Residential Segregation and Overweight/Obesity Among African-American Adults: A Critical Review

Structural Racism, Lifestyle Behaviors, and Obesity-related Cancers among Black and Hispanic/Latino Adults in the United States: A Narrative Review

One in three adults in the United States has obesity; a chronic disease that is implicated in the etiology of at least 14 cancers. Cancer is the leading cause of death among U.S. Hispanic/Latino adults and the second most common cause of death, after cardiovascular disease, for Black adults. Our country's legacy in overt discrimination (e.g., slavery, segregation) generated inequities across all spheres in which people function as defined by the socioecological model-biological, individual, community, structural-and two of the many areas in which it manifests today are the disproportionate burden of obesity and obesity-related cancers in populations of color. Inequities due to environmental, social, and economic factors may predispose individuals to poor lifestyle behaviors by hindering an individual's opportunity to make healthy lifestyles choices. In this review, we examined the evidence on obesity and the lifestyle guidelines for cancer prevention in relation to cancer risk and outcomes for Black and Hispanic/Latino adults. We also discussed the role of structural and societal inequities on the ability of these two communities to adopt and maintain healthful lifestyle behaviors in accordance with the lifestyle guidelines for cancer prevention and control.

Differences in Body Weight According to Skin Color and Sex in Mexican Adults

OBJECTIVES

1) To analyze the differences in body weight according to skin color in Mexican adults. 2) Identify mediator variables that could explain possible differences in body weight according to skin color.

METHODS

A nationally representative survey of Mexican adults was analyzed (n = 12,021). People with obesity were identified (body mass index, BMI > 30) based on self-reported weight and height. Skin color was measured by self-report using a chromatic scale. The mediator variables were socioeconomic level, height, neighborhood public services, public safety, and discrimination based on skin color.

RESULTS

Compared to white-skinned women, brown-skinned women had higher BMI and a higher probability of being obese. These differences in weight by skin color are related to the lower level of education and more discrimination experiences of brown-skinned women. In men, there were no differences in weight according to skin color.

CONCLUSIONS

In Mexican women (but not in men), darker skin color was associated with a higher probability of being obese, and the examined social factors partially explained this disparity.

Interpersonal Discrimination, Neighborhood Inequities, and Children's Body Mass Index: A Descriptive, Cross-Sectional Analysis

Psychosocial stressors have been implicated in childhood obesity, but the role of racism-related stressors is less clear. This study explored associations between neighborhood inequities, discrimination/harassment, and child body mass index (BMI). Parents of children aged 5-9 years from diverse racial/ethnic backgrounds (n = 1307), completed surveys of their child's exposure to discrimination/harassment. Census tract data derived from addresses were used to construct an index of concentration at the extremes, a measure of neighborhood social polarization. Child's height and weight were obtained from medical records. Multiple regression and hierarchical models examined child's BMI and racism at the individual and census tract levels. Children residing in the most Black-homogenous census tracts had 8.2 percentage units higher BMI percentile (95% confidence interval, 1.5-14.9) compared with white-homogenous tracts (P = .03). Household income and home values were lower, poverty rates higher, and single parent households more common among Black-homogeneous census tracts. Almost 30% of children experienced discrimination/harassment in the past year, which was associated with a 5.28-unit higher BMI percentile (95% confidence interval, 1.72-8.84; P = .004). Discrimination and racial/economic segregation were correlated with higher child BMI. Longitudinal studies are needed to understand whether these factors may be related to weight gain trajectories and future health.

Neighborhood characteristics of low radon testing activities: A longitudinal study in Atlanta, Georgia, United States

Radon testing remains low even nationwide although its exposure is the leading cause of lung cancer among non-smokers. Little has been done to examine the neighborhood characteristics with low testing prevalence. This study investigated the associations between indoor radon testing and neighborhood characteristics in an urban environment with the highest Radon potential. A total of 25 years (1990-2015) of radon tests (n = 6355) were pooled from public and private sources in DeKalb County, Georgia, United States. Neighborhoods were characterized using racial residential segregation for African Amercians in addition to other social indicators. The associations between neighborhood characteristics and radon testing rates were evaluated using Ordinary Least Squares and Spatial Regression Models, respectively. Results show that the testing rates were lower than 6.5% over the 25 years. Summers followed by early springs experienced more tests than the other seasons. Areas of low testing rates (≤1.55%) spatially matches the mostly segregated neighborhoods. Residential segregation expanded in the 25 years and was significantly correlated (P value < 0.05) with low testing rates, even after other social indicators were controlled. Associations with the other social indicators, such as income or education, were weaker. Concertedly identifying the culturally relevant interventions in segregated communities is necessary to reduce and eliminate threats from environmental radon.

Considering social determinants of health in the relationship between physical activity and exercise engagement and cognitive impairment among persons with epilepsy

Many persons with epilepsy (PWE) are not as active or physically fit as compared to the general population. This lack of engagement in physical activity has been attributed to a number of factors, few of which take into consideration the social determinants of health (SDH). In this perspective, we highlight how SDH are considered in explaining lower levels of physical activity engagement among PWE, particularly for those experiencing cognitive impairment. We also discuss how these data can be applied in research to yield a greater impact on the quality of life among PWE. Consideration of SDH allows for increased understanding of how cognition can be both a determinant of physical activity and an outcome of environments conducive to physical activity in PWE.

Using photovoice to explore social determinants of obesity in two underserved communities in the southeast

Over the past 25 years, the adult obesity rate in the U.S. has increased 70%, with obesity placing a disproportionate chronic disease burden on African Americans. Using Photovoice methodology, this study aimed to: (1) explore the social determinants contributing to obesity from the perspectives of residents of two low-income municipalities in Birmingham, Alabama with varying levels of segregation, (2) better understand residents' perceptions of contributors to obesity in their communities, and (3) examine residents' perceptions of interventions that might be effective in promoting positive change. Focus groups (N=10) segmented by race and community were conducted by trained moderators. Transcriptions were analyzed by theoretical thematic analysis. The study design and data analysis analyses were guided by a conceptual framework based on the Social Determinants of Obesity model. Findings from this study lend support to the efficacy of the conceptual framework as a multilevel approach describing obesity disparities in the south. Regardless of community and race, participants believed that elements of their built environment, such as fast food restaurants and unsafe walking conditions, contributed to obesity, and that schools and churches should play an active role in addressing the issue.

Effects of gentrification on health status after Hurricane Katrina

Despite substantial debate about the impacts of gentrification on cities, neighborhoods, and their residents, there is limited evidence to demonstrate the implications of gentrification for health. We examine the impacts of gentrification on several health measures using a unique individual-level longitudinal data set. We employ data from the Resilience in Survivors of Hurricane Katrina (RISK) project, a study of low-income parents, predominantly non-Hispanic Black single mothers, who participated in a New Orleans-based study before and after Hurricane Katrina. After Katrina, all participants were displaced, at least temporarily, from New Orleans, and had little or no control over neighborhood placement immediately following the storm. This near-random displacement after Katrina created a natural experiment. We employ a quasi-experimental intent to treat design to assess the causal effects of gentrification on health in the RISK population. We do not find evidence of significant main effects of being displaced to a gentrified neighborhood on BMI, self-rated health, or psychological distress. The analysis employs a quasi-experimental design and has several additional unique features--homogeneous population, limited selection bias, and longitudinal data collection-- that improve our ability to draw causal conclusions about the relationship between gentrification and health. However, the unique context of displacement by natural disaster may limit the generalizability of our findings to other circumstances or residents experiencing gentrification.

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.

The Impacts of Residential Segregation on Obesity

BACKGROUND

This study examined the association between residential segregation and obesity for Whites, African Americans, Hispanics, and Asians. This study considered 3 dimensions of residential segregation, isolation, dissimilarity, and concentration.

METHODS

By combining individual-level data from the Behavioral Risk Factor Surveillance System and county-level data from the County Health Rankings and Roadmaps, the total sample size was 204,610 respondents (160,213 Whites, 21,865 African Americans, 18,027 Hispanics, and 4505 Asians) from 205 counties in the United States. Two-level logistic regression models were performed.

RESULTS

African Americans and Hispanics in counties with high levels of isolation, dissimilarity, and concentration were more likely to be obese; these relationships did not hold true for Whites and Asians. Counties with a higher percentage of populations with the income below the poverty line and a higher percentage of fast food restaurants in the county were associated with a higher likelihood of obesity for all racial/ethnic groups. African Americans and Hispanics with low levels of education and income were more likely to be obese.

CONCLUSIONS

Residential segregation had a contextual influence on weight status, and the context of counties influenced racial/ethnic groups differently. Obesity reduction programs should consider the contextual influence on minority populations and target subgroups living in highly segregated areas.

Developing a data-driven spatial approach to assessment of neighbourhood influences on the spatial distribution of myocardial infarction

BACKGROUND

There is a growing understanding of the role played by 'neighbourhood' in influencing health status. Various neighbourhood characteristics-such as socioeconomic environment, availability of amenities, and social cohesion, may be combined-and this could contribute to rising health inequalities. This study aims to combine a data-driven approach with clustering analysis techniques, to investigate neighbourhood characteristics that may explain the geographical distribution of the onset of myocardial infarction (MI) risk.

METHODS

All MI events in patients aged 35-74 years occurring in the Strasbourg metropolitan area (SMA), from January 1, 2000 to December 31, 2007 were obtained from the Bas-Rhin coronary heart disease register. All cases were geocoded to the census block for the residential address. Each areal unit, characterized by contextual neighbourhood profile, included socioeconomic environment, availability of amenities (including leisure centres, libraries and parks, and transport) and psychosocial environment as well as specific annual rates standardized (per 100,000 inhabitants). A spatial scan statistic implemented in SaTScan was then used to identify statistically significant spatial clusters of high and low risk of MI.

RESULT

MI incidence was non-randomly spatially distributed, with a cluster of high risk of MI in the northern part of the SMA [relative risk (RR) = 1.70, p = 0.001] and a cluster of low risk of MI located in the first and second periphery of SMA (RR 0.04, p value  =  0.001). Our findings suggest that the location of low MI risk is characterized by a high socioeconomic level and a low level of access to various amenities; conversely, the location of high MI risk is characterized by a high level of socioeconomic deprivation-despite the fact that inhabitants have good access to the local recreational and leisure infrastructure.

CONCLUSION

Our data-driven approach highlights how the different contextual dimensions were inter-combined in the SMA. Our spatial approach allowed us to identify the neighbourhood characteristics of inhabitants living within a cluster of high versus low MI risk. Therefore, spatial data-driven analyses of routinely-collected data georeferenced by various sources may serve to guide policymakers in defining and promoting targeted actions at fine spatial level.

Residential Segregation and Racial Cancer Disparities: A Systematic Review

BACKGROUND

This paper provides the first review of empirical studies of segregation and black-white cancer disparities.

METHODS

We searched all years of PubMed (through May 2016) using these terms: racial segregation, residential segregation, neighborhood racial composition (first terms) and (second terms) cancer incidence, mortality, survival, stage at diagnosis, screening. The 17 (of 668) articles that measured both segregation and a cancer outcome were retained.

RESULTS

Segregation contributed significantly to cancer and to racial cancer disparities in 70% of analyses, even after controlling for socioeconomic status and health insurance. Residing in segregated African-American areas was associated with higher odds of later-stage diagnosis of breast and lung cancers, higher mortality rates and lower survival rates from breast and lung cancers, and higher cumulative cancer risks associated with exposure to ambient air toxics. There were no studies of many types of cancer (e.g., cervical). Studies differed in their measure of segregation, and 40% used an invalid measure. Possible mediators of the segregation effect usually were not tested.

CONCLUSIONS

Empirical analysis of segregation and racial cancer disparities is a recent area of research. The literature is limited to 17 studies that focused primarily on breast cancer. Studies differed in their measure of segregation, yet segregation nonetheless contributed to cancer and to racial cancer disparities in 70% of analyses. This suggests the need for further research that uses valid measures of segregation, examines a variety of types of cancers, and explores the variables that may mediate the segregation effect.

Inequities in tobacco retailer sales to minors by neighbourhood racial/ethnic composition, poverty and segregation, USA, 2015

OBJECTIVE

Tobacco retailers are an important source of tobacco products for minors. Previous research shows racial discrimination in sales to minors, but no national study has examined neighbourhood correlates of retailer under-age sales.

METHODS

We accessed publicly available results of 2015 US Food and Drug Administration (FDA) inspections of tobacco retailers (n=108 614). In this cross-sectional study, we used multilevel logistic regression to predict the likelihood of retailer sale to a minor based on tract characteristics. We assessed the proportion of residents identifying as American Indian, Asian, Black, Latino and White; Isolation Index scores for each racial/ethnic group; the proportion of people less than age 65 living in poverty; and the proportion of residents age 10-17 in relation to retailer inspection results.

RESULTS

The proportion of American Indian residents, Black residents, Latino residents and residents less than age 65 under the poverty line in a neighbourhood are independently, positively associated with the likelihood that a retailer in that neighbourhood will fail an under-age buy inspection. The proportion of White residents and residents age 10-17 are independently, negatively associated with the likelihood of sale of tobacco products to a minor. Isolation Index scores show a similar pattern. In multivariable models holding neighbourhood characteristics constant, higher proportions of Black (+), Latino (+) and age 10-17 (-) residents remained significant predictors of the likelihood of under-age sale.

DISCUSSION

Regulatory agencies should consider oversampling retailers in areas with higher likelihood of sales to minors for inspection. Interventions with tobacco retailers to reduce inequities in youth access should be implemented.

Research on neighborhood effects on health in the United States: A systematic review of study characteristics

Neighborhood effects on health research has grown over the past 20 years. While the substantive findings of this literature have been published in systematic reviews, meta-analyses, and commentaries, operational details of the research have been understudied. We identified 7140 multi-level neighborhoods and health papers published on US populations between 1995 and 2014, and present data on the study characteristics of the 256 papers that met our inclusion criteria. Our results reveal rapid growth in neighborhoods and health research in the mid-2000s, illustrate the dominance of observational cross-sectional study designs, and show a heavy reliance on single-level, census-based neighborhood definitions. Socioeconomic indicators were the most commonly analyzed neighborhood variables and body mass was the most commonly studied health outcome. Well-known challenges associated with neighborhood effects research were infrequently acknowledged. We discuss how these results move the agenda forward for neighborhoods and health research.