Neighborhood Income Inequality Research Articles

Abstract 15849: Studying the Effects of Race, Community Health, and Vascular Inequities on Outcomes for Peripheral Artery Disease: Principal Components Analysis of Community Health Metrics Using the Agency for Healthcare Research and Quality Social Determinants of Health Database

Introduction: Healthcare disparities associated with peripheral artery disease (PAD) are influenced by differences in healthcare quality and social determinants of health (SDOH). Hypothesis: We used principal components analysis (PCA) to summarize key themes of community-level SDOH variables. Methods: This retrospective analysis used data from a single health system quality improvement database of patients diagnosed with PAD between 2016-2019. Subjects were geocoded to census tracts and variables from the Agency for Healthcare Quality and Research SDOH database were obtained to examine small-area variability in social, economic, educational, physical infrastructure, and healthcare contexts. PCA was used to identify major themes in SDOH heterogeneity across communities. Relevant SDOH variables were normalized within a data matrix and those with a loading value >0.2 were retained in a principal component (PC). PCs with an eigenvalue > 1.0 were identified to parsimoniously exemplify key themes. Results: Among 7,187 subjects with PAD, the mean age was 72.2 11.1 years, 45.9% were female, 9.4% self-reported as non-Hispanic Black, and 86.6% as non-Hispanic White. PCA was applied to 29 SDOH variables relevant to vascular health. PCA retained 6 PCs to an SDOH matrix describing 73.8% of variance in census tract level data. The greatest variance in data was attributed to socioeconomic advantage (PC1) and urbanicity/migration context (PC2) with some overlap in Black neighborhood context (PC3), income inequality (PC4), multi-race cohesion (PC5), and underrepresented minority context (PC6). Conclusions: PCA transforms high-dimensional SDOH data into distinct typologies of community health while retaining complex features of the data. Future analysis will weight these results within a hierarchical model that accounts for patient-level characteristics and quality of care to inform a more complete social-ecological model of whole-person vascular care.

Association of census-tract level gentrification and income inequality with 6-year incidence of metabolic syndrome in the Hispanic Community Health Study/Study of Latinos, an epidemiologic cohort study

BackgroundMetabolic syndrome varies by socio-demographic characteristics, with younger (18–29 years) and older (50–69 years) Hispanic/Latino having higher prevalence compared to other groups. While there is substantial research on neighborhood influences on cardiometabolic health, there are mixed findings regarding the effects of gentrification and few studies have included Hispanic/Latinos. The role of neighborhood income inequality on metabolic health remains poorly understood. ObjectivesExamined associations of neighborhood gentrification and income inequality with metabolic syndrome (MetSyn) using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Design, Setting and ParticipantsThe HCHS/SOL is a community-based cohort of adults of Hispanic/Latinos (aged 18–74). Analyses included 6710 adults who did not meet criteria for MetsS at baseline (2008–2011) and completed the visit 2 examination (2014–2017). Poisson regressions estimated odds ratios (IRR) and 95% confidence intervals (CI) for neighborhood gentrification and change in income inequality with MetSyn incidence. Main outcome and exposure measuresGentrification was measured with an index that included changes (2000 to 2006–2010) in education, poverty, and income. Change in neighborhood income inequality (2005–2009 to 2012–2016) was measured using the Gini coefficient of income distribution. MetSyn was defined using National Cholesterol Education Program Adult Treatment Panel III criteria. ResultsAmong 6647 Hispanic/Latino adults, 23% (N = 1530) had incident MetSyn. In models adjusted for socio-demographic, health insurance status, and neighborhood characteristics, gentrification (IRR, 1.00, 95%CI, 0.96–1.03) and income inequality change (IRR, 1.00, 95%CI, 0.99–1.00) were not associated with MetSyn at visit 2. There was no association between cross-sectional income inequality (2005–2009) and MetSyn at visit 2 (IRR, 0.97, 95%CI, 0.82–1.15). ConclusionNeighborhood gentrification and income inequality change were not associated with incidence of MetSyn over 6 years among Hispanic/Latino adults. This study demonstrated that income-based residential changes alone may not be sufficient to explain neighborhood influences on health outcomes among this population.

Social mix and the city: Council housing and neighbourhood income inequality in Vienna

The Austrian capital of Vienna is widely acknowledged as one of the most livable cities, featuring a unique model of council housing that accounts for roughly 25% of all residential dwellings. This paper studies whether the broad provision of council housing is linked with a higher social mix in the neighbourhood. The analysis is based on administrative wage tax data at a small-scale raster grid of 500 × 500 meter with neighbourhood income inequality as an indicator for the social mix. While council housing is widely spread across the city, we find distinct spatial clusters of high and low income and inequality. Spatial econometric models show that council housing in Vienna is associated with lower income areas but slightly correlates with higher neighbourhood income inequality. These findings suggest that well-designed public housing policies may contribute to a higher social mix in a city.

An investigation of the longitudinal relationship between neighbourhood income inequality and individual self-rated health in England.

There are mixed findings on whether neighbourhood income inequality leads to better self-rated health (SRH) or not. This study considers two hypotheses: individuals living in more unequal neighbourhoods have better SRH and the level of neighbourhood income inequality and its impact on SRH is moderated by household and neighbourhood level income related variables. Data from Waves 8-10 of the UK Household Longitudinal Study for respondents living in England at wave 8 were used. Neighbourhood income inequality was measured using Gini coefficients of household income from the Pay As You Earn and benefits systems for Lower Super Output Areas. Longitudinal ordinal multilevel models predicted self-rated health in 2016-18, 2017-19 and 2019-20 by income inequality and its interaction with household income, neighbourhood median income and neighbourhood deprivation, conditional on individual educational attainment, age, sex, ethnic group, years lived in current residence, region of residence and study wave. There were 24,889 respondents analysed over three waves. SRH was worse for those living in more income equal neighbourhoods. There was no indication that neighbourhood inequality was moderated by household income, neighbourhood median income or neighbourhood deprivation. These findings are in line with the balance of existing evidence and support policy interventions that aim to create mixed communities for the purpose of improving population health.

Do social support and community engagement act as mechanisms in the association between neighbourhood income inequality and the mental health of mothers in Calgary, Canada? A mediation analysis.

According to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada. Data collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement. Income inequality was not significantly associated with higher depressive symptoms (β=0.32, 95%CI=-0.067, 0.70), anxiety symptoms (β=0.11, 95%CI=-0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (β=-0.13, 95%CI=-0.15, -0.097), while community engagement was not significantly associated with depressive symptoms (β=0.059, 95%CI=-0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (β=-0.17, 95%CI=-0.20, -0.13) but not with higher levels of community engagement (β=0.14, 95%CI=-0.14, 0.41). The current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.

Neighborhood income inequality associated with functional independence after ischemic stroke: a cohort study (S28.007)

Neighborhood income inequality associated with functional independence after ischemic stroke: a cohort study (S28.007)

Relative Deprivation, Income Inequality, and Cardiovascular Health: Observational and Mendelian Randomization Studies in Hong Kong Chinese.

The associations between absolute vs. relative income at the household or neighborhood level and cardiovascular disease (CVD) risk remain understudied in the Chinese context. Further, it is unclear whether stress biomarkers, such as cortisol, are on the pathway from income to CVD risk. We examined the associations of absolute and relative income with CVD risk observationally, as well as the mediating role of cortisol, and validated the role of cortisol using Mendelian Randomization (MR) in Hong Kong Chinese. Within Hong Kong's FAMILY Cohort, associations of absolute and relative income at both the individual and neighborhood levels with CVD risk [body mass index (BMI), body fat percentage, systolic blood pressure, diastolic blood pressure, self-reported CVD and self-reported diabetes] were examined using multilevel logistic or linear models (n = 17,607), the mediating role of cortisol using the mediation analysis (n = 1,562), and associations of genetically predicted cortisol with CVD risk using the multiplicative generalized method of moments (MGMMs) or two-stage least squares regression (n = 1,562). In our cross-sectional observational analysis, relative household income deprivation (per 1 SD, equivalent to USD 128 difference in Yitzhaki index) was associated with higher systolic blood pressure (0.47 mmHg, 95% CI 0.30–0.64), but lower BMI (−0.07 kg/m2, 95% CI −0.11 to −0.04), independent of absolute income. Neighborhood income inequality was generally unrelated to CVD and its risk factors, nor was absolute income at the household or neighborhood level. Cortisol did not clearly mediate the association of relative household income deprivation with systolic blood pressure. Using MR, cortisol was unrelated to CVD risk. Based on our findings, relative household income deprivation was not consistently associated with cardiovascular health in Hong Kong Chinese, nor were neighborhood income inequality and absolute income, highlighting the context-specific ways in which relative and absolute income are linked to CVD risk.

Is neighbourhood income inequality associated with maternal mental health? A longitudinal analysis of pregnant and new mothers living in Calgary, Alberta

ObjectivesRising income inequality is a potential risk factor for poor mental health, however, little work has investigated this link among mothers. Our goal was to determine if neighbourhood-level income inequality...

Neighborhood-Level Predictors of Sexual Violence Across Intimate Partner and Non-Intimate Partner Relationships: A Case–Control Study

Ample research explores individual factors associated with sexual violence, yet individual, dyadic, and environmental influences on intimate partner sexual violence (IPSV) occurring in the larger context of non-intimate partner violence (NIPSV) remain relatively unexplored. The current study aimed to determine the extent to which county-level indicators in combination with individual and dyadic factors are associated with sexual violence across relationship types. Reported IPSV and NIPSV cases were obtained from the Tennessee Bureau of Investigation’s (TBI) online incident-based reporting system. County-level variables indicative of neighborhood physical disorder, violent crime, income inequality, firearm prevalence, and community alcohol use patterns were retrieved from the online resource County Health Rankings and Roadmaps. Using a nested case–control design, we determined significant sexual violence risk within younger cohorts and across relationship types, finding three significant county-level factors: 1) income inequality, 2) rate of firearm fatalities, and 3) percentage of female residents. Suggested prevention and intervention efforts include targeting younger age groups for IPSV and NIPSV education, developing resources for a range of relational partners, improving legal access and law enforcement training for reporting, and continued examination of the role of firearms.

Neighborhood Income Inequality and Alcohol Use among Adolescents in Boston, Massachusetts.

Objectives: Previous research has indicated that area-level income inequality is associated with increased risk in alcohol consumption. However, few studies have been conducted among adolescents living within smaller area units, such as neighborhoods. We investigated whether neighborhood income inequality is associated with alcohol consumption among adolescents. Methods: We analyzed cross-sectional data from a sample of 1878 adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey. Multilevel logistic regression modeling was used to determine the role of neighborhood income inequality and the odds for alcohol consumption and to determine if social cohesion and depressive symptoms were mediators. Results: In comparison to the first tertile of income inequality, or the most equal neighborhood, adolescent participants living in the second tertile (AOR = 1.20, 95% CI: 0.89, 1.61) and third tertile (AOR = 1.44, 95% CI: 1.06, 1.96) were more likely to have consumed alcohol in the last 30 days. Social cohesion and depressive symptoms were not observed to mediate this relationship. Conclusions: Findings indicate that the distribution of incomes within urban areas may be related to alcohol consumption among adolescents. To prevent alcohol consumption, public health practitioners should prioritize prevention efforts for adolescents living in neighborhoods with large gaps between rich and poor.

A longitudinal analysis of relationships between neighborhood context and underserved children's physical activity in a rapidly growing city.

Neighborhood context, which may be impacted by urban growth or residential mobility, is associated with childhood physical activity. This secondary analysis examined associations of objectively measured neighborhood characteristics with young children’s moderate-to-vigorous physical activity (MVPA) and sedentary/rest time (SRT) over a period of rapid infrastructure change.Underserved preschoolers (n = 426) from a 36-month obesity prevention intervention were included in a secondary analysis (2019–2020). Based on household addresses, participants were coded as movers or non-movers and linked to four neighborhood variables: 1) distance to recreation sites, 2) annual crimes, 3) annual stray dogs, and 4) Gini index of income inequality. Accelerometry captured MVPA and SRT at baseline and 36 months. Baseline-to-follow-up neighborhood variables within moved and non-moved groups were compared. Multivariable regression assessed associations between follow-up MVPA/SRT and neighborhood variables.45.3% of participants (n = 193) moved. Distance to the closest recreation site decreased significantly for non-movers (0.75 to 0.72 mi, p < 0.001). Nearby crimes significantly decreased for both groups (movers: 90 to 80, p < 0.001; non-movers: 77 to 74, p < 0.001) as did stray dogs (movers: 36 to 15, p < 0.001; non-movers: 36 to 18, p < 0.001). Neighborhood income inequality decreased significantly for movers (0.41 to 0.38, p = 0.03). Child MVPA minutes/day significantly decreased over time from median = 84.7 [Q1 = 64.1, Q3 = 103.9] to median = 73.6 [Q1 = 56.1, Q3 = 96.0], p < 0.001). No significant associations were detected between neighborhood variables and child physical activity.In a rapidly growing county, neighborhood context generally improved over time regardless of move status. Within this context, no associations between neighborhood characteristics and MVPA/SRT were detected in children.

What Are the Main Socio-Economic and Behavioral Characteristics That Determine Voluntary Pension Contributions for Self-Employed Workers in Chile?

This study contributes to the literature by examining how socio-economic and behavioral characteristics such as neighborhood income inequality and peer effects determine voluntary pension contributions for self-employed workers in Chile. We use a survey representative of the Chilean household sector and we run five different probit regressions to elucidate voluntary contributions to the pension system for self-employed workers. Additionally, we run probit models with a heteroscedastic structure (hetprobit models). The results show that the driving forces of the decision to contribute for retirement are significantly related to age, income, sex, area of residence, education, belonging to or from indigenous descent, multidimensional poverty, job formality, cash transfers, having a current account and credit card. Exceptionally, this study finds that behavioral aspects, that where not considered in depth so far both in research and public policy, are significant in savings contribution. Our research concludes that neighborhood income inequality and peer effects should be further analyzed as part of the context for which public policies are designed.

Neighborhood Income Inequality and Adolescent Relationship Aggression: Results of a Nationally Representative, Longitudinal Study.

Adolescent relationship aggression (ARA) is a prevalent public health issue with myriad adverse health outcomes. Experts suggest that a research focus on individual- and family-level risk factors for ARA has been too limited, proposing that research on the "outer layers" of the social-ecological model, including community-level risk factors, may hold promise for the development of interventions targeting ARA. This study assessed the longitudinal association between one community-level risk factor-income inequality-and ARA victimization and perpetration. The study also examined variations of this association by race/ethnicity, income, and/or sex. This study is based on 723 participants (351 male and 372 female participants) from the Survey on Teen Relationships and Intimate Violence (STRiV). We assessed data across two waves (2013 and 2016). Logistic regression models were used to assess the association between neighborhood income inequality and both ARA victimization and perpetration. We included interaction terms to assess whether these associations varied by race/ethnicity and/or income, and we stratified analyses by sex. We did not detect associations between income inequality and ARA victimization or perpetration in the overall sample. However, for female participants from families with more income, living in a neighborhood with more income inequality was associated with increased risk of ARA victimization (odds ratio [OR] = 1.163; p < .05). More affluent, compared with less affluent, adolescent girls in mixed-income neighborhoods may be at increased risk of ARA victimization.

Abstract P398: Relative versus Absolute Neighborhood Economic Conditions and Risk of Stroke in a United States National Cohort

Introduction: Neighborhood economic conditions are important predictors of incident stroke. Neighborhood economic conditions can be characterized differently but studies have not identified which characterizations are most predictive of incident stroke. Previous work has suggested that the income distribution within the population may be more relevant for chronic disease than the absolute value of median income of the population. This project aims to estimate the effects of neighborhood income and neighborhood income inequality on incidence stroke. Hypothesis: Neighborhood income inequality and absolute neighborhood income will predict incident stroke above and beyond demographic characteristics and individual socioeconomic status. Methods: We used data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national longitudinal study of black and white older adults (N=29,443). Baseline median household income and the Gini coefficient of income inequality at the Census Tract level were obtained from the 2000 decennial census. Both variables were standardized to have a mean of 0 and a standard deviation of 1; z-score of median household income was multiplied by -1 (representing neighborhood income deprivation) to allow for comparability. Using Cox Proportional Hazards analysis we examined the risk of stroke associated with these exposures in separate models. Model 1 was unadjusted, Model 2 was adjusted for demographic characteristics (age, race, sex, marital status), and Model 3 was adjusted for individual socioeconomic characteristics (household income and education). Results: Within Model 1, neighborhood income deprivation (HR: 1.18; 95% CI 1.11-1.24) and neighborhood income inequality (HR: 1.10; 95% CI: 1.05-1.16) were both significantly associated with risk of stroke. The association persisted in Model 2: neighborhood income deprivation (HR: 1.13; 95% CI 1.07-1.20) and neighborhood income inequality (HR: 1.06; 95% CI: 1.00-1.11). Within Model 3, neighborhood income deprivation maintained its positive association (HR: 1.06; 95% CI 1.00-1.13), while neighborhood income inequality was no longer predictive of stroke risk (HR:1.04; 95% CI 0.99-1.10). Conclusions: Neighborhood income deprivation and neighborhood income inequality were similar predictors of incident stroke. The effect of absolute economic resources in a Census Tract was slightly larger than the relative economic standards within a Census Tract. There is a need to investigate other characterizations of neighborhood economic conditions, such as residential income segregation. The findings from this project suggest that there are multiple policy levels that can be used to decrease incident stroke, through decreasing income inequality and improving the absolute economic conditions of deprived neighborhoods.

Longitudinal measures of neighborhood poverty and income inequality are associated with adverse birth outcomes in Texas

BackgroundInequity in adverse birth outcomes between black and white women in the U.S. is persistent, despite decades of research and prevention efforts. Neighborhood environments are plausibly related to pre-pregnancy health and other risk factors for adverse birth outcomes and may help explain black/white inequities. Despite the fact that neighborhoods change over time, most prior work has relied upon cross-sectional measures of neighborhood economic contexts. MethodsWe used birth certificates for non-Hispanic black and white women in Texas (2009–2011, N = 470,896) to examine whether longitudinal measures of neighborhood economic context (poverty and income inequality, based on census tract data from 1990 to 2010) were associated with preterm birth, low birthweight and small-for-gestational-age (SGA) with hierarchical generalized linear models. We also tested whether (1) the longitudinal measures explained black/white inequities or (2) moderated the effect of race on the birth outcomes. Finally, we compared the models with longitudinal measures to models with cross-sectional measures of neighborhood economic context. ResultsLongitudinal measures of neighborhood economic context were associated with all three birth outcomes, but did not explain racial inequities. Except for income inequality and SGA, there was no evidence of moderation by race. Substituting cross-sectional measures of economic context for longitudinal ones resulted in similar findings. ConclusionPolicies that either address structural neighborhood-level economic disadvantage or mitigate the effects of such disadvantage are warranted to improve the health of mothers and prevent adverse birth outcomes.

Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study.

OBJECTIVESPrevious research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.METHODSThe study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.RESULTSThere were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.CONCLUSIONSThis study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.

Aboriginal Status and Neighborhood Income Inequality Moderate the Relationship between School Absenteeism and Early Childhood Development.

The negative impact of school absenteeism on children’s academic performance has been documented in the educational literature, yet few studies have used validated development indicators, or investigated individual and neighborhood characteristics to illuminate potential moderating factors. Using cross-sectional Early Development Instrument (EDI) panel data (2001–2005) we constructed multilevel linear and logistic regression models to examine the association between school absenteeism and early childhood development, moderated by Aboriginal status, length of school absence, neighborhood-level income inequality, and children’s sex assigned at birth. Our study included 3572 children aged four to eight in 56 residential neighborhoods in Saskatoon, Canada. Results indicated that Aboriginal children missing an average number of school days (3.63 days) had significantly lower EDI scores compared to non-Aboriginal children, controlling for individual and neighborhood factors. As school absenteeism lengthened, the gap in EDI scores between Aboriginal and non-Aboriginal children narrowed, becoming non-significant for absences greater than two weeks. Children with long-term school absence (>4 weeks of school), living in neighborhoods of low income inequality, had significantly better physical and social development scores compared to children from medium or high income inequality neighborhoods. Across all EDI domains, girls living in neighborhoods with low income inequality had significantly better EDI scores than boys in similar neighborhoods; however, sex-differences in EDI scores were not apparent for children residing in high income inequality neighborhoods. Results add to the literature by demonstrating differences in the relationship between school absenteeism and early developmental outcomes moderated by Aboriginal status, length of school absence, neighborhood income inequality, and sex assigned at birth. These moderating factors show that differential approaches are necessary when implementing policies and programs aimed at improving school attendance.

Neighbourhood disadvantage and depressive symptoms among adolescents followed into emerging adulthood

BackgroundResidents of disadvantaged neighbourhoods report higher levels of depressive symptoms; however, few studies have employed prospective designs during adolescence, when depression tends to emerge. We examined associations of neighbourhood social...

"If they focus on giving us a chance in life we can actually do something in this world": Poverty, inequality, and youths' critical consciousness.

Critical consciousness (CC) has emerged as a framework for understanding how low-income and racial/ethnic minority youth recognize, interpret, and work to change the experiences and systems of oppression that they face in their daily lives. Despite this, relatively little is known about how youths' experiences with economic hardship and structural oppression shape how they "read their world" and motivate participation in critical action behaviors. We explore this issue using a mixed-methods design and present our findings in two studies. In Study 1 we examine the types of issues that a sample of low-income and predominantly racial/ethnic minority youth (ages 13-17) living in the Chicago area discuss when asked to reflect on issues that are important to them. The most commonly mentioned themes were community violence (59%), prejudice and intolerance (31%), world issues (25%), and economic disparities (18%). In Study 2 we examine youths' quantitative reports of engaging in critical action behavior; more than 65% had participated in at least one activity targeting social change in the previous 6 months. We then examined relationships between youths' experiences with poverty within their households and neighborhoods, neighborhood income inequality, and exposure to violence and youths' likelihood of participating in critical action behaviors. Greater exposure to violence and neighborhood income inequality were related to an increased likelihood of engaging in critical action behaviors. This work highlights the diverse ways that low-income and racial/ethnic minority youth reflect on societal inequality and their commitment to effecting change through sociopolitical participation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Income inequality and psychological distress at neighbourhood and municipality level: An analysis in the Netherlands.

This study examines the associations between income inequality at neighbourhood and municipality level and psychological distress in a country with a relatively low income inequality, the Netherlands. Multilevel linear regression analyses were used to investigate associations between income inequality and mean income at the neighbourhood (n = 7803) and municipality (n = 406) level and psychological distress (scale range 10-50), in a country-wide sample of 343,327 individuals, adjusted for gender, age, ethnicity, marital status, education and household income. No significant association was found between neighbourhood income inequality and psychological distress after adjustment for individual and neighbourhood level confounding. However, a higher neighbourhood income inequality in neighbourhoods with the middle to highest mean neighbourhood incomes was associated with more psychological distress. Individuals living in municipalities with the highest income inequality reported 2.5% higher psychological distress compared to those living in municipalities with the lowest income inequality. Income inequality seems to matter more for mental health at the municipality than neighbourhood level.