Feelings of safety during daytime walking: associations with mental health, physical activity and cardiometabolic health in high vacancy, low-income neighborhoods in Detroit, Michigan

Neighborhood factors associated with late effects among survivors of adolescent and young adult cancer

PURPOSE

The purpose of this study is to evaluate the associations between neighborhood income, education, and neighborhood racial composition (measured as a low percentage of white residents) and risk of developing cardiovascular diseases (CVD), diabetes (DM), and severe depression among survivors of AYA cancer and matched non-cancer peers.

METHODS

Two-year survivors of AYA cancers diagnosed at age 15-39 yrs at Kaiser Permanente Southern California (diagnosed 2000-2012) and individually matched (1:13) non-cancer subjects were included. The development of CVD, DM, and severe depression was ascertained via electronic health records. Neighborhood characteristics were obtained from census-based geocoded data. Cox regression evaluated associations between neighborhood characteristics and the health outcomes of interest among both the cancer survivors and the non-cancer comparison cohort and effect modification by cancer survivor status on these relationships.

RESULTS

Among cancer survivors (n = 6774), living in mostly non-white neighborhoods, was associated with risk of CVD (hazard ratio (HR) = 1.54 (95% CI 1.00-2.36)), while lower education level (HR = 1.41 (95% CI 1.02-1.94)) was associated with risk of severe depression. None of the neighborhood characteristics were associated with risk of DM. Effect modification was found for neighborhood education and risk of DM and severe depression.

CONCLUSION

When jointly considered, cancer survivors who resided in the most disadvantaged neighborhoods were at the highest risk of developing these health outcomes compared to other subgroups.

IMPLICATIONS FOR CANCER SURVIVORS

Our findings may inform screening strategy and addressing social determinants of health among AYA cancer survivors.

The significance of feeling safe for resilience of adolescents in sub-Saharan Africa

Introduction

Adolescents in sub-Saharan Africa (SSA) are exposed to several challenges and risk factors, linked to historical legacies. Sub-Saharan Africa has one of the highest rates of poverty and inequality in the world, is one of the regions most negatively affected by climate change, performs poorly on many health measures, and has high rates of different forms of violence, especially gender-based violence. These contextual challenges impact adolescent mental health outcomes, preventing them to access resilience-enabling pathways that support positive outcomes despite adversity. This study aimed to contribute to knowledge generation on resilience of young people in the understudied SSA region by investigating which variables directly (or indirectly) affect the resilience of adolescents.

Methods

Purposive sampling was used to collect quantitative survey data from 3,312 adolescents (females = 1,818; males = 1,494) between the ages of 12 and 20 years, participating in interventions implemented by a non-governmental organization, the Regional Psychosocial Support Initiative. Data were collected in Angola (385, 11.6%), Eswatini (128, 3.9%), Kenya (390, 11.8%), Lesotho (349, 10.5%), Mozambique (478, 14.4%), Namibia (296, 8.9%), South Africa (771, 23.3%), Uganda (201, 6.1%), and Zambia (314, 9.5%). The survey collected data on socio-demographic status, resilience (CYRM-R), depression (PHQ-9), self-esteem (Rosenberg Self-Esteem Scale) and feelings of safety (self-developed scale). Mental health was defined as lower levels of depression, higher levels of self-esteem and higher levels of feeling safe. A mediation analysis was conducted to investigate the relationship between the predictors (the socio-demographic variables) and the output (resilience), with the mediators being depression, self-esteem and feeling safe (which all link to mental health).

Results

This study contributes to a gap in knowledge on country-level comparative evidence on significant predictors that impact resilience outcomes (directly or indirectly) for adolescents in sub-Saharan African countries. The results indicate that, when considering all countries collectively, feeling safe is the only predictor that has a significant direct effect on overall resilience and personal resilience, but not on caregiver resilience. When considering each country separately, feeling safe has a direct effect on overall, personal and caregiver resilience for all countries; but not for South Africa and Mozambique.

Discussion

The results provide evidence on which to craft youth development interventions by measuring mediators (depression, self-esteem and feeling safe) and resilience for adolescents in sub-Saharan Africa. The overall results of the present paper point toward a contextually relevant pathway to supporting their resilience, namely, the need to systemically target the creation and/or strengthening of structures that enable adolescents to feel safe.

Pathways between neighbourhood factors, stress and glycaemic control in individuals with type 2 diabetes in Southeastern United States: a cross-sectional pathway analysis

OBJECTIVES

Understanding the pathway by which neighbourhood factors influence glycaemic control may be crucial to addressing health disparities in diabetes. This study aimed to examine if the pathway between neighbourhood factors and glycaemic control is mediated by stress.

DESIGN

Structured equation modelling (SEM) was used to investigate direct and indirect effects in the relationship between neighbourhood factors, stress and glycaemic control, with standardised estimates to allow comparison of paths.

PARTICIPANTS

Data was obtained from 615 adults with type 2 diabetes in the Southeastern United States.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome variable was glycaemic control determined by glycated haemoglobin (HbA1c) within the prior 6 months. Neighbourhood factors included neighbourhood violence, aesthetic quality of the neighbourhood, access to healthy food, and social cohesion. Stress was measured using the perceived stress scale.

RESULTS

In the final model (χ²(158)=406.97, p<0.001, root mean square error of approximation=0.05, p-close 0.38, Comparative Fit Index=0.97, Tucker-Lewis index=0.96, the coefficient of determination=1.0), violence (r=0.79, p=0.006), neighbourhood aesthetics (r=0.74, p=0.02) and social cohesion (r=0.57, p=0.04) were significantly associated with higher perceived stress. Stress (r=0.06, p=0.004) was directly associated with higher glycaemic control. Significant indirect effects existed between violence and higher HbA1c (r=0.05, p=0.04). After controlling for other neighbourhood factors, there was no significant relationship between access to healthy food and either stress or glycaemic control.

CONCLUSIONS

While a number of neighbourhood factors were directly associated with stress, only neighbourhood violence had a significant indirect effect on glycaemic control via stress within the tested pathway. Future studies should examine individual-level stress management interventions and should consider community-level interventions targeting neighbourhood violence as strategies for addressing disparities in diabetes.

Factors Affecting Perceived Health Benefits and Use Behaviors in Urban Green Spaces During the COVID-19 Pandemic in Southern China Megacities

Background: The COVID-19 pandemic has alienated people from urban green spaces (UGSs) that have various health outcomes for humans. However, little is known about the influential factors of perceived health benefits and use behaviors in UGSs during the COVID-19 pandemic. This study aims to explore the key factors that influence perceived health benefits and use behaviors in UGSs and to assess the mediating role of place attachment in relationships during the COVID-19 pandemic in Chinese megacities. Methods: We conducted an online questionnaire survey from December 2020 to March 2021 in Guangzhou and Shenzhen, China. Six multiple regression models were constructed to investigate the main factors by which UGSs influence citizens' perceived health benefits and use behaviors. Four mediation models were established using the structural equation modeling (SEM) method to explore the mediating effect of place attachment. Results: A total of 628 questionnaires were included in the analysis. The results revealed that some UGS components (green space access, maintenance, and soundscape) significantly affected perceived health benefits for citizens (physical, mental, and social health) during the COVID-19 pandemic. Conversely, use behaviors (frequency of visits, duration of visits, and activity intensity) were mainly affected by the sociodemographic context but less affected by UGS components. In addition, UGS components were found to significantly predict place attachment, which in turn influenced the perceived health benefits, frequency, and duration of visits. Conclusions: This study distinguished the key factors that affect perceived health benefits and use behaviors during the COVID-19 pandemic: green space access, maintenance, soundscape, and sociodemographic characteristics. Place attachment still needs to be considered when discussing how to encourage citizens to visit UGSs during the pandemic. These findings provide implications for policymakers and landscape planners regarding design and management measures for UGSs that are conducive to coping with pandemics.