Neighborhood Environment Research Articles

Validation of the physical activity neighborhood environment scale using geographic information systems among urban men and women in regional China

AimsTo examine the concurrent validity of the Chinese version of Physical Activity Neighborhood Environment Scale (PANES-CHN) among urban adults in regional China. MethodsWith multistage sampling approaches, 801 eligible urban adults aged 35–74 years were recruited from Nanjing municipality of China between July and September of 2019. The neighbourhood built environment features were measured subjectively with PANES-CHN and objectively with geographic information system. The concurrent validity of PANES was assessed using Spearman’s correlations (rs). ResultsAmong the total 801 participants, the mean age was 54.4 (standard deviation = 11.5), while 48.7 % were men. Overall, of all the five objectively-measurable built environment characteristics, the Spearman correlations were examined significant between subjective and objective measurements for commercial facilities (item 2) (rs = 0.19, 95CI%=0.12, 0.25), recreational facilities (item 6) (rs = 0.10, 95CI%=0.02, 0.16), traffic junctions (item 12) (rs = 0.15, 95CI%=0.07, 0.22), medical/education facilities (item 17) (rs = 0.22, 95CI%=0.15, 0.29), but not for public transport stops. Similar scenarios were observed for participants aged 35–60 years, with sufficient physical activity, men or women. The rs value for medical/education facilities (item 17) was significantly higher in participants aged 35–59 years (0.28 vs. 0.13; p = 0.04) than those aged 60 + years. ConclusionsPANES-CHN generally has an acceptable validity for assessing built environment characteristics among urban adults in China, which implies that PANES-CHN can be used to measure built environment attributes in health-related population studies.

Place-Based FACT: Treatment Outcomes and Patients’ Experience with Integrated Neighborhood-Based Care

Locating specialized mental healthcare services in the neighborhood of people with severe mental illnesses (SMI) has been suggested as a way of improving treatment outcomes by increasing patient engagement and integration with the local care landscape. The current mixed methods study aimed to examine patient experience and treatment outcomes in three Flexible Assertive Community Treatment (FACT) teams that relocated to the neighborhood they served, compared to seven teams that continued to provide FACT as usual from a central office. Routine Outcome Measurement (ROM) and care use data were analyzed to compare change in treatment outcomes for patients in place-based FACT (n = 255) and FACT as usual (n = 833). Additionally, retrospective in-depth interviews were conducted with twenty patients about their experience with place-based FACT. Quantitative analysis showed mental health admission days decreased more in place-based than FACT as usual, although this difference was small. Both groups showed improved quality of life, psychosocial functioning, and symptomatic remission rates, and decreased unmet and overall needs for care. There was no change over time in met needs for care, employment, and daily activities. Qualitative analysis showed that patients experienced place-based FACT as more accessible, a better safety net, a more personal approach, better integrated with other forms of care, involving their social network, and embedded in their neighborhood and daily environment. This study showed that location and integration matter to patients, and the long term impact of place-based FACT on treatment outcomes should be explored.

“If you just sit at home and look out of the window, then there is no life.” an ethnographic study of how home-dwelling people with dementia use the cityscape's life in practice

In the near future, more people with dementia will be living at home within an urban context due to a combination of an increased number of people living with dementia and this past decade's urbanization. A common perception is that home-dwelling people with dementia experience a shrinking world, but emerging research from the UK, Sweden, and the Netherlands has broadened this notion by foregrounding how people with dementia experience neighborhoods as a resource in self-care practices. With this article, we contribute to this emerging body of literature and aim to explore how people with dementia experience the cityscape in relation to the onset and progression of their dementia. This study outlines findings from a 7-month ethnographic study involving 12 home-dwelling people with dementia. Using semi-structured interviews, walking interviews, and photovoice, the study explores how the cityscape of Copenhagen, Denmark, affects the everyday life of home-dwelling people living with dementia. Through thematic analysis, three key themes are identified: interaction with the city's life and space as self-care practices, getting out and about as a way to practice a sense of “being in the world” and the loss of orientation abilities and the changing boundaries of the cityscape. The findings from this study contribute to current discussions concerning how people with dementia experience and perceive city and neighborhood environments.

Exploring the Relationship between Built Environment Attributes and Physical Activity in Lower-Income Aging Adults: Preliminary Insights from a Multi-Level Trial.

The built environment has been linked to physical activity (PA) behaviors, yet there is limited knowledge of this association among lower-income midlife and older adults who are insufficiently active. The present cross-sectional study utilized baseline data collected between October 2017 and November 2019 from a clustered randomized controlled trial to determine how built environment attributes were associated with PA behaviors among midlife and older adults (n = 255) residing in or near affordable housing sites (n = 10). At each site, perceptions of the built environment were collected and scored at the participant level via the abbreviated Neighborhood Environment Walkability Survey (NEWS-A), while objective built environment attributes were measured and scored by trained research staff using the Physical Activity Resource Assessment (PARA). Multiple PA behaviors-walking, total PA, and moderate-to-vigorous PA (MVPA) (min/wk)-were measured using the validated Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Adjusted linear regression models examined associations between NEWS-A measures and PA behaviors, and site-level correlations between PARA measures and PA behaviors were examined using Spearman's rank correlations. At the participant level, adjusted models revealed that a one point increase in the NEWS-A aesthetics score was associated with a 57.37 min/wk increase in walking (β = 57.37 [95% CI: 20.84, 93.91], p = 0.002), with a similar association observed for street connectivity and MVPA (β = 24.31 min/wk [95% CI: 3.22, 45.41], p = 0.02). At the site level, MVPA was positively correlated with the quality of the features of local, PA-supportive environmental resources (ρ = 0.82, p = 0.004). Findings indicate that participant- and site-level measures of the built environment may play a role in promoting PA behavior among this demographic and similar populations. Results also suggest that improvements in aesthetic attributes and street connectivity, along with enhancing the quality of local, PA-supportive environmental resources, may be effective strategies for promoting physical activity among lower-income midlife and older adults.

Living with a Smart Knee

After years of wear and tear, many individuals may experience chronic knee pain and require total knee replacement (TKR) to maintain quality of life. However, this approach is limited by a risk of chronic pain after knee replacement. The Persona IQ Smart Knee, an advanced option for all ages designed to improve recovery, may help to overcome this challenge. Despite proven safety and efficacy, factors such as neighbourhood and physical environment or access to healthcare may limit accessibility. Contraindications and other limitations associated with the failure of electronic components may further affect use. However, emerging research is focused on optimizing storage and device size, helping to address potential limitations and promote improved patient outcomes.

Childhood maltreatment and alcohol and tobacco use trajectories in rural Chinese adolescents

BackgroundThere is a high prevalence of childhood maltreatment among Chinese children and adolescents, but little is known about its impact on alcohol and tobacco use trajectories and how positive school and neighborhood environments moderate the associations. The objective of this study was to assess the association between multiple forms of childhood maltreatment and longitudinal alcohol and tobacco use trajectories, and to assess the possibility that perceived connections to school and neighborhood moderate these associations.MethodsThis longitudinal cohort study included 2594 adolescents (9 to 13 years) from a low-income rural area in China. Childhood exposure to abuse and neglect was assessed using the Childhood Trauma Questionnaire. Participants reported past-month alcohol and tobacco use at three time points over 1 year.ResultsGrowth curve models revealed that childhood sexual abuse was associated with a higher risk of past-month drinking (OR = 1.53, 95% CI 1.19–2.03, p < 0.001) and smoking (OR = 1.82, 95% CI 1.30–2.55, p < 0.001). Neglect was associated with a higher risk of past-month drinking (OR = 1.52, 95% CI 1.06–1.90, p < 0.05) and smoking (OR = 2.02, 95% CI 1.34–3.02, p < 0.001). None of the maltreatment forms predicted a faster increase in either drinking or smoking. These associations were found independent of personal, family, and contextual characteristics. School and neighborhood connection moderated the association between physical abuse and past-month drinking, such that physical abuse was associated with a greater risk of drinking only for youth who perceived low school or neighborhood connections.ConclusionsFindings demonstrate the importance of early experiences of childhood maltreatment for adolescent alcohol and tobacco use. Enhancing school and neighborhood connectedness for physically abused youth may help protect them from alcohol use.

Abstract PO2-09-07: Neighborhood Disadvantage and Social Adversity in Breast Cancer Patients

Abstract Introduction: Neighborhood disadvantage has been shown to independently predict breast cancer specific survival even after considering access to care barriers. This effect may be explained in part by biologic influences of the neighborhood environment on breast tumors. Social genomics literatures posits that this relationship is mediated by chronic stress in the form of social adversity, i.e. disadvantaged neighborhoods may be leading to increased stress for patients which in turn may effect tumor biology. Our objective in this study was to link a measure of patient-reported neighborhood specific stress with an objective and widely used measure of neighborhood disadvantage, the Area Deprivation Index (ADI). Methods: In this prospective cohort study patients with stage I-IV breast cancer completed survey questions from a validated Neighborhood Social Environment Adversity Survey (NSEAS) to measure perceived stress caused by their environment. Questions included both 5-item and 4-item Likert scale answer choices with higher scores indicating higher stress. Responses were standardized into Z-scores and composite and subscale scores were calculated by summation. Subscales included threat to safety, social cohesion, and aesthetic quality. Survey questions demonstrated good reliability with a Cronbach’s α of 0.72. Cohort addresses were used to determine the ADI, a continuous measure from 1-10 with higher scores indicating more disadvantage. Hierarchical linear regression was used to assess the relationship between ADI and NSEAS composite and subscale scores while controlling for covariates. Results: 380 breast cancer patients completed the NSEAS 61.6% were Hispanic, 17.0% were Non-Hispanic White, and 21.4% were Non-Hispanic Black. Mean age (SD) was 56 (12) years. Mean (SD) ADI was 4 (3). On univariate analysis, we found that ADI significantly predicts NSEAS composite and subscale scores (Composite β =0.63, t=5.68, p&amp;lt; 0.001; Threat to Safety β =0.18, t=5.07, p&amp;lt; 0.001; Social Cohesion β =0.19, t=3.35, p&amp;lt; 0.001; Aesthetic Quality β =0.15, t=4.20, p&amp;lt; 0.001). After controlling for age, race, ethnicity, highest education level, patient insurance, and annual household income, we found that ADI continued to significantly predict levels of NSEAS (Composite β =0.48, t=4.02, p&amp;lt; 0.001; Threat to Safety β =0.14, t=3.57, p&amp;lt; 0.001; Social Cohesion β =0.14, t=2.34, p=0.02; Aesthetic Quality β =0.12, t=3.09, p=0.002). Conclusion: In our novel study, we found that higher levels of neighborhood disadvantage independently predict higher levels of perceived neighborhood stress in breast cancer patients. Because of the known detrimental effects of both chronic stress and neighborhood disadvantage on health, understanding the specific factors of stress caused by neighborhood-level social adversity can help define targetable areas of intervention for future studies. These findings contribute to current literature on how and why neighborhood disadvantage leads to worse breast cancer outcomes. Table 1. Hierarchical Regression Illustrating Relationship between Neighborhood Disadvantage and Patient-Reported Neighborhood Social Environment Adversity Survey Scores Citation Format: Alexandra Hernandez, Maya Lubarsky, Susan Kesmodel, Michael Antoni, Neha Goel. Neighborhood Disadvantage and Social Adversity in Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-07.

Abstract PO3-10-03: Nationwide Impact of Neighborhood Poverty Hotspots on Breast Cancer Mortality

Abstract Title: Nationwide Impact of Neighborhood Poverty Hotspots on Breast Cancer Mortality Background: Poverty is known to lead to the worst breast cancer (BC) outcomes, at the individual and county level. However, we believe that the relationship between poverty and breast cancer mortality is more complex and can be influenced by the economic status and available resources of the surrounding neighborhoods. Our goal is to understand to what extent poverty in the surrounding neighborhood may contribute to breast cancer mortality on a national scale and the county areas at the highest risk. Methods: This study examines the association between neighborhood effects of poverty on overall and BC mortality among women diagnosed between 2005 and 2019 from NCI SEER. We also obtained county-level five-year poverty estimates from the American Community Survey. Counties with poverty estimates above or below the national mean were high-poverty (H) or low-poverty (L) counties, respectively. We then used local indicators of spatial autocorrelation (LISA) analysis with Local Moran’s I of the poverty estimates and their H- and L-county categorization to define four neighborhood poverty environments for US counties. Specifically, H-counties among other H-counties were classified as poverty hotspots (HH) counties, L-counties among other L-counties were classified as poverty cold spots (LL), H-counties among LL-counties were HL-counties, and L-counties among HH-counties were LH-counties. Non-Hispanic White (NHW), Non-Hispanic Black, and Hispanic women at least 20 years of age diagnosed with local, regional, or distal stage BC between 2005-2009 and 2010-2014 that survived more than one year after diagnosis were aggregated by county of residence at diagnosis to determine their neighborhood poverty environment at BC diagnosis. Women included in the study had a Local Moran's I p-value less than or equal to 0.3 for their county of residence. A Poisson regression model that adjusts for age at diagnosis, race/ethnicity (NHW vs. not-NHW), BC stage, year of diagnosis (2005-2009 vs. 2010-2014), both local and systemic treatment except for hormone therapy, and Estrogen Receptor (ER) status (negative vs. positive) was used to assess the effects of county-level poverty cluster types on BC mortality. Results: Our analysis includes 24,070 women diagnosed with BC, of which 6,919 women died, and 2,262 of these deaths were specific to BC. In total, 4,528 women were in HH counties from CA, GA, KY, LA, NM, UT, and HI; 14,112 women were in LL counties; 4,338 women were in HL counties; 1,092 women were in LH counties. Women in HH, LH, and HL counties had a 1.28 (95%CI:1.15,1.42), 1.23 [95%CI:1.01-1.48], and 1.05 [CI: 0.93,1.17] relative risk of cause-specific BC death respectively when compared to deaths in LL counties after adjustment for year of diagnosis, age at diagnosis, race/ethnicity, stage at diagnosis, treatment, and estrogen receptor status. When stratified by ER status or BC stage at diagnosis, the relative risk of BC mortality for women in HH counties diagnosed with ER-positive, local or regional stage had a 1.35 (95% CI: 1.19,1.52), 1.32 (95%CI: 1.13,1.54), and a 1.21 (95%CI:1.02,1.43) when compared to women in LL counties, respectively. Our analysis also showed that total death trends were similar to the trends observed in cause-specific deaths. In addition, we observed similar total and cause-specific BC death trends when using a p-value of 0.05 for the LISA analysis. Conclusion: We use LISA spatial clustering to demonstrate the impact national poverty neighborhood environments have on BC mortality, thus identifying counties of worst BC outcomes through neighborhood poverty environments. Our findings suggest that prioritization of resource allocations to HH counties would significantly improve BC outcomes. Citation Format: Ifeoma Nwigwe, Michael Desjardins, Kala Visvanathan. Nationwide Impact of Neighborhood Poverty Hotspots on Breast Cancer Mortality [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-03.

Assessing structural models of neighborhood and family sociodemographic characteristics and their relations with externalizing psychopathology.

Externalizing psychopathology has been found to have small to moderate associations with neighborhood and family sociodemographic characteristics. However, prior studies may have used suboptimal operationalizations of neighborhood sociodemographic characteristics and externalizing psychopathology, potentially misestimating relations between these constructs. To address these limitations, in the current study we test different measurement models of these constructs and assess the structural relations between them. Using a population-representative sample of 2,195 twins and siblings from the Georgia Twin Study and data from the National Neighborhood Data Archive and 2000 U.S. Census, we assessed the fit of competing measurement models for family sociodemographic, neighborhood sociodemographic, and neighborhood environment characteristics. In structural models, we regressed a general externalizing dimension on different operationalizations of these variables separately and then simultaneously in a final model. Latent variable operationalizations of family sociodemographic, neighborhood sociodemographic, and neighborhood environment characteristics explained no more variance in broad externalizing psychopathology than other operationalizations. In an omnibus model, family sociodemographic characteristics showed a small association with externalizing psychopathology, while neighborhood sociodemographic and environmental characteristics did not. Family sociodemographic characteristics showed small associations with neighborhood sociodemographic and environmental characteristics, and neighborhood sociodemographic characteristics were moderately associated with neighborhood environment. These findings suggest that family sociodemographic characteristics are more associated with the development of broad externalizing psychopathology in youth than neighborhood sociodemographic characteristics and neighborhood environment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Associations between Neighborhood Characteristics and Childhood Overweight and Obesity in a National Dataset

BackgroundNational child obesity rates continue to climb. While neighborhood factors are known to influence childhood weight, more work is needed to further our understanding of these relationships and inform intervention and policy approaches reflective of complex real-world contexts. MethodsTo evaluate the associations between neighborhood components and childhood overweight/obesity, we analyzed sequential, cross-sectional data from the National Survey of Children’s Health collected annually between 2016 and 2021. To characterize the complexity of children’s neighborhood environments, several interrelated neighborhood factors were examined: amenities, detractions, support, and safety. We used ordinal logistic regression models to evaluate the associations between these exposures of interest and childhood weight status, adjusting for potential confounders. ResultsOur analytic sample contained 96,858 children representing a weighted population of 28,228,799 children ages 10–17 years. Child weight status was healthy in 66.5%, overweight in 16.8%, and obese in 17.2%. All four neighborhood factors were associated with child weight status. The odds of overweight or obesity generally increased with a decreasing number of amenities and increasing number of detractions, with the highest adjusted odds ratio seen with no amenities and all three possible detractions (1.71; 95% confidence interval [1.31, 2.11]). ConclusionsMultiple factors within a child’s neighborhood environment were associated with child weight status in this sample representative of the US population aged 10–17 years. This suggests the need for future research into how policies and programs can support multiple components of a healthy neighborhood environment simultaneously to reduce rates of childhood overweight/obesity.

Neighborhood physical environments and change in cardiometabolic risk factors over 14 years in the study of Women's health across the nation

BackgroundNeighborhood physical environments may influence cardiometabolic health, but prior studies have been inconsistent, and few included long follow-up periods. MethodsChanges in cardiometabolic risk factors were measured for up to 14 years in 2830 midlife women in the Study of Women's Health Across the Nation, a multi-ethnic/racial cohort of women from seven U.S. sites. Data on neighborhood food retail environments (modified Retail Food Environment Index) and walkability (National Walkability Index) were obtained for each woman's residence at each follow-up. Data on neighborhood access to green space, parks, and supermarkets were available for subsets (32–42%) of women. Models tested whether rates of change in cardiometabolic outcomes differed based on neighborhood characteristics, independent of sociodemographic and health-related covariates. ResultsLiving in more (vs. less) walkable neighborhoods was associated with favorable changes in blood pressure outcomes (SBP: −0.27 mmHg/year, p = 0.002; DBP: −0.22 mmHg/year, p < 0.0001; hypertension status: ratio of ORs = 0.79, p < 0.0001), and small declines in waist circumference (−0.09 cm/year, p = 0.03). Small-magnitude associations were also observed between low park access and greater increases in blood pressure outcomes (SBP: 0.37 mmHg/year, p = 0.003; DBP: 0.15 mmHg/year, p = 0.04; hypertension status: ratio of ORs = 1.16, p = .04), though associations involving DBP and hypertension were only present after adjustment for sociodemographic variables. Other associations were statistically unreliable or contrary to hypotheses. ConclusionNeighborhood walkability may have a meaningful influence on trajectories of blood pressure outcomes in women from midlife to early older adulthood, suggesting the need to better understand how individuals interact with their neighborhood environments in pursuit of cardiometabolic health.

Understanding the Association Between Social Determinants of Health and Receipt of Immunotherapy for Melanoma.

In this review article, we sought to elucidate how the social determinants of health, including socioeconomic status, education, neighborhood or physical environment, access to healthcare, and race/ethnicity, affect the likelihood of receiving immunotherapy, a novel and expensive treatment for melanoma.&nbsp; Methods: The PubMed database was queried up to May 2023, for studies pertaining to health disparities in melanoma, including studies examining the utilization of immunotherapy agents for the treatment of melanoma across various social determinants of health. Disparities in the utilization of immunotherapy exist across various social determinants. A total of 10 studies were found to report on disparities in receipt of immunotherapy. These studies reported an association between insurance status, education level, socioeconomic status, as well as proximity to a cancer research center, and a lower likelihood of receiving immunotherapy. As the number of novel immunotherapy drugs grows, it is important to understand the various disparities affecting the delivery of immunotherapy across social determinants. The findings from this study can help to drive public health policy aimed at addressing inequities in the treatment of melanoma as well as other cancers.&nbsp; &nbsp; J Drugs Dermatol. 2024;23(5):311-315. doi:10.36849/JDD.7803.

Neighbourhood safety and academic performance: the role of student gender and family socioeconomic status

Introduction. Neighbourhood safety is directly linked to the level of disadvantage in the area of residence. Aim. The present research aimed to examine the impact of neighbourhood safety on the academic performance of secondary school students, taking into account gender and socioeconomic background. Methodology and research methods. The current study used a quantitative cross-sectional study design. Data were collected from 448 secondary school students on a voluntary basis. Chi-square and Kendall’s Tau-c (Tc) tests were used to analyse the data and determine the relationship and strength of direction between variables. Results. The findings indicated a significant and positive association between children’s academic performance and neighbourhood crime safety (P &lt; 0.05, Tc = 0.202), as well as feeling safe, walking in the neighbourhood during the day or night (P &lt; 0.05, Tc = 0.127). However, bullying and harassment in the neighbourhood were found to be significantly and negatively associated with academic performance (P &gt; 0.05, Tc = -0.053). When introducing family socioeconomic status as a control variable, the results indicated variation in academic performance in relation to neighbourhood safety. When controlling for student gender, neighbourhood safety had no different effects on academic performance. The findings showed that, in relation to neighbourhood safety, children from families with higher socioeconomic status academically outperform children from lower socioeconomic status families. Scientific novelty. The study not only focused on the connection between neighbourhood safety and academic performance but was also unique in the sense that it also dealt with differences in academic performance based on gender and family socioeconomic level. Practical significance. The study produces a number of interesting conclusions and makes valuable recommendations for significant stakeholders. The primary study recommendations aim is to create a secure, supportive, and protective neighbourhood environment by enforcing the law and encouraging community involvement in order to reduce the threat of crime, violence, and harassment.

Socioeconomic status, alcohol use and the role of social support and neighbourhood environment among individuals meeting criteria for a mental health problem: a cross-sectional study

PurposeIndicators of socioeconomic status (SES), such as education and occupational grade, are known to be associated with alcohol use but this has not been examined among individuals with a mental health problem. This study developed latent classes of SES, their associations with alcohol use, and examined the indirect effect via social support and neighbourhood environment.MethodsA secondary analysis of the 2014 Adult Psychiatric Morbidity Survey was conducted among participants with a mental health problem (N = 1,436). SES classes were determined using a range of indicators. Alcohol use was measured using the Alcohol Use Disorder Identification Test. Social support and neighbourhood neighbourhood environment were measured using validated questionnaires. A latent class analysis was conducted to develop SES classes. Multinomial logistic regression examined associations of SES and alcohol use. Structural equation models tested indirect effects via social support and neighbourhood environment.ResultsA four-class model of SES was best-fitting; “economically inactive,GCSE-level and lower educated,social renters”, “intermediate/routine occupation,GCSE-level educated,mixed owner/renters”, “retired, no formal education,homeowners”, and “professional occupation,degree-level educated,homeowners”. Compared to “professional occupation,degree-level educated, homeowners”, SES classes were more likely to be non-drinkers; odds were highest for “economically inactive,GCSE-level and lower educated,social renters” (OR = 4.96,95%CI 3.10–7.93). “Retired, no formal education,homeowners” were less likely to be hazardous drinkers (OR = 0.35,95%CI 0.20–0.59). Associations between “economically inactive,GCSE-level and lower educated,social renters” and “retired, no formal education,homeowners” and non- and harmful drinking via social support and neighbourhood environment were significant.ConclusionsIn contrast to the alcohol harms paradox, among individuals with a mental health problem, lower SES groups were more likely to be non-drinkers while no associations with harmful drinking were found. There is also a need to examine the alcohol harms paradox in the context of the area in which they live.

Influence of parental nativity and perceived neighborhood environment on physical activity and screen time of United States youth

ObjectiveThis study assessed how parental nativity and perceived environment are associated with physical activity and screen time of U.S. children and adolescents. MethodsData originated from the 2020–21 U.S. National Survey of Children's Health. We conducted multivariable Poisson regression to assess the cross-sectional association of parental nativity and perceived neighborhood environment variables on parental reports of youth meeting national physical activity and screen time guidelines. We tested interactions of parental nativity and neighborhood environment variables on both outcomes. Analyses were conducted using STATA v17 and p < 0.05 indicated statistical significance. ResultsThe sample of 24,928 children and 30,951 adolescents was 11.6 years of age, on average, with approximately 39% under 200% of the federal poverty level. About one-third of the sample (27.5%) had foreign-born parents. In adjusted models, we found that compared to youth with U.S.-born parents, those with foreign-born parents had a lower prevalence of meeting physical activity guidelines. Youth whose parents reported living in safe neighborhoods had a higher prevalence of meeting guidelines for physical activity (children: PR = 1.20, 95%CI 1.14, 1.27; adolescents: PR = 1.23, 95%CI 1.14, 1.32) and screen time (children: PR = 1.19, 95%CI 1.13, 1.26; adolescents: PR = 1.16, 95%CI 1.06, 1.28) than youth whose parents reported unsafe neighborhoods. We found similar associations between neighborhoods considered supportive or with many amenities and meeting physical activity and screen time guidelines. ConclusionsYouth whose parents are foreign-born have a lower prevalence of sufficient activity, and perceived parental neighborhood safety and support may be significant influences on youth physical activity and screen time.

The Maternal and Infant Environmental Health Riskscape study of perinatal disparities in greater Houston: rationale, study design and participant profiles.

The Maternal and Infant Environmental Health Riskscape (MIEHR) Center was established to address the interplay among chemical and non-chemical stressors in the biological, physical, social, and built environments that disproportionately impact perinatal health among Black pregnant people in a large and diverse urban area with documented disparities in the U.S. The MIEHR cohort is recruiting non-Hispanic Black and non-Hispanic white pregnant people who deliver their infants at major obstetric hospitals in Houston, Texas. At enrollment, all participants are asked to provide urine samples for chemical [metals, cotinine, and polycyclic aromatic hydrocarbons (PAHs)] analyses and blood samples. A subset of the cohort is asked to provide oral and vaginal swabs, and fecal samples. Questionnaire and electronic health record data gather information about residential address history during pregnancy, pregnancy history and prenatal care, sociodemographic and lifestyle factors, experiences of discrimination and stress, and sources of social support. Using information on where a participant lived during their pregnancy, features of their neighborhood environment are characterized. We provide summaries of key individual- and neighborhood-level features of the entire cohort, as well as for Black and white participants separately. Between April 2021 and February 2023, 1,244 pregnant people were recruited. Nearly all participants provided urine samples and slightly less than half provided blood samples. PAH exposure patterns as assessed on 47% of participants thus far showed varying levels depending on metabolite as compared to previous studies. Additionally, analyses suggest differences between Black and white pregnant people in experiences of discrimination, stress, and levels of social support, as well as in neighborhood characteristics. Our findings to date highlight racial differences in experiences of discrimination, stress, and levels of support, as well as neighborhood characteristics. Recruitment of the cohort is ongoing and additional neighborhood metrics are being constructed. Biospecimens will be analyzed for metals and PAH metabolites (urine samples), miRNAs (plasma samples) and the microbiome (oral swabs). Once enrollment ends, formal assessments are planned to elucidate individual- and neighborhood-level features in the environmental riskscape that contribute to Black-White disparities in perinatal health.

Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study

BackgroundDespite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China). MethodsThe PURE-China study recruited 47,931 participants aged 35–70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes. ResultsOf 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 – 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80–0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90–0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants. ConclusionFavorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.

Longitudinal associations between neighborhood safety and adolescent adjustment: The moderating role of affective neural sensitivity

Research on social determinants of health has highlighted the influence of neighborhood characteristics (e.g., neighborhood safety) on adolescents’ health. However, it is less clear how changes in neighborhood environments play a role in adolescent development, and who are more sensitive to such changes. Utilizing the first three waves of data from the Adolescent Brain Cognitive Development (ABCD) project (N = 7932, M (SD) age = 9.93 (.63) years at T1; 51% boys), the present study found that increases in neighborhood safety were associated with decreased adolescent externalizing symptoms, internalizing symptoms, but not sleep disturbance over time, controlling for baseline neighborhood safety. Further, adolescents’ insula and anterior cingulate cortex (ACC) reactivity to positive emotional stimuli moderated the association between changes in neighborhood safety and adolescent adjustment. Among youth who showed higher, but not lower, insula and ACC reactivity to positive emotion, increases in neighborhood safety were linked with better adjustment. The current study contributes to the differential susceptibility literature by identifying affective neural sensitivity as a marker of youth’s susceptibility to changes in neighborhood environment. The findings highlight the importance of neighborhood safety for youth during the transition to adolescence, particularly for those with heightened affective neural sensitivity.

Practical causal mediation analysis: extending nonparametric estimators to accommodate multiple mediators and multiple intermediate confounders.

Mediation analysis is appealing for its ability to improve understanding of the mechanistic drivers of causal effects, but real-world data complexities challenge its successful implementation, including (i) the existence of post-exposure variables that also affect mediators and outcomes (thus, confounding the mediator-outcome relationship), that may also be (ii) multivariate, and (iii) the existence of multivariate mediators. All three challenges are present in the mediation analysis we consider here, where our goal is to estimate the indirect effects of receiving a Section 8 housing voucher as a young child on the risk of developing a psychiatric mood disorder in adolescence that operate through mediators related to neighborhood poverty, the school environment, and instability of the neighborhood and school environments, considered together and separately. Interventional direct and indirect effects (IDE/IIE) accommodate post-exposure variables that confound the mediator-outcome relationship, but currently, no readily implementable nonparametric estimator for IDE/IIE exists that allows for both multivariate mediators and multivariate post-exposure intermediate confounders. The absence of such an IDE/IIE estimator that can easily accommodate both multivariate mediators and post-exposure confounders represents a significant limitation for real-world analyses, because when considering each mediator subgroup separately, the remaining mediator subgroups (or a subset of them) become post-exposure intermediate confounders. We address this gap by extending a recently developed nonparametric estimator for the IDE/IIE to allow for easy incorporation of multivariate mediators and multivariate post-exposure confounders simultaneously. We apply the proposed estimation approach to our analysis, including walking through a strategy to account for other, possibly co-occurring intermediate variables when considering each mediator subgroup separately.

The Role of Neighbourhood Social and Built Environments – Including Third Places – in Older Adults’ Social Interactions

ABSTRACT Neighbourhood environments shape older adults’ social interactions. This research conceptualises a comprehensive set of perceived and objective measures of neighbourhood social and built environments, including third places, with older adults’ social interactions. In Melbourne, based on the person-environment fit framework, mediation analyses showed that the perceived social environment measures of community spirit, participation in community groups and belonging to suburb, were the strongest predictors of social interactions, followed by a few types of perceived third places. Our findings suggest that policymakers should focus on how the objective environment characteristics are interpreted as levers when planning for changes.