Low Neighborhood Research Articles

The role of socioeconomic deprivation in gastrointestinal cancer clinical trial enrollment at an NCI-designated comprehensive cancer center.

785 Background: Socioeconomic deprivation has been described as a barrier to cancer clinical trial participation. However, few studies have examined socioeconomic deprivation using patient-level or granular geocoded designations. To overcome this challenge, the Area Deprivation Index (ADI) was used to assess neighborhood socioeconomic deprivation in a cohort of gastrointestinal cancer clinical trial patients at an NCI-Designated Comprehensive Cancer Center. Methods: Patients enrolled in a gastrointestinal cancer clinical trial from 2008 to 2019 with an identifiable ADI national rank were identified. Socioeconomic deprivation was assessed using the ADI, a publicly available, validated dataset that ranks census block groups into percentiles using variables such as income, education, employment, and housing characteristics. For this study, ADI was categorized as quintiles listed in the table. Statistical analyses included Chi-square and Kruskal-Wallis tests. Results: The median age of the cohort (N=1,334) was 62.0 years. Most patients were male (54.3%). Race included White (88.2%), African American (6.8%), and Asian (1.5%) patients. Hispanic/Latinx patients made up 6.7% of the cohort. The median ADI was 46. The proportion of enrollees from lowest to highest ADI quintile was 11.2%, 29.3%, 27.3%, 19.1%, and 13.1%. Trial enrollment differed by ADI and age (p=0.019), gender (p=0.042), race (p<0.001), and insurance (p=0.001). Conclusions: In this study, patients enrolled in gastrointestinal cancer clinical trials had lower neighborhood socioeconomic deprivation than the national or state average. African American, Hispanic/Latinx, female, and uninsured patients comprised a lower proportion of enrollees compared to catchment area estimates (10.6%, 17.7%, 51.3%, and 12.4%, respectively). These findings suggest inequity in clinical trial enrollment and warrant further studies to identify drivers of these disparities. [Table: see text]

A longitudinal study of protective factors against substance use in early adolescence. An ecological approach.

Adolescent substance use has been widely related to different individual, school, family and community factors. Yet, the number of studies with all these variables together in a model from an ecological perspective is still low, and they rarely used a longitudinal design. The aim of this study was to explore, from an ecological perspective, the prospective impact of different individual, school, family and neighbourhood factors on adolescent substance use. This was a longitudinal study with a one-year follow up. There were 881 participants (Mage=12.57; 48.1% females) at wave 1, of which 686 (Mage=13.51; 51.8% females) were followed-up at wave 2. Validated questionnaires were used for data collection. Regression analyses showed that higher substance use was predicted by high family socio-economic status cross-sectionally and longitudinally, and it was related to low neighbourhood socio-economic status cross-sectionally only. Participants who disliked school and had a poor academic performance were more likely to use substances, both cross-sectionally and longitudinally. The inclusion of families in substance use prevention programmes could be a key component in these interventions. Moreover, promotion of a positive school climate could protect adolescents from using substances.

Short-term Air Pollution Levels and Blood Pressure in Older Women.

Evidence of associations between daily variation in air pollution and blood pressure (BP) is varied and few prior longitudinal studies adjusted for calendar time. We studied 143,658 postmenopausal women 50 to 79 years of age from the Women's Health Initiative (1993-2005). We estimated daily atmospheric particulate matter (PM) (in three size fractions: PM2.5, PM2.5-10, and PM10) and nitrogen dioxide (NO2) concentrations at participants' residential addresses using validated lognormal kriging models. We used linear mixed-effects models to estimate the association between air pollution concentrations and repeated measures of systolic and diastolic BP (SBP, DBP) adjusting for confounders and calendar time. Short-term PM2.5 and NO2 were each positively associated with DBP {0.10 mmHg [95% confidence interval (CI): 0.04, 0.15]; 0.13 mmHg (95% CI: 0.09, 0.18), respectively} for interquartile range changes in lag 3-5 day PM2.5 and NO2. Short-term NO2 was negatively associated with SBP [-0.21 mmHg (95%CI: -0.30, -0.13)]. In two-pollutant models, the NO2-DBP association was slightly stronger, but for PM2.5 was attenuated to null, compared with single-pollutant models. Associations between short-term NO2 and DBP were more pronounced among those with higher body mass index, lower neighborhood socioeconomic position, and diabetes. When long-term (annual) and lag 3-5 day PM2.5 were in the same model, associations with long-term PM2.5 were stronger than for lag 3-5 day. We observed that short-term PM2.5 and NO2 levels were associated with increased DBP, although two-pollutant model results suggest NO2 was more likely responsible for observed associations. Long-term PM2.5 effects were larger than short-term.

Pioneer tree species accumulate higher neighbourhood diversity than late-successional species in a subtropical forest

A long-standing paradigm in ecology is that species diversity in a community accrues over succession. Central to this process are the mechanisms that regulate neighbourhood diversity around species of different functional groups such as early vs late-successional species. However, there is poor understanding of the accumulation of this neighbourhood diversity and its contribution to community diversity. We calculated neighbourhood species and phylogenetic diversities for adult trees of 10 species belonging to three groups: early-, mid-, and late-successional species in a 25-ha forest stem-mapping plot in subtropical China. We compared these diversities with homogeneous and heterogeneous Poisson null models to assess the roles of individual species and habitat heterogeneity in community assembly. We also calculated the neighbourhood species composition to quantify beta diversity turnover across different species groups. We observed that species richness, phylogenetic diversity and beta diversity all decreased from early- to mid- and late-successional species. Compared with homogeneous Poisson null model, early-successional trees had higher neighbourhood species but a lower phylogenetic diversity. Mid-successional trees showed no significant departure in richness and phylogenetic diversity from the null model. In contrast, late-successional trees had lower neighbourhood species richness and also a lower phylogenetic diversity than the null model. Both neighbourhood richness and phylogenetic diversity of all three species groups were well fitted by the heterogeneous Poisson model, indicating that environmental filtering predominated neighbourhood diversity. Our results underscore the importance of the early successional species in the accumulation of neighbourhood diversity and their contributions to diversity of plant communities. We suggest that secondary forests, which are mostly composed of early successional species, warrant a due attention in biodiversity conservation.

Impact of ambient air pollution exposure during pregnancy on adverse birth outcomes: generalized structural equation modeling approach

BackgroundAir pollution and several prenatal factors, such as socio-demographic, behavioural, physical activity and clinical factors influence adverse birth outcomes. The study aimed to investigate the impact of ambient air pollution exposure during pregnancy adjusting prenatal risk factors on adverse birth outcomes among pregnant women in MACE birth cohort.MethodsData for the study was obtained from the Mother and Child in the Environment (MACE) birth cohort study in Durban, South Africa from 2013 to 2017. Land use regression models were used to determine household level prenatal exposure to PM2.5, SO2 and NOx. Six hundred and fifty-six births of pregnant females were selected from public sector antenatal clinics in low socio-economic neighbourhoods. We employed a Generalised Structural Equation Model with a complementary log–log-link specification.ResultsAfter adjustment for potential prenatal factors, the results indicated that exposure to PM2.5 was found to have both significant direct and indirect effects on the risk of all adverse birth outcomes. Similarly, an increased level of maternal exposure to SO2 during pregnancy was associated with an increased probability of being small for gestational age. Moreover, preterm birth act a mediating role in the relationship of exposure to PM2.5, and SO2 with low birthweight and SGA.ConclusionsPrenatal exposure to PM2.5 and SO2 pollution adversely affected birth outcomes after controlling for other prenatal risk factors. This suggests that local government officials have a responsibility for better control of air pollution and health care providers need to advise pregnant females about the risks of air pollution during pregnancy.

Neighborhood characteristics and arterial stiffness among Black adults - Results from the Jackson Heart Study and Morehouse-Emory Cardiovascular Center for Health Equity.

Poor quality neighborhood environments are independent risk factors for cardiovascular disease (CVD) but are understudied in Black adults, who face large CVD health disparities. Arterial stiffness, a marker of early vascular aging, precedes development of hypertension and adverse CVD events but the effect of neighborhood on arterial stiffness among Black adults remains unknown. We compared the association between neighborhood environment and arterial stiffness among Black adults in Jackson, MS and Atlanta, GA. We studied 1582 Black adults (mean age 53 ± 10, 35% male) living in Jackson, MS from the Jackson Heart Study (JHS) and 451 Black adults (mean age 53 ± 10, 39% male) living in Atlanta, GA from the Morehouse-Emory Cardiovascular Center for Health Equity (MECA) study, without known CVD. Neighborhood problems (includes measures of aesthetic quality, walking environment, food access), social cohesion (includes activity with neighbors), and violence/safety were assessed using validated questionnaires. Arterial stiffness was measured as pulse wave velocity (PWV) using magnetic resonance imaging in JHS and as PWV and augmentation index (AIx) using applanation tonometry (SphygmoCor, Inc.) in MECA. Multivariable linear regression models were used to examine the association between neighborhood characteristics and arterial stiffness, adjusting for potential confounders. Improved social characteristics, measured as social cohesion in JHS (β = -0.32 [-0.63, -0.02], p = 0.04) and activity with neighbors (β = -0.23 [-0.40, -0.05], p = 0.01) in MECA, were associated with lower PWV in both cohorts and lower AIx (β = -1.74 [-2.92, - 0.56], p = 0.004) in MECA, after adjustment for CVD risk factors and income. Additionally, in MECA, better food access (β = -1.18 [-2.35, - 0.01], p = 0.05) was associated with lower AIx and, in JHS, lower neighborhood problems (β = -0.33 [-0.64, - 0.02], p = 0.04) and lower violence (β = -0.30 [-0.61, 0.002], p = 0.05) were associated with lower PWV. Neighborhood social characteristics show an independent association with the vascular health of Black adults, findings that were reproducible in two distinct American cities.

Abstract A049: Racial/ethnic and socioeconomic inequities in clinical trial participation among US community oncology patients, 2011-2021

Abstract Introduction: While oncology clinical trials disproportionately recruit from academic medical centers, most patients receive care in the community setting. However, there is limited information regarding clinical trial participation rates, including inequities by race/ethnicity and the social determinants of health (SDoH), in community practices. Here we assessed factors associated with clinical study drug (CSD, proxy for trial participation) receipt among patients diagnosed with 21 common cancers in community practices. Methods: This retrospective study used the nationwide Flatiron Health electronic health record-derived de-identified database of patients with cancer. The cohort included patients (≥ 18 years) diagnosed with cancer (initial, advanced, or metastatic diagnosis; depending on the cancer type) between January 2011 and November 2021 (follow-up through March 2022). We examined inequities in receipt of CSD after diagnosis by race/ethnicity, insurance coverage, and area-level SDoH indicators (e.g., socioeconomic status [SES] and predominant race/ethnicity [proxy for residential segregation]). SDoH indicators contextualizing where patients live were defined using Census block group/tract data from the American Community Survey (2015-2019). To evaluate factors associated with CSD receipt, we used time-to-event analysis where patients were followed from index diagnosis to their first documented receipt of CSD, death, or last recorded activity. Separate Cox proportional hazards models adjusted for clinical characteristics (i.e., age, sex, performance status, and stage) were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: This study included 196,270 patients (median age: 69 years, 49.5% women; 75.2% non-Hispanic/Latinx [NH] White, 6.2% NH-Black, 3.3% Latinx), of whom 3.7% received CSDs. Black (2.6%, HR 0.56 [CI: 0.51- 0.62]) and Latinx patients (2.6% (HR 0.54 [CI: 0.48-0.62]) were less likely to receive CSDs than white patients (4.3%). Individual and area-level SDoH were associated with CSD receipt. For example, patients without documented insurance (2.7%, HR 0.61 [CI: 0.56-0.66]) or with Medicaid coverage (2.6%, HR 0.58 [CI: 0.52-0.65]) were less likely to receive CSDs than patients with commercial coverage (4.7%). Patients living in predominately non-white and lower SES neighborhoods were less likely to receive CSDs, as were those in neighborhoods whose residents disproportionately lacked U.S. citizenship, had limited English proficiency, and had low rates of vehicle ownership. Conclusion: There are substantial inequities in CSD receipt among patients who receive care in community cancer clinics. Black, Latinx, and uninsured patients, as well as those from historically marginalized neighborhoods were less likely to receive CSDs. Without focused policy and operational efforts to increase clinical trial enrollment of racially, ethnically, and socio-demographically diverse patient populations, clinical trials may proliferate inequities in investigational drug access and potentially cancer outcomes. Citation Format: Jenny Guadamuz, Ronac Mamtani, Xiaoliang Wang, Cleo A. Ryals, Ivy Altomare, Alemseged A. Asfaw, Wendy Camelo Castillo, Harlan Pittell, Gregory S. Calip, Somnath Sarkar. Racial/ethnic and socioeconomic inequities in clinical trial participation among US community oncology patients, 2011-2021 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A049.

Abstract C087: Neighborhood influences on chronic hepatitis B monitoring behaviors among Asian Americans residing in Philadelphia county

Abstract The incidence of liver and intrahepatic bile duct cancer for Asian Americans is almost 2 times greater in comparison to Non-Hispanic white women and men. A major factor that contributes to liver cancer is hepatitis b (HBV) infection, which disproportionally affects Asian Americans, who represent 7% of the total US population but makes up around 58% of HBV-linked hepatocellular carcinoma cases. The purpose of this study was to examine the relationship between the neighborhood environment, including neighborhood walkability, Asianicity, and neighborhood disadvantage on HBV monitoring related behavior such as doctors' visits and HBV blood testing among Asian HBV patients. A total of 160 study participants were recruited from March 2019 to March 2020 through combined recruitment approaches, including through medical record review by authorized staff from collaborating health clinics, pharmacies, or community health centers and community-based organizations including racial/ethnic based educational and community centers, religion-based organizations, and senior centers. Study measures included baseline assessment information including sociodemographics, HBV infection history, HBV monitoring behavior, and knowledge about HBV prevention, diagnosis and treatment. Neighborhood level measures included neighborhood disadvantage, Asianicity, and neighborhood walkability using census and online measures. Hierarchical generalized linear models (HGLM) were used to account for individual nested within neighborhoods for predicting factors associated with doctor’s visits and blood test. Greater neighborhood disadvantage (OR=0.97, 95% CI=0.95-0.99, p=0.0041) and Asianicity (OR=0.97, 95% CI=0.95-0.98, p=0.0003), and lower neighborhood walkability (OR=1.06, 95% CI=1.02-1.09, p=0.0039) were associated with a lower likelihood of doctor visits for CHB. Greater Asianicity (OR=0.97, 95% CI=0.96-0.99, p=0.0044) was associated with a lower likelihood of HBV blood testing in the past 6 months. Evident neighborhood environment effects suggest the need to incorporate these factors into interventions to enhance HBV self-monitoring behaviors and slow disease progression of chronic HBV. Citation Format: Aisha Bhimla, Wenyue Lu, Lin Zhu, Yin Tan, Di Zhu, Jade Truehart, Ming-Chin Yeh, Minhhuyen Nguyen, Grace X. Ma. Neighborhood influences on chronic hepatitis B monitoring behaviors among Asian Americans residing in Philadelphia county [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C087.

Use of sodium-glucose cotransporter 2 inhibitors in Alberta adults with chronic kidney disease: a cross-sectional study identifying care gaps to inform knowledge translation.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have important kidney and cardiovascular benefits in adults with chronic kidney disease. Among adults with diabetes, we characterized the prevalence of chronic kidney disease eligible for SGLT2 inhibitor treatment, based on definitions of eligibility from trials and diabetes guidelines, and assessed the predictors of SGLT2 inhibitor use. We conducted a cross-sectional study using linked administrative data from Alberta Health in adults with diabetes (2002-2019). Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m2 with severe or greater proteinuria (trial-based definition); or eGFR less than 60 mL/min/1.73 m2 or moderate or greater proteinuria regardless of eGFR (diabetes guideline-based definition). Predictors (sociodemographic characteristics, comorbidities and health care utilization) of SGLT2 inhibitor use were identified using logistic regression. Of 446 315 adults with diabetes, 76 630 (17.2%, guideline-based definition; 12 867 [2.9%], trial-based definition) had chronic kidney disease eligible for SGLT2 inhibitor treatment. A total of 7.1% used SGLT2 inhibitors. Older age, lower hemoglobin A1c (HbA1c) levels, female sex, lower neighbourhood income, rural residence and hospital admission were among variables associated with nonuse of SGLT2 inhibitors (adjusted odds ratios [ORs] from 0.13 [age ≥ 85 yr] to 0.92 [rural residence], p < 0.05). Family physician visits were associated with higher SGLT2 inhibitor use (adjusted OR 4.01, p < 0.001 for > 4 visits/yr). Considering all adults, both with and without diabetes, 162 012 individuals with chronic kidney disease (5% of all Alberta adults) may benefit from treatment with SGLT2 inhibitors. Many adults with chronic kidney disease would derive heart and kidney benefits from treatment with SGLT2 inhibitors but had low SGLT2 inhibitor use as of 2019. Efforts will be needed to address lower use of SGLT2 inhibitors among female, older and lower-income adults, and to enhance primary care and promote awareness of the benefits of SGLT2 inhibitors independent of glycemic control.

Association of Neighborhood Child Opportunity Index with presenting visual acuity in amblyopic children

To demonstrate the use of a novel measure of neighborhood quality, the Child Opportunity Index (COI), for investigating health disparities in pediatric ophthalmology. This study included children 2-12 years of age from a registry of patients diagnosed with amblyopia at an urban pediatric hospital between 2010 and 2014. Children previously treated for amblyopia were excluded. Patient demographics, residential addresses, and logMAR visual acuities were collected. The association between visual acuity at presentation and COI was examined using linear mixed-effects models adjusting for individual-level factors, including age, sex, race, ethnicity, and insurance type. This study included 1,050 amblyopic children, of whom 317 (37%) were non-White and 149 (19%) were Hispanic; 461 (44%) had public insurance. Regarding residence, 129 (12%) lived in areas of very low opportunity (COI <20); 489 (47%) in areas of very high opportunity (COI ≥80). Children residing in the lowest opportunity neighborhoods correctly identified approximately two fewer letters at presentation with their better-seeing eye compared with children from the highest opportunity neighborhoods after adjusting for individual-level factors (-0.0090 logMAR per 20 unit increase in COI; 95% CI, -0.0172 to -0.0008; P = 0.031). No difference was appreciated in the worse-seeing eye. Amblyopic children residing in communities with low neighborhood opportunity had slightly worse visual acuity in the better-seeing eye at presentation. Although statistically significant in the better-seeing eye, the two-letter difference attributable to neighborhood environment may not be clinically significant, and the impact of this disparity on treatment outcomes deserves further investigation.

COMMUNAL SUPPORT PREDICTS BETTER MENTAL HEALTH: KNOWLEDGE TRANSLATION AMONG OLDER ADULTS DURING COVID-19

Abstract The well-being of older adults has been linked to the quality of their neighbourhood environment. Given that COVID-19 affected poorer neighbourhoods disproportionately, we partnered with community organizations to identify meso-level psychosocial factors that may improve loneliness, depressive mood, and cognitive function. Five variables were identified through focus groups with older adults and community organizations. These variables were drawn from validated scales, including communal provisions, neighbourhood friendship, self-expression, social experiences, and time outdoors. This paper presents preliminary findings from surveys administered to 151 community-dwelling older adults across British Columbia and interviews in four neighbourhoods.Purposeful and snowball sampling were used to recruit older adults (age 55+) from community centres and neighbourhood houses. Online surveys measured the five meso-level psychosocial exposure variables. Outcome variables included an index of loneliness, depressive mood, self-rated memory, semantic fluency and delayed recall. Data was geocoded and aggregated by Forward Sortation Area. Regression and cross-level mediation analysis were conducted. Four neighbourhoods were selected from a 2x2 matrix of high and low neighbourhood deprivation (CANUE, 2016). Mental health was associated with better social experiences (B=.26, p=.003). Time outdoors (B=.35, p=.047) was associated with better delayed recall. Mental health was better in poorer neighbourhoods (B=.20, p=.015). This was partially mediated by communal provisions (B=.19, p=.032). Social experiences (B=.23, p=.009) fully mediated these effects on mental health. Participants described being of local community services and took on opportunities to volunteer. Social experiences and neighbourhood resources may help support mental health and well-being among older adults during the pandemic and beyond.

NEIGHBORHOOD COHESION, LIVING ALONE, AND ALL-CAUSE MORTALITY IN COMMUNITY-DWELLING OLDER CHINESE AMERICANS

Abstract This study aimed to examine whether neighborhood cohesion would mitigate the adverse effect of living alone on all-cause mortality in community-dwelling older Chinese Americans. Data were drawn from the Population Study of Chinese Elderly (PINE, N = 3,157, 59-105 years, 58% female), a longitudinal study started in 2011. Mortality was tracked through December 2021 (N = 642 deceased). Cox regression indicated that neighborhood cohesion moderated the association between living alone and all-cause mortality (HR = 0.74, 95%CI [0.57, 0.97]), showing that among participants living alone (N = 678), those with high neighborhood cohesion had a 41% lower mortality risk than their counterparts with low neighorhood cohesion. In contrast, among participants living with others, those with high and low neighborhood cohesion had a similar mortality risk. These findings highlight that strong neighborhood cohesion may protect against the increased risk of premature mortality associated with living alone in older Chinese Americans.

31: CHILDHOOD OPPORTUNITY INDEX AMONG CRITICALLY ILL CHILDREN: A MULTICENTER, RETROSPECTIVE COHORT STUDY

Introduction: Children from impoverished neighborhoods have increased likelihood of severity of illness and pediatric intensive care unit (PICU) admission. Existing metrics to score environmental influences do not account for the diverse range of factors that could impact child health. The Childhood Opportunity Index (COI), a metric of local and regional neighborhood factors, highlights social disparities that impact childhood wellbeing. We sought to characterize COI among critically ill children and explore for potential relationships between COI and poor clinical outcomes. Methods: We performed a retrospective, multicenter cohort study including children (< 18 years) admitted to 47 PICUs from January 2018 through December 2019 using the Pediatric Hospital Information System registry. COI for each patient encounter was characterized by demographic data including race and United States Census Geographic Regions. For exploratory modelling, clinical outcomes were index mortality and hospital length of stay (LOS). Descriptive, comparative (chi-square, ANOVA, and Kruskal-Wallis tests), and associative (logistic/linear modelling) statistics were employed. Results: Of the 26,912 children studied, 44.8% resided in low or very low COI neighborhoods. Hispanic and Black children more frequently resided in very low COI areas (35.4% and 47.7%, respectively) as compared to White (15.7%), Asian (10.7%), and Pacific Islander (11.5%) children. COI varied by region with the East South-Central region having the greatest frequency of critically ill children from very low (27.1%) and low (28.5%) COI neighborhoods. The New England region showed the greatest proportion of PICU encounters from very high COI areas (35.5%) (p < 0.001). Exploratory models found COI to be inversely associated with mortality (odds ratio 0.91, 95% confidence interval 0.85-0.96) and LOS (p < 0.001). Conclusions: This large, multicenter study revealed racial and geographic variation in COI among hospitalized critically ill children. Those residing in lower COI neighborhoods experienced a greater risk of mortality and prolonged LOS. Our findings suggest that utilization of COI in identifying potentially modifiable environmental factors can inform public health initiatives and further research towards reducing health inequity.

Allostatic load and the influence of economic adversity and neighborhood disadvantage on cognitive function in a multiethnic cohort

AbstractBackgroundPrevious research has demonstrated a link between objective socio‐economic indicators and cognitive test performance. Although some studies include subjective indicators, such as perceived neighborhood environment, little is known about which specific factors are most strongly associated with cognitive performance and whether these measures are useful beyond traditional SES proxies. Further, in addition to being disproportionately at risk of experiencing neighborhood disadvantage and lower SES, racial/ethnic minorities are more likely to be diagnosed with dementia and receive less timely care compared with White individuals. This study aims to investigate how perceived neighborhood environment and neighborhood disadvantage are related to cognitive performance within a large diverse sample.MethodA probability‐based sample of participants (N = 3858; Female = 59%; Black = 51%; Hispanic = 14%) from the Dallas Heart Study Phase 2 (DHS‐2; Mean: Age = 50, Education = 13) were administered the Montreal Cognitive Assessment (MoCA), in addition to measures of perceptions of neighborhood physical environment and violence, and perceived SES. Multiple regression was used to determine associations of these variables with MoCA scores relative to traditional SES measures (i.e., income, education), controlling for demographic and relevant health factors. Post‐hoc analyses stratified by racial/ethnic group were conducted to determine whether indicators differentially influenced test scores.ResultAfter controlling for socio‐demographic and health factors, reporting lower quality neighborhood resources and difficulty paying for “very basics like food and heating” and “medical care” were associated with lower MoCA scores in the overall sample. Post‐hoc analyses revealed significant relationships between MoCA scores and quality of neighborhood resources, “food and heating,” and “medical care” only in Black participants, while “violence” was significantly associated with lower MoCA scores in Hispanics. There were no significant relationships found in Whites. Overall, subjective measures of SES and neighborhood environment contributed modest variance in the overall model, specifically for Black and Hispanic participants (R 2 = 3% to 5%).ConclusionExperiencing neighborhood and economic adversity was associated with lower scores on a cognitive screening measure and accounted for more variance than income or education in Black individuals and income in Hispanic individuals, while no relationship was seen in White participants. Future research is needed to determine whether these allostatic stressors influence cognitive impairment or dementia later in life.

Evaluation of low traffic neighbourhood (LTN) impacts on NO2 and traffic

• Generalised difference in differences is used to examine effects of LTN. • LTNs reduced NO 2 both within intervention areas (5.7%) and in boundary areas (8.9%) • Traffic volumes were reduced by 58.2% within LTNs and by 13.4% at LTN boundary sites. Traffic restriction measures may create safer and healthier places for community members but may also displace traffic and air pollution to surrounding streets. Effective urban planning depends on understanding the magnitude of changes resulting from policy measures, both within and surrounding intervention areas; these are largely unstudied in the case of Low traffic Neighbourhoods (LTN). We evaluated impacts of three LTNs in the London Borough of Islington, UK, on air pollution and traffic flows in and around intervention areas, based on monthly Nitrogen Dioxide (NO 2 ) and traffic volume data provided by the local authority. We identified pre- and post-intervention monitoring periods and intervention, boundary and control sites. We then adapted the generalised difference in differences approach to evaluate the effects within LTNs and at their boundary. We found that LTNs have the potential to substantially reduce air pollution and traffic in target areas, without increasing air pollution or traffic volumes in surrounding streets. These results provide sound arguments in favour of LTNs to promote health and wellbeing in urban communities.

A Comparison Between the Rates of Radiation Oncologist and Urologist Consultations in Men Diagnosed With Prostate Cancer in Northern Ontario, Canada

PurposeRecommendations from Cancer Care Ontario stress the importance of multidisciplinary care from radiologists and urologists for prostate cancer treatment. The present study sought to examine what percentage of patients had a consultation with a radiation oncologist before undergoing a radical prostatectomy in Ontario, Canada, between 2010 and 2019. Methods and MaterialsAdministrative health care databases were used to analyze the number of consultations billed to the Ontario Health Insurance Plan from radiologists and urologists who treated men with a first prostate cancer diagnosis (n = 22,169). ResultsIn Ontario, 94.70% of Ontario Health Insurance Plan billings for patients with prostate cancer who had a prostatectomy within 1 year of a prostate cancer diagnosis were from urology, and 37.66% and 1.77% of billings were received from radiation oncology and medical oncology specialties, respectively. When sociodemographic variables were examined, having a lower neighborhood income (adjusted odds ratio [aOR], 0.69; confidence interval [CI], 0.62-0.76) and a rural residence (aOR, 0.72; CI, 0.65-0.79) were associated with lower odds of receiving a consultation from a radiation oncologist. When billings for consultations were examined geographically by region, Northeast Ontario (Local Health Integrated Network 13) had the lowest odds of receiving a radiation consultation compared with the rest of Ontario (aOR, 0.50; CI, 0.42-0.59). ConclusionsThe results of this study show that differences in equitable access to multidisciplinary health care exist for men with a first prostate cancer diagnosis who reside in more northern and rural regions within Ontario, relative to the rest of the province. The reasons for these findings are likely multifactorial and may include factors such as patient treatment preference and distance/travel to receive treatment. However, as diagnosis year increased, so did the chances of receiving a radiation oncologist consultation, and this upward trend may reflect the implementation of Cancer Care Ontario guidelines.

The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups

BackgroundRacial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans).MethodsThis study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates—including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19—four sets of weighted binary logistic regressions were conducted.ResultsThe rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05).ConclusionOur study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.

The Associations of Racial Discrimination and Neighborhood Disadvantage With World Assumptions Among Black, Latine, and Asian Young Adults.

The theory of shattered assumptions proposes that experiencing traumatic events can change how people view themselves and the world. Most adults experience a traumatic event during their lifetime, and some subsequently develop post-traumatic stress disorder (PTSD). However, the current conceptualization of trauma (i.e., Criterion A PTSD) may be too narrow to adequately capture the range of potentially traumatizing events that People of Color experience, including racial discrimination and neighborhood disadvantage. This study investigated the association of racial discrimination and neighborhood disadvantage with core beliefs about the world being safe and predictable (i.e., world assumptions) among a sample of Black, Latine, and Asian young adults. Multi-step analyses of covariance tested associations between racial discrimination and neighborhood disadvantage with world assumptions and whether these held in the context of other traumatic exposures. Results indicated that racial discrimination negatively impacted world assumptions among Asian young adults only and this effect remained in the context of trauma. In addition, low neighborhood support negatively impacted world assumptions across all racial groups and neighborhood violence negatively impacted world assumptions among Latine young adults only; however, this effect did not remain in the context of trauma. This study indicates it is worthwhile to consider other adverse events in the conceptualization of trauma, such as racial discrimination and neighborhood disadvantage, that may impact world assumptions and contribute to subsequent post-trauma psychopathology.

ASPHALT II: Study Protocol for a Multi-Method Evaluation of a Comprehensive Peer-Led Youth Community Sport Programme Implemented in Low Resource Neighbourhoods.

To reduce inequalities in children's sport participation, studies are needed to explore ways in which children from low resource neighbourhoods can be engaged and retained in sport. GAME Community is a peer-led community sport programme which aims to promote physical activity through participation in inclusive street sports activities targeting 8-15-year-old children living in low resource neighbourhoods. The GAME Community intervention is implemented by the non-profit street sport organisation GAME. Five components support the implementation of GAME Community: (1) training of peer leaders; (2) a focus on inclusion of inactive girls; (3) parental involvement; (4) community engagement; (5) strengthened organisational support to peer leaders. In the ASPHALT II study, we aim to evaluate GAME Community and hence contribute to understanding how children growing up in low resource neighbourhoods can be engaged and retained in physical activity through participation in peer-led, community-based sport and to generate new understandings on the scale up of community interventions. The primary objective of the evaluation is to investigate the implementation of GAME Community and the programme's reach, and to establish the functioning and mechanisms of the programme. The secondary objective is to establish the health enhancing potential of the programme. The evaluation of GAME Community involves three linked but independent studies that investigate (1) the functioning (i.e., mechanisms and processes), (2) reach, and (3) outcomes. The functioning of the five intervention components is investigated using qualitative methodologies. Programme reach will be investigated based on participant registrations. Systematic observations using a novel combination of validated tools will provide information on outcomes (physical activity level and social behaviour) during GAME Community activities. Investigating functioning, reach, and outcomes of the GAME Community intervention by using multiple methods is a strength, as different data complement and inform each other. This study will provide in-depth insights into if and how children living in low resource neighbourhoods can be engaged and retained in physical activity through participation in peer-led, community-based sport. Contributions of this evaluation include new understanding of the mechanisms and scalability of a community-based street sport intervention.

Residential urban food environment profiles and diet outcomes among adults in Brooklyn, New York: a cross-sectional study.

To assess the clustering properties of residential urban food environment indicators across neighbourhoods and to determine if clustering profiles are associated with diet outcomes among adults in Brooklyn, New York. Cross-sectional. Five neighbourhoods in Brooklyn, New York. Survey data (n 1493) were collected among adults in Brooklyn, New York between April 2019 and September 2019. Data for food environment indicators (fast-food restaurants, bodegas, supermarkets, farmer's markets, community kitchens, Supplemental Nutrition Assistance Program application centres, food pantries) were drawn from New York databases. Latent profile analysis (LPA) was used to identify individuals' food access-related profiles, based on food environments measured by the availability of each outlet within each participant's 800-m buffer. Profile memberships were associated with dietary outcomes using mixed linear regression. LPA identified four residential urban food environment profiles (with significant high clusters ranging from 17 to 57 across profiles): limited/low food access, (n 587), bodega-dense (n 140), food swamp (n 254) and high food access (n 512) profiles. Diet outcomes were not statistically different across identified profiles. Only participants in the limited/low food access profile were more likely to consume sugar-sweetened beverages (SSB) than those in the bodega-dense profile (b = 0·44, P < 0·05) in adjusted models. Individuals in limited and low food access neighbourhoods are vulnerable to consuming significant amounts of SSB compared with those in bodega-dense communities. Further research is warranted to elucidate strategies to improve fruit and vegetable consumption while reducing SSB intake within residential urban food environments.