The neighborhood environment and obesity: Understanding variation by race/ethnicity

Individually Perceived Parameters of Residential Infrastructure and Their Relationship with Cardiovascular Risk Factors

In modern medicine, studies devoted to the assessment of the parameters of residential infrastructure and the population's attitude towards them have become quite large-scale. Objectives: The aim of the study was to establish associations between individually perceived parameters of residential infrastructure and the main modifiable cardiovascular risk factors (hypertension, obesity, lipid and carbohydrate metabolism disorders) in one of the subjects of the Russian Federation. Methods: The epidemiological study "Study of the influence of social factors on chronic non-communicable diseases" started in 2015 and ended in 2023. The sample was formed by using the stratification method based on the assignment to a medical organization. The study included 1598 respondents aged 35 to 70 years (491 rural residents). The study of infrastructure parameters was conducted based on the subjective opinions of respondents using the neighborhood environment walkability scale (NEWS) questionnaire, divided into eight scales. Logistic regression analysis was used to identify associations between infrastructure parameters and cardiovascular risk factors; the odds ratio (OR) and 95% confidence interval were evaluated. Results: Individually perceived infrastructure parameters of the scale B, reflecting the accessibility of infrastructure facilities, were associated with hypertension [OR = 1.33], obesity [OR = 1.40], and abdominal obesity [OR = 1.59]. Elements of the social infrastructure of the scale C, describing the streets in the residential area, increased the likelihood of developing obesity [OR = 1.42] and visceral obesity [OR = 1.43]. The characteristics of the residential area, represented by the scale D that evaluates pedestrian infrastructure, were associated with all major cardiovascular risk factors (hypertension [OR = 1.65], obesity [OR = 1.62] and abdominal obesity [OR = 1.82], and disorders of lipid [OR = 1.41] and carbohydrate metabolism [OR = 1.44]). Conclusion: Social factors represented by various aspects of infrastructure have become important criteria for determining cardiovascular health. Environmental conditions affect cardiovascular risk factors through behavioral patterns that shape the respondent's lifestyle. Interventions in urban planning-increasing accessibility to infrastructure facilities for the population, developing a pedestrian-friendly urban environment, improving physical activity resources in areas, planning recreation areas, and landscaping-can become the most important concept for the prevention of cardiovascular diseases.

The Relationship Between Neighborhood Disadvantage and Markers of Chronic Pain Risk: Findings From the Oklahoma Study of Native American Pain Risk (OK-SNAP)

Socioeconomic disadvantage contributes to health inequities, including chronic pain. Yet, research examining socioeconomic disadvantage and pain risk in Native Americans (NAs) is scant. This exploratory analysis assessed relationships between socioeconomic position (SEP), ethnicity, and neighborhood disadvantage on pronociceptive processes in 272 healthy, chronic pain-free NAs (n = 139) and non-Hispanic Whites (NHWs, n = 133) from the Oklahoma Study of Native American Pain Risk (OK-SNAP). Neighborhood disadvantage was quantified using the Area Deprivation Index (ADI). Regression models tested whether ADI predicted pain-promoting outcomes (ie, peripheral fiber functionality, pain sensitivity, pain and nociceptive amplification, and endogenous pain inhibition) above-and-beyond SEP and ethnicity. The Ethnicity × ADI interaction was also tested. Of the 11 outcomes tested, 9 were not statistically significant. Of the significant findings, neighborhood disadvantage predicted impaired inhibition of the nociceptive flexion reflex above-and-beyond SEP and ethnicity. Additionally, ethnicity moderated the relationship between ADI and warm detection threshold; disadvantage was associated with higher thresholds for NAs, but not for NHWs. Together, the results suggest neighborhood disadvantage is associated with reduced C-fiber function and impaired spinal inhibition, thus pointing to a role of neighborhood disadvantage in the relationship between the environment and pain inequities. PERSPECTIVE: This study assessed neighborhood socioeconomic disadvantage and pronociceptive processes in chronic pain-free Native Americans (NAs) and non-Hispanic Whites (NHWs). Irrespective of ethnicity, greater neighborhood disadvantage predicted less descending inhibition of spinal nociception. Neighborhood disadvantage was associated with a marker of C-fiber impairment (higher warm detection threshold) in NAs only.

Social and Structural Determinants of Health and Social Injustices Contributing to Obesity Disparities

PURPOSE OF REVIEW: To analyze how social and structural determinants of health and social injustice impact the risk of obesity, its treatment and treatment outcomes, and to explore the implications for prevention and future treatment interventions. RECENT FINDINGS: Racial and ethnic minorities, such as non-Hispanic Black adults and Hispanic adults, and adults with a low socioeconomic status have a greater risk of obesity than non-Hispanic white adults and adults with a high socioeconomic status. The underlying causes of obesity disparities include obesogenic neighborhood environments, inequities in access to obesity treatment, and lack of access to affordable nutrient-dense foods. Experts have called for interventions that address the social and structural determinants of obesity disparities. Population-based interventions that focus on improving neighborhood conditions, discouraging the consumption of unhealthy foods and beverages, expanding access to obesity treatment, and ensuring equitable access to fruits and vegetables have been proven to be effective. There is a growing body of evidence that shows the relationship between social and structural determinants of health and injustice on disparities in obesity among racial and ethnic minorities and individuals with a low SES. Population-based, equity-focused interventions that address the underlying causes of obesity disparities are needed to reduce obesity disparities and improve the health outcomes of minoritized and marginalized groups.

Assessing the Influence of Redlining on Intergenerational Wealth and Body Mass Index Through a Quasi-experimental Framework

BACKGROUND

Higher levels of body mass index (BMI), particularly for those who have obesity defined as class II and III, are correlated with excess risk of all-cause mortality in the USA, and these risks disproportionately affects marginalized communities impacted by systemic racism. Redlining, a form of structural racism, is a practice by which federal agencies and banks disincentivized mortgage investments in predominantly racialized minority neighborhoods, contributing to residential segregation. The extent to which redlining contributes to current-day wealth and health inequities, including obesity, through wealth pathways or limited access to health-promoting resources, remains unclear. Our quasi-experimental study aimed to investigate the generational impacts of redlining on wealth and body mass index (BMI) outcomes.

METHODS

We leveraged the Panel Study of Income Dynamics (PSID) and Home Owners' Loan Corporation (HOLC) maps to implement a geographical regression discontinuity design, where treatment assignment is randomly based on the boundary location of PSID grandparents in yellowlined vs. redlined areas and used outcome measures of wealth and mean BMI of grandchildren. To estimate our effects, we used a continuity-based approach and applied data-driven procedures to identify the most appropriate bandwidths for a valid estimation and inference.

RESULTS

In our fully adjusted model, grandchildren with grandparents living in redlined areas had lower average household wealth (β =  - $35,419; 95% CIrbc - $37,423, - $7615) and a notably elevated mean BMI (β = 7.47; 95% CIrbc - 4.00, 16.60), when compared to grandchildren whose grandparents resided in yellowlined regions.

CONCLUSION

Our research supports the idea that redlining, a historical policy rooted in structural racism, is a key factor contributing to disparities in wealth accumulation and, conceivably, body mass index across racial groups.

Obesity in U.S. low-income veterans:Prevalence, clinical characteristics, and homelessness

OBJECTIVE

Obesity is associated with lower socioeconomic status. To date, however, scarce research has examined the prevalence, comorbidity, and incremental burden of obesity in relation to medical, psychiatric, functional, and homelessness measures among low-income veterans.

METHODS

A nationally representative sample of 1004 low-income U.S. veterans was examined. Bivariate and multivariable analyses were conducted to assess relationships between obesity and medical and psychiatric comorbidities, functioning, and homelessness measures.

RESULTS

The prevalence estimate of obesity among low-income U.S. veterans was 38.2% (confidence interval (CI): 34.2; 42.2), which is higher than previously reported for the general U.S. veteran population. It was particularly high among young, females with children. Obesity was associated with co-occurring medical (chronic pain, diabetes, sleep disorders, high blood pressure, heart disease) and psychiatric (trauma- and anxiety-related) conditions, poor functioning, and current psychiatric medication use. Veterans with obesity were less likely to have current savings and more likely to have current debt. They also were more likely to have experienced evictions and foreclosures and less likely to use active coping or positive reframing as a means of dealing with stressful situations.

CONCLUSION

The prevalence of obesity among U.S. veterans is high. Specific demographic groups particularly vulnerable to developing obesity warrant targeted interventions. Modifying weight management programs, understanding coping styles, and assessing, monitoring, and treating obesity in low-income veterans may help improve overall health and quality of life in multiple domains.

Race- and Gender-Specific Associations between Neighborhood-Level Socioeconomic Status and Body Mass Index: Evidence from the Southern Community Cohort Study

Obesity and a low socioeconomic status (SES), measured at the neighborhood level, are more common among Americans of Black race and with a low individual-level SES. We examined the association between the neighborhood SES and body mass index (BMI) using data from 80,970 participants in the Southern Community Cohort Study, a cohort that oversamples Black and low-SES participants. BMI (kg/m2) was examined both continuously and categorically using cut points defined by the CDC. Neighborhood SES was measured using a neighborhood deprivation index composed of census-tract variables in the domains of education, employment, occupation, housing, and poverty. Generally, the participants in lower-SES neighborhoods were more likely to have a higher BMI and to be considered obese. We found effect modification by race and sex, where the neighborhood-BMI association was most apparent in White female participants in all the quintiles of the neighborhood SES (ORQ2 = 1.55, 95%CI = 1.34, 1.78; ORQ3 = 1.71, 95%CI = 1.48, 1.98; ORQ4 = 1.76, 95%CI = 1.52, 2.03; ORQ5 = 1.64, 95%SE = 1.39, 1.93). Conversely, the neighborhood-BMI association was mostly null in Black male participants (ORQ2 = 0.91, 95%CI = 0.72, 1.15; ORQ3 = 1.05, 95%CI = 0.84, 1.31; βQ4 = 1.00, 95%CI = 0.81, 1.23; ORQ5 = 0.76, 95%CI = 0.63, 0.93). Within all the subgroups, the associations were attenuated or null in participants residing in the lowest-SES neighborhoods. These findings suggest that the associations between the neighborhood SES and BMI vary, and that other factors aside from the neighborhood SES may better predict the BMI in Black and low-SES groups.

Children who appeared or remained overweight or obese predict a higher follow-up blood pressure and higher risk of hypertension: a 6-year longitudinal study in Yantai, China

Few longitudinal studies have examined the effect of weight status change on blood pressure change over time and incidence of hypertension among Chinese children. The longitudinal study enrolled 17,702 Chinese children aged 7 years in Yantai in 2014 as baseline, with a continuous 5 years of follow-up to 2019. Generalized estimating equation model was fitted to examine the main and interaction effects of weight status change and time with blood pressure and the incidence of hypertension. Compared with the participants who remained normal weight, the participants who remained overweight or obese had higher systolic blood pressure (SBP) (β = 2.89, p < 0.001) and diastolic blood pressure (DBP) (β = 1.79, p < 0.001). Significant interactions were identified between weight status change and time with SBP (χ2interaction = 697.77, p < 0.001) and DBP (χ2interaction = 270.49, p < 0.001). The odds ratio (OR) and 95% confidence interval (CI) of hypertension were 1.70 (1.59-1.82) for participants who appeared overweight or obese, 2.26 (2.14-2.40) for participants who remained overweight or obese, compared with the participants who remained normal weight. Those who switched from overweight or obesity to normal weight had almost the same risk of developing hypertension (OR = 1.13, 95% CI: 1.02 to 1.26) as children who remained normal weight. Children who appeared or remained overweight or obese predict a higher follow-up blood pressure and higher risk of hypertension, whereas losing weight could reduce blood pressure and the risk of hypertension. Children who appeared or remained overweight or obese predict a higher follow-up blood pressure and higher risk of hypertension, whereas losing weight could reduce blood pressure and the risk of hypertension.

Neighborhood Social Cohesion and Obesity in the United States

Low neighborhood social cohesion (nSC) has been associated with obesity. Still, few studies have assessed the nSC-obesity relationship among a large, nationally representative, and racially/ethnically diverse sample of the United States population. To address this literature gap, we examined cross-sectional associations among 154,480 adult participants of the National Health Interview Survey (NHIS) from 2013-2018. We also determined if associations varied by race/ethnicity, sex/gender, age, annual household income, and food security status. Based on a 4-item scale from the Project on Human Development in Chicago Neighborhoods Community Survey, we categorized nSC as low, medium, and high. Based on body mass index (BMI) recommendations, we categorized obesity as ≥30 kg/m2. We used Poisson regression with robust variance to directly estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) while adjusting for sociodemographic characteristics, such as annual household income, educational attainment, and marital status, along with other confounders. Study participants' mean age ± standard error was 47.1±0.1 years; most (69.2%) self-identified as Non-Hispanic (NH)-White, and 51.0% were women. NH-Black and Hispanic/Latinx adults comprised more of the population in neighborhoods with low nSC (14.0% NH-Black, 19.1% Hispanic/Latinx, and 61.8% NH-White) versus high nSC (7.7% NH-Black, 10.4% Hispanic/Latinx and 77.0% NH-White). Low vs. high nSC was associated with a 15% higher prevalence of obesity (PR=1.15 [95% CI: 1.12-1.18]), and the magnitude of the association was more substantial among NH-White (PR=1.21 [95% CI: 1.17-1.25]) compared to associations among Hispanic/Latinx (PR=1.04 [95% CI: 0.97-1.11]) and NH-Black (PR=1.01 [95% CI: 0.95-1.07]) adults. Low vs. high nSC was associated with a 20% higher prevalence of obesity in women (PR=1.20 [95% CI: 1.16-1.24]) compared to a 10% higher prevalence in men (PR=1.10 [95% CI: 1.06-1.14]). Low vs. high nSC was associated with a 19% higher prevalence of obesity among adults ≥50 years old (PR=1.19 [95% CI: 1.15-1.23]) compared to a 7% higher prevalence of obesity among adults <50 years old (PR=1.07 [95% CI: 1.03-1.11]). Efforts to address nSC may improve health and address health disparities.

Social determinants of health, health disparities, and adiposity

Social determinants of health (SDoH), or the socioeconomic, environmental, and psychosocial conditions in which individuals spend their daily lives, substantially influence obesity as a cardiovascular disease (CVD) risk factor. The coronavirus disease 2019 (COVID-19) pandemic highlighted the converging epidemics of obesity, CVD, and social inequities globally. Obesity and CVD serve as independent risk factors for COVID-19 severity and lower-resourced populations most impacted by adverse SDoH have the highest COVID-19 mortality rates. Better understanding the interplay between social and biologic factors that contribute to obesity-related CVD disparities are important to equitably address obesity across populations. Despite efforts to investigate SDoH and their biologic effects as drivers of health disparities, the connections between SDoH and obesity remain incompletely understood. This review aims to highlight the relationships between socioeconomic, environmental, and psychosocial factors and obesity. We also present potential biologic factors that may play a role in the biology of adversity, or link SDoH to adiposity and poor adipo-cardiology outcomes. Finally, we provide evidence for multi-level obesity interventions targeting multiple aspects of SDoH. Throughout, we emphasize areas for future research to tailor health equity-promoting interventions across populations to reduce obesity and obesity-related CVD disparities.

The Role of Prenatal Psychosocial Stress in the Associations of a Proinflammatory Diet in Pregnancy With Child Adiposity and Growth Trajectories

Importance

Prenatal psychosocial stress and nutrition may each program offspring adiposity, an important predictor of lifelong cardiometabolic health. Although increased stress and poor nutrition have been found to co-occur in pregnancy, little is known about their combined longitudinal associations in the offspring.

Objective

To investigate whether the associations of the Dietary Inflammatory Index (DII) with offspring adiposity differ by prenatal stress levels and whether these associations change with age.

Design, Setting, and Participants

Project Viva, a prospective prebirth cohort study of mother-child dyads in Massachusetts, included singleton children of mothers enrolled between April 1999 and July 2002, with follow-up visits at early childhood, midchildhood, and early adolescence. Data analysis was performed from October 31, 2020, to October 31, 2022.

Exposures

Food frequency-derived DII score in pregnancy was the exposure. Effect modifiers included stress-related measures in pregnancy; depressive symptoms assessed using the Edinburgh Postnatal Depression Scale (EPDS), dichotomized at scores greater than or equal to 13 vs less than 13; and census tract-level social vulnerability (overall Social Vulnerability Index and its 4 main subindices), dichotomized at the 75th percentile.

Main Outcomes and Measures

Overall adiposity, comprising sex- and age-standardized body mass index (BMI z), sum of subscapular and triceps skinfolds, fat mass index (FMI), and body fat percentage estimated using bioelectrical impedance analysis (BIA) and dual x-ray absorptiometry (DXA); and central adiposity, comprising waist circumference, ratio of subscapular to triceps skinfolds, and DXA-derived trunk FMI.

Results

Among 1060 mother-child dyads, mean (SD) maternal age was 32.6 (4.6) years, and 811 (77%) mothers were non-Hispanic White. Mean (SD) DII score was -2.7 (1.3) units, Social Vulnerability Index level was 38th (27th) percentile, and 8% of mothers had depressive symptoms. Mean (SD) age of the children was 3.3 (0.3) years at the early childhood visit, 7.9 (0.8) years at the midchildhood visit, and 13.2 (0.9) years at the early adolescence visit. In adjusted analyses, children born to mothers in the highest (vs lowest) quartile of DII had slower decrease in BMI z scores (β, 0.03 SD units/y; 95% CI, 0.01-0.05 SD units/y), and faster adiposity gain (eg, BIA total FMI β, 0.11 kg/m2/y; 95% CI, 0.03-0.19 kg/m2/y) over time. Associations of prenatal DII quartiles with childhood adiposity were stronger (eg, BIA total FMI quartile 4 vs quartile 1 change in β, 1.40 kg/m2; 95% CI, 0.21-2.59 kg/m2) among children of mothers with high vs low EPDS scores in pregnancy, although EPDS scores did not modify the change over time. Associations of prenatal DII with adiposity change over time, however, were greater among children whose mothers lived in neighborhoods with a high (BIA percentage body fat: β, 0.55% per year; 95% CI, 0.04%-1.07% per year) vs low (β, 0.13% per year; 95% CI, -0.20 to 0.46% per year), percentage of racial and ethnic minorities, and residents with limited English-language proficiency.

Conclusions and Relevance

The findings of this cohort study suggest that it may be useful to simultaneously evaluate prenatal diet and psychosocial stress in women as targets for interventions intended to prevent excess childhood adiposity.

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.

Assessing Hispanic/Latino and Non-Hispanic White Social Determinants of Obesity Among a Community Sample of Residents in the Rural Southeast US

Employing an ecological approach, we sought to identify social determinants of obesity among Hispanics/Latinos and non-Hispanic whites living in the Southeast US. Data on social determinants of obesity (individual, family, community and cultural/contextual) were collected from 217 participants [106 Hispanics/Latinos; 111 non-Hispanic whites]; height and weight  were objectively measured. We compared prevalence of overweight and obese between ethnic groups and BMI values within each group by social determinants. Hispanics had a 1.9-fold increase (OR 1.93, 95% CI: 1.05-3.55) in overweight prevalence compared to non-Hispanic whites after adjusting for age and gender. We found positive estimates between unfavorable family-level determinants and BMI among Hispanic/Latinos. In contrast, non-Hispanic whites who reported unfavorable neighborhood characteristics had higher BMI's. Findings highlight the need for targeted approaches for the prevention and control of obesity.

Associations Between Age of Onset of Pediatric Overweight/Obesity, a Child’s Sociodemographic Characteristics, and Characteristics of a Child’s Home Census Tract

Purpose

To identify associations between age of onset of overweight/obesity, a child’s sociodemographic characteristics, and characteristics of a child’s home census tract.

Design

Retrospective electronic health record review of children with overweight/obesity.

Setting

Three primary care centers associated with a free-standing, tertiary-care pediatric institution in Cincinnati.

Subjects

Patients born between August 1, 2013 and July 31, 2014, who had a body mass index (BMI) ≥85th percentile before 5 years of age (n = 794).

Measures

Primary outcome was the patient’s age at the first encounter when BMI was ≥85th percentile. Patient-level predictors were sex, age, race/ethnicity, health insurance, and number of moves captured in the health record. Census tract-level predictors were density of bus stops, presence of grocery stores, and a Socioeconomic Deprivation Index.

Analysis

Multivariable linear regression models assessed for independent associations between age of onset of overweight/obesity and predictors.

Results

Patients were 55.8% female, 73.6% black, and 79.1% publicly insured. Each additional move per year was associated with onset of overweight/obesity occurring 4.05 months earlier ( P < .0001). No significant associations between age of onset of overweight/obesity and census tract-level density of bus stops ( P = .82), presence of grocery stores ( P = .39), and socioeconomic deprivation ( P = .53) were demonstrated.

Conclusion

Public policy efforts toward improving access to grocery stores or public transportation may not be sufficient to prevent childhood obesity. Population-level interventions related to improving housing may also reduce obesity.

Effect of Social Environments on Cardiovascular Disease in the United States

Background This study aims to examine the effect of time-variant perceived neighborhood social cohesion, perceived neighborhood physical disorder, and local crime on cardiovascular disease (CVD) incidence from 2006 through 2016. Methods and Results We obtained data from the Health & Retirement Study. Respondents aged ≥50 years and with no recorded history of CVD until 2006 (N=8826) were included and followed for 10 years. Cox proportional hazards models were estimated with CVD incidence as an outcome variable and time-variant social environment factors (perceived neighborhood social cohesion, perceived neighborhood physical disorder, and local crime) as exposures, after controlling for sociodemographic factors and CVD-related risk/protective factors. Our results showed that perceived neighborhood social cohesion was associated with CVD among Black respondents, but not Hispanic and White respondents. Perceived neighborhood physical disorder and local crime rates were not associated with CVD incidence across all racial and ethnic groups. Conclusions The results demonstrate that perceptions of favorable social environments need to be considered to reduce CVD risk among Black adults. Further research is needed to identify different pathways through which living in favorable social environments benefits cardiovascular health by racial and ethnic groups.

Rate of Nutrition-Related Chronic Diseases Among a Multi-Ethnic Group of Uninsured Adults

The prevalence of nutrition-related chronic diseases, such as obesity, cardiovascular disease, and type 2 diabetes, among adults in the U.S. is of increasing importance. These conditions adversely affect the overall public health, health care systems, and economy. Marginalized minority groups have been disproportionally affected by these conditions. Lack of or inadequate health insurance limits access to health care, which contributes to poor health outcomes among individuals with these conditions. South Florida is home to diverse racial/ethnic minority groups, many of whom are uninsured and do not have access to expert-delivered nutrition education services. It is imperative to thoroughly study the health needs of these underserved patient populations and examine the rate of nutrition-related conditions among them in order to develop medically and culturally tailored nutrition education programs for them. Therefore, the aim of this study was to assess the prevalence of nutrition-related diseases among multi-racial/ethnic uninsured individuals living in South Florida. A four-week electronic health record of adult patients (N=272) from a free clinic in South Florida was analyzed. Spearman`s correlation and binary regression models were used to assess the relationship between the variables. The sample included females (65%) and males (35%). The mean age was 49.08±14.56 years. Overall, 87% had at least one nutrition-related condition, with overweight/obesity being the most observed (75.2%), followed by hypertension (39%), dyslipidemia (27.2%), and diabetes (23.9%). BMI was a significant predictor of the prevalence of hypertension among Whites (p=0.008) and Blacks (p=0.002) but not Asians (p=0.536). Overall, a high rate of nutrition-related chronic diseases was found among uninsured adults in this study. This supports the need for increased medically, culturally, and economically tailored nutrition education programs in free clinic settings.

Ethnic Disparities in Early-Onset Gastric Cancer: A Population-Based Study in Texas and California

BACKGROUND

Incidence rates of gastric cancer are increasing in young adults (age &lt;50 years), particularly among Hispanic persons. We estimated incidence rates of early-onset gastric cancer (EOGC) among Hispanic and non-Hispanic White persons by census tract poverty level and county-level metro/nonmetro residence.

METHODS

We used population-based data from the California and Texas Cancer Registries from 1995 to 2016 to estimate age-adjusted incidence rates of EOGC among Hispanic and non-Hispanic White persons by year, sex, tumor stage, census tract poverty level, metro versus nonmetro county, and state. We used logistic regression models to identify factors associated with distant stage diagnosis.

RESULTS

Of 3,047 persons diagnosed with EOGC, 73.2% were Hispanic White. Incidence rates were 1.29 [95% confidence interval (CI), 1.24-1.35] and 0.31 (95% CI, 0.29-0.33) per 100,000 Hispanic White and non-Hispanic White persons, respectively, with consistently higher incidence rates among Hispanic persons at all levels of poverty. There were no statistically significant associations between ethnicity and distant stage diagnosis in adjusted analysis.

CONCLUSIONS

There are ethnic disparities in EOGC incidence rates that persist across poverty levels.

IMPACT

EOGC incidence rates vary by ethnicity and poverty; these factors should be considered when assessing disease risk and targeting prevention efforts.

Associations between neighborhood built environment, residential property values, and adult BMI change: The Seattle Obesity Study III

Objective

To examine associations between neighborhood built environment (BE) variables, residential property values, and longitudinal 1- and 2-year changes in body mass index (BMI).

Methods

The Seattle Obesity Study III was a prospective cohort study of adults with geocoded residential addresses, conducted in King, Pierce, and Yakima Counties in Washington State. Measured heights and weights were obtained at baseline (n = 879), year 1 (n = 727), and year 2 (n = 679). Tax parcel residential property values served as proxies for individual socioeconomic status. Residential unit and road intersection density were captured using Euclidean-based SmartMaps at 800 m buffers. Counts of supermarket (0 versus. 1+) and fast-food restaurant availability (0, 1–3, 4+) were measured using network based SmartMaps at 1600 m buffers. Density measures and residential property values were categorized into tertiles. Linear mixed-effects models tested whether baseline BE variables and property values were associated with differential changes in BMI at year 1 or year 2, adjusting for age, gender, race/ethnicity, education, home ownership, and county of residence. These associations were then tested for potential disparities by age group, gender, race/ethnicity, and education.

Results

Road intersection density, access to food sources, and residential property values were inversely associated with BMI at baseline. At year 1, participants in the 3rd tertile of density metrics and with 4+ fast-food restaurants nearby showed less BMI gain compared to those in the 1st tertile or with 0 restaurants. At year 2, higher residential property values were predictive of lower BMI gain. There was evidence of differential associations by age group, gender, and education but not race/ethnicity.

Conclusion

Inverse associations between BE metrics and residential property values at baseline demonstrated mixed associations with 1- and 2-year BMI change. More work is needed to understand how individual-level sociodemographic factors moderate associations between the BE, property values, and BMI change.

•

Strong, inverse cross-sectional relationships between the built environment, residential property values (a proxy for individual socioeconomic status), and measured BMI were observed.

•

Measures of the built environment and residential property values showed modest and inconsistent associations with 1- and 2-year BMI change.

•

There was suggestive evidence that age may moderate the association between urban density and 1- and 2-year BMI change while education may moderate the association between residential property values and 2-year BMI change.

Association of Neighborhood Economic Trajectories With Changes in Weight Status Among Black and White Adults in the Southeastern US

IMPORTANCE

Neighborhood environment is an important factor associated with population disparities in obesity. However, few studies have examined whether and in what ways long-term trajectories of neighborhood conditions may be associated with weight outcomes. Moreover, there is a lack of research focusing on multidimensional and nuanced measures that make distinctions between multiple types of neighborhood change (eg, gentrification vs overall growth).

OBJECTIVE

To examine the association between long-term neighborhood economic trajectories and changes in weight status among Black and White adults residing in predominantly low-income communities in the southeastern US.

DESIGN, SETTING, AND PARTICIPANTS

This study was a longitudinal analysis of participants in the Southern Community Cohort Study. Five types of neighborhood economic trajectories (stability, growth, displacement, abandonment, and poverty concentration) were measured using data from the US Census and the American Community Survey from 2000 to 2016. Data were analyzed from December 12, 2021, to July 16, 2022. A total of 33 621 Black and White adults in the southeastern US were included in the analytic sample.

EXPOSURE

Neighborhood economic trajectory.

MAIN OUTCOMES AND MEASURES

Substantial weight gain and substantial weight loss (ie, gaining or losing ≥10% of baseline weight) between baseline (March 2002 to September 2009) and follow-up (November 2008 to January 2013) periods were assessed using self-reported information.

RESULTS

Among 33 621 participants, the mean (SD) age was 53.4 (8.8) years; 22 116 participants (65.8%) were women, 21 782 (64.8%) were Black, and 11 839 (35.2%) were White. Compared with residents in neighborhoods with stable trajectories, those in neighborhoods with growth trajectories that did not displace original residents were less likely to experience substantial weight gain (odds ratio [OR], 0.75; 95% CI, 0.58-0.97), whereas those in neighborhoods with poverty concentration trajectories were more likely to experience substantial weight gain (OR, 1.08; 95% CI, 1.00-1.17). These patterns appeared stronger among Black participants (eg, substantial weight gain in poverty concentration group: OR, 1.10 [95% CI, 1.00-1.22]; in growth group: OR, 0.76 [95% CI, 0.56-1.02]) compared with White participants (eg, substantial weight gain in poverty concentration group: OR, 1.03 [95% CI, 0.90-1.18]; in growth group: OR, 0.84 [95% CI, 0.52-1.36]). Differences in patterns were also observed among men (eg, substantial weight gain in poverty concentration group: OR, 1.02 [95% CI, 0.88-1.17]; in growth group: OR, 0.58 [95% CI, 0.35-0.96]) compared with women (eg, substantial weight gain in poverty concentration group: OR, 1.12 [95% CI, 1.02-1.23]; in growth group: OR, 0.83 [95% CI, 0.62-1.12]). However, none of the interaction terms between Black vs White participants and men vs women were statistically significant. Neighborhood trajectory was not associated with substantial weight loss (poverty concentration group: OR, 1.00 [95% CI, 0.93-1.09]; abandonment group: OR, 1.01 [95% CI, 0.84-1.15]; displacement group: OR, 1.04 [95% CI, 0.83-1.23]; growth group: OR, 0.88 [95% CI, 0.69-1.12]).

CONCLUSIONS AND RELEVANCE

In this cohort study, neighborhood economic trajectories were associated with weight gain. These findings highlight the importance of using more nuanced and multidimensional measures of neighborhood change in public health research.

Neighborhood Environment and Metabolic Risk in Hispanics/Latinos From the Hispanic Community Health Study/Study of Latinos

INTRODUCTION

This study examines the associations of neighborhood environments with BMI, HbA1c, and diabetes across 6 years in Hispanic/Latino adults.

METHODS

Participants from the Hispanic Community Health Study/Study of Latinos San Diego site (n=3,851, mean age=39.4 years, 53.3% women, 94.0% Mexican heritage) underwent assessment of metabolic risk factors and diabetes status (categorized as normoglycemia, prediabetes, and diabetes) at baseline (2008-2011) and approximately 6 years later (2014-2017). In the Study of Latinos Community and Surrounding Areas Study ancillary study (2015-2020), participant baseline addresses were geocoded, and neighborhoods were defined using 800-meter circular buffers. Neighborhood variables representing socioeconomic deprivation, residential stability, social disorder, walkability, and greenness were created using Census and other public databases. Analyses were conducted in 2020-2021.

RESULTS

Complex survey regression analyses revealed that greater neighborhood socioeconomic deprivation was associated with higher BMI (β=0.14, p<0.001) and HbA1c (β=0.08, p<0.01) levels and a higher odds of worse diabetes status (i.e., having prediabetes versus normoglycemia and having diabetes versus prediabetes; OR=1.25, 95% CI=1.06, 1.47) at baseline. Greater baseline neighborhood deprivation also was related to increasing BMI (β=0.05, p<0.01) and worsening diabetes (OR=1.27, 95% CI=1.10, 1.46) statuses, whereas social disorder was related to increasing BMI levels (β=0.05, p<0.05) at Visit 2. There were no associations of expected protective factors of walkability, greenness, or residential stability.

CONCLUSIONS

Neighborhood deprivation and disorder were related to worse metabolic health in San Diego Hispanic/Latino adults of mostly Mexican heritage. Multilevel interventions emphasizing individual and structural determinants may be most effective in improving metabolic health among Hispanic/Latino individuals.

Microsimulation projections of obesity interventions on cardiometabolic health disparities in the United States

OBJECTIVE

The aim of this study was to estimate long-term impacts of health education interventions on cardiometabolic health disparities.

METHODS

The model simulates how health education implemented in the United States throughout 2019 to 2049 would lead to changes in adult BMI and consequent hypertension and type 2 diabetes. Health outcome changes by sex, racial/ethnic (non-Hispanic White, non-Hispanic Black, and Hispanic), and weight status (normal: 18.5 ≤ BMI < 25; overweight: 25 ≤ BMI < 30; and obesity: 30 ≤ BMI) subpopulations were compared under a scenario with and one without health education.

RESULTS

By 2049, the intervention would reduce average BMI of women with obesity to 27.7 kg/m2 (CI: 27.4-27.9), which would be 2.9 kg/m2 lower than the expected average BMI without an intervention. Education campaigns would reduce type 2 diabetes prevalence, but it would remain highest among women with obesity at 27.7% (CI: 26.2%-29.2%). The intervention would reduce hypertension prevalence among White women by 4.7 percentage points to 38.0% (CI: 36.4%-39.7%). For Black women in the intervention, the 2049 hypertension prevalence would be 52.6% (CI: 50.7%-54.5%). Results for men and women were similar.

CONCLUSIONS

Long-term health education campaigns can reduce obesity-related disease. All population groups benefit, but they would not substantially narrow cardiometabolic health disparities.

Differential associations of the built environment on weight gain by sex and race/ethnicity but not age

OBJECTIVE

To explore the built environment (BE) and weight change relationship by age, sex, and racial/ethnic subgroups in adults.

METHODS

Weight trajectories were estimated using electronic health records for 115,260 insured Kaiser Permanente Washington members age 18-64 years. Member home addresses were geocoded using ArcGIS. Population, residential, and road intersection densities and counts of area supermarkets and fast food restaurants were measured with SmartMaps (800 and 5000-meter buffers) and categorized into tertiles. Linear mixed-effect models tested whether associations between BE features and weight gain at 1, 3, and 5 years differed by age, sex, and race/ethnicity, adjusting for demographics, baseline weight, and residential property values.

RESULTS

Denser urban form and greater availability of supermarkets and fast food restaurants were associated with differential weight change across sex and race/ethnicity. At 5 years, the mean difference in weight change comparing the 3rd versus 1st tertile of residential density was significantly different between males (-0.49 kg, 95% CI: -0.68, -0.30) and females (-0.17 kg, 95% CI: -0.33, -0.01) (P-value for interaction = 0.011). Across race/ethnicity, the mean difference in weight change at 5 years for residential density was significantly different among non-Hispanic (NH) Whites (-0.47 kg, 95% CI: -0.61, -0.32), NH Blacks (-0.86 kg, 95% CI: -1.37, -0.36), Hispanics (0.10 kg, 95% CI: -0.46, 0.65), and NH Asians (0.44 kg, 95% CI: 0.10, 0.78) (P-value for interaction <0.001). These findings were consistent for other BE measures.

CONCLUSION

The relationship between the built environment and weight change differs across demographic groups. Careful consideration of demographic differences in associations of BE and weight trajectories is warranted for investigating etiological mechanisms and guiding intervention development.

Examining the impacts of neighborhood poverty on bodyweight across the BMI distribution: a quantile and MSM modeling approach

PURPOSE

Given that the relationships between higher BMI and adverse health outcomes are nonconstant and most pronounced at either ends of the BMI distribution, we assess the association between neighborhood poverty and BMI at multiple points along the BMI distribution.

METHODS

Using data from the 1999 to 2015 Panel Study of Income Dynamics of Black and White adults in the United States, we estimate quantile regression models while jointly applying a marginal structural modeling approach to account for time-varying individual-level factors that may be simultaneously mediators as well as confounders.

RESULTS

Neighborhood poverty was not found to be associated with bodyweight at any point along the BMI distribution for Black or White males. However, high neighborhood poverty, compared to low neighborhood poverty, predicted increases in bodyweight for Black females at the lower end of the BMI distribution and for White females at the higher end of the BMI distribution. No association was found between neighborhood poverty and BMI at the mean.

CONCLUSIONS

Results identify the most vulnerable subgroups, suggesting that White females at the higher end of the BMI distribution as well as Black females at the lower end of the BMI distribution are particularly sensitive to obesogenic environments.

A spatial analysis of the effect of neighborhood contexts on cumulative number of confirmed cases of COVID-19 in U.S. Counties through October 20 2020

COVID-19 has become a nationwide public health crisis in the United States and the number of COVID-19 cases is different by U.S. counties. Also, previous studies have reported that neighborhood contexts have an influence on health outcomes. Therefore, the objective of this study was to examine the association between neighborhood contexts and cumulative number of confirmed COVID-19 cases (per 100,000) in U.S. counties. Cumulative number of COVID-19 cases gained from USA FACTS and variables related to neighborhood contexts gained from the 2018 5-Year American Community Survey at the county level. Data were analyzed using spatial autoregressive models. According to the present results, firstly, larger population, high poverty rate, higher % of bachelor's degree, higher % of no health insurance, higher employment rate, higher % of manufacturing jobs, higher % of primary industry jobs, higher % of commute by drove alone, higher % of foreign born, higher % of Hispanic, and higher % of Black are positively associated with higher cumulative number of COVID-19 cases. Secondly, higher income, higher % of cash assistance recipient, higher % of SNAP recipient, higher unemployment rate, higher % of commute by walked, higher % of Asian, and higher % of senior citizen are negatively associated with higher cumulative number of COVID-19 cases. In conclusion, there exist geographical differences in cumulative number of COVID-19 cases in U.S. counties, which is influenced by various neighborhood contexts. Hence, these findings emphasize the need to take various neighborhood contexts into account when planning COVID-19 prevention.

African American Ethnicity, Hypertension, Diabetes, and Arthritis Independently Predict Co-occurring Depression and Obesity among Community-dwelling Older Adult Alabamians

Although obesity and depression are quite common among older adults, surprisingly published literature has not examined factors associated with co-occurring depression and obesity among older adults. The knowledge that fills this gap would be advantageous for public health social workers and other health professionals who provide health care and public health services to older adults. The objectives of this study were to access the prevalence of and independent predictors of co-occurring depression and obesity among older adults in the state of Alabama. A retrospective analysis was conducted using a statewide survey of Alabamian community-dwelling older adults (n = 1,166). Binomial logistic regression was used to examine predictors of co-occurring depression and obesity. The prevalence of co-occurring depression and obesity among older adults was 16%. In the multivariate analysis, African American ethnicity (OR = 1.505, CI: 1.019-2.223), hypertension (OR = 1.593, CI: 1.050-2.416), diabetes (OR = 1.768, CI: 1.188-2.632), and arthritis (OR = 1.640, CI: 1.096-2.454) were positively associated with co-occurring depression and obesity). Older age (OR = 0.963, CI: 0.942-0.985) and higher levels of physical activity (OR = 1.640, CI: 1.096-2.454) were negatively associated with co-occurring depression and obesity. There is a need for the development and implementation of suitable interventions to prevent and manage co-occurring depression and obesity among older adults, particularly older adults with arthritis, hypertension, diabetes, or of African American ethnicity.

Trajectories of Multiple Behavioral Risk Factors and Their Associations With Cognitive Function Trajectories Among Older African Americans and White Americans

Objectives: This study examined the joint trajectories of behavioral risk factors (smoking, alcohol drinking, and body mass index) and their associations with cognitive function trajectories among older African Americans and white Americans. Methods: Data from the Health and Retirement Study (1998-2014) were used. Group-based mixture modeling and multinomial logistic regression analysis were performed. Results: Three joint trajectories of behavioral risk factors (overweight, smoking and drinking, and drinking and overweight) and three cognitive function trajectories (low, moderate, and high) were identified. A significantly higher percentage of African Americans were in the "overweight," "smoking and drinking," and "low" cognitive functioning groups as measured by the total cognition composite score compared to white Americans. After accounting for covariates, the "drinking and overweight" group was associated with the "moderate" or "high" cognitive functioning group. Discussion: Future interventions targeting the combinations of behavioral risk factors are needed to promote healthy aging among high-risk populations.

Relationship of neighborhood social determinants of health on racial/ethnic mortality disparities in US veterans-Mediation and moderating effects

OBJECTIVE

To examine mediation and moderation of racial/ethnic all-cause mortality disparities among Veteran Health Administration (VHA)-users by neighborhood deprivation and residential segregation.

DATA SOURCES

Electronic medical records for 10/2008-9/2009 VHA-users linked to National Death Index, 2000 Area Deprivation Index, and 2006-2009 US Census.

STUDY DESIGN

Racial/ethnic groups included American Indian/Alaskan Native (AI/AN), Asian, non-Hispanic black, Hispanic, Native Hawaiian/Other Pacific Islander, and non-Hispanic white (reference). We measured neighborhood deprivation by Area Deprivation Index, calculated segregation for non-Hispanic black, Hispanic, and AI/AN using the Isolation Index, evaluated mediation using inverse odds-weighted Cox regression models and moderation using Cox regression models testing for neighborhood*race/ethnicity interactions.

PRINCIPAL FINDINGS

Mortality disparities existed for AI/ANs (HR = 1.07, 95%CI:1.01-1.10) but no other groups after covariate adjustment. Neighborhood deprivation and Hispanic segregation neither mediated nor moderated AI/AN disparities. Non-Hispanic black segregation both mediated and moderated AI/AN disparities. The AI/AN vs. non-Hispanic white disparity was attenuated for AI/ANs living in neighborhoods with greater non-Hispanic black segregation (P = .047). Black segregation's mediating effect was limited to VHA-users living in counties with low black segregation. AI/AN segregation also mediated AI/AN mortality disparities in counties that included or were near AI/AN reservations.

CONCLUSIONS

Neighborhood characteristics, particularly black and AI/AN residential segregation, may contribute to AI/AN mortality disparities among VHA-users, particularly in communities that were rural, had greater black segregation, or were located on or near AI/AN reservations. This suggests the importance of neighborhood social determinants of health on racial/ethnic mortality disparities. Living near reservations may allow AI/AN VHA-users to maintain cultural and tribal ties, while also providing them with access to economic and other resources. Future research should explore the experiences of AI/ANs living in black communities and underlying mechanisms to identify targets for intervention.

Frequency of Restaurant, Delivery and Takeaway Usage Is Not Related to BMI among Adults in Scotland

BACKGROUND

The frequency of visits to restaurants has been suggested to contribute to the pandemic of obesity. However, few studies have examined how individual use of these restaurants is related to Body Mass Index (BMI).

AIM

To investigate the association between the usage of different types of food outlets and BMI among adults in Scotland.

METHOD

The study was cross-sectional. Participants completed an online survey for seven consecutive days where all food purchased at food outlets was reported each day. We explored the relationship between BMI and usage of these food outlets.

RESULTS

The total number of participants that completed the survey was 681. The BMI of both males and females was not related to frequency of use of Full-Service Restaurants (FSRs), Fast-Food Restaurants (FFRs), delivery or takeaways, when assessed individually or combined (TFOs = total food outlets).

CONCLUSION

These cross-sectional data do not support the widespread belief that consumption of food out of the home at fast-food and full-service restaurants, combined with that derived from deliveries and takeaways, is a major driver of obesity in Scotland.

Early Individual and Family Predictors of Weight Trajectories From Early Childhood to Adolescence: Results From the Millennium Cohort Study

Background: Early infancy and childhood are critical periods in the establishment of lifelong weight trajectories. Parents and early family environment have a strong effect on children's health behaviors that track into adolescence, influencing lifelong risk of obesity. Objective: We aimed to identify developmental trajectories of body mass index (BMI) from early childhood to adolescence and to assess their early individual and family predictors. Methods: This was a secondary analysis of the Millennium Cohort Study and included 17,165 children. Weight trajectories were estimated using growth mixture modeling based on age- and gender-specific BMI Z-scores, followed by a bias-adjusted regression analysis. Results: We found four BMI trajectories: Weight Loss (69%), Early Weight Gain (24%), Early Obesity (3.7%), and Late Weight Gain (3.3%). Weight trajectories were mainly settled by early adolescence. Lack of sleep and eating routines, low emotional self-regulation, child-parent conflict, and low child-parent closeness in early childhood were significantly associated with unhealthy weight trajectories, alongside poverty, low maternal education, maternal obesity, and prematurity. Conclusions: Unhealthy BMI trajectories were defined in early and middle-childhood, and disproportionally affected children from disadvantaged families. This study further points out that household routines, self-regulation, and child-parent relationship are possible areas for family-based obesity prevention interventions.

Do the Walkability and Urban Leisure Amenities of Neighborhoods Affect the Body Mass Index of Individuals? Based on a Case Study in Seoul, South Korea

This study investigates the impact of neighborhood-built environments on obesity in interrelationship with socioeconomic status (SES)—controlling for dietary patterns and physical activities of residents—using structural equation modeling (SEM). A total of 577 samples who are between 19 and 64 years old and reside in Seoul are extracted from Korea National Health and Nutrition Examination Survey (KNHNES), 2015. Neighborhood environments are represented as the two latent constructs—walkability and leisure amenities—composited with indicators such as density of intersections, density of mixed-use area, and the area of open spaces and are aggregated by jurisdictional unit in Seoul. We found that greater walkability in a neighborhood explained a lower body mass index (BMI) among residents, whereas more urban leisure amenities in a neighborhood explained a higher BMI. The finding suggests that a walking-friendly environment is more effective than active recreational amenities in inducing people to engage in daily physical activities to the level that reduces obesity rate. SES exerted a negative impact on BMI of a greater magnitude than the impact of either of the environmental living conditions, reinforcing the importance of general wealth and education level in leading to a healthy lifestyle. Our research contributes to growing evidence of a relationship between obesity and the built environment in the context of Asian countries where the prevalence of obesity is becoming a serious issue and requires immediate attention.

An index of geospatial disadvantage predicts both obesity and unmeasured body weight

Neighborhood context impacts health. Using an index of geospatial disadvantage measures to predict neighborhood socioeconomic disparities would support area-based allocation of preventative resources, as well as the use of location as a clinical risk factor in care of individual patients. This study tested the association of the Area Deprivation Index (ADI), a neighborhood-based index of socioeconomic contextual disadvantage, with elderly obesity risk. We sampled 5066 Medicare beneficiaries at the University of Missouri between September 1, 2013 and September 1, 2014. We excluded patients with unknown street addresses, excluded body mass index (BMI) lower than 18 or higher than 62 as probable errors, and excluded patients with missing BMI data. We used a plot of simple proportions to examine the association between ADI and prevalence of obesity, defined as BMI of 30 and over. We found that obesity was significantly less prevalent in the least-disadvantaged ADI decile (decile 1) than in all other deciles (p < 0.05) except decile 7. Obesity prevalence within the other deciles (2–6 and 8–10) was not significantly distinguishable except that decile 2 was significantly lower than decile 4. Patients with missing BMI data were more likely to reside in the most disadvantaged areas. There was a positive association between neighborhood disadvantage and obesity in this Midwestern United States Medicare population. The association of missing BMI information with neighborhood disadvantage may reflect unmeasured gaps in care delivery to the most disadvantaged patients. These preliminary results support the continued study of neighborhood socioeconomic measures to identify health disparities in populations.

Do neighborhood characteristics contribute beyond individual demographics to cancer control behaviors among African American adults?

BACKGROUND

Recent years have seen increased interest in the role of neighborhood factors in chronic diseases such as cancers. Less is known about the role of neighborhood factors beyond individual demographics such as age or education. It is particularly important to examine neighborhood effects on health among African American men and women, considering the disproportionate impact of cancer on this group. This study evaluated the unique contribution of neighborhood characteristics (e.g., racial/ethnic diversity, income) beyond individual demographics, to cancer control behaviors in African American men and women.

METHODS

Individual-level data were drawn from a national survey (N = 2,222). Participants' home addresses were geocoded and merged with neighborhood data from the American Community Survey. Multi-level regressions examined the unique contribution of neighborhood characteristics beyond individual demographics, to a variety of cancer risk, prevention, and screening behaviors.

RESULTS

Neighborhood racial/ethnic diversity, median income, and percentage of home ownership made modest significant contributions beyond individual factors, in particular to smoking status where these factors were associated with lower likelihood of smoking (ps < .05). Men living in neighborhoods with older residents, and greater income and home ownership were significantly more likely to report prostate specific antigen testing (ps < .05). Regional analyses suggested different neighborhood factors were associated with smoking status depending on the region.

CONCLUSION

Findings provide a more nuanced understanding of the interplay of social determinants of health and neighborhood social environment among African American men and women, with implications for cancer control interventions to eliminate cancer disparities.

Neighborhood Cohesion, Disorder, and Physical Function in Older Adults: An Examination of Racial/Ethnic Differences

Objectives: This study examined the link between neighborhood social cohesion, disorder, and physical function in older adults, and identified potential racial/ethnic differences in these associations. Method: Data come from the National Health and Aging Trends Study (NHATS; N = 5,619). A series of linear regression models were used to predict physical function. Subgroup analyses and neighborhood/race interactions were used to examine differences. Results: Neighborhood disorder was associated with poorer physical function (p < .05), while neighborhood cohesion was not (p = .06). Although tests of interactions were not significant, subgroup analyses showed that neighborhood disorder, and not social cohesion, was associated with poorer physical function only in Whites. Discussion: Disadvantaged neighborhood social environment may contribute to differences in physical function among older adults. Racial and ethnic differences warrant closer investigation in studies of neighborhoods and functional health.

The association between obesity and self-reported current depression among adult cancer survivors residing in Brazil

BACKGROUND

The purpose of the current study was to investigate the association between obesity and self-reported current depression (SRCD) in a population-based sample of adult Brazilian cancer survivors.

METHODS

The sample for this study (N=930) was based on the 2013 Brazilian National Health Survey. SRCD was assessed using the 8-item Patient Health Questionnaire (PHQ-8). Obesity was defined as a body mass index ≥30 kg/m2. Multivariable weighted logistic regression models were conducted to investigate the association between obesity and SRCD among Brazilian adult cancer survivors.

RESULTS

The weighted prevalence of obesity and SRCD among adult cancer survivors was 26.4% (95% confidence interval [CI] 22.5 to 30.3%) and 13.7% (95% CI 10.4 to 17.1%), respectively. Overall there was no significant weighted and adjusted association between obesity and SRCD among cancer survivors (adjusted odds ratio [AOR] 0.99 [95% CI 0.56 to 1.73]). Nevertheless, among cancer survivors of working age (18-59 y), this association was significant (AOR 2.19 [95% CI 1.28 to 3.73]) and therefore obesity is significantly associated with a 119% increase in the odds of SRCD among Brazilian adult cancer survivors of working age.

CONCLUSIONS

Since both obesity and depression may lead to worse health and quality of life outcomes in this young and middle-aged population, further investigations are needed in order to establish the causality and directionality of this association.

Cross-Sectional Associations of Neighborhood Perception, Physical Activity, and Sedentary Time in Community-Dwelling, Socioeconomically Diverse Adults

Background: Little is known about the role of perceived neighborhood environment as a determinant of physical activity (PA) and sedentary time (ST) in understanding obesity-related health behaviors. We focus on a biracial, socioeconomically diverse population using objectively measured ST, which is under-represented in the literature.

Methods: We examined the association between self-reported neighborhood perception (Likert-scale questions), PA using the Baecke questionnaire, and both non-sedentary time and ST using accelerometry from wave 4 of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (n = 2,167). After applying exclusion criteria, the sample size was n = 1,359 for analyses of self-reported PA and n = 404 for analyses of accelerometry data. Factor analysis identified key neighborhood characteristics to develop a total neighborhood perception score (NPS). Higher NPS indicated less favorable neighborhood perception. Linear regression was used to determine the relationship between NPS, PA, non-sedentary time, and ST.

Results: Complete data were available for n = 1,359 [age 56.6(9.0) years, 59.5% female, 62.2% African American] for whom we identified four neighborhood perception factors: (1) concern about crime, (2) physical environment, (3) location of violent crime, and (4) social environment. Worsening perception of the overall neighborhood [β = −0.13 (SE = 0.03); p = 0.001], the physical environment [−0.11 (0.05); p = 0.03], and the social environment [−0.46 (0.07); p < 0.0001] were associated with decreased PA. Worsening perception of the overall neighborhood [1.14 (0.49); p = 0.02] and neighborhood social environment [3.59 (1.18); p = 0.003] were associated with increased ST over the day. There were no interactions for race, sex, poverty status, or economic index.

Conclusion: Poor overall neighborhood perception, perceived social environment, and perceived neighborhood physical environment are associated with PA and ST in a multi-racial, socioeconomically diverse cohort of urban adults.

Clinical Trial Registration: The HANDLS study is registered at ClinicalTrials.gov as NCT01323322.

Cultural Influences on Childhood Obesity in Ethnic Minorities: A Qualitative Systematic Review

Introduction: Childhood obesity remains an unrelenting public health problem disproportionately affecting ethnic minorities. Although research has examined ethnicity as a factor of childhood obesity, few studies have examined cultural influences. The purpose of this systematic review was to examine the qualitative evidence of cultural influences on childhood obesity in ethnic minority groups. Methodology: Selective sampling of studies since 2008 yielded 251 articles. Twelve articles that addressed cultural influences on childhood obesity were identified for review. The Culture Care Theory Sunrise Enabler factors were used as an a priori framework for theme coding. Results: Nine themes emerged: child feeding, family, gender roles, food, healthy child appearance, physical activity, sedentary activity, food cost, and obesogenic environment. Discussion: Cultural care practices such as traditional foods and family meals are protective factors in childhood obesity and should be encouraged by nurses caring for and working with ethnic minority populations.

A systematic review employing the GeoFERN framework to examine methods, reporting quality and associations between the retail food environment and obesity

This systematic review quantifies methods used to measure the 'retail food environment' (RFE), appraises the quality of methodological reporting, and examines associations with obesity, accounting for differences in methods. Only spatial measures of the RFE, such as food outlet proximity were included. Across the 113 included studies, methods for measuring the RFE were extremely diverse, yet reporting of methods was poor (average reporting quality score: 58.6%). Null associations dominated across all measurement methods, comprising 76.0% of 1937 associations in total. Outcomes varied across measurement methods (e.g. narrow definitions of 'supermarket': 20.7% negative associations vs 1.7% positive; broad definitions of 'supermarket': 9.0% negative associations vs 10.4% positive). Researchers should report methods more clearly, and should articulate findings in the context of the measurement methods employed.

Neighborhood Social Environment and Cardiovascular Disease Risk

Purpose of review

Limited physical activity (PA) and obesity are two primary risk factors for cardiovascular disease (CVD). Within a socio-ecological framework, neighborhood social environment may play a key role in influencing PA and obesity. However, the mechanisms underlying this relationship remain ambiguous. Our goals in this review are: (1) to summarize findings from the recent studies on neighborhood social environment in relation to PA and obesity as CVD risk factors, and (2) to briefly describe several innovative approaches to assessing neighborhood social environment.

Recent findings

Almost all recent studies assessed neighborhood social environment around residential areas. There were consistent associations between neighborhood social environment and PA and obesity, with some exceptions (indicating null associations or paradoxical associations). However, a focus on residential social environment may limit results because these studies did not account for any exposures occurring away from individuals' homes. Additionally, the majority of studies utilized a cross-sectional design, which limits our ability to make inferences regarding the causality of the association between social environment and PA or obesity as CV risk factors.

Summary

The majority of the studies on neighborhood social environment characterized factors around residential areas and assessed participant activity via self-reported surveys. Future research should leverage tools to account for the spatial mismatch between environmental exposures and outcomes by using global positioning systems, ecological momentary assessments, virtual neighborhood audits, and simulation modeling. These approaches can overcome major limitations by tracking individuals' daily activity and real-time perceptions of neighborhood social environments linked to CVD events.

The National Institute on Minority Health and Health Disparities Research Framework

We introduce the National Institute on Minority Health and Health Disparities (NIMHD) research framework, a product that emerged from the NIMHD science visioning process. The NIMHD research framework is a multilevel, multidomain model that depicts a wide array of health determinants relevant to understanding and addressing minority health and health disparities and promoting health equity. We describe the conceptual underpinnings of the framework and define its components. We also describe how the framework can be used to assess minority health and health disparities research as well as priorities for the future. Finally, we describe how fiscal year 2015 research project grants funded by NIMHD map onto the framework, and we identify gaps and opportunities for future minority health and health disparities research.

Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population

BACKGROUND

Americans have a shorter life expectancy compared with residents of almost all other high-income countries. We aim to estimate the impact of lifestyle factors on premature mortality and life expectancy in the US population.

METHODS

Using data from the Nurses' Health Study (1980-2014; n=78 865) and the Health Professionals Follow-up Study (1986-2014, n=44 354), we defined 5 low-risk lifestyle factors as never smoking, body mass index of 18.5 to 24.9 kg/m2, ≥30 min/d of moderate to vigorous physical activity, moderate alcohol intake, and a high diet quality score (upper 40%), and estimated hazard ratios for the association of total lifestyle score (0-5 scale) with mortality. We used data from the NHANES (National Health and Nutrition Examination Surveys; 2013-2014) to estimate the distribution of the lifestyle score and the US Centers for Disease Control and Prevention WONDER database to derive the age-specific death rates of Americans. We applied the life table method to estimate life expectancy by levels of the lifestyle score.

RESULTS

During up to 34 years of follow-up, we documented 42 167 deaths. The multivariable-adjusted hazard ratios for mortality in adults with 5 compared with zero low-risk factors were 0.26 (95% confidence interval [CI], 0.22-0.31) for all-cause mortality, 0.35 (95% CI, 0.27-0.45) for cancer mortality, and 0.18 (95% CI, 0.12-0.26) for cardiovascular disease mortality. The population-attributable risk of nonadherence to 5 low-risk factors was 60.7% (95% CI, 53.6-66.7) for all-cause mortality, 51.7% (95% CI, 37.1-62.9) for cancer mortality, and 71.7% (95% CI, 58.1-81.0) for cardiovascular disease mortality. We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3-29.8) for women and 25.5 years (95% CI, 24.7-26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3-44.9) for women and 37.6 years (95% CI, 35.8-39.4) for men. The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8-16.2) longer among female Americans with 5 low-risk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1-14.2).

CONCLUSIONS

Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults.