Perceived Neighborhood Safety, Social Cohesion, and Psychological Health of Older Adults

Exploring the pathways linking visual green space to depression in older adults in Shanghai, China: using street view data

OBJECTIVES

To examine (1) how visual green space quantity and quality affect depression among older adults; (2) whether and how the links may be mediated by perceived stress, physical activity, neighbourhood social cohesion, and air pollution (PM2.5); and (3) whether there are differences in the mediation across visual green space quantity and quality.

METHOD

We used older adults samples (aged over 65) from the WHO Study on Global Ageing and Adult Health in Shanghai, China. Depression was quantified by two self-reported questions related to the diagnosis of depression and medications or other treatments for depression. Visual green space quantity and quality were calculated using street view images and machine learning methods (street view green space = SVG). Mediators included perceived stress, social cohesion, physical activity, and PM2.5. Multilevel logistic and linear regression models were applied to understand the mediating roles of the above mediators in the link between visual green space quantity and quality and depression in older adults.

RESULTS

SVG quantity and quality were negatively related to depression. Significant partial mediators for SVG quality were social cohesion and perceived stress. For SVG quantity, there was no evidence that any of the above mediators mediated the association.

CONCLUSION

Our results indicated that visual green space quantity and quality may be related to depression in older adults through different mechanisms.

Staffing and Antipsychotic Medication Use in Nursing Homes and Neighborhood Deprivation

Importance

Inappropriate use of antipsychotic medications in nursing homes is a growing public health concern. Residents exposed to higher levels of socioeconomic deprivation in the area around a nursing home may be currently exposed, or have a long history of exposure, to more noise pollution, higher crime rates, and have less opportunities to safely go outside the facility, which may contribute to psychological stress and increased risk of receiving antipsychotic medications inappropriately. However, it is unclear whether neighborhood deprivation is associated with use of inappropriate antipsychotic medications and whether this outcome is different by facility staffing levels.

Objective

To evaluate whether reported inappropriate antipsychotic medication use differs in severely and less severely deprived neighborhoods, and whether these differences are modified by higher levels of total nurse staffing.

Design, Setting, and Participants

This was a cross-sectional analysis of a national sample of nursing homes that linked across 3 national large-scale data sets for the year 2019. Analyses were conducted between April and June 2023.

Exposure

Neighborhood deprivation status (severe vs less severe) and total staffing hours (registered nurse, licensed practical nurse, certified nursing assistant).

Main Outcome and Measures

This study estimated the association between neighborhood deprivation and the percentage of long-stay residents who received an antipsychotic medication inappropriately in the nursing home at least once in the past week and how this varied by nursing home staffing through generalized estimating equations. Analyses were conducted on the facility level and adjusted for state fixed effects.

Results

This study included 10 966 nursing homes (1867 [17.0%] in severely deprived neighborhoods and 9099 [83.0%] in less deprived neighborhoods). Unadjusted inappropriate antipsychotic medication use was greater in nursing homes located in severely deprived neighborhoods (mean [SD], 15.9% [10.7%] of residents) than in those in less deprived neighborhoods (mean [SD], 14.2% [8.8%] of residents). In adjusted models, inappropriate antipsychotic medication use was higher in severely deprived neighborhoods vs less deprived neighborhoods (19.2% vs 17.1%; adjusted mean difference, 2.0 [95% CI, 0.35 to 3.71] percentage points) in nursing homes that fell below critical levels of staffing (less than 3 hours of nurse staffing per resident-day).

Conclusions and Relevance

These findings suggest that levels of staffing modify disparities seen in inappropriate antipsychotic medication use among nursing homes located in severely deprived neighborhoods compared with nursing homes in less deprived neighborhoods. These findings may have important implications for improving staffing in more severely deprived neighborhoods.

Perceived neighborhood disorder, social cohesion, and depressive symptoms in spousal caregivers

OBJECTIVES

Prior research into the factors linked to mental health of caregivers of older adults have largely focused on individual- or household-level characteristics, but neighborhood supports and stressors may also matter for caregiver mental health. The current study fills this knowledge gap by examining the association of neighborhood social cohesion and disorder and depressive symptoms among spousal caregivers.

METHOD

We used data from the 2006 to 2016 waves of the Health and Retirement Study, which include 2,322 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood social cohesion and disorder with depressive symptoms.

RESULTS

A higher level of perceived neighborhood social cohesion was associated with fewer depressive symptoms (b = -0.06, 95% CI: -0.10, -0.02). On the other hand, greater perceived neighborhood disorder was associated with more symptoms (b = 0.04, 95% CI: 0.01, 0.08). The association of perceived social cohesion with depressive symptoms remained even after controlling for perceived disorder, but neighborhood disorder was no longer associated with depressive symptoms after accounting for reported neighborhood social cohesion.

CONCLUSIONS

This study suggests neighborhood supports and stressors matter for caregiver well-being. Neighborhood-based social support may be particularly important for caregivers as they navigate the challenges caregiving for an aging spouse can bring. Future studies should determine if enhancing positive characteristics of the neighborhood promotes well-being of spousal caregivers.

Community social environments and cigarette smoking

Cigarette smoking remains a primary contributor to health disparities in the United States, and significant evidence suggests that smoking behavior is socially influenced. Though residential neighborhoods are important for health disparities, recent evidence suggests that people spend the majority of their waking time away from the residential neighborhood. We advance research on neighborhoods and smoking by using individual, neighborhood, and activity space data for adults in the Los Angeles Family and Neighborhood Survey (L.A.FANS). Moving beyond socioeconomic indicators of neighborhoods, we investigate the ways in which residential neighborhood social cohesion, neighborly exchange, and perceived danger impact smoking behavior after accounting for confounding factors in both the residential neighborhood and other activity spaces in which adults spend their days. We find that perceptions of danger in the residential neighborhood is robustly associated with the likelihood of smoking cigarettes. Further, measures of community social organization interact with perceived danger to influence smoking behavior. Adults with high levels of perceived danger are twice as likely to smoke if residing in communities with lower levels of social organization in the form of helpful, trusting, and supportive relationships. Understanding how the social organization of communities contributes to smoking disparities is important for curbing smoking's impact on population health.

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Adults with high perceived neighborhood danger are more likely current smokers.

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Adults in high danger low social cohesion neighborhoods twice as likely to smoke.

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Adults in high danger low neighborly exchange neighborhoods twice as likely to smoke.

Neighborhood social cohesion and serious psychological distress among Asian, Black, Hispanic/Latinx, and White adults in the United States: a cross-sectional study

BACKGROUND

Serious psychological distress (SPD) is common and more prevalent in women, older adults, and individuals with a low-income. Prior studies have highlighted the role of low neighborhood social cohesion (nSC) in potentially contributing to SPD; however, few have investigated this association in a large, nationally representative sample of the United States. Therefore, our objective was to investigate the overall and racial/ethnic-, sex/gender-, self-rated health status-, age-, and household income-specific relationships between nSC and SPD.

METHODS

We used data from survey years 2013 to 2018 of the National Health Interview Survey to investigate nSC and SPD among Asian, Non-Hispanic (NH)-Black, Hispanic/Latinx, and NH-White men as well as women in the United States (N = 168,573) and to determine modification by race/ethnicity, sex/gender, self-rated health status, age, and annual household income. nSC was measured by asking participants four questions related to the trustworthiness and dependability of their neighbors. nSC scores were trichotomized into low (< 12), medium (12-14), and high (15-16). SPD was measured using the Kessler 6 psychological distress scale with scores ≥ 13 indicating SPD. After adjusting for sociodemographic, health behavior, and clinical confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).

RESULTS

Among 168,573 participants, most were Non-Hispanic (NH)-White (69%), and mean age was 47 ± 0.01 years. After adjustment, low vs. high nSC was associated with a 75% higher prevalence of SPD overall (PR = 1.75 [1.59-1.92]), 4 times the prevalence of SPD among Asian men (PR = 4.06 [1.57-10.50]), 2 times the prevalence of SPD among participants in at least good health (PR = 2.02 [95% CI: 1.74-2.35]), 92% higher prevalence of SPD among participants ≥ 50 years old (PR = 1.92 [1.70-2.18]), and approximately 3 times the prevalence of SPD among Hispanic/Latinx participants with household incomes ≥ $75,000 (PR = 2.97 [1.45-6.08]).

CONCLUSIONS

Low nSC was associated with higher SPD in the overall population and the magnitude of the association was higher in Asian men, participants who reported good health, older participants, and Hispanic/Latinx adults with higher household incomes. Future research should continue to examine how neighborhood contexts can affect health across various sociodemographic groups, especially among groups with multiple marginalized social identities.

Associations between water, sanitation, and depression among older people in Ghana: empirical evidence from WHO-SAGE Wave 2 survey

BACKGROUND

While depression is the most frequent psychiatric disorder among the older adults, the use of water and sanitation has been associated with both physical and psychological adverse outcomes. We investigated the associations of water and sanitation with depressive symptoms among older adults in Ghana.

METHODS

The study used data from 4,735 participants in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 2 of adults aged ≥50 years. Major depressive episode (MDE) was assessed using the World Mental Health Survey version of the Composite International Diagnostic Interview and we classified water and sanitation sources based on the Joint Monitoring Program. Multivariate logistic regressions evaluated the associations.

RESULTS

Approximately 7.3% of respondents reported a MDE, 90% and 78% used improved water sources and sanitation facilities respectively, and 77% shared sanitation facilities. Individuals who used unimproved water sources and unimproved sanitation were 1.6 and 1.3 times more likely to report MDE respectively. Also, sex-based analysis showed that the effect of the use of unimproved water and sanitation on depression was much appreciable and more substantial among women compared to men.

CONCLUSIONS

The findings suggest the importance of water and sanitation to the well-being of older people, particularly among women. Policies targeted at improving the mental health in old age should include water and sanitation.

Multi-Level Social Capital and Subjective Wellbeing Among the Elderly: Understanding the Effect of Family, Workplace, Community, and Society Social Capital

Background

Maintaining the subjective wellbeing of the elderly people is one of the major concerns in promoting health aging. This study concerned the influence of multi-level social capital on subjective welling and explored the affecting path among the elderly.

Methods

A total of 1,078 elderly individuals anonymously and effectively surveyed in 2018, data was collected including their family, workplace, community, society social capital and subjective wellbeing, we used the structural equation modeling to test the hypothesis relationships among the variables.

Results

We found that the total score of subjective wellbeing among the aging participants was 72.36 ± 10.08 on a range of 0–100. Family (β = 0.151, P &lt; 0.001), workplace (β = 0.090, P &lt; 0.001), community (β = 0.163, P &lt; 0.001) social capital had a direct positive effect on subjective wellbeing. Society social capital had a direct positive effect on family (β = 0.253, P &lt; 0.001), workplace (β = 0.585, P &lt; 0.001), community (β = 0.438, P &lt; 0.001) social capital. And society social capital had an indirect positive effect on subjective wellbeing through the mediating role of family, workplace, and community social capital.

Conclusion

The research demonstrated that all the micro, meso and macro levels of social capital have protective effects for subjective wellbeing through direct or indirect way, inspiring to provide continuous improvement measures for multi-level social capital aimed at the elderly people.

The Use of Urban Parks by Older Adults in the Context of Perceived Security

The perception of urban greenery is determined by many aspects, including the personal security of different groups of city dwellers. The objective of this study was to investigate if there are differences between the sense of security of older adults and other groups of urban park users, and which factors play an important role in the evaluation of personal security and thus determine the use (or not) of parks. A survey questionnaire was administrated to a sample of randomly selected park users in Poland (n = 394), including seniors (s = 69). The results show statistically significant differences in security perception between respondents under the age of 60 and those over the age of 60 in the case of all questioned factors. At the same time, all of them are important for a sense of security in older adults. This knowledge is crucial for designing more inclusive and age-friendly urban parks, which should meet the needs and expectations of older adults and encourage them to engage in more activity.

Association of elder abuse, crime victimhood and perceived neighbourhood safety with major depression among older adults in India: a cross-sectional study using data from the LASI baseline survey (2017-2018)

OBJECTIVE

The study aims to explore the associations of elder abuse, crime victimhood and perceived safety with depression among older adults and examine the interactive effects of sex and place of residence in those associations.

DESIGN

A cross-sectional study was conducted using a large survey data.

SETTING AND PARTICIPANTS

The study used data from the Longitudinal Ageing Study in India wave 1 (2017-2018). The effective sample size was 31 464 older adults (aged 60 years or older).

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variable was major depression, calculated using Short Form Composite International Diagnostic Interview. Descriptive statistics along with bivariate and multivariate analyses were performed to fulfil the objectives.

RESULTS

5.22% of the older adults (n=1587) experienced abuse in the past 1 year. 1.33% of the older individuals (n=402) were victims of a violent crime, and 14.30% (n=1886) perceived an unsafe neighbourhood. Also, 8.67% of the older adults (n=2657) were suffering from depression. Older adults who were abused had 2.5 odds of suffering from depression (adjusted OR (AOR): 2.47, CI: 1.96 to 3.10) and victims of a violent crime were 84% more likely to be depressed (AOR: 1.84, CI: 1.15 to 2.95) compared with their counterparts. Besides, older individuals who perceived as living in unsafe neighbourhood were 61% more likely to be depressed (AOR: 1.61, CI: 1.34 to 1.93) compared with their counterparts. In the interaction analysis, older women who reported abuse had higher odds of suffering from depression (AOR: 3.27; CI: 2.34 to 4.57) compared with older men who were not abused. Similar result was found in older adults reporting abuse and residing in rural areas (AOR: 3.01, CI: 2.22 to 4.07) compared with those urban residents reporting no abuse.

CONCLUSIONS

Healthcare providers should pay more attention to the mental health implications of elder abuse, crime victimhood and perceived safety to grasp the underlying dynamics of the symptomology of late-life depression.

What predicts how safe people feel in their neighborhoods and does it depend on functional status?

Feeling unsafe in one's neighborhood is related to poor health. Features of the neighborhood environment have been suggested to inform perceptions of neighborhood safety. Yet, the relative contribution of these features (e.g., uneven sidewalks, crime, perceived neighborhood physical disorder) on perceived neighborhood safety, particularly among people with disabilities who may view themselves as more vulnerable, is not well understood. We examined whether sidewalk quality assessed by third party raters, county-level crime rates, and perceived neighborhood disorder would relate to neighborhood safety concerns, and whether functional limitations would exacerbate these links. Using data from the 2012/2014 waves of the Health and Retirement Study (n = 10,653, mean age = 66 years), a national sample of older US adults, we demonstrate that those with and without functional limitations felt less safe in areas with more crime and perceived as more disordered. When considered simultaneously, however, only perceived disorder statistically significantly predicted safety concerns. Living in neighborhoods with better sidewalk quality was statistically significantly related to feeling less safe, but only among those with functional limitations. Sidewalk quality was not statistically significantly related to safety reports among those without functional limitations. To our knowledge, this study is among the first to examine multiple features of the neighborhood environment simultaneously in relation to perceived neighborhood safety. Our findings highlight the relative importance of perceived physical disorder, and that these perceptions relate to safety concerns. Replication of this research is needed to determine the robustness of these patterns, including rich data on pedestrian use and sidewalk proximity to roadways. Community-level interventions that simultaneously target the multifaceted features of the neighborhood environment that shape people's safety reports may be needed to reduce burden of health.

Community and Social Context: An Important Social Determinant of Cardiovascular Disease

Disease prevention frameworks and clinical practice guidelines in the United States (US) have traditionally ignored upstream social determinants of health (SDOH), which are critical for reducing disparities in cardiovascular disease (CVD)-the leading cause of death in the US. Existing evidence demonstrates a protective effect of social support, social cohesion, and community engagement on overall health and wellbeing. Increasing community and social support is a major objective of the Healthy People 2030 initiative, with special provisions for vulnerable populations. However, to date, existing evidence of the association between community and social context (CSC)-an integral SDOH domain-and CVD has not been reviewed extensively. In particular, the individual and cumulative impact of CSC on CVD risk and the pathways linking CSC to cardiovascular outcomes are not well understood. In this review, we critically appraise current knowledge of the association between CSC and CVD, describe potential pathways linking CSC to CVD, and identify opportunities for evidence-based policy and practice interventions to improve CVD outcomes.

Active Aging through Volunteerism: A Longitudinal Assessment of Perceived Neighborhood Safety as a Predictor among Older Adults, 2008-2018

Volunteering can play an important role in active aging. The resource theory of volunteering posits that volunteerism depends on human, social, and cultural capital. Benefits of volunteering have been documented at the micro-, meso-, and macrolevels, positively affecting individual older people as well as their local communities and society at large. Taking a process-oriented theoretical approach, this study focused on the mesolevel factor of the environment with the purpose of determining the relationship between perceived neighborhood safety and volunteerism over the course of a decade and the extent to which this relationship differs by gender and race. Longitudinal data from the Health and Retirement Study in the United States of America between 2008 and 2018 were used (N = 72,319 adults 60 years and older). Generalized estimating equations (GEE) with robust standard errors were employed while controlling for a number of covariates. A third of the sample volunteered in the past year (33%). The probability of volunteering among older adults who rated their perceived neighborhood safety as excellent was greater compared with those who rated their perceived neighborhood safety as fair/poor after controlling for all other model covariates (ME: 0.03, 95% CI: 0.02, 0.05). Among males rating their perceived neighborhood safety as excellent, the probability of volunteering was higher (ME: 0.04, 95% CI: 0.02, 0.07). Among females, the probability of volunteering was higher among those who perceived their neighborhood safety to be excellent (ME: 0.03, 95% CI: 0.01, 0.05) or very good (ME: 0.02, 95% CI: 0.00, 0.04). White respondents who rated their neighborhood safety as excellent (ME: 0.05, 95% CI: 0.03, 0.07) or very good (ME: 0.04, 95% CI: 0.02, 0.06) had a higher probability of volunteerism. Results were not significant among Black respondents and those who described their race as “other.” This study's process-oriented theoretical approach indicates that initiatives aimed at improving neighborhood safety and older adults' perceptions of neighborhood safety could increase social capital and lead older adults to engage in more volunteering, providing benefits at micro-, meso-, and macrolevels—to older individuals, their local communities, and society at large.

Cross-Sectional and Longitudinal Association between Neighborhood Environment and Perceived Control in Older Adults: Findings from HRS

The current study examined how neighborhood environments are related to older adults’ perceived control over time. A longitudinal study design was employed using data sampled from the Health and Retirement Study (HRS) 2014 and 2018. In total, 3170 older adults, whose age ranged between 60 and 99 years at the baseline, were followed up with a 4-year lag. Measures included two domains of neighborhood characteristics: social cohesion and physical disorder (at baseline and follow-up) and perceived control (at follow-up). Path coefficients between the latent factors were examined using structural equation modeling. Results showed that there was a significant cross-sectional and longitudinal association between neighborhood social cohesion and older adults’ perceived control, while neighborhood physical disorder was cross-sectionally associated with perceived control. Study findings provide evidence for promoting social integration and social capital in their neighborhood that might contribute to older adults’ perceived competence and beliefs in control.

Moving the 2030 Agenda Ahead: Exploring the Role of Multiple Mediators toward Perceived Environment and Social Sustainability in Residential Neighbourhoods

Neighbourhood safety represents an important topic of study to illustrate the reasons behind the increases in crime and mitigate its effects in neighbourhoods. This study examines how the social and environmental features of neighbourhoods may influence the social sustainability of residents based on the assumption that the perception of safety and social cohesion mediates the effects of neighbourhood environment on social sustainability. A quantitative method was employed to collect data from residents in a low-rise residential area in Penang, Malaysia. The results of structural equation modelling (SEM) indicated the positive and significant effect of neighbourhood accessibility on perceived disorder, whilst the effect of accessibility on social cohesion was negative. Disorders may comprise social and physical disorders, and may have a negative effect on perception of safety, but not on social cohesion. The relationship between disorders and social sustainability is serially mediated by the perception of safety and social cohesion. This implies that those who perceived high disorderliness in a neighbourhood environment reported a lower level of perception of safety, social cohesion and lower levels of social sustainability. Attempts need to be made to reduce neighbourhood disorderliness to pave the way for 2030 Agenda goals implementation.

Social Cohesion in Health: A Concept Analysis

The concept of social cohesion has been indicated to be a critical social determinant of health in recent literature. Inconsistencies surrounding the conceptualization and operationalization have made utilizing these findings to inform health intervention and policy difficult. The objective of this article is to provide a theoretical clarification of the concept "social cohesion," as it relates to health behaviors and outcomes by using the Rodgers' evolutionary method for concept analyses. This article uncovers the critical attributes, antecedents, and consequences of social cohesion and provides reflection on future use of social cohesion in health literature.

Does social capital interact with economic hardships in influencing older adults' health? A study from China

BACKGROUND

The importance of social and economic capital as predictors of health is widely documented, yet the complexity of interactions between them and effects on older people's health is still unclear. Combining the material and psychosocial explanations of health, this study explores the potential interactions between social and economic capital in influencing older adults' health in urban and rural China.

METHODS

Using data from the China Family Panel Survey, physical and mental health in 2018 were regressed on social and economic capital indicators in 2016, controlling for sociodemographic characteristics of 3535 respondents aged 65 and older. Rothman's synergy index was calculated to investigate potential interaction effects.

RESULTS

Economic hardships were significantly related to both self-reported health and mental health. Neighborhood cohesion and social participation were significantly associated with mental health for all, bonding trust was significantly associated with mental health for urban older people. We found no significant associations between social capital components and self-reported health. There was an interaction effect between low neighborhood cohesion and economic hardships, and between low social participation and economic hardships, creating an increased burden of poor mental health. The interaction effect between low bonding trust and economic hardships on mental health was apparent only among urban older people.

CONCLUSIONS

Geographical settings are important factors in the complexity between social and economic capital in affecting older health. Intervention efforts directed towards reducing simultaneously multiple dimensions of deprivation, such as poverty, social exclusion, social isolation, could be helpful in improving older people's health. In materially deprived places, policies to promote health equity by improving social capital but without eliminating poverty may be less effective.

Functional Limitations and Perceived Neighborhood Walkability Among Urban Dwelling Older Adults

Older adults with functional limitations (FLs) often experience obstacles to walking. Although health promotion programs targeting physical activity are available in lower-income areas, few studies have compared the walking experiences of older adults who have FLs with those who do not in the community. The purpose of this cross-sectional survey was to compare perceptions of neighborhood walkability among older adults living in lower-income communities with and without FLs. Participants (N = 132) were recruited in 2018 at regional health clinics in Flint, Michigan. To be eligible, participants had to be 65 years of age or older, report no cognitive decline, and be Flint residents. Of the 132 participants, the mean age was 69.74 (SD = 4.97). The majority were female (66%); African American (77%); single, divorced, or widowed (72%); educated below the General Education Development level (57%), and had a FL (67%). Older adults with FLs were significantly (p < 0.05) less likely than those without to visit many places within walking distance, to have well-lit neighborhoods at night, and to reside in neighborhoods where sidewalks were separated from the road and traffic. Multiple regression analyses revealed that having a FL was associated with poorer neighborhood perceptions of mixed-land-use (b = −0.19, p < 0.05) and more walking hazards (b = −0.26, p < 0.05). Findings suggest that a FL is associated with perceptions of walkability. It is essential to develop disability-friendly support systems and accommodations to encourage walking in lower-income communities.

Challenges and lessons learnt from the ENJOY project: recommendations for future collaborative research implementation framework with local governments for improving the environment to promote physical activity for older people

BACKGROUND

The physical environment has been shown to have a positive effect on the promotion of physical activity of older people. Outdoor environments that incorporate specialised exercise equipment suitable for older people are uniquely placed to promote physical activity and social connectedness amongst older people. The ENJOY project included the installation of specialised outdoor exercise equipment (the Seniors Exercise Park) and the delivery of a physical and social activity program for older people as part of a prospective pre-post research design. The installation of the specialised equipment in public sites and an aged care facility was also aimed at increasing usage of the equipment by older people from the wider community and to increase physical and social activities.

METHOD

A conceptual framework for implementation and several engagement methods were utilised to guide the research and to support the participating partners throughout the project. This paper is a reflective narrative describing the collaborative process and approach utilised to engage local governments and community, and reports the challenges and the lessons learnt to inform future strategies for implementation.

RESULTS

The conceptual framework for the implementation process that guided the conduct and delivery of the ENJOY project included the core elements of the Interactive Systems Framework and the ecologic framework. These models incorporate elements of research-to-practice and community-centred implementation to accommodate the unique perspectives of a range of stakeholders.

CONCLUSION

Partner characteristics such as local governments' structure and policy as well as community factors can impact on implementation. Partnership with local governments with effective communication, strategic planning and community and seniors engagement approaches are recommended for successful implementation. The lessons learnt can further assist public health research design around changes to the built environment to positively impact on older people's physical activity levels.

TRIAL REGISTRATION

Trial registration number ACTRN12618001727235. Date of registration 19th October 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375979.

"Our Home Is a Muddy Structure": Perceptions of Housing and Health Risks Among Older Adults in Contrasting Neighborhoods in Ghana

Aging occurs in a variety of social and physical environmental settings that affect health. However, despite their rapidly growing populations, public health research in sub-Saharan Africa has yet to address the role of residential environments in the health and well-being of older adults. In this study, we utilized an ethnographic research methodology to explore barriers and facilitators to health among older adults residing in two contrasting neighborhoods in Accra, Ghana. Our specific objective was to identify patterns of health risks among older adults in the two neighborhoods. Data were collected through qualitative interviews with a purposive sample of health workers (n = 5), community leaders (n = 2), and older adults residing in a slum and non-slum neighborhood (n = 30). Our thematic data analysis revealed that, despite different underlying drivers, health barriers across the slum and non-slum were largely similar. The harmful effects of these health barriers - poor built environments, housing precariousness, unsanitary living conditions, defective public services, and social incivilities - were mitigated by several facilitators to health, including affordable housing and social supports in the slum and better housing and appealing doors in the non-slum. Our study contributes to a more nuanced understanding of the ways in which aging and urban environments intersect to influence population health in resource poor settings. In particular, rather than the commonly referenced dichotomy of poor and non-poor settlements in discourses of neighborhood health, our findings point to convergence of health vulnerabilities that are broadly linked to urban poverty and governmental neglect of the elderly.

Local variation in cannabis use patterns among young adults in the San Francisco Bay Area

This study evaluated whether neighborhood-level disorder, social cohesion, and perceived safety, were associated with days of cannabis use in the prior month in a representative sample of young adults in Alameda and San Francisco Counties in California (N = 1272). We used multiscale geographically weighted regression, modeled by county, to measure associations between cannabis use days and neighborhood attributes, adjusting for sociodemographic characteristics and self-rated health. Positive associations were found between number of cannabis use days and neighborhood disorder, and greater perceived safety. Higher levels of social cohesion predicted fewer cannabis use days. Racial/ethnic, sex and, socioeconomic compositions of participants residing in areas with significant neighborhood-level associations varied substantially, suggesting that risk factors for young adult cannabis use may be highly localized. Public health efforts in cannabis education and intervention should be tailored to fit the culture and composition of local neighborhoods.

Thriving during COVID-19: Predictors of psychological well-being and ways of coping

COVID-19 has led to global dramatic shifts in daily life. Following the biopsychosocial model of health, the goal of the current study was to predict people's psychological well-being (PWB) during the initial lockdown phase of the pandemic and to investigate which coping strategies were most common among people with low and high PWB. Participants were 938 volunteers in the United States who responded to an online survey during the lockdown in April 2020. The main findings were that all three groups of variables, biological, psychological, and socio-economic, significantly contributed to PWB explaining 53% variance. Social loneliness and sense of agency were the strongest predictors. PWB was significantly predicted by physical health (not gender nor age); by spirituality, emotional loneliness, social loneliness, and sense of agency; by job security (not income, nor neighborhood safety, nor hours spent on social media). Comparing the coping strategies of participants, results show more intentional coping in the high-PWB group and more passive coping in the low-PWB group. During this unprecedented pandemic, the findings highlight that ability to sustainably cope with the global shifts in daily life depends on actively and intentionally attending to PWB by being one's own agent for physical health, spiritual health, and social connection.

Home garden use during COVID-19: Associations with physical and mental wellbeing in older adults

The COVID-19 pandemic has affected many aspects of people's lives. Lockdown measures to reduce the spread of COVID-19 have been more stringent for those aged over 70, at highest risk for the disease. Here, we examine whether home garden usage is associated with self-reported mental and physical wellbeing in older adults, during COVID-19 lockdown in Scotland. This study analysed data from 171 individuals (mean age 84 ± 0.5 years) from the Lothian Birth Cohort 1936 study who completed an online survey approximately two months after lockdown commenced (May/June, 2020), and reported having access to a home garden. The survey also included items on garden activities (gardening, relaxing), frequency of garden usage during lockdown, and measures of self-rated physical health, emotional and mental health, anxiety about COVID-19, and sleep quality. Ordinal regression models were adjusted for sex, living alone, education, occupational social class, anxiety and depressive symptoms, body mass index, and history of diabetes and cardiovascular disease. Neither gardening nor relaxing in the garden were associated with health outcomes. However, higher frequency of garden usage during lockdown was associated with better self-rated physical health (P = 0.005), emotional and mental health (P = 0.04), sleep quality (P = 0.03), and a composite health score (P = 0.001), after adjusting for covariates. None of the garden measures were associated with perceived change in physical health, mental and emotional health, or sleep quality, from pre-lockdown levels. The results of the current study provide support for positive health benefits of spending time in a garden-though associations may be bidirectional-and suggest that domestic gardens could be a potential health resource during the COVID-19 pandemic.

"What Doesn't Kill You, Makes You Stronger": Psychosocial Resources and the Mental Health of Black Older Adults

A robust body of research has shown that Black Americans are less likely than Whites to have psychiatric disorders despite the social and economic disadvantage and systemic racism that they face. This mental health paradox has been demonstrated across all ages of the life course, including older adulthood. One of the prevailing explanations for the lower prevalence of psychiatric disorders among Blacks pertains to the influence of psychosocial resources on mental health. Psychosocial resources can directly or indirectly support mental health through physiological and psychological pathways. They can also mitigate the adverse effects of social stressors of discrimination and other stressors on psychological distress and mental illness. Black older adults may particularly benefit from psychosocial resources because they have had a lifetime of experiencing and overcoming adversity. Although this cycle of stress adaptation can wear away at the physical body, it may facilitate mental health resilience. In this chapter, we review research on the relationship between psychosocial resources and mental health. The chapter begins with a brief review of the Black-White mental health paradox and the mechanisms through which psychosocial resources operate to influence mental health. We then review research on intrapersonal, interpersonal, and community-level psychosocial resources that are particularly salient for Black Americans. Throughout the chapter we highlight research specifically focused on Black older adults and discuss the cultural relevance of each resource to their mental health and psychological functioning.

The role of neighborhood stressors on cognitive function: A coordinated analysis

The objective of this study was to evaluate the association between perceived neighborhood stressors, encompassing negative perceived neighborhood characteristics, and specific cognitive abilities in adulthood. We conducted a coordinated analysis across three studies of adults in the United States and found that perceived neighborhood stressors were consistently associated with poorer performance on attention-demanding cognitive tasks. We specifically found that perceived neighborhood stressors were associated with lower performance in spatial abilities, working memory, and executive function but not perceptual speed, and that the effect was most consistent for lower perceived neighborhood safety followed by lower perceived aesthetic quality, greater perceived neighborhood crime, and lower perceived neighborhood cohesion. These results highlight the importance of the psychosocial neighborhood context for cognitive health in adulthood.

Psychological distress links perceived neighborhood characteristics to longitudinal trajectories of cognitive health in older adulthood

RATIONALE

Perceived neighborhood characteristics have been linked to cognitive health in older adulthood. The pathways through which neighborhood characteristics could influence cognition in older adulthood, however, have not been fully explored. Poorer quality neighborhoods may negatively influence cognition through feelings of psychological distress.

OBJECTIVE

To examine whether perceived neighborhood physical disorder and social cohesion were associated with change in episodic memory and semantic verbal fluency through anxiety and depressive symptoms.

METHODS

Using the Health and Retirement Study (HRS; n = 13,919), mediation models were conducted. Change in cognition (episodic memory and semantic verbal fluency) were modeled using latent growth curve models.

RESULTS

Higher physical disorder was associated with worse initial episodic memory and verbal fluency through greater anxiety symptoms. Higher social cohesion was associated with better initial episodic memory and verbal fluency through both lower anxiety and fewer depressive symptoms. Further, individuals with higher social. cohesion reported lower anxiety and in turn, showed a slower rate of verbal fluency decline. A direct effect of physical disorder on initial episodic memory remained, after accounting for indirect effects and covariates.

CONCLUSIONS

Overall, individuals who live in neighborhoods with high physical disorder and low social cohesion may experience greater psychological distress. Symptoms of anxiety and depression may, in turn, interfere with cognitive functioning. Neighborhood characteristics may be an important, targetable area for intervention to improve not only mental health outcomes, but cognitive health outcomes in older adulthood.

Housing stability and diabetes among people living in New York city public housing

Public housing provides affordable housing and, potentially, housing stability for low-income families. Housing stability may be associated with lower incidence or prevalence and better management of a range of health conditions through many mechanisms. We aimed to test the hypotheses that public housing residency is associated with both housing stability and reduced risk of diabetes incidence, and the relationship between public housing and diabetes risk varies by levels of housing stability. Using 2004-16 World Trade Center Health Registry data, we compared outcomes (housing stability measured by sequence analysis of addresses, self-reported diabetes diagnoses) between 730 New York City public housing residents without prevalent diabetes at baseline and 730 propensity score-matched non-public housing residents. Sequence analysis found 3 mobility patterns among all 1460 enrollees, including stable housing (65%), limited mobility (27%), and unstable housing patterns (8%). Public housing residency was associated with stable housing over 12 years. Diabetes risk was not associated with public housing residency; however, among those experiencing housing instability, a higher risk of diabetes was found among public housing versus non-public housing residents. Of those stably housed, the association remained insignificant. These findings provide important evidence for a health benefit of public housing via housing stability among people living in public housing.

Influence of Individual and Contextual Perceptions and of Multiple Neighborhoods on Depression

The risk of depression is related to multiple various determinants. The consideration of multiple neighborhoods daily frequented by individuals has led to increased interest in analyzing socio-territorial inequalities in health. In this context, the main objective of this study was (i) to describe and analyze the spatial distribution of depression and (ii) to investigate the role of the perception of the different frequented spaces in the risk of depression in the overall population and in the population stratified by gender. Data were extracted from the 2010 SIRS (a French acronym for "health, inequalities and social ruptures") cohort survey. In addition to the classic individual characteristics, the participants reported their residential neighborhoods, their workplace neighborhoods and a third one: a daily frequented neighborhood. A new approach was developed to simultaneously consider the three reported neighborhoods to better quantify the level of neighborhood socioeconomic deprivation. Multiple simple and cross-classified multilevel logistic regression models were used to analyze the data. Depression was reported more frequently in low-income (OR = 1.89; CI = [1.07-3.35]) or middle-income (OR = 1.91; CI = [1.09-3.36]) neighborhoods and those with cumulative poverty (OR = 1.64; CI = [1.10-2.45]). In conclusion, a cumulative exposure score, such as the one presented here, may be an appropriate innovative approach to analyzing their effects in the investigation of socio-territorial inequalities in health.

Association between telomere length and neighborhood characteristics by race and region in US midlife and older adults

Disadvantaged neighborhoods are correlated with worse health outcomes, particularly among US Blacks. However, less is known about the link between neighborhood characteristics and biomarkers of cellular age, such as telomere length (TL), which may be implicated in racial health inequities. Moreover, this relationship may vary across US region given patterns of racial segregation across the US. Therefore, this study analyzed 2008 Health and Retirement Study data on 3,869 US-born white and Black adults >50 years old to examine race differences in the relationship between salivary TL and (1) neighborhood safety, cleanliness, and social cohesion and (2) interactions between neighborhood characteristics and US region. Neighborhood characteristics were not associated with TL in whites. However, significant associations were found among Blacks with variation by region. Blacks living in less clean neighborhoods in the Northeast (b = -0.03, SE = 0.01, p < 0.05), Midwest (b = -0.04, SE = 0.01, p < 0.01), and South (b = -0.05, SE = 0.01, p < 0.01) as well as those reporting less neighborhood safety and social cohesion in the Midwest (b = -0.03, SE = 0.02, p < 0.05 and b = -0.03, SE = 0.01, p < 0.05) and South (b = -0.03, SE = 0.01, p < 0.05 for both characteristics) had shorter TL than Blacks in the West. Therefore, exposure to neighborhood level historical discrimination and neglect may be detrimental to TL in Blacks. Future research should further examine how neighborhoods contribute to aging disparities.

Association between Recent Falls and Changes in Outdoor Environments near Community-Dwelling Older Adults' Homes over Time: Findings from the NHATS Study

Neighborhood environments have been increasingly associated with incidents of falling and the fear of falling. However, little is known about the causal impact of neighborhood environments on falling. This study identifies whether changes in outdoor environmental attributes over a one-year period are associated with the occurrence of recent falls among community-dwelling older adults aged 65 and older in the United States. Data were obtained from 4802 adults aged 65 years or older from the National Health and Aging Trends Study (NHATS). Logistic regression analyses were performed to identify neighborhood risk factors linked to the odds of experiencing recent falls at the one-year follow-up. Almost one in ten subjects (9.7% of 4802 subjects) who had not fallen before reported experiencing recent falls after one year. After adjusting for sociodemographic, health, and walking-related behavioral covariates, these subjects were more likely to reside in areas with higher environmental barriers on sidewalks/streets and uneven walking surfaces or broken steps, compared to non-fallers. Our findings suggest that safe and well-maintained outdoor environments may help prevent falls among community-dwelling older adults who engage in outdoor activities. Clinical and environmental interventions for promoting both safe walking and safe environments are warranted.

Fear of Outdoor Falling Among Community-Dwelling Middle-Aged and Older Adults: The Role of Neighborhood Environments

Background and Objectives

Fear of falling is a substantial barrier to walking and has been associated with increased fall risks. This study examines neighborhood environmental risk factors related to fear of outdoor falling in middle-aged and older adults.

Research Design and Methods

A total of 394 participants aged 50 years or older living independently in the community were recruited between 2013 and 2014 from an integrated health care network serving Central Texas. Fear of outdoor falling and perceived neighborhood environmental variables were assessed using self-reported questionnaires. Logistic regression identified perceived neighborhood environmental variables associated with fear of outdoor falling.

Results

Sixty-nine (17.9%) of 385 participants reported having a fear of outdoor falling. Compared to those who did not report a fear of outdoor falling, those who reported having a fear of outdoor falling were more likely to be adults aged 65 years or older (odds ratio [OR] = 2.974, 95% confidence interval [CI] = 1.247-7.094), be female (OR = 4.423, 95% CI = 1.830-10.689), have difficulty with walking for a quarter of a mile (OR = 2.761, 95% CI = 1.124-6.782), and have had a fall in the past year (OR = 4.720, 95% CI = 1.472-15.137). Among the neighborhood environmental characteristics examined, low traffic speed on streets (OR = 0.420, 95% CI = 0.188-0.935), drainage ditches (OR = 2.383, 95% CI = 1.136-5.000), and broken sidewalks (OR = 3.800, 95% CI = 1.742-8.288) were associated with the odds of having a fear of outdoor falling.

Discussion and Implications

In addition to the individual factors, findings from this study suggest the importance of addressing the environmental risk factors in identifying and reducing fear of outdoor falling among middle-aged and older adults.

Older Adults in Public Open Spaces: Age and Gender Segregation

Background and Objectives

There is a substantial body of literature on the importance of the environment in the lives of older adults. Nonetheless, to date, there has been limited research on everyday activities of urban older adults in public open spaces. The present study examined the activities of older adults in public open spaces in Israel with a specific focus on age and gender as potential variables of relevance.

Research Design and Methods

Using still photography, we systematically photographed four sessions in two different public outdoor settings attended by older Israelis. Still photographs were converted to narrative descriptions, and then coded, quantified, and compared using descriptive statistics.

Results

The majority (311, 97%) of older adults arrived alone to the public setting. Of these, 44% formed a social group of two or more people, whereas the remaining older adults stayed alone. When social interactions occurred, they were primarily gender homogenous (69%); women were more likely to integrate in spontaneous social conversations and men were more likely to participate in common games.

Discussions and Implications

Our findings call attention to the important role played by the outdoor environment as a venue for social activities among older adults. The findings further stress the high levels of aloneness experienced by older adults, which do not seem to be alleviated by the mere attendance of public spaces.

Perceived neighborhood characteristics predict severity and emotional response to daily stressors

RATIONALE

Neighborhood characteristics may influence health and well-being outcomes through stressors in daily life.

OBJECTIVES

This study tested whether a varied set of perceived characteristics of neighborhood (i.e., social cohesion, safety, aesthetic quality, violence) predicted stressor frequency and severity as well as negative emotional responses to stressors. We predicted greater reported cohesion and safety and less violence would be associated with less frequent stressor exposure and severity and less intense negative affect following stressors; we conducted subsequent tests of neighborhood aesthetic quality as a predictor.

METHODS

Participants (n = 233, age 25-65 years) were residents in a socio-economically, racially, and ethnically diverse zip code in Bronx, New York, most who participated in the Effects of Stress on Cognitive Aging, Physiology and Emotion study between 2012 and 2013. They provided demographic information and neighborhood ratings, then participated in the EMA protocol in which they completed brief smartphone surveys of current negative affect and stressor exposure, severity, and recency, five times daily for 14 days.

RESULTS

No coded neighborhood characteristic was related to the frequency of stressors. Individuals who reported greater neighborhood violence, however, rated their stressors as more severe. Individuals rating their neighborhood lower in safety or aesthetic quality, or higher in violence, had greater negative affect following stressors.

CONCLUSION

Even among people living within the same zip code, individual differences in perceptions of neighborhood predict how stressful they appraised stressors in daily life to be and how much negative affect they reported following stressors.

Short- and Long-Term Impacts of Neighborhood Built Environment on Self-Rated Health of Older Adults

Background and Objectives

Proximity to health care, healthy foods, and recreation is linked to improved health in older adults while deterioration of the built environment is a risk factor for poor health. Yet, it remains unclear whether individuals prone to good health self-select into favorable built environments and how long-term exposure to deteriorated environments impacts health. This study uses a longitudinal framework to address these questions.

Research Design and Methods

The study analyzes 3,240 Americans aged 45 or older from the Panel Study of Income Dynamics with good self-reported health at baseline, and follows them from 1999 to 2013. At each biennial survey wave, individual data are combined with data on services in the neighborhood of residence (defined as the zip code) from the Economic Census. The analysis overcomes the problem of residential self-selection by employing marginal structural models and inverse probability of treatment weights.

Results

Logistic regression estimates indicate that long-term exposure to neighborhood built environments that lack health-supportive services (e.g., physicians, pharmacies, grocery stores, senior centers, and recreational facilities) and are commercially declined (i.e., have a high density of liquor stores, pawn shops, and fast food outlets) increases the risk of fair/poor self-rated health compared to more average neighborhoods. Short-term exposure to the same environments as compared to average neighborhoods has no bearing on self-rated health after adjusting for self-selection.

Discussion and Implications

Results highlight the importance of expanding individuals' access to health-supportive services prior to their reaching old age, and expanding access for people unlikely to attain residence in service-dense neighborhoods.