Patterns of local segregation: Do they matter for neighborhood crime?

Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study

OBJECTIVE

Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population.

METHODS

Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables.

RESULTS

Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (β = -0.59, B = -9.38, 95% CI [-14.00, -4.76]), anxiety symptoms (β = -0.61, B = -14.19, 95% CI [-21.76, -6.61]), appetite loss (β = -0.41, B = -10.52, 95% CI [-15.61, -5.42]), and sleeplessness (β = -0.50, B = -9.56, 95% CI [-13.95, -5.17]) in the early 20s.

CONCLUSIONS

Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.

Perceived childhood neighborhood safety and sleep health during childhood and adulthood among a cohort of African American women

OBJECTIVE

To investigate associations between perceived childhood neighborhood safety and sleep over the life course.

METHODS

Among a cohort of 1693 Black/African American women aged 23-35 years at enrollment (2010-2012), participants recalled neighborhood safety (safe vs. unsafe) when they were 5, 10, and 15 years old. Participants' mothers/caregivers and participants reported sleep-related health behaviors at age 5. We used ordinal logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for sleep-related health behaviors (i.e., rarely/never or sometimes vs. mostly/always going to bed by 8:00 p.m., bed in a quiet room, bed in a dimly lit or unlit room), separately. Adulthood sleep duration and insomnia symptoms were reported at enrollment and over three follow-up periods. We applied generalized estimating equations to log binomial regression models to estimate relative risks (RR) for adulthood sleep characteristics.

RESULTS AND CONCLUSIONS

Four percent of participants reported an unsafe neighborhood at age 5 years, only, and 12% reported an unsafe neighborhood at all ages. Participants in perceived unsafe vs. safe neighborhoods at age 5 had higher odds of poor sleep-related health behaviors (e.g., rarely/never or sometimes going to bed in a quiet room: OR = 1.73 [1.27-2.35]). Participants in perceived unsafe vs. safe neighborhoods throughout childhood had higher risk of short sleep (RR = 1.10 [1.02-1.18]) and insomnia symptoms (RR = 1.07 [1.00-1.15]) during adulthood after adjustment for life course socioeconomic characteristics and adulthood health behaviors and characteristics. Perceived unsafe childhood neighborhood was associated with poorer sleep over the life course and may serve as an early intervention target.

Voicing narratives of structural violence in interpersonal firearm violence research and prevention in the United States

Violence is defined as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation." Encompassed in this definition are multiple, interrelated forms of violence, including interpersonal firearm death and injury, but also the systems, policies, and practices enacted by those with power to advantage some groups while depriving others of meaningful opportunities for meeting their basic needs-known as "structural violence". Yet dominant violence prevention narratives too often ignore or deemphasize the deeply intertwined threads of structural violence with other forms of violence, leading to policies and practices that are frequently insufficient, and often harmful, for reducing interpersonal firearm violence and building community safety, particularly in minoritized and structurally marginalized communities. We highlight ways in which limited scrutiny of structural violence, the omission of its defining characteristics-power and deprivation-from functional characterizations and frameworks of interpersonal firearm violence, and the inadequate distribution of power and resources to those most impacted by violence to self-determine narratives of and solutions to interpersonal firearm violence grossly impacts how interpersonal firearm violence is collectively conceived, discussed, and addressed. Expanding dominant narratives of interpersonal firearm violence, guided by the wisdom and determination of those most impacted, such that the goal of prevention and intervention efforts is not merely the absence of violence but rather the creation of a community safety and health ecosystem is essential to meet this critical moment in firearm violence research and prevention.

Traumatic Life Events and Stressors: Associations With Substance Use Problems of Men Under Community Supervision

This study aims to determine associations between sources of stress and substance use problems among men under community supervision programs. We used ordinary least squares regression models to test the hypotheses that the traumatic life events and stressors of men under community supervision and their partners, respectively, were associated with the substance use problems of men under community supervision. The sample included 230 men involved in community supervision programs in New York City and 230 women who were their intimate partners. We found that the traumatic events and the depression and anxiety of men under community supervision and partner's substance use problems were associated with the substance use problems of the men. These findings underscore the importance of addressing trauma in substance use treatment for men under community supervision. Future research can explore how stressful events impact substance use, sources of coping for couples, and the association between racism, traumatic events, stress, and substance use. Clinical Trial Registration: NCT01690494.

RANKING RESIDENTIAL NEIGHBORHOODS BASED ON THEIR SUSTAINABILITY: A CM-BWM APPROACH

Population growth and rapid urbanization have consequences that are reflected in the economic, environmental, and social stability of city-residential neighborhoods. These impacts directly affect not only residents but also real estate markets and local governments. The professionals working in the latter entities have become increasingly concerned about urban sustainability and its strategic integration into their plans. Strategies have been implemented that focus on both addressing negative aspects of residential neighborhoods and enhancing positive features that can contribute to the continuous improvement of locals’ living conditions. This study applies the multiple-criteria decision analysis approach and a combination of cognitive mapping and the best-worst method (BWM) to identify the most relevant criteria and use these to rank residential neighborhoods according to their sustainability. To apply the selected techniques, two group meetings were held with a panel of decision makers. The results were validated by the panel members and the Funchal City Council councilor for urbanism, who concurred that the proposed ranking system facilitates the identification of the most sustainable residential neighborhoods. The contributions and limitations of the methodological approach are also discussed.

A descriptive exploration of the geographic and sociodemographic concentration of firearm homicide in the United States, 2004-2018

This study examined the population-based incidence of firearm homicide in the United States to identify geographic concentrations and to determine whether such concentrations have changed over time. It further examined the simultaneous associations of urbanization, poverty, and ethnicity/race with firearm homicide incidence. Using county-level data from the National Vital Statistics System and the U.S. Census Bureau for the years 2004-2018, the findings show geographic patterns not commonly recognized, including several lengthy and continuous corridors with a high incidence of firearm homicide, traversing both metro and non-metro areas. While the data clearly show a strongly disproportionate concentration of firearm homicide incidence in a subset of the population defined by geography, they do not suggest increasing concentration over time. The study findings also generally indicate increasing firearm homicide incidence with increasing levels of surrounding poverty, a phenomenon observed for both metro and non-metro areas.

A New Measure of Community Health: Findings from the Healthy Aging Data Reports

BACKGROUND AND OBJECTIVES

The purpose of this study was to develop a multidimensional measure of community healthy aging that is more nuanced than existing measures. The social ecological framework guided this analysis of the latent structure of community prevalence rates of chronic diseases and functional impairments.

RESEARCH DESIGN AND METHODS

The sample was 471 communities in Massachusetts (n=319) and New Hampshire (n=152). Data were drawn from publicly available healthy aging data reports for both states. Community prevalence rates for 45 chronic conditions, rates of mortality, and Medicare service utilization were estimated with the 2014-2015 CMS Medicare Beneficiary Summary Files and used in factor analyses to explore the latent structure of community healthy aging.

RESULTS

Results revealed a multidimensional structure composed of four latent population health components: serious complex chronic disease, indolent chronic disease, physical disability, and psychological disability. We found that while lower community socioeconomic status is a major determinant of all four components of population health, it is predictably associated with higher levels of serious complex chronic disease and physical disability and yet surprisingly with lower levels of indolent chronic disease and psychological disability.

DISCUSSION AND IMPLICATIONS

The four-dimensional model provides a more nuanced measure of community healthy aging than mortality rate, and it identifies community health disparities that otherwise may go undetected. Understanding the multiple levels that influence community healthy aging may reveal new interventions or programs to improve it and allow policymakers or other stakeholders to more accurately tailor interventions to match the conditions of need.

Estimating exposure to neighborhood crime by race and ethnicity for public health research

BACKGROUND

Police-reported crime data (hereafter "crime") is routinely used as a psychosocial stressor in public health research, yet few studies have jointly examined (a) differences in crime exposure based on participant race and ethnicity, (b) differences in measures of crime exposure, and (c) considerations for how exposure to police is captured in police-recorded crime data. We estimate neighborhood exposure to crime and discuss the implications of structural differences in exposure to crime and police based on race and ethnicity.

METHODS

Using GPS coordinates from 1188 participants in the Newborn Epigenetics Study, we estimated gestational exposure to crime provided by the Durham, North Carolina, Police Department within (a) 800 m and (b) the Census block group of residence. We controlled for non-overlapping spatial boundaries in crime, Census, residential, and police data to report crime spatial (crime per km2) and population (crime per 1000 people per km2) density.

RESULTS

We demonstrate dramatic disparities in exposure to crime based on participant race and ethnicity and highlight variability in these disparities based on the type of crime and crime measurement method chosen.

CONCLUSIONS

Public health researchers should give thoughtful consideration when using police-reported crime data to measure and model exposure to crime in the United States, as police-reported data encompasses joint exposure to police and crime in the neighborhood setting.

The Importance of Space and Time in Aggravated Assault Victimization

Interpersonal crimes such as aggravated assault greatly impacts upon an individuals' sense of personal safety and security as the crime results in a physical injury. Understanding where and when aggravated assaults are most likely to occur is therefore vital to minimize the victimization risk associated with this crime. The main aim of this study is to explore the relative importance of space and time in aggravated assault victimization. This was done using national level aggravated assault data (2008-2010) obtained from New Zealand Police and census data from Statistics New Zealand. Both the spatial and temporal distribution of aggravated assault are outlined to examine their association with aggravated assault victimization. Aggravated assault is found to cluster in space but not in time. The relationships between aggravated assault risk in space and time and a suite of social, economic, and lifestyle variables was then examined. A clear socioeconomic gradient was found between aggravated assault risk by space and all neighborhood characteristics with high-risk neighborhoods having greater residential mobility and ethnic/racial diversity, as well as being more deprived, having higher rates of unemployment, and lower median household incomes. No clear pattern emerged between aggravated assault by time and the selected neighborhood characteristics. The policy implications of these findings in terms of policing and diversity conclude.

Cumulative Impact of Environmental Pollution and Population Vulnerability on Pediatric Asthma Hospitalizations: A Multilevel Analysis of CalEnviroScreen

The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0–14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014–1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010–1.013; RR = 1.002, 95% CI = 1.001–1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities.

Minorities and foreign born are disproportionately affected by injuries due to violence: an analysis based on a National Trauma Registry 2008-2017

BACKGROUND

Populations of different ethnicity and country of origin living in the same country may possess particular features of violence-related injuries. This study aims to compare violence-related injury characteristics and circumstances, hospital resource utilization and in-hospital mortality among the major ethnic groups in Israel.

METHODS

A study based on the Israeli National Trauma Registry database of patients hospitalized due to violence-related injuries between 2008 and 2017. Data included demographic, injury and hospitalization characteristics and in-hospital mortality. Statistical analysis included χ²-test and multiple logistic regression.

RESULTS

During the study period, 16,151 violence related-hospitalizations were reported, of which; 46.1% were Arab Israelis (AI), 3.2% were Israelis born in Ethiopia (IBE), 12.7% were Israelis born in the former Soviet Union (IBFSU) and 38.0% were all other Israelis (AOI). The proportion of violence-related hospitalizations among AI, IBE and IBFSU was greater than their respective proportion in the Israeli population. In comparison to the other groups, stab injuries were significantly greater among IBE (30% vs 39%); unarmed brawl-related injuries were greater among IBFSU (22-41% vs 49%) and firearm injuries were greatest among AI (2-8% vs 23%). These differences in violence mechanism persisted even after accounting for age, gender, injury place and time differences. The foreign born groups had higher rates for injuries sustained on the street/road (58% for IBE, 54% for IBFSU vs 46% for AI and AOI, each), with IBE also showing higher rates for weekend and weeknight injuries compared to the other groups (83% vs 71-75%). IBE were more likely to suffer from severe and critical injuries (19% vs 12-16%), to be admitted to the intensive care unit (17% vs 9-11%) and to have prolonged hospital stays of seven days or more (20% vs 16-17%), with no significant difference in in-hospital mortality between the comparison groups.

CONCLUSIONS

Characteristics of violence-related casualties differed significantly among diverse ethnic populations living in the same country. Each population group showed specific attributes regarding injury mechanism, circumstances, severity and hospital utilization. Violence prevention programs should be culturally adapted and take into account ethnicity and country of origin of the target population.

Associations of neighborhood-level racial residential segregation with adverse pregnancy outcomes

BACKGROUND

Previous analyses utilizing birth certificate data have shown environmental factors such as racial residential segregation may contribute to disparities in adverse pregnancy outcomes. However, birth certificate data are ill equipped to reliably differentiate among small for gestational age, spontaneous preterm birth, and medically indicated preterm birth.

OBJECTIVE

We sought to utilize data from electronic medical records to determine whether residential segregation among Black women is associated with an increased risk of adverse pregnancy outcomes.

STUDY DESIGN

The study population was composed of 4770 non-Hispanic Black women who delivered during the years 2009 through 2013 at a single urban medical center. Addresses were geocoded at the level of census tract, and this tract was used to determine the degree of residential segregation for an individual's neighborhood. Residential segregation was measured using the Gi* statistic, a z-score that measures the extent to which the neighborhood racial composition deviates from the composition of the larger surrounding area. The Gi* statistic z-scores were categorized as follows: low (z < 0), medium (z = 0-1.96), and high (z > 1.96). Adverse pregnancy outcomes included overall preterm birth, spontaneous preterm birth, medically indicated preterm birth, and small for gestational age. Hierarchical logistic regression models accounting for clustering by census tract and repeated births among mothers were used to estimate odds ratios of adverse pregnancy outcomes associated with segregation.

RESULTS

In high segregation areas, the prevalence of overall preterm birth was significantly higher than that in low segregation areas (15.5% vs 10.7%, respectively; P < .001). Likewise, the prevalence of spontaneous preterm birth and medically indicated preterm birth were higher in high (9.5% and 6.0%) vs low (6.2% and 4.6%) segregation neighborhoods (P < .001 and P = .046, respectively). The associations of high segregation with overall preterm birth (odds ratio, 1.31; 95% confidence interval, 1.02-1.69) and spontaneous preterm birth (odds ratio, 1.37; 95% confidence interval, 1.02-1.85) remained significant with adjustment for neighborhood poverty, insurance status, parity, and maternal medical conditions.

CONCLUSION

Among non-Hispanic Black women in an urban area, high levels of segregation were independently associated with the higher odds of spontaneous preterm birth. These findings highlight one aspect of social determinants (ie, segregation) through which adverse pregnancy outcomes may be influenced and points to a potential target for intervention.

America's Churning Races: Race and Ethnicity Response Changes Between Census 2000 and the 2010 Census

A person's racial or ethnic self-identification can change over time and across contexts, which is a component of population change not usually considered in studies that use race and ethnicity as variables. To facilitate incorporation of this aspect of population change, we show patterns and directions of individual-level race and Hispanic response change throughout the United States and among all federally recognized race/ethnic groups. We use internal U.S. Census Bureau data from the 2000 and 2010 censuses in which responses have been linked at the individual level (N = 162 million). Approximately 9.8 million people (6.1 %) in our data have a different race and/or Hispanic-origin response in 2010 than they did in 2000. Race response change was especially common among those reported as American Indian, Alaska Native, Native Hawaiian, Other Pacific Islander, in a multiple-race response group, or Hispanic. People reported as non-Hispanic white, black, or Asian in 2000 usually had the same response in 2010 (3 %, 6 %, and 9 % of responses changed, respectively). Hispanic/non-Hispanic ethnicity responses were also usually consistent (13 % and 1 %, respectively, changed). We found a variety of response change patterns, which we detail. In many race/Hispanic response groups, we see population churn in the form of large countervailing flows of response changes that are hidden in cross-sectional data. We find that response changes happen across ages, sexes, regions, and response modes, with interesting variation across racial/ethnic categories. Researchers should address the implications of race and Hispanic-origin response change when designing analyses and interpreting results.

Structural racism and health inequities in the USA: evidence and interventions

Despite growing interest in understanding how social factors drive poor health outcomes, many academics, policy makers, scientists, elected officials, journalists, and others responsible for defining and responding to the public discourse remain reluctant to identify racism as a root cause of racial health inequities. In this conceptual report, the third in a Series on equity and equality in health in the USA, we use a contemporary and historical perspective to discuss research and interventions that grapple with the implications of what is known as structural racism on population health and health inequities. Structural racism refers to the totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. These patterns and practices in turn reinforce discriminatory beliefs, values, and distribution of resources. We argue that a focus on structural racism offers a concrete, feasible, and promising approach towards advancing health equity and improving population health.

Local Residential Segregation Matters: Stronger Association of Census Tract Compared to Conventional City-Level Measures with Fatal and Non-Fatal Assaults (Total and Firearm Related), Using the Index of Concentration at the Extremes (ICE) for Racial, Economic, and Racialized Economic Segregation, Massachusetts (US), 1995-2010

Research on residential segregation and health, primarily conducted in the USA, has chiefly employed city or regional measures of racial segregation. To test our hypothesis that stronger associations would be observed using local measures, especially for racialized economic segregation, we analyzed risk of fatal and non-fatal assault in Massachusetts (1995-2010), since this outcome is strongly associated with residential segregation. The segregation metrics comprised the Index of Concentration at the Extremes (ICE), the Index of Dissimilarity, and poverty rate, with measures computed at both the census tract and city/town level. Key results were that larger associations between fatal and non-fatal assaults and residential segregation occurred for models using the census tract vs. city/town measures, with the greatest associations observed for racialized economic segregation. For fatal assaults, comparing the bottom vs. top quintiles, the incidence rate ratio (and 95% confidence interval (CI)) in models using the census tract measures equaled 3.96 (95% CI 3.10, 5.06) for the ICE for racialized economic segregation, 3.26 (95% CI 2.58, 4.14) for the ICE for income, 3.14 (95% CI 2.47, 3.99) for poverty, 2.90 (95% CI 2.21, 3.81) for the ICE for race/ethnicity, and only 0.93 (95% CI 0.79, 1.11) for the Index of Dissimilarity; in models that included both census tract and city/town ICE measures, this risk ratio for the ICE for racialized economic segregation was higher at the census tract (3.29; 95% CI 2.43, 4.46) vs. city/town level (1.61; 95% CI 1.12, 2.32). These results suggest that, at least in the case of fatal and non-fatal assaults, research on residential segregation should employ local measures, including of racialized economic segregation, to avoid underestimating the adverse impact of segregation on health.