Neighborhood Risk Research Articles

Abstract 4805: Identifying neighborhood hot spots of HPV-associated cancers for targeted interventions of HPV vaccination uptake in underserved communities of South Florida

Abstract Background: Although the incidence of cervical cancer in the US has declined, the incidences of other HPV-associated cancers are on the rise. HPV vaccination is an important primary prevention strategy for reducing the burden of HPV-associated cancers. In South Florida (population over 6 million), the percentage of adolescents aged 13-15 years who completed the recommended HPV vaccine series is 54%, which lags significantly behind the Healthy People 2030 target of 80%. In addition, vaccination disparities exist in South Florida by races/ethnicities and sexes, with non-Hispanic black males having the lowest rate at 27%. To address HPV cancer disparities, we performed a geospatial analysis on the incidence of HPV-associated cancers by sex and races/ethnicity to identify communities in South Florida with high incidence of HPV-associated cancer to target interventions that may improve HPV-vaccine uptake via community outreach and engagement. Methods: The average annual (2010-2019) incidence of HPV-associated cancers in women (cervical, oropharyngeal, vulva, vaginal, and anal) and men (oropharyngeal, penile, and anal) were calculated for Hispanics, Non-Hispanic Whites (NHWs) and Non-Hispanic Blacks (NHB) at the census tract level across South Florida using data from the Florida Cancer Data System (FCDS), the state incident cancer registry. Geospatial hot spot analyses were used to identify clusters of census tracts with high HPV cancer incidence by sex and race/ethnicity. Socioeconomic and cervical screening data of the hot spots were analyzed to identify other neighborhood risk conditions that may be associated with high HPV cancer risk. Results: For Hispanics and NHBs in South Florida, census tract hot spots for male and female HPV cancers appear to overlap in low-income neighborhoods; however, hot spots for NHW males are mostly in medium to higher income areas and do not overlap with hot spots observed for NHW females, likely given that NHW females generally report higher cervical screening rates. Conclusion: There is a positive association between male and female HPV cancer incidence in Hispanic and NHB communities of South Florida, justifying the need for increased HPV vaccination and screening programs in these neighborhoods. While increasing cervical screening rate in the hot spot neighborhoods is urgent for cervical cancer control, increasing gender-neutral HPV vaccination uptake in these communities will not only reduce the incidences of male HPV cancers but also help to accelerate cervical cancer elimination by reducing HPV infection. Citation Format: Ming Lee, Sara Parrott, Rebecca Kaiser, Ridhi Vyas, Danielle Gabuzda, Arianna Vazquez, Daniela Flores Quetant, Nancy Elliott, Valerie Bethel, Amanda Rivera, Brandon Mahal, Raymond Balise, Elizabeth Franzmann, Erin Kobetz. Identifying neighborhood hot spots of HPV-associated cancers for targeted interventions of HPV vaccination uptake in underserved communities of South Florida [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4805.

Abstract P450: Assessing Admission Risk in Under-Resourced Neighborhoods: An Analysis by Race

Introduction: Cardiovascular disease (CVD) disproportionately affects socioeconomically disadvantaged communities and people of racial minority backgrounds. The Area Deprivation Index (ADI) is a validated measure of census-level characteristics based on income, education, employment, housing, and more. Although ADI is often linked to adversity, it is less well known if ADI is associated with racial disparities in CVD admission among cardiac patients living in disadvantaged communities. Hypothesis: We hypothesized that among a cohort of cardiac patients, risk for CVD admissions would be associated with ADI and that risk would vary by race. Methods: We identified ADI among n=27694 patients receiving care in a large health care system. We compared individual’s demographic variables using chi square for categorical variables and t-test for continuous variables. Using, ANOVA we determined differences in ADI by race. We further used ADI to identify neighborhoods with disproportionate rates CVD admissions using linear regression. Results: Figure Panel A shows that the ADI of American Indians, Blacks, and Asians was higher compared with that of Whites. Completion of an ANOVA test provided a p-value <0.05, showing that the average ADI is not equal between race groups. Panel B shows a linear association between higher ADI and increased risk of CVD event. Yet, some block groups were outliers with lower than predicted CVD events, labeled as low utilizers. Conclusion and Implications: Racial minority groups tended to have a higher ADI, yet some groups at high risk for CVD had disproportionately lower CVD events. These findings along with our team’s future work will inform interventions to address neighborhood level social determinants of cardiac health. Interventions that account for the unique social and healthcare contexts and inequities specific to at-risk communities will in turn help address the health challenges unique to these groups.

Family risk, parental cortisol contagion, and parenting: A process-oriented approach to spillover.

This multi-method longitudinal study sought to investigate linkage in parental neuroendocrine functioning - indicated by cortisol - over two measurement occasions. In addition, we examined how parental cortisol linkage may operate as an intermediate factor in the cascade of contextual risks and parenting. Participants were 235 families with a young child (Mage = 33.56, 36.00 years for mothers and fathers respectively), who were followed for two annual measurement occasions. Parental cortisol linkage was measured around a laboratory conflict discussion task at both measurement occasions (i.e., pre-discussion, 20- and 40-minute post-discussion for each measurement occasion). Maternal and paternal parenting behavior was observed during a parent-child discipline discussion task. Findings indicated similar levels of cortisol linkage between parents over the two measurement occasions. Furthermore, cortisol linkage between parents operated as an intermediate factor between contextual risks and more compromised parenting behavior. That is, greater contextual risks, indicated by greater neighborhood risk and interparental conflict, were linked to greater cortisol linkage between parents over time, which was in turn linked to greater authoritarian parenting during parent-child interaction. Findings highlighted the importance of understanding physiological-linkage processes with respect to the impact of contextual risks on family functioning and may have crucial implications for clinical work.

Pilot examination of independent and interactive effects of maltreatment and neighborhood risk on child attachment

ABSTRACT Elucidating the influence of microsystem and exosystem factors on development is an important goal of developmental psychopathology. This study examined the effects of maltreatment and neighborhood risk on child-caregiver attachment. Maltreatment records, neighborhood risk indices, and Strange Situation data were collected from a diverse sample of 170 four-year-old children and their caregivers. Relative contributions of maltreatment, neighborhood risk, and their interaction on attachment insecurity and disorganization were explored via latent moderation. Maltreated children demonstrated higher rates of insecure attachment, but not attachment disorganization, independent of neighborhood risk. Controlling for maltreatment, preliminary results suggested no effects of neighborhood risk on attachment. Findings support prior research that has identified maltreatment as a salient risk to the formation of secure attachment relationships. However, results add heterogeneity to the limited research investigating effects of neighborhood on attachment. Overall, this study highlights the importance of examining multilevel ecological risk in relation to attachment relationship development.

Neighborhood Disadvantage and Risk of Heart Failure: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Heart failure (HF) affects >6 million US adults, with recent increases in HF hospitalizations. We aimed to investigate the association between neighborhood disadvantage and incident HF events and potential differences by diabetes status. We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005-2007). Neighborhood disadvantage was assessed using a Z score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term. The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06-1.60), 1.36 (95% CI, 1.11-1.66), and 1.45 (95% CI, 1.18-1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction P=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92-1.96), and it was 1.50 (95% CI, 1.16-1.94) for adults without diabetes. In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.

Household, neighbourhood and service provider risk factors for piped drinking-water intermittency in urban and peri-urban Zambia: A cross-sectional analysis

Given nearly one third of sub-Saharan Africa’s population lack access to an improved water source that is available when needed, service continuity restricts access to safely managed services. Household surveys, water regulators, and utilities all gather data on service continuity, but few studies have integrated these disparate datasets to quantify continuity-related risk factors and inequalities. This study aimed to assess the added value of utility and regulator data for international monitoring by assessing factors affecting piped water availability in urban and peri-urban Zambia. Household ‘user’ data from the 2018 Demographic and Health Survey (n = 3047) were spatially linked to provider data from an international utility database and regulator reports. Multilevel modelling quantified provider-related and socio-economic risk factors for households reporting water being unavailable for at least one day in the previous fortnight. 47% (95% CI: 45%, 49%) of urban and peri-urban households reported water being unavailable for at least one full day, ranging from 18% (95% CI: 14%, 23%) to 76% (95% CI: 70%, 81%) across providers. Controlling for provider, home ownership (odds ratio (OR) = 1.31; p <0.01), speaking Luvale, Kaonde, Lunda (OR = 2.06; p <0.05) or Tonga (OR = 1.78; p <0.1) as an ethnicity proxy, and dry season interview dates (OR = 1.91; p <0.05) were associated with household-reported interruptions. Households using a neighbour’s tap (OR = 1.33; p <0.1) and in mid-wealth neighbourhoods (OR = 4.31; p <0.1) were more likely to report interruptions. For every $1000 increase in utility-level GDP per capita, the odds of an interruption were 0.51 times less (p<0.01). Substantial inequalities in drinking-water availability were found between provider coverage areas. Spatial integration of user, provider and regulator data enriches analysis, providing a finer-scale perspective than otherwise possible. However, wider use of utility or regulator data requires investment in monitoring of small-scale community supply intermittency and utility coverage area data.

Abstract HUP3: Neighborhood Deprivation and Functional Outcomes Following Ischemic Stroke

Introduction: The association between neighborhood deprivation and risk of disease is well-documented. However, the role of neighborhood deprivation in long-term outcomes following acute brain injury remains understudied. We tested the hypothesis that neighborhood deprivation leads to unfavorable long-term functional outcomes following acute ischemic stroke (AIS). Methods: We conducted a nested study within the Yale Longitudinal Study of Acute Brain Injury, a prospective study which follows patients with acute brain injury admitted to the Yale Health System. The present study focused on AIS survivors and assessed neighborhood deprivation using the Area Deprivation Index (ADI), a metric that uses 9-digit zip codes to rank neighborhoods based on income, employment, education, and housing quality. Patients were stratified into tertiles based on their ADI, designated as low, intermediate, or high deprivation. Functional outcomes were evaluated using the modified Rankin Scale at one-year post-stroke, dichotomized into favorable (scores 0-2) and unfavorable (scores 3-6). Our analysis employed multivariable logistic regression for adjusted analyses. Results: Among 2,540 AIS patients enrolled between 2018 and 2021, 2,164 patients had zip code and outcomes data (mean age 69 years, 48% female, 7.5% Black, 7.7% Hispanic). The one-year unadjusted risk of poor outcomes was 35%, 40% and 46% for patients residing in neighborhoods with low, intermediate, and high deprivation, respectively (unadjusted p=0.001). These findings remained significant in multivariate analyses that controlled for confounding factors: compared to patients living in neighborhoods with low deprivation, those living in areas with intermediate and high deprivation had 44% (OR 1.44, 95% CI 1.11-1.86) and 107% (OR 2.07, 95% CI 1.58-2.72) greater risk of unfavorable outcomes (test-for-trend p<0.001). Conclusion: Our study, focusing on survivors of AIS participating in a prospective acute brain injury study, underscores the connection between neighborhood deprivation and an elevated risk of unfavorable outcomes. We validate the utility of the ADI as a valuable analytical tool for evaluating neighborhood deprivation as a composite for several social determinants of health.

Abstract WMP53: Neighborhood Deprivation and Functional Outcomes Following Ischemic Stroke

Introduction: The association between neighborhood deprivation and risk of disease is well-documented. However, the role of neighborhood deprivation in long-term outcomes following acute brain injury remains understudied. We tested the hypothesis that neighborhood deprivation leads to unfavorable long-term functional outcomes following acute ischemic stroke (AIS). Methods: We conducted a nested study within the Yale Longitudinal Study of Acute Brain Injury, a prospective study which follows patients with acute brain injury admitted to the Yale Health System. The present study focused on AIS survivors and assessed neighborhood deprivation using the Area Deprivation Index (ADI), a metric that uses 9-digit zip codes to rank neighborhoods based on income, employment, education, and housing quality. Patients were stratified into tertiles based on their ADI, designated as low, intermediate, or high deprivation. Functional outcomes were evaluated using the modified Rankin Scale at one-year post-stroke, dichotomized into favorable (scores 0-2) and unfavorable (scores 3-6). Our analysis employed multivariable logistic regression for adjusted analyses. Results: Among 2,540 AIS patients enrolled between 2018 and 2021, 2,164 patients had zip code and outcomes data (mean age 69 years, 48% female, 7.5% Black, 7.7% Hispanic). The one-year unadjusted risk of poor outcomes was 35%, 40% and 46% for patients residing in neighborhoods with low, intermediate, and high deprivation, respectively (unadjusted p=0.001). These findings remained significant in multivariate analyses that controlled for confounding factors: compared to patients living in neighborhoods with low deprivation, those living in areas with intermediate and high deprivation had 44% (OR 1.44, 95% CI 1.11-1.86) and 107% (OR 2.07, 95% CI 1.58-2.72) greater risk of unfavorable outcomes (test-for-trend p<0.001). Conclusion: Our study, focusing on survivors of AIS participating in a prospective acute brain injury study, underscores the connection between neighborhood deprivation and an elevated risk of unfavorable outcomes. We validate the utility of the ADI as a valuable analytical tool for evaluating neighborhood deprivation as a composite for several social determinants of health.

Neighborhood risk and prenatal care utilization in Rhode Island, 2005-2014.

The importance of prenatal care is undeniable, as pregnant persons who receive on-time, adequate prenatal care have better maternal and infant health outcomes compared with those receiving late, less than adequate prenatal care. Previous studies assessing the relationship between neighborhood factors and maternal health outcomes have typically looked at singular neighborhood variables and their relationship with maternal health outcomes. In order to examine a greater number of place-based risk factors simultaneously, our analysis used a unique neighborhood risk index to assess the association between cumulative risk and prenatal care utilization, which no other studies have done. Data from Rhode Island Vital Statistics for births between 2005 and 2014 were used to assess the relationship between neighborhood risk and prenatal care utilization using two established indices. We assessed neighborhood risk with an index composed of eight socioeconomic block-group variables. A multivariate logistic regression model was used to examine the association between adequate use and neighborhood risk. Individuals living in a high-risk neighborhood were less likely to have adequate or better prenatal care utilization according to both the APNCU Index (adjusted odds ratio [aOR] 0.91, 95% confidence interval [CI] 0.87-0.95) and the R-GINDEX (aOR 0.88, 95% CI 0.85-0.91) compared with those in low-risk neighborhoods. Understanding the impact of neighborhood-level factors on prenatal care use is a critical first step in ensuring that underserved neighborhoods are prioritized in interventions aimed at making access to prenatal care more equitable.

Direct and interactive effects of attendance rates on growth in language, literacy and mathematics skills for children enrolled in voluntary preschool programs

Attendance plays an important role in student academic success; yet few studies examine associations between preschool attendance rates and academic skills for children enrolled in early childhood programs. To address this gap, this population-based study examined associations between preschool attendance rates and language, literacy and mathematics skill growth for a cohort of four-year-old children (N = 20,414) enrolled in a state-funded public prekindergarten program within an urban county (N = 1,720 classrooms, N = 922 programs). Measures included linked administrative data on preschool attendance and program-administered direct assessments of oral language, literacy, and mathematics. Latent growth curve analysis (LGCA) found that attendance rates were associated with greater rates of change in all academic skills across the preschool year, controlling for child demographic covariates, preschool program provider type, and neighborhood risk. In addition, higher attendance benefited children more who entered preschool with lower initial academic skills as compared to children who entered preschool with higher academic skills. Implications of the findings, including future directions, and application to early childhood education policy and practice are shared.

NEIGHBORHOOD SOCIOECONOMIC POSITION, LIVING ARRANGEMENTS, AND CARDIOMETABOLIC DISEASE AMONG OLDER PUERTO RICANS

Abstract Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations such as Puerto Rico. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. Using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03, and II 2006/07), linked with 2000 Census data for neighborhood-level conditions, this study examined the association between neighborhood SEP, living arrangements, and risk of cardiometabolic conditions among island-dwelling Puerto Ricans aged 60 and older, who lived in the same residence across both waves (N=2,769). Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but neighborhood SEP was unrelated to developing cardiometabolic conditions at follow-up. Living without a partner - alone, with children, or with others - was negatively associated with reporting having and developing cardiometabolic conditions relative to living with a partner. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone was associated with lower risk of reporting having one condition, and living with children was associated with lower risk of developing one cardiometabolic condition when living within a socioeconomically advantaged neighborhood. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions.

Examining holistic developmental strengths and needs of multilingual kindergartners using the Early Development Instrument

Using an asset-based framework, this study examines the holistic developmental health outcomes of young English Learners (ELs) in the United States using the Early Development Instrument (EDI), stratified by first language and neighborhood risk measured by the National Neighborhood Equity Index (NNEI). Drawing from data spanning 154 school districts across 11 states and the District of Columbia from 2016 to 2020 (n = 192,892 kindergartners), the analyses encompassed descriptive statistics, Pearson Chi-square tests, and logistic regression models. The results highlight that EL kindergartners were more likely to be On Track in the social competence (OR = 1.17; 95 % CI = 1.13, 1.20), emotional maturity (OR = 1.26; 95 % CI = 1.22, 1.30), and physical health and well-being (OR = 1.47; 95 % CI = 1.43,1.51) domains compared to non-EL kindergartners. Yet, in the communication skills and general knowledge (OR = 0.75; CI = 0.72, 0.77) and language and cognitive development (OR = 0.72; CI = 0.70, 0.74) domains, EL kindergartners were less likely to be On Track compared to non-EL kindergartners. Notably, Korean- and Mandarin-speaking kindergartners showed the highest rates of being On Track across all EDI domains. Additionally, EL kindergartners in less challenged neighborhoods were surprisingly less likely to be On Track compared to those in more adverse neighborhoods across all developmental domains. Implications of these findings, which shed light on distinctive strengths and needs, are discussed.

Psychosis prevalence in London neighbourhoods; A case study in spatial confounding

Analysis of impacts of neighbourhood risk factors on mental health outcomes frequently adopts a disease mapping approach, with unknown neighbourhood influences summarised by random effects. However, such effects may show confounding with observed predictors, especially when such predictors have a clear spatial pattern. Here, the standard disease mapping model is compared to methods which account and adjust for spatial confounding in an analysis of psychosis prevalence in London neighbourhoods. Established area risk factors such as area deprivation, non-white ethnicity, greenspace access and social fragmentation are considered as influences on psychosis. The results show evidence of spatial confounding in the standard disease mapping model. Impacts expected on substantive grounds and available evidence are either nullified or reversed in direction. It is argued that the potential for spatial confounding to affect inferences about geographic disease patterns and risk factors should be routinely considered in ecological studies of health based on disease mapping.

Mexican-origin parent and child reported neighborhood factors and youth substance use.

Structural oppression affects health behaviors through residence in suboptimal neighborhoods and exposure to community violence. Youth and parents report perceptions of neighborhood factors that can affect youth substance use behaviors. Given that Latinx youth report higher levels of perceived community violence than other racial and ethnic groups, it is imperative to examine how youth- and parent-perceived neighborhood-level factors may relate to youth substance use. Data were collected using clinical interviews with family triads (fathers, mothers, and youth) and parent-child dyads (father or mother and youth) enrolled in the Seguimos Avanzando study of 344 Mexican-origin families in Indiana. Neighborhood measures, including perceptions of exposure to violence, neighborhood characteristics, and neighborhood collective efficacy, were included in parent and youth surveys. Self-report measures for past year alcohol and drug use were included in the youth survey only. T-tests were conducted to estimate differences in neighborhood reports among the sample triads. A series of linear regression models were used to estimate the associations between youth-, mother-, and father-reported perceptions of neighborhood factors and youth substance use. Preliminary results indicate that fathers reported higher levels of exposure to violence than mothers [t(163) = 2.33, p = 0.02] and youth [t(173) = 3.61, p < 0.001]. Youth reported lower negative neighborhood characteristics than mothers [t(329) = 6.43, p < 0.001] and fathers [t(169) = 3.73, p < 0.001]. Youth reported significantly better neighborhood collective efficacy than mothers [t(296) = 3.14, p = 0.002], but not statistically different from fathers. Results from the primary analysis showed that youth exposure to violence was positively associated with youth substance use (b = 0.24, SE = 0.06, p < 0.0001), but the youth's neighborhood characteristics and collective efficacy were not significantly associated with youth substance use. None of the parent-reported neighborhood variables were associated with youth substance use. The discrepant findings between parent and youth reports of perceived neighborhood characteristics and substance use have important implications for researchers and community stakeholders, and for developing targeted interventions and prevention strategies. Our study highlights the need to address youth experience of community violence and to prioritize creating safe and inclusive neighborhood environments. Potential strategies include improving community resources, strengthening social support networks, promoting open communication about neighborhood risks, and fostering collaborative efforts to address substance use behaviors.

Abstract IA038: Neighborhood factors for adiposity change and cardiovascular health among Black breast cancer survivors

Abstract Maintaining a healthy weight and cardiovascular health (CVH) after a breast cancer (BC) diagnosis is gaining clinical attention because they are essential for reducing the burden of cardiovascular disease, achieving optimal cancer survivorship, and possibly reducing mortality after a BC diagnosis. Individual behaviors and choices are largely influenced by the surrounding social and built environment; however, the neighborhood risk factors influencing post-diagnosis weight change and CVH are unclear among Black women, who have higher rates of obesity, unfavorable CVH and mortality than any other racial/ethnic group. To address this knowledge gap, we conducted analyses based on the Women's Circle of Health Follow-Up Study (WCHFS), a population-based prospective cohort of Black BC survivors in New Jersey. In the first analysis, adiposity changes during the period ~10 months to 2 years after diagnosis were evaluated among 785 women enrolled in the WCHFS. We found that despite a high baseline prevalence of overweight or obesity, weight gain was common. Greater density of fast-food restaurants and lower walkability were identified as neighborhood-level risk factors for weight gain. We also showed that intentional weight loss was much less common than weight gain, and its neighborhood risk factors were considerably different from unintentional weight loss. In a subsequent analysis, we aimed to capture the complex interplay between neighborhood features through neighborhood archetype analysis based on 16 social and built environment features, and to estimate their associations with CVH around 2 years after diagnosis among Black women. The CVH index used American Heart Association definition and scoring criteria for BMI, diet, smoking, physical activity, blood pressure, cholesterol, glucose, and sleep. We found that Black BC survivors, on average, reached only half of the recommended optimal CVH score, and no participant met all ideal CVH metrics. Among the four neighborhood archetypes identified, we found that the archetype associated with the most favorable post-diagnostic CVH was characterized by diverse racial and ethnic populations, a higher neighborhood socioeconomic status, greater densities of restaurants, food stores, physical activity facilities, walkable destinations, and ambulatory care. However, only 16% of our participants lived in this type of neighborhood. In summary, our work revealed that residential environments may considerably impact adiposity change and CVH among Black BC survivors. Through these studies, we provided insights into the distinct neighborhood characteristics and archetypes that may influence BC survivorship for Black women. Recognizing that social determinants of health act at multiple levels, domains, and factors, it is crucial that future research comprehensively investigates neighborhood and other multilevel determinants to identify the specific social barriers that must be addressed to achieve the most measurable improvements in BC survivorship for Black women. Citation Format: Bo Qin, Carola T. Sánchez-Díaz, Hari S. Iyer, Noreen Goldman, Nur Zeinomar, Andrew G. Rundle, Christine B. Ambrosone, Kitaw Demissie, Chi-Chen Hong, Gina S. Lovasi, Elisa V. Bandera. Neighborhood factors for adiposity change and cardiovascular health among Black breast cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA038.

Nurturing resilience in American Indian/Alaska Native preschool children: the role of cultural socialization, executive function, and neighborhood risk.

American Indian and Alaska Native (AI/AN) children possess numerous cultural assets, yet higher exposures to neighborhood risks (e.g., lack of housing, crime) may present barriers to healthy cognitive development, including executive function (EF). Cultural socialization may promote resilience and support children's early cognition, but this has not been adequately studied. The present study examined the effects of neighborhood risk and cultural socialization on EF for AI/AN preschool children. Parents/caregivers of 768 AI/AN preschoolers from the 2015 AI/AN Head Start Family and Community Experiences (FACES) Study rated neighborhood risk via two scales: "Neighborhood Problems" and "Environmental Conditions," and cultural socialization practices via two scales: cultural activities and tribal language activities. Children's EF was measured directly using the Pencil Tap Task and the Leiter-R attention subscale. Families perceived neighborhood risks as relatively low, and overall risk did not predict children's EF. However, higher average language socialization was significantly related to higher EF, as were two specific language activities (encouraging children to learn their tribal language, making sure children heard their tribal language) and two cultural activities (playing AI/AN games, participating in tribal ceremonies), controlling for neighborhood risk. Findings suggest some aspects of cultural socialization may promote resilience among AI/AN preschoolers by supporting early EF. Mechanisms may include increased spiritual, social, and cultural connections, and practice with EF skills during cultural games. Future research should partner with AI/AN communities to investigate culturally grounded EF interventions and reevaluate measures of neighborhood risk to promote resilience and connectedness for AI/AN children.

Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity

(Abstracted from JAMA Network Open 2023;6(5):e2315301) Women of low socioeconomic position are more likely to have poorer pregnancy outcomes than those of higher socioeconomic position, according to a growing body of epidemiological studies. Residence in low socioeconomic areas is associated with limited availability, access, and quality of health and social services.

Novel Methods of Identifying Individual and Neighborhood Risk Factors for Loss to Follow-Up After Ophthalmic Screening.

Residence in a middle-class neighborhood correlated with lower follow-up compared with residence in more affluent neighborhoods. The most common explanations for not following up were the process of making an appointment and lack of symptoms. To explore which individual-level and neighborhood-level factors influence follow-up as recommended after positive ophthalmic and primary care screening in a vulnerable population using novel methodologies. From 2017 to 2018, 957 participants were screened for ophthalmic disease and cardiovascular risk factors as part of the Real-Time Mobile Teleophthalmology study. Individuals who screened positive for either ophthalmic or cardiovascular risk factors were contacted to determine whether or not they followed up with a health care provider. Data from the Social Vulnerability Index, a novel virtual auditing system, and personal demographics were collected for each participant. A multivariate logistic regression was performed to determine which factors significantly differed between participants who followed up and those who did not. As a whole, the study population was more socioeconomically vulnerable than the national average (mean summary Social Vulnerability Index score=0.81). Participants whose neighborhoods fell in the middle of the national per capita income distribution had a lower likelihood of follow-up compared with those who resided in the most affluent neighborhoods (relative risk ratio=0.21, P -value<0.01). Participants cited the complicated process of making an eye care appointment and lack of symptoms as the most common reasons for not following up as instructed within 4 months. Residence in a middle-class neighborhood, difficulty accessing eye care appointments, and low health literacy may influence follow-up among vulnerable populations.

Effects of family and neighborhood vulnerability on dual language learner and monolingual children’s preschool outcomes

IntroductionResearch has documented that home and neighborhood contexts of children from low-income families are associated with lower cognitive and social–emotional skills than their higher-income peers. Even though over a third of young children growing up in poverty are dual language learners (DLLs), little research has examined how contextual effects differ between DLL and monolingual children. The current study examines how these two contexts, neighborhood vulnerability and family socioeconomic risk, impact executive function (EF) and social–emotional skills in DLL and monolingual preschoolers.MethodsA secondary analysis was completed on data from two Head Start programs. A series of cross-classified models with interactions were conducted to examine the moderating role of DLL status on associations between neighborhood vulnerability and family risk and preschoolers’ EF and social-emotional skills.ResultsProficient bilingual children’s EF skills were not impacted by neighborhood risks, suggesting that proficient bilingual children may have more opportunities to grow their EF skills when switching between English and Spanish regardless of neighborhood context. An unexpected result occurred for emergent bilingual children who were reported to demonstrate fewer behavior problems regardless of family risk, highlighting the importance of ensuring all DLL families have access to resources to promote their children’s social–emotional skills; and teachers have the proper training to support the behaviors of children in their classroom with varying levels of English proficiency.DiscussionAlthough speaking two languages may be a protective factor for young DLLs growing up in poverty, little research has examined how contextual effects differ between DLL and monolingual children. The current study contributes by examining how DLL status, especially two different DLL statuses (i.e., Proficient Bilinguals and Emergent Bilinguals), may vary as a buffer in moderating the negative associations between collective neighborhood vulnerability, individual family risk, and children’s EF and social–emotional skills.

Neighborhood resources and risk of cognitive decline among a community-dwelling long-term care population in the U.S.

ObjectiveTo examine the associations between neighborhood resources (i.e., number of restaurants, recreation centers, or social services for seniors and persons with disability per land area) and cognitive decline among a community-dwelling long-term care population and whether they differ by baseline cognition status. Study designProspective longitudinal cohort study. MethodsWe used a longitudinal dataset that assessed over a two-year period older adults receiving state-funded home- and community-based services in Michigan Metropolitan areas (N = 9,802) and applied nonlinear mixed models with a random intercept with Poisson distribution. ResultsCognitively intact older adults were less likely to experience cognitive decline when they resided in resource-rich neighborhoods, compared to those cognitively intact but living in neighborhoods that lacked resources. But their cognitively impaired or dementia-diagnosed counterparts did not similarly benefit from living in neighborhoods with rich resources. ConclusionsNeighborhood resources may be an important aspect of intervention to mitigate cognitive decline before older adults become cognitively impaired.