Assessment of neighborhood context in a nationally representative study

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Role of Ethnic Community Social Capital in the Association between Acculturation and Psychological Distress among Older Korean Americans

Guided by the theories of social capital and stress-buffering, we examined how the association between low acculturation and poor mental health among older immigrants would be modified by social capital in ethnic communities (social cohesion, social engagement, perceived ethnic density, and the quality of social interaction). Using data from the Study of Older Korean Americans (N = 2,150, Mean age = 73.4), direct and interactive effect models were examined. Lower acculturation was associated with a greater level of psychological distress, and their link was modified by social cohesion (β = .19, p < .01) and negative social interactions (β =  - .97, p < .01). Findings suggest that the mental health risk associated with low acculturation could be intensified when older immigrants perceive low sense of cohesion in their ethnic communities or have negative interactions with ethnic community members.

Neighborhood Conditions and Social Network Turnover among Older Adults

Increasing research highlights heterogeneity in patterns of social network change, with growing evidence that these patterns are shaped in part by social structure. The role of social and structural neighborhood conditions in the addition and loss of kin and non-kin network members, however, has not been fully considered. In this paper, we argue that the residential neighborhood context can either facilitate or prevent the turnover of core network relationships in later life - a period of the life course characterized by heightened reliance on network ties and vulnerability to neighborhood conditions. Using longitudinal data from the National Social Life, Health, and Aging Project linked with data from the American Community Survey, we find that higher levels of neighborhood concentrated disadvantage are associated with the loss of older adults' kin and non-kin network members over time. Higher levels of perceived neighborhood social interaction, however, are associated with higher rates of adding non-kin network members and lower rates of adding kin network members over time. We suggest that neighborhood conditions, including older adults' perceptions of neighborhood social life, represent an underexplored influence on kin and non-kin social network dynamics, which could have implications for access to social resources later in the life course.

Relational burden, depression, and loneliness among American older adults: an inquiry into the 'dark side of social capital'

OBJECTIVES

Social networks and resources embedded in them are shown to promote mental health. This study examines whether there may be deleterious consequences of interpersonal ties and social capital on loneliness and depression in later life.

METHOD

Using data from the latest wave of National Social Life, Health and Aging Project (NSHAP) 2015-2016, we examine how relational burden is associated with mental health outcomes among older American adults. We also assess whether relational burden measured at the contextual, or regional, level may moderate the link between collective efficacy (neighborhood cohesion) and depression/loneliness.

RESULTS

Individual-level relational burden stemming from both kin and non-kin members is associated with higher levels of depression and loneliness. Moreover, regional-level kin and non-kin types of relational burden significantly amplify the negative relationship between collective efficacy and depression. For loneliness, however, we do not find such cross-level interaction.

CONCLUSION

Unlike prior research using conventional measures of social capital (e.g. trust, frequency of social interaction, and organizational participation) to evaluate its potential downside, our study contributes to the literature by directly operationalizing the concept of 'relational burden', stress due to excessive demands from others, at individual and contextual levels of analysis.

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.

The association between relationship strain and emotional well-being among older adult couples: the moderating role of social connectedness

OBJECTIVES

The present study examines the moderating role of social connectedness (i.e. closeness, talk frequency, social network size, and neighborhood social ties) in the association between one's own and spouse's relationship strain and emotional well-being (i.e. depressive symptoms, happiness, and loneliness).

METHOD

Married couples (N = 865) were drawn from the second wave of the National Social, Health, and Aging Project. One Actor Partner Interdependence Model (APIM) and one Actor Partner Interdependence Model with Moderation (APIMoM) were conducted.

RESULTS

In terms of actor effects, relationship strain was associated with all emotional well-being outcomes. Wives' and husbands' greater relationship strain was associated with spouses' loneliness. Only wives' greater relationship strain was associated with her husbands' higher level of depressive symptoms and no partner effects were found for happiness. In six instances, social connectedness factors helped to ameliorate the association between self/spouse relationship strain, depressive symptoms, and happiness. However, wives' greater neighborhood social ties amplified the association between wives greater relationship strain and husbands' greater depressive symptoms. We did not find that social connectedness factors moderated the associations between self/spouse relationship strain and loneliness.

CONCLUSION

Even in late life marriages, marital strain is associated with less happiness and greater depressive symptoms and loneliness. Practitioners addressing emotional well-being may need to pay attention to spousal perceptions of relationship strain and social relationships external to the marital relationship when working with heterosexual couples. Efforts throughout the life course should be made to ensure connections with diverse types of social networks.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.1910786.

Everyday discrimination in later life: A social network approach

What factors shape everyday discrimination among older adults? Existing perspectives focus on individual identities and social group membership (e.g., race/ethnicity, age) as key determinants of perceived discrimination. This paper examines the idea that individuals' broader social contexts - including their personal social networks - also shape perceived discrimination, and in ways that may differ across racial groups. Using data from Round 3 of the National Social Life, Health, and Aging Project (N = 3312), I consider how properties of personal networks are associated with how frequently older adults report everyday discrimination. Results indicate that more kin-centric personal networks protect against more frequent everyday discrimination, but that this protective effect may be stronger among White older adults. I propose why more kin-centric networks may play a different role in the perceived discrimination of White and Black older adults, and close by suggesting that social network composition may be a source of heterogeneity in the link between everyday discrimination and inequality in later life outcomes such as health.

Disorder, networks, and cognition: do social networks buffer the influence of neighborhood and household disorder on cognitive functioning?

OBJECTIVES

To examine whether neighborhood and household disorder matter for cognitive functioning among middle-aged and older adults and whether the disorder-cognition link is moderated by social network resources.

METHOD

Data are drawn from National Social Life, Health, and Aging Project (NSHAP) Wave 2 (N = 3198). Both neighborhood and household were considered as key residential contexts that shape one's social life and health. Exposure to neighborhood and household disorder was measured using interviewer assessments of signs of disorder and decay, including the presence of disrepair, trash, noise, and unpleasant smells such as air pollution, in the buildings and streets in which the respondent lives. Cognitive function was measured using the survey-adapted Montreal Cognitive Assessment (MoCA-SA). Network size, network range, and frequency of interaction among network members were assessed as moderators.

RESULTS

Neighborhood and household disorder were independently associated with cognitive function. However, disorder in the household appeared to have more direct associations with cognitive function than did the neighborhood when both were present. The association between household disorder and cognitive function was mitigated by network size, such that poor housing conditions were associated with lower cognitive function only for those with small social networks.

CONCLUSION

This study suggests a larger network may play a role in minimizing the negative influence of household disorder on cognitive function for middle-aged and older adults. Social policy and intervention aimed at promoting network ties may help reduce further disparities in cognitive function, especially for those vulnerable groups living in a poor-quality household.

Stress Exposure and Physical Health among Older African American and Caribbean Black Women

Objectives: This study assessed whether multiple stress exposures and stress accumulation explained differences in physical health among Afro-Caribbean and African American women in older adulthood. Whether specific stressors uniquely influenced the health of African American and Afro-Caribbean women was also examined. Methods: Data were drawn from the National Survey of American Life (NSAL) (N=867; 50 years and older). Physical health was assessed by multiple chronic conditions, functional limitations, and self-rated health. Weighted binary logistic regression and ordered logistic regression analyses were conducted. Results: Compared to Afro-Caribbean women, African American women had worse physical health and greater stress exposure. Nonetheless, stress exposure did not explain ethnic differences in physical health. The association between specific measures of stress and physical health was dependent on the stressor and physical health measure. Discussion: Findings emphasize the importance of ethnic variation in health and stress exposure among older US Black women. Study implications are discussed.

Geographic proximity to neighborhood resources and depression among older adults in South Korea

OBJECTIVES

Older adults are closely connected to their neighborhoods and they spend more time there than younger adults. Because their mobility is often impeded by diminished health and functioning, access to neighborhood health and social services is essential for their well-being. This article examines whether geographic proximity to these types of neighborhood resources is associated with depression among older adults in South Korea.

METHODS

Data are from A Profile of Older Adults: 2015 which sampled 1,455 community-dwelling individuals ages 60 and older in South Korea. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the outcome. We measured geographic proximity to neighborhood destinations, which included the time it takes the respondent to go to the grocery store, hospital, government office, senior center, social service center, and bus stop. We conducted latent profile analyses (LPA) with a distal outcome using the BCH method to determine whether geographic proximity to neighborhood resources is associated with depression.

RESULTS

The LPA identified three distinct subgroups of geographic proximity to neighborhood resources: High Access (10%), Moderate Access (41%), and Low Access (49%). Low Access (b = 3.71, p < .001) and Moderate Access (b = 3.00, p < .001) groups had higher levels of depression compared to those in the High Access group.

DISCUSSION

Our findings suggest that access to essential services in one's neighborhood is associated with lower levels of depression, which supports existing evidence that age-friendly community initiatives are important to older adults' psychological well-being.

Novel Insights From Interviewer Assessments of Personal Attributes, Home Environment, and Residential Context in NSHAP

OBJECTIVES

This study was aimed to describe the interviewer-assessed measures present in the 2015/2016 Round of National Social Life, Health, and Aging Project (NSHAP), outline strengths of interviewer-assessed measures, and explore how interviewer assessments in the domains of home environment and personal characteristics are associated with older adult health.

METHOD

Data come from the 2015/2016 Round of the NSHAP.

RESULTS

We provide descriptive results from the interviewer assessments of personal attributes, indoor home environment, and outdoor residential context. We present an illustrative analysis of reports of falls, a health outcome that might be predicted by characteristics assessed by the interviewer, and we suggest directions for further research.

DISCUSSION

Interviewer assessments collected in NSHAP are useful as proxy measures and can be used in combination with respondent's reports and ecological measures to generate insights into healthy aging.

Social Health in the National Social Life, Health, and Aging Project

OBJECTIVES

In this article, we present the theoretical framework that guided the development of the National Social Life, Health, and Aging Project (NSHAP) including the measures of social health. We discuss the literature that links social measures to other outcomes, and we discuss in detail how researchers might construct common measures of social health, including those that reflect social relationships, sexuality, social networks, social resources, and social participation.

METHODS

The NSHAP includes multiple detailed measures of social health, collected in the rounds of data collection carried out in 2005, 2010, and 2015, allowing for study of changes over time and as people age among a nationally representative sample of the community-dwelling population of older adults in the United States.

RESULTS

We define indicators of social health, describe measures of each in the 2015 round of NSHAP, and show the distribution of the measures by gender and age. We present scales of dimensions of social health that have been developed elsewhere and describe their properties.

DISCUSSION

We briefly discuss the distribution of these measures by age and gender in the 2015 round of NSHAP. Simple analyses of these categorized measures reveal differences by age and gender that deserve closer attention in future investigations using the NSHAP data.

Local Ties in the Social Networks of Older Adults

OBJECTIVES

Family members and friends who live nearby may be especially well-positioned to provide social support and companionship for community-residing older adults, but prior research has not examined the distribution and characteristics of local ties in older adults' networks. We hypothesize that local ties are newer, more frequently accessed, and more embedded in the network, and that social disadvantage and neighborhood conditions structure older adults' access to local ties.

METHODS

We use egocentric network data from 15,137 alters named by 3,735 older adults in Wave 3 of the National Social Life, Health, and Aging Project (NSHAP). We conduct dyadic analysis to compare characteristics of local and nonlocal ties. Logistic regression models estimate how personal and neighborhood characteristics are associated with naming local kin and local non-kin ties.

RESULTS

Nearly half of the older adults named at least one local network tie, and about 60% of these local ties are non-kin. Local ties are newer, frequently accessed, and highly embedded in older adults' networks. Local kin ties are most common among socially disadvantaged older adults. Local non-kin ties are most common among white older adults and those who live in areas with high levels of collective efficacy, although local non-kin ties are also associated with residence in high-poverty neighborhoods.

DISCUSSION

Local ties may bring unique benefits for community-residing older adults, but their availability is likely structured by residential mobility, neighborhood context, disparities in resources, and support needs. Future research should consider their implications for health and well-being.

Hispanic Ethnic Density May Be Protective for Older Black/African American and Non-Hispanic White Populations for Some Health Conditions: An Exploration of Support and Neighborhood Mechanisms

BACKGROUND AND PURPOSE

Hispanic ethnic density (HED) is associated with salubrious health outcomes for Hispanics, yet recent research suggests it may also be protective for other groups. The purpose of this study was to test whether HED was protective for other racial-ethnic groups. We tested whether social support or neighborhood social integration mediated the association between high HED and depressive symptoms (CES-D) and physical morbidity 5 years later. Lastly, we tested whether race-ethnicity moderated both main and indirect effects.

METHODS

We used Waves 1 (2005-2006), and 2 (2010-2011) from The National Social Life, Health, and Aging Project, a national study of older U.S. adults. Our sample was restricted to Wave 1 adults who returned at Wave 2, did not move from their residence between waves, and self-identified as Hispanic, non-Hispanic White (NHW), or non-Hispanic Black (NHB; n = 1,635). We geo-coded respondents' addresses to a census-tract and overlaid racial-ethnic population data. Moderated-mediation models using multiple imputation (to handle missingness) and bootstrapping were used to estimate indirect effects for all racial-ethnic categories.

RESULTS

Depressive symptoms were lower amongst racial-ethnic minorities in ethnically (Hispanic) dense neighborhoods; this effect was not stronger in Hispanics. HED was not associated with physical morbidity. Sensitivity analyses revealed that HED was protective for cardiovascular events in all racial-ethnic groups, but not arthritis, or respiratory disease. Social support and neighborhood social integration were not mediators for the association between HED and outcomes, nor were indirect effects moderated by race-ethnicity.

CONCLUSIONS

This study offers some evidence that HED may be protective for some conditions in older adults; however, the phenomena underlying these effects remains a question for future work.

A Pharmacist and Health Coach-Delivered Mobile Health Intervention for Type 2 Diabetes: Protocol for a Randomized Controlled Crossover Study

BACKGROUND

Aggressive management of blood glucose, blood pressure, and cholesterol through medication and lifestyle adherence is necessary to minimize the adverse health outcomes of type 2 diabetes. However, numerous psychosocial and environmental barriers to adherence prevent low-income, urban, and ethnic minority populations from achieving their management goals, resulting in diabetes complications. Health coaches working with clinical pharmacists represent a promising strategy for addressing common diabetes management barriers. Mobile health (mHealth) tools may further enhance their ability to support vulnerable minority populations in diabetes management.

OBJECTIVE

The aim of this study is to evaluate the impact of an mHealth clinical pharmacist and health coach-delivered intervention on hemoglobin A1c (HbA1c, primary outcome), blood pressure, and low-density lipoprotein (secondary outcomes) in African-Americans and Latinos with poorly controlled type 2 diabetes.

METHODS

A 2-year, randomized controlled crossover study will evaluate the effectiveness of an mHealth diabetes intervention delivered by a health coach and clinical pharmacist team compared with usual care. All patients will receive 1 year of team intervention, including lifestyle and medication support delivered in the home with videoconferencing and text messages. All patients will also receive 1 year of usual care without team intervention and no home visits. The order of the conditions received will be randomized. Our recruitment goal is 220 urban African-American or Latino adults with uncontrolled type 2 diabetes (HbA1c ≥8%) receiving care from a largely minority-serving, urban academic medical center. The intervention includes the following: health coaches supporting patients through home visits, phone calls, and text messaging and clinical pharmacists supporting patients through videoconferences facilitated by health coaches. Data collection includes physiologic (HbA1c, blood pressure, weight, and lipid profile) and survey measures (medication adherence, diabetes-related behaviors, and quality of life). Data collection during the second year of study will determine the maintenance of any physiological improvement among participants receiving the intervention during the first year.

RESULTS

Participant enrollment began in March 2017. We have recruited 221 patients. Intervention delivery and data collection will continue until November 2021. The results are expected to be published by May 2022.

CONCLUSIONS

This is among the first trials to incorporate health coaches, clinical pharmacists, and mHealth technologies to increase access to diabetes support among urban African-Americans and Latinos to achieve therapeutic goals.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/17170.

Multiple vulnerabilities: The effects of neighborhood structural changes upon older residents' mental health and perceptions of the broader community

Neighborhoods' structural conditions are consequential for their social circumstances and residents' well-being. Neighborhood effects might be accentuated among older residents because their daily activities and social lives are more confined to their immediate communities. This study examines how changing neighborhood socioeconomic disadvantage affects older residents' depression and stress, as well as perceptions of neighborhood context. This study employed waves 2 (2010-2011) and 3 (2015-2016) of the National Social Life, Health, and Aging Project survey (N = 2357) and fixed-effects linear regression models to study these relationships. While rising neighborhood socioeconomic disadvantage was associated with more depression and stress, it was negatively associated with overall neighborhood social capital and neighborhood social cohesion, and was only associated with lower perceptions of neighborhood safety among respondents who relocated to new neighborhoods. Beyond cross-sectional associations, changing neighborhood socioeconomic disadvantage is associated with changes in mental health and perceptions of neighborhood social context.

Social Relationships and Loneliness in Late Adulthood: Disparities by Sexual Orientation

OBJECTIVE

This is the first national study to examine disparities in loneliness and social relationships by sexual orientation in late adulthood in the United States.

BACKGROUND

Prior studies have shown that lesbian, gay, and bisexual (LGB) individuals often struggle with social relationships across the life course, likely because of stigma related to sexual orientation. However, little is known about whether loneliness is more prevalent among LGB people than among other groups in late adulthood, and if so, which relationships contribute to the loneliness gap.

METHOD

We analyzed data from a nationally representative sample of older adults from the 2015-2016 National Social Life, Health, and Aging Project (N = 3,567) to examine the disparity in loneliness by sexual orientation and identify links between this disparity and multiple dimensions of social relationships, including partner, family, friend, and community relationships.

RESULTS

Older LGB adults were significantly lonelier than their heterosexual counterparts, primarily due to a lower likelihood of having a partner and, to a lesser extent, lower levels of family support and greater friend strain. While they were also disadvantaged in the size of close family and frequency of community participation, these factors were less relevant to their loneliness. Overall, the conventionally defined inner layers of relationships (partnership and family) contributed more to the loneliness disparity than the outer layers of relationships (friends and community).

CONCLUSION

These findings suggest that strengthening the partnerships and family relationships of sexual minorities is essential to reducing the loneliness gap.

As Goes the City? Older Americans' Home Upkeep in the Aftermath of the Great Recession

The private home is a crucial site in the aging process, yet the upkeep of this physical space often poses a challenge for community-dwelling older adults. Previous efforts to explain variation in disorderly household conditions have relied on individual-level characteristics, but ecological perspectives propose that home environments are inescapably nested within the dynamic socioeconomic circumstances of surrounding spatial contexts, such as the metro area. We address this ecological embeddedness in the context of the Great Recession, an event in which some U.S. cities saw pronounced and persistent declines across multiple economic indicators while other areas rebounded more rapidly. Panel data (2005-6 and 2010-11) from a national survey of older adults were linked to interviewer home evaluations and city-level economic data. Results from fixed-effects regression support the hypothesis that older adults dwelling in struggling cities experienced an uptick in disorderly household conditions. Findings emphasize the importance of city-specificity when probing effects of a downturn. Observing changes in home upkeep also underscores the myriad ways in which a city's most vulnerable residents- older adults, in particular-are affected by its economic fortunes.

Exploring the contingent associations between functional limitations and depressive symptoms across residential context: a multilevel panel data analysis

Objectives: This study examines the multilevel relationship between functional limitations and depressive symptoms among community-dwelling US older adults, and how it is moderated by community environmental characteristics (neighborhood fear, social cohesion, structural disadvantage and residential stability).Method: Data come from two waves of National Social Life, Health and Aging Project (NSHAP) collected in 2005/2006 and 2010/2011, consisting of 2,261 individuals aged 57-85 (mean = 68.5; SD = 7.5) nested in 100 regional areas. Two-level hierarchical linear models are fitted to test if and to what extent limited physical capacity and neighborhood measures are interactively related to depressive symptoms.Results: Adjusting for confounders (e.g. age, gender, education, employment status, social support), we find a significant positive relationship between functional limitations and depressive symptoms. At the aggregate level, socially cohesive neighborhoods are negatively related to depression. Several cross-level interactions are also observed. First, the association between poor functional health and depression is greater in neighborhoods perceived to be less safe. It is also stronger in places with more structural disadvantages. Lastly, the physical impairment-depression link is more pronounced where there is higher residential stability, i.e., greater proportion of long-term residents.Conclusion: Our study bridges an important empirical gap in the literature. Prior studies have rarely investigated how the connection between functional limitations and depressive symptoms among older adults is conditioned by neighborhood characteristics. By using multilevel analysis of population-based longitudinal data, we show that physical space (neighborhood community) plays a critical role in understanding this important, yet understudied, relationship.

Crime, Perceived Danger, and Adiposity: The Role of Gender

Objectives: We examine whether police-reported crime is associated with adiposity and examine to what extent the association between crime and adiposity is explained by perceived neighborhood danger with a particular focus on gender differences. Method: Data are drawn from the wave of 2010-2011 National Social Life, Health, and Aging Project merged with information on neighborhood social environment and Federal Bureau of Investigation (FBI) crime report. We use burglary as a main predictor. Waist circumference (WC) and body mass index (BMI) are used to assess adiposity. Results: Living in neighborhoods with higher levels of burglary is associated with a larger WC, a higher BMI, and greater adiposity risk for women, but not for men. These associations are partially explained by perceived danger among women. Discussion: Our findings identify neighborhood burglary rates as a contextual risk in later-life adiposity and highlight that perceived neighborhood safety contributes to gender differences in health outcomes.

Neighborhood Disadvantage and Biological Aging: Using Marginal Structural Models to Assess the Link Between Neighborhood Census Variables and Epigenetic Aging

OBJECTIVES

Past research has reported an association between neighborhood disadvantage and healthy aging, but most of these studies utilize self-report measures of health or physical functioning and do not properly account for neighborhood selection effects, creating concerns regarding inflated associations. To overcome these limitations and provide a more stringent estimate of effects, the current study investigated the effect of neighborhood disadvantage on aging using newly developed epigenetic methods to assess rate of biological aging and marginal structural modeling (MSM) to account for potential confounds due to neighborhood selection.

METHODS

We tested the hypothesis that neighborhood disadvantage accelerates aging using U.S. census data and five waves of interview data from a sample of 100 middle-aged African American women. Using a recently developed epigenetic index of aging, biological age was measured using weighted methylation values at 71 CpG sites. We calculated a measure of accelerated methylomic aging (in years) based upon the residual scores resulting from a regression of methylomic age on chronological age.

RESULTS

Controlling for a variety of individual difference factors that could be confounded with neighborhood effects, including various health behaviors, neighborhood disadvantage was associated with accelerated biological aging. Using MSM to account for selection effects, a standard deviation increase in neighborhood disadvantage accelerated aging an average of 9 months.

CONCLUSIONS

Our findings converge with prior work to provide strong evidence that neighborhood context is a significant determinant of healthy aging.

Disablement in Context: Neighborhood Characteristics and Their Association With Frailty Onset Among Older Adults

OBJECTIVES

Frailty, an aggregate expression of risk resulting from age- or disease-associated physiologic accumulation, is responsible for large economic and societal costs. Little is known about how the context in which older adult's live may contribute to differences in frailty. This study clarifies the role of neighborhood structural characteristics and social processes for understanding declines in health status.

METHOD

Data from two waves of the National Social Life, Health and Aging Project were linked to tract-level information from the 2000 Census (n = 1,925). Frailty was measured with in-home assessments and self-report. Ordered logistic regressions were employed to estimate the role of tract-level structural and social process indicators at baseline on frailty at follow-up.

RESULTS

Living in a neighborhood characterized with a higher density of African Americans and with more residential instability was associated with higher odds of frailty. Adults in neighborhoods with increasing levels of physical disorder had higher odds of frailty (adjusted odds ratio [AOR]: 1.20, 95% confidence interval [CI]: 1.03, 1.39), while those exposed to more social cohesion had lower odds (AOR: 0.87, CI: 0.78, 0.97).

DISCUSSION

For older adults, both neighborhood structural and social process characteristics appear to be independently associated with frailty.

Longitudinal Associations of Neighborhood-level Racial Residential Segregation with Obesity Among Blacks

BACKGROUND

Despite 50 years since the passage of the Fair Housing Act of 1968, the majority of black Americans continue to live in highly segregated communities. Differing exposure to obesogenic environments in segregated neighborhoods may contribute to racial disparities in obesity prevalence.

METHODS

We used prospective data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine associations between levels of neighborhood-level racial residential segregation and incident obesity in black men and women. Obesity, determined by measured anthropometry, and residential segregation, measured using the local Gi*statistic, were recorded at baseline and follow-up at years 7, 10, 15, 20, and 25. We used marginal structural survival models to account for time-dependent confounding and for loss to follow-up.

RESULTS

Black women living in highly segregated neighborhoods at the prior exam were 30% more likely to become obese during the follow-up period as compared with women living in neighborhoods with low levels of segregation after adjustment for sociodemographic and cardiovascular risk covariates (hazard ratio = 1.3 [95% confidence interval = 1.0, 1.7]). Cumulatively high exposure to segregation averaged across time points was associated with 50% higher hazard of obesity (hazard ratio = 1.5 [95% confidence interval = 1.0, 2.3]) among women. We observed few differences in obesity incidence among men by segregation levels.

CONCLUSIONS

Fewer health-promoting resources, stressful neighborhood context, and social norms that are less stigmatizing of obesity may contribute to these findings, but more research on specific pathways leading from segregation to obesity is needed to understand differing patterns between men and women.

Moderating Effects of Community Social Capital on Depression in Later Years of Life: A Latent Interaction Model

OBJECTIVE

This study tested the stress-buffering model and examined the buffering role of community social capital on late-life depression.

METHODS

This study used the data from the second wave of National Social Life, Health, and Aging Project (NSHAP, 2010-2012). In the present study, a total of 2,362 older adults aged 65 and older (Mage = 74.5, SD = 6.69) were included. Latent moderated structural equations model was tested by comparing the main effect model and interaction model. Depression, stress, and community social capital were constructed as latent variables for the analyses.

RESULTS

The main effect model was acceptable: χ² (df = 334) = 1596.4, p = .000; RMSEA = .04 (.038 - .042); CFI = .91; and SRMR = .05. And interaction model was significant (D = 35.0, p < .001). The latent constructs of stress (β = . 50, p < .001) and community social capital (β = -.14, p < .001) not only had a direct effect on depression, but their interaction was also significant (β = -.21, p < .01).). The group with a high level of social capital presented a relatively stable slope in the prediction of stress on depression, suggesting their resilience, while the group with a low level of community social capital demonstrated a steep slope, indicating heighten vulnerability to depression when faced with stress.

CONCLUSIONS

The findings support the hypothesis of stress buffering model and identify the protective effects of community social capital on depression of older adults.

CLINICAL IMPLICATIONS

Older adults with lower community social capital are particularly vulnerable to depression. The results highlight that practitioners and policymakers should pay more attention to finding ways to enhance community resources to improve older adults' mental health.

Putting Sex Into Context in Later Life: Environmental Disorder and Sexual Interest Among Partnered Seniors

Background and Objectives

This study examines whether neighborhood and household disorder is associated with sexual interest among partnered seniors.

Research Design and Methods

Analyses use dyadic data from Wave 2 of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of community-dwelling older adults (2010-2011). Measures of environmental disorder were conducted by trained interviewers. Survey data were also linked to census tract information from the 2009 American Community Survey. We used actor-partner interdependence models to estimate the likelihood of reporting low sexual interest.

Results

There was no observed association between neighborhood context (physical disorder or census tract socioeconomic disadvantage) and sexual interest, but husbands were more likely to report low sexual interest if they lived in more disorderly households. High marital quality protected against low sexual interest, but these evaluations did not mediate or moderate the putative effect of household disorder.

Discussion and Implications

Regardless of the broader neighborhood context, helping older adults maintain an orderly home space may help sustain sexual functioning. Future research should consider how various features of the environment matter for additional aspects of late-life sexuality.

(Where) Is Functional Decline Isolating? Disordered Environments and the Onset of Disability

The onset of disability is believed to undermine social connectedness and raise the risk of social isolation, yet spatial environments are seldom considered in this process. This study examines whether unruly home and neighborhood conditions intensify the association between disability onset and several dimensions of social connectedness. I incorporate longitudinal data from the National Social Life, Health, and Aging Project, which contains environmental evaluations conducted by trained observers ( N = 1,558). Results from Poisson, ordinal logistic, and linear regression models reveal heterogeneous consequences of disablement: disability onset was associated with reduced core network size, fewer friends, lower likelihood of social interaction, and less overall social connectedness-though mainly when accompanied by higher levels of household disorder. There was limited evidence that neighborhood disorder moderated consequences of disability. Findings point to the importance of the home as an environmental resource and underscore important contextual contingencies in the isolating consequences of disability.

The role of social capital in the relationship between physical constraint and mental distress in older adults: a latent interaction model

OBJECTIVE

Building upon the widely known link between physical and mental health, the present study explored the buffering effects of social capital (indicated by social cohesion, social ties, and safety) in the relationship between physical constraint (indicated by chronic conditions and functional disability) and mental distress (indicated by symptoms of depression and anxiety).

METHOD

Using data from 2,264 community-dwelling older adults in the National Social Life, Health, and Aging Project (NSHAP) Wave 2 (M_age = 74.51, SD = 6.67), a latent interaction model was tested. The model of mental distress, including both the main effect of physical constraint and social capital and their latent interaction, presented an excellent fit.

RESULTS

The latent constructs of physical constraint (β = .54, p < .001) and social capital (β = -.11, p < .01) not only had a direct effect on mental distress, but their interaction was also significant (β = -.26, p < .001). Subgroup analysis showed that the group with a low level of social capital had a heightened vulnerability to mental distress when faced with physical constraint, whereas the group with a high level of social capital demonstrated resilience.

CONCLUSION

Findings call attention to ways to enhance older individuals' social capital in efforts to promote their health and well-being.

Cognition in Context: The Role of Objective and Subjective Measures of Neighborhood and Household in Cognitive Functioning in Later Life

BACKGROUND AND OBJECTIVES

Although the role of place on health is not new, less is known about how place matters for cognition. By investigating both neighborhood and home as the sociospatial realms of older adults, we explore associations between health and place across multiple contexts. We also distinguish objective and subjective measures of place and disentangle their differential associations with cognition.

RESEARCH DESIGN AND METHODS

We analyzed place effects on cognition from the National Social Life, Health, and Aging Project (N = 2,260) linked to neighborhood characteristics and crime data. We measured place in four ways: (a) objective indicators of neighborhood such as police-reported crime rates and interviewer-reported on presence of disordered conditions on the streets; (b) perceptions of neighborhood by respondents (perceived danger and social cohesion); (c) objective conditions of home (interviewer's report on presence of clutters, odor, and messiness); (4) perceived social support, strain, and threat by household members. The MoCA-SA was used to assess cognitive functioning.

RESULTS

Subjective interpretations appeared to have more direct effects on cognition than did objective indicators of neighborhood or home. When examining these living environments together, we found the association between neighborhood and cognition is partially explained by characteristics of home environment, especially perceived social support. We found a buffering effect of social support on cognition for women, not for men.

DISCUSSION AND IMPLICATIONS

Late life living environments are important contexts for aging. Aging-in-Place interventions should address subjective interpretations of place to reduce future risks of cognitive decline.

Neighborhood Environments and Sexual Risk Behaviors for HIV Infection Among U.S. Women: A Systematic Review

Empirical evidence indicates that aspects of the neighborhood environment may affect HIV prevention efforts. Therefore, the neighborhood environment should be considered when implementing prevention interventions. However, much of the empirical evidence is derived from studies conducted among drug users, men, or adolescents. Such evidence may not be as applicable to adult women whose primary risk for HIV infection is via heterosexual sexual behavior. Therefore, a systematic review examining the relationship between neighborhood environments and HIV sexual risk behaviors among adult U.S. women was conducted. Three databases were searched for articles published in English in peer-reviewed journals between 1/1/1980 and 12/31/2016 meeting relevant criteria. Seven articles identified from the three databases or additional hand searches met inclusion criteria and were summarized. Findings were mixed with several studies indicating associations between neighborhood environments and HIV sexual risk behaviors. However, all summarized studies were cross-sectional. Longitudinal studies conducted among women are needed.

Contextualization of Survey Data: What Do We Gain and Does It Matter?

Survey research designs that integrate contextual data have become more prevalent in recent decades, presumably to enable a more refined focus on the person as the unit of analysis and a greater emphasis on interindividual differences due to social forces and contextual conditions. This article reviews varied approaches to contextualizing survey data and examines the value of linking two data sources to respondent information: interviewer ratings and neighborhood information (measured via census tracts). The utility of an integrative approach is illustrated with data from the Health and Retirement Study. The results reveal modest gains by using a contextualized approach but also demonstrate that neglecting contextual factors may lead to misdirected substantive conclusions, especially for older racial and ethnic minorities. To enhance the ecological validity of survey data, investigators should select theoretically-meaningful contextual data for specific research questions and consider cross-level interactions.

The Associations and Correlations Between Self-reported Health and Neighborhood Cohesion and Disorder in a Community-dwelling U.S. Chinese Population

Purpose of the Study

Characteristics of neighborhood have been found to be associated with physical and psychological health status of older adults, especially in relationship to social dynamics like cohesion and disorder. This study aims to examine correlations and associations between sociodemographic characteristics, self-reported health status, cohesion, and disorder among Chinese older adults in the greater Chicago area.

Design and Methods

The Population Study of Chinese Elderly in Chicago is a cross-sectional, population-based study with community-dwelling Chinese older adults aged 60 and older, recruited through a community-based participatory research approach. Cohesion was measured through six questions; disorder was measured through eight questions. Correlation and regression analyses were conducted using SAS.

Results

Among 3,158 participants enrolled in the study, 92.3% reported any neighborhood cohesion; 69.8% reported any neighborhood disorder. After controlling for age, sex, education, income, marital status, living arrangement, number of children, years in the community, years in the United States, country of origin, language preference, and location, a higher level of cohesion is associated with higher quality of life (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.13, 1.39) and a higher level of disorder is associated with lower overall health status (OR: 0.97, 95% CI: 0.95, 0.99) and lower quality of life (OR: 0.96, 95% CI: 0.95, 0.98).

Implications

Our findings suggest that neighborhood cohesion and neighborhood disorder are correlated to the health of U.S. Chinese older adults. Future longitudinal research should examine the relationship between community characteristics, both structural and social, and health-related outcomes.

Development of a community's self-efficacy scale for preventing social isolation among community-dwelling older people (Mimamori Scale)

BACKGROUND

Among older people in developed countries, social isolation leading to solitary death has become a public health issue of vital importance. Such isolation could be prevented by monitoring at-risk individuals at the neighborhood level and by implementing supportive networks at the community level. However, a means of measuring community confidence in these measures has not been established. This study is aimed at developing the Community's Self-Efficacy Scale (CSES; Mimamori scale in Japanese) for community members preventing social isolation among older people.

METHODS

The CSES is a self-administered questionnaire developed on the basis of Bandura's self-efficacy theory. The survey was given to a general population (GEN) sample (n = 6,000) and community volunteer (CVOL) sample (n = 1,297). Construct validity was determined using confirmatory factor analysis. Internal consistency was calculated using Cronbach's alpha. The Generative Concern Scale (GCS-R) and Brief Sense of Community Scale (BSCS) were also administered to assess criterion-related validity of the CSES.

RESULTS

In total, 3,484 and 859 valid responses were received in the GEN and CVOL groups, respectively. The confirmatory factor analysis identified eight items from two domains-community network and neighborhood watch-with goodness of fit index = 0.984, adjusted goodness of fit index = 0.970, comparative fit index = 0.988, and root mean square error of approximation = 0.047. Cronbach's alpha for the entire CSES was 0.87 and for the subscales was 0.80 and higher. The score of the entire CSES was positively correlated with the GCS-R in both the GEN (r = 0.80, p < 0.001) and CVOL (r = 0.86, p < 0.001) samples.

CONCLUSIONS

The CSES demonstrated adequate reliability and validity for assessing a community's self-efficacy to aid in its preventing social isolation among older people. The scale is potentially useful for promoting health policies, practices, and interventions within communities. This may help prevent social isolation among older people and contribute to overall well-being in aging societies in Japan and abroad.

Does disorder get "into the head" and "under the skin"? Layered contexts and bi-directional associations

This paper utilizes a layered context approach to examine how neighborhood and household conditions are associated with the objective and subjective well-being of older adults. Using two waves of data from the National Social Life, Health, and Aging Project (n=2261), we assess subjective mental health through self-reported measures of perceived stress and distress and objective physical health through C-reactive protein (CRP). Environmental disorder was measured by independent, trained interviewers. Cross-sectional results indicate that household disorder is positively associated with perceived stress and distress, overwhelming the association between neighborhood disorder and mental health outcomes. Yet longitudinal findings point to a reverse process, whereby highly stressed women experience deterioration in their home environment across the two waves. Few significant findings surfaced for CRP. Taken together, our findings illustrate the complex interplay between health and proximal environments and underscore how feedback cycles operate between "health" and "place" across multiple outcomes.

Urbanism, Neighborhood Context, and Social Networks

Theories of urbanism suggest that the urban context erodes individuals' strong social ties with friends and family. Recent research has narrowed focus to the neighborhood context, emphasizing how localized structural disadvantage affects community-level cohesion and social capital. In this paper, we argue that neighborhood context also shapes social ties with friends and family- particularly for community-dwelling seniors. We hypothesize that neighborhood disadvantage, residential instability, and disorder restrict residents' abilities to cultivate close relationships with neighbors and non-neighbor friends and family. Using data from the National Social Life, Health, and Aging Project (NSHAP), we find that older adults who live in disadvantaged neighborhoods have smaller social networks. Neighborhood disadvantage is also associated with less close network ties and less frequent interaction - but only among men. Furthermore, residents of disordered neighborhoods have smaller networks and weaker ties. We urge scholars to pay greater attention to how neighborhood context contributes to disparities in network-based access to resources.

How Neighborhood Poverty Structures Types and Levels of Social Integration

Social integration is fundamental to health and well-being. However, few studies have explored how neighborhood contexts pattern types and levels of social integration that individuals experience. We examined how neighborhood poverty structures two dimensions of social integration: integration with neighbors and social integration more generally. Using data from the United States Third National Health and Nutrition Examination Survey, we linked study participants to percent poverty in their neighborhood of residence (N = 16,040). Social integration was assessed using a modified Social Network Index and neighborhood integration based on yearly visits with neighbors. We fit multivariate logistic regression models that accounted for the complex survey design. Living in high poverty neighborhoods was associated with lower social integration but higher visits with neighbors. Neighborhood poverty distinctly patterns social integration, demonstrating that contexts shape the extent and quality of social relationships.