Prostate cancer aggressiveness and financial toxicity among prostate cancer patients.

INTRODUCTION: Financial toxicity (FT) is a growing concern among cancer survivors that adversely affects the quality of life and survival. Individuals diagnosed with aggressive cancers are often at a greater risk of experiencing FT. The objectives of this study were to estimate FT among prostate cancer (PCa) survivors after 10-15 years of diagnosis, assess the relationship between PCa aggressiveness at diagnosis and FT, and examine whether current cancer treatment status mediates the relationship between PCa aggressiveness and FT. METHODS: PCa patients enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP) were recontacted for long-term follow-up. The prevalence of FT in the PCaP cohort was estimated. FT was estimated using the COmprehensive Score for Financial Toxicity, a validated measure of FT. The direct effect of PCa aggressiveness and an indirect effect through current cancer treatment on FT was examined using causal mediation analysis. RESULTS: More than one-third of PCa patients reported experiencing FT. PCa aggressiveness was significantly independently associated with high FT; high aggressive PCa at diagnosis had more than twice the risk of experiencing FT than those with low or intermediate aggressive PCa (adjusted odds ratio [aOR] = 2.13, 95% CI = 1.14-3.96). The proportion of the effect of PCa aggressiveness on FT, mediated by treatment status, was 10%, however, the adjusted odds ratio did not indicate significant evidence of mediation by treatment status (aOR = 1.05, 95% CI = 0.95-1.20). CONCLUSIONS: Aggressive PCa was associated with high FT. Future studies should collect more information about the characteristics of men with high FT and identify additional risk factors of FT.

Neighborhood deprivation and risk of mortality among men with prostate cancer: Findings from a long-term follow-up study.

BACKGROUND: The overall survival rate of prostate cancer (PCa) has improved over the past decades. However, huge socioeconomic and racial disparities in overall and prostate cancer-specific mortality exist. The neighborhood-level factors including socioeconomic disadvantage and lack of access to care may contribute to disparities in cancer mortality. This study examines the impact of neighborhood deprivation on mortality among PCa survivors. METHODS: North Carolina-Louisiana Prostate Cancer Project (PCaP) data were used. A total of 2113 men, 1046 AA and 1067 EA, with PCa were included in the analysis. Neighborhood deprivation was measured by the Area Deprivation Index (ADI) at the census block group level using data from the US Census Bureau. Quintiles of ADI were created. Cox proportional hazards and competing risk models with mixed effects were performed to estimate the effect of neighborhood deprivation on all-cause and PCa-specific mortality adjusted for age, race, study site, insurance status, and comorbidities. RESULTS: Participants living in the most deprived neighborhoods had an increased risk for all-cause mortality (quintiles 4 + 5: adjusted hazard ratio [aHR] = 1.51, 95% confidence interval [CI] = 1.16-1.96) compared to those in the least deprived (quintile 1) neighborhoods. The risk of prostate cancer-specific mortality was also higher among those living in the deprived neighborhoods (quintiles 4 + 5: aHR = 1.90, 95% CI = 1.10-3.50) than those in the least deprived neighborhood. CONCLUSIONS: The findings suggest neighborhood-level resources or health interventions are essential to improve survival among men with PCa. Additional research should focus on the mechanisms of how the neighborhood environment affects mortality.

Potential Impact of 2020 US Decennial Census Data Collection on Disaster Preparedness and Population Mental Health.

Increasing in frequency and impact in the United States and worldwide, disasters can lead to serious mental health consequences. Although US census data are essential for disaster preparedness and the identification of community-level risk factors for adverse postdisaster mental health outcomes, the US Census Bureau faces many challenges as we approach 2020 Decennial Census data collection. Despite the utility of the information provided by the Census and American Community Survey (ACS), the 2020 US Census and subsequent ACS data face threats to validity. As a result, public health funding could be misallocated, and disaster preparedness and response efforts misinformed; this can also contribute to the worsening of mental health inequities, particularly in the context of disaster. Undercutting the Census and the ACS, rich data sources that allow representation of all people in the United States, is a step backward in our effort to mitigate the population mental health consequences of disasters.

Neighborhood Environment Measurements and Anthropometric Indicators of Obesity: Results from the Women and Their Children's Health (WaTCH) Study.

We compared geographic information system (GIS)- and Census-based approaches for measuring the physical and social neighborhood environment at the census tract-level versus and audit approach on associations with body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Data were used from the 2012-2014 Women and Their Children's Health (WaTCH) Study (n=940). Generalized linear models were used to obtain odds ratios (ORs) for BMI (≥30 kg/m2), WC (>88 cm), and WHR (>0.85). Using an audit approach, more adverse neighborhood characteristics were associated with a higher odds of WC (OR: 1.10; 95% CI: 1.05, 1.15) and WHR (OR: 1.09; 95% CI: 1.05, 1.14) after adjustment for age, race/ethnicity, income, and oil spill exposure. There were no significant associations between GIS- and Census- based measures with obesity in adjusted models. Quality aspects of the neighborhood environment captured by audits at the individual-level may be more relevant to obesity than physical or social aspects at the census-tract level.

Individual-level exposure to disaster, neighborhood environmental characteristics, and their independent and combined associations with depressive symptoms in women.

PURPOSE: The severity of the stress response to experiencing disaster depends on individual exposure and background stress prior to the event. To date, there is limited research on the interaction between neighborhood environmental stress and experiencing an oil spill, and their effects on depression. The objective of the current study was to assess if the association between exposure to the Deepwater Horizon Oil Spill (DHOS) and depressive symptoms varied by neighborhood characteristics. METHODS: US Census data (2010) and longitudinal data collected in two waves (2012-2014 and 2014-2016) from female residents [N = 889 (Wave I), 737 (Wave II)] of an area highly affected by the DHOS were analyzed. Multilevel and individual-level negative binomial regressions were performed to estimate associations with depressive symptoms in both waves. An interaction term was included to estimate effect modification of the association between DHOS exposure and depressive symptoms by neighborhood characteristics. Generalized estimating equations were applied to the negative binomial regression testing longitudinal associations. RESULTS: Census tract-level neighborhood characteristics were not associated with depressive symptoms. Exposure to the DHOS and neighborhood physical disorder were associated with depressive symptoms cross-sectionally. There was no evidence of effect modification; however, physical/environmental exposure to the DHOS was associated with increased depressive symptoms only among women living in areas with physical disorder. Exposure to the DHOS remained associated with depressive symptoms over time. CONCLUSIONS: Findings support the enduring consequences of disaster exposure on depressive symptoms in women and identify potential targets for post-disaster intervention based on residential characteristics.

Neighborhood environments and obesity among Afro-Caribbean, African American, and Non-Hispanic white adults in the United States: results from the National Survey of American Life.

OBJECTIVE: To examine possible associations between perceived neighborhood environments and obesity among a U.S. nationally representative sample of Afro-Caribbean, African American, and Non-Hispanic white adults. METHODS: Data was used from the 2001-2003 National Survey of American Life (NSAL). All measures including neighborhood characteristics, height, and weight were self-reported. Multivariate logistic regression was used to compute odds ratios (ORs) of obesity (body mass index (BMI) ≥ 30 kg/m(2)) based on perceived neighborhood physical and social characteristics. RESULTS: The odds of obesity were significantly lower for adults who reported involvement in clubs, associations, or help groups (odds ratio (OR): 0.62; 95% confidence interval (CI): 0.44, 0.85) and perceived that they had a park, playground, or open space in their neighborhood (odds ratio (OR): 0.68; 95% confidence interval (CI): 0.47, 0.98). These associations remained significant after adjusting for leisure-time physical activity. Race/ethnicity appeared to modify the association between involvement in clubs, associations, or help groups and obesity. CONCLUSIONS: Providing parks, playgrounds, or open space or increasing the perception of those amenities may assist in the prevention of obesity, especially in ethnically diverse neighborhoods in the United States. More research is needed to investigate how perceptions of the neighborhood environment influence obesity and whether perceptions of the neighborhood environment differ between individuals within the same neighborhoods.

Epigenetic Age Acceleration and Disparities in Posttraumatic Stress in Women in Southeast Louisiana: NIMHD Social Epigenomics Program.

Importance: Disasters experienced by an entire community provide opportunities to understand individual differences in risk for adverse health outcomes over time. DNA methylation (DNAm) differences may help to distinguish individuals at increased risk following large-scale disasters. Objective: To examine the association of epigenetic age acceleration with probable posttraumatic stress disorder (PTSD) and PTSD symptom severity in women. Design, Setting, and Participants: This prospective cohort study examined data from participants in the Women and Their Children's Health cohort, who were characterized longitudinally following the Deepwater Horizon oil spill (DHOS) in 2010 and through numerous hurricanes in the Gulf Coast region of the US. Wave 1 occurred August 6, 2012, through June 26, 2014, and wave 2 occurred September 2, 2014, through May 27, 2016. Data were analyzed between August 18 and November 4, 2023. Address-based sampling was used to recruit women aged 18 to 80 years and residing in 1 of the 7 Louisiana parishes surrounding the DHOS-affected region. Recruitment consisted of 2-stage sampling that (1) undersampled the 2 more urban parishes to maximize probability of participant oil exposure and (2) proportionally recruited participants across census tracts in the 5 other parishes closest to the spill. Exposure: Posttraumatic stress subsequent to the DHOS. Main Outcome and Measures: Epigenetic age acceleration was measured by DNAm assayed from survey wave 1 blood samples. Posttraumatic stress disorder was assessed using the PTSD Checklist for DSM-5 at survey wave 2, and lifetime trauma exposure was assessed using the Life Events Checklist for DSM-5. General linear models were used to examine the association between wave 1 DNAm age and wave 2 probable PTSD diagnosis and symptom severity. Results: A total of 864 women (mean [SD] age, 47.1 [12.0] years; 328 Black [38.0%], 19 American Indian [2.2%], 486 White [56.3%], and 30 of other racial groups, including uknown or unreported [3.5%]) were included. Black and American Indian participants had a higher age acceleration at wave 1 compared with White participants (ß = 1.64 [95% CI, 1.02-2.45] and 2.34 [95% CI, 0.33-4.34], respectively), and they had higher PTSD symptom severity at wave 2 (ß = 7.10 [95% CI, 4.62-9.58] and 13.08 [95% CI, 4.97-21.18], respectively). Epigenetic age acceleration at wave 1 was associated with PTSD symptom severity at wave 2 after adjusting for race, smoking, body mass index, and household income (ß = 0.38; 95% CI, 0.11-0.65). Conclusions and Relevance: In this cohort study, epigenetic age acceleration was higher in minoritized racial groups and associated with future PTSD diagnosis and severity. These findings support the need for psychoeducation about traumatic responses to increase the likelihood that treatment is sought before years of distress and entrenchment of symptoms and comorbidities occur.

Escaping to and being active in neighbourhood parks: park use in a post-disaster setting.

Neighbourhood parks may serve as a coping resource in post-disaster communities, yet little is known about the impact of large-scale disasters on park use. The objective of this study is to explore the impact of Hurricane Katrina (August 2005) on park use by visitors from flooded areas of New Orleans, Louisiana, compared to visitors from non-flooded areas. In 2006 and 2007, following Hurricane Katrina, 201 adults who visited 27 New Orleans parks were interviewed. Visitors from flooded neighbourhoods used their parks less often and were less likely to engage in animal interaction than visitors from non-flooded neighbourhoods. They placed more importance on escape and physically-active motivations than visitors from non-flooded areas. Social reasons were also more important to visitors from flooded areas, but these differences disappeared after adjusting for race. Neighbourhood parks are a community asset that may play a role in the post-disaster recovery process by providing opportunities for escape and physical activity.

Work-family spillover and depression: Are there racial differences among employed women?

The intersection of work and family life can be a source of burden (negative) and a source of growth (positive). Negative work-to-family and family-to-work spillover have been linked to poor mental health, while positive work-to-family and family-to-work spillover have been linked to improved health outcomes. Less is known about these relationships in racial subgroups. Louisiana, USA, has a large proportion of African Americans, providing a unique population in which to study these relationships. The objectives of this study were to examine, among a sample of women in southern Louisiana in 2017, levels of work-family spillover by race and how the relationship between work-family spillover and depressive symptoms varies by race. 284 employed women (61% White, 39% Black) met eligibility criteria and participated in a survey to collect information on work-family spillover (positive and negative) and depressive symptoms. White women experienced higher levels of both kinds of negative spillover (work-to-family and family-to-work) as well as higher levels of positive work-to-family spillover compared to Black women. There were no differences between White and Black women with respect to positive family-to-work spillover. Higher levels of negative work-to-family spillover were related to greater depressive symptoms among both Blacks and Whites. But higher levels of negative family-to-work spillover were related to higher levels of depressive symptoms among Black women only. A protective relationship from positive family-to-work spillover for depressive symptoms was observed among White women only. This study fills an important gap in the literature on racial differences in the relationship between work-family spillover and depression.

Validity of social-cognitive measures for physical activity in middle-school girls.

OBJECTIVE: The factorial validity and measurement equivalence/invariance of scales used to measure social-cognitive correlates of physical activity among adolescent girls were examined. METHODS: Confirmatory factor analysis was applied to questionnaire responses obtained from a multi-ethnic sample (N = 4885) of middle-school girls from six regions of the United States. A cohort of 1893 girls completed the scales in both sixth and eighth grades, allowing longitudinal analysis. RESULTS: Theoretically and statistically sound models were developed for each scale, supporting the factorial validity of the scales in all groups. Multi-group and longitudinal invariance was confirmed across race/ethnicity groups, age within grade, BMI categories, and the 2-year period between grades. CONCLUSIONS: The scores from the scales provide valid assessments of social-cognitive variables that are putative mediators or moderators of change in physical activity. The revised scales can be used in observational studies of change or interventions designed to increase physical activity among girls during early adolescence.

The effect of area deprivation on COVID-19 risk in Louisiana.

BACKGROUND: Louisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana. METHODS: The Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed. RESULTS: Neighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and -33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods. CONCLUSION: While the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation.

The Relationship Between Social Vulnerability and COVID-19 Incidence Among Louisiana Census Tracts.

Objective: To examine the association between the Centers for Disease Control and Prevention (CDC)'s Social Vulnerability Index (SVI) and COVID-19 incidence among Louisiana census tracts. Methods: An ecological study comparing the CDC SVI and census tract-level COVID-19 case counts was conducted. Choropleth maps were used to identify census tracts with high levels of both social vulnerability and COVID-19 incidence. Negative binomial regression with random intercepts was used to compare the relationship between overall CDC SVI percentile and its four sub-themes and COVID-19 incidence, adjusting for population density. Results: In a crude stratified analysis, all four CDC SVI sub-themes were significantly associated with COVID-19 incidence. Census tracts with higher levels of social vulnerability were associated with higher COVID-19 incidence after adjusting for population density (adjusted RR: 1.52, 95% CI: 1.41-1.65). Conclusions: The results of this study indicate that increased social vulnerability is linked with COVID-19 incidence. Additional resources should be allocated to areas of increased social disadvantage to reduce the incidence of COVID-19 in vulnerable populations.

PTSD symptom profiles among Louisiana women affected by the 2010 Deepwater Horizon Oil Spill: A latent profile analysis.

BACKGROUND: Few prior studies have investigated the latent class structure of PTSD using DSM-5 symptoms. METHODS: To describe latent PTSD profiles among women who resided in Deepwater Horizon Oil Spill (DHOS)-affected coastal Louisiana communities, we used data from women enrolled in The Women and Their Children's Health (WaTCH) Study. Latent profile analysis was performed on the 20-item PTSD Checklist for DSM-5 (PCL-5) and model fit statistics for 2-class through 6-class solutions were compared. The pseudo-class draws method was employed on the best class solution to compare key covariates (including demographics, mental health indicators, DHOS exposure indicators, and trauma exposures) across classes. RESULTS: Among 1997 women (mean age 46.63 ± 12.14 years, 56.8% white, mean trauma categories 6.09 ± 2.98, 9.55% previously diagnosed with PTSD), model fit statistics supported a five-class solution: low symptoms (mean PCL-5 = 4.10), moderate without mood alterations (mean = 19.73), moderate with mood alterations (mean = 34.24), severe without risk-taking (mean = 55.75), and severe with risk-taking (mean = 53.80). Women in the low-symptom class were significantly more likely to be white, have finished high school, have an income of at least $40,001 per year, be married or living with a partner, and endorse fewer trauma categories than women in the four symptomatic classes. Women with moderate to severe symptoms often had co-morbid depressive symptoms and no prior PTSD diagnosis. LIMITATIONS: This study was limited by use of self-reported data and one-time assessment of PTSD symptoms. DISCUSSION: Five distinct latent profiles of DSM-5 PTSD symptoms consisted of notably different individuals. Most affected women did not report prior PTSD diagnosis. Future research and practice identifying and addressing barriers to care for trauma-affected women in these communities is warranted.

Untangling the disaster-depression knot: The role of social ties after Deepwater Horizon.

The mental health consequences of disasters, including oil spills, are well known. The goal of this study is to examine whether social capital and social support mediate the effects of exposure to the Deepwater Horizon oil spill on depression among women. Data for the analysis come from the first wave of data collection for the Women and Their Children's Health Study, a longitudinal study of the health effects of women exposed to the oil spill in southern Louisiana, USA. Women were interviewed about their exposure to the oil spill, depression symptoms, structural social capital (neighborhood organization participation), cognitive social capital (sense of community and informal social control), and social support. Structural equation models indicated that structural social capital was associated with increased levels of cognitive social capital, which were associated with higher levels of social support, which in turn were associated with lower levels of depression. Physical exposure to the oil spill was associated with greater economic exposure, which in turn was associated with higher levels of depression. When all variables were taken into account, economic exposure was no longer associated with depression, and social support and cognitive social capital mediated the effect of economic exposure on depression, explaining 67% of the effect. Findings support an extension of the deterioration model of social support to include the additional coping resource of social capital. Social capital and social support were found to be beneficial for depression post-oil spill; however, they were themselves negatively impacted by the oil spill, explaining the overall negative effect of the oil spill on depression. A better understanding of the pathways between the social context and depression could lead to interventions for improved mental health in the aftermath of a disaster.

The Women and Their Children's Health (WaTCH) study: methods and design of a prospective cohort study in Louisiana to examine the health effects from the BP oil spill.

PURPOSE: The Deepwater Horizon Oil Spill is the largest marine oil spill in US history. Few studies have evaluated the potential health effects of this spill on the Gulf Coast community. The Women and Their Children's Health (WaTCH) study is a prospective cohort designed to investigate the midterm to long-term physical, mental and behavioural health effects of exposure to the oil spill. PARTICIPANTS: Women were recruited by telephone from pre-existing lists of individuals and households using an address-based sampling frame between 2012 and 2014. Baseline interviews obtained information on oil spill exposure, demographics, physical and mental health, and health behaviours. Women were also asked to provide a household roster, from which a child between 10 and 17 years was randomly selected and recruited into a child substudy. Telephone respondents were invited to participate in a home visit in which blood samples, anthropometrics and neighbourhood characteristics were measured. A follow-up interview was completed between 2014 and 2016. FINDINGS TO DATE: 2852 women completed the baseline interview, 1231 of whom participated in the home visit, and 628 children participated in the child's health substudy. The follow-up interview successfully reinterviewed 2030 women and 454 children. FUTURE PLANS: WaTCH continues to conduct follow-up surveys, with a third wave of interviews planned in 2017. Also, we are looking to enhance the collection of spatially related environmental data to facilitate assessment of health risks in the study population. In addition, opportunities to participate in behavioural interventions for subsets of the cohort have been initiated. There are ongoing studies that examine the relationship between genetic and immunological markers with mental health.

Girls' perception of physical environmental factors and transportation: reliability and association with physical activity and active transport to school.

BACKGROUND: Preliminary evidence suggests that the physical environment and transportation are associated with youth physical activity levels. Only a few studies have examined the association of physical environmental factors on walking and bicycling to school. Therefore, the purpose of this study was (1) to examine the test-retest reliability of a survey designed for youth to assess perceptions of physical environmental factors (e.g. safety, aesthetics, facilities near the home) and transportation, and (2) to describe the associations of these perceptions with both physical activity and active transport to school. METHODS: Test and retest surveys, administered a median of 12 days later, were conducted with 480 sixth- and eighth-grade girls in or near six U.S. communities. The instrument consisted of 24 questions on safety and aesthetics of the perceived environment and transportation and related facilities. Additionally, girls were asked if they were aware of 14 different recreational facilities offering structured and unstructured activities, and if so, whether they would visit these facilities and the ease with which they could access them. Test-retest reliability was determined using kappa coefficients, overall and separately by grade. Associations with physical activity and active transport to school were examined using mixed model logistic regression (n = 610), adjusting for grade, race/ethnicity, and site. RESULTS: Item-specific reliabilities for questions assessing perceived safety and aesthetics of the neighborhood ranged from 0.31 to 0.52. Reliabilities of items assessing awareness of and interest in going to the 14 recreational facilities ranged from 0.47 to 0.64. Reliabilities of items assessing transportation ranged from 0.34 to 0.58. Some items on girls' perceptions of perceived safety, aesthetics of the environment, facilities, and transportation were important correlates of physical activity and, in some cases, active transport to school. CONCLUSION: This study provides some psychometric support for the use of the questionnaire on physical environmental factors and transportation for studying physical activity and active transport to school among adolescent girls. Further work can continue to improve reliability of these self-report items and examine their association of these factors with objectively measured physical activity.

Physical activity attitudes, preferences, and practices in African American, Hispanic, and Caucasian girls.

Physical activity levels in girls decline dramatically during adolescence, most profoundly among minorities. To explore ethnic and racial variation in attitudes toward physical activity, semistructured interviews (n = 80) and physical activity checklists (n = 130) are conducted with African American, Hispanic, and Caucasian middle school girls in six locations across the United States. Girls from all groups have similar perceptions of the benefits of physical activity, with staying in shape as the most important. Girls have similar negative perceptions of physical activity, including getting hurt, sweating, aggressive players, and embarrassment. Chores, running or jogging, exercises, and dance are common activities for girls regardless of ethnicity. Basketball, swimming, running, and dance are commonly cited favorite activities, although there are slight differences between ethnic groups. The results suggest that factors other than ethnicity contribute to girls' physical activity preferences and that distinct interventions may not be needed for each ethnic group.

Assessing mediation of behavioral and stress pathways in the association between neighborhood environments and obesity outcomes.

Although many studies have reported associations between characteristics of the neighborhood environment and obesity, little is understood about the pathways or mechanisms through which these associations operate. The purpose of this study was to examine possible behavioral and stress pathways hypothesized to mediate the association between neighborhood environments and obesity and whether pathways contribute to different obesity outcomes. Cross-sectional data were used from the 2012-2014 Women and Their Children's Health Study (WaTCH) in Louisiana (N = 909). Participants' neighborhoods, body mass index (BMI) and waist circumference (WC) were objectively measured. The causal inference approach to mediation analysis was used to obtain indirect estimates for self-reported measures of physical activity, low access to food, and depression. The mean BMI was 32.0 kg/m(2) and the mean WC was 98.6 cm. The (adverse) neighborhood environment was significantly associated BMI (ß = 0.17 kg/m(2); 95% Confidence Interval (CI): 0.03, 0.31) and WC (ß = 0.64; 95% CI: 0.34, 0.95, after adjusting for covariates. Neither depression, physical activity, nor low food access mediated those associations. Further research that investigates and uses better measures of the behavioral and stress pathways through which the neighborhood environment influences obesity is warranted.

Exploring heterogeneity and correlates of depressive symptoms in the Women and Their Children's Health (WaTCH) Study.

INTRODUCTION: Oil spill exposures are associated with increased levels of depression, which is often measured using continuous scores or dichotomous cut points on screening tools in population-based studies. Latent profile analysis can overcome analytic limitations such as 1) masking of heterogeneity in outcomes among people within dichotomous categories and 2) loss of information about symptom patterns among those with the same continuous score. This study examined variation in depressive symptoms and assessed the associations between depressive symptomatology and oil spill exposure, socioeconomic risk factors, and social capital. METHODS: Between 2012 and 2014, we interviewed 2852 women in southeastern Louisiana. We performed latent profile analysis then tested the adjusted associations between sociodemographic characteristics, oil spill exposure and latent class membership. RESULTS: Results indicated a three-class solution in which classes varied by symptom severity as the best fit. The strongest associations were among women with the most severe depressive symptoms, who were less educated, were more economically vulnerable, and had the least social support compared to women with no depressive symptoms. LIMITATIONS: This study is limited by its cross-sectional design and the self-reported nature of exposures and depressive symptoms, but results are consistent with prior literature. CONCLUSIONS: Our results support the conventional use of screening tools to estimate depressive symptomatology. Nevertheless, the identification of subgroups within study participants highlights an important finding: the subgroups were comprised of characteristically different women with varying levels of depressive symptoms, a discovery that would have been overlooked if the CES-D was used conventionally.