Neighborhood-level Risk Factors Research Articles

Neighborhood level risk factors for type 1 diabetes in youth: the SEARCH case-control study

BackgroundEuropean ecologic studies suggest higher socioeconomic status is associated with higher incidence of type 1 diabetes. Using data from a case-control study of diabetes among racially/ethnically diverse youth in the United States (U.S.), we aimed to evaluate the independent impact of neighborhood characteristics on type 1 diabetes risk. Data were available for 507 youth with type 1 diabetes and 208 healthy controls aged 10-22 years recruited in South Carolina and Colorado in 2003-2006. Home addresses were used to identify Census tracts of residence. Neighborhood-level variables were obtained from 2000 U.S. Census. Multivariate generalized linear mixed models were applied.ResultsControlling for individual risk factors (age, gender, race/ethnicity, infant feeding, birth weight, maternal age, number of household residents, parental education, income, state), higher neighborhood household income (p = 0.005), proportion of population in managerial jobs (p = 0.02), with at least high school education (p = 0.005), working outside the county (p = 0.04) and vehicle ownership (p = 0.03) were each independently associated with increased odds of type 1 diabetes. Conversely, higher percent minority population (p = 0.0003), income from social security (p = 0.002), proportion of crowded households (0.0497) and poverty (p = 0.008) were associated with a decreased odds.ConclusionsOur study suggests that neighborhood characteristics related to greater affluence, occupation, and education are associated with higher type 1 diabetes risk. Further research is needed to understand mechanisms underlying the influence of neighborhood context.

Neighborhood level risk factors for type 1 diabetes in youth: the SEARCH case-control study

Neighborhood level risk factors for type 1 diabetes in youth: the SEARCH case-control study

Abstract 69: A Tale of Two Cities: The Role of Neighborhood Socioeconomic Status in Spatial Clustering of Bystander CPR in Austin and Houston

Objective: To determine 1) the location of bystander CPR clusters and 2) the effect of neighborhood-level risk factors on clusters. Methods: Secondary analysis of the Austin/Travis County and Houston/Harris County Cardiac Arrest Registry to Enhance Survival (CARES) dataset. Population: Consecutive arrests from October 1, 2006 to December 31, 2009 (Austin) and from January 1, 2007 to December 31, 2009 (Houston). Data Analysis: Spatial scan statistic (SaTScan v9.1) was used to test spatial clusters of bystander CPR stratified by private and public arrest location. A Bernoulli model was used to determine significant clustering of the case (all OHCA with a non-EMS bystander initiated CPR) location distribution as compared to the controls (all other OHCA events) location distribution. “High” clusters indicated areas where the number of bystander CPR events were greater than expected while “low” clusters indicated areas where the number of bystander CPR events were lower than expected. Results: Two “high” private and two public (one “low” and one “high”) clusters were identified in Austin. Two “high” private clusters had approximately 1.8-2.6 times more bystander CPR cases than expected, while the “high” public cluster, located in the same area as the private “high” cluster, had 2.0 times more bystander CPR cases than expected. The “low” public cluster was in the Austin city center and contained nearly 80% fewer than expected. Three private (two “high” and one “low) and one “high” public clusters, were identified in Houston. Two “high” private clusters in the south had nearly 4.4 times more than expected, while the “low” private cluster included only 34 cases, 57% fewer than expected. The “high” public cluster was, just west of city center, included 14 cases, 2.5 times more than expected. However, when adjusted for neighborhood median household income, all clusters disappeared in Austin, though only the public arrest cluster disappeared in Houston. Conclusion: Our findings suggest that high and low clusters of bystander CPR can be partially explained by median household income. Further research will be required to better understand why such vast disparities in the provision of bystander CPR exist.

Social Networks and the Risk of Gunshot Injury

Objectives: This study investigates the relationship between an individual’s position in a social network and the probability of being a victim of a fatal or non-fatal gunshot wound.Methods: This study combines detailed observational data from the police with records of fatal and non-fatal gunshot injuries among 763 individuals in Boston’s Cape Verdean community. After creating the social networks of these high-risk individuals, logistic regression is used to uncover the relationship between the odds of being a victim of a gunshot injury and various network characteristics. Results: The probability of gunshot victimization is directly related to one’s network distance to other gunshot victims - i.e., the closer someone is to a gunshot victim, the more likely that person is to also be a gunshot victim. This social distance to gunshot victims operates above and beyond other types of exposure to gun violence. Younger individuals, gang members, and individuals with a high density of gang members in their interpersonal networks are also at increased risk of being a gunshot victim. Conclusions: Risk of gunshot injuries in urban areas is more greatly concentrated than previously thought. While individual and neighborhood level risk factors contribute to the aggregate rates of violence, this study suggests that most of the actual risk of gun violence is concentrated in a small social network of identifiable individuals.

Neighborhood-level risk and resilience factors: an emerging issue in childhood asthma epidemiology

Evaluation of: Gupta RS, Zhang X, Sharp LK, Shannon JJ, Weiss KB. The protective effect of community factors on childhood asthma. J. Allergy Clin. Immunol. 123(6), 1297–1304.e2 (2009).The recent increase in the prevalence of asthma in children is now recognized as the result of a complex interplay of genetic, sociodemographic and environmental factors. Multilevel models simultaneously account for neighborhood characteristics that may be related to childhood asthma, independently of individual-level attributes. Most research that focuses on the physical and social characteristics of neighborhoods to explain disparities in childhood asthma assess such factors as persistent poverty, residential racial segregation and environmental degradation. Researchers have only begun to test models that specifically focus on risk and protective factors at the community/neighborhood level in relation to asthma. Social capital, which measures norms of reciprocity, social ties between neighborhood residents and civic engagement has the potential to buffer the effects of neighborhood risk factors on childhood asthma. Further research, specifically longitudinal studies, needs to be carried out to determine whether findings on neighborhood-level risk and protective factors can guide the development of preventive interventions for childhood asthma.

Predictors of Preterm Births and Low Birthweight in an Inner-City Hospital in Sub-Saharan Africa

Adverse birth outcomes remain significant contributors to perinatal mortality as well as developmental disabilities worldwide but limited evidence exists in sub-Saharan Africa based on a conceptual framework incorporating neighborhood context. This study therefore set out to determine the prevalence and risk factors for preterm births and low birthweight in an urban setting from this region. A cross-sectional study of all live births from May 2005 to December 2007 in an inner-city maternity hospital in Lagos, Nigeria. Factors predictive of preterm births and low birthweight were determined by unconditional multivariable logistic regression within a conceptual framework for adverse birth outcomes. Population attributable risk (PAR%) for each factor was also determined. Of the 4,314 newborns enrolled, 859 (19.9%) were preterm and 440 (10.2%) were low birthweight. One-third of mothers received no antenatal care while about 6% had HIV and another 6% had a history of hypertensive disorders. About 43% of the low birthweight infants were born full term. Maternal predictors of preterm delivery and/or low birthweight were marital status, occupation, residential accommodation with shared sanitation facilities, lack of antenatal care, absence of previous cesarean section, hypertensive disorders and antepartum hemorrhage. Gender and intrauterine growth restriction (IUGR) were also predictive of low birthweight. Premature rupture of membranes (PAR = 33.91%) and antepartum hemorrhage (PAR = 33.54%) were the leading contributors to preterm birth in contrast to IUGR (PAR = 82.28%) and premature rupture of membranes (PAR = 32.31%) for low birthweight. [corrected] The burden of preterm and low birthweight deliveries in this setting is associated with modifiable individual and neighborhood-level risk factors that warrant community-oriented public health interventions.

Racial disparity in bacterial vaginosis: the role of socioeconomic status, psychosocial stress, and neighborhood characteristics, and possible implications for preterm birth

Racial disparity in preterm birth is one of the most salient, yet least well-understood health disparities in the United States. The preterm birth disparity may be due to differences in how women experience their racial identity in light of neighborhood factors, psychosocial stress, or the prevalence of or response to genital tract infections such as bacterial vaginosis (BV). The latest research emphasizes a need to explore all these factors simultaneously. This cross-sectional study of parous women in King County, Washington, USA investigated the effects of household income, psychosocial stress, and neighborhood socioeconomic characteristics on risk of BV after accounting for known individual-level risk factors. Relevant demographic, socioeconomic, and medical data were linked to U.S. census socioeconomic data by geocoding subjects' residential addresses. It was found that having a low income was significantly associated with an increased prevalence of BV among African American but not White American women. A higher number of stressful life events was significantly associated with higher BV prevalence among both African American and White American women. However, perceived stress was not related to BV risk among either group of women. Among White American women, neighborhood socioeconomic status (SES) was univariately associated with increased BV prevalence by principal components analysis, but was no longer significant after adjusting for individual-level risk factors. No neighborhood SES effects were observed for African American women. These results suggest that both the effects of individual- and neighborhood-level risk factors for BV may differ importantly by racial group, and stressful life events may have physiological effects independent of perceived stress.

Risk areas and neighborhood-level risk factors for Shigella dysenteriae 1 and Shigella flexneri

Annually, there are 165 million cases of shigellosis resulting in 1.1 million deaths in the developing world. Two species of the causative agent, Shigella dysenteriae 1 and Shigella flexneri, are responsible for acute diarrheal illness. Vaccines are being developed against both but many questions remain about the disease burden, distribution of species in space and time, and community-level risk factors. This study answers two questions. What are the differences in neighborhood-level risk factors between S. dysenteriae 1 and S. flexneri? Does shigellosis caused by the two different species occur in the same neighborhoods and are those high-risk neighborhoods persistent in time? Cases from a hospital in rural Bangladesh were assigned to one of the two shigellosis types and age-matched individuals were randomly chosen from the community to be controls. Information was collected for neighborhood-level variables hypothesized to be related to shigellosis. During the 3-year study period, there were 161 cases of S. dysenteriae 1 and 225 cases of S. flexneri. Incidence of both types was highest in children under 2 followed by children from 2 to 5. The location of S. dysenteriae 1 risk varies in time but S. flexneri risk areas were persistent in time. Neighborhoods near bazaars with many non-septic latrines were at highest risk for S. dysenteriae 1. S. flexneri was most common in flood-controlled areas. S. dysenteriae 1 risk is more related to hygiene and sanitation and S. flexneri is more related to the environment.

Editorial

Editorial

Perceived crime and informal social control in the neighborhood as a context for adolescent behavior: A risk and resilience perspective

Greater understanding of adolescent perceptions of peer behavior can contribute to the development of effective interventions targeting adolescent problem behavior. The investigation discussed in this article drew from social disorganization theory to examine the effects of perceived neighborhood informal social control and perceived neighborhood crime on adolescents' perceptions of peers' behavior. The study used a nationally representative sample of 2,099 public middle and high school students. Results are discussed in the context of risk and protective processes that can guide prevention efforts for promoting a more supportive neighborhood environment. Key words: adolescence; crime; neighborhoods; peers; resilience; risk A risk and resilience perspective provides a useful roadmap for conducting research on adolescent prosocial and problem behavior. Substantive theory and earlier research direct attention to potential risk and protective factors at the individual, family, school, neighborhood, and broad environmental levels. Building from this knowledge base, studies can be designed to examine the nature of relationships among selected factors at a subset of system levels. Results from these investigations have implications for building theory and for designing and implementing effective interventions (Fraser & Galinsky, 1997). Using this perspective, the investigation discussed in this article drew on social disorganization theory to identify and examine neighborhood-level risk and protective factors that are hypothesized to influence adolescents' perceptions of prosocial and problem behavior among neighborhood peers. It is important to understand these perceptions and the conditions that influence them, because they represent a key component of the social context that influences and constrains the decisions and behavior of adolescents. The interpersonal, community, and institutional settings in which adolescents participate strongly influence their values, orientations, and behavior (Bowen & Chapman, 1996; Farrell & Bruce, 1997; Guterman & Cameron, 1997; Hinton-Nelson, Roberts, & Snyder, 1996; Nettles & Pleck, 1993; Williams, Stiffman, & O'Neal, 1998). Structural and normative properties in these settings operate as a field of forces (Lewin, 1951) that constrains pure volunteerism through sets of behavioral prescriptions and proscriptions. A critical setting in which adolescent behavior originates and occurs centers on peer groups. Crane (1991) formulated a social contagion model to account for the increased prevalence of adolescent problems in neighborhoods facing serious economic and social obstacles and argued that the chief agent for the spread of problems among adolescents is peer influence. He demonstrated that exposure to high levels of problematic behavior among neighborhood peers increased the risk of engaging in similar behavior. Of the many social circles in which adolescents participate, peers represent an important comparison point for adolescents in evaluating their own attitudes and behavior (Gillmore, Hawkins, Day, & Catalano, 1992), especially for early adolescents (Steinberg, 1996). Furthermore, adolescents' estimates of the prevalence of high-risk behaviors among peers are predictors of their own likelihood of engaging in the same behaviors (Gerrard, Gibbons, Benthin, & Hessling, 1996; Gibbons, Helweg-Larsen, & Gerrard, 1995). Although a number of studies have focused on the role of adolescent friendships and peer acceptance on adolescent attitudes and behavior (for example, East et al., 1992; Walters & Bowen, 1997), few studies have examined the perceptions of adolescents about the behavior of their peers in specific contexts, such as in neighborhoods and schools. Even fewer studies have attempted to identify conditions that influence these perceptions. Using a nationally representative sample of 2,099 adolescents, the present investigation examined the perceptions of adolescents about the level of prosocial and problem behavior among peers of about the same age in their neighborhood. …