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Cândido LM, Vieira LA, de Avelar NCP, Danielewicz AL. Perceived Characteristics of the Built Neighborhood Environment and Negative Self-Rated Health in Brazilian Community-Dwelling Older Adults. Exp Aging Res 2023; 49:557-568. [PMID: 36239321 DOI: 10.1080/0361073x.2022.2133296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Research indicates that self-rated health is associated with worse health outcomes in older adults. Thus, it is important to assess the association between built neighborhoods and self-rated health to establish strategies to improve the quality of life in the older adult population. OBJECTIVE To evaluate the association between the perceived characteristics of the built neighborhood and the negative self-rated health in Brazilian community-dwelling older adults. METHODS A cross-sectional study for finite random samples was performed with older adults who used the municipal public health service. The outcome was negative self-rated health using the question "How do you perceive your health?" The regular, bad, and very bad responses were grouped as negative self-perception. The exposure variables were the perceived characteristics of the built neighborhood, which was evaluated by the adapted version of the Neighborhood Environment Walkability Scale. RESULTS A total of 308 older adults were analyzed. Living close to food establishments (OR: 0.46; 95% CI: 0.25;0.85), fitness/bodybuilding gyms and/or clubs (OR: 0.51; 95% CI: 0.28;0.93), and safety to walk during the day (OR: 0.37; 95% CI: 0.16;0.87) and night (OR: 0.47; 95% CI: 0.26;0.84) were protective against negative self-rated health. CONCLUSION Therefore, living in neighborhoods with better characteristics was less associated with negative self-rated health, demonstrating the importance of promoting strategies to improve the neighborhood infrastructure and this population's perception of health.
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Affiliation(s)
- Letícia Martins Cândido
- Graduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, Brazil
| | - Luiza Alves Vieira
- Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil
| | | | - Ana Lúcia Danielewicz
- Graduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, Brazil
- Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Brazil
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Roth KB, Goplerud DK, Adams LB, Maury ME, Musci RJ. The relationship between neighborhood typologies and self-rated health in Maryland: A latent class analysis. Health Place 2023; 83:103079. [PMID: 37423092 DOI: 10.1016/j.healthplace.2023.103079] [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] [Received: 01/04/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
Despite widespread evidence that neighborhood conditions impact health, few studies apply theory to clarify the physical and social factors in communities that drive health outcomes. Latent class analysis (LCA) addresses such gaps by identifying distinct neighborhood typologies and the joint influence that neighborhood-level factors play in health promotion. In the current study, we conducted a theory-driven investigation to describe Maryland neighborhood typologies and examined differences in area-level self-rated poor mental and physical health across typologies. We conducted an LCA of Maryland census tracts (n = 1384) using 21 indicators of physical and social characteristics. We estimated differences in tract-level self-rated physical and mental health across neighborhood typologies using global Wald tests and pairwise comparisons. Five neighborhood classes emerged: Suburban Resourced (n = 410, 29.6%), Rural Resourced (n = 313, 22.6%), Urban Underserved (n = 283, 20.4%), Urban Transient (n = 226, 16.3%), Rural Health Shortage (n = 152, 11.0%). Prevalence of self-rated poor physical and mental health varied significantly (p < 0.0001) by neighborhood typology, with the Suburban Resourced neighborhood class demonstrating the lowest prevalence of poor health and the Urban Underserved neighborhoods demonstrating the poorest health. Our results highlight the complexity of defining "healthy" neighborhoods and areas of focus to mitigate community-level health disparities to achieve health equity.
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Affiliation(s)
- Kimberly B Roth
- Mercer University School of Medicine, Department of Community Medicine, 1250 E 66th Street, Savannah, GA, 31404, USA.
| | - Dana K Goplerud
- Johns Hopkins School of Medicine, Departments of Medicine and Pediatrics, Baltimore, MD, 21205, USA; Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Leslie B Adams
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Mikalah E Maury
- Mercer University School of Medicine, Department of Community Medicine, 1250 E 66th Street, Savannah, GA, 31404, USA
| | - Rashelle J Musci
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway, Hampton House, Baltimore, MD, 21205, USA
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Rodrigues DE, César CC, Xavier CC, Caiaffa WT, Proietti FA. Exploring neighborhood socioeconomic disparity in self-rated health: a multiple mediation analysis. Prev Med 2021; 145:106443. [PMID: 33516758 DOI: 10.1016/j.ypmed.2021.106443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/25/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
There is still a need for more empirical investigations to better understand the causal pathways by which neighborhood socioeconomic contexts translate into states of health. This study explored the relationship between neighborhood socioeconomic position and health, as well as the role of social cohesion, violence, places to buy healthy food, and sports and leisure spaces in mediating this relationship in a diverse set of neighborhoods in Brazil. We applied a general multiple mediation approach to analyze a cross-sectional survey of 4.046 adults living in 149 neighborhoods in 2008 and 2009. The property value was chosen as an indicator of neighborhood socioeconomic position and self-rated health as the outcome. The four mediators were constructed from the self-perception of the participants. Results: We found that people living in economically advantaged neighborhoods were less likely to report their health as being fair/poor/very poor (OR = 0.71; 95% CI = 0.63, 0.76) than people living in disadvantaged neighborhoods, and this effect was mediated by the perception of violence in the neighborhoods. On average, 8.4% of the neighborhood socioeconomic disparity in self-rated health may be explained by violence. We did not ascertain as mediators social cohesion, places to buy healthy food, and sports and leisure spaces. Violence perception mediates the relationship between neighborhood socioeconomic position and self-rated health. Targeted interventions designed to improve the health status of the population could usefully focus on reducing the level of violence in which people live.
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Affiliation(s)
- Daiana Elias Rodrigues
- Oswaldo Cruz Foundation, Belo Horizonte, Brazil; School of Medicine, Universidade Federal de Minas Gerais; Belo Horizonte, Brazil.
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Cruz MS, Sousa Silva E, Krenzinger M, Valiati L, Gonçalves DM, Vasconcellos MTLD, Villar LM, Priebe S, Heritage P. Study protocol of personal characteristics and socio-cultural factors associated with mental health and quality of life of residents living in violent territories. BMC Psychiatry 2020; 20:96. [PMID: 32127005 PMCID: PMC7055079 DOI: 10.1186/s12888-020-02487-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 02/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Throughout the world, millions of people living in deprived urban environments with frequent experiences of violence are mentally distressed. There is little evidence about which characteristics of people living in such environments are associated with lower or higher levels of mental distress and how they may cope with experiences of violence. METHODS/DESIGN This study is part of the research project 'Building the Barricades' (ES/S000720/1 ESRC-AHRC GCRF Mental Health 2017), which uses a mixed-method approach. Quantitative and qualitative studies will be conducted in 16 favelas in the area of Maré in Rio de Janeiro, Brazil. The quantitative study consists of a survey of 1200 randomly selected adults living in Maré and of 200 individuals who frequent the open-use drug sites. The survey will assess sociodemographic characteristics, experiences of different forms of violence, physical and mental health status (including drug use) and active participation in cultural consumption and production. In the qualitative study we will conduct 60 in-depth interviews and 8 focus groups of participants selected from respondents to the survey to assess in more detail their experiences of violence and coping strategies. In order to analyze the quantitative data we will use descriptive statistics and explore associations in uni- and multi-variable analyses. Qualitative data will be subjected to thematic analysis. DISCUSSION This is an exploratory study to identify characteristics and coping strategies that appear to help people to overcome experiences of violence in deprived areas without developing mental distress. The findings could inform policies to reduce mental distress and improve the quality of life of people living in urban areas affected by violence.
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Affiliation(s)
- Marcelo Santos Cruz
- Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás 71 fundos, Rio de Janeiro, 22290-140, Brazil.
| | - Eliana Sousa Silva
- grid.503479.cRedes da Maré, R. Sargento Silva Nunes 1012. Nova Holanda, Maré, Rio de Janeiro, 21044-242 Brazil
| | - Miriam Krenzinger
- grid.8536.80000 0001 2294 473XSchool of Social Work, Federal University of Rio de Janeiro, Av. Pasteur, 250, Urca, Rio de Janeiro, 22290-240 Brazil
| | - Leandro Valiati
- grid.8532.c0000 0001 2200 7498Federal University of Rio Grande do Sul. Faculdade de Ciências Econômicas, Anexo Av João Pessoa 52, Porto Alegre, Rio Grande do Sul 90040-000 Brazil
| | - Dalcio Marinho Gonçalves
- grid.503479.cRedes da Maré, R. Sargento Silva Nunes 1012. Nova Holanda, Maré, Rio de Janeiro, 21044-242 Brazil
| | | | - Livia Melo Villar
- grid.418068.30000 0001 0723 0931Viral Hepatitis Laboratory of Oswaldo Cruz Foundation, Av Brasil, n° 4365, Manguinhos, Rio de Janeiro, 21040-900 Brazil
| | - Stefan Priebe
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, London, E13 8SP UK
| | - Paul Heritage
- grid.4868.20000 0001 2171 1133Department of Drama/People’s Palace Projects, c/o School of English and Drama, Queen Mary University of London, Mile End Road, London, E1 4NS UK
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Chen YN, Coker D, Kramer MR, Johnson BA, Wall KM, Ordóñez CE, McDaniel D, Edwards A, Hare AQ, Sunpath H, Marconi VC. The Impacts of Residential Location on the Risk of HIV Virologic Failure Among ART Users in Durban, South Africa. AIDS Behav 2019; 23:2558-2575. [PMID: 31049812 DOI: 10.1007/s10461-019-02523-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Using a case-control study of patients receiving antiretroviral treatment (ART) in 2010-2012 at McCord Hospital in Durban, South Africa, we sought to understand how residential locations impact patients' risk of virologic failure (VF). Using generalized estimating equations to fit logistic regression models, we estimated the associations of VF with socioeconomic status (SES) and geographic access to care. We then determined whether neighborhood-level poverty modifies the association between individual-level SES and VF. Automobile ownership for men and having non-spouse family members pay medical care for women remained independently associated with increased odds of VF for patients dwelling in moderately and severely poor neighborhoods. Closer geographic proximity to medical care was positively associated with VF among men, while higher neighborhood-level poverty was positively associated with VF among women. The programmatic implications of our findings include developing ART adherence interventions that address the role of gender in both the socioeconomic and geographical contexts.
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Affiliation(s)
- Yi-No Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Daniella Coker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Claudia E Ordóñez
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Darius McDaniel
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex Edwards
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna Q Hare
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA
| | - Henry Sunpath
- Infectious Diseases Unit, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Vincent C Marconi
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
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Shahu A, Herrin J, Dhruva SS, Desai NR, Davis BR, Krumholz HM, Spatz ES. Disparities in Socioeconomic Context and Association With Blood Pressure Control and Cardiovascular Outcomes in ALLHAT. J Am Heart Assoc 2019; 8:e012277. [PMID: 31362591 PMCID: PMC6761647 DOI: 10.1161/jaha.119.012277] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Observational studies demonstrate that communities of low socioeconomic status have higher blood pressure and worse cardiovascular outcomes. Yet, whether the clinical outcomes resulting from antihypertensive therapy vary by socioeconomic context in a randomized clinical trial, in which participants are treated under a standard protocol, is unknown. Methods and Results We used data from ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to study the effect of socioeconomic context, defined as the county-level median household income, of study sites. We stratified sites into income quintiles and compared characteristics, blood pressure control, and cardiovascular outcomes among ALLHAT participants in the lowest- and highest-income quintiles. Among 27 862 qualifying participants, 2169 (7.8%) received care in the lowest-income sites (quintile 1) and 10 458 (37.6%) received care in the highest-income sites (quintile 5). Participants in quintile 1 were more likely to be women, to be black, to be Hispanic, to have fewer years of education, to live in the South, and to have fewer cardiovascular risk factors. After adjusting for baseline demographic and clinical characteristics, quintile 1 participants were less likely to achieve blood pressure control (<140/90 mm Hg) (odds ratio, 0.48; 95% CI, 0.37-0.63) and had greater all-cause mortality (hazard ratio [HR], 1.25; 95% CI, 1.10-1.41), heart failure hospitalizations/mortality (HR, 1.26; 95% CI, 1.03-1.55), and end-stage renal disease (HR, 1.86; 95% CI, 1.26-2.73), but lower angina hospitalizations (HR, 0.70; 95% CI, 0.59-0.83) and coronary revascularizations (HR, 0.71; 95% CI, 0.57-0.89). Conclusions Despite standardized treatment protocols, ALLHAT participants in the lowest-income sites experienced poorer blood pressure control and worse outcomes for some adverse cardiovascular events, emphasizing the importance of measuring and addressing socioeconomic context. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
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Affiliation(s)
- Andi Shahu
- Department of Medicine Johns Hopkins Hospital Baltimore MD
| | - Jeph Herrin
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Health Research & Educational Trust Chicago IL
| | - Sanket S Dhruva
- San Francisco Veterans Affairs Medical Center San Francisco CA.,University of California, San Francisco School of Medicine San Francisco CA
| | - Nihar R Desai
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Barry R Davis
- Coordinating Center for Clinical Trials University of Texas School of Public Health Houston TX
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT
| | - Erica S Spatz
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
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