Neighborhood Ecologies, Cases, and Deaths during the Beginning of the COVID-19 Pandemic: Lessons for Current and Future Epidemics?

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected Black and Latinx communities. Ecologic analyses have shown that counties with a higher percentage of Latinx and Black people have worse COVID-19 outcome rates. Few ecologic analyses have been published at the neighborhood (census tract) level. We sought to determine whether certain sociodemographic neighborhood ecologies were associated with COVID-19 case and death rates in metropolitan Atlanta, Georgia. METHODS: We used census data and principal-component analysis to identify unique neighborhood ecologies. We then estimated correlation coefficients to determine whether the neighborhood profiles produced by a principal-component analysis were correlated with COVID-19 case and death rates. We conducted geographically weighted regression models to assess how correlation coefficients varied spatially for neighborhood ecologies and COVID-19 outcomes. RESULTS: We identified two unique neighborhood profiles: (1) high percentage of residents, Hispanic ethnicity, without a high school diploma, without health insurance, living in crowded households, and lower percentage older than 65 years; and (2) high percentage of residents, Black race, living in poverty, unemployed, and households receiving Supplemental Nutrition Assistance Program benefits. Profile 1 was associated with COVID-19 case rate (Pearson r = 0.462, P < 0.001) and profile 2 was associated with COVID-19 death rate (Spearman r = 0.279, P < 0.001). Correlations between neighborhood profiles and COVID-19 outcomes varied spatially. CONCLUSIONS: Neighborhoods were differentially at risk of COVID-19 cases or deaths depending on their sociodemographic ecology at the beginning of the COVID-19 pandemic. Prevention methods and interventions may need to consider different social determinants of health when addressing potential cases and deaths during future emergent epidemics.

Charity's Neighborhoods.

This tribute compares Charity Scott to Fred Rogers, highlighting how Charity nurtured health law colleagues' unique gifts and built community. Continuing the neighborhood theme, it highlights encouraging developments relating to health, housing, and place: Medicaid housing supports and potential reparations for redlining-related health inequities.

Neighborhood Disadvantage Predicts Delay in Care in Bilateral Breast Reduction.

PURPOSE: The Area Deprivation Index (ADI) is a validated quantifiable measure of neighborhood disadvantage and social determinants of health (SDoH). Higher percentiles in ADI correlate with the most disadvantaged neighborhoods: lower income, lower education, and less access to transportation. Using ADI, we aimed to investigate the impact of SDoH on bilateral breast reduction (BBR) complication rates. METHODS: A retrospective study of BBR patients from 2015 to 2021 was conducted. Patient addresses were matched to ADI percentiles and grouped into most (top 80% ADI) and least disadvantaged. Multivariable regressions were used to compare postoperative treatment between groups and adjust for confounders. RESULTS: In total, 568 patients were analyzed and 47% were high ADI. Time-to-event analysis revealed a 155% (ß = 2.55; CI, 1.87-3.48; P < 0.001) increase in time to presentation for treatment of wound-related complications among higher-deprivation patients compared to their lower-deprivation counterparts. This difference in time to presentation equated to approximately 3 days overall when comparing higher to lower deprivation patients; however, this difference between the groups increased to 12 days when comparing those who experienced wound-related complications beyond day 30. CONCLUSIONS: High deprivation was associated with increased delays to treatment after complications. More research is needed to determine the factors that impact postoperative courses among high ADI patients.

The potential role of perceived neighborhood social cohesion on COVID-19 vaccination uptake among individuals aged 50 and older: Results from the Korean Community Health Survey.

The COVID-19 pandemic highlighted the critical importance of vaccination in controlling infectious diseases. While previous research has identified social cohesion as a potential facilitator of health behaviors, empirical studies exploring its direct impact on COVID-19 vaccination rates, especially across different age groups, remain limited. This cross-sectional study utilized data from the 2021 Korean Community Health Survey, a nationally representative survey conducted in South Korea. The analysis focused on adults aged 50 and older, categorizing them into two age groups (50-64 and ≥65). We investigated the association between perceived neighborhood social cohesion and COVID-19 vaccination status, controlling for socio-economic status, health behaviors, and concerns related to COVID-19. Statistical analysis was conducted using complex sample multiple logistic regression to adjust for potential confounders. The study included 135,352 participants, with an analysis showing that in the age group ≥65, higher levels of perceived neighborhood social cohesion were significantly associated with increased vaccination uptake (aOR for trust between neighbors: 1.200, 95% CI: 1.058-1.362; aOR for mutual assistance among neighbors: 1.491, 95% CI: 1.312-1.695). Interestingly, these associations were not significant in the 50-64 age group. Additionally, satisfaction with healthcare services was associated with higher vaccination uptake in both age groups (aOR: 1.106, 95% CI: 1.004-1.219 for 50-64; aOR: 1.306, 95% CI: 1.160-1.471 for ≥65). Our findings suggest that perceived neighborhood social cohesion plays a crucial role in influencing COVID-19 vaccination uptake among older adults, particularly those aged 65 and above. These results indicate that health policies aimed at enhancing social cohesion may effectively improve vaccination rates, especially among the elderly. Future research should explore the impact of social cohesion on other age groups and assess the causal relationships in longitudinal studies.

AI-Facilitated Assessment of Built Environment Using Neighborhood Satellite Imagery and Cardiovascular Risk.

BACKGROUND: Built environment affects cardiovascular health, but comprehensive assessment in a scalable fashion, for population health and resource allocation, is constrained by limitations of current microscale measures. OBJECTIVES: The purpose of this study was to investigate the association between satellite image-based environment and risk of major adverse cardiovascular events (MACE). METHODS: Using a pretrained deep neural network, features depicting the built environment from Google Satellite Imagery (GSI) around 64,230 patients in Northern Ohio undergoing coronary artery calcium (CAC) scoring were extracted. Elastic net regularized Cox proportional hazards models identified associations of GSI features with MACE risk (defined as myocardial infarction, stroke, heart failure, or death). A composite GSI risk score was constructed using features that demonstrated nonzero coefficients in the elastic net model. We assessed association of this score with MACE risk, after adjusting for CAC scores and the social vulnerability index (SVI). Its interactions with CAC scores were also examined in subgroups. RESULTS: Adjusting for CAC and traditional risk factors, the GSI risk score was significantly associated with higher MACE risk (HR: 2.67; 95% CI: 1.63-4.38; P < 0.001). However, adding SVI reduced this association to nonsignificance (HR: 1.54; 95% CI: 0.91-2.60; P = 0.11). Patients in the highest quartile (Q4) of GSI risk score had a 56% higher observed risk of MACE (HR: 1.56; 95% CI: 1.32-1.86; P < 0.005) compared with the lowest quartile (Q1). The GSI risk score had the strongest association with MACE risk in patients with CAC = 0. This association was attenuated, but remained significant, with higher CAC. CONCLUSIONS: AI-enhanced satellite images of the built environment were linked to MACE risk, independently of traditional risk factors and CAC, but this was influenced by social determinants of health, represented by SVI. Satellite image-based assessment of the built environment may provide a rapid scalable integrative approach, warranting further exploration for enhanced risk prediction.

Probabilistic bias analysis for exposure misclassification of household income by neighbourhood in a cohort of individuals with colorectal cancer.

INTRODUCTION: Despite poor agreement, neighbourhood income is used as a proxy for household income, due to a lack of data availability. We quantified misclassification between household and neighbourhood income and demonstrate quantitative bias analysis (QBA) in scenarios where only neighbourhood income is available in assessing income inequalities on colorectal cancer mortality. METHODS: This was a retrospective study of adults with colorectal cancer diagnosed 2006-14 from Statistics Canada's Canadian Census Health and Environment Cohort. Neighbourhood income quintiles from Statistics Canada were used. Census household income quintiles were used to determine bias parameters and confirm results of the QBA. We calculated positive and negative predictive values using multinomial models, adjusting for age, sex and rural residence. Probabilistic QBA was conducted to explore the implication of exposure misclassification when estimating the effect of income on 5-year mortality. RESULTS: We found poor agreement between neighbourhood and household income: positive predictive values ranged from 21% to 37%. The bias-adjusted risk of neighbourhood income on 5-year mortality was similar to the risk of mortality by household income. The bias-adjusted relative risk of the lowest income quintile compared with the highest was 1.42 [95% simulation interval (SI) 1.32-1.53] compared with 1.46 [95% confidence interval (CI) 1.39-1.54] for household income and 1.18 (95% CI 1.12-1.24) for neighbourhood income. CONCLUSION: QBA can be used to estimate adjusted effects of neighbourhood income on mortality which represent household income. The predictive values from our study can be applied to similar cohorts with only neighbourhood income to estimate the effects of household income on cancer mortality.

Does growing up in a physical activity-friendly neighborhood increase the likelihood of remaining active during adolescence and early adulthood?

BACKGROUND: The SOPHYA-cohort-study investigated whether the objectively characterized and perceived residential neighborhood of Swiss youth predict accelerometer-measured physical activity and activity in specific domains (participation in a sports club and cycling) five years later. METHODS: At baseline in 2014, 1230 children and adolescents aged 6 to 16 years participated and wore accelerometers for 7 days. Of these children, 447 participated again in the follow-up study in 2019 and provided longitudinal accelerometer measurements. Sociodemographic factors and perceptions of the local neighbourhood were assessed by questionnaire. Specific objective environmental data (e.g. built environment or social environment) was modelled to the children's address at baseline. Multivariate linear and logistic regression models were applied to identify short- and long-term characteristics that are associated with accelerometer-based physical activity, cycling and participation in organised sport. RESULTS: If the neighborhood-score as perceived by the parents in 2014 was in the middle or lowest tertile, children were significantly less active cross-sectionally in 2014 (-41.1 (-78.0;-4.2) and -52.4 (-88.6;-16.2) counts per minute, cpm), and five years later (-52.4 (-88.6;-16.2) and 48.1 (-86.6;-9.7) cpm). In addition, they were also less likely to accumulate active minutes above the median at both measuring points compared to peers of the same age and sex. Using objective environmental data modeled around the children's residential address, similar associations were found: In the tertile with the lowest proportion of green space children achieved less cpm in 2014, while a high main street density and a low socioeconomic environment, respectively, hindered physical activity tracking above the median longitudinally. Also for cycling and participation in a sport club, the associations with the perceived and objective environment were more pronounced in the longitudinal analyses. CONCLUSION: The results suggest that growing up in a physical activity friendly neighborhood increases the likelihood of remaining active during adolescence and early adulthood. Interventions should be implemented to ensure that children growing up in an unfavorable neighborhood do not fall behind at an early stage.

Neighborhood poverty and hopelessness in older adults: The mediating role of perceived neighborhood disorder.

Hopelessness is one of the strongest predictors of health and mortality, particularly for older populations. Prior research has found associations between individual-level socioeconomic factors and hopelessness, but less is known about the potential importance of neighborhood-level socioeconomic contexts for hopelessness. In particular, the role of neighborhood disorder as a potential explanatory factor for poor psychological well-being remains underexplored. This study investigates whether neighborhood poverty is associated with a sense of hopelessness among older adults and if perceived neighborhood disorder mediates the link between poverty and hopelessness. Individual-level data came from the 2014/2016 Health and Retirement Study and were merged with neighborhood-level poverty data from the 2012-2016 and 2014-2018 American Community Survey. Linear regression models were employed to examine the association between neighborhood poverty, disorder, and hopelessness. Respondents in neighborhoods with higher poverty levels reported a greater sense of hopelessness (b = 0.11, 95% CI = 0.08, 0.15, p < .001), controlling for individual-level sociodemographic and health characteristics. Greater perceived neighborhood disorder was also positively associated with a sense of hopelessness (b = 0.16, 95%CI = 0.14, 0.18). When we included both neighborhood poverty and disorder in the same model, the association between neighborhood poverty and hopelessness was reduced by two thirds (b = 0.04, 95%CI = 0.0003, 0.07), while the association between perceived disorder and hopelessness remained robust (b = 0.16, 95%CI = 0.14, 0.18). We further examined the formal mediating effects of neighborhood disorder using structural equation modeling. The total effect of neighborhood poverty on hopelessness was significant (ß = 0.08, bootstrapped 95%CI = 0.05, 0.10). The direct effect of neighborhood poverty was not significant (ß = 0.02, bootstrapped 95% CI = -0.01, 0.04), while the indirect effect through neighborhood disorder was significant (ß = 0.06, bootstrapped 95% CI = 0.05, 0.07). Neighborhood disorder mediated 75% of the association between neighborhood poverty and hopelessness. In light of these findings, improving neighborhood conditions, such as signs of disorder, may alleviate feelings of hopelessness in older adults residing in impoverished neighborhoods.

Neighborhood socioeconomic factors and characteristics correlated with avoidable emergency department visits: A spatial analysis of a Canadian academic hospital.

INTRODUCTION: The influence of neighborhood characteristics and socioeconomic status (SES) factors on avoidable emergency department (ED) utilization is not well understood in a universal healthcare system. We examined correlations between these factors and avoidable ED visits at a Canadian academic hospital. MATERIALS AND METHODS: We conducted a retrospective cohort study using administrative ED data from a hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023, and neighborhood data from the Statistics Canada Census of Population 2021. Avoidable visits were classified using the Emergency Department Avoidability Classification (EDAC), and mapped to neighborhoods using Canadian postal codes. SES was defined primarily based on education attained, household income, employment and housing security. The top 20 postal codes with the highest avoidable ED visits were categorized into quartiles and analyzed for trends using chi-squared tests of spatial association and Spearman rank correlations. RESULTS: A consistent ordinal trend across quartiles was observed throughout the study period, with quartile 1 representing the lowest avoidable ED visits and quartile 4 the highest. The quartiles were unevenly distributed spatially, though there was a significant association between close proximity to the ED and avoidable visits (X2 = 7.07, p <0.05). The quartile with the highest avoidable ED visits (quartile 4) had the greatest proportion of one-person households (35.5%) and one-parent families (37.8%), and showed statistically significant positive correlations with male sex, living alone and having an indigenous identity. Quartile 4 had the highest rates of individuals not completing high school (18.6%, p < 0.05), unemployment (13.7%), households spending greater than 30% of their income on shelter (26.5%), and households earning less than $30,000 annually (16.6%, compared to 8.7% in quartile 1 with the lowest avoidable ED visits). DISCUSSION: In a universal healthcare setting, lower SES neighborhoods were correlated with higher rates of avoidable ED visits. Targeted interventions that address social determinants of health disparities in neighborhoods with lower SES could reduce the burden of avoidable ED visits, and promote more equitable healthcare utilization.

Depression risk and resilience in a diverse sample of older adults in the United States.

Living in poor and physically deteriorating neighborhoods is associated with heightened likelihood of experiencing depression. At the same time, not all people experience their neighborhoods in the same way. We predicted and tested the possibility that variability in this association can be explained by the social support that people derive both from their personal networks and other people residing in the same neighborhood, and that this moderation varies by race/ethnicity. Health and Retirement Study data (2018/2020 waves) were used to evaluate the role of individual-level and contextual risk and resilience factors in association with depression among US older non-Hispanic white adults (n = 4,986, mean age 67 years), non-Hispanic black adults (n = 1,342, mean age 65 years), and Hispanic adults (n = 937, mean age 64 years). Four notable findings emerged. First, perceived neighborhood disorder was related to increased depression risk for non-Hispanic white and black participants, but not Hispanic participants. Second, participants residing in census tracts with higher poverty rates were more likely to report depression. Third, non-Hispanic white participants residing in census tracts with greater Hispanic resident density had reduced depression risk. This same pattern was not observed among non-Hispanic black participants. Finally, perceived support from family was associated with reduced depression risk among all participants. These data suggest both individual- and contextual-level sources of risk and resiliency for depression. The implications for theories that seek to explain the relative resilience to neighborhood disorder observed among US Hispanic residents are discussed.

Neighborhood Disadvantage and Birth Outcomes Among Refugees.

OBJECTIVE: To examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment. METHODS: This register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance. These data were linked to individual-level birth register data. Outcomes included low birth weight, preterm birth, and small-for-gestational-age infants. Associations between neighborhood disadvantage at resettlement and birth outcomes up to 20 years after resettlement were examined using multivariable regressions adjusting for characteristics of the women at resettlement. RESULTS: Each SD of increase in neighborhood disadvantage was associated with an 18% increase in low birth weight risk (0.61 percentage points [pp], 95% confidence interval [CI]: 0.19-1.02), 15% increase in preterm birth risk (0.64 pp, 95% CI: 0.22-1.07), and 7% increase in small-for-gestational-age risk (0.78 pp, 95% CI: 0.01-1.54) 5 years after resettlement. Results did not differ after adjusting for urbanicity and conational density, but associations were attenuated after adjusting for municipality-level fixed effects, suggesting that local government characteristics may partially explain the associations. CONCLUSIONS: Resettling in a disadvantaged neighborhood is associated with higher risk of adverse birth outcomes among refugee women. This highlights how policy decisions affecting settlement of refugees can have long-term consequences, including on the health of the next generation.

Neighborhood Disadvantage and Prostate Tumor Aggressiveness among African American and European American Men.

BACKGROUND: Studies have identified associations between neighborhood disadvantage (ND), which is more likely to affect African American (AA) individuals, and aggressive prostate cancer. Thus, ND may contribute to prostate cancer disparities. However, it is unknown what ND components drive aggressive disease and whether associations vary by race. METHODS: We evaluated associations between aggressive prostate cancer and four ND metrics-Area Deprivation Index (ADI), validated Bayesian Neighborhood Deprivation Index (NDI), racial isolation (RI) index, and historical redlining, and whether these factors interacted with race, among men with prostate cancer treated at the University of Maryland Greenebaum Comprehensive Cancer Center (2004-2021). RESULTS: We included 1,458 men (698 European American and 760 AA). AA men were more likely to experience ND. In adjusted models, the ADI, RI, and redlining were significantly associated with aggressive versus nonaggressive prostate cancer overall [ADI, OR for one SD increase = 1.14, 95% confidence interval (CI), 1.00-1.30; RI, OR = 1.27, CI, 1.07-1.51; redlining, OR = 1.77; CI, 1.23-2.56] and among AA men. The NDI was associated with aggressive prostate cancer among AA men (OR = 1.32, 95% credible interval: 1.13-1.57); percent in poverty received the largest importance weight. The ADI (P heterogeneity = 0.002) and NDI (exceedance probability heterogeneity = 98.1%) significantly interacted with race, such that associations were significantly stronger for AA men. CONCLUSIONS: We identified novel significant positive associations for racial segregation and historical redlining with aggressive prostate cancer and significant interactions between ND indices and race. IMPACT: Findings inform specific ND components that are associated with aggressive prostate cancer and suggest the ND effect is stronger for AA men, which has implications for interventions to reduce disparities.

Neighborhood Safety Concerns and the Onset of Depressive Symptoms Among Women: A Population-based Prospective Cohort Study in South Korea.

Neighborhood safety is crucial for the well-being of residents; however, longitudinal evidence is scarce. This study explored the association between neighborhood safety concerns and depressive symptoms among women. A nationally representative sample of 10,008 women was surveyed in 2016. Six dimensions of neighborhood safety concerns were assessed: crime, food, safety at night, traffic accidents, building and facility, and general safety. The total score for neighborhood safety concerns ranged from 6 to 24, with higher scores indicating greater concerns. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiologic Studies Depression. For cross-sectional analyses, we explored how neighborhood safety concerns were associated with concurrent depressive symptoms at baseline. For the longitudinal analyses, we explored how they were associated with depressive symptom onset at the 2-year follow-up (2018) among women without depressive symptoms at baseline (n = 7,643). Logistic regressions were employed. The mean (standard deviation [SD]) of the neighborhood safety concern score was 12.7 (3.3). In the cross-sectional analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.23-fold (95% CI: 1.13-1.35) increase in the odds of concurrent depressive symptoms at the baseline year. In the longitudinal analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.15-fold (95% CI: 1.03-1.29) increase in the odds of experiencing the onset of depressive symptoms at the follow-up year. This study suggests that neighborhood safety concerns are risk factors for the development of depressive symptoms of female residents. Policy efforts are necessary to ensure community safety.

West African Genetic Ancestry, Neighborhood Deprivation, and Prostate Cancer.

Importance: Racial disparities in prostate cancer are likely the result of complex relationships between both socioeconomic and environmental factors captured by the neighborhood environment and genetic factors, including West African genetic ancestry. However, few studies have examined the combined role of neighborhood environment and genetic ancestry in developing lethal prostate cancer. Objective: To examine the interactions between West African genetic ancestry and neighborhood deprivation in modifying prostate cancer risk and mortality. Design, Setting, and Participants: This case-control study was conducted in the Greater Baltimore area. Participants included men of African and European descent (617 cases with prostate cancer, 852 controls without prostate cancer) enrolled between January 2005 and January 2016. Follow-up was performed through December 31, 2020, using the National Death Index. Analysis was conducted from August 2023 to January 2024. Exposure: Included exposures were West African genetic ancestry, derived from large-scale genotyping, and neighborhood deprivation, defined using 2000 census-tract-level Neighborhood Deprivation Index (NDI) score. Main Outcomes and Measures: Outcomes of interest were prostate cancer and all-cause mortality. Results: Among a total of 1469 participants (mean [SD] age, 64.96 [7.95] years), there were 736 self-identified Black and 733 White men, and the mean (range) proportion of West African genetic ancestry was 0.27 (0.04-0.84) among participants residing in areas with low levels of deprivation and 0.48 (0.07-0.83) among participants residing in areas with high levels of deprivation. Multivariable logistic regression analysis revealed a significant multiplicative interaction of West African genetic ancestry and neighborhood deprivation with the odds of a prostate cancer diagnosis (P for interaction = .02). Among individuals living in neighborhoods with high NDI scores, West African genetic ancestry was associated with increased odds of a prostate cancer diagnosis (age-adjusted odds ratio [OR], 1.98; 95% CI, 1.23-3.19). In contrast, West African genetic ancestry was associated with reduced odds of this diagnosis among individuals residing in areas with medium to low levels of deprivation (age-adjusted OR, 0.22; 95% CI, 0.11-0.44). There was no significant multiplicative interaction between West African genetic ancestry and neighborhood deprivation for all-cause mortality (P for interaction = .44). The positive association of neighborhood deprivation with prostate cancer was independent of West African genetic ancestry (age- and West African ancestry-adjusted OR, 1,70; 95% CI, 1.50-1.94). Conclusions and Relevance: This case-control study of men with West African and European ancestry found that West African genetic ancestry was associated with increased odds of prostate cancer among males who resided in neighborhoods with high deprivation but lower odds in more affluent neighborhoods. Thus, neighborhood environments may play a critical role in defining how genetic ancestry modulates prostate cancer risk.

Neighborhood Child Opportunity and Preterm Birth Rates by Race and Ethnicity.

Importance: In the US, infants born to non-Hispanic Black birthing parents are 50% more likely to be born preterm than those born to non-Hispanic White birthing parents, and individual-level factors do not fully account for this inequity. Neighborhood context, rooted in historic patterns of structural racism, may facilitate understanding patterns of inequity in preterm birth. Objective: To estimate the association between neighborhood opportunity level, measured by the Child Opportunity Index (COI), and preterm birth among infants in Massachusetts. Design, Setting, and Participants: In this cross-sectional, population-based study, Massachusetts birth certificates from 3 large metropolitan areas (Boston, Springfield, and Worcester) were linked to US Census tract-level data from the COI, and log binomial regression models and generalized estimating equations were fit to examine associations of different levels of opportunity with preterm birth. Singleton infants born in Massachusetts between February 1, 2011, and December 31, 2015, were included. Analyses were originally conducted in 2019 and updated in 2024. Exposure: Level of child opportunity (measured by the COI) at the US Census tract level. Race and ethnicity were ascertained from the birth certificate, as reported by the birthing parent. Main Outcomes and Measures: Live birth before 37 completed weeks' gestation. Results: The analytic dataset included 267 553 infants, of whom 18.9% were born to Hispanic, 10.1% to non-Hispanic Asian or Pacific Islander, 10.1% to non-Hispanic Black, and 61.0% to non-Hispanic White birthing parents. More than half of infants born to non-Hispanic Black and Hispanic birthing parents were born into very low opportunity neighborhoods, and in crude models, this was associated with greater prevalence of preterm birth relative to very high opportunity neighborhoods (prevalence ratio, 1.44; 95% CI, 1.37-1.52). After adjustment for covariates, infants born into very low opportunity neighborhoods still had a greater prevalence of preterm birth (prevalence ratio, 1.16; 95% CI, 1.10-1.23). Conclusions and Relevance: In this cross-sectional study of neighborhood opportunity and preterm birth, elevated risk associated with exposure to a very low opportunity neighborhood, coupled with the disproportionate exposure by race and ethnicity, points to a modifiable factor that may contribute to racial and ethnic inequities in preterm birth. Future research should investigate interventions that seek to address neighborhood opportunity.

Lasting Legacy: The Enduring Relationship Between Racially Restrictive Housing Covenants and Health and Wellbeing.

Racially restrictive covenants in housing deeds, commonplace in Minnesota for houses built from the 1910s to the 1950s, provided a foundation for the myriad of policies that made it difficult for people of color to obtain housing. Though covenants were ruled illegal in 1968, their legacy continues to shape neighborhoods. The Mapping Prejudice Project's efforts in Hennepin County, Minnesota, produced the first systematic documentation of racially restrictive covenants. We use this novel data set to explore the relationship between historic covenants and current health and wellbeing outcomes. Using regression analysis to control for neighborhood level covariates, we compare previously covenanted neighborhoods to neighborhoods without covenants. Today, previously covenanted neighborhoods have higher life expectancy and lower rates of obesity, diabetes, coronary heart disease, and asthma than neighborhoods without racially restrictive covenants. Additionally, previously covenanted neighborhoods have less upward mobility for children from poorer households, and there are larger gaps in upward mobility between white and Black children. These findings contribute to a growing literature that shows racist policies, even decades after they are legally enforceable, leave an imprint on neighborhoods. Using the novel data from the Mapping Prejudice Project, we provide statistical analysis that confirms qualitative and anecdotal evidence on the role of racial covenants in shaping neighborhoods.

Neighborhood Racial and Ethnic Predominance, Child Opportunity, and Violence-Related Mortality among Children and Adolescents in Chicago.

Our objective was to determine whether Child Opportunity Index (COI), a measure of neighborhood socioeconomic and built environment specific to children, mediated the relationship of census tract Black or Hispanic predominance with increased rates of census tract violence-related mortality. The hypothesis was that COI would partially mediate the relationship. This cross-sectional study combined data from the American Community Survey 5-year estimates, the COI 2.0, and the Illinois Violent Death Reporting System 2015-2019 for the City of Chicago. Individuals ages 0-19 years were included. The primary exposure was census tract Black, Hispanic, White, and other race predominance (> 50% of population). The primary outcome was census tract violence-related mortality. A mediation analysis was performed to evaluate the role of COI as a potential mediator. Multivariable logistic regression modeling census tract violence-related mortality demonstrated a direct effect of census tract Black predominance (adjusted odds ratio [aOR] 2.59, 95% confidence interval [CI] 1.30-5.14) on violence-related mortality compared to White predominance. There was no association of census tract Hispanic predominance with violence-related mortality compared to White predominance (aOR 1.57, 95% CI 0.88-2.84). Approximately 64.9% (95% CI 60.2-80.0%) of the effect of census tract Black predominance and 67.9% (95% CI 61.2-200%) of the effect of census tract Hispanic predominance on violence-related mortality was indirect via COI. COI partially mediated the effect of census tract Black and Hispanic predominance on census tract violence-related mortality. Interventions that target neighborhood social and economic factors should be considered to reduce violence-related mortality among children and adolescents.

Daily Diversity Flows: Racial and Ethnic Context Between Home and Work.

The racial and ethnic diversification of the U.S. population has transformed the demographic makeup of communities and rapidly increased exposure to diversity in American neighborhoods. Although diversity exposure occurs throughout people's daily lives, the conventional approach to describing diversity only at places of residence potentially understates the full extent of this phenomenon. In this study, we explore short-term, within-day changes in the diversity of different neighborhoods by considering U.S. workers' work and residential locations. Using estimates for daytime and nighttime populations among metropolitan census tracts, our empirical analyses investigate the extent to which the process of daytime mobility for work relates to changes in the racial and ethnic diversity of different spaces. Our results indicate widespread daily shifts toward diversity for most neighborhood types, especially those with residential (nighttime) populations that are predominantly Black, Latino, or Asian. We find that patterns of intraday diversification experienced minor declines across recent decades but are present in most metropolitan areas. Our findings also show that intraday changes in racial and ethnic diversity overlap with nonracial forms of daily diversity change. Further, average within-day changes in diversity are more pronounced in areas with greater residential segregation.

Interpersonal, Community, and Societal Stressors Mediate Black-White Memory Disparities.

OBJECTIVES: Structural racism creates contextual stressors that disproportionately affect Black, relative to White, older adults in the United States and may contribute to worse cognitive health. We examined the extent to which interpersonal, community, and societal stressors uniquely explain Black-White disparities in initial memory and memory change. METHODS: The sample included 14,199 non-Latino Black and White older adults (Mage = 68.32, 19.8% Black) from the U.S. Health and Retirement Study who completed psychosocial questionnaires at baseline and a word list memory task every 2 years over an 8-year period. Interpersonal, community, and societal stressors were operationalized as self-reported everyday discrimination, neighborhood physical disorder, and subjective societal status, respectively. Latent growth curves modeled longitudinal memory performance. Stressors were modeled simultaneously and allowed to correlate. Covariates included age, sex, education, wealth, parental education, and Southern residence. RESULTS: Compared to White participants, Black participants experienced more discrimination (ß = -0.004, standard error [SE] = 0.001, p < .001), more neighborhood physical disorder (ß = -0.009, SE = 0.002, p < .001), and lower perceived societal status (ß = -0.002, SE = 0.001, p = .001), each of which uniquely mediated the racial disparity in initial memory. Sensitivity analyses utilizing proxy-imputed memory scores revealed an additional racial disparity in memory change, wherein Black participants evidenced a faster decline than White participants. This disparity in memory change was only uniquely mediated by more everyday discrimination among Black participants. DISCUSSION: Elements of structural racism may contribute to cognitive disparities via disproportionate stress experiences at multiple contextual levels among Black older adults. Future research should consider multilevel protective factors that buffer against negative impacts of racism on health.

Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity.

Importance: Limited access to healthy foods, resulting from residence in neighborhoods with low food access, is a public health concern. The contribution of this exposure in early life to child obesity remains uncertain. Objective: To examine associations of neighborhood food access during pregnancy or early childhood with child body mass index (BMI) and obesity risk. Design, Setting, and Participants: Data from cohorts participating in the US nationwide Environmental Influences on Child Health Outcomes consortium between January 1, 1994, and March 31, 2023, were used. Participant inclusion required a geocoded residential address in pregnancy (mean 32.4 gestational weeks) or early childhood (mean 4.3 years) and information on child BMI. Exposures: Residence in low-income, low-food access neighborhoods, defined as low-income neighborhoods where the nearest supermarket is more than 0.5 miles for urban areas or more than 10 miles for rural areas. Main Outcomes and Measures: BMI z score, obesity (age- and sex-specific BMI ≥95th percentile), and severe obesity (age- and sex-specific BMI ≥120% of the 95th percentile) from age 0 to 15 years. Results: Of 28 359 children (55 cohorts; 14 657 [51.7%] male and 13 702 [48.3%] female; 590 [2.2%] American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander; 1430 [5.4%] Asian; 4034 [15.3%] Black; 17 730 [67.2%] White; and 2592 [9.8%] other [unspecified] or more than 1 race; 5754 [20.9%] Hispanic and 21 838 [79.1%] non-Hispanic) with neighborhood food access data, 23.2% resided in low-income, low-food access neighborhoods in pregnancy and 24.4% in early childhood. After adjusting for individual sociodemographic characteristics, residence in low-income, low-food access (vs non-low-income, low-food access) neighborhoods in pregnancy was associated with higher BMI z scores at ages 5 years (ß, 0.07; 95% CI, 0.03-0.11), 10 years (ß, 0.11; 95% CI, 0.06-0.17), and 15 years (ß, 0.16; 95% CI, 0.07-0.24); higher obesity risk at 5 years (risk ratio [RR], 1.37; 95% CI, 1.21-1.55), 10 years (RR, 1.71; 95% CI, 1.37-2.12), and 15 years (RR, 2.08; 95% CI, 1.53-2.83); and higher severe obesity risk at 5 years (RR, 1.21; 95% CI, 0.95-1.53), 10 years (RR, 1.54; 95% CI, 1.20-1.99), and 15 years (RR, 1.92; 95% CI, 1.32-2.80). Findings were similar for residence in low-income, low-food access neighborhoods in early childhood. These associations were robust to alternative definitions of low income and low food access and additional adjustment for prenatal characteristics associated with child obesity. Conclusions: Residence in low-income, low-food access neighborhoods in early life was associated with higher subsequent child BMI and higher risk of obesity and severe obesity. We encourage future studies to examine whether investments in neighborhood resources to improve food access in early life would prevent child obesity.