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Tan X, Zhang H, Ren X. The effects of neighborhood socioeconomic status on ADL/IADL among Chinese older adults-neighborhood environments as mediators. Front Public Health 2024; 11:1202806. [PMID: 38298263 PMCID: PMC10828966 DOI: 10.3389/fpubh.2023.1202806] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
Background There have been few consistencies in the effects and pathways of neighborhood socioeconomic status (SES) on functional limitations. This study aimed to investigate whether neighborhood socioeconomic status influences ADL/IADL in older residents in China through the neighborhood built environment and social environment. Methods Activities of daily living/IADL were assessed in a sample of 5,887 Chinese individuals aged 60 or older, utilizing data obtained from the 2011 China Health and Retirement Longitudinal Study (CHARLS 2011). Neighborhood SES was measured by the neighborhood per-capita net income. Neighborhood built environment was measured by the security resources, motion resources, living resources, service resources for older adults, and medical resources of neighborhood. Neighborhood social environment was measured by the organizations, unemployment subsidies, minimum living allowance, subsidies to persons older than 65, and pensions to persons older than 80 of the neighborhood. The two-level logistical regression model and multilevel structural equation model (MSEM) were used. Results The rate of ADL/IADL loss among Chinese older adults aged 60 and above in 2011 were 32.17 and 36.87%, respectively. Neighborhood SES was significantly associated with ADL/IADL in older adults. Compared with the respondents living in communities with lower SES, those living in communities with higher SES possessed better ADL (β = -0.33, p < 0.05) and IADL (β = -0.36, p < 0.05) status. The path of neighborhood socioeconomic status on ADL was completely mediated by the neighborhood built environment (β = -0.110, p < 0.05) and neighborhood social environment (β = -0.091, p < 0.05). Additionally, the effect of neighborhood socioeconomic status on IADL was fully mediated by the neighborhood built environment (β = -0.082, p < 0.05) and neighborhood social environment (β = -0.077, p < 0.05). Conclusion Neighborhood SES was significantly correlated with ADL/IADL through the neighborhood environment. Improving the ADL/IADL status of older adults residing in low socioeconomic neighborhoods requires enhancing the built and social environment by provisioning additional neighborhood resources.
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Affiliation(s)
- Xiaoshuang Tan
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Hong Zhang
- Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohui Ren
- Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Cunningham SD, Mandelbaum J, Shebl FM, Abraham M, O’Connor Duffany K. Neighborhood Social Environment and Body Mass Index: The Mediating Role of Mental Wellbeing. Int J Environ Res Public Health 2023; 20:6602. [PMID: 37623185 PMCID: PMC10454589 DOI: 10.3390/ijerph20166602] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
The association between neighborhood-built environment and body mass index (BMI) is well-characterized, whereas fewer studies have explored the mechanisms underlying the relationship between neighborhood social environment and obesogenic behaviors. Using data from a random sample of 16,820 residents ≥18 years from all 169 Connecticut towns and seven ZIP Codes in New York, this study examines the influence of neighborhood social environment on residents' mental wellbeing, physical activity, and BMI. Structural equation modeling was conducted to estimate direct and indirect effects of neighborhood social environment on BMI, using mental wellbeing and physical activity as intermediate variables. There were significant total [β(SE) = 0.741 (0.170), p < 0.0001], direct [β(SE) = 0.456 (0.1890), p = 0.016], and indirect [β(SE) = 0.285 (0.061), p < 0.0001] effects of neighborhood social environment on BMI. Low physical activity was a partial mediator of the effect of non-favorable neighborhood social environment on BMI [β(SE) = -0.071 (0.011), p < 0.0001]. The association between neighborhood social environment and BMI was also mediated by mental wellbeing [β(SE) = 0.214 (0.060), p < 0.0001], and by mental wellbeing through physical activity [β(SE) = 0.071 (0.011), p < 0.0001]. Study findings provide further support for building strong social environments to improve population health and suggest that strategies prioritizing mental wellbeing may benefit behavioral interventions aimed at reducing obesity risk and should be a focus of prevention efforts in and of itself.
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Affiliation(s)
- Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06032, USA;
| | | | - Fatma M. Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | | | - Kathleen O’Connor Duffany
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
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Tamura K, Johnson DA, Neally SJ, Sims M, Powell-Wiley TM. Relationships between neighborhood social stressors and sleep among Jackson Heart Study participants: mediation through physical activity and psychosocial stressors. Sleep Adv 2022; 3:zpac032. [PMID: 37193404 PMCID: PMC10174476 DOI: 10.1093/sleepadvances/zpac032] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/07/2022] [Indexed: 05/18/2023]
Abstract
Study Objectives To examine associations between perceived neighborhood social environment (PNSE) and sleep, mediated by physical activity (PA) and psychosocial stressors. Methods A sample (n = 4705) of African Americans (mean age 55.0 years; 63.4% female) enrolled in the 2000-2004 Jackson Heart Study (JHS). Four self-reported sleep outcomes were analyzed: sleep duration (minutes/night), sleep quality (high/low), short sleep (short ≤ 6 h vs recommended = 7-8 h), and long sleep (long ≥ 9 h vs recommended). PNSE factors included violence (e.g. robbery), problems (trash/litter), and social cohesion (trusting neighbors). PA and psychosocial stressors (lifetime and everyday discrimination, perceived stress, and depressive symptoms) were tested as mediators. With bootstrap-generated 95% bias-corrected confidence intervals (BC CIs), linear regression was used to test for mediation adjusting for covariates. Results Neighborhood violence and problems were associated with sleep duration, mediated through PA (B = -1.97, 95%BC CI = -3.76, -0.60; B = -1.23, 95%BC CI = -2.55, -0.27, respectively), lifetime discrimination (B = 2.61, 95%BC CI = 0.93, 4.80; B = 2.25, 95%BC CI = 0.93, 3.94), perceived stress (B = -3.08, 95%BC CI = -6.20, -0.41; B = -2.17, 95%BC CI = -4.33, -0.28), and depressive symptoms (B = -2.22, 95%BC CI = -5.09, -0.25; B = -1.94, 95%BC CI = -4.10, -0.35). Social cohesion was positively associated with sleep duration, mediated through PA, lifetime discrimination, and perceived stress. Similar patterns were demonstrated for binary outcomes. Yet, effect sizes were relatively small. PNSE was neither directly nor indirectly associated with sleep outcomes by everyday discrimination. Conclusions Each PNSE factor was associated with sleep outcomes, mediated by PA and psychosocial stressors. Further research should emphasize effective community efforts to decrease adverse neighborhood conditions and psychosocial factors and increase PA; thereby reducing CVD events for African Americans.
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Affiliation(s)
- Kosuke Tamura
- Corresponding author. Kosuke Tamura, PhD, Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mario Sims
- Department of Social Medicine, Population and Public Health, University of California at Riverside, Riverside, CA, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Dawson CT, Wu W, Fennie KP, Ibañez G, Cano MÁ, Pettit JW, Jo Trepka M. Parental-perceived neighborhood characteristics and adolescent depressive symptoms: A multilevel moderation analysis. J Community Psychol 2019; 47:1568-1590. [PMID: 31209901 PMCID: PMC6699891 DOI: 10.1002/jcop.22205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 05/22/2018] [Revised: 03/13/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
AIMS This study examines the moderating role of parental neighborhood perceptions on the relationship between neighborhood structural disadvantage and adolescent depressive symptoms. METHODS Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) consisting of 12,105 adolescents and their parents were used. RESULTS Mixed effects multilevel modeling revealed that parental-perceived neighborhood disorder was associated with higher levels of adolescent depressive symptoms (β = .27, p ≤ .001). The interaction between neighborhood concentrated poverty and parental-perceived neighborhood disorder was also significant (β = -.14, p ≤ .01). Low and high levels of parental-perceived neighborhood disorder were associated with lower (β = -.41, p < .05) and higher (β = .46, p ≤ .01) levels of adolescent depressive symptoms, respectively, with increasing concentrated poverty. Parental-perceived collective efficacy was not associated with adolescent depressive symptoms nor was it a moderator. CONCLUSION Findings suggest that the neighborhood's social environment may mitigate adolescent depressive symptoms. Implications for structural interventions are discussed.
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Affiliation(s)
- Christyl T. Dawson
- Department of Epidemiology, Robert Stempel College of
Public Health and Social Work, Florida International University, 11200 SW 8th
Street, AHC-5, Miami, FL 33199, USA
| | - Wensong Wu
- Department of Mathematics and Statistics, School of
Integrated Science and Humanity, Florida International University, 11200 SW 8th
Street, DM 430, Miami, FL 33199, USA
| | - Kristopher P. Fennie
- Department of Epidemiology, Robert Stempel College of
Public Health and Social Work, Florida International University, 11200 SW 8th
Street, AHC-5, Miami, FL 33199, USA
| | - Gladys Ibañez
- Department of Epidemiology, Robert Stempel College of
Public Health and Social Work, Florida International University, 11200 SW 8th
Street, AHC-5, Miami, FL 33199, USA
| | - Miguel Á. Cano
- Department of Epidemiology, Robert Stempel College of
Public Health and Social Work, Florida International University, 11200 SW 8th
Street, AHC-5, Miami, FL 33199, USA
| | - Jeremy W. Pettit
- Department of Psychology, School of Integrated Science and
Humanity, Florida International University, 11200 SW 8th Street, DM 256, Miami, FL
33199, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of
Public Health and Social Work, Florida International University, 11200 SW 8th
Street, AHC-5, Miami, FL 33199, USA
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Smith JA, Zhao W, Wang X, Ratliff SM, Mukherjee B, Kardia SLR, Liu Y, Roux AVD, Needham BL. Neighborhood characteristics influence DNA methylation of genes involved in stress response and inflammation: The Multi-Ethnic Study of Atherosclerosis. Epigenetics 2017; 12:662-673. [PMID: 28678593 PMCID: PMC5687339 DOI: 10.1080/15592294.2017.1341026] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Living in a disadvantaged neighborhood is associated with poor health outcomes even after accounting for individual-level socioeconomic factors. The chronic stress of unfavorable neighborhood conditions may lead to dysregulation of the stress reactivity and inflammatory pathways, potentially mediated through epigenetic mechanisms such as DNA methylation. We used multi-level models to examine the relationship between 2 neighborhood conditions and methylation levels of 18 genes related to stress reactivity and inflammation in purified monocytes from 1,226 participants of the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based sample of US adults. Neighborhood socioeconomic disadvantage, a summary of 16 census-based metrics, was associated with DNA methylation [False discovery rate (FDR) q-value ≤ 0.1] in 2 out of 7 stress-related genes evaluated (CRF, SLC6A4) and 2 out of 11 inflammation-related genes (F8, TLR1). Neighborhood social environment, a summary measure of aesthetic quality, safety, and social cohesion, was associated with methylation in 4 of the 7 stress-related genes (AVP, BDNF, FKBP5, SLC6A4) and 7 of the 11 inflammation-related genes (CCL1, CD1D, F8, KLRG1, NLRP12, SLAMF7, TLR1). High socioeconomic disadvantage and worse social environment were primarily associated with increased methylation. In 5 genes with significant associations between neighborhood and methylation (FKBP5, CD1D, F8, KLRG1, NLRP12), methylation was associated with gene expression of at least one transcript. These results demonstrate that multiple dimensions of neighborhood context may influence methylation levels and subsequent gene expression of stress- and inflammation-related genes, even after accounting for individual socioeconomic factors. Further elucidating the molecular mechanisms underlying these relationships will be important for understanding the etiology of health disparities.
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Affiliation(s)
- Jennifer A Smith
- a Department of Epidemiology , School of Public Health, University of Michigan , Ann Arbor , MI , USA.,b Survey Research Center, Institute for Social Research, University of Michigan , Ann Arbor , MI , USA
| | - Wei Zhao
- a Department of Epidemiology , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Xu Wang
- c Department of Epidemiology and Biostatistics , Dornsife School of Public Health, Drexel University , Philadelphia , PA , USA
| | - Scott M Ratliff
- a Department of Epidemiology , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Bhramar Mukherjee
- d Department of Biostatistics , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Sharon L R Kardia
- a Department of Epidemiology , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Yongmei Liu
- e Department of Epidemiology and Prevention , School of Medicine, Wake Forest University , Winston-Salem , NC , USA
| | - Ava V Diez Roux
- c Department of Epidemiology and Biostatistics , Dornsife School of Public Health, Drexel University , Philadelphia , PA , USA
| | - Belinda L Needham
- a Department of Epidemiology , School of Public Health, University of Michigan , Ann Arbor , MI , USA
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Salahuddin M, Nehme E, Ranjit N, Kim YJ, Oluyomi AO, Dowdy D, Lee C, Ory M, Hoelscher DM. Does Parents' Social Cohesion Influence Their Perception of Neighborhood Safety and Their Children's Active Commuting to and From School? J Phys Act Health 2016; 13:1301-9. [PMID: 27617435 DOI: 10.1123/jpah.2016-0148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The role of parents' perceptions of the neighborhood environment in determining children's active commuting to and from school (ACS) is understudied. This study examined the association between parents' perceptions of neighborhood social cohesion, perceived neighborhood safety, and their children's ACS. METHODS This cross-sectional analysis (n = 857 from 81 elementary schools in Texas) examined baseline data from the Texas Childhood Obesity Prevention Policy Evaluation project. Participants had a mean age of 9.6 (0.6) years, and 50% were girls. Mixed effects logistic regression models were used to assess gender-stratified associations between parent's perceived social cohesion and children's ACS and their perception of neighborhood safety. RESULTS A positive significant association was observed between levels of perceived social cohesion and children's ACS for boys (P = 0.047); however, an inverse significant association was observed among girls (P = 0.033). Parents of boys living in neighborhoods with medium to high social cohesion were more likely to perceive their neighborhood as safe compared with parents living in neighborhoods with low social cohesion, though nonsignificant. Perceived neighborhood safety for walking and biking was associated with greater ACS among boys (P = 0.003). CONCLUSIONS Our study findings indicate that both social and physical environments are important factors in determining ACS among boys.
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de Vries McClintock HF, Wiebe DJ, O'Donnell AJ, Morales KH, Small DS, Bogner HR. Neighborhood social environment and patterns of adherence to oral hypoglycemic agents among patients with type 2 diabetes mellitus. Fam Community Health 2015; 38:169-79. [PMID: 25739064 PMCID: PMC4351782 DOI: 10.1097/fch.0000000000000069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 05/17/2023]
Abstract
This study examined whether neighborhood social environment was related to patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus. Residents in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage, compared to residents in neighborhoods with one or no high features present, were significantly more likely to have an adherent pattern compared to a nonadherent pattern. Neighborhood social environment may influence patterns of adherence. Reliance on a multilevel contextual framework, extending beyond the individual, to promote diabetic self-management activities may be essential for notable public health improvements.
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Affiliation(s)
- Heather F. de Vries McClintock
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, U.S.A
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Douglas J. Wiebe
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Alison J. O'Donnell
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, U.S.A
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Knashawn H. Morales
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Dylan S. Small
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA, U.S.A
| | - Hillary R. Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, U.S.A
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A
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Yang TC, Matthews SA, Shoff C. Individual health care system distrust and neighborhood social environment: how are they jointly associated with self-rated health? J Urban Health 2011; 88:945-58. [PMID: 21455831 DOI: 10.1007/s11524-011-9561-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Americans' distrust in the health care system has increased in the past decades; however, little research has explored the impact of distrust on self-rated health and even less is known about whether neighborhood social environment plays a role in understanding the relationship between distrust and self-rated health. This study fills these gaps by investigating both the direct and moderating associations of neighborhood social environment with self-rated health. Our analysis is based on the 2008 Philadelphia Health Management Corporation's household survey and neighborhood-level data. Findings from multilevel logistic regression show that after controlling for individual- and neighborhood-level covariates, distrust is directly and adversely related to self-rated health, and that neighborhood social affluence and stability are directly and negatively associated with the odds of reporting poor/fair health. Neighborhood disadvantage and crime rates are not directly related to self-rated health, but increase the odds of having poor/fair health via distrust. Overall, our results suggest that macro-level actions can alter individual's perception of residential environment and lead to improved health. To improve the public health in an urban setting, rebuilding confidence in the health care system is integral, and the policies that help establish safe and cohesive neighborhoods may reduce the adverse effect of distrust on self-rated health.
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