1
|
Pichardo MS, Pichardo CM, Talavera GA, Gallo LC, Kuo CC, Castañeda SF, Chambers EC, Daviglus ML, Pirzada A, Perreira KM, Sotres-Alvarez D, Peña Ortiz TY, Plascak JJ. Change in Neighborhood Socioeconomic Status and Adherence to the Cancer Prevention Lifestyle Guidelines in Hispanic/Latino Adults: Results from the HCHS/SOL Study. CANCER RESEARCH COMMUNICATIONS 2023; 3:1981-1991. [PMID: 37783658 PMCID: PMC10542571 DOI: 10.1158/2767-9764.crc-23-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/03/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023]
Abstract
Neighborhood conditions are dynamic; the association of changing neighborhood socioeconomic factors with cancer preventive behaviors remains unclear. We examined associations of neighborhood socioeconomic deprivation, gentrification, and change in income inequality with adherence to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention in The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The HCHS/SOL enrolled 16,415 adults, ages 18–74 years, at baseline (2008–2011), from communities in the Bronx, NY, Chicago, IL, Miami, FL, and San Diego, CA. Geocoded baseline addresses were linked to the 2000 decennial Census and 5-year American Community Survey (2005–2009 and 2012–2016) tracts to operationalize neighborhood deprivation index (NDI), gentrification, and income inequality. Complex survey multinominal logistic regression models estimated the relative risk ratio (RRR) with overall guideline adherence level (low, moderate, high) and by components—diet, physical activity, body mass index (BMI), and alcohol intake. Overall, 14%, 60%, and 26% of the population had low, moderate, and high ACS guideline adherence, respectively. NDI was negatively associated with risk of high (vs. low) guideline adherence [RRR = 0.87, 95% confidence interval (CI) = 0.78–0.98], although attenuated after controlling for individual socioeconomic status (SES; RRR = 0.89, 95% CI = 0.80–1.00), and associated with lower adherence to BMI recommendations (low vs. moderate RRR = 0.90, 95% CI = 0.84–0.97; high RRR = 0.86, 95% CI = 0.77–0.97). Gentrification was associated with higher likelihood of meeting the dietary recommendations (low vs. moderate RRR = 1.04, 95% CI = 1.01–1.07), but not with overall adherence or individual components. Change in income inequality was not associated with outcomes. Neighborhood deprivation may be negatively associated with ACS guideline adherence among Hispanic/Latino adults. SIGNIFICANCE This study provides new evidence on the link between neighborhood gentrification, changing income inequality and adoption and maintenance of cancer preventive behaviors in an understudied population in cancer research. We observed that while neighborhood deprivation may deter from healthy lifestyle behaviors, positive changes in neighborhood SES via the process of gentrification, may not influence lifestyle guideline adherence among Hispanic/Latino adults.
Collapse
Affiliation(s)
- Margaret S. Pichardo
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Catherine M. Pichardo
- South Bay Latino Research Center, Department of Psychology, San Diego State University, San Diego, California
| | | | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, California
| | - Charlene C. Kuo
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland
| | | | - Earle C. Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, New York
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois
| | - Amber Pirzada
- Institute for Minority Health Research, University of Illinois Chicago, Chicago, Illinois
| | - Krista M. Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Jesse J. Plascak
- Division of Cancer Prevention and Control, Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
2
|
Pichardo MS, Pichardo CM, Talavera GA, Gallo LC, Castañeda SF, Sotres-Alvarez D, Molina Y, Evenson KR, Daviglus ML, Hou L, Joyce B, Aviles-Santa L, Plascak J. Neighborhood segregation and cancer prevention guideline adherence in US Hispanic/Latino adults: Results from the HCHS/SOL. Front Oncol 2022; 12:1024572. [PMID: 36601483 PMCID: PMC9806719 DOI: 10.3389/fonc.2022.1024572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022] Open
Abstract
Background Adherence to the American Cancer Society (ACS) guidelines for cancer prevention is associated with a lower risk of cancer and mortality. The role of neighborhood segregation on adherence to the guidelines among Hispanic/Latino adults is relatively unexplored. Materials and methods The Hispanic Community Health Study/Study of Latinos is a community-based prospective cohort of 16,462 Hispanic/Latino adults, ages 18-74 years enrolled in 2008-2011 from the Bronx, Chicago, Miami and San Diego. Dimensions of neighborhood segregation were measured using 2010 United States' census tracts:-evenness (the physical separation of a group), exposure (the propensity for contact between groups), and their joint effect (hypersegregation). ACS guideline adherence levels - low, moderate, high - were created from accelerometry-measured physical activity, dietary intake, alcohol intake, and body mass index. Weighted multinominal logistic regressions estimated relative risk ratios (RRR) and 95% confidence intervals (CI) for guideline adherence levels and its components. Results Hispanic/Latino adults were classified as low (13.7%), moderate (58.8%) or highly (27.5%) adherent to ACS guidelines. We found no evidence of an association between segregation and overall guideline adherence. Exposure segregation associated with lower likelihood of moderate adherence to alcohol recommendations (RRRmoderate vs. low:0.86, 95%CI:0.75-0.98) but higher likelihood for diet recommendations (RRRmoderate vs. low:1.07, 95%CI:1.01-1.14). Evenness segregation associated with lower likelihood of high adherence to the physical activity recommendations (RRRhigh vs. low:0.73, 95%CI:0.57-0.94). Hypersegregation was associated with individual guideline components. Conclusion We found evidence of a cross-sectional relationship between neighborhood segregation and ACS cancer prevention guideline components, but not with overall ACS guideline adherence.
Collapse
Affiliation(s)
- Margaret S. Pichardo
- Department of Psychology, San Diego State University, San Diego, CA, United States,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States,Department of Surgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, United States,*Correspondence: Margaret S. Pichardo,
| | - Catherine M. Pichardo
- Department of Psychology, San Diego State University, San Diego, CA, United States,Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States,Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - Gregory A. Talavera
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Sheila F. Castañeda
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Kelly R. Evenson
- Department of Epidemiology, Northwestern University, Chicago, IL, United States
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, United States
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Brian Joyce
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Larissa Aviles-Santa
- National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Jesse Plascak
- Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, United States
| |
Collapse
|
3
|
Gao X, Kershaw KN, Barber S, Schreiner PJ, Do DP, Diez Roux AV, Mujahid MS. Associations Between Residential Segregation and Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2022; 11:e023084. [PMID: 35048712 PMCID: PMC9238487 DOI: 10.1161/jaha.121.023084] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Residential segregation, a geospatial manifestation of structural racism, is a fundamental driver of racial and ethnic health inequities, and longitudinal studies examining segregation's influence on cardiovascular health are limited. This study investigates the impact of segregation on hypertension in a multiracial and multiethnic cohort and explores whether neighborhood environment modifies this association. Methods and Results Leveraging data from a diverse cohort of adults recruited from 6 sites in the United States with 2 decades of follow-up, we used race- and ethnicity-stratified Cox models to examine the association between time-varying segregation with incident hypertension in 1937 adults free of hypertension at baseline. Participants were categorized as residing in segregated and nonsegregated neighborhoods using a spatial-weighted measure. We used a robust covariance matrix estimator to account for clustering within neighborhoods and assessed effect measure modification by neighborhood social or physical environment. Over an average follow-up of 7.35 years, 65.5% non-Hispanic Black, 48.1% Chinese, and 53.7% Hispanic participants developed hypertension. Net of confounders, Black and Hispanic residents in segregated neighborhoods were more likely to develop hypertension relative to residents in nonsegregated neighborhoods (Black residents: hazard ratio [HR], 1.33; 95% CI, 1.09-1.62; Hispanic residents: HR, 1.33; 95% CI, 1.04-1.70). Results were similar but not significant among Chinese residents (HR, 1.20; 95% CI, 0.83-1.73). Among Black residents, neighborhood social environment significantly modified this association such that better social environment was associated with less pronounced impact of segregation on hypertension. Conclusions This study underscores the importance of continued investigations of groups affected by the health consequences of racial residential segregation while taking contextual neighborhood factors, such as social environment, into account.
Collapse
Affiliation(s)
- Xing Gao
- Division of Epidemiology School of Public Health University of California Berkeley CA
| | - Kiarri N Kershaw
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Sharrelle Barber
- Department of Epidemiology & Biostatistics Dornsife School of Public Health Drexel University Philadelphia PA
| | - Pamela J Schreiner
- Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - D Phuong Do
- Public Health Policy and Administration Zilber School of Public Health University of Wisconsin-Milwaukee Milwaukee WI
| | - Ana V Diez Roux
- Department of Epidemiology & Biostatistics Dornsife School of Public Health Drexel University Philadelphia PA
| | - Mahasin S Mujahid
- Division of Epidemiology School of Public Health University of California Berkeley CA
| |
Collapse
|
4
|
Hanna DB, Hua S, Gonzalez F, Kershaw KN, Rundle AG, Van Horn LV, Wylie-Rosett J, Gellman MD, Lovasi GS, Kaplan RC, Mossavar-Rahmani Y, Shaw PA. Higher Neighborhood Population Density Is Associated with Lower Potassium Intake in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010716. [PMID: 34682466 PMCID: PMC8535329 DOI: 10.3390/ijerph182010716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022]
Abstract
Current U.S. dietary guidelines recommend a daily potassium intake of 3400 mg/day for men and 2600 mg/day for women. Sub-optimal access to nutrient-rich foods may limit potassium intake and increase cardiometabolic risk. We examined the association of neighborhood characteristics related to food availability with potassium intake in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). 13,835 participants completed a 24-h dietary recall assessment and had complete covariates. Self-reported potassium intake was calibrated with an objective 24-h urinary potassium biomarker, using equations developed in the SOL Nutrition & Physical Activity Assessment Study (SOLNAS, N = 440). Neighborhood population density, median household income, Hispanic/Latino diversity, and a retail food environment index by census tract were obtained. Linear regression assessed associations with 24-h potassium intake, adjusting for individual-level and neighborhood confounders. Mean 24-h potassium was 2629 mg/day based on the SOLNAS biomarker and 2702 mg/day using multiple imputation and HCHS/SOL biomarker calibration. Compared with the lowest quartile of neighborhood population density, living in the highest quartile was associated with a 26% lower potassium intake in SOLNAS (adjusted fold-change 0.74, 95% CI 0.59–0.94) and a 39% lower intake in HCHS/SOL (adjusted fold-change 0.61 95% CI 0.45–0.84). Results were only partially explained by the retail food environment. The mechanisms by which population density affects potassium intake should be further studied.
Collapse
Affiliation(s)
- David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
- Correspondence:
| | - Simin Hua
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Franklyn Gonzalez
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.N.K.); (L.V.V.H.)
| | - Andrew G. Rundle
- Department of Epidemiology, Columbia University, New York, NY 10032, USA;
| | - Linda V. Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.N.K.); (L.V.V.H.)
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Marc D. Gellman
- Department of Psychology, University of Miami, Coral Gables, FL 33124, USA;
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics and Urban Health Collective, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Pamela A. Shaw
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA;
| |
Collapse
|
5
|
Braid L, Oliva R, Nichols K, Reyes A, Guzman J, Goldman RE, Woo Baidal JA. Community Perceptions in New York City: Sugar-Sweetened Beverage Policies and Programs in the First 1000 Days. Matern Child Health J 2021; 26:193-204. [PMID: 34618312 PMCID: PMC8495667 DOI: 10.1007/s10995-021-03255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
Objectives To examine perceptions of Sugar-sweetened beverage (SSB) policies and programs focused on the first 1000 days—gestation through age 2 years—among community stakeholders in Washington Heights and the South Bronx, two neighborhoods in New York City with disproportionately high prevalence of childhood obesity. Methods A multilevel framework informed interview guide development. Using purposeful sampling, we recruited study participants who were (1) able to speak English or Spanish and (2) resided or employed in Washington Heights or the South Bronx. Participants included community leaders (local government officials, community board members, and employees from community- and faith-based organizations) as well as community members. Trained research staff conducted semi-structured in-depth interviews. Using immersion/crystallization and template style coding, the study team performed thematic analysis until no new relevant themes emerged. Results Among the 19 female study participants, perceived facilitators to SSB policy and program implementation included sustained partnerships with broad coalitions; continual education and clear messaging; and increased accessibility to healthier beverages. Perceived barriers included systems-level challenges accessing programs that support healthy beverage options, and individual-level lack of access to affordable healthy beverages. Acceptable potential intervention strategies included messaging that emphasizes health in pregnancy and infancy; policies that require healthy beverages as the default option in restaurants; and policies that remove SSBs from childcare settings. Some strongly favored SSB excise taxes while others opposed them, but all participants supported reinvestment of SSB tax revenue into health resources among marginalized communities. Conclusions A multi-pronged approach that incorporates engagement, access, equitable reinvestment of revenue, and continual clear messaging may facilitate implementation of policies and programs to reduce SSB consumption in the first 1000 days.
Collapse
Affiliation(s)
- Lucy Braid
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 100032, USA.,UC Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, USA
| | - Rocio Oliva
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 100032, USA.,The Warren Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, USA.,Institute of Human Nutrition, Columbia University Medical Center, 630 W. 168th Street, New York, NY, USA
| | - Kelsey Nichols
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 100032, USA
| | - Anita Reyes
- New York City Department of Health and Mental Hygiene, Center for Bronx Health Equity, New York, NY, USA
| | - Jairo Guzman
- Coalición Mexicana (Mexican Coalition), Bronx, NY, USA
| | - Roberta E Goldman
- The Warren Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, USA
| | - Jennifer A Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, 100032, USA.
| |
Collapse
|
6
|
Yang TC, Park K, Matthews SA. Racial/ethnic segregation and health disparities: Future directions and opportunities. SOCIOLOGY COMPASS 2020; 14:e12794. [PMID: 32655686 PMCID: PMC7351362 DOI: 10.1111/soc4.12794] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/08/2020] [Indexed: 05/10/2023]
Abstract
Health researchers have investigated the association between racial segregation and racial health disparities with multilevel approaches. This study systematically reviews these multilevel studies and identifies broad trends and potential directions for future research on racial segregation and health disparities in the US. After searching databases including CINAHL and MEDLINE, we identified and systematically reviewed 66 articles published between 2003 and 2019 and found four major gaps in racial/ethnic segregation and health disparities: (a) the concept of segregation was rarely operationalized at the neighborhood level, (b) except for the evenness and exposure dimension, other dimensions of segregation are overlooked, (c) little attention was paid to the segregation between whites and non-black minorities, particularly Hispanics and Asians, and (d) mental health outcomes were largely absent. Future directions and opportunities include: First, other segregation dimensions should be explored. Second, the spatial scales for segregation measures should be clarified. Third, the theoretical frameworks for black and non-black minorities should be tested. Fourth, mental health, substance use, and the use of mental health care should be examined. Fifth, the long-term health effect of segregation has to be investigated, and finally, other competing explanations for why segregation matters at the neighborhood level should be answered.
Collapse
Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, 315 AS, 1400 Washington Avenue, Albany, NY 12222
| | - Kiwoong Park
- Department of Sociology & Criminology, University of Arkansas, 211 Old Main, University of Arkansas Fayetteville, AR 72701
| | - Stephen A Matthews
- Department of Sociology & Criminology, Pennsylvania State University, 211 Oswald Tower, University Park, PA 16802
| |
Collapse
|
7
|
Disparities in food consumption between economically segregated urban neighbourhoods. Public Health Nutr 2019; 23:525-537. [PMID: 31839024 DOI: 10.1017/s1368980019003501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine associations between economic residential segregation and prevalence of healthy and unhealthy eating markers. DESIGN Cross-sectional. A stratified sample was selected in a three-stage process. Prevalence of eating markers and their 95 % CI were estimated according to economic residential segregation: high (most segregated); medium (integrated) and low (less segregated or integrated). Segregation was measured at the census tract and assessed using the Getis-Ord local $G_i^{\rm{\ast}}$ statistic based on the proportion of heads of household in a neighbourhood earning a monthly income of 0-3 minimum wages. Binary logistic regression using generalized estimating equations were used to model the associations. SETTING Belo Horizonte, Brazil. PARTICIPANTS Adults (n 1301) residing in the geographical environment (178 census tracts) of ten units of the Brazilian primary-care service known as the Health Academy Program. RESULTS Of the 1301 participants, 27·7 % lived in highly segregated neighbourhoods, where prevalence of regular consumption of fruit was lower compared with more affluent areas (34·6 v. 53·2 %, respectively). Likewise, regular consumption of vegetables (70·1 v. 87·6 %), fish (23·6 v. 42·3 %) and replacement of lunch or dinner with snacks (0·8 v. 4·7 %) were lower in comparison to more affluent areas. In contrast, regular consumption of beans was higher (91·0 v. 79·5 %). The associations of high-segregated neighbourhood with consumption of vegetables (OR = 0·62; 95 % CI 0·39, 0·98) and beans (OR = 1·85; 95 % CI 1·07, 3·19) remained significant after adjustments. CONCLUSIONS Economic residential segregation was associated with healthy eating markers even after adjustments for individual-level factors and perceived food environment.
Collapse
|
8
|
Li K, Wen M, Fan JX. Neighborhood Racial Diversity and Metabolic Syndrome: 2003-2008 National Health and Nutrition Examination Survey. J Immigr Minor Health 2019; 21:151-160. [PMID: 29603089 DOI: 10.1007/s10903-018-0728-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study investigated the independent association between neighborhood racial/ethnic diversity and metabolic syndrome among US adults, and focused on how this association differed across individual and neighborhood characteristics (i.e., race/ethnicity, sex, age, urbanity, neighborhood poverty). Objectively-measured biomarker data from 2003 to 2008 National Health and Nutrition Examination Survey were linked to census-tract profiles from 2000 decennial census (N = 10,122). Multilevel random intercept logistic regression models were estimated to examine the contextual effects of tract-level racial/ethnic diversity on individual risks of metabolic syndrome. Overall, more than 20% of the study population were identified as having metabolic syndrome, although the prevalence also varied across demographic subgroups and specific biomarkers. Multilevel analyses showed that increased racial/ethnic diversity within a census tract was associated with decreased likelihood of having metabolic syndrome (OR 0.71, 95% CI 0.52-0.96), particularly among female (OR 0.64; 95% CI 0.43-0.96), young adults (OR 0.60; 95% CI 0.39-0.93), and residents living in urban (OR 0.67; 95% CI 0.48-0.93) or poverty neighborhoods (OR 0.54; 95% CI 0.31-0.95). The findings point to the potential benefits of neighborhood racial/ethnic diversity on individual health risks.
Collapse
Affiliation(s)
- Kelin Li
- Department of Sociology, California State University-Dominguez Hills, 1000 E Victoria St, Carson, CA, 90747, USA.
| | - Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Jessie X Fan
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Wong MS, Chan KS, Jones-Smith JC, Colantuoni E, Thorpe RJ, Bleich SN. The neighborhood environment and obesity: Understanding variation by race/ethnicity. Prev Med 2018; 111:371-377. [PMID: 29197530 PMCID: PMC5930051 DOI: 10.1016/j.ypmed.2017.11.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/13/2017] [Accepted: 11/26/2017] [Indexed: 01/10/2023]
Abstract
Neighborhood characteristics have been associated with obesity, but less is known whether relationships vary by race/ethnicity. This study examined the relationship between soda consumption - a behavior strongly associated with obesity - and weight status with neighborhood sociodemographic, social, and built environments by race/ethnicity. We merged data on adults from the 2011-2013 California Health Interview Survey, U.S. Census data, and InfoUSA (n=62,396). Dependent variables were soda consumption and weight status outcomes (body mass index and obesity status). Main independent variables were measures of three neighborhood environments: social (social cohesion and safety), sociodemographic (neighborhood socioeconomic status, educational attainment, percent Asian, percent Hispanic, and percent black), and built environments (number of grocery stores, convenience stores, fast food restaurants, and gyms in neighborhood). We fit multi-level linear and logistic regression models, stratified by individual race/ethnicity (NH (non-Hispanic) Whites, NH African Americans, Hispanics, and NH Asians) controlling for individual-level characteristics, to estimate neighborhood contextual effects on study outcomes. Lower neighborhood educational attainment was associated with higher odds of obesity and soda consumption in all racial/ethnic groups. We found fewer associations between study outcomes and the neighborhood, especially the built environment, among NH African Americans and NH Asians. While improvements to neighborhood environment may be promising to reduce obesity, null associations among minority subgroups suggest that changes, particularly to the built environment, may alone be insufficient to address obesity in these groups.
Collapse
Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Kitty S Chan
- Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Jessica C Jones-Smith
- Department of Health Services & Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Sara N Bleich
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| |
Collapse
|
10
|
D'Agostino EM, Patel HH, Ahmed Z, Hansen E, Sunil Mathew M, Nardi MI, Messiah SE. Impact of change in neighborhood racial/ethnic segregation on cardiovascular health in minority youth attending a park-based afterschool program. Soc Sci Med 2018; 205:116-129. [PMID: 29705630 DOI: 10.1016/j.socscimed.2018.03.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 03/20/2018] [Accepted: 03/24/2018] [Indexed: 01/05/2023]
Abstract
Research on the mechanistic factors associating racial/ethnic residential segregation with health is needed to identify effective points of intervention to ultimately reduce health disparities in youth. We examined the association of changes in racial/ethnic segregation and cardiovascular health outcomes including body mass index percentile, sum of skinfold thicknesses, systolic and diastolic blood pressure percentile, and 400 m run time in non-Hispanic Black (NHB) and Hispanic youth (n = 2,250, mean age 9.1 years, 54% male; 51% Hispanic, 49% NHB; 49% high area poverty; 25% obese) attending Fit2Play™, a multisite park-based afterschool program in Miami, Florida, USA. A series of crude and adjusted two-level longitudinal generalized linear mixed models with random intercepts for park effects were fit to assess the association of change in segregation between home and program/park site and cardiovascular health outcomes for youth who participated for up to two school years in Fit2Play™. After adjusting for individual-level factors (sex, age, time, and park-area poverty) models showed significantly greater improvements in cardiovascular health if youth attended Fit2Play™ in an area less segregated than their home area (p < 0.05 for all outcomes) except 400 m run time and diastolic blood pressure percentile in Hispanics (p<.001 and p = 0.11, respectively). Area poverty was not found to confound or significantly modify this association. These findings have implications for youth programming focused on reducing health disparities and improving cardiovascular outcomes in NHB and Hispanic youth, particularly in light of a continually expanding obesity epidemic in these groups. Parks and Recreation Departments have potential to expand geographic mobility for minorities, therein supporting the national effort to reduce health inequalities.
Collapse
Affiliation(s)
- Emily M D'Agostino
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA.
| | - Hersila H Patel
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Zafar Ahmed
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Eric Hansen
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - M Sunil Mathew
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria I Nardi
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Sarah E Messiah
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
11
|
Elfassy T, Yi SS, Llabre MM, Schneiderman N, Gellman M, Florez H, Prado G, Zeki Al Hazzouri A. Neighbourhood socioeconomic status and cross-sectional associations with obesity and urinary biomarkers of diet among New York City adults: the heart follow-up study. BMJ Open 2017; 7:e018566. [PMID: 29289939 PMCID: PMC5778292 DOI: 10.1136/bmjopen-2017-018566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine whether neighbourhood socioeconomic status (SES) is associated with body mass index (BMI), waist circumference (WC) and biomarkers of diet (urinary sodium and potassium excretion). DESIGN A cross-sectional study. SETTING The data reported were from the 2010 Heart Follow-up Study, a population-based representative survey of 1645 adults. PARTICIPANTS Community-dwelling diverse residents of New York City nested within 128 neighbourhoods (zip codes). PRIMARY AND SECONDARY OUTCOME MEASURES BMI (kg/m2) and WC (inches) were measured during in-home visits, and 24-hour urine sample was collected to measure biomarkers of diet: sodium (mg/day) and potassium (mg/day), with high sodium and low potassium indicative of worse diet quality. RESULTS After adjusting for individual-level characteristics using multilevel linear regressions, low versus high neighbourhood SES tertile was associated with 1.83 kg/m2 higher BMI (95% CI 0.41 to 3.98) and 251 mg/day lower potassium excretion (95% CI -409 to 93) among women only, with no associations among men (P values for neighbourhood SES by sex interactions <0.05). CONCLUSION Our results suggest that women may be particularly vulnerable to the effects of a socioeconomically disadvantaged neighbourhood. Future neighbourhood research should explore sex differences, as these can inform tailored interventions. TRIAL REGISTRATION NUMBER NCT01889589; Results.
Collapse
Affiliation(s)
- Tali Elfassy
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Stella S Yi
- Department of Population Health, New York University School of Medicine, New York, USA
| | - Maria M Llabre
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Marc Gellman
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Hermes Florez
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | | |
Collapse
|
12
|
Kim T, Rhee CM, Streja E, Soohoo M, Obi Y, Chou JA, Tortorici AR, Ravel VA, Kovesdy CP, Kalantar-Zadeh K. Racial and Ethnic Differences in Mortality Associated with Serum Potassium in a Large Hemodialysis Cohort. Am J Nephrol 2017; 45:509-521. [PMID: 28528336 PMCID: PMC5546877 DOI: 10.1159/000475997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/14/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hyperkalemia is observed in chronic kidney disease patients and may be a risk factor for life-threatening arrhythmias and death. Race/ethnicity may be important modifiers of the potassium-mortality relationship in maintenance hemodialysis (MHD) patients given that potassium intake and excretion vary among minorities. METHODS We examined racial/ethnic differences in baseline serum potassium levels and all-cause and cardiovascular mortality using Cox proportional hazard models and restricted cubic splines in a cohort of 102,241 incident MHD patients. Serum potassium was categorized into 6 groups: ≤3.6, >3.6 to ≤4.0, >4.0 to ≤4.5 (reference), >4.5 to ≤5.0, >5.0 to ≤5.5, and >5.5 mEq/L. Models were adjusted for case-mix and malnutrition-inflammation cachexia syndrome (MICS) covariates. RESULTS The cohort was composed of 50% whites, 34% African-Americans, and 16% Hispanics. Hispanics tended to have the highest baseline serum potassium levels (mean ± SD: 4.58 ± 0.55 mEq/L). Patients in our cohort were followed for a median of 1.3 years (interquartile range 0.6-2.5). In our cohort, associations between higher potassium (>5.5 mEq/L) and higher mortality risk were observed in African-American and whites, but not Hispanic patients in models adjusted for case-mix and MICS covariates. While in Hispanics only, lower serum potassium (<3.6 mEq/L) levels were associated with higher mortality risk. Similar trends were observed for cardiovascular mortality. CONCLUSIONS Higher potassium levels were associated with higher mortality risk in white and African-American MHD patients, whereas lower potassium levels were associated with higher death risk in Hispanics. Further studies are needed to determine the underlying mechanisms for the differential association between potassium and mortality across race/ethnicity.
Collapse
Affiliation(s)
- Taehee Kim
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
de Mestral C, Mayén AL, Petrovic D, Marques-Vidal P, Bochud M, Stringhini S. Socioeconomic Determinants of Sodium Intake in Adult Populations of High-Income Countries: A Systematic Review and Meta-Analysis. Am J Public Health 2017; 107:e1-e12. [PMID: 28207328 DOI: 10.2105/ajph.2016.303629] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A poorer quality diet among individuals with low socioeconomic status (SES) may partly explain the higher burden of noncommunicable disease among disadvantaged populations. Because there is a link between sodium intake and noncommunicable diseases, we systematically reviewed the current evidence on the social patterning of sodium intake. OBJECTIVES To conduct a systematic review and a meta-analysis of the evidence on the association between SES and sodium intake in healthy adult populations of high-income countries. SEARCH METHODS We followed the PRISMA-Equity guidelines in conducting a literature search that ended June 3, 2016, via MEDLINE, Embase, and SciELO. We imposed no publication date limits. SELECTION CRITERIA We considered only peer-reviewed articles meeting the following inclusion criteria: (1) reported a measure of sodium intake disaggregated by at least 1 measure of SES (education, income, occupation, or any other socioeconomic indicator); (2) were written in English, Spanish, Portuguese, French, or Italian; and (3) were conducted in a high-income country as defined by the World Bank (i.e., per capita national gross income was higher than $12 746). We also excluded articles that exclusively sampled low-SES individuals, pregnant women, children, adolescents, elderly participants, or diseased patients or that reported results from a trial or intervention. DATA COLLECTION AND ANALYSIS As summary measures, we extracted (1) the direction (positive, negative, or neutral) and the magnitude of the association between each SES indicator and sodium intake, and (2) the estimated sodium intake according to SES level. When possible and if previously unreported, we calculated the magnitude of the relative difference in sodium intake between high- and low-SES groups for each article, applying this formula: ([value for high-SES group - value for low-SES group]/[value for high-SES group]) × 100. We considered an association significant if reported as such, and we set an arbitrary 10% relative difference as clinically relevant and significant. We conducted a meta-analysis of the relative difference in sodium intake between high- and low-SES groups. We included articles in the meta-analysis if they reported urine-based sodium estimates and provided the total participant numbers in the low- and high-SES groups, the estimated sodium intake means for each group (in mg/day or convertible units), and the SDs (or transformable measures). We chose a random-effects model to account for both within-study and between-study variance. MAIN RESULTS Fifty-one articles covering 19 high-income countries met our inclusion criteria. Of these, 22 used urine-based methods to assess sodium intake, and 30 used dietary surveys. These articles assessed 171 associations between SES and sodium intake. Among urine-based estimates, 67% were negative (higher sodium intake in people of low SES), 3% positive, and 30% neutral. Among diet-based estimates, 41% were negative, 21% positive, and 38% neutral. The random-effects model indicated a 14% relative difference between low- and high-SES groups (95% confidence interval [CI] = -18, -9), corresponding to a global 503 milligrams per day (95% CI = 461, 545) of higher sodium intake among people of low SES. CONCLUSIONS People of low SES consume more sodium than do people of high SES, confirming the current evidence on socioeconomic disparities in diet, which may influence the disproportionate noncommunicable disease burden among disadvantaged socioeconomic groups. Public Health Implications. It is necessary to focus on disadvantaged populations to achieve an equitable reduction in sodium intake to a population mean of 2 grams per day as part of the World Health Organization's target to achieve a 25% relative reduction in noncommunicable disease mortality by 2025.
Collapse
Affiliation(s)
- Carlos de Mestral
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Ana-Lucia Mayén
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Dusan Petrovic
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Pedro Marques-Vidal
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Murielle Bochud
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Silvia Stringhini
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| |
Collapse
|
14
|
Lim S, Yi SS, Lundy De La Cruz N, Trinh-Shevrin C. Defining Ethnic Enclave and Its Associations with Self-Reported Health Outcomes Among Asian American Adults in New York City. J Immigr Minor Health 2017; 19:138-146. [PMID: 26699378 PMCID: PMC4919243 DOI: 10.1007/s10903-015-0334-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence on ethnic enclave-health associations for Asian Americans is limited due to an inconsistent definition of ethnic enclave. The authors aimed to establish a robust criterion for defining Asian enclaves in New York City (NYC) and assessed the association between enclave residence and health outcomes among Asian American adults. Data came from 2009-2012 NYC Community Health Surveys and 2008-2012 American Community Survey. Asian enclave was defined as an area with high dissimilarity and isolation scores as well as high concentration of Asians. Five of 55 NYC community districts were identified as Asian enclaves. After controlling for confounding, enclave residence was associated with positive perception of general health with borderline significance (prevalence ratio = 1.06, 95 % CI 0.98, 1.15), but not with current smoking, hypertension, and diabetes. Ethnic enclave residence in urban areas may not produce a substantial impact on chronic health outcomes for Asian Americans beyond individual-level factors.
Collapse
Affiliation(s)
- Sungwoo Lim
- New York City Department of Health and Mental Hygiene, New York, NY, USA.
- Bureau of Epidemiology Services, Division of Epidemiology, New York City Department of Health and Mental Hygiene, Gotham Center, CN-6, 42-09 28th Street, Queens, NY, 11101-4132, USA.
| | - Stella S Yi
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | | | - Chau Trinh-Shevrin
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| |
Collapse
|
15
|
Yi SS, Beasley JM, Kwon SC, Huang KY, Trinh-Shevrin C, Wylie-Rosett J. Acculturation and activity behaviors in Chinese American immigrants in New York City. Prev Med Rep 2016; 4:404-409. [PMID: 27570733 PMCID: PMC4992039 DOI: 10.1016/j.pmedr.2016.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/05/2016] [Accepted: 08/07/2016] [Indexed: 11/30/2022] Open
Abstract
Asian Americans have lower levels of physical activity (PA) compared to other racial/ethnic groups; however, there is little understanding of the social and cultural determinants of PA in this population. Few analyses describe specific PA domains (occupation-, transportation-, recreation-related), focus on one Asian subgroup, or use validated scales. The study objective was to assess the association between acculturation and activity behaviors (meeting 2008 PA guidelines, activity minutes by PA domain, sitting time) in a cross-sectional sample of urban-dwelling, Chinese American immigrants. Data were from the Chinese American Cardiovascular Health Assessment (CHA CHA) 2010-11 among participants with valid reports of PA minutes, assessed by the WHO Global Physical Activity Questionnaire (n = 1772). Acculturation was assessed using the Stephenson Multigroup Acculturation Scale, a 32-item instrument which characterizes two acculturative dimensions: ethnic society (Chinese) immersion and dominant society (American) immersion (maximum possible scores = 4). Multivariable models regressing activity behaviors on acculturation were run, adjusting for age, sex, household income, education, and age at immigration. Ethnic society immersion was high (mean = 3.64) while dominant society immersion was moderate (mean = 2.23). Higher ethnic society immersion was associated with less recreation-related PA (- 40.7 min/week); higher dominant society immersion was associated with a higher odds of meeting PA guidelines (OR: 1.66 (1.25, 2.20), p < 0.001) and more recreation-related PA (+ 36.5 min/week). Given low PA levels in Chinese adults in China, results suggest that PA for leisure may increase and become a more normative behavior among Chinese American immigrants with acculturation. Understanding acculturation level may inform strategies to increase PA in Chinese Americans.
Collapse
Affiliation(s)
- Stella S. Yi
- NYU School of Medicine, Department of Population Health, United States
| | | | - Simona C. Kwon
- NYU School of Medicine, Department of Population Health, United States
| | - Keng-Yen Huang
- NYU School of Medicine, Department of Population Health, United States
| | | | - Judith Wylie-Rosett
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, United States
| |
Collapse
|
16
|
Ethnic Enclaves and Type II Diabetes: a Focus on Latino/Hispanic Americans. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0518-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
17
|
Ryabov I. Examining the role of residential segregation in explaining racial/ethnic gaps in spending on fruit and vegetables. Appetite 2016; 98:74-9. [DOI: 10.1016/j.appet.2015.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 12/08/2015] [Accepted: 12/20/2015] [Indexed: 11/26/2022]
|