Neighborhood Health Research Articles

NEIGHBORHOOD PREDICTORS OF MENTAL HEALTH OF OLDER AMERICANS: EVIDENCE FROM A 5-YEAR LONGITUDINAL STUDY

Abstract With increasing dependence on other people in old age, environmental resources become an important asset for older adults to experience healthy aging. Data on the longitudinal relationship between neighborhood and mental health in late life is scanty. This study utilized hierarchical multiple regression model analysis to investigate whether and which neighborhood factors predicted depression and anxiety among older Americans followed up for over five years within the same neighborhood. Two waves of data containing a cohort of 1,731 older adults from the NSHAP project were used. Outcome measures were depression and anxiety. Predictors were four neighborhood factors: Social cohesion (NSC), social ties (NSC), neighborhood problems (NP), and perceived neighborhood danger (PND). We adjusted for demographic and physical health characteristics. The mean age of the respondents was 71.4 ± 6.5 years and were mostly females (55.5%). Lower NSC and a higher PND significantly predicted depression. However, the model only explained 2.8% of the variance in depression. In the covariate-adjusted model, none of the neighborhood factors predicted depression, but the model significantly improved to 32.5%. NP was the only significant predictor of anxiety in the final model and explained 27.8% of the variance in anxiety. Covariates, which are primary determinants of mental health disparity, have a much larger role to play. This study sheds some light on the complexity of the relationship between neighborhood and mental health in older adults. Future policy development and interventions should target improving both physical and social environments to enhancing the mental wellbeing of older adults.

IN THE EYES OF THE BEHOLDER: RACE, PLACE, AND HEALTH

Abstract Racial and ethnic health disparities are fundamentally connected to neighborhood quality. For example, racial and ethnic minorities are more likely to live in neighborhoods with signs of physical disorder (e.g., graffiti, vandalism), and physically disordered environments have been noted to associate with increased risk for chronic illness. Given that older adults may spend more time in their neighborhoods than younger adults as they transition out of the workforce, examining associations between neighborhood physical disorder and health among older minorities is of critical importance. Using 2016-2018 Health and Retirement Study (HRS) data, a representative sample of US adults aged 51 years and older (n= 9,080, mean age 68 years), we conducted a series of weighted linear regressions to examine links between neighborhood disorder as rated by third parties and both participant-perceived neighborhood safety and self-rated health. Study results indicated that higher neighborhood physical disorder was significantly related to more neighborhood safety concerns among non-Hispanic White and Hispanic residents, but not among non-Hispanic Blacks. On the other hand, neighborhood physical disorder was significantly associated with poorer health among all racial/ethnic groups. These patterns persisted after adjusting for education, sex, age, and census tract concentrated disadvantaged, population density, and racial/ethnic diversity. Our results indicate that community level interventions targeting neighborhood physical disorder may improve community health and minimize racial/ethnic health disparities.

PATHWAYS OF NEIGHBOURHOOD OBESOGENIC ENVIRONMENT DURING COVID-19: IMPACTS AND WAY FORWARD

Prior to the COVID-19 outbreak, obesity is already a pandemic illness on its own. It has been a public health priority in developing countries especially Malaysia where the obesity rate in the country is one of the highest in South East Asia. Early studies have concurred that the presence of COVID-19 makes anatomising the obesity pandemic even more urgent as impaired metabolic health increase complications and mortality in COVID-19 patients. COVID-19 induced movement restriction orders and related policies by the Malaysia government are believed to have altered the country’s food and physical activity environments. The paper expanded the original Neighbourhood Environment, Health Behaviours and BMI (NEHB-BMI Model) where the pathways of neighbourhood obesogenic environment that reflects COVID-19 induced changes to the constructs from the perspective of Malaysia is presented. Through the discussion, three key variables were added to the model: 1) government environment; 2) establishment/business environment; and 3) individual psychosocial factors. Exploring the impacts of COVID-19 to the obesogenic environment constructs paves way to gauging insights by allowing associations between the presented variables to be tested in future studies, especially in the South East Asian region where such studies are very limited.

Understanding perceptions of neighborhood health and non-communicable disease risk in urban contexts in Ghana

Global health surveillance reports show Africa's epidemiologic transition from one dominated by higher burdens of nutritional, maternal, and communicable diseases to one increasingly dominated by non-communicable diseases (NCDs). Debates on the increasing cases of NCDs in the African context have focused on individualistic risk factors to the neglect of other similar important determinants such as the living environment. Drawing on theoretical tenets of the protection motivation theory and using cross-sectional data, we examined neighborhood risk perceptions and self-rated risk of developing NCDs in Ghana. The dependent variable ‘self-rated risk of developing NCDs’ was measured as a binary outcome and the focal independent variable – perceived neighborhood health risk – as an index. We fitted multivariate multilevel regression models to a sample of 1376 individuals across 9 neighborhoods. Results show that respondents who perceived their neighborhoods as risky were more likely to rate their risk of developing NCDs high. A unit increase in neighborhood violence was associated with 8% likelihood of self-rated risk of developing NCDs. However, a unit increase in the aesthetic quality of respondent's neighborhood was associated with lower likelihood of self-rated risk of developing NCDs. Engaging in regular physical activity, and non-tobacco use were associated with a lower likelihood of perceived NCDs risk. We suggest policy agendas intended for reducing the burden of NCDs in Ghana and other LMICs could incorporate programs that target improving environmental characteristics to minimize risks and offer people the opportunity to make healthy choices.

Revisiting revitalization: exploring how structural determinants moderate pathways between neighborhood change and health

Vacant housing can produce many issues that affect residents’ quality of life, especially in historically segregated communities of color. To address these challenges, local governments invest in strategic, place-based revitalization initiatives focused on the regeneration of vacant housing. Yet, the outcomes of these efforts remain contested. To maximize health benefits of revitalization investments, a more nuanced understanding of pathways between neighborhood changes and residents’ responses, adaptations, and ability to thrive is necessary, though, remains largely absent in the literature. Using the Vacants to Value initiative in Baltimore, MD as a case study, we explore (1) how health manifests among certain groups in the context of vacant housing revitalization; (2) how vacant housing and its regeneration engender social and cultural environmental change i.e., gentrification; and (3) what structural determinants (cultural norms, policies, institutions, and practices) contribute to the distribution of material resources and benefits of revitalization. Results suggest that vacant housing revitalization requires more than just physical remedies to maximize health. Our findings demonstrate how vacant housing revitalization influences the physical environment, social environment, and structural determinants of material resources and community engagement that can ultimately impact residents’ physical, mental, and social health. This study recommends that because housing disparities are rooted in structural inequalities, how policies, practices, and processes moderate pathways for residents to adapt and benefit from neighborhood changes is consequential for health and health equity. Establishing shared governance structures is a promising approach to foster equitable decision-making and outcomes. Going forward in urban regeneration, pathways to retain and strengthen the social environment while revitalizing the physical environment may be promising to achieve healthy communities.

Utilization of Autologous HCT in Multiple Myeloma: A Novel Linkage of CIBMTR, Cancer Registry and Hospitalization Data in California

Introduction: Autologous hematopoietic cell transplant (autoHCT) is associated with improved overall survival for patients with multiple myeloma (MM), but utilization remains low. While MM disease characteristics and patient comorbidities inform the complex decision to proceed with autoHCT, race/ethnicity, neighborhood socioeconomic status (nSES) and health insurance have also been shown to strongly associate with use of autoHCT. Using a novel data linkage, we assess autoHCT utilization patterns over time and attempt to confirm previously seen associations between sociodemographics and access to transplant. Methods: This retrospective cohort study used linked data between the California Cancer Registry (CCR), the Center for International Blood and Marrow Transplant Research (CIBMTR) and the California Patient Discharge Database (PDD). From the CCR, we identified patients ages 18-79 diagnosed with first primary MM between 1991 and 2016 that were linked to the CIBMTR or PDD (95.5% of eligible CCR patients). Use of autoHCT was ascertained from all three sources. We estimated the cumulative incidence of autoHCT after MM diagnosis and determined the association of sociodemographic factors with receipt of autoHCT using multivariable Cox proportional hazards regression. Secondary analyses assessed interactions of race/ethnicity, nSES, and health insurance by year of diagnosis. All analyses accounted for death as a competing risk. Results: The cohort consisted of 29,109 MM patients with a median follow-up time of 10.2 years. Non-Hispanic White (NHW), Black/African American (B/AA), Hispanic, and Asian patients comprised 57%, 14%, 20% and 9% of the cohort, respectively. Overall, 18.9% of patients (n=5500) underwent an autoHCT. Median time from diagnosis to transplant was 9.7 months (interquartile range: 6.9-16.2). The CIBMTR captured 70.8% of autoHCTs (17.8% all three sources, 36.7% CIBMTR and PDD, 10.2% CIBMTR and CCR, and 6.1% CIBMTR only); the remaining autoHCTs were captured from PDD only (19.0%), CCR only (4.7%) or PDD and CCR (5.5%). The cumulative incidence of autoHCT at 12 months increased in recent time periods (Figure 1). During 1991-2016, compared with NHW patients B/AA patients were less likely to undergo autoHCT (adjusted Hazard Ratio [HR] and 95% confidence interval [CI] (HR: 0.79, CI: 0.72 - 0.86) while Hispanic and Asian patients had similar utilization of autoHCT. Those residing in low nSES (HR 0.77, CI: 0.72 - 0.82)) or intermediate nSES ((HR 0.86, CI: 0.80 - 0.92)) versus highest nSES and those covered by Medicaid (HR 0.69, CI: 0.64 - 0.76) or Medicare (HR 0.83, CI: 0.78 - 0.89) compared to private insurance were also less likely to undergo autoHCT. Furthermore, findings indicate interactions of year of diagnosis with race/ethnicity (p for interaction <0.001), nSES (p <0.001) and health insurance (p =0.001). In models stratified by time period, Hispanic (HR 0.63, CI: 0.41 - 0.97) patients were less likely to have an autoHCT than NHW patients in 1991-1995, but less so in later years. B/AA patients had lower utilization throughout the study period, particularly after 2005. The differences for patients residing in the lowest versus highest nSES became less pronounced over time, with the strongest association observed in 1991-1995 (HR 0.38, CI: 0.26 - 0.56). Patients with Medicare were less likely to undergo autoHCT after 2006, while patients with Medicaid were less likely to undergo autoHCT over the entire study period. Multivariable models restricted to the 2011-2016 time period are presented in Table 1. Conclusion: This is the first study to evaluate autoHCT utilization and sociodemographic factors in MM over time. Despite increased overall utilization, we found that B/AA patients were less likely than NHW patients to receive autoHCT with no change over time. Contrary to prior studies, Hispanic patients were less likely to undergo autoHCT only in the earliest era. We also observed that patients residing in the lowest nSES neighborhoods were less likely to utilize autoHCT, but differences decreased over time. Finally, those with public funded health insurance were less likely to undergo autoHCT. Additional studies are needed to further identify barriers to autoHCT utilization, particularly in B/AA patients and those with public health insurance. Identifying and mitigating these barriers is essential to ensuring greater and more equitable access to this highly effective therapy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Ecological Associations between Obesity Prevalence and Neighborhood Determinants Using Spatial Machine Learning in Chicago, Illinois, USA

Some studies have established relationships between neighborhood conditions and health. However, they neither evaluate the relative importance of neighborhood components in increasing obesity nor, more crucially, how these neighborhood factors vary geographically. We use the geographical random forest to analyze each factor’s spatial variation and contribution to explaining tract-level obesity prevalence in Chicago, Illinois, United States. According to our findings, the geographical random forest outperforms the typically used nonspatial random forest model in terms of the out-of-bag prediction accuracy. In the Chicago tracts, poverty is the most important factor, whereas biking is the least important. Crime is the most critical factor in explaining obesity prevalence in Chicago’s south suburbs while poverty appears to be the most important predictor in the city’s south. For policy planning and evidence-based decision-making, our results suggest that social and ecological patterns of neighborhood characteristics are associated with obesity prevalence. Consequently, interventions should be devised and implemented based on local circumstances rather than generic notions of prevention strategies and healthcare barriers that apply to Chicago.

Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management.

Addressing social determinants of health (SDoH) is associated with improved clinical outcomes for patients with chronic diseases in safety-net settings. This qualitative study supplemented by descriptive quantitative analysis investigates the degree of alignment between patient and clinicians’ perceptions of SDoH resources and referrals in clinics within the public healthcare delivery system in San Francisco. We conducted a qualitative analysis of in-depth interviews, patient-led neighborhood tours, and in-person clinic visit observations with 10 patients and 7 primary care clinicians. Using a convergent parallel mixed methodology, we also completed a descriptive quantitative analysis comparing the categories of neighborhood health resources mentioned by patients or community leaders to the resources integrated into the electronic health record. We found that patients held a wealth of knowledge about neighborhood resources relevant to SDoH that were highly localized and specific to their communities. In addition, multiple stakeholders were involved in conducting SDoH screenings and referrals, including clinicians, system navigators such as case workers, and community-based organizations. Yet, the information flow between these stakeholders and patients lacked systematization, and the prioritization of social needs by patients and clinicians was misaligned, as represented by qualitative themes as well as quantitative differences in resource category distribution analysis (p < 0.001). Our results shed light upon opportunities for strengthening social care delivery in safety-net healthcare settings by improving patient engagement, clinic workflow, EHR engagement, and resource dissemination.

Neighborhood health effects on the physical health of the elderly: Evidence from the CHRLS 2018

BackgroundThere are more than 26 million elderly people in China, and due to the Health China strategy proposed in 2020, “Elderly Health” has become an important topic of concern for all sectors of society. Neighborhoods provide important social relationships. However, Chinese researchers have not extensively explored the impact of these relationships on the physical health of the elderly. MethodsBased on the data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), we constructed a comprehensive research framework integrating ordinary least square (OLS) regression, heterogeneity analysis, IV-2SLS, robustness testing, and Karlson–Holm–Breen (KHB) mediating effect analysis, which can be used to thoroughly examine neighborhood health effects (NHEs) in relation to the physical health of the elderly. ResultsThe OLS results showed that the NHEs (B = 0.4689, p < 0.01) had a positive influence on the physical health of the elderly, and were lower than the NHEs estimated by IV-2SLS (B = 0.5018, p < 0.01). The mediating effects of social networks and social relationships were analyzed using KHB, and both the total (B = 0.6056, p < 0.01) and indirect (B = 0.0800, p < 0.01) effects on neighborhood health were significant, with the total effect being 10 times larger than the direct effect and 13.24% of the total effect coming from the mediating variable. ConclusionsFirstly, the NHEs positively influence the physical health of elderly persons, but there are heterogeneous differences. Secondly, the IV-2SLS estimation results suggest that not controlling for endogeneity leads to underestimation of the role of the NHEs. Thirdly, using the county-level NHEs, self-rated health, and health changes to replace variables, and grouping by smokers (small sample) and never smoked (large sample), the influence of the NHEs on the physical health of the elderly is robust. Finally, social networks and social relationships are important transmission mechanisms of the NHEs when it comes to the physical health of the elderly.

Onset of depression and anxiety among patients with gout after diagnosis: a population-based incident cohort study

BackgroundGout may be associated with an increased incidence of mental health disorders, however, published findings have been limited and inconsistent. Therefore, our objective was to conduct a population-based cohort study to evaluate the incidence of depression and anxiety after gout diagnosis.MethodsWe used linked population-based administrative health data in British Columbia, Canada that includes information on demographics, outpatient visits, and inpatient visits from the period of January 1, 1990 to March 31, 2018. We assessed depression and anxiety using validated International Classification of Diseases, 9th and 10th Revision coding algorithms. We applied multivariable Cox proportional hazard models to evaluate incident depression and anxiety among patients with gout in comparison to non-gout controls, adjusting for age, sex, neighbourhood income quintile, residence, comorbidities, and health care utilization.ResultsWe included 157,426 incident cases of gout (60.2% male; mean age 57.1 years) and 157,426 non-gout controls (60.2% male; mean age 56.9 years). The incidence rate of depression among individuals with gout and non-gout controls was 12.9 (95% confidence interval [CI] 12.7–13.2) and 11.1 (95% CI 10.9–11.4) per 1000 person-years, respectively. The incidence rate of anxiety for those with gout was 5.4 (95% CI 5.3–5.5) per 1000 person-years and for non-gout controls was 4.6 (95% CI 4.4–4.7) per 1000 person-years. Individuals with gout had an increased onset of depression (adjusted hazard ratio [aHR], 1.08; 95% CI 1.05–1.11) and anxiety (aHR, 1.10; 95% CI 1.05–1.14) compared to non-gout controls.ConclusionOur population-based study shows an increased incidence of depression and anxiety following gout diagnosis in comparison to non-gout controls. Findings suggest the importance of considering psychiatric impacts in addition to the physical impacts of gout.

The effect of residential proximity to brownfields, highways, and heavy traffic on serum metal levels in the Detroit Neighborhood Health Study.

Research in environmental sciences has demonstrated that land in close proximity to brownfields and heavily trafficked highways is contaminated with toxic metals. Despite this, little is known about the influence of brownfields and highways on metal levels in residents living nearby. We used data from 774 participants in the Detroit Neighborhood Health Study to estimate the effect of residential proximity to brownfields, highways, and present-day traffic on serum levels of lead, mercury, manganese, and copper using generalized estimating equations. We found that a 1 standard deviation increase in residential brownfield density within 200m was associated with increased serum lead levels (β: 0.04, 95% CI: -0.01, 0.09). The same modeled increase in a subset of historic industrial-use brownfields was associated with elevated serum mercury (β: 0.06, 95% CI: 0.03, 0.09). Increased highway and traffic density was positively associated with serum manganese (β: 0.02, 95% CI: 0.01, 0.04). Highway and traffic density was also positively associated with serum lead (β: 0.02, 95% CI: 0.01, 0.03) after restricting the analysis to participants who did not move during the study follow-up period. These findings draw attention to the importance of remediating polluted post-industrial sites in heavily populated areas, particularly as residents continue to move into densely populated cities around the globe.

Serum lead, mercury, manganese, and copper and DNA methylation age among adults in Detroit, Michigan.

Although the effects of lead, mercury, manganese, and copper on individual disease processes are well understood, estimating the health effects of long-term exposure to these metals at the low concentrations often observed in the general population is difficult. In addition, the health effects of joint exposure to multiple metals are difficult to estimate. Biological aging refers to the integrative progression of multiple physiologic and molecular changes that make individuals more at risk of disease. Biomarkers of biological aging may be useful to estimate the population-level effects of metal exposure prior to the development of disease in the population. We used data from 290 participants in the Detroit Neighborhood Health Study to estimate the effect of serum lead, mercury, manganese, and copper on three DNA methylation-based biomarkers of biological aging (Horvath Age, PhenoAge, and GrimAge). We used mixed models and Bayesian kernel machine regression and controlled for participant sex, race, ethnicity, cigarette use, income, educational attainment, and block group poverty. We observed consistently positive estimates of the effects between lead and GrimAge acceleration and mercury and PhenoAge acceleration. In contrast, we observed consistently negative associations between manganese and PhenoAge acceleration and mercury and Horvath Age acceleration. We also observed curvilinear relationships between copper and both PhenoAge and GrimAge acceleration. Increasing total exposure to the observed mixture of metals was associated with increased PhenoAge and GrimAge acceleration and decreased Horvath Age acceleration. These findings indicate that an increase in serum lead or mercury from the 25th to 75th percentile is associated with a ∼0.25-year increase in two epigenetic markers of all-cause mortality in a population of adults in Detroit, Michigan. While few of the findings were statistically significant, their consistency and novelty warrant interest.

Perceived neighborhood factors, health behaviors, and related outcomes in the Hispanic Community Health Study/Study of Latinos

Hispanic/Latino populations may experience significant neighborhood disadvantage, but limited research has explored whether these factors affect their health behaviors. Associations between perceived neighborhood factors at Visit 1 and health behaviors and related outcomes at Visit 2 in the Hispanic Community Health Study/Study of Latinos were evaluated. Multivariable logistic regression assessed cross-sectional and longitudinal relationships between perceived neighborhood social cohesion (NSC, 5 items), and neighborhood problems (NP, 7 items), with cancer screening, current smoking, excessive/binge drinking, hypertension, obesity, physical activity, and poor diet by gender and birthplace. NSC and NP scores were converted into quartiles. Mean age of participants was 42.5 years and 62.1% were women. Perceived NP, but not perceived NSC, differed by gender (p < 0.001). In unstratified models, no significant associations were observed between perceived NSC and any health behavior, whereas greater perceived NP was associated with less adherence to colon cancer screening (moderate level: aOR = 0.68, 95% CI = 0.51, 090) and more physical activity (very high level: aOR = 1.34, 95% CI = 1.06, 1.69) compared to low perceived NP. Women with moderate perceived NP, versus low NP, had a lower odds of colon cancer screening at Visit 1 (aOR = 0.62, 95% CI = 0.43, 0.91) and higher odds of mammogram adherence at Visit 2 (aOR = 2.86, 95% CI = 1.44, 5.68). Men with high perceived NP had a higher odds of excessive or binge drinking at Visit 2 (aOR = 1.99, 95% CI = 1.19, 3.31). We conclude that perceived NP were significantly related to health behaviors among HCHS/SOL individuals. Perceptions of neighborhood environment may be considered modifiable factors of structural neighborhood environment interventions.

Racial Capitalism and Neighborhood Health Disparities: the COVID-19 in California Counties.

PurposeThis article explores the association between racial capitalism and neighborhood-level health disparities, with a particular focus on COVID-19 in California.MethodsThis article investigates COVID-19 incidence in 58 California counties. To account for racial capitalism, the study looks at the per capita incomes ratios (1) between whites and Blacks and (2) between whites and Hispanics. Other county-level neighborhood characteristics were controlled.ResultsFindings from spatial autoregressive models indicate that increases in white-Black and white-Hispanic income disadvantages lead to an increase in COVID-19 incidence in 58 California counties. Findings also reveal that the disadvantage that results from the white-Black income ratio in COVID-19 spread decreases in counties that report high levels of income inequality between whites and Hispanics.DiscussionFindings indicate that a greater income disadvantage for racial minorities is connected to a more COVID-19 incidence. With regard to racial demographics in California, the interaction effect between measures for racial income disadvantages is discussed.

Sex differences in saliva-based DNA methylation changes and environmental stressor in young African American adults.

Low socioeconomic status neighborhood exposure to stress and violence may be sources of negative stimuli that poses significant health risks for children, adolescents and throughout the life course of an individual. The study aims to investigate if aberrant epigenetic DNA methylation changes may be a potential mechanism for regulating neighborhood exposures and health outcomes. Exposure to environmental stressors identified in 98 young African American (AA) adults aged 18-25 years old from the Washington D.C., area were used in the study. We correlated the association between stress markers; cortisol, CRP, IgG, IGA, IgM, and self-reported exposure to violence and stress, with quantitative DNA methylation changes in a panel of gene-specific loci using saliva DNA. In all participants studied, the exposure to violence was significant and negatively correlated with DNA methylation of MST1R loci (p = 0.032; r = -0.971) and nominally significant with NR3C1 loci (p = 0.053; r = -0.948). In addition, we observed significant and negative correlation of DNA methylation changes of LINE1 (p = 0.044; r = -0.248); NR3C1 (p = 0.017; r = -0.186); MSTR1 (p = 0.022; r = -0.192); and DRD2 (p = 0.056; r = -0.184; albeit nominal significant correlation) with IgA expression. On the other hand, we observed a significant and position correlation of DNA methylation changes in DRD2 (p = 0.037; r = 0.184) with IgG expression. When participants were stratified by sex, we observed in AA young male adults, significant DNA methylation changes of MST1R (p< 0.05) and association with exposure to violence and IgG level. We also observed significant DNA methylation levels of DRD2 (p< 0.05) and association with IgA, IgG, and cortisol level. Furthermore, we observed significant DNA methylation changes of NR3C1 (p< 0.05) with stress, IgA, and IgG in the male participants only. On the other hand, we only observed significant and a positive association of IgG with DNA methylation levels of ESR1 (p = 0.041) in the young AA female participants. Our preliminary observation of significant DNA methylation changes in neuronal and immune genes in saliva samples supports our recently published genome-wide DNA methylations changes in blood samples from young AA male adults indicating that saliva offers a non-invasive means for DNA methylation prediction of exposure to environmental stressors in a gender-specific manner.

Opening the black box of the relationship between neighborhood socioeconomic status and mental health: Neighborhood social-interactive characteristics as contextual mechanisms.

Previous studies have linked low neighborhood socioeconomic status (NSES) to mental health problems. However, few studies have investigated the mechanisms underlying this association and most focused on the association with negative indicators of mental health, such as symptoms of depression or anxiety. This paper investigated whether neighborhood social characteristics (social interaction, trust, safety, organization participation, and attachment) mediate the association between NSES and mental health. We combined Danish register data with survey data from the North Denmark Region Health Survey 2017. Mental health was assessed with the Rand 12-item Short-form Survey (SF-12). The sample consisted of 14,969 individuals nested in 1047 neighborhoods created with an automated redistricting algorithm. We fitted multilevel structural equation mediation models and used a Monte Carlo simulation method to estimate confidence intervals for the indirect effects. NSES was positively associated with mental health. Neighborhood trust significantly mediated this relationship, accounting for 34% of the association after controlling for other mediators. These results indicate that higher levels of mental health in more affluent neighborhoods are partially explained by higher levels of trust. Improving neighborhood trust could mitigate sociogeographic inequalities in mental health.

The Neighborhood Health Initiative: An Academic-Clinic-Community Partnership to Address the Social Determinants of Health.

A medical school, Federally Qualified Health Center, and community-based organizations wanted to improve social determinants of health and health outcomes in an urban area with economic and health inequities. To describe the development of the partnership called the Neighborhood Health Initiative (NHI). Community-engaged strategy with multidisciplinary partnerships used an established framework to develop trust, assess needs, and respond. Co-locating primary care services, traditional healers, mental health, and legal services in response to community partners' and residents' concerns helped to create a community-centered health home. As part of the needs assessment, community health workers conducted multiple visits to build trust and ascertain community members' strengths and challenges. Selected shared projects provide solutions to locally identified problems constituted community-driven initiatives. The NHI is working toward sustainable strategies to improve population health in an underserved area of Austin, Texas. Consistent and frequent contact contributed to developing relationships and trust; limiting partners and objectives focused activities on meeting initial goals of the NHI. Next steps include evaluation of the three aims of the NHI and process evaluation to guide future initiatives.

Factors Influencing Mobility During the COVID-19 Pandemic in Community-Dwelling Older Adults

ObjectiveTo describe and identify factors influencing mobility among older adults during the first 5 months of the COVID-19 pandemic. DesignA cross-sectional telesurvey. SettingCommunity dwelling older adults, situated within the first 5 months of the COVID-19 pandemic, in Hamilton, Canada. ParticipantsA random sample of 2343 older adults were approached to be in the study, of which 247 completed the survey (N=247). Eligible participants were aged ≥65 years. InterventionsNot applicable. Main Outcome MeasuresMobility was measured using global rating of change items and the Late Life Function Instrument (LLFI). Multivariate linear regression models were used to examine the association between mobility and related factors based on Webber's model. Results247 older adults (29% male, mean age 78±7.3 years) completed surveys between May and August 2020. Respectively, 26%, 10%, and 9%, rated their ability to engage in physical activity, housework, and move around their home as worse compared with the start of the pandemic. The mean LLFI score was 60.9±13.4. In the model, walking volume (β=0.03 95% confidence interval 0.013, 0.047), fall history (β=-0.04, 95% confidence interval -0.08, -0.04), male sex (β=0.06, 95% confidence interval 0.02, 0.09), unpleasant neighborhood (β=-0.06, 95% confidence interval -0.11, -0.02), musculoskeletal pain (β=-0.07, 95% confidence interval -0.11, -0.03), and self-reported health (β=0.08, 95% confidence interval 0.03, 0.13) had the strongest associations with LLFI scores and explained 64% of the variance in the LLFI score. ConclusionsPhysical and environmental factors may help explain poorer mobility during lockdowns. Future research should examine these associations longitudinally to see if factors remain consistent over time and could be targeted for rehabilitation.

Heterogeneity in grocery shopping patterns among low-income minority women in public housing

BackgroundPublic housing residents, who tend to be predominantly female and racial/ethnic minorities, are at a particularly high risk for chronic health conditions. Prior studies have suggested that a lack of access to healthy and affordable food may be an important barrier in public housing communities, but evidence is mixed on the association between the neighborhood food environment and dietary quality, suggesting the need to examine food access patterns in low-income, minority communities more deeply. The purpose of this study was to examine the variability in grocery shopping patterns, and the factors that predict them, among low-income minority women in public housing.MethodsInterviewer-administered surveys and body composition measurements were collected in the Watts Neighborhood Health Study, an ongoing longitudinal cohort study of low-income urban public housing residents located in South Los Angeles. Descriptive analyses were conducted to understand the variation in grocery shopping patterns among women. Logistic and ordered logistic regression models were estimated to examine the association between resident characteristics and grocery shopping patterns.ResultsThere was considerable variability in grocery shopping patterns, including the types of grocery stores accessed, distance travelled, frequency of shopping, and reasons behind grocery store choice. Grocery shopping patterns were associated with several participant characteristics, including race/ethnicity, working status, access to a car, income, and education. Hispanic participants were less likely to shop at a supermarket, travel further distances to shop, shop more frequently, and were more likely to prioritize price in their choice of primary grocery store than non-Hispanic Black women participants.ConclusionsThere was considerable variability in grocery shopping patterns, even within this low-income, minority community despite access to the same neighborhood food environment. Convenience and quality, in addition to price, were priorities for choice of primary grocery store, and differences by race/ethnicity suggest that initiatives to improve the neighborhood food environment should consider quality of food, cultural factors, and availability of foods desired by the surrounding community, in addition to price and proximity of grocery stores.

Factors Associated With Control of Diabetes and Hypertension Among Patients Seen as Part of a Longitudinal Medical School Service-Learning Program From 2018-2019: An Exploratory Analysis.

IntroductionThe Florida International University (FIU) Green Family Neighborhood Health Education Learning Program (NeighborhoodHELP) in Miami-Dade County serves communities impacted by adverse social determinants of health. This study identified sociodemographic factors affecting control of diabetes and hypertension among NeighborhoodHELP patients.MethodsThis non-concurrent cohort study evaluated NeighborhoodHELP patients who received care at mobile health centers (MHCs) utilizing de-identified data extracted from the MHCs' clinical quality metrics data set for the 2018-2019 fiscal year. A total of 143 eligible adults with diabetes and 222 adults with hypertension were identified. Condition control was defined as blood pressure ≤ 130 mmHg (systolic) and ≤ 80 mmHg (diastolic) or hemoglobin A1c (HbA1c) ≤ 7% (diabetes). Association with age, gender, ethnicity, marital status, language, service area, income per-capita, and medical student assignment was explored using logistic regression.ResultsThe model showed decreased diabetes control likelihood among Haitian-Creole speakers (OR: 0.13; 95% CI: 0.02-0.75). Odds of diabetes control were greater in two discrete areas serviced by the program, one known as Hippocrates (OR: 4.9; 95% CI: 1.23-19.37) and the other Semmelweis (OR: 3.71; 95% CI: 1.07-12.83). Income greater than $10,000 increased hypertension control likelihood (OR: 2.22; 95% CI: 1.03-4.8).ConclusionsAmong NeighborhoodHELP patients, geographic region and language impact diabetes control, while income affects hypertension control. Further research is warranted to identify the role of other factors.