1
|
Arcaya MC, Ellen IG, Steil J. Neighborhoods And Health: Interventions At The Neighborhood Level Could Help Advance Health Equity. Health Aff (Millwood) 2024; 43:156-163. [PMID: 38315920 DOI: 10.1377/hlthaff.2023.01037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Housing is tied to neighborhoods. Therefore, to understand how housing affects health and health equity, the role of neighborhood environments must be considered. This article is a critical review of the relationship between neighborhoods and health. We discuss inequality among US neighborhoods and the roots of that inequality. We then explore the ways in which neighborhood environments may shape health, review the evidence about these effects, and discuss policy responses. Many studies document an association between neighborhoods and physical and mental health, and a few studies suggest that some of these relationships are causal. Thus, the evidence suggests that interventions at the neighborhood scale can potentially help advance health equity. Further research on the long-term impacts of neighborhoods on health and more rigorous studies of the impact of particular neighborhood interventions are needed. To advance health equity, policy makers also need to better understand the institutional arrangements and social policies that have created neighborhood inequality and pursue innovative approaches to changing them.
Collapse
Affiliation(s)
- Mariana C Arcaya
- Mariana C. Arcaya, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Justin Steil
- Justin Steil, Massachusetts Institute of Technology
| |
Collapse
|
2
|
Vu C, C Arcaya M, Kawachi I, Williams D. The mental health toll of the Great Migration: a comparison of mental health outcomes among descendants of African American migrators. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02605-x. [PMID: 38231395 DOI: 10.1007/s00127-023-02605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Research is beginning to examine the health outcomes of migrators of the Great Migration, a movement of up to eight million African Americans from the South to the North and West during the twentieth century. However, sparse evidence exists studying the health outcomes of the descendants of Great Migration movers. The aim for this study was to compare the lifetime prevalence of mental health disorders by migration status. METHODS We used a sample of 3183 African American adults from the National Survey of American Life (2001-2003). Using birthplaces of participants and their mothers, we classified adults as (1) Southern stayers, (2) migrators to the South, (3) migrators to the North or (4) Northern stayers. The outcomes were lifetime prevalence of any mental health, mood, anxiety, and substance use disorders. We used weighted log-Poisson regression models and adjusted for demographic characteristics and socioeconomic status. RESULTS Migrators to the North and Northern stayers had higher risks of any lifetime mental health, mood, anxiety, and substance use disorders compared to Southern stayers in the adjusted models. Migrators to the North and Northern stayers were more likely to report perceived discrimination. CONCLUSION This study suggests that migrating families to the North may have experienced mental health adversities.
Collapse
Affiliation(s)
- Cecilia Vu
- Harvard TH Chan School of Public Heath, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Mariana C Arcaya
- Department of Urban Studies at Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02138, USA
| | - Ichiro Kawachi
- Harvard TH Chan School of Public Heath, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - David Williams
- Harvard TH Chan School of Public Heath, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA
| |
Collapse
|
3
|
Schwartz GL, Leifheit KM, Arcaya MC, Keene D. Eviction as a community health exposure. Soc Sci Med 2024; 340:116496. [PMID: 38091853 DOI: 10.1016/j.socscimed.2023.116496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/23/2024]
Abstract
Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals' social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction's individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction's potentially multilevel consequences for policy advocacy and cost-benefit analyses.
Collapse
Affiliation(s)
- Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Urban Health Collaborative & Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Kathryn M Leifheit
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mariana C Arcaya
- Department of Urban Studies & Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Danya Keene
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
4
|
Vu C, Arcaya MC, Kawachi I, Williams DR. In Search of the Promised Land: County-Level Disadvantage and Low Birth Weight among Black Mothers of the Great Migration. J Urban Health 2023; 100:1093-1101. [PMID: 37580548 PMCID: PMC10728401 DOI: 10.1007/s11524-023-00778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/16/2023]
Abstract
The Great Migration was a movement of roughly eight million Black Southerners relocating to the North and West from 1910 to 1980. Despite being one of the most significant mass internal migrations during the twentieth century, little is known about the health outcomes resulting from migration and whether migrators' destination choices were potential mechanisms. This study measured the association between destination county disadvantage and odds of low birth weight during the last decade of the Great Migration. We used the US Census from 1970 as well as the birth records of first-time Black mothers who migrated from the South collected through the National Center of Health Statistics from 1973 to 1980 (n = 154,145). We examined three measures of area-based opportunity: Black male high school graduation rate, Black poverty rate, and racialized economic residential segregation. We used multilevel logistic regression, where mothers were nested within US counties, to quantify the relationship between county disadvantage and low birth weight. After adjusting for individual risk and protective factors for infant health, there was no relationship between county opportunity measures and low birth weight among migrators. Although high socioeconomic opportunity is typically associated with protection of low birth weight, we did not see these outcomes in this study. These results may support that persistent racial discrimination encountered in the North inhibited infant health even as migrators experienced higher economic opportunity relative to the South.
Collapse
Affiliation(s)
- Cecilia Vu
- Center for Antiracist Research, Boston University, Boston, MA, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mariana C Arcaya
- Department of Urban Studies, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
| |
Collapse
|
5
|
Davis BA, Arcaya MC, Williams DR, Krieger N. The impact of county-level fees & fines as exploitative revenue generation on US birth outcomes 2011-2015. Health Place 2023; 80:102990. [PMID: 36842240 DOI: 10.1016/j.healthplace.2023.102990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/30/2022] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
Fees and fines collected through courts and law enforcement can comprise a considerable proportion of revenue for local governments. Law enforcement, as agents of revenue generation, change policing behavior to increase revenue, at times targeting Black and brown neighborhoods to bolster municipal budgets. This structural racism in revenue generation has not yet been assessed as an exposure for adverse health. Using the 2012 Census of Governments, and 2011-2015 vital statistics from the National Center of Health Statistics, we examine the relationship between countyaverage fees and fines as a percent of total own-source revenue and county-level characteristics, and risk of preterm birth and low birthweight across the United States. Mothers residing in counties with the greatest reliance on fees and fines had 1.08 (95% CI: 1.03-1.12) times the odds of preterm birth and 1.07 (95% CI: 1.02-1.11) times the odds of low birthweight than mothers residing in counties with the least reliance on fees and fines, controlling for individual- and county-level covariates. The addition of countylevel racial composition, and the Index of Concentration at the Extremes (ICE), reduced these associations yet remained statistically significant. Future studies should continue to examine how racist, exploitative revenue generation through police and court activities influences the health of residents.
Collapse
Affiliation(s)
- Brigette A Davis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of African and African American Studies, Harvard University, Cambridge, MA, USA.
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
6
|
Lowe SR, James P, Arcaya MC, Vale MD, Rhodes JE, Rich-Edwards J, Roberts AL, Koenen KC. Do levels of posttraumatic growth vary by type of traumatic event experienced? An analysis of the Nurses' Health Study II. Psychol Trauma 2022; 14:1221-1229. [PMID: 32212776 PMCID: PMC7529660 DOI: 10.1037/tra0000554] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Posttraumatic growth (PTG) has been documented in the aftermath of a range of traumatic events, including bereavement, physical assault, and rape. However, only a handful of studies have examined whether levels of total PTG, as well as the 5 domains of PTG (Appreciation of Life, New Possibilities, Relating to Others, Personal Strength, and Spiritual Change), vary by the type of potentially traumatic event. The current study examined variation in total PTG and PTG domains, as well as posttraumatic stress (PTS), by event type using data from a large epidemiological study. METHOD Participants were from a substudy of the Nurses' Health Study 2, an epidemiologic study of female nurses in the United States (N = 1,574). RESULTS Controlling for demographic covariates, we found that rape was consistently associated with lower PTG, both total PTG and all five PTG domains, relative to other event types. Other findings were limited to specific PTG domains; for example, intimate partner violence (IPV) was associated with higher Personal Strength and New Possibilities. In contrast, rape and IPV were associated with higher PTS, and the serious illness or injury of someone close with lower PTS, relative to other event types. CONCLUSION These results add to the growing literature exploring variation in PTG by event type and suggest that different events could yield markedly different patterns of PTG domains and PTS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Sarah R. Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Mariana C. Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Boston, MA
| | - Mira D. Vale
- Department of Sociology, University of Michigan, Ann Arbor, MI
| | - Jean E. Rhodes
- Department of Psychology, University of Massachusetts Boston, Boston, MA
| | - Janet Rich-Edwards
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrea L. Roberts
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA
| | - Karestan C. Koenen
- Department of Social Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA
| |
Collapse
|
7
|
Binet A, Nidam Y, Houston-Read R, Lopez CG, del Rio GZ, Abreu D, Baty C, Baty A, Genty J, Graham G, Joseph J, Justice W, Roderigues G, Underhill D, Gavin V, Arcaya MC. Ownership of change: Participatory development of a novel latent construct for neighborhoods and health equity research. Soc Sci Med 2022; 309:115234. [DOI: 10.1016/j.socscimed.2022.115234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
|
8
|
Schwartz GL, Leifheit KM, Chen JT, Arcaya MC, Berkman LF. Childhood eviction and cognitive development: Developmental timing-specific associations in an urban birth cohort. Soc Sci Med 2021; 292:114544. [PMID: 34774367 DOI: 10.1016/j.socscimed.2021.114544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 08/17/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Eviction upends children's lives and exacerbates deprivation; it remains largely unexamined as a determinant of cognitive development. We assess whether children evicted in infancy, early childhood, and middle childhood exhibit lower scores on four cognitive assessments (measuring executive function, mathematical reasoning, written language skills, and vocabulary skills) at age 9. Using linear regression and selection weights, we analyze longitudinal data from the Fragile Families and Child Wellbeing Study, a national, urban birth cohort (N = 1724 for eviction during infancy, 2126 for early childhood, 1979 for middle childhood). These stages of childhood follow the timing of FFCWS' data collection waves, with "infancy" data collected in the first year of life, "early childhood" in the third and fifth years of life, and "middle childhood" in the ninth year. In adjusted models, children evicted in middle childhood exhibited scores 0.20-0.43 SDs below similar children who were not (depending on the assessment; p-values = 0.004-0.055), the equivalent of as much as a full year of schooling. Point estimates of the association between eviction in infancy and 3/4 cognitive skills at age 9 were also large, but imprecisely estimated (between -0.25 and -0.28 SDs; p-values = 0.053-0.101), while point estimates for eviction in early childhood were near zero and statistically insignificant. Our large estimates for middle childhood and infancy, compared to earlier residential mobility studies, indicate downwardly mobile moves may exhibit more severe associations with future cognition. Estimates suggest preventing eviction may be a powerful, cost-effective way to safeguard children's cognitive development.
Collapse
Affiliation(s)
- Gabriel L Schwartz
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
| | - Kathryn M Leifheit
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy & Management, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Jarvis T Chen
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lisa F Berkman
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
9
|
Sandoval-Olascoaga S, Venkataramani AS, Arcaya MC. Eviction Moratoria Expiration and COVID-19 Infection Risk Across Strata of Health and Socioeconomic Status in the United States. JAMA Netw Open 2021; 4:e2129041. [PMID: 34459904 PMCID: PMC8406080 DOI: 10.1001/jamanetworkopen.2021.29041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Housing insecurity induced by evictions may increase the risk of contracting COVID-19. OBJECTIVE To estimate the association of lifting state-level eviction moratoria, which increased housing insecurity during the COVID-19 pandemic, with the risk of being diagnosed with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included individuals with commercial insurance or Medicare Advantage who lived in a state that issued an eviction moratorium and were diagnosed with COVID-19 as well as a control group comprising an equal number of randomly selected individuals in these states who were not diagnosed with COVID-19. Data were collected from OptumLabs Data Warehouse, a database of deidentified administrative claims. The study used a difference-in-differences analysis among states that implemented an eviction moratorium between March 13, 2020, and September 4, 2020. EXPOSURES Time since state-level eviction moratoria were lifted. MAIN OUTCOMES AND MEASURES The primary outcome measure was a binary variable indicating whether an individual was diagnosed with COVID-19 for the first time in a given week with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code U07.1. The study analyzed changes in COVID-19 diagnosis before vs after a state lifted its moratorium compared with changes in states that did not lift it. For sensitivity analyses, models were reestimated on a 2% random sample of all individuals in the claims database during this period in these states. RESULTS The cohort consisted of 509 694 individuals (254 847 [50.0%] diagnosed with COVID-19; mean [SD] age, 47.0 [23.6] years; 239 056 [53.3%] men). During the study period, 43 states and the District of Columbia implemented an eviction moratorium and 7 did not. Among the states that implemented a moratorium, 26 (59.1%) lifted their moratorium before the US Centers for Disease Control and Prevention issued their national moratorium, while 18 (40.1%) maintained theirs. In a Cox difference-in-differences regression model, individuals living in a state that lifted its eviction moratorium experienced higher hazards of a COVID-19 diagnosis beginning 5 weeks after the moratorium was lifted (hazard ratio [HR], 1.39; 95% CI, 1.11-1.76; P = .004), reaching an HR of 1.83 (95% CI, 1.36-2.46; P < .001) 12 weeks after. Hazards increased in magnitude among individuals with preexisting comorbidities and those living in nonaffluent and rent-burdened areas. Individuals with a Charlson Comorbidity Index score of 3 or greater had an HR of 2.37 (95% CI, 1.67-3.36; P < .001) at the end of the study period. Those living in nonaffluent areas had an HR of 2.14 (95% CI, 1.51-3.05; P < .001), while those living in areas with a high rent burden had an HR of 2.31 (95% CI, 1.64-3.26; P < .001). CONCLUSIONS AND RELEVANCE The findings of this difference-in-differences analysis suggest that eviction-led housing insecurity may have exacerbated the COVID-19 pandemic.
Collapse
Affiliation(s)
- Sebastian Sandoval-Olascoaga
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge
- OptumLabs Visiting Fellow, Eden Prairie, Minnesota
| | - Atheendar S. Venkataramani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Mariana C. Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge
| |
Collapse
|
10
|
Schwartz GL, Leifheit KM, Berkman LF, Chen JT, Arcaya MC. Health Selection Into Eviction: Adverse Birth Outcomes and Children's Risk of Eviction Through Age 5 Years. Am J Epidemiol 2021; 190:1260-1269. [PMID: 33454765 PMCID: PMC8484772 DOI: 10.1093/aje/kwab007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 01/02/2023] Open
Abstract
Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. We tested whether infants experiencing an adverse birth outcome-low birthweight or prematurity, as well as lengthy hospital stays-were more likely to be evicted in early childhood, through age 5 years. We analyzed 5,655 observations contributed by 2,115 participants in the Fragile Families and Child Wellbeing Study-a national, randomly sampled cohort of infants born in large US cities between 1998 and 2000-living in rental housing at baseline. We fitted proportional hazards models using piecewise logistic regression, controlling for an array of confounders and applying inverse probability of selection weights. Having been born low birthweight or preterm was associated with a 1.74-fold increase in children's hazard of eviction (95% confidence interval: 1.02, 2.95), and lengthy neonatal hospital stays were independently associated with a relative hazard of 2.50 (95% confidence interval: 1.15, 5.44) compared with uncomplicated births. Given recent findings that unstable housing during pregnancy is associated with adverse birth outcomes, our results suggest eviction and health may be cyclical and co-constitutive. Children experiencing adverse birth outcomes are vulnerable to eviction and require additional supports.
Collapse
Affiliation(s)
- Gabriel L Schwartz
- Correspondence to Dr. Gabriel L. Schwartz, Institute for Health Policy Studies, University of California San Francisco, 995 Potrero Avenue, Building 80, Ward 83, San Francisco, CA 94110 (e-mail: )
| | | | | | | | | |
Collapse
|
11
|
Lowe SR, Raker EJ, Arcaya MC, Zacher ML, Waters MC, Rhodes JE. A Life-Course Model of Trauma Exposure and Mental Health Among Low-Income Survivors of Hurricane Katrina. J Trauma Stress 2020; 33:950-961. [PMID: 32816358 PMCID: PMC7725975 DOI: 10.1002/jts.22581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/11/2020] [Accepted: 06/10/2020] [Indexed: 12/26/2022]
Abstract
Prior research has provided robust evidence that exposure to potentially traumatic events (PTEs) during a disaster is predictive of adverse postdisaster mental health outcomes, including posttraumatic stress symptoms (PTSS) and nonspecific psychological distress (PD). However, few studies have explored the role of exposure to other PTEs over the life-course in shaping postdisaster mental health. Based on the broader literature on trauma exposure and mental health, we hypothesized a path analytic model linking predisaster PTEs to long-term postdisaster PTSS and PD via predisaster PD, short-term postdisaster symptoms, and disaster-related and postdisaster PTEs. We tested this model using data from the Resilience in Survivors of Katrina study, a longitudinal study of low-income, primarily non-Hispanic Black mothers exposed to Hurricane Katrina and assessed before the disaster and at time points 1, 4, and 12 years thereafter. The models evidenced a good fit with the data, RMSEA < .01-.04, CFIs > .99. In addition, 44.1%-67.4% of the effect of predisaster PTEs on long-term postdisaster symptoms was indirect. Descriptive differences were observed across models that included PTSS versus PD, as well as models that included all pre- and postdisaster PTEs versus only those that involved assaultive violence. The results suggest the importance of incorporating disaster preparedness in clinical work with trauma survivors and the value in attending to other lifetime PTEs when working in postdisaster contexts.
Collapse
Affiliation(s)
- Sarah R. Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ethan J. Raker
- Department of Sociology, Harvard University, Cambridge, Massachusetts, USA
| | - Mariana C. Arcaya
- Department of Urban Studies, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Meghan L. Zacher
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Mary C. Waters
- Department of Sociology, Harvard University, Cambridge, Massachusetts, USA
| | - Jean E. Rhodes
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Raker EJ, Arcaya MC, Lowe SR, Zacher M, Rhodes J, Waters MC. Mitigating Health Disparities After Natural Disasters: Lessons From The RISK Project. Health Aff (Millwood) 2020; 39:2128-2135. [PMID: 33284697 PMCID: PMC8533028 DOI: 10.1377/hlthaff.2020.01161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Climate change exacerbates the severity of natural disasters, which disproportionately affect vulnerable populations. Mitigating disasters' health consequences is critical to promoting health equity, but few studies have isolated the short- and long-term effects of disasters on vulnerable groups. We filled this gap by conducting a fifteen-year (2003-2018) prospective study of low-income, predominantly Black parents who experienced Hurricane Katrina: the Resilience in Survivors of Katrina (RISK) Project. Here we describe this project and synthesize lessons from work that has resulted from it. Our findings can guide policy makers, service providers, and health officials in disaster planning and response. We synthesize them into an organizational schema of five priorities: Primary efforts should be aimed at preventing exposure to trauma through investments in climate resilience and by eliminating impediments to evacuation, health care policies should promote uninterrupted and expanded access to care, social services should integrate and strive to reduce the administrative burden on survivors, programs should aid survivors in forging or strengthening connections to their communities, and policy makers should fund targeted long-term services for highly affected survivors.
Collapse
Affiliation(s)
- Ethan J Raker
- Ethan J. Raker is a PhD candidate in the Department of Sociology at Harvard University, in Cambridge, Massachusetts
| | - Mariana C Arcaya
- Mariana C. Arcaya is an associate professor of urban planning at the Massachusetts Institute of Technology, in Cambridge, Massachusetts
| | - Sarah R Lowe
- Sarah R. Lowe is an assistant professor in the Department of Social and Behavioral Sciences at the Yale School of Public Health, in New Haven, Connecticut
| | - Meghan Zacher
- Meghan Zacher is a postdoctoral fellow in the Population Studies and Training Center at Brown University, in Providence, Rhode Island
| | - Jean Rhodes
- Jean Rhodes is the Frank L. Boyden Professor of Psychology at the University of Massachusetts, Boston, in Boston, Massachusetts
| | - Mary C Waters
- Mary C. Waters is the PVK Professor of Arts and Sciences and the John L. Loeb Professor of Sociology at Harvard University
| |
Collapse
|
13
|
Zacher M, Raker EJ, Arcaya MC, Lowe SR, Rhodes J, Waters MC. Physical Health Symptoms and Hurricane Katrina: Individual Trajectories of Development and Recovery More Than a Decade After the Storm. Am J Public Health 2020; 111:127-135. [PMID: 33211584 DOI: 10.2105/ajph.2020.305955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine how physical health symptoms developed and resolved in response to Hurricane Katrina.Methods. We used data from a 2003 to 2018 study of young, low-income mothers who were living in New Orleans, Louisiana, when Hurricane Katrina struck in 2005 (n = 276). We fit logistic regressions to model the odds of first reporting or "developing" headaches or migraines, back problems, and digestive problems, and of experiencing remission or "recovery" from previously reported symptoms, across surveys.Results. The prevalence of each symptom increased after Hurricane Katrina, but the odds of developing symptoms shortly before versus after the storm were comparable. The number of traumatic experiences endured during Hurricane Katrina increased the odds of developing back and digestive problems just after the hurricane. Headaches or migraines and back problems that developed shortly after Hurricane Katrina were more likely to resolve than those that developed just before the storm.Conclusions. While traumatic experiences endured in disasters such as Hurricane Katrina appear to prompt the development of new physical symptoms, disaster-induced symptoms may be less likely to persist or become chronic than those emerging for other reasons.
Collapse
Affiliation(s)
- Meghan Zacher
- Meghan Zacher is with the Population Studies and Training Center and the Data Science Initiative, Brown University, Providence, RI. Ethan J. Raker and Mary C. Waters are with the Department of Sociology, Harvard University, Cambridge, MA. Mariana C. Arcaya is with the Department of Urban Studies, Massachusetts Institute of Technology, Cambridge. Sarah R. Lowe is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. Jean Rhodes is with the Department of Psychology, University of Massachusetts, Boston
| | - Ethan J Raker
- Meghan Zacher is with the Population Studies and Training Center and the Data Science Initiative, Brown University, Providence, RI. Ethan J. Raker and Mary C. Waters are with the Department of Sociology, Harvard University, Cambridge, MA. Mariana C. Arcaya is with the Department of Urban Studies, Massachusetts Institute of Technology, Cambridge. Sarah R. Lowe is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. Jean Rhodes is with the Department of Psychology, University of Massachusetts, Boston
| | - Mariana C Arcaya
- Meghan Zacher is with the Population Studies and Training Center and the Data Science Initiative, Brown University, Providence, RI. Ethan J. Raker and Mary C. Waters are with the Department of Sociology, Harvard University, Cambridge, MA. Mariana C. Arcaya is with the Department of Urban Studies, Massachusetts Institute of Technology, Cambridge. Sarah R. Lowe is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. Jean Rhodes is with the Department of Psychology, University of Massachusetts, Boston
| | - Sarah R Lowe
- Meghan Zacher is with the Population Studies and Training Center and the Data Science Initiative, Brown University, Providence, RI. Ethan J. Raker and Mary C. Waters are with the Department of Sociology, Harvard University, Cambridge, MA. Mariana C. Arcaya is with the Department of Urban Studies, Massachusetts Institute of Technology, Cambridge. Sarah R. Lowe is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. Jean Rhodes is with the Department of Psychology, University of Massachusetts, Boston
| | - Jean Rhodes
- Meghan Zacher is with the Population Studies and Training Center and the Data Science Initiative, Brown University, Providence, RI. Ethan J. Raker and Mary C. Waters are with the Department of Sociology, Harvard University, Cambridge, MA. Mariana C. Arcaya is with the Department of Urban Studies, Massachusetts Institute of Technology, Cambridge. Sarah R. Lowe is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. Jean Rhodes is with the Department of Psychology, University of Massachusetts, Boston
| | - Mary C Waters
- Meghan Zacher is with the Population Studies and Training Center and the Data Science Initiative, Brown University, Providence, RI. Ethan J. Raker and Mary C. Waters are with the Department of Sociology, Harvard University, Cambridge, MA. Mariana C. Arcaya is with the Department of Urban Studies, Massachusetts Institute of Technology, Cambridge. Sarah R. Lowe is with the Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT. Jean Rhodes is with the Department of Psychology, University of Massachusetts, Boston
| |
Collapse
|
14
|
Abstract
We explore whether housing displacement pressure could help explain place-based disparities in Massachusetts COVID-19 prevalence. We use qualitative data from the Healthy Neighborhoods Study to illustrate how rising and unaffordable housing costs are experienced by residents in municipalities disproportionately affected by COVID-19. We then predict municipal-level COVID-19 case rates as a function of home value increases and housing cost burden prevalence among low-income households, controlling for previously identified community-level risk factors. We find that housing value increase predicts higher COVID-19 case rates, but that associations are ameliorated in areas with higher home values. Qualitative data highlight crowding, "doubling up," homelessness, and employment responses as mechanisms that might link housing displacement pressure to COVID-19 prevalence.
Collapse
Affiliation(s)
- Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.
| | - Yael Nidam
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.
| | - Andrew Binet
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.
| | - Reann Gibson
- Conservation Law Foundation, 62 Summer St, Boston, MA, 02110, USA.
| | - Vedette Gavin
- Conservation Law Foundation, 62 Summer St, Boston, MA, 02110, USA.
| |
Collapse
|
15
|
Raker EJ, Lowe SR, Arcaya MC, Johnson ST, Rhodes J, Waters MC. Twelve years later: The long-term mental health consequences of Hurricane Katrina. Soc Sci Med 2019; 242:112610. [PMID: 31677480 PMCID: PMC8450020 DOI: 10.1016/j.socscimed.2019.112610] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/13/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
In August 2005, Hurricane Katrina caused unprecedented damage, widespread population displacement, and exposed Gulf Coast residents to traumatic events. The hurricane's adverse impact on survivors' mental health was apparent shortly after the storm and persisted, but no study has examined the long-term effects now that more than a decade has transpired. Using new data from a panel study of low-income mothers interviewed once before Hurricane Katrina and now three times after, we document changes in mental health, and estimate the sociodemographic and hurricane-related factors associated with long-term trajectories of mental health. We find that post-traumatic stress symptoms (PTSS) declined at each of the three post-Katrina follow-ups, but 12 years after the hurricane, one in six still had symptoms indicative of probable post-traumatic stress disorder. The rate of non-specific psychological distress (PD) remained consistently higher in all three follow-ups, compared to the pre-disaster period. In full covariate-adjusted models, no sociodemographic variables predicted long-run combinations of PTSS and PD. However, 12 years later, exposure to hurricane-related traumatic events and pre-disaster PD significantly predicted co-occurring PTSS and PD. Hurricane-related housing damage predicted PTSS in earlier follow-ups, but no longer predicted PTSS in the long-term. Furthermore, hurricane-related traumatic events significantly differentiated the risk of having persistent PTSS, relative to recovering from PTSS. The results suggest that there is still a non-negligible group of survivors with continued need for recovery resources and that exposure to traumatic events is a primary predictor of adverse mental health more than a decade post-disaster.
Collapse
Affiliation(s)
| | | | | | - Sydney T Johnson
- Harvard Center for Population and Development Studies, United States
| | - Jean Rhodes
- University of Massachusetts, Boston, United States
| | | |
Collapse
|
16
|
Arcaya MC, Schnake-Mahl A, Binet A, Simpson S, Church MS, Gavin V, Coleman B, Levine S, Nielsen A, Carroll L, Ursprung S, Wood B, Reeves H, Keppard B, Sportiche N, Partirdge J, Figueora J, Frakt A, Alfonzo M, Abreu D, Abreu T, Ambroise T, Andrade E, Barrientos E, Baty A, Baty C, Benner K, Bennett C, Blanchette A, Bongiovanni R, Cardile O, Corchado C, Dixon C, Dodson C, Dominguez J, Durena M, Fiestas Y, Genty J, Graffam N, Gonzalez A, Grigsby E, Hayden P, Alvado SH, Hernandez Z, Hodes I, Johnson J, Keefe K, Latimer K, Levine S, Logg C, Martinez N, Mboup K, McPhorson D, Meacham S, Mohammed D, Moss E, Nielsen A, O'Brien K, Owens L, Partridge J, Johnson LP, Power MB, Rebelo T, Remy R, Roderigues G, Sabtow Q, Sanchez C, Seeder A, Sepulveda R, Sportiche N, Ursprung S, West E, Winters L, Wood B, Youmans T. Community change and resident needs: Designing a Participatory Action Research study in Metropolitan Boston. Health Place 2018; 52:221-230. [PMID: 30015179 DOI: 10.1016/j.healthplace.2018.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/18/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022]
Abstract
The health implications of urban development, particularly in rapidly changing, low-income urban neighborhoods, are poorly understood. We describe the Healthy Neighborhoods Study (HNS), a Participatory Action Research study examining the relationship between neighborhood change and population health in nine Massachusetts neighborhoods. Baseline data from the HNS survey show that social factors, specifically income insecurity, food insecurity, social support, experiencing discrimination, expecting to move, connectedness to the neighborhood, and local housing construction that participants believed would improve their lives, identified by a network of 45 Resident Researchers exhibited robust associations with self-rated and mental health. Resident-derived insights into relationships between neighborhoods and health may provide a powerful mechanism for residents to drive change in their communities.
Collapse
Affiliation(s)
- Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA.
| | - Alina Schnake-Mahl
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
| | - Andrew Binet
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA.
| | - Shannon Simpson
- Dudley Street Neighborhood Initiative, 550 Dudley St, Roxbury, MA 02119, USA.
| | | | - Vedette Gavin
- Conservation Law Foundation, 62 Summer St, Boston, MA 02110, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Arcaya MC, Coleman RL, Razak F, Alva ML, Holman RR. Health selection into neighborhoods among patients enrolled in a clinical trial. Prev Med Rep 2017; 8:51-54. [PMID: 28924547 PMCID: PMC5593304 DOI: 10.1016/j.pmedr.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 02/07/2023] Open
Abstract
Health selection into neighborhoods may contribute to geographic health disparities. We demonstrate the potential for clinical trial data to help clarify the causal role of health on locational attainment. We used data from the 20-year United Kingdom Prospective Diabetes Study (UKPDS) to explore whether random assignment to intensive blood-glucose control therapy, which improved long-term health outcomes after median 10 years follow-up, subsequently affected what neighborhoods patients lived in. We extracted postcode-level deprivation indices for the 2710 surviving participants of UKPDS living in England at study end in 1996/1997. We observed small neighborhood advantages in the intensive versus conventional therapy group, although these differences were not statistically significant. This analysis failed to show conclusive evidence of health selection into neighborhoods, but data suggest the hypothesis may be worthy of exploration in other clinical trials or in a meta-analysis.
Collapse
Affiliation(s)
- Mariana C. Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ruth L. Coleman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, England, United Kingdom
| | - Fahad Razak
- Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Rury R. Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, England, United Kingdom
| |
Collapse
|
18
|
Daepp MIG, Arcaya MC. The effect of health on socioeconomic status: Using instrumental variables to revisit a successful randomized controlled trial. Econ Hum Biol 2017; 27:305-314. [PMID: 29051044 DOI: 10.1016/j.ehb.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Abstract
Poor health is widely recognized as a consequence of social disadvantage, but health problems may also help transmit social disadvantage over time and generations. Experimentally assigned health exposures, namely those tested in randomized controlled trials, may provide opportunities to estimate the causal effects of health on socioeconomic status (SES). We revisit data from the Diabetes Control and Complications Trial, a randomized controlled trial of glucose control therapy in Type 1 diabetic patients, and use treatment assignment as an instrument for health status to test the causal effect of treatment-related health improvement on subsequent SES measured during the trial's follow-up study, the Epidemiology of Diabetes Interventions and Complications study. We used the Two-Factor Hollingshead Index of Social Position, which comprises education and occupation, to measure SES. Glycated hemoglobin (HbA1c) served as a proxy for health status. Ordinary least squares (OLS) regression models showed that lower HbA1c at the trial's end was associated with higher SES at both the start of the follow-up and 17 years later. However, instrumental variable analyses showed no causal effect of HbA1c on SES, suggesting that OLS estimates are biased by endogeneity. Sensitivity analyses showed robustness to several alternate specifications. While the HbA1c advantage conferred by random assignment to treatment within the trial did not produce higher Hollingshead Index scores, we note that occupation and education categories may be harder to affect than are outcomes such as income. This analysis offers evidence that clinical trial data may be a rich and unrecognized resource for estimating health effects on SES.
Collapse
Affiliation(s)
- Madeleine I G Daepp
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA
| | - Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139, USA.
| |
Collapse
|
19
|
Affiliation(s)
- Mariana C. Arcaya
- Mariana C. Arcaya is an assistant professor of urban planning and public health in the Department of Urban Studies and Planning, Massachusetts Institute of Technology, in Cambridge
| | - José F. Figueroa
- José F. Figueroa is an instructor of medicine at Harvard Medical School and an associate physician in the Department of Medicine, Brigham and Women’s Hospital, in Boston, Massachusetts
| |
Collapse
|
20
|
Arcaya MC, Lowe SR, Asad AL, Subramanian SV, Waters MC, Rhodes J. Association of posttraumatic stress disorder symptoms with migraine and headache after a natural disaster. Health Psychol 2017; 36:411-418. [PMID: 27929328 PMCID: PMC6666314 DOI: 10.1037/hea0000433] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Previous research shows that migraine and general headache symptoms increase after traumatic events. Questions remain about whether posttraumatic stress disorder (PTSD) produces migraine/headache symptoms, or if individuals afflicted by migraine/headache are especially likely to develop PTSD. We test whether PTSD symptoms following a natural disaster are associated with higher odds of reporting frequent headaches/migraines postdisaster. We decompose PTSD into intrusion, avoidance, and hyperarousal symptom clusters to examine which, if any, are uniquely related to headache/migraine postdisaster. METHOD We use prospectively collected pre- and postdisaster data to explore whether overall PTSD symptoms and symptom clusters are associated with migraine/headache in a sample of Hurricane Katrina survivors. We account for severity of hurricane exposure and control for baseline migraine and headache problems to reduce the probability that heightened PTSD susceptibility among those who already suffered from the conditions could explain observed associations. RESULTS PTSD symptoms were associated with higher odds of experiencing frequent headaches or migraines with a standard deviation change in PTSD score corresponding to over twice the odds (95% confidence interval [1.64, 2.68]) of having trouble with frequent headaches or migraines in the post-Katrina period. Each additional point on the intrusion subscale (sample M [SD] = 1.6 [1.1]) was associated with 55% higher odds of reporting frequent headache/migraine (95% confidence interval [1.03, 2.33]), but we found no association with avoidance or hyperarousal symptoms. CONCLUSIONS Clinicians and disaster planners should be aware that disaster survivors might be at heightened risk of migraine/headache episodes, and those experiencing intrusive reminders may be most affected. (PsycINFO Database Record
Collapse
Affiliation(s)
- Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology
| | - Sarah R Lowe
- Department of Psychology, Montclair State University
| | | | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
| | | | - Jean Rhodes
- Department of Psychology, University of Massachusetts Boston
| |
Collapse
|
21
|
Arcaya MC. Invited Commentary: Foreclosures and Health in a Neighborhood Context. Am J Epidemiol 2017; 185:436-439. [PMID: 28184426 DOI: 10.1093/aje/kww169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/08/2016] [Indexed: 11/13/2022] Open
Abstract
Recent systematic reviews link foreclosure to worse health at both the individual and population levels. In this issue of the Journal, Downing et al. (Am J Epidemiol. 2017;185(6):429-435) add to what is known about foreclosure and health by examining annual measures of glycemic control in relation to local foreclosure activity. They provided evidence that between 2007 and 2010, glycemic control was not associated with rates of completed foreclosure among a continuously insured managed-care population of persons with type 2 diabetes living in 9 California counties. In this commentary, I consider 5 possible interpretations of the null results: 1) foreclosures do not affect health in general, 2) glycated hemoglobin is insensitive to local foreclosure activity, 3) the presence of real estate owned foreclosures (rather than the competed foreclosure rate) affects health, 4) an integrated health-care delivery system buffers patients from the effects of the foreclosure crisis, and 5) community conditions and responses to the foreclosure crisis buffer patients from the effects of the foreclosure crisis. I close by arguing that research on the contextual effects of foreclosure on health should continue despite the ongoing recovery of the housing market.
Collapse
|
22
|
Arcaya MC, Tucker-Seeley RD, Kim R, Schnake-Mahl A, So M, Subramanian SV. Research on neighborhood effects on health in the United States: A systematic review of study characteristics. Soc Sci Med 2016; 168:16-29. [PMID: 27637089 DOI: 10.1016/j.socscimed.2016.08.047] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/17/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022]
Abstract
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.
Collapse
Affiliation(s)
| | | | - Rockli Kim
- Harvard Chan School of Public Health, USA
| | | | - Marvin So
- Harvard Chan School of Public Health, USA
| | | |
Collapse
|
23
|
Graif C, Arcaya MC, Diez Roux AV. Moving to opportunity and mental health: Exploring the spatial context of neighborhood effects. Soc Sci Med 2016; 162:50-8. [PMID: 27337349 PMCID: PMC4969097 DOI: 10.1016/j.socscimed.2016.05.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 04/05/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
Studies of housing mobility and neighborhood effects on health often treat neighborhoods as if they were isolated islands. This paper argues that conceptualizing neighborhoods as part of the wider spatial context within which they are embedded may be key in advancing our understanding of the role of local context in the life of urban dwellers. Analyses are based on mental health and neighborhood context measurements taken on over 3000 low-income families who participated in the Moving to Opportunity for Fair Housing Demonstration Program (MTO), a large field experiment in five major U.S. cities. Results from analyses of two survey waves combined with Census data at different geographic scales indicate that assignment to MTO's experimental condition of neighborhood poverty <10% significantly decreased average exposure to immediate and surrounding neighborhood disadvantage by 97% and 59% of a standard deviation, respectively, relative to the control group. Escaping concentrated disadvantage in either the immediate neighborhood or the surrounding neighborhood, but not both, was insufficient to make a difference for mental health. Instead, the results suggest that improving both the immediate and surrounding neighborhoods significantly benefits mental health. Compared to remaining in concentrated disadvantage in the immediate and surrounding neighborhoods, escaping concentrated disadvantage in both the immediate and surrounding neighborhoods (on average over the study duration) as a result of the intervention predicts an increase of 25% of a standard deviation in the composite mental health scores.
Collapse
Affiliation(s)
- Corina Graif
- Department of Sociology and Criminology and Population Research Institute, Pennsylvania State University, 603 Oswald Tower, University Park, PA 16802, United States.
| | - Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Avenue 9-326, Cambridge, MA 02139, United States.
| | - Ana V Diez Roux
- Drexel University School of Public Health, Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104, United States.
| |
Collapse
|
24
|
Arcaya MC, Graif C, Waters MC, Subramanian SV. Health Selection into Neighborhoods Among Families in the Moving to Opportunity Program. Am J Epidemiol 2016; 183:130-7. [PMID: 26656481 DOI: 10.1093/aje/kwv189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/10/2015] [Indexed: 12/27/2022] Open
Abstract
Moving to Opportunity for Fair Housing was a randomized experiment that moved very low-income US families from high-poverty neighborhoods to low-poverty neighborhoods starting in the early 1990s. We modeled report of a child's baseline health problem as a predictor of neighborhood outcomes for households randomly assigned to move from high- to low-poverty neighborhoods. We explored associations between baseline health problems and odds of moving with the program upon randomization (1994-1997), neighborhood poverty rate at follow-up (2002), and total time spent in affluent neighborhoods and duration-weighted poverty. Among 1,550 households randomized to low-poverty neighborhoods, a smaller share of households reporting baseline child health problems (P = 0.004) took up the intervention (38%) than those not reporting a health problem (50%). In weighted and covariate-adjusted models, a child health problem predicted nearly 40% lower odds of complying with the experimental condition (odds ratio = 0.62, 95% confidence interval: 0.42, 0.91; P = 0.015). Among compliers, a baseline child health problem predicted 2.5 percentage points' higher neighborhood poverty at take-up (95% confidence interval: 0.90, 4.07; P = 0.002). We conclude that child health problems in a household prior to randomization predicted lower likelihood of using the program voucher to move to a low-poverty neighborhood within the experiment's low-poverty treatment arm and predicted selection into poorer neighborhoods among experimental compliers. Child morbidity may constrain families attempting to improve their life circumstances.
Collapse
|
25
|
Arcaya MC, Graif C, Waters MC, Subramanian SV. Health Selection into Neighborhoods Among Families in the Moving to Opportunity Program. Am J Epidemiol 2016. [PMID: 26656481 DOI: 10.1093/aje/kwvl89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
Moving to Opportunity for Fair Housing was a randomized experiment that moved very low-income US families from high-poverty neighborhoods to low-poverty neighborhoods starting in the early 1990s. We modeled report of a child's baseline health problem as a predictor of neighborhood outcomes for households randomly assigned to move from high- to low-poverty neighborhoods. We explored associations between baseline health problems and odds of moving with the program upon randomization (1994-1997), neighborhood poverty rate at follow-up (2002), and total time spent in affluent neighborhoods and duration-weighted poverty. Among 1,550 households randomized to low-poverty neighborhoods, a smaller share of households reporting baseline child health problems (P = 0.004) took up the intervention (38%) than those not reporting a health problem (50%). In weighted and covariate-adjusted models, a child health problem predicted nearly 40% lower odds of complying with the experimental condition (odds ratio = 0.62, 95% confidence interval: 0.42, 0.91; P = 0.015). Among compliers, a baseline child health problem predicted 2.5 percentage points' higher neighborhood poverty at take-up (95% confidence interval: 0.90, 4.07; P = 0.002). We conclude that child health problems in a household prior to randomization predicted lower likelihood of using the program voucher to move to a low-poverty neighborhood within the experiment's low-poverty treatment arm and predicted selection into poorer neighborhoods among experimental compliers. Child morbidity may constrain families attempting to improve their life circumstances.
Collapse
|
26
|
James P, Hart JE, Arcaya MC, Feskanich D, Laden F, Subramanian SV. Neighborhood Self-Selection: The Role of Pre-Move Health Factors on the Built and Socioeconomic Environment. Int J Environ Res Public Health 2015; 12:12489-504. [PMID: 26457712 PMCID: PMC4626981 DOI: 10.3390/ijerph121012489] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/16/2015] [Accepted: 09/23/2015] [Indexed: 11/16/2022]
Abstract
Residential self-selection bias is a concern in studies of neighborhoods and health. This bias results from health behaviors predicting neighborhood choice. To quantify this bias, we examined associations between pre-move health factors (body mass index, walking, and total physical activity) and post-move neighborhood factors (County Sprawl Index, Census tract socioeconomic status (SES)) in the Nurses' Health Study (n = 14,159 moves from 1986-2008). Individuals in the highest quartile of pre-move BMI (BMI > 28.4) compared to the lowest quartile (BMI < 22.5) moved to counties that averaged 2.57 points lower on the sprawl index (95% confidence interval -3.55, -1.59) indicating that individuals moved to less dense counties; however, no associations were observed for pre-move walking nor total physical activity. Individuals with higher pre-move BMI tended to move to Census tracts with lower median income and home values and higher levels of poverty. Analyses examining the change in neighborhood environments after a move demonstrated that healthy pre-move behaviors were associated with moves to worse socioeconomic environments. This type of self-selection would bias results downward, underestimating the true relationship between SES and physical activity. Generally, the magnitudes of associations between pre-move health factors and neighborhood measures were small and indicated that residential self-selection was not a major source of bias in analyses in this population.
Collapse
Affiliation(s)
- Peter James
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA.
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| | - Jaime E Hart
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
| | - Mariana C Arcaya
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| | - Diane Feskanich
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
| | - Francine Laden
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA.
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.
| |
Collapse
|
27
|
Arcaya MC, Arcaya AL, Subramanian SV. [Inequalities in health: definitions, concepts, and theories]. Rev Panam Salud Publica 2015; 38:261-271. [PMID: 26758216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Individuals from different backgrounds, social groups, and countries enjoy different levels of health. This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. We describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behavior, environmental, and selection explanations. Concepts of relative versus absolute; dose response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. We close by reflecting on what conditions make health inequalities unjust, and to consider the merits of policies that prioritize the elimination of health disparities versus those that focus on raising the overall standard of health in a population.
Collapse
Affiliation(s)
- Mariana C Arcaya
- Departamento de Ciencias Sociales y Conductuales, Escuela de Salud Pública T.H. Chan, Universidad de Harvard, Boston, MA, Estados Unidos de América,
| | - Alyssa L Arcaya
- Agencia de Protección Ambiental de los Estados Unidos, Nueva York, NY, Estados Unidos de América
| | - S V Subramanian
- Departamento de Ciencias Sociales y Conductuales, Escuela de Salud Pública T.H. Chan, Universidad de Harvard, Boston, MA, Estados Unidos de América,
| |
Collapse
|
28
|
Yasaitis LC, Arcaya MC, Subramanian SV. Comparison of estimation methods for creating small area rates of acute myocardial infarction among Medicare beneficiaries in California. Health Place 2015; 35:95-104. [PMID: 26291680 PMCID: PMC5072888 DOI: 10.1016/j.healthplace.2015.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022]
Abstract
Creating local population health measures from administrative data would be useful for health policy and public health monitoring purposes. While a wide range of options--from simple spatial smoothers to model-based methods--for estimating such rates exists, there are relatively few side-by-side comparisons, especially not with real-world data. In this paper, we compare methods for creating local estimates of acute myocardial infarction rates from Medicare claims data. A Bayesian Monte Carlo Markov Chain estimator that incorporated spatial and local random effects performed best, followed by a method-of-moments spatial Empirical Bayes estimator. As the former is more complicated and time-consuming, spatial linear Empirical Bayes methods may represent a good alternative for non-specialist investigators.
Collapse
Affiliation(s)
- Laura C Yasaitis
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow St, Cambridge, MA 02138, USA.
| | - Mariana C Arcaya
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| |
Collapse
|
29
|
Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Glob Health Action 2015; 8:27106. [PMID: 26112142 PMCID: PMC4481045 DOI: 10.3402/gha.v8.27106] [Citation(s) in RCA: 271] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/23/2015] [Accepted: 04/03/2015] [Indexed: 11/14/2022] Open
Abstract
Individuals from different backgrounds, social groups, and countries enjoy different levels of health. This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. We describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behavior, environmental, and selection explanations. Concepts of relative versus absolute; dose-response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. We close by reflecting on what conditions make health inequalities unjust, and to consider the merits of policies that prioritize the elimination of health disparities versus those that focus on raising the overall standard of health in a population.
Collapse
Affiliation(s)
- Mariana C Arcaya
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA
| | - Alyssa L Arcaya
- Region 2, United States Environmental Protection Agency, New York, NY, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA;
| |
Collapse
|
30
|
|
31
|
Abstract
The relationship between posttraumatic stress disorder (PTSD) and asthma in the wake of natural disasters is poorly understood. Using pre- and postdisaster data (N = 405) from the Resilience in Survivors of Katrina (RISK) project, we examined associations between PTSD symptoms, measured by the Impact of Event Scale-Revised (IES-R), and self-reported postdisaster asthma attacks. A 1-point increase in the IES-R avoidance score, which corresponded to one standard deviation change in this sample, was associated with double the odds of reporting an asthma attack or episode since the hurricane, 95% CI Revise spacing among characters: [1.22, 4.16]. Association with hyperarousal and intrusion symptoms was null. Further research using objective measures of asthma morbidity is needed; nevertheless, these findings may help inform postdisaster health services delivery and predisaster mitigation planning.
Collapse
Affiliation(s)
- Mariana C. Arcaya
- Center for Population and Development Studies, Harvard School of Public Health, Cambridge, Massachusetts, USA
| | - Sarah R. Lowe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Jean E. Rhodes
- Department of Psychology, University of Massachusetts, Boston, Massachusetts, USA
| | - Mary C. Waters
- Department of Sociology, Harvard University, Cambridge, Massachusetts, USA
| | - S. V. Subramanian
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
32
|
James P, Ito K, Banay RF, Buonocore JJ, Wood B, Arcaya MC. A health impact assessment of a proposed bill to decrease speed limits on local roads in Massachusetts (U.S.A.). Int J Environ Res Public Health 2014; 11:10269-91. [PMID: 25279544 PMCID: PMC4210978 DOI: 10.3390/ijerph111010269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 09/19/2014] [Accepted: 09/23/2014] [Indexed: 11/20/2022]
Abstract
Decreasing traffic speeds increases the amount of time drivers have to react to road hazards, potentially averting collisions, and makes crashes that do happen less severe. Boston’s regional planning agency, the Metropolitan Area Planning Council (MAPC), in partnership with the Massachusetts Department of Public Health (MDPH), conducted a Health Impact Assessment (HIA) that examined the potential health impacts of a proposed bill in the state legislature to lower the default speed limits on local roads from 30 miles per hour (mph) to 25 mph. The aim was to reduce vehicle speeds on local roads to a limit that is safer for pedestrians, cyclists, and children. The passage of this proposed legislation could have had far-reaching and potentially important public health impacts. Lower default speed limits may prevent around 18 fatalities and 1200 serious injuries to motorists, cyclists and pedestrians each year, as well as promote active transportation by making local roads feel more hospitable to cyclists and pedestrians. While a lower speed limit would increase congestion and slightly worsen air quality, the benefits outweigh the costs from both a health and economic perspective and would save the state approximately $62 million annually from prevented fatalities and injuries.
Collapse
Affiliation(s)
- Peter James
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA 02215, USA.
| | - Kate Ito
- Metropolitan Area Planning Council, 60 Temple Place, Boston, MA 02111, USA.
| | - Rachel F Banay
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA 02215, USA.
| | - Jonathan J Buonocore
- Center for Health and the Global Environment, Harvard School of Public Health, 401 Park Drive, Boston, MA 02215, USA.
| | - Benjamin Wood
- Massachusetts Department of Public Health, Division of Prevention and Wellness, 250 Washington Street, Boston, MA 02108, USA.
| | - Mariana C Arcaya
- Metropolitan Area Planning Council, 60 Temple Place, Boston, MA 02111, USA.
| |
Collapse
|
33
|
Kozhimannil KB, Arcaya MC, Subramanian SV. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database. PLoS Med 2014; 11:e1001745. [PMID: 25333943 PMCID: PMC4205118 DOI: 10.1371/journal.pmed.1001745] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. METHODS AND FINDINGS Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project--a 20% sample of US hospitals--we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. CONCLUSIONS Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors-such as hospital policies, practices, and culture--in determining cesarean section use. Please see later in the article for the Editors' Summary.
Collapse
Affiliation(s)
- Katy B. Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Mariana C. Arcaya
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
34
|
James P, Arcaya MC, Parker DM, Tucker-Seeley RD, Subramanian SV. Do minority and poor neighborhoods have higher access to fast-food restaurants in the United States? Health Place 2014; 29:10-7. [PMID: 24945103 DOI: 10.1016/j.healthplace.2014.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/24/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Disproportionate access to unhealthy foods in poor or minority neighborhoods may be a primary determinant of obesity disparities. We investigated whether fast-food access varies by Census block group (CBG) percent black and poverty. METHODS We measured the average driving distance from each CBG population-weighted centroid to the five closest top ten fast-food chains and CBG percent black and percent below poverty. RESULTS Among 209,091 CBGs analyzed (95.1% of all US CBGs), CBG percent black was positively associated with fast-food access controlling for population density and percent poverty (average distance to fast-food was 3.56 miles closer (95% CI: -3.64, -3.48) in CBGs with the highest versus lowest quartile of percentage of black residents). Poverty was not independently associated with fast-food access. The relationship between fast-food access and race was stronger in CBGs with higher levels of poverty (p for interaction <0.0001). CONCLUSIONS Predominantly black neighborhoods had higher access to fast-food while poverty was not an independent predictor of fast-food access.
Collapse
Affiliation(s)
- Peter James
- Harvard School of Public Health, Department of Epidemiology, 401 Park Drive, 3rd Floor West, Boston, MA 02215, USA.
| | - Mariana C Arcaya
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA.
| | - Devin M Parker
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, 18 N Park Street, Apt C, Hanover, NH 03755, USA.
| | - Reginald D Tucker-Seeley
- Department of Social and Behavioral Sciences, 450 Brookline Avenue, Dana Farber Cancer Institute, Center for Community-Based Research, LW743, Boston, MA 02115, USA.
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Kresge Building 7th Floor, 716, Boston, MA 02115-6096, USA.
| |
Collapse
|