Longitudinal neighbourhood determinants with cognitive health and dementia disparities: protocol of the Multi-Ethnic Study of Atherosclerosis Neighborhoods and Aging prospective cohort study

INTRODUCTION

The burden of Alzheimer's disease (AD) and AD-related dementias (ADRD) is increasing nationally and globally, with disproportionate impacts on lower-income, lower education and systematically marginalised older adults. Presence of inequalities in neighbourhood factors (eg, social context, physical and built environments) may affect risk of cognitive decline and be key for intervening on AD/ADRD disparities at the population level. However, existing studies are limited by a dearth of longitudinal, detailed neighbourhood measures linked to rich, prospective cohort data. Our main objective is to identify patterns of neighbourhood change related to prevalence of-and disparities in-cognitive decline and dementia.

METHODS AND ANALYSES

We describe the process of collecting, processing and linking extensive neighbourhood data to the Multi-Ethnic Study of Atherosclerosis (MESA), creating a 25+ years dataset. Within the MESA parent study, the MESA Neighborhoods and Aging cohort study will characterise dynamic, longitudinal neighbourhood social and built environment variables relevant to cognition for residential addresses of MESA participants. This includes administering new surveys, expanding residential address histories, calculating new measures derived from spatial data and implementing novel deep learning algorithms on street-level imagery. Applying novel statistical techniques, we will examine associations of neighbourhood environmental characteristics with cognition and clinically relevant AD/ADRD outcomes. We will investigate determinants of disparities in outcomes by socioeconomic position and race/ethnicity and assess the contribution of neighbourhood environments to these disparities. This project will provide new evidence about pathways between neighbourhood environments and cognitive outcomes, with implications for policies to support healthy ageing.

ETHICS AND DISSEMINATION

This project was approved by the University of Washington and Drexel University Institutional Review Boards (protocols #00009029 and #00014523, and #180900605). Data will be distributed through the MESA Coordinating Center. Findings will be disseminated in peer-reviewed scientific journals, briefs, presentations and on the participant website.

Fear of violence during armed conflict: Social roles and responsibilities as determinants of fear

This article investigates the prevalence and determinants of fear as a consequence of living through armed conflict. We use survey data from Nepal during the armed conflict (1996-2006) to examine how trauma, sex and gender, age, marriage, and household size affect fear of violence. We also disaggregate types of worry, and find substantial variance on whether respondents were more concerned about livelihood consequences of conflict than physical danger. We supplement quantitative analyses with discussion of in-depth interviews from the study area on these same topics. Overall, our results highlight the enduring impact of gender roles in Nepal and that conflict might disproportionately affect those who are already vulnerable and have greater social responsibilities. This article provides a unique comparison between fear of violence during armed conflict in a low-income country to the fear of crime literature based in high-income countries.

The Gender Gap in Fear of Crime, 1973-1994: A Methodological Approach

The literature on fear of crime consistently finds much higher levels of reported fear among women than among men (Baumer, 1978; Ferraro, 1996; Warr, 1984). Thus we know which segment of the population is most fearful, and we know some of the correlates associated with that fear, but there has been little research that has examined social change in respondents' fear of crime, particularly in regard to the question of whether the gender gap in fear of crime has changed over time. In the present article, using data from the General Social Survey from 1973 to 1994 and data from the Uniform Crime Reports, five methods of studying social change are applied in examining this question: proximate decomposition, trend analysis, pooled time-series analysis, a changing parameter model, and a hierarchical linear regression model. These methods will be used to answer three questions. First, did fear of crime increase from 1973 to 1994, and is that change attributable to individual attitude change or to population turnover? Second, has the gender gap in reported fear of crime narrowed or widened over time? Third, can relevant variables be identified, such as the nation's violent crime rate, to account for changes in the gender gap?

Findings from these analyses indicate that, overall, a gradual rise in levels of reported fear of crime has occurred, but this masks considerable variation, including periods of declining fear of crime. Although women are much more likely to fear crime, the gender gap has narrowed as men's reported fear of crime has gradually increased over time while women's has remained stable (albeit at a high level). Although no variables are found to explain the gender gap in fear of crime, hierarchical linear models reveal that the nation's violent crime rate is associated with men's rising fear of crime over time.

Crime, fear of crime and mental health: synthesis of theory and systematic reviews of interventions and qualitative evidence

Background

Crime and fear of crime may impact negatively on health and well-being. Interventions to reduce crime and fear of crime, particularly interventions in the physical environment, may be a promising way to improve population-level well-being.

Project components

(1) Mapping review of theories and pathways; (2) systematic review of effectiveness; (3) systematic review of UK qualitative data; and (4) focus groups and interviews with stakeholders.

Methods

(1) The mapping review was a pragmatic non-systematic review focusing on theoretical literature and observational quantitative studies and development of a theoretical model of pathways. (2 and 3) The systematic reviews followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. In total, 18 databases including EMBASE, MEDLINE, PsycINFO and Science Citation Index were searched from inception to 2010. Studies presenting data on the built environment and the fear of crime were included. Quality assessment was conducted. Data synthesis was conducted narratively for the intervention review, with harvest plots to synthesise data on inequalities, and by thematic analysis for the review of qualitative evidence. (4) Semistructured interviews with nine stakeholders working in community safety and two focus groups with members of the public were conducted to inform the methods of the project and the dissemination of findings. Data were analysed thematically.

Results

(1) There are complex and often indirect links between crime, fear of crime, environment, and health and well-being at both individual and population levels. Fear of crime is associated with poorer health outcomes. There is considerable debate about the measurement of fear of crime. Both fear of crime and crime are associated with a range of environmental factors. (2) A total of 12,093 references were screened on abstract for the two systematic reviews. Of these, 47 effectiveness studies (22 controlled and 25 uncontrolled) were included in the systematic review of effectiveness, with 36 conducted in the UK, 10 in the USA and one in the Netherlands. There is some evidence that home security improvements and non-crime-related environmental improvements may improve some fear of crime outcomes. There is little evidence that the following reduce fear of crime: street lighting improvements, closed-circuit television, multicomponent environmental crime prevention programmes or regeneration programmes. The evidence on housing improvement is mixed. Very few data on the health and well-being outcomes of crime reduction interventions were located and the study quality overall is poor. (3) A total of 39 studies were included in the systematic review of qualitative data. Several factors in the physical environment are perceived to impact on fear of crime. However, factors in the local social environment appear to be more important as drivers of fear of crime. There is considerable evidence for limitations on physical activity as a result of fear of crime, but less for mental health impacts. (4) Stakeholders see fear of crime as harder to address than crime and as linked to health and well-being. Environmental interventions, such as Secured by Design, are widely used and positively regarded.

Limitations

The review is relatively restricted in its scope and a number of relevant interventions and themes are excluded. The underlying evidence base is of limited quality, particularly for the effectiveness review, and is heterogeneous.

Conclusions

Broader social interventions appear more promising than crime-focused environmental interventions as a means of improving fear of crime, health and well-being. The qualitative evidence suggests that fear of crime may impact on physical activity. More broadly, crime and fear of crime appear to be linked to health and well-being mainly as aspects of socioeconomic disadvantage. This review indicates the following gaps in the literature: evaluation research on the health impacts of crime reduction interventions; more robust research on interventions to reduce fear of crime; systematic reviews of non-environmental interventions to reduce fear of crime and systematic reviews of qualitative evidence on other crime-related topics.

Funding

The National Institute for Health Research Public Health Research programme.

The effects of health, environmental, and socio-psychological variables on fear of crime and its consequences among urban black elderly individuals

Despite extensive research on fear of crime among elder members of the population, little attention has been paid to the fear of crime among Black urban elderly individuals. Using a sample of 372 low income urban Black persons aged sixty-two and over the causes and consequences of such fear were investigated. Fear of crime reduces subjective well-being of these older adults and limits their mobility. Age, gender, education, marital status, loneliness, self-reported health status, previous victimization experience, media exposure, trust of neighbors, length of residence, and type of housing were tested to identify significant predictors of fear of crime. Some of these variables had a diverse impact on fear of crime at home versus outside of the home. For example, while gender was the strongest predictor of fear of crime outside the home, it was not significantly associated with fear inside the home. Surprisingly, self-reported health status was not related to fear of crime among this sample of urban Black elderly individuals.

Fear of crime and the likelihood of victimization: a bi-ethnic comparison

Fear of crime and the likelihood of future victimization for Hispanics and Blacks in the United States was examined. The sample size was 2,235 (1,696 Black and 539 Hispanic respondents). Fear of crime and the likelihood of victimization were perceived as serious social problems by both Hispanics and Blacks, but Hispanics and women reported higher levels of fear of crime and felt more likely to be victimized than Blacks and men did.