Neighborhood Poverty and Physical Health at Midlife: The Role of Life-Course Exposure

Community Efficacy for Non-Communicable Disease Management and Medication Adherence: The Sequential Mediating Role of Self-Efficacy and Depressive Symptoms

Purpose

We assess whether the sequential mediating effects of self-efficacy and depressive symptoms on the relationship between community efficacy for non-communicable disease management (COEN) and medication adherence and whether these relationships differed by sex and age.

Patients and Methods

Overall, 662 individuals from 12 communities in China were interviewed twice 1 year apart. Serial mediation analysis examined whether the relationship between COEN and medication adherence was mediated by self-efficacy and depressive symptoms. Model invariance across sex and age groups was assessed using multi-group analysis.

Results

Serial mediation analysis indicated that self-efficacy and depressive symptoms sequentially mediated relationship between COEN and medication adherence. Multi-group analysis by sex showed that the path from self-efficacy to medication adherence was significant only for females and from depressive symptoms to medication adherence was significant only for males.

Conclusion

Interventions that enhance individual self-efficacy may be beneficial in decreasing depressive symptoms and improving medication adherence.

Austerity, Health and Public Safety in Low-Income Neighborhoods: Grassroots Responses to the Decline of Local Services in Southeast England

This article uses ethnographic and qualitative research to explore the health implications and social responses of a low-income neighborhood in Southeast England, to more than a decade of austerity policies and declining institutional and welfare support. Findings examine how cuts to public services and welfare programs alongside changes to the area's social structure shape resident's perceptions of health risks and threats. Residents pointed to poor levels of mental health that were exacerbated by financial insecurity, the closure of community facilities and difficulties accessing support and professional help. An increase in social disorder and sense of danger within the vicinity were attributed to changes in the area's social composition and a reduction of policing in the neighborhood, which were an additional cause of anxiety for residents. Many people felt their neighborhood was treated inequitably with regard to law-and-order, health provision and other services designed to address health problems and risks and dangers in their social environment. This institutional vacuum generates unmet health needs facilitating informal practices and methods for managing health, such as through self-provision or using alternative, and more readily available, sources of medical advice and treatment. The demise of older forms of social control and surveillance that ran parallel with closure of the area's communal spaces had been partly compensated by social media usage, while informal methods of policing were a growing presence in the neighborhood in reaction to rising lawlessness and the ineffectiveness of police and local authorities.

The Price of Growing Up in a Low-Income Neighborhood: A Scoping Review of Associated Depressive Symptoms and Other Mood Disorders among Children and Adolescents

Neighborhoods, as built and social environments, have significant implications for mental health. Children raised in high-poverty neighborhoods, who are disproportionately Black, Indigenous, and people of color, have a greater risk of adverse life outcomes. Neighborhood gentrification is also salient when examining mental health outcomes as neighborhood economic contexts shift around a child. This review scopes, describes, synthesizes, and critiques the existing literature on the relationship between neighborhood poverty/gentrification and mood disorder symptoms among children ages 3-17 in the United States (U.S.). Given the history of structural racism in the creation of U.S. neighborhoods, inclusion criteria required that study samples be racially diverse. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, seven databases and grey literature were searched; 17 studies were included (total n = 122,089). Fourteen studies found significant associations between neighborhood poverty/gentrification and child depression. Three longitudinal studies found significant results suggesting that childhood neighborhood poverty/gentrification may have a lagged effect, with depression emerging later in life. Neighborhood poverty and gentrification require further examination as social determinants of mental health. Researchers should examine neighborhood poverty and gentrification as social determinants of mental health. Policies that reduce neighborhood economic disparities are needed across the U.S.

Earlier-life individual and spatial socioeconomic conditions and later-life physical activity

This study investigated the association between earlier-life (before age 16) individual and spatial socioeconomic conditions and later-life (mean age 61) physical activity (PA), and the role of later-life characteristics. Contemporary and historical Census data as well as three bi-annual waves of nationally representative panel data from the Understanding America Study (N = 1,981) were used. Multilevel growth curve models were estimated to address the research questions. Father's education in respondents' earlier life was positively associated with light and moderate PA in respondents' later life. Growing up in a higher-poverty area was negatively associated with moderate and vigorous later-life PA. Findings underscore the long-term ramifications of earlier-life circumstances for later-life PA. Consideration should be given to socioeconomic conditions at both individual and spatial levels over the life course to promote PA at older ages.

Association between Neighbourhood Deprivation Trajectories and Self-Perceived Health: Analysis of a Linked Survey and Health Administrative Data

Life course exposure to neighbourhood deprivation may have a previously unstudied relationship with health disparities. This study examined the association between neighbourhood deprivation trajectories (NDTs) and poor reported self-perceived health (SPH) among Quebec's adult population. Data of 45,990 adults with complete residential address histories from the Care-Trajectories-Enriched Data cohort, which links Canadian Community Health Survey respondents to health administrative data, were used. Accordingly, participants were categorised into nine NDTs (T1 (Privileged Stable)-T9 (Deprived Stable)). Using multivariate logistic regression, the association between trajectory groups and poor SPH was estimated. Of the participants, 10.3% (95% confidence interval [CI]: 9.9-10.8) had poor SPH status. This proportion varied considerably across NDTs: From 6.4% (95% CI: 5.7-7.2) for Privileged Stable (most advantaged) to 16.4% (95% CI: 15.0-17.8) for Deprived Stable (most disadvantaged) trajectories. After adjustment, the likelihood of reporting poor SPH was significantly higher among participants assigned to a Deprived Upward (odds ratio [OR]: 1.77; 95% CI: 1.48-2.12), Average Downward (OR: 1.75; CI: 1.08-2.84) or Deprived trajectory (OR: 1.81; CI: 1.45-2.86), compared to the Privileged trajectory. Long-term exposure to neighbourhood deprivation may be a risk factor for poor SPH. Thus, NDT measures should be considered when selecting a target population for public-health-related interventions.

Life Course Neighbourhood Deprivation and Self-Rated Health: Does It Matter Where You Lived in Adolescence and Do Neighbourhood Effects Build Up over Life?

There is an overreliance on concurrent neighbourhood deprivation as a determinant of health. Only a small section of the literature focuses on the cumulative exposure of neighbourhood deprivation over the life course. This paper uses data from the 1958 National Child Development Study, a British birth cohort study, linked to 1971–2011 Census data at the neighbourhood level to longitudinally model self-rated health between ages 23 and 55 by Townsend deprivation score between ages 16 and 55. Change in self-rated health is analysed using ordinal multilevel models to test the strength of association with neighbourhood deprivation at age 16, concurrently and cumulatively. The results show that greater neighbourhood deprivation at age 16 predicts worsening self-rated health between ages 33 and 50. The association with concurrent neighbourhood deprivation is shown to be stronger compared with the measurement at age 16 when both are adjusted in the model. The concurrent association with change in self-rated health is explained by cumulative neighbourhood deprivation. These findings suggest that neglecting exposure to neighbourhood deprivation over the life course will underestimate the neighbourhood effect. They also have potential implications for public policy suggesting that neighbourhood socioeconomic equality may bring about better population health.