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Beyer L, Keen R, Ertel KA, Okuzono SS, Pintro K, Delaney S, Slopen N. Comparing two measures of neighborhood quality and internalizing and externalizing behaviors in the adolescent brain cognitive development study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02614-4. [PMID: 38305870 DOI: 10.1007/s00127-024-02614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE There is widespread recognition of the importance and complexity of measuring neighborhood contexts within research on child psychopathology. In this study, we assessed the cross-sectional associations between two measures of neighborhood quality and internalizing and externalizing behaviors in preadolescence. METHODS Drawing on baseline data from the Adolescent Brain Cognitive Development Study (n = 10,577 preadolescents), we examined two multi-component assessments of neighborhood quality in relation to children's internalizing and externalizing symptoms: the Area Deprivation Index (ADI), which measures socioeconomic adversity, and the Child Opportunity Index 2.0 (COI), which measures economic, educational, and environmental opportunity. Both measures were categorized into quintiles. We then used mixed-effects linear regression models to examine bivariate and adjusted associations. RESULTS The bivariate associations displayed strong inverse associations between the COI and ADI and externalizing symptoms, with a graded pattern of fewer externalizing behaviors with increasing neighborhood quality. Only the ADI was associated with externalizing behaviors in models adjusted for child and family characteristics. We did not observe a clear association between either measure of neighborhood quality and internalizing behaviors in bivariate or adjusted models. CONCLUSIONS Neighborhood quality, as measured by the COI and ADI, was associated with externalizing behaviors in preadolescent children. The association using the ADI persisted after adjustment for family-level characteristics, including financial strain. Our results indicate that different assessments of neighborhood quality display distinct associations with preadolescent behavioral health. Future research is needed to assess the association between neighborhood quality and behavior trajectories and to identify place-based intervention strategies.
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Affiliation(s)
- Logan Beyer
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA.
- Harvard Medical School, Boston, USA.
| | - Ryan Keen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Karen A Ertel
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, USA
| | - Sakurako S Okuzono
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Kedie Pintro
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Scott Delaney
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Center On the Developing Child, Harvard University, Boston, USA
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Barber LE, Maliniak ML, Nash R, Moubadder L, Haynes D, Ward KC, McCullough LE. A Comparison of Three Area-Level Indices of Neighborhood Deprivation and Socioeconomic Status and their Applicability to Breast Cancer Mortality. J Urban Health 2024; 101:75-79. [PMID: 38158547 PMCID: PMC10897108 DOI: 10.1007/s11524-023-00811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
Neighborhood deprivation indices are widely used in research, but the performance of these indices has rarely been directly compared in the same analysis. We examined the Area Deprivation Index, Neighborhood Deprivation Index, and Yost index, and compared their associations with breast cancer mortality. Indices were constructed for Georgia census block groups using 2011-2015 American Community Survey data. Pearson correlation coefficients and percent agreement were calculated. Associations between each index and breast cancer mortality were estimated among 36,795 women diagnosed with breast cancer using Cox proportional hazards regression. The indices were strongly correlated (absolute value of correlation coefficients > 0.77), exhibited moderate (41.4%) agreement, and were similarly associated with a 36% increase in breast cancer mortality. The similar associations with breast cancer mortality suggest the indices measure the same underlying construct, despite only moderate agreement. By understanding their correlations, agreement, and associations with health outcomes, researchers can choose the most appropriate index for analysis.
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Affiliation(s)
- Lauren E Barber
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA.
| | - Maret L Maliniak
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Rebecca Nash
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - David Haynes
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Kevin C Ward
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Lauren E McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
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Conley CC, Derry-Vick HM, Ahn J, Xia Y, Lin L, Graves KD, Pan W, Fall-Dickson JM, Reeve BB, Potosky AL. Relationship between area-level socioeconomic status and health-related quality of life among cancer survivors. JNCI Cancer Spectr 2024; 8:pkad109. [PMID: 38128004 PMCID: PMC10868382 DOI: 10.1093/jncics/pkad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
Area-level socioeconomic status (SES) impacts cancer outcomes, such as stage at diagnosis, treatments received, and mortality. However, less is known about the relationship between area-level SES and health-related quality of life (HRQOL) for cancer survivors. To assess the additive value of area-level SES data and the relative contribution of area- and individual-level SES for estimating cancer survivors' HRQOL, we conducted a secondary analysis of data from a population-based survey study of cancer survivors (the Measuring Your Health [MY-Health] Study). Multilevel multinomial logistic regression models were used to examine the relationships between individual-level SES, area-level SES as measured by the Centers for Disease Control and Prevention's Social Vulnerability Index, and HRQOL group membership (high, average, low, or very low HRQOL). Area-level SES did not significantly increase model estimation accuracy compared to models using only individual-level SES. However, area-level SES could be an appropriate proxy when the individual-level SES is missing.
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Affiliation(s)
- Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Heather M Derry-Vick
- Cancer Prevention Precision Control Institute, Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Yi Xia
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA
| | - Li Lin
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kristi D Graves
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Wei Pan
- Health Statistics and Data Science Core, Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jane M Fall-Dickson
- Georgetown University School of Nursing, Georgetown University Medical Center, Washington, DC, USA
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bryce B Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Arnold L Potosky
- Department of Oncology, Georgetown University, Washington, DC, USA
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Okuzono SS, Wilson J, Slopen N. Resilience in development: Neighborhood context, experiences of discrimination, and children's mental health. Dev Psychopathol 2023; 35:2551-2559. [PMID: 37641977 DOI: 10.1017/s0954579423001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
An understanding of child psychopathology and resilience requires attention to the nested and interconnected systems and contexts that shape children's experiences and health outcomes. In this study, we draw on data from the National Survey of Children's Health, 2016 to 2021 (n = 182,375 children, ages 3- to 17 years) to examine associations between community social capital and neighborhood resources and children's internalizing and externalizing problems, and whether these associations were moderated by experiences of racial discrimination. Study outcomes were caregiver-report of current internalizing and externalizing problems. Using logistic regression models adjusted for sociodemographic characteristics of the child and household, higher levels of community social capital were associated with a lower risk of children's depression, anxiety, and behaviors. Notably, we observed similar associations between neighborhood resources and child mental health for depression only. In models stratified by the child's experience of racial/ethnic discrimination, the protective benefits of community social capital were specific to those children who did not experience racial discrimination. Our results illustrate heterogeneous associations between community social capital and children's mental health that differ based on interpersonal experiences of racial/ethnic discrimination, illustrating the importance of a multilevel framework to promote child wellbeing.
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Affiliation(s)
- Sakurako S Okuzono
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph Wilson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center on the Developing Child, Cambridge, MA, USA
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Rollings KA, Noppert GA, Griggs JJ, Melendez RA, Clarke PJ. Comparison of two area-level socioeconomic deprivation indices: Implications for public health research, practice, and policy. PLoS One 2023; 18:e0292281. [PMID: 37797080 PMCID: PMC10553799 DOI: 10.1371/journal.pone.0292281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES To compare 2 frequently used area-level socioeconomic deprivation indices: the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI). METHODS Index agreement was assessed via pairwise correlations, decile score distribution and mean comparisons, and mapping. The 2019 ADI and 2018 SVI indices at the U.S. census tract-level were analyzed. RESULTS Index correlation was modest (R = 0.51). Less than half (44.4%) of all tracts had good index agreement (0-1 decile difference). Among the 6.3% of tracts with poor index agreement (≥6 decile difference), nearly 1 in 5 were classified by high SVI and low ADI scores. Index items driving poor agreement, such as high rents, mortgages, and home values in urban areas with characteristics indicative of socioeconomic deprivation, were also identified. CONCLUSIONS Differences in index dimensions and agreement indicated that ADI and SVI are not interchangeable measures of socioeconomic deprivation at the tract level. Careful consideration is necessary when selecting an area-level socioeconomic deprivation measure that appropriately defines deprivation relative to the context in which it will be used. How deprivation is operationalized affects interpretation by researchers as well as public health practitioners and policymakers making decisions about resource allocation and working to address health equity.
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Affiliation(s)
- Kimberly A. Rollings
- Institute for Healthcare Policy and Innovation, Health & Design Research Fellowship Program, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Grace A. Noppert
- Institute for Social Research, Social Environment and Health, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jennifer J. Griggs
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Robert A. Melendez
- Institute for Social Research, Social Environment and Health, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Philippa J. Clarke
- Institute for Social Research, Social Environment and Health, Survey Research Center, University of Michigan, Ann Arbor, Michigan, United States of America
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Zolotor A, Huang RW, Bhavsar NA, Cholera R. Quantifying Associations Between Child Health and Neighborhood Social Vulnerability: Does the Choice of Index Matter? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.20.23291679. [PMID: 37461577 PMCID: PMC10350141 DOI: 10.1101/2023.06.20.23291679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Importance Policymakers have increasingly utilized place-based social disadvantage indices to quantify the impacts of place on health and inform equitable resource allocation. Indices vary in design, content, and purpose but are often used interchangeably, potentially resulting in differential assignments of relative disadvantage depending on index choice. Objective To compare associations between three commonly used disadvantage indices (Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI)) and two epidemiologically distinct child health outcomes-infant well-child check (WCC) attendance and adolescent obesity. Design Cross-sectional analysis of Duke University Health System electronic health record (EHR) data from January 2014 to December 2019. Participants Children ≤18 years of age with outpatient encounters between January 2014 and December 2019, and who were Durham County residents were eligible. WCC attendance was assessed for infants ages 0-15 months; obesity was assessed for children ages 11-17 years. Exposures 2014 Social Vulnerability Index (SVI), 2015 Area Deprivation Index (ADI), and 2015 Child Opportunity Index (COI) 2.0. Main Outcomes 1) Infant WCC attendance: attending less than the minimum recommended six WCCs in the first 15 months of life, and 2) Adolescent obesity: BMI ≥ the 95th percentile at both the most recent encounter and an encounter within the prior 9-36 months. Results Of 10175 patients in the WCC cohort, 20% (n = 2073) had less than six WCCs. Of 14961 patients in the obesity cohort, 20% (n = 2933) had obesity. All three indices were associated with both WCCs (OR for SVI 1.10, 95% CI 1.08-1.12; OR for ADI 1.10, 95% CI 1.08-1.12; OR for COI 1.12, 95% CI 1.10-1.14) and obesity (OR for SVI 1.05, 95% CI 1.04-1.08; OR for ADI 1.08, 95% CI 1.06-1.10; OR for COI 1.07, 95% CI 1.05-1.08). Conclusions and relevance Higher social disadvantage as defined by all three indices was similarly associated with both adolescent obesity and decreased infant WCC attendance. While the COI incorporates a broader set of child-specific variables, the SVI and ADI may often be just as suitable for pediatric research. Users should consider population and outcome characteristics when selecting an index.
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Affiliation(s)
- Anna Zolotor
- Trinity College of Arts & Sciences, Duke University
- Duke-Margolis Center for Health Policy
| | - Ro W. Huang
- Trinity College of Arts & Sciences, Duke University
- Duke-Margolis Center for Health Policy
| | - Nrupen A. Bhavsar
- Duke University School of Medicine (DUSM) Department of Surgery
- DUSM Department of Biostatistics and Bioinformatics and Bioinformatics
| | - Rushina Cholera
- Duke-Margolis Center for Health Policy
- DUSM Department of Population Health Sciences
- DUSM Department of Pediatrics
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