Linking profiles of neighborhood elements to health and related outcomes among children across the United States

Neighborhood built environment, obesity, and diabetes: A Utah siblings study

Background

This study utilizes innovative computer vision methods alongside Google Street View images to characterize neighborhood built environments across Utah.

Methods

Convolutional Neural Networks were used to create indicators of street greenness, crosswalks, and building type on 1.4 million Google Street View images. The demographic and medical profiles of Utah residents came from the Utah Population Database (UPDB). We implemented hierarchical linear models with individuals nested within zip codes to estimate associations between neighborhood built environment features and individual-level obesity and diabetes, controlling for individual- and zip code-level characteristics (n = 1,899,175 adults living in Utah in 2015). Sibling random effects models were implemented to account for shared family attributes among siblings (n = 972,150) and twins (n = 14,122).

Results

Consistent with prior neighborhood research, the variance partition coefficients (VPC) of our unadjusted models nesting individuals within zip codes were relatively small (0.5%-5.3%), except for HbA1c (VPC = 23%), suggesting a small percentage of the outcome variance is at the zip code-level. However, proportional change in variance (PCV) attributable to zip codes after the inclusion of neighborhood built environment variables and covariates ranged between 11% and 67%, suggesting that these characteristics account for a substantial portion of the zip code-level effects. Non-single-family homes (indicator of mixed land use), sidewalks (indicator of walkability), and green streets (indicator of neighborhood aesthetics) were associated with reduced diabetes and obesity. Zip codes in the third tertile for non-single-family homes were associated with a 15% reduction (PR: 0.85; 95% CI: 0.79, 0.91) in obesity and a 20% reduction (PR: 0.80; 95% CI: 0.70, 0.91) in diabetes. This tertile was also associated with a BMI reduction of -0.68 kg/m2 (95% CI: -0.95, -0.40).

Conclusion

We observe associations between neighborhood characteristics and chronic diseases, accounting for biological, social, and cultural factors shared among siblings in this large population-based study.

The relationship between neighborhood typologies and self-rated health in Maryland: A latent class analysis

Despite widespread evidence that neighborhood conditions impact health, few studies apply theory to clarify the physical and social factors in communities that drive health outcomes. Latent class analysis (LCA) addresses such gaps by identifying distinct neighborhood typologies and the joint influence that neighborhood-level factors play in health promotion. In the current study, we conducted a theory-driven investigation to describe Maryland neighborhood typologies and examined differences in area-level self-rated poor mental and physical health across typologies. We conducted an LCA of Maryland census tracts (n = 1384) using 21 indicators of physical and social characteristics. We estimated differences in tract-level self-rated physical and mental health across neighborhood typologies using global Wald tests and pairwise comparisons. Five neighborhood classes emerged: Suburban Resourced (n = 410, 29.6%), Rural Resourced (n = 313, 22.6%), Urban Underserved (n = 283, 20.4%), Urban Transient (n = 226, 16.3%), Rural Health Shortage (n = 152, 11.0%). Prevalence of self-rated poor physical and mental health varied significantly (p < 0.0001) by neighborhood typology, with the Suburban Resourced neighborhood class demonstrating the lowest prevalence of poor health and the Urban Underserved neighborhoods demonstrating the poorest health. Our results highlight the complexity of defining "healthy" neighborhoods and areas of focus to mitigate community-level health disparities to achieve health equity.

The role of social cohesion in explaining rural/urban differences in healthcare access and health status among older adults in the mid-Atlantic United States

Social cohesion can influence health. It is higher among rural versus urban residents, but the burden of chronic disease is higher in rural communities. We examined the role of social cohesion in explaining rural/urban differences in healthcare access and health status. Rural (n = 1080) and urban (n = 1846) adults (ages 50+) from seven mid-Atlantic U.S. states completed an online, cross-sectional survey on social cohesion and health. We conducted bivariate and multivariable analyses to evaluate the relationships of rurality and social cohesion with healthcare access and health status. Rural participants had higher social cohesion scores than did urban participants (rural: mean = 61.7, standard error[SE] = 0.40; urban: mean = 60.6, SE = 0.35; adjusted beta = 1.45, SE = 0.54, p < .01). Higher social cohesion was associated with greater healthcare access: last-year check-up: adjusted odds ratio[aOR] = 1.25, 95% confidence interval[CI] = 1.17-1.33; having a personal provider: aOR = 1.11, 95% CI = 1.03-1.18; and being up-to-date with CRC screening: aOR = 1.17, 95% CI = 1.10-1.25. In addition, higher social cohesion was associated with improved health status: higher mental health scores (adjusted beta = 1.03, SE = 0.15, p < .001) and lower body mass index (BMI; beta = -0.26, SE = 0.10, p = .01). Compared to urban participants, rural participants were less likely to have a personal provider, had lower physical and mental health scores, and had higher BMI. Paradoxically, rural residents had higher social cohesion but generally poorer health outcomes than did urban residents, even though higher social cohesion is associated with better health. These findings have implications for research and policy to promote social cohesion and health, particularly for health promotion interventions to reduce disparities experienced by rural residents.

Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study

This study aimed to describe the health status of children and how social deprivation affects their use of healthcare services and mortality. Children living in mainland France were selected from the national health data system (SNDS) on their date of birth or birthday in 2018 (< 18 years) and followed for one year. Information included data on healthcare reimbursements, long-term chronic diseases (LTDs) eligible for 100% reimbursement, geographic deprivation index (FDep) by quintile (Q5 most disadvantaged), and individual complementary universal insurance (CMUc) status, granted to households with an annual income below the French poverty level. The number of children who had at least one annual visit or hospital admission was compared using the ratio of geographic deprivation (rQ5/Q1) and CMUc (rCMUc/Not) after gender and age-standardization. Over 13 million children were included; 17.5% had CMUc, with an increase across quintiles (rQ5/Q1 = 3.5) and 4.0% a LTD (rQ5/Q1 = 1.44). The 10 most frequent LTDs (6 psychiatric) were more common as the deprivation increased. Visits to general practitioners (GPs) were similar (≈84%) for each FDep quintile and the density of GPs similar. The density decreased with increasing deprivation for specialists and visits: paediatricians (rQ5/Q1 = 0.46) and psychiatrists (rQ5/Q1 = 0.26). Dentist visits also decreased (rQ5/Q1 = 0.86) and deprived children were more often hospitalised for dental caries (rQ5/Q1 = 2.17, 2.1% vs 0.7%). Emergency department (ED) visits increased with deprivation (rCMUc/Not = 1.35, 30% vs 22%) but 50% of CMUc children lived in a municipality with an ED vs. 25% without. Approximately 9% of children were admitted for a short stay and 4.5% for a stay > 1 night (rQ5/Q1 = 1.44). Psychiatric hospitalization was more frequent for children with CMUc (rCMUc/Not = 3.5, 0.7% vs 0.2%). Higher mortality was observed for deprived children < 18 years (rQ5/Q1 = 1.59). Our results show a lower use of pediatricians, other specialists, and dentists among deprived children that may be due, in part, to an insufficient supply of care in their area of residence. These results have been used to recommend optimization and specifically adapted individual or area-wide policies on the use of healthcare services, their density, and activities.

Informal supports, housing insecurity, and adolescent outcomes: Implications for promoting resilience

Adolescents in low-income, marginalized families are vulnerable to behavior problems that impede healthy functioning and threaten long-term well-being. Informal supports may fill an important gap for these households as they navigate financial and social stressors. Instrumental support from social networks and neighborhood cohesion may promote family stability and youth well-being; further, these informal supports may promote resilience to housing insecurity, which is linked with a range of adverse adolescent outcomes. The present study utilized data from a large sample of at-risk families with children (N = 2425) to investigate whether instrumental support and neighborhood cohesion predicted adolescent behavior problems over 10 years and whether these links were mediated by housing insecurity. Results of structural equation modeling with latent variables showed direct links from instrumental support to anxious/depressed behaviors and from neighborhood cohesion to aggressive behaviors, as well as an indirect link from instrumental support to aggressive behavior via housing insecurity. Findings suggest informal supports are an important source of resilience for low-income families who may be excluded from or are reluctant to engage with formal social systems. Further, stable, connected communities with highly embedded social networks can promote housing stability and youth well-being in a virtuous cycle.

Supportive Neighborhoods, Family Resilience and Flourishing in Childhood and Adolescence

Flourishing is linked with health and well-being in childhood and adulthood. This study applied a promotive factors model to examine how neighborhood assets might benefit child and adolescent flourishing by promoting family resilience. Using data from the combined 2018 and 2019 National Survey of Children’s Health, structural equation models tested direct and indirect relationships between neighborhood physical environment, neighborhood social cohesion, family resilience, and flourishing among 18,396 children and 24,817 adolescents. After controlling for multiple covariates that may influence flourishing, the models supported that higher levels of neighborhood social cohesion were directly associated with higher levels of flourishing adolescents, and indirectly by positive associations with family resilience for both children and adolescents. No indirect effects between neighborhood physical environments and flourishing were supported by the data for either children or adolescents. However, neighborhood physical environments were positively associated with adolescent flourishing. Understanding social environmental factors that strengthen and enhance child and adolescent flourishing are critical toward designing prevention, intervention, and policy efforts that can build on the existing strengths of families and their communities.

A Latent Class Analysis of Perceived Neighborhood Conditions Associated with Mental Disorders Among Children in the United States

The current study examined the association between perceived neighborhood conditions and common childhood mental disorders in a nationally representative sample of children in the U.S. The data were derived from the 2017 National Survey of Children's Health, including American children aged 6-17 years (N = 15,438). Latent class analysis was used to identify subtypes of perceived neighborhood conditions regarding neighborhood physical environment, social capital, and violence. Three classes were identified: Ideal Neighborhood (55.99%); Insufficient Assets (27.38%), and Broken and Unsafe Neighborhood (16.63%). The effects of latent classes on psychiatric outcomes (i.e. attention deficit hyperactivity disorder, depression, anxiety, conduct problem, and any of these four disorders) were examined. Class membership was differentially associated with the mental disorders after adjustment for demographic variables, food insufficiency, and guardian's mental health. The Broken and Unsafe Neighborhood class was associated with greater odds of all childhood psychiatric disorders than the Ideal Neighborhood and Insufficient Assets class. Insufficient Assets class was associated with greater odds of all childhood psychiatric disorders than the Ideal Neighborhood class. The findings suggest that neighborhood-level interventions to decrease children's mental health burdens are critically needed.

Examining the relationship between poverty and length of stay: a repeated cross-sectional study of paediatric hospitalisations in Chile

OBJECTIVE

To measure poverty-based disparities in inpatient length of stay for paediatric hospitalisations. In particular, this paper examines the relationship between municipality level poverty rates and length of stay, accounting for individual level characteristics.

DESIGN

We use patient discharge data to conduct a repeated cross-sectional study of the totality of paediatric hospitalisations in 15 regions of Chile, in the years 2011, 2013, 2015 and 2017.

SETTING

All hospital discharges in 15 regions of Chile.

PARTICIPANTS

1 033 222 discharges for children under the age of 15, between 2011 and 2017.

OUTCOME MEASURES

Length of stay (LOS); LOS by type of insurance and type of hospital; hospitalisation rates; municipality-level average LOS.

RESULTS

We find that municipality level poverty rates are a significant predictor of LOS, even after controlling for individual and area level characteristics, including type of insurance. Children from municipalities in the poorest quintile have a LOS that is 14% shorter as compared with children from municipalities in the richest quintile. This relationship is stronger for publicly insured children: the decrease in LOS associated with the same poverty change is of 22%.

CONCLUSIONS

This paper shows that there is an association between municipality-level poverty rates and length of stay for paediatric hospitalisations in Chile. For the vast majority of the sample, and after controlling for individual level characteristics, an increase in the municipality level poverty rate is associated with a decrease in the length of stay. Further, there is a non-linearity in the relationship, where at the highest poverty rates, poverty and LOS are positively associated. These findings are robust after controlling for type of hospital (public vs private), type of insurance (public vs private), type of diagnosis, as well as year and region fixed effects.

Review on the role of socioeconomic status in child health and development

PURPOSE OF REVIEW

This review presents findings from recent studies investigating the role of socioeconomic status (SES) in child development. Studies on associations between SES and different parameters of physical and psychological health, on interventions and possible resilience factors are reviewed.

RECENT FINDINGS

Several cross-sectional and longitudinal studies demonstrate social disparities in child behavior and health. They underline the detrimental effects of low SES on child development. Some studies also highlight the potentially adverse effects of early diseases or vulnerabilities on later career and social position. Whereas most studies applied parent-based measures of SES, some studies emphasize the significance of child-based (e.g. perceived social position) and area-level indicators of SES (e.g. area deprivation). With respect to intervention, study findings suggest positive effects of programs aiming to improve specific neighborhood characteristics and psychosocial functioning of individuals.

SUMMARY

The relation between SES and health is bidirectional and stable, and the effects of interventions aiming at changing behaviors of children and families with low SES are small. There is a need for further center-based and area-level interventions and studies evaluating the effects of these interventions.