Chicago Community Adult Health Study Research Articles

Grandmothers residing with grandchildren: Social determinants of health, health behaviors, and health outcomes

The purpose of this study was to explore the associations between social determinants of health, health behaviors, and physical and mental health among African American and Hispanic caregiving grandmothers. We use cross-sectional secondary data from the Chicago Community Adult Health Study, originally designed to understand the health of individual households based on residential context. In a multivariate regression model, discrimination, parental stress, and physical health problems were significantly associated with depressive symptoms in caregiving grandmothers. Considering the multiple sources of stress experienced by this grandmother sample, researchers should develop and strengthen contextually relevant interventions for improving the health of caregiving grandmothers. Healthcare providers must be equipped with skills to address caregiving grandmothers’ unique needs related to stress. Finally, policy makers should promote the development of legislation that can positively influence caregiving grandmothers and their families. Expanding the lens through which caregiving grandmothers living in minoritized communities are viewed can catalyze meaningful change.

Narrowing Racial Differences in Trust: How Discrimination Shapes Trust in a Racialized Society

In the United States, survey research and qualitative studies consistently find that people of color-and Blacks in particular-report substantially lower levels of trust than do whites. These racial differences in trust pervade a range of social contexts, from interpersonal relationships with friends, family, and neighbors to interactions with the health care and criminal justice systems. Scholars often attribute racial differences in trust to historical and contemporary forms of discrimination, yet few studies have assessed the relationship among race, discrimination, and trust in the context of the United States. Using the Chicago Community Adult Health Study, I examine how the experience of discrimination relates to generalized trust, trust in neighbors, and trust in community police. Findings reveal that personal experience with discrimination contributes modestly to racial differences in trust. In fact, the negative association between discrimination and generalized trust appears strongest for whites. These findings suggest that understanding distrust requires a richer conceptual framework that moves beyond personal experience with discrimination. I argue that the theory of systemic racism provides a framework for understanding distrust as a consequence of countervailing efforts to uphold and contest the racial hierarchy.

Psychological and neighborhood factors associated with urban women's preventive care use.

Women are more likely than men to forego care-including preventive care. Understanding which factors influence women's preventive care use has the potential to improve health. This study focuses on the largely understudied areas of psychological barriers (depression) and neighborhood factors (support and stressors) that may be associated with women's preventive care use through secondary analysis of the Chicago Community Adult Health Study. Across models, 30-40% of the variance in preventive care adherence was explained by the neighborhood. Depressive symptoms were not associated with preventive care use when neighborhood factors were included. However, stratified models showed that associations varied by race/ethnicity. Previous research has tended to focus on individual determinants of care, but this study suggests that barriers to care are far more complex. Efforts aimed at improving care utilization need to be multipronged and interventions need to take an individual's demographics, mental health, and context into account.

Assessing the Role of Health Behaviors, Socioeconomic Status, and Cumulative Stress for Racial/Ethnic Disparities in Obesity.

This study aimed to examine the explanatory role of health behaviors, socioeconomic position (SEP), and psychosocial stressors on racial/ethnic obesity disparities in a multiethnic and multiracial sample of adults. Using data from the Chicago Community Adult Health Study (2001-2003), Oaxaca-Blinder decomposition analysis was conducted to quantify the extent to which health behaviors (fruit and vegetable consumption and physical activity), SEP, and cumulative stressors (e.g., perceived discrimination, financial strain) each explained differences in obesity prevalence in Black, US-born Hispanic, and non-US-born Hispanic compared with non-Hispanic White participants. SEP and health behaviors did not explain obesity differences between racial/ethnic minorities and White individuals. Having high levels of stress in four or more domains explained 4.46% of the differences between Black and White individuals, whereas having high levels of stress in three domains significantly explained 14.13% of differences between US-born Hispanic and White. Together, the predictors explained less than 20% of differences between any racial/ethnic minority group and White individuals. Exposure to stressors may play a role in obesity disparities, particularly among Black and US-born Hispanic individuals. Other obesity-related risk factors need to be examined to understand the underlying mechanisms explaining obesity disparities.

Assessing the role of ethnic enclaves in the relationship between neighborhood conditions and participation in neighborhood-focused activism among Latinos in Chicago

ABSTRACT Latinos in the US often settle in ethnic enclave neighborhoods, which research and theory suggests have residents who are less engaged in neighborhood activism. However, we know little about the relationship between living in a Latino ethnic enclave compared to other types of neighborhoods and engaging in neighborhood-focused activism among Latinos. This study, therefore, investigates whether both neighborhood organizational resources and neighborhood needs influence participation in neighborhood-focused activism among Chicago Latinos, and especially, whether those relationships are strongest in Latino ethnic enclave neighborhoods. We conducted multilevel logistic regression predicting neighborhood activism among a subsample of Latino respondents from the Chicago Community Adult Health Study but found no significant neighborhood effects. However, we examined only residents of Mexican descent and found that both organizational resources and needs had the largest, positive effects on neighborhood activism in predominantly Mexican descent neighborhoods. This study contributes to our understanding of neighborhood context and Latino engagement.

Psychosocial Stress and Overweight and Obesity: Findings From the Chicago Community Adult Health Study.

Psychosocial stress has been implicated as a risk factor for overweight and obesity. However, research on psychosocial stressors and overweight and obesity has typically focused on single stressors in isolation, which may overestimate the impact of a specific stressor and fail to describe the role of cumulative stress on overweight and obesity risk. This study explores the association between overweight/obesity and cumulative exposure to a wide range of psychosocial stressors, among a multiracial/ethnic sample of adults. Using secondary data from the Chicago Community Adult Health Study (n = 2,983), we conducted multinomial logistic regression analyses to quantify associations between eight psychosocial stressors, individually and in combination, and measured overweight and obesity, adjusted for sociodemographic factors, alcohol use and smoking. In separated covariate-adjusted models, childhood adversities (odds ratio [OR] = 1.16; confidence interval [CI] = [1.03, 1.30]), acute life events (OR = 1.18; CI = [1.04, 1.34]), financial strain (OR = 1.30; CI = [1.15, 1.47]), and relationship stressors (OR = 1.18; CI = [1.04, 1.35]) were associated with increased odds of obesity. In a model adjusted for all stressors simultaneously, financial strain was the only stressor independently associated with overweight (OR = 1.17; CI = [1.00, 1.36]) and obesity (OR = 1.21; CI = [1.05, 1.39]). Participants with stress exposure in the highest quintile across 2, 3, or ≥4 (compared to no) types of stressors had significantly higher odds of obesity. Multiple types of stressors may be risk factors for obesity, and cumulative exposure to these stressors may increase the odds of obesity. Reducing exposure to stressors at the population level may have the potential to contribute to reducing the burden of obesity.

Barrios, ghettos, and residential racial composition: Examining the racial makeup of neighborhood profiles and their relationship to self-rated health

Racial/ethnic disparities in self-rated health persist and according to the social determinants of health framework, may be partially explained by residential context. The relationship between neighborhood factors and self-rated health has been examined in isolation but a more holistic approach is needed to understand how these factors may cluster together and how these neighborhood typologies relate to health. To address this gap, we conducted a latent profile analysis using data from the Chicago Community Adult Health Study (CCAHS; N = 2969 respondents in 342 neighborhood clusters) to identify neighborhood profiles, examined differences in neighborhood characteristics among the identified typologies and tested their relationship to self-rated health. Results indicated four distinct classes of neighborhoods that vary significantly on most neighborhood-level social determinants of health and can be defined by racial/ethnic composition and class. Residents in Hispanic, majority black disadvantaged, and majority black non-poor neighborhoods all had significantly poorer self-rated health when compared to majority white neighborhoods. The difference between black non-poor and white neighborhoods in self-rated health was not significant when controlling for individual race/ethnicity. The results indicate that neighborhood factors do cluster by race and class of the neighborhood and that this clustering is related to poorer self-rated health.

The weight of racism: Vigilance and racial inequalities in weight-related measures

In the United States, racial/ethnic inequalities in obesity are well-documented, particularly among women. Using the Chicago Community Adult Health Study, a probability-based sample in 2001–2003 (N = 3105), we examined the roles of discrimination and vigilance in racial inequalities in two weight-related measures, body mass index (BMI) and waist circumference (WC), viewed through a cultural racism lens. Cultural racism creates a social environment in which Black Americans bear the stigma burden of their racial group while White Americans are allowed to view themselves as individuals. We propose that in this context, interpersonal discrimination holds a different meaning for Blacks and Whites, while vigilance captures the coping style for Blacks who carry the stigma burden of the racial group. By placing discrimination and vigilance within the context of cultural racism, we operationalize existing survey measures and utilize statistical models to clarify the ambiguous associations between discrimination and weight-related inequalities in the extant literature. Multivariate models were estimated for BMI and WC separately and were stratified by gender. Black women had higher mean BMI and WC than any other group, as well as highest levels of vigilance. White women did not show an association between vigilance and WC but did show a strong positive association between discrimination and WC. Conversely, Black women displayed an association between vigilance and WC, but not between discrimination and WC. These results demonstrate that vigilance and discrimination may hold different meanings for obesity by ethnoracial group that are concealed when all women are examined together and viewed without considering a cultural racism lens.

The Role of Disadvantaged Neighborhood Environments in the Association of John Henryism With Hypertension and Obesity.

The John Henryism hypothesis proposes that high-effort, active coping in impoverished, low-resource environments is associated with an increased risk of cardiovascular disease, but a lower risk of disease in a high-resource environment. To test this hypothesis, we examined the association of John Henryism Active Coping (JHAC) with objectively measured neighborhood disadvantages and the relationship to hypertension (including systolic [SBP] and diastolic [DBP] blood pressure) and elevated body mass index (BMI). The study included 3105 participants- 39.93% non-Hispanic blacks, 31.66% non-Hispanic whites, and 25.83% Hispanic and 2.58% non-Hispanic other. All participants aged 18 to 92 years were surveyed and underwent a baseline clinical examination as part of the Chicago Community Adult Health Study, from 2001 to 2003. Coping was measured using four items from the JHAC scale, and neighborhood disadvantage was assessed using rater assessments and the US Census data. In multilevel regression models clustered by neighborhood, neither JHAC nor neighborhood disadvantage was significantly associated with hypertension (SBP and DBP) or BMI. However, significant interaction effects of neighborhood disadvantage and JHAC on hypertension (odds ratio [standard error {SE}] = 0.66 [0.11], p = .018), SBP (B [SE] = -2.63 [1.33], p = .048), DBP (B [SE] = -2.08 [0.87], p = .017), and BMI (B [SE] = -1.86 [0.46], p < .001) were found, such that JHAC was related to increases in disadvantaged neighborhoods and decreases in advantaged neighborhoods. In a large study that modeled objective measures of neighborhood disadvantage, JHAC was associated with increased risk for cardiovascular disease among individuals living in highly disadvantaged neighborhoods which lack resources and opportunities for upward social mobility. This is consistent with the John Henryism hypothesis.

Testing Immigrant Social Ties Explanations for Latino Health Paradoxes: The Case of Social Support and Depression Symptoms

We tested the immigrant social ties hypothesis for Latino health outcomes by examining whether positive social support from, and negative interactions with, spouses/partners, friends/relatives, and children accounted for the differences in depression symptoms between immigrant and U.S.-born Latinos. We analyzed data from the 2001–2003 Chicago Community Adult Health Study. Immigrants and U.S.-born Latinos reported similar levels of positive support from spouses/partners and children, but the U.S.-born reported higher levels of positive support from friends/relatives. At the same time, U.S.-born Latinos reported higher levels of negative interactions with friends/relatives, spouses/partners, and children. For the full sample and the sample with children, U.S.-born Latinos show higher levels of depression symptoms when compared to immigrant Latinos, even after controlling for sociodemographic characteristics. However, no differences on depression symptoms were found when the sample was restricted to married ...

Parent-Teacher Association, Soup Kitchen, Church, or the Local Civic Club? Life Stage Indicators of Volunteer Domain.

Gaps in existing literature hinder our knowledge of how life stage-related identities (e.g., worker, parent, student, etc.) influence individuals' decisions about whether and how to get involved in community service. Interventions to increase volunteerism throughout the life course require a more nuanced understanding of this relationship. We use multinomial logistic models to analyze how life phase factors relate to involvement in different types of voluntary organizations across the adult life course in the Chicago Community Adult Health Study. Half of the adults did not volunteer. Those who did volunteer were categorized as charitable, youth-oriented, religious, civic, or multidomain volunteers. Age, employment, family structure, demographics, and self-rated health differentially predicted volunteering in specific domains. Findings from this study suggest that recruitment and retention efforts employed by different nonprofit organizations may be more effective if they take into consideration the life phase factors that enhance or detract from likelihood of engagement.

Childhood adversity, adult neighborhood context, and cumulative biological risk for chronic diseases in adulthood.

We examined the association between childhood adversity and cumulative biological risk for a variety of chronic diseases in adulthood, and whether this association varied by neighborhood affluence. Data were drawn from the Chicago Community Adult Health Study (2001-2003), a cross-sectional probability sample that included interviews and blood collection (n = 550 adults). A childhood adversity score was calculated from eight items. Neighborhood affluence was defined using Census data. An index to reflect cumulative biological risk was constructed as a count of eight biomarkers above clinically established thresholds, including systolic and diastolic blood pressure, resting heart rate, C-reactive protein, waist circumference, hemoglobin A1c, and total and high-density lipoprotein cholesterol. Generalized linear models with a Poisson link function were used to estimate incident rate ratios (IRRs). A 1-standard-deviation increase in the childhood adversity score was associated with a 9% increase in cumulative biological risk, after adjustment for demographic and behavioral characteristics (IRR = 1.09, 95% confidence interval (CI) = 1.02-1.17). This association was modified by neighborhood affluence (IRR = 0.92, 95% CI = 0.86, 0.99). Stratified models indicated that childhood adversity was associated with elevated cumulative biological risk only among individuals who resided in low-affluence (bottom tertile) neighborhoods (IRR = 1.16, 95% CI = 1.05, 1.28); there was no association in high-affluence (top tertile) neighborhoods (IRR = 0.97, 95% CI = 0.83, 1.14). Childhood adversity is associated with elevated cumulative biological risk in adulthood, and neighborhood affluence may buffer this association. Results demonstrate the importance of neighborhood characteristics for associations between childhood adversity and disease risk, even after accounting for adult socioeconomic status.

Racial/ethnic disparities in hypertension prevalence: reconsidering the role of chronic stress.

We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults. We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n = 3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models. Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range = 0-12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR = 1.05; 95% CI = 0.99, 1.12), and Whites showed no association (OR = 0.95; 95% CI = 0.87, 1.03). Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.

Neighborhood walkable urban form and C-reactive protein

BackgroundWalkable urban form predicts physical activity and lower body mass index, which lower C-reactive protein (CRP). However, urban form is also related to pollution, noise, social and health behavior, crowding, and other stressors, which may complement or contravene walkability effects. PurposeThis paper assesses within-neighborhood correlation of CRP, and whether three features of walkable urban form (residential density, street connectivity, and land use mix) are associated with CRP levels. MethodsCRP measures (n=610) and sociodemographic data come from the 2001–3 Chicago Community Adult Health Study, linked with objective built environment data. ResultsWithin-neighborhood correlations of CRP are greater than those of related health measures. A one standard deviation increase in residential density predicts significantly higher log CRP (e.g. β=0.11, p<.01) in Chicago, while a one standard deviation increase in land use mix predicts significantly lower CRP (e.g. β=−0. 19, p<0.01). Street connectivity is unrelated to CRP in this highly walkable city. DiscussionResults suggest that residential density may be a risk factor for inflammation, while greater walkability of mixed land use areas may be protective. It may be that negative aspects of density overcome the inflammatory benefits of walking.

The Relationship between Perceived Discrimination and Psychotherapeutic and Illicit Drug Misuse in Chicago, IL, USA

Based on several stress-coping frameworks, recent studies have suggested that perceived experiences of discrimination, a psychosocial stressor, may be associated with various risky health behaviors. The 2001 Chicago Community Adult Health Study (n = 3,101), a face-to-face representative probability sample of adults in Chicago, IL, USA, was used to examine the relationship among lifetime everyday discrimination, major discrimination, and the use of illicit and psychotherapeutic drugs for nonmedical reasons. We used negative binomial logistic and multinomial regression analyses controlling for potential confounders. Approximately 17% of the respondents reported using one or more illicit drugs and/or misusing one or more psychotherapeutic drug. Adjusting for socio-demographic characteristics, other stressors and various personality-related characteristics, results from negative binomial regression suggest that respondents who experienced moderate to high levels of everyday discrimination misused on average 1.5 different kinds of drugs more than respondents that experienced relatively low levels of everyday discrimination (p < 0.05). Similarly, an increase in one lifetime major discrimination event was associated with an increase of misusing 1.3 different drugs on average regardless of experiences of everyday discrimination (p < 0.001). When examining the types of drugs misused, results from multinomial logistic regression suggest that everyday discrimination was only associated with illicit drug use alone; however, lifetime major discrimination was associated with increased odds of using any illicit and both illicit/psychotherapeutic drugs. Mental health and substance use clinical providers should be aware of these potential relationships and consider addressing the harmful effects of perceived discrimination, in all patients not only among racial/ethnic minority patients.

Contextualizing nativity status, Latino social ties, and ethnic enclaves: an examination of the ‘immigrant social ties hypothesis’

ObjectivesResearchers have posited that one potential explanation for the better-than-expected health outcomes observed among some Latino immigrants, vis-à-vis their US-born counterparts, may be the strength of social ties and social support among immigrants.MethodsWe examined the association between nativity status and social ties using data from the Chicago Community Adult Health Study's Latino subsample, which includes Mexicans, Puerto Ricans, and other Latinos. First, we used ordinary least squares (OLS) regression methods to model the effect of nativity status on five outcomes: informal social integration; social network diversity; network size; instrumental support; and informational support. Using multilevel mixed-effects regression models, we estimated the association between Latino/immigrant neighborhood composition and our outcomes, and whether these relationships varied by nativity status. Lastly, we examined the relationship between social ties and immigrants' length of time in the USA.ResultsAfter controlling for individual-level characteristics, immigrant Latinos had significantly lower levels of social ties than their US-born counterparts for all the outcomes, except informational support. Latino/immigrant neighborhood composition was positively associated with being socially integrated and having larger and more diverse social networks. The associations between two of our outcomes (informal social integration and network size) and living in a neighborhood with greater concentrations of Latinos and immigrants were stronger for US-born Latinos than for immigrant Latinos. US-born Latinos maintained a significant social ties advantage over immigrants – regardless of length of time in the USA – for informal social integration, network diversity, and network size.ConclusionAt the individual level, our findings challenge the assumption that Latino immigrants would have larger networks and/or higher levels of support and social integration than their US-born counterparts. Our study underscores the importance of understanding the contexts that promote the development of social ties. We discuss the implications of these findings for understanding Latino and immigrant social ties and health outcomes.

Neighborhood-level stressors, social support, and diurnal patterns of cortisol: The Chicago Community Adult Health Study

Neighborhood disadvantage has consistently been linked to increased rates of morbidity and mortality, but the mechanisms through which neighborhood environments may get “under the skin” remain largely unknown. Differential exposure to chronic environmental stressors has been identified as a potential pathway linking neighborhood disadvantage and poor health, particularly through the dysregulation of stress-related biological pathways such as cortisol secretion, but the majority of existing observational studies on stress and neuroendocrine functioning have focused exclusively on individual-level stressors and psychosocial characteristics. This paper aims to fill that gap by examining the association between features of the neighborhood environment and the diurnal cortisol patterns of 308 individuals from Chicago, Illinois, USA. We found that respondents in neighborhoods with high levels of perceived and observed stressors or low levels of social support experienced a flatter rate of cortisol decline throughout the day. In addition, overall mean cortisol levels were found to be lower in higher stress, lower support neighborhoods. This study adds to the growing evidence of hypocortisolism among chronically stressed adult populations and suggests hypocortisolism rather than hypercortisolism as a potential mechanism linking social disadvantage to poor health.

Neighborhood Context and Hypertension Outcomes Among Latinos in Chicago

Although a health advantage in hypertension has been documented among Latinos, this advantage appears to be eroding. Of particular concern is the observation that Latinos are less likely to be screened and treated for hypertension and to having it controlled. Scholars have suggested that, above and beyond individual-level factors, neighborhood characteristics may be important predictors of health and health care. We analyzed 2001-2003 data from the Chicago Community Adult Health Study to examine (a) the relationship between the Latino and immigrant composition of neighborhoods in Chicago and several outcomes among Latinos: having hypertension, utilizing hypertension-related health care, and being treated for hypertension; and (b) whether there was a differential effect of neighborhood Latino/immigrant concentration by language of interview and nativity status. We controlled for additional neighborhood characteristics relevant to hypertension and to the availability and accessibility of health care resources. Neighborhoods with higher concentrations of immigrants and Latinos were associated with Latinos having lower odds of hypertension (OR = 0.60, p = 0.03). However, among those with hypertension, our results point to deleterious effects on hypertension care (OR = 0.55, p = 0.06) and treatment (OR = 0.54, p = 0.04) associated with living in neighborhoods with higher concentrations of immigrants and Latinos. We detected no significant interaction effects between immigrant/Latino neighborhood composition and language of interview or being an immigrant in this sample. These results suggest that improving access to care for Latinos with hypertension requires enhanced placement of community clinics and other safety-net health centers in neighborhoods with higher proportions of immigrants and Latinos.

Investigating the Relationship between Perceived Discrimination, Social Status, and Mental Health.

A growing body of evidence suggests that experiences with discrimination have implications for mental health and that these associations may vary by social status. We use data from the Chicago Community Adult Health Study (CCAHS) to examine how two types of perceived discrimination, chronic everyday discrimination and major lifetime discrimination, are linked to mental health, and how this association varies by race/ethnicity, gender, and socioeconomic status. Results indicate that everyday discrimination is generally independently linked to greater depressive symptoms, loneliness, and hostility across all social status groups. Major discrimination is not associated with depressive symptoms or loneliness after adjusting for a host of covariates, but is associated with hostility, especially for certain groups. These findings highlight the need to examine multiple indicators of discrimination and mental health, and to pay attention to both differences and similarities in these associations by social status.

Are there hopeless neighborhoods? An exploration of environmental associations between individual-level feelings of hopelessness and neighborhood characteristics

Feelings of hopelessness are prospectively associated with increased risk of death, progression of atherosclerosis and other health outcomes. Places as well as people may promote a sense of hopelessness. We used the Chicago Community Adult Health Study to investigate whether feelings of hopelessness cluster at the neighborhood level. Random-intercept logistic models were used to examine associations of hopelessness with neighborhood conditions (physical disorder and decay, perceived violence and disorder, social cohesion) and census-based measures of neighborhood socioeconomic conditions (poverty, unemployment, % high school dropouts) from 1980–2000. Of the 3074 participants, 459 were categorized as experiencing hopelessness. Greater physical disorder and perceived disorder and a higher unemployment rate were associated with increased odds of hopelessness. Individuals' reports of hopelessness reflect physical, socioeconomic, and opportunity characteristics of their neighborhoods above and beyond their individual characteristics. Changing opportunity structures in a neighborhood may play a key role in reducing individuals' feelings of hopelessness.