Neighborhood cohesion, neighborhood disorder, and cardiometabolic risk

Neighborhood Safety and Hypertension Risk: A Systematic Review

BACKGROUND

Responding to the increasing focus on residential environments, our systematic review aimed to consolidate existing empirical evidence regarding the impact of neighborhood safety on blood pressure. We also summarized the mediating and moderating mechanisms through which neighborhood safety influences blood pressure, alongside their direct effects, to offer insights for future research.

METHODS

We searched 5 electronic databases (PubMed, Ovid MEDLINE, CINAHL Complete, ProQuest Dissertations and Theses Global, and Web of Science) for the period up to and including December 27, 2022. The initial search yielded 4944 studies reviewed, of which 19 met our criteria and were reviewed.

RESULTS

Our findings consistently show that living in a safe neighborhood is associated with lower blood pressure outcomes. While most cross-sectional studies found that the association was not statistically significant (7/10 studies showed insignificant results), longitudinal studies that tracked changes in neighborhood safety over time (4/5 studies) showed significant negative associations between neighborhood safety and blood pressure. Additionally, some studies identified sex (n=3), age (n=2), and neighborhood characteristics (n=4) as significant moderators, with the strength of the association between neighborhood safety and blood pressure varying across different demographic groups and neighborhood contexts.

CONCLUSIONS

Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions. This review also highlights the importance of adopting longitudinal designs, especially those using time-varying measures of neighborhood environments.

Neighborhood disorder and social cohesion: A longitudinal investigation of links with maternal cardiometabolic risk one year postpartum

OBJECTIVE

Neighborhood characteristics can influence cardiometabolic health, including during the perinatal period. However, maternal health research has largely examined the influence of objective neighborhood measures, limiting insights into psychological and social processes. We examined associations of perceived neighborhood disorder and social cohesion with maternal cardiometabolic risk 1 year postpartum and explored potential pathways of psychological distress and physical activity.

METHODS

A predominantly low-income sample of Black, Latina, and White postpartum women (n = 987) were participants in the Community Child Health Network study. Women reported on neighborhood characteristics at 1 month postpartum and on symptoms of depression, anxiety, and posttraumatic stress disorder and physical activity at 6 months postpartum. Biometrics and biological samples were collected at 1 year postpartum, including blood pressure, height, weight, and dried blood spots for cardiometabolic biomarkers (e.g., C-reactive protein, glycosylated hemoglobin). In this pre-registered study, we used structural equation modeling to estimate latent variables for disorder, social cohesion, distress, physical activity, and cardiometabolic risk. We fit a parallel mediation model to test associations between latent neighborhood factors at 1 month postpartum, distress and physical activity at 6 months postpartum, and cardiometabolic risk at 1 year postpartum.

RESULTS

Greater social cohesion, but not disorder, was significantly associated with lower distress and greater physical activity. However, there were no significant associations between disorder or social cohesion with subsequent cardiometabolic risk nor evidence for indirect effects of distress or physical activity.

CONCLUSION

Results suggest that social cohesion may be more pertinent than disorder for health-relevant behavioral mechanisms in postpartum women.

It's Not Too Late: Physical and Social Activity Slow Cognitive Decline in Those Living With Mild Cognitive Impairment

Current evidence concerning the effect of physical activity and social engagement on cognitive functioning in older adults with mild cognitive impairment (MCI) is underdeveloped. Drawing upon cognitive reserve theory, we used linear mixed models to investigate the impact of physical activity and social engagement on cognitive functioning in older adults living with MCI utilizing 16 years of data from the Health and Retirement Study (n = 1462). The average cognitive score (sum of immediate and delayed word recall, serial seven subtraction test, counting backwards, range: 0-27) at baseline was 9.6, with the average score decreasing by 0.14 points each year. Controlling for covariates, each unit increase in physical activity and social engagement, respectively, reduced the effect of time on cognitive functioning by 0.01 (β = 0.007, p < .0001) and 0.03 (β = 0.029, p = .04) points, small effects that accumulate over time. Findings suggest that greater physical activity and social engagement offer cognitive protection among older adults experiencing MCI.

Person-Centered Approach to Understanding Psychosocial Stressor Subgroups and Cardiovascular Disease: New Perspectives From the Multi-Ethnic Study of Atherosclerosis Study

BACKGROUND

This study examined the longitudinal associations of psychosocial stress subgroups with cardiovascular disease (CVD) events and whether social support, neighborhood cohesion, and physical activity modified these associations in MESA (Multi-Ethnic Study of Atherosclerosis).

METHODS AND RESULTS

Data from 6349 adults (aged: 62.2 ± 10.2 years; 52.9% women) from the MESA study with no prior CVD in 2000 to 2002 (baseline) were used in this analysis. Latent class analysis was used to specify distinct psychosocial stress subgroups based on self-reported stressors stemming from respondents' neighborhood and social environment. Adjudicated CVD events (fatal and nonfatal events) were ascertained annually through the year 2019. Cox proportional hazards models were used to examine the associations between subgroup membership and CVD events. Five distinct psychosocial stress subgroups were identified via latent class analysis and were labeled "moderate neighborhood noise" (12.1%), "excessive neighborhood noise" (6.4%), "multiple high stressors" (6.3%), "high discrimination" (21.4%), and "optimal" (53.8%). By 2019, 1121 participants had experienced a CVD event. Membership in the high discrimination (hazard ratio [HR], 1.29 [95% CI, 1.10-1.51]) subgroup was associated with higher risk of a CVD event when adjusted for sociodemographic characteristics and cardiovascular health metrics. Neither social support, neighborhood cohesion, nor physical activity modified this association (P>0.05).

CONCLUSIONS

Distinct subgroups of individuals with high self-reported psychological distress-particularly related to discrimination and chronic stress are associated with high incident cardiovascular events.

Multilevel Mediators on the Associations of Neighborhood Social Environmental Factors and Severity of Metabolic Syndrome: The Jackson Heart Study

BACKGROUND

Neighborhood characteristics serve as risk factors for metabolic syndrome (MetS). However, the intermediary factors linking this relationship remain understudied. Thus, we investigated the sex-specific mediating role of C-reactive protein, physical activity (PA), and perceived stress in the associations of perceived neighborhood social environment (PNSE) with MetS severity among Black adults.

METHODS AND RESULTS

This cross-sectional study included 3185 adults (64% women) from exam 1 (2000-2004) of the Jackson Heart Study. MetS severity Z scores were calculated based on the Adult Treatment Panel III criteria formula. PNSE included neighborhood violence, problems, and social cohesion. Men and women were analyzed separately. A bootstrap resampling technique with 95% bias-corrected CI (95% BC CI) was used to evaluate whether C-reactive protein, PA, and perceived stress mediated the association between each PNSE and MetS severity, adjusting for covariates. All PNSE factors were directly related to MetS severity in women but not in men. In women, neighborhood problems were indirectly associated with MetS severity mediated through PA (β=0.02 [95% BC CI, 0.00-0.05]). In men, neighborhood violence, problems, and social cohesion were indirectly associated with MetS severity mediated through PA (β=0.05 [95% BC CI, 0.01-0.10]; β=0.03 [95% BC CI, 0.00-0.06]; and β=-0.04 [95% BC CI, -0.09 to -0.01], respectively). Neither C-reactive protein nor perceived stress mediated such associations in either women or men.

CONCLUSIONS

All PNSEs (violence, problems, and social cohesion) were directly related to MetS severity in women only. PA mediated the relationship between each PNSE and MetS in a sex-specific manner. Efforts focusing on local conditions are needed to better understand why such disparities exist for at-risk minoritized groups.

Perceptions of neighborhood disorder and gun carrying during adolescence: The indirect effect of exposure to violence

OBJECTIVE

As society strives to curb gun violence among adolescents, understanding the risk factors associated with gun carrying is of critical importance. The current study seeks to examine the relationship between perceived neighborhood disorder and adolescents' susceptibility to carrying a gun to school. More specifically, the aim of the current study was threefold: (1) to examine the direct relationship between perceived neighborhood disorder and exposure to violence, (2) to investigate the association between perceived neighborhood disorder and gun carrying, and (3) to test the mediating effect of exposure to violence on the relationship between perceived neighborhood disorder and gun carrying.

METHODS

Data from waves I and II (1994-1996) of the National Longitudinal Study of Adolescent to Adult Health was analyzed (N = 11,887). Due to the binary nature of the mediating and dependent variables (i.e., exposure to violence and gun carrying) a series of logistic regression models were estimated.

RESULTS

Our analyses revealed that perceived neighborhood disorder is positive and significantly associated with, both, exposure to violence and gun carrying. The relationship between perceived neighborhood disorder and gun carrying was fully mediated by exposure to violence.

CONCLUSIONS

While neighborhood disorder is a risk factor for gun carrying among youth, exposure to violence explains the relationship between perceived neighborhood disorder and carrying a gun to school. To reduce the prevalence of gun carrying and gun violence among the adolescent population, mental health resources should be provided to those who reside in communities with high levels of disorder and violence.

Maternal perceived safety and parenting practices with young children: a cross-sectional analysis from 15 low-income and middle-income countries

Introduction

Social environments can influence parents' caregiving capacities and the quality of nurturing care provided to children. These links, in turn, can shape children's developmental outcomes over the life course. We aimed to examine the relationship between maternal perceived safety at home and in the neighbourhood and maternal parenting practices in low-income and middle-income countries (LMICs).

Method

We combined cross-sectional data from the Multiple Indicator Cluster Surveys in 15 LMICs (2018-2019). Mothers of children aged 36-59 months were included in the sample. We assessed maternal perceived safety at home and in the neighbourhood and two parenting outcomes of maternal stimulation and discipline. We used multiple logistic regression models to estimate the associations while adjusting for sociodemographic characteristics and maternal well-being in the pooled sample. Also, analyses were performed for each country separately.

Results

After adjusting for covariates, maternal perceived safety at home was associated with increased odds of high maternal stimulation (OR: 1.15, 95% CI: 1.01; 1.32) and lower odds of aggressive psychological discipline (OR: 0.87, 95% CI: 0.77; 0.98). Maternal perception of safety in the neighbourhood was associated with lower odds of aggressive psychological discipline (OR: 0.79, 95% CI: 0.71; 0.88), aggressive physical discipline (OR: 0.87, 95% CI: 0.77; 0.98) and non-violent discipline (OR: 0.78, 95% CI: 0.63; 0.95).

Conclusion

Maternal perceived safety at home and in the neighbourhood was positively associated with improved parenting behaviours with young children in LMICs. Interventions that address safety and security at home and across communities may have the potential to enhance maternal well-being and parenting practices to promote integral child development.

Connected communities: Perceived neighborhood social cohesion during adolescence and subsequent health and well-being in young adulthood-An outcome-wide longitudinal approach

Does higher perceived neighborhood social cohesion in adolescence lead to better health and well-being 10-12 years later? We evaluated this question using data from a large, prospective, and nationally representative sample of US adolescents (Add Health; N = 10,963), and an outcome-wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological well-being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes. These results were maintained after robust control for a wide range of potential confounders.

A multilevel approach to social support as a determinant of mental health during COVID-19

The COVID-19 pandemic has detrimentally affected the mental health of lower income communities. We sought to investigate the relationship among multilevel social support, specifically individual-, network-, and neighborhood-level social supports, COVID-19-related stressors, and probable diagnoses of depression, anxiety, and posttraumatic stress (PTS), within a racially diverse and predominantly low-socioeconomic status population. We used multiple logistic regressions to assess the odds of diagnosis for high versus low social support and stressor levels. Participants who endorsed high levels of stress had significantly higher odds of probable diagnoses. Participants who endorsed low individual-level social support had higher odds of probable depression and anxiety. Those who endorsed low neighborhood-level social support had higher odds of probable depression and probable PTS. Network-level social support was not significantly associated with the health indicators of interest. Results indicate the importance of both individual- and neighborhood-level support to protect mental health during COVID-19.

The influence of nativity/birthplace, neighborhood cohesion, and duration lived in the neighborhood on psychological distress

Introduction

Nativity/birthplace and neighborhood cohesion are potential contributing factors to psychological distress. This study explores the impact of nativity/birthplace and neighborhood cohesion on moderate-severe psychological distress among United States (US) adults, considering the duration lived in a neighborhood.

Methods

Using the 2013-2018 National Health Interview Survey data, we conducted a stratified analysis based on years lived in the neighborhood (≤10 years [n = 96,175] and >10 years [n = 68,187]). Bivariate chi-square tests and multivariable logistic regression models were used to assess the statistical differences and associations between moderate-severe psychological distress and nativity/birthplace, and neighborhood cohesion, while adjusting for other covariates.

Results

Individuals with 10 years or less of residence reported higher levels of moderate-severe psychological distress than those with more than 10 years (22.3 % vs. 18.1 %). Low or medium neighborhood cohesion, regardless of duration of residence, was associated with significantly higher odds of moderate-severe psychological distress compared to high cohesion. Foreign-born individuals had higher odds of psychological distress after more than 10 years in a neighborhood, although this difference was not statistically significant. However, they had lower odds of psychological distress after 10 years or less in the neighborhood compared to US-born individuals. Similarly, the interaction of foreign-born status and 10 years or less of residence in a neighborhood showed decreased odds of psychological distress.

Conclusions

These findings underscore the importance of strong social cohesion in neighborhoods for positive mental well-being. Establishing community initiatives to enhance neighborhood social cohesion is crucial.

Protocol for a pragmatic trial of Cannabidiol (CBD) to improve chronic pain symptoms among United States Veterans

BACKGROUND

Chronic pain affects over 100 million Americans, with a disproportionately high number being Veterans. Chronic pain is often difficult to treat and responds variably to medications, with many providing minimal relief or having adverse side effects that preclude use. Cannabidiol (CBD) has emerged as a potential treatment for chronic pain, yet research in this area remains limited, with few studies examining CBD's analgesic potential. Because Veterans have a high need for improved pain care, we designed a clinical trial to investigate CBD's effectiveness in managing chronic pain symptoms among Veterans. We aim to determine whether CBD oral solution compared to placebo study medication is associated with greater improvement in the Patient Global Impression of Change (PGIC).

METHODS

We designed a randomized, double-blind, placebo-controlled, pragmatic clinical trial with 468 participants. Participants will be randomly assigned in a 1:1 ratio to receive either placebo or a CBD oral solution over a 4-week period. The trial is remote via a smartphone app and by shipping study materials, including study medication, to participants. We will compare the difference in PGIC between the CBD and placebo group after four weeks and impacts on secondary outcomes (e.g., pain severity, pain interference, anxiety, suicide ideation, and sleep disturbance).

DISCUSSION

Once complete, this trial will be among the largest to date investigating the efficacy of CBD for chronic pain. Findings from this clinical trial will contribute to a greater knowledge of CBD's analgesic potential and guide further research. Given the relative availability of CBD, our findings will help elucidate the potential of an accessible option for helping to manage chronic pain among Veterans.

TRIAL REGISTRATION

This protocol is registered at clinicaltrials.gov under study number NCT06213233.

A national cohort study of community belonging and its influence on premature mortality

BACKGROUND

Community belonging, an important constituent of subjective well-being, is an important target for improving population health. Ageing involves transitioning across different social conditions thus, community belonging on health may vary across the life course. Using a nationally representative cohort, this study estimates the life stage-specific impact of community belonging on premature mortality.

METHODS

Six cycles of the Canadian Community Health Survey (2000-2012) were combined and linked to the Canadian Vital Statistics Database (2000-2017). Respondents were followed for up to 5 years. Multivariable-adjusted modified Poisson regression models were used to estimate the relative risk of premature mortality for three life stages: early adulthood (18-35 years), middle adulthood (36-55 years) and late adulthood (56-70 years).

RESULTS

The final analytical sample included 477 100 respondents. Most reported a 'somewhat strong' sense of belonging (45.9%). Compared with their 'somewhat strong' counterparts, young adults reporting a 'somewhat weak' sense of belonging exhibited an increased relative risk (RR) of 1.76 (95% CI 1.27 to 2.43) for premature mortality, whereas middle-aged adults reporting the same exhibited a decreased RR of 0.82 (95% CI 0.69, 0.98). Among older adults, groups reporting a 'very strong' (RR 1.10, 95% CI 1.01, 1.21) or a 'very weak' sense (RR 1.14, 95% CI 1.01, 1.28) of belonging exhibited higher RRs for premature mortality.

CONCLUSION

The results demonstrate how community belonging relates to premature mortality differs across age groups underscoring the importance of considering life stage-specific perspectives when researching and developing approaches to strengthen belonging.

Neighborhood-Level Stressors and Individual-Level Cardiovascular Disease Risk in Native Hawaiians: a Cross-Sectional Study

Introduction

Native Hawaiian people have higher rates of illness and death related to cardiovascular disease (CVD) than non-Hispanic White people. Research in other populations has shown that individual-level CVD risk factors (ie, high-fat diet, physical inactivity, obesity, and tobacco use) are associated with neighborhood characteristics (ie, social cohesion, walkability, availability of healthy food, and safety). This association has yet to be examined among Native Hawaiians.

Methods

We conducted a cross-sectional survey of community-dwelling Native Hawaiian people in 2020. Three multiple regression models and 1 logistic regression model were assessed. Each model included individual-level CVD risk factors, age, sex, education, income, and neighborhood characteristics.

Results

The regression models for body mass index (BMI) and physical activity showed significant results. The BMI model (R2 = 0.22, F = 4.81, P < .001) demonstrated that age, sex, education level, physical activity, and percentage of fat in the diet were significantly related to BMI. The availability of healthy foods had a significant, independent relationship with BMI (standardized β = -1.47, SE = 0.53, P = .01). The physical activity model (R2 = 0.21, F = 4.46, P < .001) demonstrated that age, sex, education, and BMI were significantly related to physical activity. None of the neighborhood characteristics had significant, independent relationships to physical activity.

Conclusions

We found that neighborhood-level factors improved the model's ability to explain variance in BMI. Efforts to decrease BMI would benefit from improving the availability of healthy foods in neighborhoods, a finding supported by research in other populations.

Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans

Introduction

Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being.

Methods

Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction.

Results

Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant.

Discussion

Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.

Associations of the neighbourhood built and natural environment with cardiometabolic health indicators: A cross-sectional analysis of environmental moderators and behavioural mediators

BACKGROUND

Most studies examining the effects of neighbourhood urban design on cardiometabolic health focused solely on the built or natural environment. Also, they did not consider the roles of neighbourhood socio-economic status (SES) and ambient air pollution in the observed associations, and the extent to which these associations were mediated by physical activity and sedentary behaviours.

METHODS

We used data from the AusDiab3 study (N = 4141), a national cohort study of Australian adults to address the above-mentioned knowledge gaps. Spatial data were used to compute indices of neighbourhood walkability (population density, intersection density, non-commercial land use mix, commercial land use), natural environment (parkland and blue spaces) and air pollution (annual average concentrations of nitrogen dioxide (NO2) and fine particulate matter <2.5 μm in diameter (PM2.5)). Census indices were used to define neighbourhood SES. Clinical assessments collected data on adiposity, blood pressure, blood glucose and blood lipids. Generalised additive mixed models were used to estimate associations.

RESULTS

Neighbourhood walkability showed indirect beneficial associations with most indicators of cardiometabolic health via resistance training, walking and sitting for different purposes; indirect detrimental associations with the same indicators via vigorous gardening; and direct detrimental associations with blood pressure. The neighbourhood natural environment had beneficial indirect associations with most cardiometabolic health indicators via resistance training and leisure-time sitting, and beneficial direct associations with adiposity and blood lipids. Neighbourhood SES and air pollution moderated only a few associations of the neighbourhood environment with physical activity, blood lipids and blood pressure.

CONCLUSIONS

Within a low-density and low-pollution context, denser, walkable neighbourhoods with good access to nature may benefit residents' cardiometabolic health by facilitating the adoption of an active lifestyle. Possible disadvantages of living in denser neighbourhoods for older populations are having limited opportunities for gardening, higher levels of noise and less healthy dietary patterns associated with eating out.

Residential Segregation, Perceived Neighborhood Environment, and All-Cause Mortality Among Community-Dwelling Older Chinese Americans

OBJECTIVES

Residential segregation profoundly affects mental and physical health. However, impacts of residential segregation and other neighborhood characteristics on health among older Asian Americans are not fully understood. This study aimed to close this gap by examining effects of residential segregation, perceived neighborhood cohesion, and neighborhood disorder on all-cause mortality among older Chinese immigrants, as well as testing whether the association between residential segregation and mortality would be mediated by perceived neighborhood cohesion and neighborhood disorder.

METHODS

Data were drawn from a subsample of 3,094 older Chinese Americans aged 60 and older (mean age = 72.8 years) from the Population Study of Chinese Elderly in Chicago. Residential segregation was derived using 2010-2014 American Community Survey data. Participants completed surveys on perceived neighborhood cohesion and neighborhood disorder between 2011 and 2013. All-cause mortality was tracked until December 2021.

RESULTS

Residential segregation was associated with elevated all-cause mortality risk; this association, however, was no longer statistically significant after controlling for sociodemographic, behavioral, and health covariates. Perceived neighborhood cohesion, but not neighborhood disorder, was significantly associated with decreased mortality risks. There were no indirect effects of residential segregation on all-cause mortality through perceived neighborhood cohesion or neighborhood disorder. These effects were consistent across male and female participants.

DISCUSSION

These results suggest the importance of neighborhood social environment, specifically perceptions of neighborhood cohesion, in influencing mortality risk among older Chinese immigrants. The findings also indicate the need to conduct further research to examine the health impact of residential segregation among this population.

Does social capital aid in leveling the income gradient in child mental health? A structural analysis of the left-behind and not-left-behind Chinese children

BACKGROUND

Few prior studies have investigated the income gradient in child mental health from a socio-environmental perspective. In an age when child mental health problems in a rapidly changing social environment have become a worldwide issue, an understanding of the socio-environmental mechanisms of the income disparities in child mental health outcomes is imperative and cost-effective.

METHODS

By conducting structural equation analyses with Chinese nationally representative survey data, this study explored the family income gradient in child depression and its potential socio-environmental pathways at the neighborhood, family and school levels, differentiating left-behind and not-left-behind children.

RESULTS

We found a robust family income gradient in depressive symptoms. Neighborhood cohesion mitigated the income gradient in depressive symptoms by playing a suppression role. School social capital acted as a mediator. Neighborhood trust, neighborhood safety and family social capital played no significant impact. The mitigating and mediating roles of social capital components were significant among only the not-left-behind children.

CONCLUSIONS

To reduce income-related inequalities in child mental health in the long run, integrating policies that directly reduce poverty with policies that improve distal socio-environments is necessary.

Go-along interview assessment of community health priorities for neighborhood renewal

Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go-along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents' community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra- and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self-worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well-being by being valid and meaningful to the community of focus.

Using street view imagery to examine the association between urban neighborhood disorder and the long-term recurrence risk of patients discharged with acute myocardial infarction in central Beijing, China

Background

To examine the association between urban neighborhood disorder and the recurrence risk of patients with acute myocardial infarction (AMI) in central Beijing, China.

Methods

Recurrent AMI was identified by the Beijing Monitoring System for Cardiovascular Diseases through the end of 2019 for patients discharged with AMI between 2007 and 2017. Cox proportional hazards models were performed to estimate associations between neighborhood disorder and AMI recurrence.

Results

Of 66,238 AMI patients, 11,872 had a recurrent event, and 3117 died from AMI during a median followup of 5.92 years. After covariate adjustment, AMI patients living in the high tertile of neighborhood disorder had a higher recurrence risk (hazard ratio [HR] 1.08, 95 % confidence interval [CI], 1.03-1.14) compared with those in the low tertile. A stronger association was noted for fatal recurrent AMI (HR 1.21, 95 % CI 1.10-1.34). The association was mainly observed in females (HR 1.04, 95 % CI: 1.02 to 1.06).

Conclusions

Serious neighborhood disorder may contribute to higher recurrence risk, particularly fatal recurrence, among AMI patients. Policies to eliminate neighborhood disorders may play an important role in the secondary prevention of cardiovascular disease.

Does the quality of street greenspace matter? Examining the associations between multiple greenspace exposures and chronic health conditions of urban residents in a rapidly urbanising Chinese city

BACKGROUND

Numerous studies have demonstrated that greenspace(GS) exposure is associated with health improvements in individuals with hypertension and diabetes. However, studies examining the associations between multiple GS exposures and chronic health conditions in developing countries are limited.

METHODS

Geospatial data and spatial analysis were employed to objectively measure the total neighbourhood vegetative cover (mean value of normalised difference vegetation index [NDVI] within specific buffer zone) and proximity to park-based GS (network distance from home to the entrance of park-based GS). Street view imagery and machine learning techniques were used to measure the subjective perceptions of street GS quality. A multiple linear regression model was applied to examine the associations between multiple GS exposures and the prevalence of hypertension and diabetes in neighbourhoods located in Qingdao, China.

RESULTS

The model explained 29.8% and 28.2% of the prevalence of hypertension and diabetes, respectively. The results suggested that: 1) the total vegetative cover of the neighbourhood was inversely correlated with the prevalence of hypertension (β = -0.272, p = 0.013, 95% confidence interval (CI): [-1.332, -0.162]) and diabetes (β = -0.230, p = 0.037, 95% CI: [-0.720, -0.008]). 2) The street GS quality was negatively correlated with the prevalence of hypertension (β = -0.303, p = 0.007, 95% CI: [-2.981, -0.491]) and diabetes (β = -0.309, p = 0.006, 95% CI: [-1.839, -0.314]). 3) Proximity to park-based GS and the prevalence of hypertension and diabetes mellitus were not significantly correlated.

CONCLUSIONS

This study used subjective and objective methods to comprehensively assess the greenspace exposure from overhead to eye level, from quantity, proximity to quality. The results demonstrated the beneficial relationships between street GS quality, total vegetative cover, and chronic health in a rapidly urbanising Chinese city. Furthermore. the effect of street GS quality was more pronounced in potentially mitigating chronic health problems, and improving the quality of street GS might be an efficient and effective intervention pathway for addressing chronic health issues in densely populated cities.

Perceived social cohesion and depressive symptoms among internal migrants in China: The mediating role of social adaptation

Background

Internal migrants are exposed to higher risks of depressive symptoms due to migration-related stress. It has been recognized that perceived neighborhood social cohesion has direct and indirect associations with depressive symptoms. However, the pathway from perceived social cohesion to internal migrants' depressive symptoms was less discussed.

Objectives

To assess mental health disparities among internal migrants. To investigate the association between social cohesion and depressive symptoms among urban-to-urban and rural-to-urban migrants and to examine the mediating role of social adaptation.

Methods

Data from the "2017 Urbanization and New Migrant Survey" was used, including 2,584 internal migrants age 18-65 from 10 cities in China. Social cohesion was measured by a six-item modified Community-level Cohesion Scale. Depressive symptoms was measured using the Center for Epidemiological Studies Depression Scale, and social adaptation was assessed by a single-item question of migrants' adaptation to local life. Multivariate linear regression models were used to examine the association between social cohesion and depressive symptoms. Baron and Kenny's mediation tests were conducted to examine the mediating role of social adaptation on the association. All analyses were adjusted using sampling weights to account for this survey's sampling design.

Results

Rural-to-urban migrants were found to have more clinically significant depressive symptoms, lower perceived social cohesion, and fair or low social adaptation than urban-to-urban migrants (all p < 0.001). Being rural-to-urban migrants as compared with urban-to-urban migrants [Odds Ratio (OR) = 1.46, 95% Confidence Interval (CI) = 1.456, 1.461, p < 0.001], had lower perceived social cohesion (OR = 1.46, 95% CI = 1.458, 1.463, p < 0.001), and poorer social adaptation (OR = 1.94, 95% CI = 1.932, 1.941, p < 0.001), are associated with higher odds of having clinically significant depressive symptoms. Social adaptation partially mediated the association between social cohesion and depressive symptoms by explaining 15.39% of its effect for urban-to-urban migrants and 18.97% for rural-to-urban migrants.

Conclusions

Findings from this study reveal mental health inequalities among internal migrants and demonstrate the importance of social adaption on the association between social cohesion and depressive symptoms. Social strategies and public policies are needed to build a more cohesive community that serves both local residents and internal migrants, especially rural-to-urban migrants.

Living alone and all-cause mortality in community-dwelling older adults: The moderating role of perceived neighborhood cohesion

OBJECTIVES

The adverse effect of living alone on health has been well-documented in community-dwelling older adults. A less understood topic in this research area is whether some neighborhood characteristics may mitigate the negative impact of living alone on health outcomes and mortality. This study aimed to extend the existing work on living arrangements and health by examining the potential interactive effect of living alone and perceived neighborhood cohesion on all-cause mortality among older Chinese Americans.

METHODS

Data were drawn from 3154 (58.0% female) participants from a prospective cohort study of community-dwelling US older Chinese adults aged 60 and older in the greater Chicago area. Living arrangements and perceived neighborhood cohesion were assessed at baseline from 2011 to 2013. Mortality status was tracked through December 2021. Covariates, including sociodemographic characteristics, health and behavioral covariates, loneliness, depression, and social engagement, were assessed at baseline. Cox proportional hazards regression model was used to test our hypotheses.

RESULTS

Living alone was significantly associated with an increased risk of all-cause mortality among participants reporting low levels of perceived neighborhood cohesion but not among those reporting high levels of perceived neighborhood cohesion. This protective effect of perceived neighborhood cohesion was robust to the inclusion of covariates.

CONCLUSIONS

Our results suggest that strong perceived neighborhood cohesion may protect against the increased risk of premature mortality associated with living alone in community-dwelling older Chinese Americans.

Childhood neighborhoods and health: Census-based neighborhood measures versus residential lived experiences

This study examines the impact of neighborhood disadvantage and neighborhood social connectedness during childhood on subsequent health status during early adulthood. We link longitudinal data from the Panel Study of Income Dynamics with Census data on children's surrounding neighborhoods. We estimate results with conventional linear regression and novel methods that better adjust for neighborhood selection processes. We find that neighborhood connectedness in childhood is protective against psychological distress in early adulthood, net of selection effects. However, greater connectedness exacerbates the risk of obesity within disadvantaged contexts for Black youth. Our results highlight a potential pathway for improving population health by investing in the social connectedness of neighborhoods alongside reducing structural inequalities.

Consequences of living environment insecurity on health and well-being in southwest China: The role of community cohesion and social support

Growing populations in developing countries have exacerbated inequality in the spatial distribution of living environments. As a result, whether living environment factors matter to health and well-being is increasingly attracting policy and scholarly attention. Yet, crucial knowledge gaps remain regarding the implications, consequences and mechanisms of one's living environment on health and well-being in developing countries. This study examined the association between living environment and psychological distress, self-rated health and satisfaction with life among Chinese adults. Furthermore, it also explored the moderating role of community cohesion and the mediating role of social support on these factors. Using probability proportionate to size sampling methods, 3765 respondents and 148 community organisers were recruited from 160 communities in Yunnan, China, in 2018. Ordinary least squares regression and structural equation modelling were conducted. The findings indicate that residents who lived in communities with higher levels of environment insecurity had lower levels of subjective health and well-being (psychological distress: β = 1.088, p < 0.001; self-rated health: β = -0.104, p < 0.01; satisfaction with life: β = -0.164, p < 0.001). Moreover, community cohesion played a moderating role in the relationship between living environment insecurity and self-rated health (β = 0.212, p < 0.05) and satisfaction with life (β = 0.183, p < 0.05); however, it had no significant effects on psychological distress. Furthermore, the moderated effects of community cohesion on living environment insecurity were mediated through perceived social support for self-rated health (proportion of total effect mediated = 11%) and satisfaction with life (proportion of total effect mediated = 29%). The present findings have implications for policy makers and community committees who can work towards social inequality in developing countries. The integrated programmes of improving living conditions and strengthening community capacity are crucial to residents' health and well-being.

Does crime trigger genetic risk for type 2 diabetes in young adults? A G x E interaction study using national data

BACKGROUND

Living in neighborhoods perceived as disordered exacerbates genetic risk for type 2 diabetes (T2D) among older adults. It is unknown whether this gene-neighborhood interaction extends to younger adults. The present study aims to investigate whether crime, an objectively measured indicator of neighborhood disorder, triggers genetic risk for T2D among younger adults, and whether this hypothesized triggering occurs through exposure to obesity.

METHODS

Data were from the Wave I (2008) National Longitudinal Study of Adolescent to Adult Health. A standardized T2D polygenic score was created using 2014 GWAS meta-analysis results. Weighted mediation analyses using generalized structural equation models were conducted in a final sample of 7606 adults (age range: 25-34) to test the overall association of T2D polygenic scores with T2D, and the mediating path through obesity exposure in low, moderate, and high county crime-rate groups. Age, sex, ancestry, educational degree, household income, five genetic principal components, and county-level concentrated advantage and population density were adjusted.

RESULTS

The overall association between T2D polygenic score and T2D was not significant in low-crime areas (p = 0.453), marginally significant in moderate-crime areas (p = 0.064), and statistically significant in high-crime areas (p = 0.007). The mediating path through obesity was not significant in low or moderate crime areas (ps = 0.560 and 0.261, respectively), but was statistically significant in high-crime areas (p = 0.023). The indirect path through obesity accounted for 12% of the overall association in high-crime area.

CONCLUSION

A gene-crime interaction in T2D was observed among younger adults, and this association was partially explained by exposure to obesity.

Inequitable Housing Practices and Youth Internalizing Symptoms: Mediation Via Perceptions of Neighborhood Cohesion

Disordered urban environments negatively impact mental health symptoms and disorders. While many aspects of the built environment have been studied, one influence may come from inequitable, discriminatory housing practices such as redlining, blockbusting, and gentrification. The patterns of disinvestment and reinvestment that follow may be an underlying mechanism predicting poor mental health. In this study, we examine pathways between such practices and internalizing symptoms (i.e., anxiety and depression) among a sample of African American youth in Baltimore, Maryland, considering moderation and mediation pathways including neighborhood social cohesion and sex. In our direct models, the inequitable housing practices were not significant predictors of social cohesion. In our sex moderation model, however, we find negative influences on social cohesion: for girls from gentrification, and for boys from blockbusting. Our moderated mediation model shows that girls in gentrifying neighborhoods who experience lower social cohesion have higher levels of internalizing symptoms. Likewise for boys, living in a formerly blockbusted neighborhood generates poorer social cohesion, which in turn drives higher rates of internalizing symptoms. A key implication of this work is that, in addition to standard measures of the contemporary built environment, considering other invisible patterns related to discriminatory and inequitable housing practices is important in understanding the types of neighborhoods where anxiety and depression are more prevalent. And while some recent work has discussed the importance of considering phenomena like redlining in considering long-term trajectories of neighborhoods, other patterns such as blockbusting and gentrification may be equally important.

Effect of Social Environments on Cardiovascular Disease in the United States

Background This study aims to examine the effect of time-variant perceived neighborhood social cohesion, perceived neighborhood physical disorder, and local crime on cardiovascular disease (CVD) incidence from 2006 through 2016. Methods and Results We obtained data from the Health & Retirement Study. Respondents aged ≥50 years and with no recorded history of CVD until 2006 (N=8826) were included and followed for 10 years. Cox proportional hazards models were estimated with CVD incidence as an outcome variable and time-variant social environment factors (perceived neighborhood social cohesion, perceived neighborhood physical disorder, and local crime) as exposures, after controlling for sociodemographic factors and CVD-related risk/protective factors. Our results showed that perceived neighborhood social cohesion was associated with CVD among Black respondents, but not Hispanic and White respondents. Perceived neighborhood physical disorder and local crime rates were not associated with CVD incidence across all racial and ethnic groups. Conclusions The results demonstrate that perceptions of favorable social environments need to be considered to reduce CVD risk among Black adults. Further research is needed to identify different pathways through which living in favorable social environments benefits cardiovascular health by racial and ethnic groups.

Examining relationships between perceived neighborhood social cohesion and ideal cardiovascular health and whether psychosocial stressors modify observed relationships among JHS, MESA, and MASALA participants

BACKGROUND

Psychosocial stressors increase the risks for cardiovascular disease across diverse populations. However, neighborhood level resilience resources may protect against poor cardiovascular health (CVH). This study used data from three CVH cohorts to examine longitudinally the associations of a resilience resource, perceived neighborhood social cohesion (hereafter referred to as neighborhood social cohesion), with the American Heart Association's Life's Simple 7 (LS7), and whether psychosocial stressors modify observed relationships.

METHODS

We examined neighborhood social cohesion (measured in tertiles) and LS7 in the Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis, and Mediators of Atherosclerosis in South Asians Living in America study. We used repeated-measures, modified Poisson regression models to estimate the relationship between neighborhood social cohesion and LS7 (primary analysis, n = 6,086) and four biological metrics (body mass index, blood pressure, cholesterol, blood glucose; secondary analysis, n = 7,291). We assessed effect measure modification by each psychosocial stressor (e.g., low educational attainment, discrimination).

RESULTS

In primary analyses, adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) for ideal/intermediate versus poor CVH among high or medium (versus low) neighborhood social cohesion were 1.01 (0.97-1.05) and 1.02 (0.98-1.06), respectively. The psychosocial stressors, low education and discrimination, functioned as effect modifiers. Secondary analyses showed similar findings. Also, in the secondary analyses, there was evidence for effect modification by income.

CONCLUSION

We did not find much support for an association between neighborhood social cohesion and LS7, but did find evidence of effect modification. Some of the effect modification results operated in unexpected directions. Future studies should examine neighborhood social cohesion more comprehensively and assess for effect modification by psychosocial stressors.

In the eyes of the beholder: Race, place and health

Racial and ethnic health disparities are fundamentally connected to neighborhood quality. For example, as a result of historical systemic inequities, racial and ethnic minorities are more likely to live in neighborhoods with signs of physical disorder (e.g., graffiti, vandalism), and physically disordered environments have been noted to associate with increased risk for chronic illness. Degree of exposure to neighborhood disorder may alter peoples' perception of their neighborhoods, however, with those most exposed (e.g., historically marginalized racial/ethnic groups) perhaps perceiving less threat from signs of neighborhood disorder. The purpose of the present study was to examine the complex interrelationships between people and place by investigating whether exposure to neighborhood physical disorder relates to residents' (1) perceptions of neighborhood safety and (2) perceptions of their health, and (3) examining whether these links vary by race/ethnicity. Using 2016-2018 Health and Retirement Study (HRS) data, a representative sample of US adults aged 51 years and older (n = 9,080, mean age 68 years), we conducted a series of weighted linear regressions to examine the role of neighborhood disorder in relation to both perceived neighborhood safety and self-rated health. Results indicated that greater neighborhood physical disorder was statistically significantly related to feeling less safe among non-Hispanic Whites and Hispanics, but not non-Hispanic Blacks. Regarding self-rated health, neighborhood physical disorder was statistically significantly related to poorer health among all racial/ethnic groups. These findings suggest that, despite differential interpretation of neighborhood disorder as a threat to safety, this modifiable aspect of peoples' environment is related to poor health regardless of one's race/ethnicity.

What predicts how safe people feel in their neighborhoods and does it depend on functional status?

Feeling unsafe in one's neighborhood is related to poor health. Features of the neighborhood environment have been suggested to inform perceptions of neighborhood safety. Yet, the relative contribution of these features (e.g., uneven sidewalks, crime, perceived neighborhood physical disorder) on perceived neighborhood safety, particularly among people with disabilities who may view themselves as more vulnerable, is not well understood. We examined whether sidewalk quality assessed by third party raters, county-level crime rates, and perceived neighborhood disorder would relate to neighborhood safety concerns, and whether functional limitations would exacerbate these links. Using data from the 2012/2014 waves of the Health and Retirement Study (n = 10,653, mean age = 66 years), a national sample of older US adults, we demonstrate that those with and without functional limitations felt less safe in areas with more crime and perceived as more disordered. When considered simultaneously, however, only perceived disorder statistically significantly predicted safety concerns. Living in neighborhoods with better sidewalk quality was statistically significantly related to feeling less safe, but only among those with functional limitations. Sidewalk quality was not statistically significantly related to safety reports among those without functional limitations. To our knowledge, this study is among the first to examine multiple features of the neighborhood environment simultaneously in relation to perceived neighborhood safety. Our findings highlight the relative importance of perceived physical disorder, and that these perceptions relate to safety concerns. Replication of this research is needed to determine the robustness of these patterns, including rich data on pedestrian use and sidewalk proximity to roadways. Community-level interventions that simultaneously target the multifaceted features of the neighborhood environment that shape people's safety reports may be needed to reduce burden of health.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.

Perceived neighborhood cohesion buffers COVID-19 impacts on mental health in a United States sample

Objective

This study examined whether perceived neighborhood cohesion (the extent to which neighbors trust and count on one another) buffers against the mental health effects of the 2020 COVID-19 pandemic.

Methods

The XXX University National COVID-19 and Mental Health Study surveyed US adults (N = 3965; M age = 39 years), measuring depressive symptoms, staying home more during than before the 2020 pandemic, and perceived neighborhood cohesion.

Results

A series of linear regressions indicated that perceiving one's neighborhood as more cohesive was not only associated with fewer depressive symptoms, but also attenuated the relationship between spending more time at home during the pandemic and depressive symptoms. These relationships persisted even after taking into account several individual-level sociodemographic characteristics as well as multiple contextual features, i.e., median household income, population density, and racial/ethnic diversity of the zip codes in which participants resided.

Conclusions

Neighborhood cohesion may be leveraged to mitigate pandemic impacts on depressive symptoms.

Neighborhood safety concerns and daily well-being: A national diary study

People living in unsafe neighborhoods often report poor health. The reasons for this are multi-faceted, but one possibility is that unsafe neighborhoods create a situation of chronic stress, which may deplete people's resources to cope with the daily stressors of life. How people respond to daily stressors (e.g., with increased self-reported negative affect and physical symptoms) is positively associated with health problems and may thus be one pathway linking perceptions of neighborhood safety to poor health. The current study investigated the relationship between neighborhood safety concerns, daily stressors, affective well-being, and physical health symptoms in a national sample of adults from the Midlife in the United States Study II (n = 1748). In 2004, participants reported neighborhood safety concerns and history of chronic stress exposure. Across eight days, they also reported daily stressors, physical symptoms and negative affect. Greater neighborhood safety concerns were associated with higher negative affect and more physical symptoms, adjusting for other sources of chronic stress. Moreover, lower perceived neighborhood safety was related to greater increases in negative affect and physical symptoms on days during which stressors were reported, even after accounting for established interactions between daily stressors and other sources of chronic stress. Exposure to neighborhoods perceived as unsafe is associated with poorer daily well-being and exacerbated responses to daily stressors, which may serve as an individual-level pathway contributing to poorer health among people living in neighborhoods perceived as unsafe.

Allostatic Load and Exposure Histories of Disadvantage

The stress pathway posits that those in disadvantaged circumstances are exposed to a higher degree of stressful experiences over time resulting in an accumulated biological burden which subsequently relates to poorer health. Trajectories of disadvantage, in the form of neighbourhood deprivation and structural social capital, are evaluated in their relation to allostatic load representing the cumulative “wear and tear” of chronic stress. This paper uses data from the British Household Panel Survey and Understanding Society in a latent class growth analysis. We identify groups of exposure trajectories over time using these classes to predict allostatic load at the final wave. The results show that persistent exposure to higher deprivation is related to worse allostatic load. High structural social capital over time relates to lower allostatic load, in line with a stress buffering effect, though this relationship is not robust to controlling for individual sociodemographic characteristics. By demonstrating a gradient in allostatic load by histories of deprivation, this analysis supports a biological embedding of disadvantage through chronic exposure to stressful environments as an explanation for social health inequalities.

Perceived Neighborhood Characteristics and Cognitive Functioning among Diverse Older Adults: An Intersectional Approach

Unfavorable neighborhood conditions are linked to health disparities. Yet, a dearth of literature examines how neighborhood characteristics contribute to cognitive health in diverse samples of older adults. The present study uses an intersectional approach to examine how race/ethnicity, gender, and education moderate the association between neighborhood perceptions and cognitive functioning in later life. We used data from adults ≥65 years old (n = 8023) in the 2010-2016 waves of the nationally representative Health and Retirement Study (HRS). We conducted race/ethnicity-stratified linear regression models where cognitive functioning, measured using the 35-point Telephone Interview Cognitive Screen (TICS), was regressed on three neighborhood characteristics-cleanliness, safety, and social cohesion. We examine whether there is heterogeneity within race/ethnicity by testing if and how the relationship between neighborhood characteristics and cognitive functioning differs by gender and education. Among White adults, worse neighborhood characteristics were associated with lower cognitive functioning among those with less education. However, for Black adults, poor perceived quality of one's neighborhood was associated with worse cognitive functioning among those with more years of education compared to those with fewer years of education. Among Mexicans, perceived neighborhood uncleanliness was associated with lower cognitive functioning among those with less education, but higher cognitive functioning for those with higher levels of education. Thus, this study contributes to the literature on racial/ethnic disparities in cognitive aging disparities by examining neighborhood contextual factors as determinants of cognitive functioning. In particular, we find that higher education in the context of less favorable neighborhood environments does not confer the same benefits to cognitive functioning among all older adults.

Evaluating the health effect of a Social Housing programme, Minha Casa Minha Vida, using the 100 million Brazilian Cohort: a natural experiment study protocol

INTRODUCTION

Social housing programmes have been shown to influence health, but their effects on cardiovascular mortality and incidence of infectious diseases, such as leprosy and tuberculosis, are unknown. We will use individual administrative data to evaluate the effect of the Brazilian housing programme Minha Casa Minha Vida (MCMV) on cardiovascular disease (CVD) mortality and incidence of leprosy and tuberculosis.

METHODS AND ANALYSIS

We will link the baseline of the 100 Million Brazilian Cohort (2001-2015), which includes information on socioeconomic and demographic variables, to the MCMV (2009-2015), CVD mortality (2007-2015), leprosy (2007-2015) and tuberculosis (2007-2015) registries. We will define our exposed population as individuals who signed the contract to receive a house from MCMV, and our non-exposed group will be comparable individuals within the cohort who have not signed a contract for a house at that time. We will estimate the effect of MCMV on health outcomes using different propensity score approaches to control for observed confounders. Follow-up time of individuals will begin at the date of exposure ascertainment and will end at the time a specific outcome occurs, date of death or end of follow-up (31 December 2015). In addition, we will conduct stratified analyses by the follow-up time, age group, race/ethnicity, gender and socioeconomic position.

ETHICS AND DISSEMINATION

The study was approved by the ethic committees from Instituto Gonçalo Muniz-Oswaldo Cruz Foundation and University of Glasgow Medical, Veterinary and Life Sciences College. Data analysis will be carried out using an anonymised dataset, accessed by researchers in a secure computational environment according to the Centre for Integration of Data and Health Knowledge procedures. Study findings will be published in high quality peer-reviewed research journals and will also be disseminated to policy makers through stakeholder events and policy briefs.

Does Facilitating Human–Place Bonds Alleviate the Negative Effects of Incivilities on Health?

The present study has two purposes—methodological and theoretical. The methodological purpose is to examine a method for the analysis of perceived incivilities and health in urban neighbourhoods. The current study investigates the direct and indirect relationships between the two variables. The theoretical purpose is to measure neighbourhood incivility as a second-order latent variable that represents physical and social incivilities, and investigates place identity and place attachment as mediators in the relationship between incivilities and health. Previous research has focused on a single dimension of incivility. By contrast, the current study considers a multidimensional form of incivility. This quantitative study comprises 265 residents from an urban neighbourhood in Penang, Malaysia. The results of the structural equation modelling suggest that perceptions towards neighbourhood play a mediating role in the relationship between incivility and health. The mediation roles of place identity and place attachment in the relationship between incivilities and health are also supported. Thus, facilitating human–place bonds alleviates the negative effects of incivilities on health in the study neighbourhood. Residents are less attached to neighbourhoods that are perceived as socially and physically deteriorated. Thus, reducing incivilities and improving place attachment may enhance neighbourhood health.

Social capital and cost-related medication nonadherence (CRN): A retrospective longitudinal cohort study using the Health and Retirement Study data, 2006-2016

Prescription drug spending and other financial factors (e.g., out-of-pocket costs) partially explain variation in cost-related medication nonadherence (CRN). Indicators of social capital such as neighborhood factors and social support may influence the health and well-being of older adults as they may rely on community resources and support from family and peers to manage conditions. Previous research on the relationship of social capital and CRN has limited evidence and contradictory findings. Hence, our objective is to assess the relationship of social capital indicators (neighborhood social cohesion, neighborhood physical disorder, positive social support, and negative social support) and CRN using a longitudinal design, 2006 to 2016, in a nationally representative sample of older adults in the United States (US). The Health and Retirement Study is a prospective panel study of US adults aged ≥ 50 years evaluated every two years. Data was pooled to create three waves and fitted using Generalized Estimating Equation modelling adjusting for both baseline and timevarying covariates (age, sex, education, race, total household income, and perceived health status). The three waves consisted of 11,791, 12,336, and 9,491 participants. Higher levels of neighborhood social cohesion and positive social support were related with lower CRN (OR 0.92, 95% CI 0.88-0.95 and OR 0.77, 95% CI 0.70-0.84, p<0.01). In contrast, higher levels of neighborhood physical disorder and negative social support were related to higher CRN (OR 1.07, 95% CI 1.03-1.11 and OR 1.46, 95% CI 1.32-1.62, p<0.01). Interventions targeting social capital are needed, reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support for older adults.

Childhood Socioeconomic Status and Physical Activity in Later Life: The Role of Perceived Neighborhood Cohesion and Wealth in Adulthood

The literature indicates that perceived neighborhood social cohesion is related to later life physical activity. However, there is no research that examines the role of childhood socioeconomic status (SES) in shaping this relationship. We use data from the Health and Retirement Study (2006-2016; N = 8,754) and a structural equation modeling approach to examine whether perceived neighborhood social cohesion and adulthood wealth mediate the relationship between childhood SES and physical activity. Perceived neighborhood social cohesion and adulthood wealth have small but statistically significant mediational effects in the relationship between childhood SES and physical activity. Research on the relationship between health and place should consider the potential impact of childhood circumstances on the neighborhood one lives in during adulthood.

Rural place attachment and urban community integration of Chinese older adults in rural-to-urban relocation

With China's rapid urbanisation, many residents, especially older adults, are suffering from psychological problems induced by rural-to-urban relocation. This study examines the association between older adults’ rural place attachment and their depression after relocation, as well as the protective roles of neighbourhood social cohesion and sense of community in the relocation place. Chinese older adults (N = 224) who relocated from rural villages to urban communities completed a survey for this study. The results showed that older adults with stronger rural place attachment experienced more depressive symptoms and a lesser sense of community in the relocation place. In addition, the association between rural place attachment and depression was weakened by neighbourhood social cohesion. That is, compared with older adults perceiving low neighbourhood social cohesion, the positive association between rural place attachment and depression was weaker for older adults perceiving high neighbourhood social cohesion. Furthermore, neighbourhood social cohesion's protective role depended on sense of community. In particular, neighbourhood social cohesion buffered the association between rural place attachment and depression for older adults with a strong sense of community but not for older adults with a weak sense of community. These results have implications for developing resources within neighbourhoods and communities to promote relocation adjustment for older adults.

Perceived neighborhood social cohesion and subsequent health and well-being in older adults: An outcome-wide longitudinal approach

BACKGROUND

Growing research documents associations between neighborhood social cohesion with better health and well-being. However, other work has identified social cohesion's "dark side" and its ability to promote negative outcomes. It remains unclear if such diverging findings are attributable to differences in study design, or other reasons. To better capture its potential heterogeneous effects, we took an outcome-wide analytic approach to examine perceived neighborhood social cohesion in relation to a range of health and well-being outcomes.

METHODS

Data were from 12,998 participants in the Health and Retirement Study-a large, diverse, prospective, and nationally representative cohort of U.S. adults age >50. Multiple regression models evaluated if social cohesion was associated with physical health, health behavior, psychological well-being, psychological distress, and social well-being outcomes. All models adjusted for sociodemographics, personality, and numerous baseline health and well-being characteristics. To evaluate the effects of change in cohesion, we adjusted for prior social cohesion. Bonferroni correction was used to account for multiple testing.

RESULTS

Perceived neighborhood social cohesion was not associated with most physical health outcomes (except for reduced risk of physical functioning limitations and better self-rated health) nor health behavior outcomes (except for more binge drinking). However, it was associated with numerous subsequent psychosocial well-being (i.e., higher: positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; reduced likelihood of infrequent contact with friends) and psychological distress outcomes (i.e., lower depression, hopelessness, negative affect, loneliness) over the 4-year follow-up period.

CONCLUSIONS

With further research, these results suggest that perceived neighborhood social cohesion might be a valuable target for innovative policies aimed at improving well-being.

Perceived neighborhood social cohesion and cardiometabolic risk: a gene × environment study

People living in socially cohesive neighborhoods generally have better health. We extend this research by evaluating the hypothesis that perceived neighborhood cohesion may influence health by attenuating genetic liability for cardiometabolic risk factors. Using data from the Health and Retirement Study (n = 6615; mean age 69.7), we conducted a gene × environment interaction study hypothesizing that perceived neighborhood cohesion would attenuate the link between polygenic scores for waist-to-hip ratio (WHR) and body mass index and a measure of multisystem cardiometabolic risk (systolic and diastolic blood pressure, heart rate, A1c, C-reactive protein, and total and high-density lipoprotein cholesterol). In support of the hypothesis, results indicated that among people perceiving low neighborhood cohesion, higher WHR polygenic scores were associated with greater cardiometabolic risk. In contrast, the genetic-cardiometabolic risk link was much attenuated among those living in neighborhoods perceived as socially cohesive. Our results support community-level interventions to enhance the social cohesiveness of individuals' neighborhoods which may provide health benefits by reducing the risks associated with known genetic risk factors.

Association between telomere length and neighborhood characteristics by race and region in US midlife and older adults

Disadvantaged neighborhoods are correlated with worse health outcomes, particularly among US Blacks. However, less is known about the link between neighborhood characteristics and biomarkers of cellular age, such as telomere length (TL), which may be implicated in racial health inequities. Moreover, this relationship may vary across US region given patterns of racial segregation across the US. Therefore, this study analyzed 2008 Health and Retirement Study data on 3,869 US-born white and Black adults >50 years old to examine race differences in the relationship between salivary TL and (1) neighborhood safety, cleanliness, and social cohesion and (2) interactions between neighborhood characteristics and US region. Neighborhood characteristics were not associated with TL in whites. However, significant associations were found among Blacks with variation by region. Blacks living in less clean neighborhoods in the Northeast (b = -0.03, SE = 0.01, p < 0.05), Midwest (b = -0.04, SE = 0.01, p < 0.01), and South (b = -0.05, SE = 0.01, p < 0.01) as well as those reporting less neighborhood safety and social cohesion in the Midwest (b = -0.03, SE = 0.02, p < 0.05 and b = -0.03, SE = 0.01, p < 0.05) and South (b = -0.03, SE = 0.01, p < 0.05 for both characteristics) had shorter TL than Blacks in the West. Therefore, exposure to neighborhood level historical discrimination and neglect may be detrimental to TL in Blacks. Future research should further examine how neighborhoods contribute to aging disparities.

The Anatomy of Health-Supportive Neighborhoods: A Multilevel Analysis of Built Environment, Perceived Disorder, Social Interaction and Mental Health in Beijing

Mental health is an exceedingly prevalent concern for the urban population. Mounting evidence has confirmed the plausibility of high incidences of mental disorders in socioeconomically disadvantaged neighborhoods. However, the association between the neighborhood built environment and individual mental health is understudied and far from conclusive, especially in developing countries such as China. The underlying mechanism requires in-depth analysis combining potential intermediates such as perceived environmental disorder and supportive social relationships. Using a health survey conducted in Beijing in 2017, this study investigates for the first time a socio-environmental pathway through which perceived disorder and social interaction account for the relationship between the built environment and mental health under the very notion of the neighborhood effect. The results from multilevel structural equation models indicate that individual mental health is influenced by the neighborhood-scale built environment through three pathways, independent of neighborhood socioeconomic disadvantages: (1) proximity to parks is the sole indicator directly linked to mental health; (2) population density, road connectivity and proximity to parks are indirectly associated with mental health through interactions with neighbors; and (3) population density, road connectivity and facility diversity are partially associated with perceived neighborhood disorder, which is indirectly correlated with mental health through interactions with neighbors. This study is a preliminary attempt to disentangle the complex relationships among the neighborhood environment, social interaction and mental health in the context of developing megacities. The relevant findings provide an important reference for urban planners and administrators regarding how to build health-supportive neighborhoods and healthy cities.

Measuring Neighborhood Order and Disorder: a Rapid Literature Review

PURPOSE OF REVIEW

Neighborhood disorder has received attention as a determinant of health in urban contexts, through pathways that include psychosocial stress, perceived safety, and physical activity. This review provides a summary of data collection methods, descriptive terms, and specific items employed to assess neighborhood disorder/order.

RECENT FINDINGS

The proliferation of methods and terminology employed in measuring neighborhood disorder (or neighborhood order) noted over the past two decades has made related studies increasingly difficult to compare. Following a search of peer-reviewed articles published from January 1998 to May 2018, this rapid literature review identified 18 studies that described neighborhood environments, yielding 23 broad terms related to neighborhood disorder/order, and a total of 74 distinct measurable items. A majority of neighborhood disorder/order measurements were assessed using primary data collection, often relying on resident self-report or investigatory observations conducted in person or using stored images for virtual audits. Items were balanced across signs of order or disorder, and further classification was proposed based on whether items were physically observable and relatively stable over time.

A comparative analysis of the impacts of objective versus subjective neighborhood environment on physical, mental, and social health

Research on the relationship between neighborhood context and health outcome has attracted notable attention. However, few studies examine and compare the associations between the objective and subjective neighborhood environment and different dimensions of health. To this end, high-resolution remote sensing images and points-of-interest (POIs) data collected in Guangzhou, China, are used together with questionnaire survey data to measure the objective and subjective characteristics of the neighborhood environment. The sample includes 1029 adults selected from 34 communities in Guangzhou, China. Hierarchical linear modeling is then employed to analyze the associations between the objective and subjective neighborhood environment and three dimensions of health (physical health, mental health, and social health), as well as compare the relative strengths of and moderating mechanisms between these associations. The results indicate that significant variations in health outcomes are observed among neighborhoods, which can be explained by both personal attributes and the neighborhood environment. Although objective and subjective measures of the neighborhood environment are both linked to the three dimensions of health, physical health and social health are influenced more by objective measures, while mental health is affected more by subjective measures. Further, subjective measures have positive moderating effects on the relationship between objective measures and mental health but do not have significant moderating effects on the relationships between objective measures and physical and social health.

Differential vulnerability to neighbourhood disorder: a gene×environment interaction study

BACKGROUND

Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D.

METHOD

We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D.

RESULTS

Greater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10, p=0.001). This significant gene×environment interaction was observed after adjusting for years of schooling, age, gender, levels of physical activity and obesity.

CONCLUSION

Findings in the present study suggested that minimising people's exposure to vandalism, vacant buildings, trash and circumstances viewed by residents as unsafe may reduce the burden of this prevalent chronic health condition, particularly for subgroups of the population who carry genetic liability for T2D.

FUNCTIONS OF VANDALISM IN YOUTH BEHAVIOUR: FROM PERSONALITY TO SOCIETY

Introduction.Graphic vandalism has become a widespread phenomenon in the space of modern cities. Traditionally, vandalism has been assessed as a negative phenomenon, leading to the destruction of the material, visual and social environment of urban public space. Recently, however, the discourse on the positive meaning of certain forms of vandalism (graffiti, street art, etc.) has been activated. At the same time, there is no discussion of the role and influence of vandalism on public and individual life, although, like any socio-cultural and socio-psychological phenomenon, vandalism has the basis and carries certain messages.

Theaimof this research was to identify and describe the functions of graphic vandalism, taking into account socio-cultural and socio-psychological aspects.

Methodology and research methods.The study was conducted in the spatial environment of the megalopolis (Ekaterinburg, Russia) by photographing results of vandal acts (more than 6000 photographs) with subsequent trace-assessment and content analysis of images.

Results and scientific novelty.The structural functions of vandalism at the socio-environmental and individual-subjective levels are identified and characterised. The signalling and designing functions, preparation of social changes and management of public mood are referred to the first level. At the second (individual-subjective) level, the demonstrative-and-protest function, functions of reactions, compensation and self-expression are allocated. The functions are illustrated with the examples of visual representations. A two-dimensional model of vandalism functions is formed, where the functions are distributed in the spaces of “construction / reconstruction”, “emotional regulation / moral regulation”. It is noted that any function of vandal activity at the individual level becomes a kind of marker “points of tension” at the socio-environmental level. The functional variety of vandalism becomes the reason of its ambiguous perception with diverse and occasionally contradictory estimates. The authors came to the conclusion that vandalism is socially considered as the evolutionary managerial instrument of social development, which is capable to weaken impermeability of the normatively and traditionally established limits, providing adjustability of the cultural and material environment in the conditions of innovative and mobilisation changes of society. From the perspective of the personality, vandalism is concerned as individual behaviour over the socially defined limits of activity among ordinary members of the society. Thus, vandalism as the phenomenon of public life acts as a norm and a deviation, to which an assessment is given in dependence on functional significance and subject self-identification of the specific vandal act.

Practical significance.The research materials and the results obtained can be used to improve and optimise the technologies for management youth vandal activity in megapolises, for prevention and sublimation of destructive forms of youth behaviour in an urban environment.