Effect Of Neighborhood Socioeconomic Status Research Articles

Effects of socioeconomic status and greenspace on respiratory emergency department visits under short-term temperature variations: An age-stratified case time-series study

IntroductionNeighborhood socioeconomic status (SES) and greenspace can affect respiratory health. However, it is unclear whether effects of neighborhood SES and greenspace on respiratory health still exist regardless of temperature variations. MethodsThis paper conducted a two-stage, age-stratified case time-series study. The first goal is to examine the associations between two temperature metrics (daily mean temperature [DMT] and diurnal temperature range [DTR]) and respiratory emergency department (ED) visits among four age groups in New York City. The second goal is to evaluate whether neighborhood SES and greenspace would be determinants of respiratory ED visits independent from temperature varying factors. A distributed lag nonlinear model was applied on ED data from 135 zip codes (October 2016 - February 2020). ResultsOur first-stage analysis indicated that older adults aged 65+ had higher risk of ED visits (RR=2.78, 95% eCI: 2.41, 3.22; with 7 days of lag) on days with low DMT (-10°C), followed by adults aged 18-64 (RR=2.48, 95% eCI: 2.32, 2.65), children and youth aged 5-17 (RR=1.38, 95% eCI: 1.24, 1.53), and young children aged 0-4 (RR=1.04, 95% eCI: 0.96, 1.13). However, no excess respiratory ED visits were observed on days with high DMT (30°C). Higher DTR was associated with higher risk, with children and youth more susceptible when DTR was high (DTR 20°C; RR=5.70, 95% eCI: 3.42, 9.49; with 7 days of lag). The second-stage analysis indicated neighborhood SES and greenspace had significant associations with respiratory ED visits regardless of temperature variations. Specifically, Higher income and greenspace exposure were negatively associated with ED visits among all age groups. ConclusionsNeighborhood SES and greenspace could affect respiratory morbidity regardless of weather conditions. Daily temperature variations accelerated the short-term risk among population subgroups under different weather conditions (e.g., higher risk of days with low DMT among older adults, higher risk of days with high DTR among children and youth aged 5-17), which could create co-effects with neighborhood SES and greenspace on respiratory health.

The effects of neighborhood socioeconomic status on ADL/IADL among Chinese older adults-neighborhood environments as mediators.

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. 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. 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). 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.

Examining the Long-term Association Between Neighborhood Socioeconomic Status and Obesity and Obesity-related Unhealthy Behaviors Among Children: Results From the Fragile Families and Child Wellbeing Study.

Literature has focused on neighborhood environments and their possible impacts on obesity and obesity-related behaviors. However, few longitudinal studies have examined the effect of neighborhood socioeconomic status (nSES) on childhood obesity. Investigate the longitudinal association between nSES and obesity and obesity-related unhealthy behaviors. We obtained data from the Fragile Families and Child Wellbeing Study (N = 2,072). The main exposure was nSES (measured using an index of five variables representing wealth, income, education, and occupation from the Decennial Census 2000) at ages 3, 5, and 9. The outcome was children's body mass index z-score (BMIz) at ages 5, 9, and 15. Three measures of obesity-related behaviors (i.e., child- or caregiver-reported soda/snack food intake, fast-food intake, and sedentary behaviors) at ages 5, 9, and 15 were included as mediators and outcomes. Cross-lagged path analyses were conducted. Higher nSES at a previous wave was associated with consuming less soda/snack foods (βs = -0.15 to -0.11 [varying by ages], p < .05) and fast-food intake (βs = -0.21 to -0.14 [varying by ages], p < .01), and less frequent sedentary behaviors (βs = -0.14 to -0.06 [varying by ages], p < .01), but not with BMIz (βs = -0.08 to 0.05 [varying by ages], p > .05). Unhealthy behaviors did not mediate the nSES-BMIz association at alpha .05. Health policies need to target low-socioeconomic neighborhoods to shape healthy lifestyles in children. To develop effective interventions, future research needs to examine comprehensive potential mediators like obesity-related parenting skills, home environments, and built and social environments on the risk of childhood obesity and obesity-related behaviors.

Abstract PD1-01: The Impact of Structural Racism on Breast Cancer Stage at Presentation

Abstract Background: Despite advances in diagnosis and treatment, racial and economic disparities in breast cancer-specific survival persist and this is exacerbated by later stage at presentation. It is essential to assess the factors that contribute to later stage at presentation to target racial and socioeconomic disparities in breast cancer mortality. The objective of this study was to analyze the effect of neighborhood socioeconomic status (SES) and race/ethnicity, as measured by the Index of Concentration at the Extremes (ICE), on breast cancer stage at presentation in a diverse metropolitan area that mirrors the projected demographics of many US regions. Methods: Patients treated at our medical campus, comprised of a safety-net hospital and an academic cancer center, with stage I-IV breast cancer from 2005-2017 were identified from our tumor registry. Census tracts were used as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed: economic (high vs. low), race/ethnicity (non-Hispanic White (NHW) vs. non-Hispanic Black (NHB) and NHW vs. Hispanic) and racialized economic (low-income NHB vs high-income NHW and low-income Hispanics vs. high-income NHW) segregation. ICE uniquely captures spatial economic and racial/ethnic segregation by mapping social inequality not otherwise captured by evaluating a population of a specific socioeconomic level or belonging to a particular racial/ethnic group. We used five separate models based on each of the ICE variables to evaluate economic and racial/ethnic segregation. Model 1 captures economic segregation (high vs. low), Model 2 captures racial segregation (NHB vs. NHW), Model 3 evaluates racialized economic segregation (low-income NHB vs high-income NHW), Model 4 captures segregation by Hispanic ethnicity (Hispanic vs. Non-Hispanic), and Model 5 captures ethnic and economic segregation (low-income Hispanics vs. high-income NHW). Our main outcome was breast cancer stage at presentation categorized as early (Stage I and II) vs. late (Stage III and IV) disease. All models controlled for the following covariates: race/ethnicity, age, insurance status, tumor subtype, and comorbidities including hypertension, diabetes, coronary artery disease, and hyperlipidemia. Results: The study population included 6,145 breast cancer patients. 52.6% were Hispanic, 26.3% were NHW, and 17.2% were NHB. Those living in the most economically marginalized neighborhoods (Quartiles 1 and 2) had significantly increased odds of presenting with later stage disease [ORQ1 1.36 (1.13-1.64), ORQ2 1.43 (1.18-1.75); p&amp;lt; 0.05]. Those living in the most racial/ethnic and economically marginalized neighborhoods (Quartile 1 of Models 3 and 5) had statistically significantly increased odds of presenting with later stage after controlling for all covariates compared to a NHW living in more economically advantaged neighborhoods [ORModel3 1.55 (1.21-1.99), ORModel5 1.43 (1.11-1.85); p&amp;lt; 0.05]. Conclusions: This study is the first to evaluate stage at presentation by ICE, which allows us to uniquely evaluate how residential racial and economic segregation may influence breast cancer disparities. Our study shows that patients in the most economically and racial/ethnically marginalized neighborhoods were more likely to present with later stage disease. This suggests that structural racism is influencing stage at presentation, and therefore effecting racial and economic disparities in breast cancer, even when accounting for demographics and tumor characteristics. To address these disparities, effective interventions are needed that account for the social and environmental contexts in which cancer patients live and can access care. Table 1: Odds Ratios for Later Stage at Presentation with Breast Cancer by Different Types of Residential Segregation Model 1: Economic segregation (high-income vs low-income) Model 2: NHB vs NHW segregation Model 3: NHB and economic segregation (low-income NHB vs high-income NHW) Model 4: Hispanic vs NHW segregation Model 5: Hispanic and economic segregation (low-income Hispanics vs. high-income NHW) Q1: Most disadvantaged neighborhoods; Q4: Reference: most advantaged neighborhoods. *p &amp;lt; 0.05 Citation Format: Alexandra Hernandez, Brianna L Cohen, Ashly Westrick, Cheyenne Thompson, Susan Kesmodel, Neha Goel. The Impact of Structural Racism on Breast Cancer Stage at Presentation [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD1-01.

Social determinants of neurocognitive and academic performance in sickle cell disease.

Sickle cell disease (SCD) is associated with poor neurocognitive outcomes due to biomedical and psychosocial factors. The aims of this study were to investigate associations between household and neighborhood socioeconomic status (SES) with cognitive and academic outcomes in SCD and to determine if these relationships were modified by sickle genotype, fetal hemoglobin, or age. We prospectively recruited patients to complete a battery of neurocognitive and academic measures. Household SES was measured using the Barratt Simplified Measure of Social Status, a composite index of parent education and occupation. The Social Vulnerability Index was used to classify individuals based on social vulnerabilities at the neighborhood level. Overall, 299 patients between the ages of 4 and 18 (mean=11.4, standard deviation=4.3) years diagnosed with SCD (57% SS/SB0 -thalassemia) completed testing. Stepwise multivariate models demonstrated that patients with low social vulnerability (i.e., high SES) at the neighborhood level displayed intelligence and math scores that were 4.70 and 7.64 points higher than those living in areas with moderate social vulnerability, respectively (p<.05). Reading performance did not differ based on neighborhood SES; however, the effect of neighborhood SES was dependent on age, such that older participants living in neighborhoods with moderate or high levels of social vulnerability displayed poorer reading scores than those with low social vulnerability (p<.05). This study identified patients with SCD at higher risk of poor academic performance based on SES. Interventions addressing academic difficulties should be offered to all children with SCD, but should be emergently offered to this subpopulation.

Gray Matter Structures Mediate Associations between Neighborhood Socioeconomic Status and Cognition in Adolescents: Application of a Mediation Analysis Method

BACKGROUND AND AIM: Over the last few years, significant developments have been taking place in high-dimensional neuroimaging data analysis. METHODS: To determine which neuroimaging features may mediate effects of neighborhood socioeconomic status (SES) on cognitive assessments, we analyzed data from the Adolescent Brain Cognitive Development (ABCD) study and conducted mediation analysis with the Causal Inference Test (CIT). To facilitate this analysis, we extended the data reduction method, Partition, for application to high-dimensional neuroimaging data. Unlike the previously proposed version that directs reduction based on attribute correlation only, we adopted a strategy for the extension that combines spatial distance with attribute correlation. RESULTS:We performed computer simulation studies to contrast the new version with the original approach and found that incorporating spatial information substantially increased data reduction for the same level of information capture and improved computational efficiency. Neuroimaging data were reduced via the modified Partition approach, yielding 88% reduction for 80% information capture. A sulcal depth feature in the superior frontal language area was identified as consistent with causal mediation (CIT P = 0.04). For this feature, there was strong evidence of marginal associations for i) neighborhood vs cognitive, ii) neighborhood vs sulcal depth, and iii) sulcal depth vs cognitive (P = 6.91e-11, 6.11e-06, and 9.63e-04, respectively). CONCLUSIONS:These results suggest that higher socioeconomic status of a neighborhood may lead to less sulcal depth in the superior frontal language area, resulting in improved cognitive performance. KEYWORDS: Big data, Causal inference, Socio-economic factors

Socioeconomic disparities in ostomy reversal among older adults with diverticulitis are more substantial among non-Hispanic Black patients

BackgroundWhile ostomies for diverticulitis are often intended to be temporary, ostomy reversal rates can be as low as 46%. There are few comprehensive studies evaluating the effects of socioeconomic status as a disparity in ostomy reversal. We hypothesized that among the elderly Medicare population undergoing partial colectomy for diverticulitis, lower socioeconomic status would be associated with reduced reversal rates. MethodsRetrospective cohort study using a 20% representative sample of Medicare beneficiaries >65 years old with diverticulitis who received ostomies between January 1, 2010, to December 31, 2017. We evaluated the effect of neighborhood socioeconomic status, measured by the Social Deprivation Index, on ostomy reversal within 1 year. Secondary outcomes were complications and mortality. ResultsOf 10,572 patients, ostomy reversals ranged from 21.2% (low socioeconomic status) to 29.8% (highest socioeconomic status), with a shorter time to reversal among higher socioeconomic status groups. Patients with low socioeconomic status were less likely to have their ostomies reversed, compared with the highest socioeconomic status group (hazard ratio 0.83, 95% confidence interval 0.74–0.93) and were more likely to die (hazard ratio 1.21, 95% confidence interval 1.10–1.33). When stratified by race/ethnicity and socioeconomic status, non-Hispanic White patients at every socioeconomic status had a higher reversal rate than non-Hispanic Black patients (White patients 32.0%–24.8% vs Black patients 19.6%–14.7%). Socioeconomic status appeared to have a higher relative impact among non-Hispanic Black patients. ConclusionAmong Medicare diverticulitis patients, ostomy reversal rates are low. Patients with lower socioeconomic status are less likely to undergo stoma reversal and are more likely to die; Black patients are least likely to have an ostomy reversal.

Impact of neighborhood socioeconomic status on the association between occupational radiation exposure and circulatory disease

Background: Exposure to ionizing radiation, even at low-to-moderate doses, increases the risk of circulatory disease (CD) incidence and mortality. The risk of CD is also influenced by an individual’s social environment, and this may modify the effect of occupational exposures like ionizing radiation. Aim: We examined the effect of neighborhood socioeconomic status (nSES) on incidence and mortality from overall CD, ischemic heart disease (IHD) and cerebrovascular disease (CeVD) in the US Radiologic Technologists Study (USRT) between 1994 and 2012. Additionally, we assessed whether nSES confounds and/or modifies the association between occupational radiation exposure and CD outcomes. Methods: Cumulative radiation dose (mGy) was estimated for each participant. We created tertiles of nSES combining six items from the 1990 Census (household income, housing value, % households with interest/income, % adults who completed high school, % adults who completed college, % of persons in managerial occupations). Using discrete time hazard models, we estimated HR and 95%CI for the association between radiation, nSES and CD outcomes. Results: Compared to residents from the top nSES tertile, technologists from low-nSES areas had an elevated risk of overall CD mortality, IHD mortality and incidence, and CeVD incidence (HRs ranging from 1.18 to 1.25, 95%CIs:1.07-1.42), but not for CeVD mortality (HR: 0.92, 95%CI: 0.75-1.15) adjusting for radiation and individual education. We found no evidence of confounding by nSES on the association between radiation and any CD outcomes. There was evidence of a multiplicative interaction between nSES tertiles and radiation exposure for all mortality outcomes (p-value for interaction: &lt;0.001 for overall CD, 0.003 for IHD and 0.004 for CeVD), but not for incidence. Conclusion: nSES is independently associated with CD mortality and incidence in a group of US radiologic technologists occupationally exposed to radiation. Additionally, nSES modifies (but does not confound) the association between radiation and CD mortality outcomes.

Effect of neighbourhood socioeconomic status on overweight and obesity in children 2-15 years of different ethnic groups.

Studies on the influence of neighbourhood socioeconomic status (N-SES) on overweight and obesity rates in children from different ethnic backgrounds are scarce. This study investigated the differential effect of N-SES on overweight (including obesity) and obesity prevalence in different ethnic groups, and if N-SES explains ethnic differences in the prevalence of overweight and obesity. A population based study of 109 766 body mass index (BMI) measurements of 86 209 children 2-15 years of Dutch, Turkish, Moroccan and South Asian descent. BMI class was determined with The International Obesity Task Force, and South Asian specific BMI cut-offs. WHO BMI criteria were applied for reference purposes. The effect of N-SES on prevalence rates was studied with generalized linear mixed models. Neighbourhood SES was negatively associated with overweight and obesity. However, the effect of N-SES on overweight was stronger in Dutch children (OR 0.75, 95% CI 0.73-0.77) than in Turkish (OR 0.86, 95% CI 0.82-0.90), Moroccan (OR 0.91, 95% CI 0.86-0.97) and South Asian (OR 0.90, 95% CI 0.84-0.96) children. The influence of N-SES on obesity showed a similar pattern, except for Moroccan children in whom obesity prevalence remained stable over the whole N-SES range. At the same N-SES, overweight and obesity prevalence was significantly higher in Turkish, Moroccan and especially South Asian children compared with Dutch children. Adjusting for N-SES attenuated the ethnic differences. Neighbourhood SES was negatively associated with overweight and obesity rates in all ethnic groups, but only partly explained the ethnic differences in overweight and obesity prevalence.

Neighborhood Socioeconomic Status and Cognitive Trajectories in a Diverse Longitudinal Cohort

ABSTRACTObjectives: Although individual-level socioeconomic status is associated with poor outcomes, less is known regarding how the social context might affect cognitive outcomes. We examined the effect of neighborhood socioeconomic status (NSES) on baseline cognitive function and trajectories of decline.Methods: The sample (N = 480) came from a longitudinal cohort recruited to study cognitive function. Mixed effects models examined the influence of NSES on baseline and rate of change in executive function, semantic memory, and episodic memory.Results: NSES was positively associated with semantic memory scores at baseline, but not with executive function or episodic memory in adjusted models, nor was it associated with cognitive change in longitudinal analyses. In exploratory analyses, for individuals with dementia, those with higher NSES declined faster in executive function and semantic memory than did those with lower NSES.Conclusions: Results suggest that NSES has limited effects independent of personal characteristics; however, findings showed a complex relation of NSES and decline, with NSES effects observed only for individuals with dementia. Results are discussed in the context of cognitive reserve.Clinical Implications: Clinical assessments of individuals who present with cognitive impairment might benefit from an understanding of the neighborhood context from which patients come.

Do Neighborhood Effects on Low-Income Minority Children Depend on Their Age? Evidence From a Public Housing Natural Experiment

We analyze data from a natural experiment involving Denver public housing that quasirandomly assigns low-income Latino and African American youth to neighborhoods. Intent-to-treat and treatment-on-treated models reveal substantial effects of neighborhood socioeconomic status, ethnicity, and safety domains on youth and young adult educational, employment, and fertility outcomes. Effects are contingent on when a youth was first assigned to public housing and the neighborhood characteristic in question. Benefits from neighbors of higher occupational prestige are stronger if a child begins experiencing them at a younger age, whereas negative consequences of neighborhood crime are only manifested for teens. Neighborhood effect sizes apparently depend on the interaction among exposure duration, disruption effects of mobility, and developmental stage-specific differences in vulnerability to the given neighborhood effect mechanism operative. Our results hold powerful and provocative implications for where assisted housing should be developed and how applicants should be assigned to neighborhoods.

Effects of neighborhood socioeconomic status on blood pressure in older adults.

ABSTRACTOBJECTIVE To test if the neighborhood socioeconomic status is associated with systolic blood pressure and hypertension in older adults.METHODS A cross-sectional population-based study with a sample of 1,705 older adults from Florianópolis, SC, Southern Brazil. The contextual variable used was the average years of schooling of the head of the household in census tracts. Participants were considered hypertensive when the systolic blood pressure was ≥ 140 mmHg, diastolic ≥ 90 mmHg, or both. Additionally, the use of antihypertensive medication was also considered. Data were analyzed by using multilevel models of logistic and linear regression.RESULTS The average age of the sample was 70.7 years and the average of systolic and diastolic blood pressure was 133.5 mmHg (SD = 20.5 mmHg) and 81.9 mmHg (SD = 12.5 mmHg), respectively. The systolic blood pressure was 4.46 mmHg (95%CI 1.00–7.92) higher and the chance of hypertension was 1.80 (95%CI 1.26–2.57) among those who lived in census tracts with lower level of schooling. When the use of antihypertensive medication was combined with blood pressure levels, none association was found between the outcome and the level of schooling of the census tract.CONCLUSIONS Analytical models more robust (such as multilevel analysis) in Brazil are still little used, with a small number of articles published. Neighborhood socioeconomic status is associated with systolic blood pressure and the chance of hypertension, regardless of individual characteristics.

A Spatial Analysis of the Effects of Neighborhood Socio-economic Status on Residential Burglaries in Tokyo

A Spatial Analysis of the Effects of Neighborhood Socio-economic Status on Residential Burglaries in Tokyo

Abstract P279: Neighborhood Socioeconomic Status and Physical Function in Late Life: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Functional impairments influence the performance of activities of daily living and may result in dependence on others for basic self-care needs. Lower individual-level socioeconomic status (SES) is associated with more self-reported disability and lower measured walking speeds which convey a higher risk of cardiovascular and all-cause mortality. The role of neighborhood-level SES on these functional outcomes has not been widely examined. Hypothesis: We hypothesized that residing in a socioeconomically disadvantaged neighborhood is inversely associated with physical function, after accounting for individual-level SES. Methods: We included 5,388 participants (42% male, 19% black, mean age: 76 years) from the 2011-2013 examination of the ARIC cohort. Neighborhood SES was constructed from census-tract data and an index score was derived based on aggregate z-score estimates from the following 6 dimensions: median household income; median value of owner-occupied units; % adults with a high school degree; % adults with a college degree; % households receiving interest, dividend or rental income; and % adults employed in executive, managerial or professional occupations. Race-specific tertiles were generated to indicate low, middle and high neighborhood SES. The Short Physical Performance Battery (SPPB) was used to derive a summary score (0-12) of physical function based on the individual’s performance on gait speed, chair stands and balance exercises. Negative binomial regression was used to quantify the difference in the log of expected counts in the SPPB score between race-stratified low, middle and high neighborhood SES, adjusting for age, sex, body mass index (BMI), smoking, hypertension, diabetes, study center, and education as a measure of individual-level SES. The multivariable-adjusted effect of neighborhood SES on a 4-meter walking speed test and on grip strength was estimated by least-squares regression. Results: Blacks had a slower walking speed, higher grip strength and lower SPPB score compared to whites. Hypertension, higher BMI, and lower education were more prevalent among white and black individuals from low SES neighborhoods, compared to those from high SES neighborhoods. White participants residing in a low SES neighborhood had a 1.1 kilogram (95% CI: 0.3, 1.9) greater grip strength compared to those residing in high SES neighborhoods. Neighborhood SES was not associated with walking speed and SPPB in either whites or blacks. Associations were robust to adjustment for education. Conclusions: Individual but not neighborhood-level SES was associated with poorer physical function. The prevalence of adverse clinical comorbidities was higher among both black and white participants living in disadvantaged neighborhoods. Poorer individual, modifiable health and SES measures may be targets for interventions to reduce functional disparities.

The effect of neighborhood socioeconomic status on education and health outcomes for children living in social housing.

We explored differences in health and education outcomes between children living in social housing and not, and effects of social housing's neighborhood socioeconomic status. In this cohort study, we used the population-based repository of administrative data at the Manitoba Centre for Health Policy. We included children aged 0 to 19 years in Winnipeg, Manitoba, in fiscal years 2006-2007 to 2008-2009 (n = 13,238 social housing; n = 174,017 others). We examined 5 outcomes: age-2 complete immunization, a school-readiness measure, adolescent pregnancy (ages 15-19 years), grade-9 completion, and high-school completion. Logistic regression and generalized estimating equation modeling generated rates. We derived neighborhood income quintiles (Q1 lowest, Q5 highest) from average household income census data. Children in social housing fared worse than comparative children within each neighborhood income quintile. When we compared children in social housing by quintile, preschool indicators (immunization and school readiness) were similar, but adolescent outcomes (grade-9 and high-school completion, adolescent pregnancy) were better in Q3 to Q5. Children in social housing had poorer health and education outcomes than all others, but living in social housing in wealthier areas was associated with better adolescent outcomes.

The association between objective walkability, neighborhood socio-economic status, and physical activity in Belgian children.

BackgroundObjective walkability is an important correlate of adults’ physical activity. Studies investigating the relation between walkability and children’s physical activity are scarce. However, in order to develop effective environmental interventions, a profound investigation of this relation is needed in all age groups. The aim of this study was to investigate the association between objective walkability and different domains of children’s physical activity, and to investigate the moderating effect of neighborhood socio-economic status in this relation.MethodsData were collected between December 2011 and May 2013 as part of the Belgian Environmental Physical Activity Study in children. Children (9–12 years old; n = 606) were recruited from 18 elementary schools in Ghent (Belgium). Children together with one of their parents completed the Flemish Physical Activity Questionnaire and wore an accelerometer for 7 consecutive days. Children’s neighborhood walkability was calculated using geographical information systems. Multilevel cross-classified modeling was used to determine the relationship between children’s PA and objectively measured walkability and the moderating effect of neighborhood SES in this relation.ResultsIn low SES neighborhoods walkability was positively related to walking for transportation during leisure time (β = 0.381 ± 0.124; 95% CI = 0.138, 0.624) and was negatively related to sports during leisure time (β = −0.245 ± 0.121; 95% CI = −0.482, −0.008). In high socio-economic status neighborhoods, walkability was unrelated to children’s physical activity. No relations of neighborhood walkability and neighborhood socio-economic status with cycling during leisure time, active commuting to school and objectively measured moderate- to vigorous-intensity physical activity were found.ConclusionsNo univocal relation between neighborhood walkability and physical activity was found in 9–12 year old children. Results from international adult studies cannot be generalized to children. There is a need in future research to determine the key environmental correlates of children’s physical activity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-014-0104-1) contains supplementary material, which is available to authorized users.

Estimating neighbourhood-level socio-economic effect on preterm births using a multilevel approach: a case study in Georgia, USA

This study investigates the contextual effect of neighbourhood socio-economic status (SES) on the risk of preterm birth (PTB) using multilevel models. Birth data retrieved from 2000 Georgia Vital Records were geocoded and joined to their respective census tracts. The census tract level Index of Deprivation (IoD) was calculated using nine 2000 Census variables based on a previously proposed ‘standard’ index. Two-level random intercept regression models were developed using 117,329 live and singleton births at the individual level and 1618 census tracts at the neighbourhood level. After adjustment for individual-level factors, IoD generated an odds ratio of 1.006 (95% CI 1.00–1.01), showing a modest but significant effect on PTB. Intra-class correlation (ICC) was 0.83% after adjusting for individual-level factors and the census tract level IoD. A wide IOR-80% interval (0.74–1.36) suggests large unexplained residual in between census tract variation remained. The median odds ratio (MOR) value of 1.17 revealed that the unmodelled neighbourhood effect was stronger than the fixed effect of census tract-level predicting variable, IoD, but weaker than the effects of several individual-level predictor variables, including race, tobacco use, prenatal care, foetal death history and marital status. Overall, better census tract-level SES would have a modest protective effect for PTB risk. The full strength of multilevel models should be exploited further to help our understanding of PTB aetiology.

Supportive parenting mediates neighborhood socioeconomic disparities in children's antisocial behavior from ages 5 to 12

We report a graded relationship between neighborhood socioeconomic status (SES) and children's antisocial behavior that (a) can be observed at school entry, (b) widens across childhood, (c) remains after controlling for family-level SES and risk, and (d) is completely mediated by maternal warmth and parental monitoring (defined throughout as supportive parenting). The children were participants in the Environmental Risk Longitudinal Twin Study (N = 2,232), which prospectively tracked the development of children and their neighborhoods across childhood. Direct and independent effects of neighborhood-level SES on children's antisocial behavior were observed as early as age 5, and the gap between children living in deprived versus more affluent neighborhoods widened as children approached adolescence. By age 12, the effect of neighborhood SES on children's antisocial behavior was as large as the effect observed for our most robust predictor of antisocial behavior: sex (Cohen d = 0.51 when comparing children growing up in deprived vs. more affluent neighborhoods in comparison to Cohen d = 0.53 when comparing antisocial behavior among boys vs. girls). However, these relatively large differences in children's levels and rate of change in antisocial behavior across deprived versus more affluent neighborhoods were completely mediated by supportive parenting practices. The implications of our findings for studying and reducing socioeconomic disparities in antisocial behavior among children are discussed.

Abstract P20: Exploring Psychosocial Pathways Between Neighborhood Characteristics and Stroke in Older Adults: the Cardiovascular Health Study

Background: Studies have not investigated whether psychosocial pathways mediate the effect of neighborhood exposures on stroke. Methods: We used data from the Cardiovascular Health Study, a longitudinal population-based cohort study of adults &gt;= 65 years, to construct race-stratified Cox proportional hazard models for time to first ischemic stroke. The key explanatory variable in the baseline model was an index of neighborhood socioeconomic status (NSES), constructed at the census-tract level from six measures of population income, education, employment and wealth. Covariates were individual sociodemographic characteristics (age, gender, marital status, education, and income). In subsequent models, we added psychosocial (depression, social support, social networks, and stressful life events), behavioral (smoking, physical activity, and alcohol), and biologic factors (EKG abnormalities, subclinical cardiovascular disease, hypertension, diabetes, and hyperlipidemia) separately and simultaneously to assess mediation of the effect of NSES on stroke. Results: Of the 3834 participants with no prior stroke, 548 had an incident ischemic stroke over the 11.5-year follow-up. Among the psychosocial factors, only depression was independently associated with higher stroke hazard (Hazard Ratio [HR]=1.26; 95% CI:1.02-1.59). However, addition of psychosocial factors to the baseline model slightly reduced the HRs among residents in the lowest relative to highest NSES quartile from 1.32 (1.01-1.74) to 1.30 (0.98-1.71). Depression ceased to be statistically significant in the model with behavioral and biological factors adjusted. We found no association between NSES and stroke incidence among African Americans. Conclusions: Psychosocial factors played a minimal role in mediating the effect of NSES on stroke incidence among whites.

Neighborhood SES and chronic pain: impact on quality of life of cancer survivors

Cancer-related chronic pain is rarely discussed regarding cancer survivors. Gender and racial disparities in pain exist. However, little is known about the effect of neighborhood socio-economic status (nSES) or the interaction between race, nSES and pain on quality of life (QOL). Black and white survivors of breast, colorectal, lung or prostate cancer or multiple myeloma from the Michigan State Cancer Registry were randomly invited to participate in a cross-sectional mail survey study. Participants (N=152, 23% black, 77% white; 51% male, 49% female) answered questions about socio-demographics, cancer and treatment history, pain, and quality of life.