The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans

Residential racial segregation is a key manifestation of anti-Black structural racism, thought to be a fundamental cause of poor health; evidence has shown that it yields neighborhood disinvestment, institutional discrimination, and targeting of unhealthy products like tobacco and alcohol. Yet research on the long-term impacts of childhood exposure to residential racial segregation is limited. Here, we analyzed data on 1823 Black participants in the Panel Study of Income Dynamics, estimating associations between childhood segregation trajectories and young adult health. Black young adults who consistently lived in high-segregation neighborhoods throughout childhood experienced unhealthier smoking and drinking behaviors and higher odds of obesity compared to other trajectory groups, including children who moved into or out of high-segregation neighborhoods. Results were robust to controls for neighborhood and family poverty. Findings underscore that for Black children who grow up in segregated neighborhoods, the roots of structurally-determined health inequities are established early in life.     

Who does well where? Exploring how self-rated health differs across diverse people and neighborhoods

This work establishes whether neighborhood disadvantage amplifies the impact of socioeconomic position (SEP) on a graded measure of self-rated health (SRH). SRH data were taken from 10,932 adults recruited across 200 Brisbane neighborhoods. After adjusting for demographics, those who lived in the most disadvantaged neighborhoods were more likely to report poor SRH than those living in the least disadvantaged neighborhoods (OR=2.67). Those with the lowest SEP and lived in the most advantaged neighborhoods had a similar probability of reporting excellent SRH as those with the highest SEP living in the most disadvantaged neighborhoods. This work highlights the importance of examining SEP and neighborhood-level disadvantage simultaneously when planning communities.     

Examine the associations between perceived neighborhood conditions,physical activity,and mental health during the COVID-19 pandemic

This study examined how neighborhood conditions changed and how neighborhood conditions were associated with physical activity and mental health during the COVID-19 pandemic among Americans. The major outcomes were stratified by the neighborhood's poverty and regression models were used to assess the associations between neighborhood conditions and their change during the pandemic and the outcomes of physical activity and mental health. The results show that low-poverty neighborhoods had more health-promoting neighborhood conditions before the outbreak and more positive changes during the outbreak. Health-promoting neighborhood conditions were associated with higher physical activity and moderate physical activity and lack of negative neighborhood conditions such as crime/violence and traffic were associated with a lower risk of mental health problems including loneliness, depression, and anxiety. Mental health problems were also significantly associated with the COVID-19 infection and death and household income level. Our findings suggest that it is plausible that the disparities of physical activity and mental health by neighborhood exacerbate due to the pandemic and people who living in socioeconomically disadvantaged neighborhoods bear increasingly disproportionate burden.     

Trends in depressive symptoms, anxiety symptoms and visits to healthcare specialists: a national study among Icelandic adolescents

AIMS: The aim of the study was to examine trends in adolescent depression and anxiety symptoms from 1997 to 2006, using four time-points (1997, 2000, 2003, and 2006), and adolescent mental health service use in the same period, using three time-points (1997, 2000, and 2006). METHODS: Four cross-sectional population-based samples of 14- and 15-year-old students, attending the compulsory 9th and 10th grades of the Icelandic secondary school system, completed questionnaires relating to mental health. In total, 21,245 students participated in the four studies. RESULTS: Anxiety symptoms increased significantly for both boys and girls, throughout the period from 1997 to 2006. Depressive symptoms increased significantly for girls, while there were no significant changes in depression among boys. During the same time period, the proportion of adolescents who visited healthcare specialists, i.e. psychiatrists, psychologists and social workers, increased significantly. The results revealed that regular visits (six times or more during 1 year) to psychiatrists and psychologists increased significantly over the same period among girls but not among boys. CONCLUSIONS: The findings show that symptoms of depression and anxiety have increased among adolescents in Iceland. Future work would benefit from further research into the trends in risk and protective factors associated with these outcomes. The findings call particular attention to the increasing risk for depression and anxiety symptoms among girls.     

Neighborhood Socioeconomic Status and Health: A Longitudinal Analysis

Higher income neighborhoods are associated with better health, a relation observed in many cross-sectional studies. However, prior research focused on the prevalence of health conditions, and examining the incidence of new health conditions may provide stronger support for a potential causal role of neighborhoods on health. We used the 2004 and 2014 waves of the Midlife in the United States Study (n?=?1726; ages 34–83) to examine health condition incidence as a function of neighborhood income. Among participants who had lived in the same neighborhood across the time period, we hypothesized that higher neighborhood income would be associated with a lower incidence of health conditions ten years later. Health included 18 chronic conditions related to mental (anxiety, depression) and physical (cardiovascular, immune) health. Multinomial logistic regression analyses adjusting for individual income and sociodemographics indicated that the odds of developing two or more new health conditions (no new health conditions as referent), was significantly lower (OR?=?0.92, CI: 0.86, 0.99) for every $10,000 increment in neighborhood income. Associations did not vary by age or neighborhood tenure. Results add to a literature documenting that higher neighborhood income is associated with better health.     

Walking, exercising, and smoking: does neighborhood matter?

Neighborhood context could affect health behaviors because of structure or contagion. We expected that residents of US neighborhoods where a high percentage of residents are poor and do not have college degrees would be more likely to smoke and less likely to walk and exercise. We examined the hypotheses using multi-level data in which survey information from a representative sample of Illinois residents is linked to census-tract information about poverty and education in their neighborhood. Contrary to expectations we found that residents of poor neighborhoods were more likely to walk than those in less disadvantaged places, adjusting for individual poverty, household income, education, race, ethnicity, sex, age, and marital status. This was the case despite the fact that residents of poor neighborhoods were more afraid to leave the house and feared being victimized on the streets. Consistent with expectations we found that residents of neighborhoods where a high percentage of residents are college educated are more likely to walk. Thus, the two aspects of neighborhood socioeconomic status had opposite effects on walking. Neighborhood context had no effect on the likelihood of exercising strenuously. Men in poor neighborhoods were more likely to smoke than those in less disadvantaged places, but neighborhood context had no significant effect on women's likelihood of smoking.     

Family Poverty Over the Early Life Course and Recurrent Adolescent and Young Adult Anxiety and Depression: A Longitudinal Study

Objectives. We determined whether exposure to family poverty over a child''s early life course predicts adolescent and young adult anxiety and depression.Methods. We used a birth cohort study of a sample of women in Brisbane, Australia, who were recruited in early pregnancy and whose children were followed up on at ages 14 and 21 years. Some 2609 mothers and adolescents provided usable data at the 14- and 21-year follow-ups.Results. After adjustment for poverty at other phases, poverty at the 14-year follow-up was the strongest predictor of adolescent and young adult anxiety and depression. The more frequently the child was exposed to poverty, the greater was the risk of that individual being anxious and depressed at both the 14- and 21-year follow-ups.Conclusions. Family poverty predicts higher rates of adolescent and young adult anxiety and depression. Increased frequency of child exposure to poverty is a consistent predictor of adolescent and young adult anxiety and depression. Repeated experiences of poverty over a child''s early life course are associated with increased levels of poor mental health.Family poverty has been associated with a variety of adverse health outcomes,^1–6 including poor mental health. Relatively little, however, is known about the extent to which poverty and socioeconomic disadvantage experienced early in the life course (e.g., fetal, childhood, or adolescent period) may have long-term consequences. Poverty experienced in early childhood has been found to affect cognitive and other health and developmental outcomes.^7–9 Little is known, however, about whether there may be critical periods during gestation, childhood, or adolescence when exposures to poverty may have major and irreversible consequences.The notion of critical or sensitive periods has a long history.¹⁰ The concept of sensitive periods must be distinguished from the effects of the intensity, duration, or frequency of exposure to a stimulus (i.e., the cumulative level of exposure). Generally, periods over the life course that might be characterized as critical or sensitive are periods when those exposed are experiencing important biological changes, and when the exposure modifies these ongoing biological changes.^11,12 Gestation, early childhood, and adolescence are stages of the life course during which the fetus, child, or adolescent is experiencing rapid biological change. Although the specific mechanisms involved in the finding of critical or sensitive periods remain a matter of debate, they are likely to include the concept of brain plasticity and epigenetic processes.¹³Whether there are critical or sensitive periods for the impact of family poverty on the development of childhood mental illness (specifically, anxiety and depression) does not appear to have been a subject of previous research. In some of the few studies that have tracked the impact of early life-course experiences of poverty on adult chronic diseases, the observation of statistically significant associations has not been accompanied by a focus on differences in life-course stage in the experience of poverty.^8,14We examined 3 specific questions concerning the association between family poverty and anxiety and depression among adolescents and young adults: Does family poverty experienced at different points over the early life course affect anxiety and depression at the 14-year (adolescent) and 21-year (young adult) follow-ups? Does recurrent exposure to family poverty have a cumulative effect on adolescent and young adult anxiety and depression? Is the association between family poverty and anxiety and depression in children and young adults independent of some possible confounding factors—specifically, mother''s age at time of pregnancy, mother''s marital status, mother''s anxiety and depression, and offspring''s income in adulthood?     

Neighborhood effects on posthospitalization mortality: a population-based cohort study of the elderly in Chicago

CONTEXT: Place of residence is associated with health outcomes. OBJECTIVE: To examine neighborhood effects on mortality after the onset of serious disease and to assess whether these effects vary for different sociodemographic or diagnostic subgroups. DESIGN, SETTING, PATIENTS: Our sample consists of a complete cohort of 10,557 elderly Medicare beneficiaries throughout the city of Chicago newly diagnosed and hospitalized for the first time with one of five common serious diseases in 1993 (stroke, myocardial infarction, congestive heart failure, hip fracture, and lung cancer) followed until 1999. Attributes of 51 zip code neighborhoods were obtained both from census data (1990) and from a comprehensive social survey of neighborhood residents (1994-1995). Cox proportional hazards models with robust standard errors were specified. MAIN OUTCOME MEASURE: Survival after hospitalization. RESULTS: People who lived in neighborhoods with higher socioeconomic status (SES) or with a better social environment had significantly longer survival after disease onset. We evaluated the differential impact of neighborhood attributes on survival depending on gender, race, and poverty using interaction terms. Only the interaction terms between neighborhood social-structural factors and individual poverty were significant, suggesting that neighborhood SES and social environment were especially helpful for people with higher income. Neighborhood attributes did not differ in their impact depending on the race or sex of the subjects. Analyses of cause-specific mortality showed that myocardial infarction was the primary force driving the associations between neighborhood attributes and mortality. CONCLUSIONS: Where people live matters with respect to posthospitalization mortality, but how neighborhoods affect this outcome depends on individual demographic and diagnostic characteristics. Myocardial infarction in particular may be a "neighborhood sensitive" condition. Individuals' health may depend not just on individuals' characteristics but also on their neighborhoods'.     

Racially mixed neighborhoods, perceived neighborhood social cohesion, and adolescent health in Canada

Using data from the Canadian Census and the National Longitudinal Survey of Children and Youth, we examine the effects of neighborhood concentration of racial minorities on general health status and depressive symptoms of Canadian adolescents. We also examine the role of perceived neighborhood cohesion and the extent to which it contributes to adolescent health. Our findings show that the racial concentration of ethnic minorities represents a health disadvantage for visible minority youth while perceived neighborhood cohesion is found to be a protective factor for both health outcomes. Perceived neighborhood cohesion is beneficial for the general health status (but not depression) of adolescents residing in neighborhoods with a high concentration of racial minorities.     

Impact of Urban Neighborhood Disadvantage on Late Stage Breast Cancer Diagnosis in Virginia

Research suggests that residents of inner-city urban neighborhoods have higher rates of late stage cancer diagnosis. Identifying urban neighborhoods with high rates of both concentrated disadvantage and late stage cancer diagnosis may assist health care providers to target screening interventions to reduce disparities. The purposes of this study were to (1) create an index to evaluate concentrated disadvantage (CD) using non-racial measures of poverty, (2) determine the impact of neighborhood CD on late stage breast cancer diagnosis in US cities, and (3) to understand the role of obesity on this relationship. We used census block group- (CBG) level poverty indicators from five Virginia cities to develop the index. Breast cancer cases of women aged 18–65 who lived in the five cities were identified from the 2000–2012 Virginia Cancer Registry. A logistic regression model with random intercept was used to evaluate the impact of disadvantage on late stage breast cancer diagnosis. CBG-level maps were developed to geographically identify neighborhoods with both high rates of CD and late breast cancer staging. Over 900 CBGs and 6000 breast cases were included. Global fit of the concentrated disadvantage model was acceptable. The effect of disadvantage on late stage was significant (OR?=?1.0083, p?=?0.032). Inner-city poverty impacts risk of late stage breast cancer diagnosis. Area-level obesity is highly correlated with neighborhood poverty (ρ?=?0.74, p?<?0.0001) but the mediating direct and indirect effects are non-significant. Intervening in these high poverty neighborhoods may help combat disparities in late stage diagnosis for urban poor and for minorities living in these underserved neighborhoods, but more study is needed to understanding the complex relationship between concentrated neighborhood poverty, obesity, and late stage diagnosis.     

Do health trajectories predict neighborhood outcomes? Evidence of health selection in a diverse sample of U.S. adults

Across the United States, residents of lower income neighborhoods evince poorer health, on average, than residents of more affluent areas. Studies aiming to explain this pattern have focused largely on the effects of neighborhood characteristics on residents' health, often overlooking the possibility that the reverse causal process—that a person's health impacts where they live, or "health selection into neighborhoods"—also plays a role. We investigated processes of health selection using the Panel Study of Income Dynamics, a longitudinal survey of U.S. households. Using ordinary least squares linear regression, we estimated the effect of householders' self-rated health on their neighborhood socioeconomic status (SES, the Census tract-level family poverty rate) in 2013, adjusting for neighborhood SES and health in 2001 as well as sociodemographic characteristics and residential mobility. Poorer health was associated with residence in higher poverty neighborhoods overall. Stratified models indicated that while health selection was observed across both race/ethnicity and class boundaries, the relationship between poor health and neighborhood poverty was stronger among non-Hispanic Black respondents, those with low income, and respondents who either moved moderate distances or did not move at all during the study period. We conclude with a call for future work exploring the mechanisms leading those in worse health to reside in higher poverty neighborhoods, and for public health policies that seek not only to improve health supporting conditions in economically disadvantaged neighborhoods, but that also support the economic and social needs of residents struggling with health problems.     

Moving to opportunity: an experimental study of neighborhood effects on mental health

OBJECTIVES: The health consequences of neighborhood poverty are a public health problem. Data were obtained to examine links between neighborhood residence and mental health outcomes. METHODS: Moving to Opportunity was a randomized, controlled trial in which families from public housing in high-poverty neighborhoods were moved into private housing in near-poor or nonpoor neighborhoods, with a subset remaining in public housing. At the 3-year follow-up of the New York site, 550 families were reinterviewed. RESULTS: Parents who moved to low-poverty neighborhoods reported significantly less distress than parents who remained in high-poverty neighborhoods. Boys who moved to less poor neighborhoods reported significantly fewer anxious/depressive and dependency problems than did boys who stayed in public housing. CONCLUSIONS: This study provides experimental evidence of neighborhood income effects on mental health.     

Perceived neighborhood social cohesion moderates the relationship between neighborhood structural disadvantage and adolescent depressive symptoms

There is a dearth of research exploring the moderating role of the social environment on neighborhood structural disadvantage and depressive symptoms, particularly among adolescents. Therefore, we examined if adolescent perceptions of neighborhood social cohesion and safety moderated the association between neighborhood structural disadvantage and adolescent depressive symptoms. This cross-sectional study used data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). The study sample consisted of 12,105 adolescents enrolled in 9th–12th grades during the 1994–1995 school year across the United States (U.S.). Mixed effects multilevel modeling was used to determine if adolescent perceptions of neighborhoods moderated the relationship between neighborhood structural disadvantage and adolescent depressive symptoms. Results showed that perceived neighborhood social cohesion moderated the relationship between neighborhood structural disadvantage and adolescent depressive symptoms (p ≤ 0.001). At higher levels of perceived neighborhood social cohesion, neighborhood structural disadvantage was associated with decreased depressive symptoms. Findings suggest that improving perceived neighborhood social cohesion may decrease adolescent depressive symptoms, particularly in neighborhoods with high disadvantage. This aspect of the neighborhood social environment may serve as a target for structural and other interventions to address the growing burden of depression among adolescents.     

Problems and help seeking in high-risk adolescent patients of health clinics

In this study, 2787 adolescents between the ages of 13 and 18 years living in inner-city communities were interviewed about their mental and physical health and their clinic use. The patients used consolidated mental and physical health clinics located in neighborhoods, hospitals, or schools; of traditional neighborhood or hospital health clinics. Analyses of selected patient problems reveal that less than one third of adolescent patients with suicide ideation, conduct disorder, and substance abuse or dependency sought or received care for those problems. Only half of the adolescents with major depression sought or received care for depression, and only two thirds of the sexually active females sought or received help with birth control. A special effort needs to be made to attract troubled youth to clinics and to identify and treat their problems, particularly when those problems involve mental health concerns.     

Relationship between neighborhood walkability and the prevalence,type, timing,and temporal characteristics of walking

We examined associations of neighborhood walkability with the prevalence, type, timing, and temporal characteristics of walking in a representative sample of United States adults. Adults (N = 2649) completed the ACT24 previous-day recall. Home address was linked to block-group National Walkability Index. Survey-adjusted Poisson and logistic regression examined the association of walkability with outcomes. Those who lived in more walkable neighborhoods were more likely to walk overall, for transport, or in the evening. In those who walked, higher walkability was associated with less morning but more evening walking. There were no associations of walkability with the frequency or duration of walking episodes.     

The Association of Individual and Neighborhood Social Cohesion,Stressors, and Crime on Smoking Status Among African-American Women in Southeastern US Subsidized Housing Neighborhoods

The purpose of this study was to examine the associations between individual and neighborhood social contextual factors and smoking prevalence among African-American women in subsidized neighborhoods. We randomly sampled 663 adult women in 17 subsidized neighborhoods in two Southeastern US states. The smoking prevalence among participants was 37.6 %, with an estimated neighborhood household prevalence ranging from 30 to 68 %. Smokers were more likely to be older, have lower incomes, have lower BMI, and live with other smokers. Women with high social cohesion were less likely to smoke, although living in neighborhoods with higher social cohesion was not associated with smoking prevalence. Women with higher social cohesion were more likely to be older and had lived in the neighborhood longer. Women with high stress (related to violence and disorder) and who lived in neighborhoods with higher stress were more likely to smoke. Younger women were more likely to have higher stress than older women. There were no statistically significant associations with objective neighborhood crime data in any model. This is the first study to examine both individual and neighborhood social contextual correlates among African-American women in subsidized neighborhoods. This study extends findings about smoking behaviors and neighborhood social contexts in this high-risk, urban population. Future research is needed to explore age and residential stability differences and perceptions of social cohesion, neighborhood disorder, and perceived violence in subsidized housing. Further research is also warranted on African-American women, subsidized housing, smoking, social context, health disparities’ effective strategies to address these individual and contextual factors to better inform future ecological-based multilevel prevention, and cessation intervention strategies.     

Neighborhood Road Environments and Physical Activity Among Youth: The CLAN Study

We examined associations between objective measures of the local road environment and physical activity (including active transport) among youth. There is little empirical evidence of the impact of the road environment on physical activity among children/adolescents in their neighborhoods. Most recent studies have examined perceptions rather than objective measures of the road environment. This was a cross-sectional study of children aged 8-9 years (n = 188) and adolescents aged 13-15 years (n = 346) who were participants in the 3-year follow-up of the Children Living in Active Neighborhoods (CLAN) longitudinal study in Melbourne, Australia. At baseline (2001), they were recruited from 19 state primary schools in areas of varying socioeconomic status across Melbourne. Habitual walking/cycling to local destinations was parent-reported for children and self-reported for adolescents, while moderate-to-vigorous physical activity (MVPA) outside school hours was recorded using accelerometers. Road environment features in each participant's neighborhood (area of radius 800 m around the home) were measured objectively using a geographical information system. Regression analyses found no associations between road environment variables and children's likelihood of making at least seven walking/cycling trips per week to neighborhood destinations. Adolescent girls residing in neighborhoods with two to three traffic/pedestrian lights were more likely to make seven or more walking/cycling trips per week as those whose neighborhoods had fewer traffic lights (OR: 2.7; 95% CI: 1.2-6.2). For adolescent boys, residing on a cul-de-sac, compared with a through road, was associated with increases in MVPA of 9 min after school, 5 min in the evenings, and 22 min on weekend days. Speed humps were positively associated with adolescent boys' MVPA during evenings. The road environment influences physical activity among youth in different ways, according to age group, sex and type of physical activity.     

奎屯市1335名初中生焦虑抑郁共病研究

目的 了解奎屯市内初班与普通班焦虑抑郁现状,探讨焦虑抑郁共病影响因子及危险因素,为青少年高危人群预防干预提供依据。方法 采取整群抽样的方法选取奎屯市3所中学共1 335名中学生。采用自编调查问卷、抑郁自评量表(SDS)、焦虑自评量表(SAS)、青少年生活事件量表(ASCLE)作为测量工具进行问卷调查,筛查焦虑、抑郁症状,分析影响焦虑抑郁共病的相关危险因素。结果 奎屯市青少年抑郁症状总检出率34.8%,焦虑症状总检出率23.7%,焦虑抑郁共病检出率50.1%。有抑郁症状者中合并焦虑者SDS、SAS评分明显高于不伴焦虑者(P均<0.01)。多元回归分析显示:内初班、女生、人际关系、学习压力是惟患焦虑抑郁共病的相关危险因素。结论 奎屯市青少年焦虑抑郁状况较为严重,尤以内初班女生为甚。应定期开展心理健康状况筛查,建立心理危机干预机制,提高青少年心理健康水平。     

Neighborhood and Gender Effects on Family Processes: Results From the Moving to Opportunity Program*

Abstract: Data from the New York City Moving to Opportunity 3‐year follow‐up were used to examine neighborhood and gender effects on adolescents’ family processes. Low‐income, minority families in public housing in high‐poverty neighborhoods were assigned randomly to (a) move to private housing in low‐poverty neighborhoods only, (b) move to private housing in neighborhoods of their choice, or (c) stay in place. Family processes, assessed by parent reports and interviewer observations, were compared for those who relocated and those who stayed in place. Parents in the low‐poverty group were observed to be harsher toward their daughters than parents in the high‐poverty group. In adolescence, residential relocation may be difficult for mother‐daughter relations and require additional services to ease the transition.