included evidence-based behavioral methods - integrated into strategies to promote group cohesion - framed to account for environmental factors contributing to health disparities. Women participated in team building activities, environmental mapping exercises, and supervised walks or taste tests.

CONCLUSIONS

Neighborhood contextual and environmental measures are described to test ecologic factors that may contribute to behavioral maintenance. Theoretically guided interventions that account for multiple levels of influence in behavior initiation and maintenance stand to improve health outcomes in vulnerable populations.