Broken (windows) theory: A meta-analysis of the evidence for the pathways from neighborhood disorder to resident health outcomes and behaviors

Neighborhood social cohesion and physical disorder in relation to social isolation in older adults: racial and ethnic differences

BACKGROUND

Neighborhood factors of social isolation have been understudied, hindering efforts to reduce social isolation at the neighborhood level. This study aims to investigate the longitudinal effects of neighborhood social cohesion and physical disorder on social isolation in community-dwelling older adults, as well as to examine whether race/ethnicity moderates the neighborhood-isolation relationship.

METHODS

We used 11-year data from the National Health and Aging Trend Study, a longitudinal national study of Medicare beneficiaries aged 65 and older. Social isolation was measured through a summary score across four domains: marital/partner status, family and friend contact, religious attendance, and club participation. A series of weighted mixed-effects logistic regression models were performed to test the study aims. Sample sizes ranged from 7,303 to 7,291 across individual domains of social isolation.

RESULTS

Approximately 20% of participants reported social isolation. Findings indicated a negative association between neighborhood social cohesion and social isolation. Higher levels of neighborhood social cohesion were longitudinally associated with lower odds of social isolation (odds ratio [OR] = 0.52, 95% CI: 0.47-0.58). Yet, the presence of neighborhood physical disorder was associated with an increased risk of overall social isolation ([OR] = 1.2, 95% CI: 1.00, 1.44). Race/ethnicity significantly moderated the effects of neighborhood social cohesion and physical disorder on social isolation. The odds of no in-person visits associated with neighborhood social cohesion are smaller among Black adults compared to White adults. Black adults had constantly lower odds of isolation from religious attendance compared to White adults regardless of the level of neighborhood social cohesion. Hispanic adults had decreased odds of having no friends associated with signs of physical disorder, while no associations were found among older White adults. White adults had higher odds of isolation from in-person visits when living in neighborhoods with signs of physical disorder, whereas no association was observed among older Black and Hispanic adults.

CONCLUSIONS

This study elucidates the role of neighborhood characteristics in shaping social isolation dynamics among older adults. Furthermore, the observed moderation effects of race/ethnicity suggest the need for culturally sensitive interventions tailored to address social isolation within specific neighborhood and racial contexts.

Connecting to Community: A Social Identity Approach to Neighborhood Mental Health

ACADEMIC ABSTRACT

Integrative theorizing is needed to advance our understanding of the relationship between where a person lives and their mental health. To this end, we introduce a social identity model that provides an integrated explanation of the ways in which social-psychological processes mediate and moderate the links between neighborhood and mental health. In developing this model, we first review existing models that are derived primarily from a resource-availability perspective informed by research in social epidemiology, health geography, and urban sociology. Building on these, the social identity model implicates neighborhood identification in four key pathways between residents' local environment and their mental health. We review a wealth of recent research that supports this model and which speaks to its capacity to integrate and extend insights from established models. We also explore the implications of the social identity approach for policy and intervention.

PUBLIC ABSTRACT

We need to understand the connection between where people live and their mental health better than we do. This article helps us do this by presenting an integrated model of the way that social and psychological factors affect the relationship between someone's neighborhood and their mental health. This model builds on insights from social epidemiology, health geography, and urban sociology. Its distinct and novel contribution is to point to the importance of four pathways through which neighborhood identification shapes residents' mental health. A large body of recent research supports this model and highlights its potential to integrate and expand upon existing theories. We also discuss how our model can inform policies and interventions that seek to improve mental health outcomes in communities.

The combined effects of adverse childhood experiences and neighborhood quality on child health and well-being

BACKGROUND

Many studies have investigated the effects of adverse childhood experiences (ACEs) on the health, development, and well-being of children and adolescents. However, most studies have failed to examine whether childhood adversity and ecological factors interact to influence relevant health outcomes.

OBJECTIVE

We used pooled data from the 2018-19 National Survey of Children's Health (n = 24,817) to assess the relationship between ACEs, neighborhood quality, and three domains of adolescent health and well-being: mental health (i.e., symptoms of anxiety problems and depression), neurodevelopmental health, and behavioral problems.

METHODS

Nine types of ACEs were captured in the NSCH data. Logistic regression models were employed to explore the relationship between ACEs, neighborhood quality, and adolescent health and well-being.

RESULTS

Our results indicate that ACEs are associated with each of these domains, with higher ACE scores associated with a higher risk of detrimental outcomes. Neighborhood disorder is also associated with several outcomes. Consistent with our expectations, in the presence of neighborhood disorder the association between higher ACEs exposure and behavior/conduct problems or neurodevelopmental disorders is larger.

CONCLUSIONS

Our results have important implications for understanding how individual and contextual factors may combine to influence child health and behaviors, as well as offering policy recommendations that might help children who experience traumatic events.

Sensitivity to early and forced marriages: Scale development and validation

The purpose of this article is to report on developing an instrument to measure society's sensitivity to early and forced marriages. The theoretical structure of the scale was based on the Radical Feminist Theory, Broken Windows Theory, and Theory of Change. Data were obtained from 451 participants from Türkiye who were aged 18 and above. The criterion validity of the scale was tested using the Attitudes toward Girl Child Marriages Scale. The final version of the scale consisted of a total of 10 items under three sub-scales called "Social Sensitivity," "Health Sensitivity," and "Legal Sensitivity." Cronbach's alpha reliability coefficient of the scale was found 0.85.

Perceived Neighborhood Conditions, Psychosocial Factors, and Sleep Problems Among Urban and Rural Older Adults in China

OBJECTIVES

To examine the associations between perceived neighborhood conditions and older Chinese adults' sleep problems, and whether these associations are mediated by psychosocial factors and moderated by urban-rural residence.

METHODS

Data were from the World Health Organization Study on global Ageing and Adult Health. We used OLS, binary, and multinomial logistic regression analyses. Karlson-Holm-Breen decomposition method was used to test mediation effects.

RESULTS

Positively perceived neighborhood social cohesion was associated with fewer insomnia symptoms and decreased odds of poor sleep quality, sleepiness, lethargy, and short sleep duration. Positively perceived neighborhood safety was related to decreased risks of poor sleep quality and sleepiness. Depression and perceived control partially mediated the effects of perceived neighborhood on sleep. Furthermore, the protective effects of neighborhood cohesion against sleep problems were more pronounced among older urban adults than their rural counterparts.

DISCUSSION

Interventions that make neighborhoods safer and more integrated will improve late-life sleep health.

Neighbourhoods & recovery from psychosis in Trinidad: A qualitative study

•Various aspects of neighbourhood environments influence recovery from psychosis.•High levels of violence at the neighbourhood level may negatively affect recovery.•Social cohesion may be a protective factor that promotes recovery.•Normalisation of cannabis use and easy access to cannabis may also hinder recovery.•Community involvement is needed to design interventions targeting these factors.

Novel Methods of Identifying Individual and Neighborhood Risk Factors for Loss to Follow-Up After Ophthalmic Screening

PRCIS

Residence in a middle-class neighborhood correlated with lower follow-up compared with residence in more affluent neighborhoods. The most common explanations for not following up were the process of making an appointment and lack of symptoms.

PURPOSE

To explore which individual-level and neighborhood-level factors influence follow-up as recommended after positive ophthalmic and primary care screening in a vulnerable population using novel methodologies.

PARTICIPANTS AND METHODS

From 2017 to 2018, 957 participants were screened for ophthalmic disease and cardiovascular risk factors as part of the Real-Time Mobile Teleophthalmology study. Individuals who screened positive for either ophthalmic or cardiovascular risk factors were contacted to determine whether or not they followed up with a health care provider. Data from the Social Vulnerability Index, a novel virtual auditing system, and personal demographics were collected for each participant. A multivariate logistic regression was performed to determine which factors significantly differed between participants who followed up and those who did not.

RESULTS

As a whole, the study population was more socioeconomically vulnerable than the national average (mean summary Social Vulnerability Index score=0.81). Participants whose neighborhoods fell in the middle of the national per capita income distribution had a lower likelihood of follow-up compared with those who resided in the most affluent neighborhoods (relative risk ratio=0.21, P -value<0.01). Participants cited the complicated process of making an eye care appointment and lack of symptoms as the most common reasons for not following up as instructed within 4 months.

CONCLUSIONS

Residence in a middle-class neighborhood, difficulty accessing eye care appointments, and low health literacy may influence follow-up among vulnerable populations.

Development, scoring, and reliability for the Microscale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) instrument

BACKGROUND

Active commuting to school can be a meaningful contributor to overall physical activity in children. To inform better micro-level urban design near schools that can support active commuting to school, there is a need for measures that capture these elements. This paper describes the adaptation of an observational instrument for use in assessing micro-scale environments around urban elementary schools in the United States.

METHODS

The Micro-scale Audit of Pedestrian Streetscapes for Safe Routes to School (MAPS-SRTS) was developed from existing audit instruments not designed for school travel environments and modifications for the MAPS-SRTS instrument include the structure of the audit tool sections, the content, the observation route, and addition of new subscales. Subscales were analyzed for inter-rater reliability in a sample of 36 schools in Austin, TX. To assess reliability for each subscale, one-way random effects single-measure intraclass correlation coefficients (ICC) were used.

RESULTS

Compared to the 30 original subscales, the adapted MAPS-SRTS included 26 (86.6%) subscales with revised scoring algorithms. Most MAPS-SRTS subscales had acceptable inter-rater reliability, with an ICC of 0.97 for the revised audit tool.

CONCLUSIONS

The MAPS-SRTS audit tool is a reliable instrument for measuring the school travel environment for research and evaluation purposes, such as assessing human-scale determinants of active commuting to school behavior and documenting built environment changes from infrastructure interventions.

Perceived Neighbourhood Disorder, Alcohol Consumption and Alcohol-Related Problems in Chile

Background: Alcohol misuse is one of the most important preventable public health risk factors. Empirical research shows that alcohol misuse is related to social and economic losses. Both theoretical and empirical evidence suggests that neighborhood disorder impacts alcohol-related behavior. However, there is limited literature in the context of developing countries. Objectives: The aim of this research is to estimate the association between perceived neighborhood disorder and (1) alcohol-related behavior and (2) alcohol-related problems in the context of the Chilean population. Our contribution focuses on the examination of the perception of disorder in urban neighborhoods and alcohol use patterns in a wide age range and sample of Chilean cities. Results: High levels of neighbor disorder perception are associated with higher levels of drinking and hazardous alcohol use. In addition, perceived neighborhood disorder is directly associated with probability of alcohol-related problems (ranging from 2% to 11%). Conclusions/Importance: The results are consistent with empirical and theoretical frameworks. This research could be used to better guide place-based policies in emerging countries with high levels of alcohol consumption to prevent alcohol risk behaviors and alcohol-related problems.

Association between property investments and crime on commercial and residential streets: Implications for maximizing public safety benefits

Physical property investments enhance public safety in communities while alleviating the need for criminal justice system responses. Policy makers and local government officials must allocate scare resources for community and economic development activities. Understanding where physical property investments have the greatest crime reducing benefits can inform decision making to maximize economic, safety, and health outcomes. This study uses Spatial Durbin models with street segment and census tract by year fixed effects to examine the impact of physical property investments on changes in property and violent crime over an 11-year period (2008-2018) in six large U.S. cities. The units of analysis are commercial and residential street segments. Street segments are classified into low, medium, and high crime terciles defined by initial crime levels (2008-2010). Difference of coefficients tests identify significant differences in building permit effects across crime terciles. The findings reveal there is a significant negative relationship between physical property investments and changes in property and violent crime on commercial and residential street segments in all cities. Investments have the greatest public safety benefit where initial crime levels are the highest. The decrease in violent crime is larger on commercial street segments, while the decrease in property crime is larger on residential street segments. Targeting the highest crime street segments (i.e., 90th percentile) for property improvements will maximize public safety benefits.

Neighborhood characteristics and HIV treatment outcomes: A scoping review

Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.

Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people

The association between community violence and mental health has been studied by reports of individual experiences, particularly in adolescents and youths, but little is known about the effect of living in disordered and violent communities. This study aims to determine the possible relation between living in disordered and violent community environments and psychological distress in Mexican adolescents and youths regardless of their individual experience of victimization and to assess the potential modifying effect of sex and age on this association. Data come from a cross-sectional survey with a representative sample of adolescents and youths living in Mexican municipalities, including 39,639 participants aged from 12 to 29 years. Disordered and violent community environments were assessed using reports from a secondary sample of adults who lived in the same communities as participants. Using exploratory factor analysis, three contextual variables related to disordered and violent community environment were created: social disorder, vandalism, and criminality. Multilevel linear regression models with random intercept were estimated. Adolescents and youths who lived in environments with higher social disorder had more psychological distress. Men in environments with greater vandalism had a higher level of psychological distress. Unexpectedly, women from communities with higher levels of crime had fewer symptoms. It is necessary to address the violence that exists in these communities, creating strategies that reduce not only crime, but also the social disorder and vandalism that could contribute to developing negative effects on mental health.

The social determinants of mental health and disorder: evidence, prevention and recommendations

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

Do Religious Struggles Mediate the Association Between Neighborhood Disorder and Health in the United States?

Over the past two decades, numerous studies have linked the subjective experience of neighborhood disorder (perceptions of crime, dilapidation and ambient strains) with poorer health. We test whether religious struggles (religious doubts and feeling abandoned or punished by God) mediate this association. Our counterfactual mediation analyses of data from the 2021 Crime, Health, and Politics Survey (CHAPS) (n = 1741) revealed consistent indirect effects of neighborhood disorder through religious struggles for anger, psychological distress, sleep disturbance, poorer self-rated health, and shorter subjective life expectancy. This study contributes to previous work by integrating the study of neighborhood context and religion.

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: A cross-sectional, population-based, multi-level analysis in a German federal state

Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.

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.

Resilience-Informed Community Violence Prevention and Community Organizing Strategies for Implementation: Protocol for a Hybrid Type 1 Implementation-Effectiveness Trial

BACKGROUND

Community violence is a persistent and challenging public health problem. Community violence not only physically affects individuals, but also its effects reverberate to the well-being of families and entire communities. Being exposed to and experiencing violence are adverse community experiences that affect the well-being and health trajectories of both children and adults. In the United States, community violence has historically been addressed through a lens of law enforcement and policing; the impact of this approach on communities has been detrimental and often ignores the strengths and experiences of community members. As such, community-centered approaches to address violence are needed, yet the process to design, implement, and evaluate these approaches is complex. Alternatives to policing responses are increasingly being implemented. However, evidence and implementation guidance for community-level public health approaches remain limited. This study protocol seeks to address community violence through a resilience framework-Adverse Community Experiences and Resilience (ACE|R)-being implemented in a major US city and leveraging a strategy of community organizing to advance community violence prevention.

OBJECTIVE

The objective of this research is to understand the impact of community-level violence prevention interventions. Furthermore, we aim to describe the strategies of implementation and identify barriers to and facilitators of the approach.

METHODS

This study uses a hybrid type 1 effectiveness-implementation design. Part 1 of the study will assess the effectiveness of the ACE|R framework plus community organizing by measuring impacts on violence- and health-related outcomes. To do so, we plan to collect quantitative data on homicides, fatal and nonfatal shootings, hospital visits due to nonaccidental injuries, calls for service, and other violence-related data. In Part 2 of the study, to assess the implementation of ACE|R plus community organizing, we will collect process data on community engagement events, deliver community trainings on community leadership and organizing, and conduct focus groups with key partners about violence and violence prevention programs in Milwaukee.

RESULTS

This project received funding on September 1, 2020. Prospective study data collection began in the fall of 2021 and will continue through the end of 2023. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2024.

CONCLUSIONS

Community violence is a public health problem in need of community-centered solutions. Interventions that center community and leverage community organizing show promise in decreasing violence and increasing the well-being of community members. Methods to identify the impact of community-level interventions continue to evolve. Analysis of outcomes beyond violence-specific outcomes, including norms and community beliefs, may help better inform the short-term and proximal impacts of these community-driven approaches. Furthermore, hybrid implementation-effectiveness trials allow for the inevitable contextualization required to disseminate community interventions where communities drive the adaptations and decision-making.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50444.

Using neighborhood characteristics to predict vacancy types: Comparing multi-scale conditions surrounding existing vacant lots

Vacant and abandoned land can be public eyesores that can potentially result in neighborhood distress in the long term. In some cases, the contextual conditions of a neighborhood have been shown to have more of a negative effect on communities than the vacant property itself. Maximum opportunities to actually reuse vacant and abandoned land is known to primarily exist in cases where the surrounding area has locational benefits or when local economic conditions are hopeful. This study examines and compares neighborhood socioeconomic characteristics around vacant lots in Minneapolis, Minnesota, USA, to identify spatial heterogeneity within vacancy types and neighborhood characteristics. Specifically, we examine 1) if the socioeconomic characteristics of a neighborhood can predict existing vacant lots and 2) what neighborhood characteristics are associated with certain vacant lot types. Three logistic regressions were tested with different buffers around each vacant lot, and a total of eighteen regressions were performed to capture the effects on six vacancy types. Results suggest that there are various types of vacancies interacting differently at the neighborhood scale, and that a large-scale neighborhood context matters when predicting vacancy types. The results also indicate three salient points. First, minority populations are a strong predictor of residential and commercial vacancies. Second, high-income areas tend to predict vacancies with potential investment opportunities or vacancies as a part of an existing park or recreational system. Third, vacant properties designated for institutional land uses tend to be found in lower-income areas, yet, not necessarily in areas with high minority populations. Managing and repurposing vacant and abandoned land should be handled more progressively with a better understanding of the socioeconomic characteristics of neighborhoods. Further, examining vacancy types by community can be a way to diagnose potential neighborhood risks associated with vacant and abandoned land.

The Association between Mental Health-Related 911 Calls and the Mental Health Professional Shortage in New York City

This study examines the relationship between designated Mental Health Professional Shortage Areas (MH HPSAs) and mental health-related 911 calls in New York City. Negative binomial regression models were used to estimate the relationship between MH HPSAs and MH 911 calls after adjusting for the population size and other neighborhood characteristics. The study found that neighborhoods designated as MH HPSAs had higher MH 911 calls compared to non-shortage areas, with a 27% increase in expected MH 911 calls after adjustment. Moreover, the results indicated that neighborhoods with higher rates of homelessness and poverty generated more MH 911 calls. The findings suggest a need to improve access to mental health services to reduce the burden on police and emergency services for crisis interventions in areas with limited resources.

Type of Refugee Accommodation and Health of Residents: A Cross-Sectional, Population-Based Cluster Analysis in South-West Germany

Objectives: Few studies have assessed whether refugees' health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on variables on the accommodation and its physical context before assessing its association with health in multivariate analyses. Methods: We performed a cluster analysis based on a hierarchal, agglomerative clustering algorithm using Euclidean Distance and Ward's method. We analysed accommodation clusters based on number of inhabitants, degree of housing deterioration, urbanity of location (urban/rural distinction), and remoteness (walking distance to shops, medical or administrative services). In total, we analysed health and accommodation data of 412 refugees and asylum seekers from 58 different accommodation facilities in the federal state of Baden-Württemberg in the south-west of Germany. Results: Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and generalized anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Conclusion: Our findings inform policymakers on layout and location of refugee collective accommodation centres.

Impact of Neighborhood Deprivation on Aging Sexual Minority People's Depression: Results from the CANUE and CLSA data

As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas.

The link between cognitive health and neighbourhood: perceptions of the public, and of policy-makers, about problems and solutions

BACKGROUND

Growing evidence indicates associations between neighbourhood-related factors such as pollution, social isolation and physical inactivity, and cognition, that is, our ability to think clearly, learn and remember. The evidence raises the possibility of neighbourhood intervention playing a role in protecting population cognitive health. However, there is little understanding of these associations among the public and policy-makers, what they mean and how they might be acted on. In this study we explored perceptions of the public and policy-makers about influences of neighbourhood factors on brain functioning, and how they should inform policy.

METHODS

Qualitative methods were used in three phases; the study ran in parallel with a quantitative study looking at neighbourhood influences on cognition. In phase one, focus groups were conducted with middle-aged (40-69) members of the public to inform statistical modelling. In phase two, similar focus groups were held in four case study areas chosen based on the modelling results. In phase three, interviews with people in public health and policy roles were conducted, including people in the case study sites.

RESULTS

Participants described effects on their cognition from community, culture and social interactions, access to green spaces and nature, upkeep and safety of the area, and pollution, traffic and noise. Solutions included better local consultation and involvement in policy and planning, support for community interactions and active and public transport, and education on cognition. There was little awareness, but much interest, from local policy-makers and implementers, about links between cognition and place. Barriers to implementation included lack of: effective engagement with local communities, local funding and joined-up health and neighbourhood policy.

CONCLUSIONS

People can perceive impacts of neighbourhoods on brain functioning and suggest ways local areas can be improved to support cognitive health. There is support for the idea of population-level interventions to support cognitive health.

Perceived Neighborhood Disorder, Self-Esteem, and the Moderating Role of Religion

A growing body of work links neighborhood conditions -and particularly perceived neighborhood disorder-with diverse aspects of psychosocial functioning, including self-esteem or the global moral self-worth of the individual. Our work augments this literature by investigating the possible roles of (a) organizational religiosity (i.e., religious attendance, religious support), (b) non-organizational religiosity (i.e., prayer and religious coping practices), and (c) the sense of divine control as potential stress in mitigating the deleterious effects of neighborhood disorder on self-esteem. Data from the Nashville Stress and Health Study (NSAHS, 2011-2014) are used to test a series of hypotheses regarding the possible stress-buffering effects of multiple religious domains. Findings from multivariable regression models indicate that: (a) perceived neighborhood disorder is inversely associated with self-esteem; (b) non-organizational religiosity and the sense of divine control each mitigate this pattern; and, interestingly, (c) organizational religiosity does not buffer the association between neighborhood disorder and self-esteem. Several study limitations, as well as a number of promising directions for future research, are identified.

Do polygenic indices capture "direct" effects on child externalizing behavior? Within-family analyses in two longitudinal birth cohorts

Behaviors and disorders characterized by difficulties with self-regulation, such as problematic substance use, antisocial behavior, and symptoms of attention-deficit/hyperactivity disorder (ADHD), incur high costs for individuals, families, and communities. These externalizing behaviors often appear early in the life course and can have far-reaching consequences. Researchers have long been interested in direct measurements of genetic risk for externalizing behaviors, which can be incorporated alongside other known risk factors to improve efforts at early identification and intervention. In a preregistered analysis drawing on data from the Environmental Risk (E-Risk) Longitudinal Twin Study (N = 862 twins) and the Millennium Cohort Study (MCS; N = 2,824 parent-child trios), two longitudinal cohorts from the UK, we leveraged molecular genetic data and within-family designs to test for genetic effects on externalizing behavior that are unbiased by the common sources of environmental confounding. Results are consistent with the conclusion that an externalizing polygenic index (PGI) captures causal effects of genetic variants on externalizing problems in children and adolescents, with an effect size that is comparable to those observed for other established risk factors in the research literature on externalizing behavior. Additionally, we find that polygenic associations vary across development (peaking from age 5-10 years), that parental genetics (assortment and parent-specific effects) and family-level covariates affect prediction little, and that sex differences in polygenic prediction are present but only detectable using within-family comparisons. Based on these findings, we believe that the PGI for externalizing behavior is a promising means for studying the development of disruptive behaviors across child development.

Using street view imagery to examine the association between urban neighborhood disorder and the long-term recurrence risk of patients discharged with acute myocardial infarction in central Beijing, China

Background

To examine the association between urban neighborhood disorder and the recurrence risk of patients with acute myocardial infarction (AMI) in central Beijing, China.

Methods

Recurrent AMI was identified by the Beijing Monitoring System for Cardiovascular Diseases through the end of 2019 for patients discharged with AMI between 2007 and 2017. Cox proportional hazards models were performed to estimate associations between neighborhood disorder and AMI recurrence.

Results

Of 66,238 AMI patients, 11,872 had a recurrent event, and 3117 died from AMI during a median followup of 5.92 years. After covariate adjustment, AMI patients living in the high tertile of neighborhood disorder had a higher recurrence risk (hazard ratio [HR] 1.08, 95 % confidence interval [CI], 1.03-1.14) compared with those in the low tertile. A stronger association was noted for fatal recurrent AMI (HR 1.21, 95 % CI 1.10-1.34). The association was mainly observed in females (HR 1.04, 95 % CI: 1.02 to 1.06).

Conclusions

Serious neighborhood disorder may contribute to higher recurrence risk, particularly fatal recurrence, among AMI patients. Policies to eliminate neighborhood disorders may play an important role in the secondary prevention of cardiovascular disease.

Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans

OBJECTIVES

This study aims to examine the relationship between everyday discrimination, neighborhood perceptions, and the incidence of daily activity limitations (i.e., activities of daily living [ADL] and instrumental activities of daily living [IADL]) among middle-aged and older African Americans. This study also examines whether neighborhood perceptions moderate the association between discrimination and the incidence of daily activity limitations.

METHODS

Data were from the 2006 to 2016 waves of the Health and Retirement Study. African Americans aged 50 or older free of ADL limitations (N = 1,934) and IADL limitations (N = 2,007) at baseline were selected. Cox proportional hazards regression models were performed to test the study aims. Multiple imputations were applied to handle missing data.

RESULTS

One-unit increase in everyday discrimination was associated with a 25% (p < .05) higher risk of ADL limitation onset. Perceived neighborhood social cohesion and physical disadvantage moderated the association between discrimination and IADL limitation onset.

DISCUSSION

Everyday discrimination represents a significant stressor that negatively affects older African Americans' performance of daily activities. Community-level efforts that improve neighborhood perceptions are needed to alleviate the negative effects of discrimination on the incidence of activity limitations.

The intersection of neighborhood and race in urban adolescent health risk behaviors

AIMS

Racial variability in associations of neighborhood socioeconomic disadvantage and neighborhood disorder with adolescent health risk behaviors remains under-researched, which this study examined over 1 year among racially diverse adolescents.

METHODS

High school students (N = 345; 18% Asian, 44% Black, 16% Multiracial, 22% White) completed surveys assessing neighborhood socioeconomic disadvantage and neighborhood disorder, and health risk behaviors (lifetime alcohol, cannabis, and cigarette use, number of sexual partners) at baseline (Year 1) and 1-year follow-up (Year 2).

RESULTS

Asian, Black, and Multiracial adolescents were more likely to endorse health risk behaviors in Year 2 compared to White adolescents living in similarly disadvantaged neighborhoods at Year 1. Associations of neighborhood disorder with health risk behavior did not differ by race.

CONCLUSION

Neighborhood socioeconomic disadvantage (but not neighborhood disorder) may predispose Asian, Black, and Multiracial adolescents to health risk behaviors. Findings may inform interventions to address racial disparities in adolescent health risk behaviors.

New York City's Stop, Question, and Frisk Policy and Psychiatric Emergencies among Black Americans

Under the Stop, Question, and Frisk (SQF) policy, New York City (NYC) police stopped Black Americans at more than twice the rate of non-Hispanic whites, after controlling for arrests and precinct differences. We examined whether police stops of Black Americans during SQF correspond positively with psychiatric emergency department (ED) visits among Black residents in NYC. We utilized as the exposure all police stops, stops including frisking, and stops including use of force among Black Americans in NYC between 2006 and 2015 from the New York City Police Department's New York City-Stop, Question, and Frisk database. We examined 938,356 outpatient psychiatric ED visits among Black Americans in NYC between 2006 and 2015 from the Statewide Emergency Department Database (SEDD). We applied Box-Jenkins time-series methods to control for monthly temporal patterns. Results indicate that all stops, frisking, and use of force of Black residents correspond with increased psychiatric ED visits among Black Americans in NYC (all stops-coef = 0.024, 95%CI = 0.006, 0.043; frisking-coef = 0.048, 95%CI = 0.015, 0.080; use of force-coef = 0.109, 95%CI = 0.028, 0.190). Our findings indicate that a one standard deviation increase in police stops equates to a 2.72% increase in psychiatric ED visits among Black residents in NYC. Use of force may have the greatest mental health consequences due to perceived threats of physical violence or bodily harm to other members of the targeted group. Racially biased and unconstitutional police encounters may have acute mental health implications for the broader Black community not directly involved in the encounter itself.

Associations between observed neighborhood physical disorder and health behaviors, New Jersey behavioral risk factor Surveillance System 2011-2016

This study tested associations between observed neighborhood physical disorder and tobacco use, alcohol binging, and sugar-sweetened beverage consumption among a large population-based sample from an urban area of the United States. Individual-level data of this cross-sectional study were from adult respondents of the New Jersey Behavioral Risk Factor Surveillance System, 2011-2016 (n = 62,476). Zip code tabulation area-level observed neighborhood physical disorder were from virtual audits of 23,276 locations. Tobacco use (current cigarette smoking or chewing tobacco, snuff, or snus use), monthly binge drinking occasions (5+/4+ drinks per occasion among males/females), and monthly sugar-sweetened beverages consumed were self-reported. Logistic and negative binomial regression models were used to generate odds ratios, prevalence rate ratios (PRR), 95 % confidence intervals (CI) by levels of physical disorder. Compared to the lowest quartile, residence in the second (PRR: 1.16; 95 % CI: 1.03, 1.13), third (PRR: 1.24; 95 % CI: 1.10, 1.40), and fourth (highest) quartile of physical disorder (PRR: 1.24; 95 % CI: 1.10, 1.40) was associated with higher monthly sugar-sweetened beverage consumption. Associations involving tobacco use and alcohol binging were mixed. Observed neighborhood disorder might be associated with unhealthy behaviors, especially sugar-sweetened beverage consumption.

Neighbourhood effects on educational attainment. What matters more: Exposure to poverty or exposure to affluence?

Neighbourhood effects studies typically investigate the negative effects on individual outcomes of living in areas with concentrated poverty. The literature rarely pays attention to the potential beneficial effects of living in areas with concentrated affluence. This poverty paradigm might hinder our understanding of spatial context effects. Our paper uses individual geocoded data from the Netherlands to compare the effects of exposure to neighbourhood affluence and poverty on educational attainment within the same statistical models. Using bespoke neighbourhoods, we create individual neighbourhood histories which allow us to distinguish exposure effects from early childhood and adolescence. We follow an entire cohort born in 1995 and we measure their educational level in 2018. The results show that, in the Netherlands, neighbourhood affluence has a stronger effect on educational attainment than neighbourhood poverty for all the time periods studied. Additionally, interactions with parental education indicate that children with higher educated parents are not affected by neighbourhood poverty. These results highlight the need for more studies on the effects of concentrated affluence and can inspire anti-segregation policies.

Economic modelling of electricity generation: long short-term memory and Q-rung orthopair fuzzy sets

The main goal of this study is to evaluate the impact of population mobility on electricity generation in Russian cities in the conditions of the spread of COVID-19, and identify hotspots. Furthermore, the evaluation is also conducted using hybrid fuzzy decision-making modelling. In this context, q-ROF DEMATEL and TOPSIS methods are taken into consideration. Additionally, a comparative evaluation is also performed with the help of Intuitionistic and Pythagorean fuzzy sets. The results are quite similar that allows to conclude that the findings are reliable and coherent. The study proves the hypothesis that human behavior changed during the COVID-19 pandemic, and electricity consumption is declining in major cities around the world. The biggest fall in energy generation was in Moscow and Yekaterinburg. In St. Petersburg and Nizhny Novgorod, the fall in energy generation is no so crucial because these cities have low building density. The study uses Long Short-Term Memory models with many different parameters. The Q-Rung Orthopair Fuzzy Sets model forecasts new COVID-19 using ten parameters. This study identifies factors influencing the spread of COVID-19 based on the theory of "broken windows" and outlines directions in limiting population mobility, which can form the basis of state policy. According to the analysis the air temperature is the variable that most affects this process.

Racial and Ethnic Differences in the Relationship Between Neighborhood Environment and Physical Activity Among Middle-Aged and Older Adults

Objectives:To examine the associations between neighborhood environment-perceived neighborhood social cohesion and perceived neighborhood physical environment-and physical activity (PA) and whether these associations differ by race/ethnicity. Methods: We analyzed data from the Health and Retirement Study, a longitudinal study of US adults aged 50+ from 2006 to 2014 (N = 17,974), using multivariate mixed-effects linear models. PA was repeatedly measured using metabolic equivalent of task estimated values accounting for the vigor and frequency of self-reported PA. Results: In multivariate models, higher levels of PA were positively associated with higher rated neighborhood social cohesion and neighborhood physical environment scores. The effects of social cohesion were stronger among non-Hispanic Whites than among non-Hispanic Black and Hispanic/Latinx participants, while race/ethnicity did not moderate the association between PA and physical environment. Discussion: Intervention strategies that address social and physical barriers of neighborhoods could promote PA in older adults. Key implications for future research are discussed.

Perceived neighborhood factors, health behaviors, and related outcomes in the Hispanic Community Health Study/Study of Latinos

Hispanic/Latino populations may experience significant neighborhood disadvantage, but limited research has explored whether these factors affect their health behaviors. Associations between perceived neighborhood factors at Visit 1 and health behaviors and related outcomes at Visit 2 in the Hispanic Community Health Study/Study of Latinos were evaluated. Multivariable logistic regression assessed cross-sectional and longitudinal relationships between perceived neighborhood social cohesion (NSC, 5 items), and neighborhood problems (NP, 7 items), with cancer screening, current smoking, excessive/binge drinking, hypertension, obesity, physical activity, and poor diet by gender and birthplace. NSC and NP scores were converted into quartiles. Mean age of participants was 42.5 years and 62.1% were women. Perceived NP, but not perceived NSC, differed by gender (p < 0.001). In unstratified models, no significant associations were observed between perceived NSC and any health behavior, whereas greater perceived NP was associated with less adherence to colon cancer screening (moderate level: aOR = 0.68, 95% CI = 0.51, 090) and more physical activity (very high level: aOR = 1.34, 95% CI = 1.06, 1.69) compared to low perceived NP. Women with moderate perceived NP, versus low NP, had a lower odds of colon cancer screening at Visit 1 (aOR = 0.62, 95% CI = 0.43, 0.91) and higher odds of mammogram adherence at Visit 2 (aOR = 2.86, 95% CI = 1.44, 5.68). Men with high perceived NP had a higher odds of excessive or binge drinking at Visit 2 (aOR = 1.99, 95% CI = 1.19, 3.31). We conclude that perceived NP were significantly related to health behaviors among HCHS/SOL individuals. Perceptions of neighborhood environment may be considered modifiable factors of structural neighborhood environment interventions.

Influence of Neighborhood Conditions on Recurrent Hospital Readmissions in Patients with Heart Failure: A Cohort Study

PURPOSE

This study examined how certain aspects of residential neighborhood conditions (ie, observed built environment, census-based area-level poverty, and perceived disorder) affect readmission in urban patients with heart failure.

METHODS

A total of 400 patients with heart failure who were discharged alive from an urban-university teaching hospital were enrolled. Data were collected about readmissions during a 2-year follow-up. The impact of residential neighborhood conditions on readmissions was examined with adjustment for 7 blocks of covariates: 1) patient demographic characteristics; 2) comorbidities; 3) clinical characteristics; 4) depression; 5) perceived stress; 6) health behaviors; and 7) hospitalization characteristics.

RESULTS

A total of 83.3% of participants were readmitted. Participants from high-poverty census tracts (≥20%) were at increased risk of readmission compared with those from census tracts with <10% poverty (hazard ratio [HR]: 1.53; 95% confidence interval: 1.03-2.27; P < .05) when adjusted for demographic characteristics. None of the built environmental or perceived neighborhood conditions were associated with the risk of readmission. The poverty-related risk of readmission was reduced to nonsignificance after including diabetes (HR: 1.33) and hypertension (HR: 1.35) in the models.

CONCLUSIONS

The effect of high poverty is partly explained by high rates of hypertension and diabetes in these areas. Improving diabetes and blood pressure control or structural aspects of impoverished areas may help reduce hospital readmissions.

Mothers with justice-involved sons: Socioeconomic impacts of COVID-19 by neighborhood disorder in the United States

Women, particularly mothers, have faced disparate socioeconomic consequences throughout the COVID-19 pandemic. Research has yet to examine whether the consequences of the pandemic vary based on the level of neighborhood disorder, which is associated with various health conditions, including COVID-19 complications. The present study utilizes data from a diverse sample of 221 women with justice-involved sons interviewed during the early months of the COVID-19 pandemic. Negative binominal and logistic regression analyses were conducted to examine whether perceived neighborhood social disorder is related to socioeconomic impacts of the COVID-19 pandemic, and whether the relation varies for mothers with and without children in their home during the pandemic. The results suggest that greater perceived neighborhood social disorder was associated with increased in COVID-19-related socioeconomic consequences. Neighborhood social disorder affected socioeconomic impacts above and beyond the effects of having a child living in the home. Additionally, Latinas experienced greater socioeconomic impacts than women of other races and ethnicities. The results indicate a key relationship between the neighborhood conditions a woman lives in and the extent of the socioeconomic consequences they faced during the early months of the COVID-19 pandemic. Future directions and direct implications of the study findings are discussed.

Examining the Built Environment for Healthy Living via Virtual Street Audits

During the fall 2019 and spring 2020 semesters, 156 MPH students enrolled in the Integrative Learning Experience at the University of Alabama at Birmingham School of Public Health explored concepts of the built environment and health by auditing 2500 street segments in 4 urban neighborhoods in Birmingham, Alabama. In teams of 4 to 5, in-class and online students worked collaboratively to assess 63 built environment variables related to transportation, land use, advertisement, and neighborhood physical disorder. This type of "community assessment" is the first stage of the Evidence-based Public Health Framework and consistent with the applied nature of an MPH degree. Authors conducted secondary data analysis of final team assignments to demonstrate how students translated observations and ratings into practical recommendations for neighborhood improvements to promote physical activity. Students recommended improvements in neighborhood infrastructure and services, specifically: creating exercise space, providing outdoor exercise equipment, improving neighborhood safety, and cultivating a culture of health. The Integrative Learning Experience course encouraged students to use their knowledge and skills to prioritize recommendations to improve neighborhood conditions. Variable ratings and observations increased student awareness of the built environment and its potential to impact individual and community health. Moreover, the project helped students make connections between proximal outcomes, such as improving neighborhood walkability, and distal outcomes, such as improved health outcomes among residents. Finally, this project modeled for students the use of evidence-based strategies for making data-informed decisions, which are essential skills for new and emerging public health professionals.

A community response approach to mental health and substance abuse crises reduced crime

Police officers often serve as first responders to mental health and substance abuse crises. Concerns over the unintended consequences and high costs associated with this approach have motivated emergency response models that augment or completely remove police involvement. However, there is little causal evidence evaluating these programs. This preregistered study presents quasi-experimental evidence on the impact of an innovative "community response" pilot in Denver that directed targeted emergency calls to health care responders instead of the police. We find robust evidence that the program reduced reports of targeted, less serious crimes (e.g., trespassing, public disorder, and resisting arrest) by 34% and had no detectable effect on more serious crimes. The sharp reduction in targeted crimes reflects the fact that health-focused first responders are less likely to report individuals they serve as criminal offenders and the spillover benefits of the program (e.g., reducing crime during hours when the program was not in operation).

Community Supervision, Housing Insecurity, & Homelessness

In recent decades, the United States has seen the simultaneous rise of mass incarceration and homelessness. The two crises interact with and worsen one another. Mass incarceration and homelessness are driven by the same structural factors and exacerbate one another in a feedback loop. People on community supervision face many barriers to housing, putting them at high risk of experiencing homelessness in the months following release. People experiencing homelessness are at heightened risk of criminal justice involvement, including violating the terms of their community supervision, for engaging in survival behaviors in public spaces. This paper presents evidence-based approaches to improving housing strategies for reentry populations, preventing homelessness among those in community supervision, and rehousing members of the reentry community experiencing homelessness. It concludes with recommendations for policymakers interested in improving housing outcomes and overall reentry success for people on community supervision.

Fractured lives in fractured cities: Towards a critical understanding of urban violence in the context of market-driven urban restructuring processes in Bogotá and Rio de Janeiro

Based on a comparative case study on two neighborhoods in Bogota and Rio de Janeiro (2017-2019) and a comprehensive literature review, this article proposes a critical Public Health approach to urban violence and makes a case for understanding the phenomenon in the context of market-driven urban territorial restructuring processes that assume specific qualities in cities of the Global South. The case studies are based on focus groups and semi-structured interviews with residents, specialists and community leaders. It is argued that urban violence is a key public health challenge, particularly in Latin America, given its dimensions and its impact on the populations' life and health. In this regard it configures "fractured lives" in what urban scholars have termed "fractured cities" - essentially unequal and polarized cities that are not merely sites of urban violence but, as we argue in this article, fundamentally shape urban violence, its qualities, dynamics and dimensions. The study is informed by a unique theoretical articulation between Latin American Social Medicine and Collective Health, critical (Latin American) geographical theory and authoritarian neoliberalism literature and shows how urban violence is directly implied in the territorial making and un-making of the cities, driven by commodification as well as both legal and illegal capitalist market logics, that include but are not limited to drug trade. The cases reflect the violence implied in permanent threats of eviction and displacement, "necropolitical" police/military interventions and what is described as a silent imposition of a "slow death" on infrastructure, the neighborhood and ultimately also its residents, which "fracture" the lives of significant parts of the urban population, produce "ill-being" and bring about health consequences that are rarely considered in relation to urban violence.

The association between resilience resources, contextual factors and mental health status: a national population-based study

Background

Although a range of risk factors have been linked with poor mental health across the population, the underlying pathways leading to mental ill health remain unclear. There is a need to investigate the effects and interplay of both protective and risk factors. This population-based study aimed to explore the effects of individual and contextual factors on mental health status. Record-linkage was implemented between health and lifestyle data drawn from HealthWise Wales (HWW), a national population health survey of people > 16 years who live or access their healthcare in Wales, and treatment data from primary healthcare records. Mental health status was assessed using three different measures, including the self-reported MHI-5 and WEMWBS scales and mental health treatment in electronic healthcare records (EHR).

Result

Using cross-sectional data from 27,869 HWW participants aged over 16 years, lifestyle factors, resilience, social cohesion and neighbourhood attraction were associated with mental health across all measures. However, compared to contextual factors, the cluster of individual factors was more closely associated with poor mental health, explaining more of the variance across all measures used (MHI-5: 9.8% versus 5.4%; WEMWBS: 15.9% versus 10.3%; EHR: 5.5% versus 3.0%). Additional analysis on resilience sub-constructs indicated that personal skills were the most closely correlated with poorer mental health.

Conclusion

Mental health status was more closely linked with individual factors across the population than contextual factors. Interventions focusing on improving individual resilience and coping skills could improve mental health outcomes and reduce the negative effect of contextual factors such as negative neighbourhood perceptions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13013-2.

Perceptions of neighborhood dangerousness and changes in sleep quality during the COVID-19 pandemic: Assessing the mediating role of changes in health behaviors

Numerous studies have demonstrated that neighborhood context contributes to variations in morbidity and mortality. This body of work includes a burgeoning literature that links adverse neighborhood characteristics (e.g., neighborhood poverty and perceptions of disorder and dangerousness) with poorer sleep outcomes. During the COVID-19 pandemic, many neighborhoods exhibited socioeconomic downturns and escalations in crime and violence. The question is the extent to which these changes in neighborhood conditions have impacted the sleep quality of residents. In this paper, we use original survey data from the 2021 Crime, Health, and Politics Survey (CHAPS), a national probability sample of adults living in the U.S., to formally test whether changes in perceptions of neighborhood dangerousness during the pandemic are associated with sleep quality during the same period. Regression analyses show that while reports of a neighborhood becoming safer during the pandemic are associated with better sleep quality, reports of a neighborhood becoming more dangerous are associated with worse sleep quality. Mediation analyses also indicate that the association between increased neighborhood dangerousness and poorer sleep quality is partially explained by a concurrent deterioration in diet quality, but not increases in alcohol or cigarette consumption. We conclude with a discussion of the implications of our findings for research and policy on neighborhood context and sleep.

The impact of neighborhood context on telomere length: A systematic review

A growing body of research demonstrates the association between neighborhood context and health. The underlying biological mechanisms of this association are not fully understood. We conducted a systematic review of studies that investigated the association between neighborhood context and telomere length (TL), a DNA-protein complex that shortens after cell division. Short TL is linked to age-related diseases and may be impacted by chronic stress. Nineteen eligible articles identified through PubMed and Scopus met inclusion criteria. Results demonstrated inconsistent support for the relationship between neighborhood disadvantage and short TL. However, findings across several studies provide evidence for an inverse association between perceived neighborhood problems and TL, suggesting that TL may be an important factor in understanding health vulnerabilities associated specifically with negative perceptions of the neighborhood context.

Violent experiences and neighbourhoods during adolescence: understanding and mitigating the association with mental health at the transition to adulthood in a longitudinal cohort study

PURPOSE

Violence occurs at multiple ecological levels and can harm mental health. However, studies of adolescents' experience of violence have often ignored the community context of violence, and vice versa. We examined how personal experience of severe physical violence and living in areas with high levels of neighbourhood disorder during adolescence combine to associate with mental health at the transition to adulthood and which factors mitigate this.

METHOD

Data were from the Environmental Risk Longitudinal Twin Study, a nationally representative birth cohort of 2232 British twins. Participants' experience of severe physical violence during adolescence and past-year symptoms of psychiatric disorder were assessed via interviews at age 18. Neighbourhood disorder was reported by residents when participants were aged 13-14. Potential protective factors of maternal warmth, sibling warmth, IQ, and family socio-economic status were assessed during childhood, and perceived social support at age 18.

RESULTS

Personal experience of severe physical violence during adolescence was associated with elevated odds of age-18 psychiatric disorder regardless of neighbourhood disorder exposure. Cumulative effects of exposure to both were evident for internalising and thought disorder, but not externalising disorder. For adolescents exposed to severe physical violence only, higher levels of perceived social support (including from family and friends) were associated with lower odds of psychiatric disorder. For those who also lived in areas with high neighbourhood disorder, only family support mitigated their risk.

CONCLUSION

Increasing support or boosting adolescents' perceptions of their existing support network may be effective in promoting their mental health following violence exposure.

Predicting Perceptions of the Built Environment using GIS, Satellite and Street View Image Approaches

BACKGROUND

High quality built environments are important for human health and wellbeing. Numerous studies have characterized built environment physical features and environmental exposures, but few have examined urban perceptions at geographic scales needed for population-based research. The degree to which urban perceptions are associated with different environmental features, and traditional environmental exposures such as air pollution or urban green space, is largely unknown.

OBJECTIVE

To determine built environment factors associated with safety, lively and beauty perceptions across 56 cities.

METHODS

We examined perceptions collected in the open source Place Pulse 2.0 dataset, which assigned safety, lively and beauty scores to street view images based on crowd-sourced labelling. We derived built environment measures for the locations of these images (110,000 locations across 56 global cities) using GIS and remote sensing datasets as well as street view imagery features (e.g. trees, cars) using deep learning image segmentation. Linear regression models were developed using Lasso penalized variable selection to predict perceptions based on visible (street level images) and GIS/remote sensing built environment variables.

RESULTS

Population density, impervious surface area, major roads, traffic air pollution, tree cover and Normalized Difference Vegetation Index (NDVI) showed statistically significant differences between high and low safety, lively, and beauty perception locations. Visible street level features explained approximately 18% of the variation in safety, lively, and beauty perceptions, compared to 3-10% explained by GIS/remote sensing. Large differences in prediction were seen when modelling between city (R2 67-81%) versus within city (R2 11-13%) perceptions. Important predictor variables included visible accessibility features (e.g. streetlights, benches) and roads for safety, visible plants and buildings for lively, and visible green space and NDVI for beauty.

CONCLUSION

Substantial within and between city differences in built environment perceptions exist, which visible street level features and GIS/remote sensing variables only partly explain. This offers a new research avenue to expand built environment measurement methods to include perceptions in addition to physical features.

Pathways between objective and perceived neighborhood factors among Black breast cancer survivors

BACKGROUND

Mounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied. We tested pathways between objective and perceived neighborhood disorder, perceived neighborhood social cohesion, and socioeconomic factors within a longitudinal cohort.

METHODS

Demographic and socioeconomic information before diagnosis was obtained at interviews conducted approximately 10 months post-diagnosis from participants in the Women's Circle of Health Follow-up Study - a cohort of breast cancer survivors self-identifying as African American or Black women (n = 310). Neighborhood perceptions were obtained during follow-up interviews conducted approximately 24 months after diagnosis. Objective neighborhood disorder was from 9 items audited across 23,276 locations using Google Street View and scored to estimate disorder values at each participant's residential address at diagnosis. Census tract socioeconomic and demographic composition covariates were from the 2010 U.S. Census and American Community Survey. Pathways to perceived neighborhood disorder were built using structural equation modelling. Model fit was assessed from the comparative fit index and root mean square error approximation and associations were reported as standardized coefficients and 95% confidence intervals.

RESULTS

Higher perceived neighborhood disorder was associated with higher objective neighborhood disorder (β = 0.20, 95% CI: 0.06, 0.33), lower neighborhood social cohesion, and lower individual-level socioeconomic factors (final model root mean square error approximation 0.043 (90% CI: 0.013, 0.068)). Perceived neighborhood social cohesion was associated with individual-level socioeconomic factors and objective neighborhood disorder (β = - 0.11, 95% CI: - 0.24, 0.02).

CONCLUSION

Objective neighborhood disorder might be related to perceived disorder directly and indirectly through perceptions of neighborhood social cohesion.

Social determinants of atrial fibrillation

Atrial fibrillation affects almost 60 million adults worldwide. Atrial fibrillation is associated with a high risk of cardiovascular morbidity and death as well as with social, psychological and economic burdens on patients and their families. Social determinants - such as race and ethnicity, financial resources, social support, access to health care, rurality and residential environment, local language proficiency and health literacy - have prominent roles in the evaluation, treatment and management of atrial fibrillation. Addressing the social determinants of health provides a crucial opportunity to reduce the substantial clinical and non-clinical complications associated with atrial fibrillation. In this Review, we summarize the contributions of social determinants to the patient experience and outcomes associated with this common condition. We emphasize the relevance of social determinants and their important intersection with atrial fibrillation treatment and outcomes. In closing, we identify gaps in the literature and propose future directions for the investigation of social determinants and atrial fibrillation.

Advancing urban mental health research: from complexity science to actionable targets for intervention

Urbanisation and common mental disorders (CMDs; ie, depressive, anxiety, and substance use disorders) are increasing worldwide. In this Review, we discuss how urbanicity and risk of CMDs relate to each other and call for a complexity science approach to advance understanding of this interrelationship. We did an ecological analysis using data on urbanicity and CMD burden in 191 countries. We found a positive, non-linear relationship with a higher CMD prevalence in more urbanised countries, particularly for anxiety disorders. We also did a review of meta-analytic studies on the association between urban factors and CMD risk. We identified factors relating to the ambient, physical, and social urban environment and showed differences per diagnosis of CMDs. We argue that factors in the urban environment are likely to operate as a complex system and interact with each other and with individual city inhabitants (including their psychological and neurobiological characteristics) to shape mental health in an urban context. These interactions operate on various timescales and show feedback loop mechanisms, rendering system behaviour characterised by non-linearity that is hard to predict over time. We present a conceptual framework for future urban mental health research that uses a complexity science approach. We conclude by discussing how complexity science methodology (eg, network analyses, system-dynamic modelling, and agent-based modelling) could enable identification of actionable targets for treatment and policy, aimed at decreasing CMD burdens in an urban context.

Multivariate analysis of 1.5 million people identifies genetic associations with traits related to self-regulation and addiction

Behaviors and disorders related to self-regulation, such as substance use, antisocial behavior and attention-deficit/hyperactivity disorder, are collectively referred to as externalizing and have shared genetic liability. We applied a multivariate approach that leverages genetic correlations among externalizing traits for genome-wide association analyses. By pooling data from ~1.5 million people, our approach is statistically more powerful than single-trait analyses and identifies more than 500 genetic loci. The loci were enriched for genes expressed in the brain and related to nervous system development. A polygenic score constructed from our results predicts a range of behavioral and medical outcomes that were not part of genome-wide analyses, including traits that until now lacked well-performing polygenic scores, such as opioid use disorder, suicide, HIV infections, criminal convictions and unemployment. Our findings are consistent with the idea that persistent difficulties in self-regulation can be conceptualized as a neurodevelopmental trait with complex and far-reaching social and health correlates.