Determining Gentrification's Relationship to Birth Outcomes in Metropolitan California.

There is inconsistent evidence as to whether gentrification, the increase of affluent residents into low-income neighborhoods, is detrimental to health. To date, there is no systematic evidence on how gentrification may matter for a range of birth outcomes across cities with varying characteristics. We utilize California's Birth Cohort File (2009-2012), Decennial Census data, and the American Community Survey (2008-2012) to investigate the relationship of gentrification to: preterm birth, low birthweight, and small-for-gestational-age across California. We find that socioeconomic gentrification is uniformly associated with better birth outcomes. Notably, however, we find that only places specifically experiencing increases in non-White gentrification had this positive impact. These associations vary somewhat by maternal characteristics and by type of gentrification measure utilized; discrepancies between alternative measurement strategies are explored. This study provides evidence that socioeconomic gentrification is positively related to birth outcomes and the race-ethnic character of gentrification matters, emphasizing the continued need to examine how gentrification may impact a range of health and social outcomes.

Financial strain moderates genetic influences on self-rated health: support for diathesis-stress model of gene-environment interplay.

Data from the Interplay of Genes and Environment across Multiple Studies (IGEMS) consortium were used to examine predictions of different models of gene-by-environment interaction to understand how genetic variance in self-rated health (SRH) varies at different levels of financial strain. A total of 11,359 individuals from 10 twin studies in Australia, Sweden, and the United States contributed relevant data, including 2,074 monozygotic and 2,623 dizygotic twin pairs. Age ranged from 22 to 98 years, with a mean age of 61.05 (SD = 13.24). A factor model was used to create a harmonized measure of financial strain across studies and items. Twin analyses of genetic and environmental variance for SRH incorporating age, age2, sex, and financial strain moderators indicated significant financial strain moderation of genetic influences on self-rated health. Moderation results did not differ across sex or country. Genetic variance for SRH increased as financial strain increased, matching the predictions of the diathesis-stress and social comparison models for components of variance. Under these models, environmental improvements would be expected to reduce genetically based health disparities.

Acculturation, Mental Health, and Wellbeing Among Hispanic/Latinx Young Adult Survivors of Childhood Cancer.

Purpose: Ethnic disparities in childhood cancer survivor (CCS) mental health have been identified, although prior survivorship research has focused predominantly on non-Hispanic/Latinx (H/L) white survivors. Methods: This study examined the association of acculturation with depressive symptoms and wellbeing among 582 young adult H/L CCS recruited to a population-based study of CCS in Southern California. Results: In multivariable regression models adjusted for covariates, greater identification with both the Hispanic and Anglo cultures was positively associated with wellbeing (p = 0.007 and p < 0.0001, respectively), and Hispanic cultural identification was associated with fewer depressive symptoms (p = 0.04). Conclusions: Greater understanding of unique protective factors among minority CCS may inform tailored interventions promoting mental health.

Educational Attainment and Perceived Need for Urgent Care.

While lower educational attainment is associated with worse health status, education may also affect one's ability to identify need for urgent care. Using data from the 2010 Medicare CAHPS survey, we estimated multivariate logistic models to test the relationship between self-reported educational attainment and the perceived need for urgent care, controlling for health status and other factors. As expected, lower educational attainment was associated with greater reported need for urgent care in bivariate analyses because of poorer health. However, lower educational attainment was associated with less perceived need for urgent care after controlling for health status, particularly for those in poor health. These findings suggest the need for interventions to improve the likelihood that people with less education recognize the need for urgent care, particularly those in poor health and in most need of urgent care.

IGEMS: The Consortium on Interplay of Genes and Environment Across Multiple Studies - An Update.

The Interplay of Genes and Environment across Multiple Studies (IGEMS) is a consortium of 18 twin studies from 5 different countries (Sweden, Denmark, Finland, United States, and Australia) established to explore the nature of gene-environment (GE) interplay in functioning across the adult lifespan. Fifteen of the studies are longitudinal, with follow-up as long as 59 years after baseline. The combined data from over 76,000 participants aged 14-103 at intake (including over 10,000 monozygotic and over 17,000 dizygotic twin pairs) support two primary research emphases: (1) investigation of models of GE interplay of early life adversity, and social factors at micro and macro environmental levels and with diverse outcomes, including mortality, physical functioning and psychological functioning; and (2) improved understanding of risk and protective factors for dementia by incorporating unmeasured and measured genetic factors with a wide range of exposures measured in young adulthood, midlife and later life.

Attained SES as a moderator of adult cognitive performance: Testing gene-environment interaction in various cognitive domains.

We examined whether attained socioeconomic status (SES) moderated genetic and environmental sources of individual differences in cognitive performance using pooled data from 9 adult twin studies. Prior work concerning SES moderation of cognitive performance has focused on rearing SES. The current adult sample of 12,196 individuals (aged 27-98 years) allowed for the examination of common sources of individual differences between attained SES and cognitive performance (signaling potential gene-environment correlation mechanisms, rGE), as well as sources of individual differences unique to cognitive performance (signaling potential gene-environment interaction mechanisms, G × E). Attained SES moderated sources of individual differences in 4 cognitive domains, assessed via performance on 5 cognitive tests ranging 2,149 to 8,722 participants. Attained SES moderated common sources of influences for 3 domains and influences unique to cognition in all 4 domains. The net effect was that genetic influences on the common pathway tended to be relatively more important at the upper end of attained SES indicating possible active rGE, whereas, genetic influences for the unique pathway were proportionally stable or less important at the upper end of attained SES. As a noted exception, at the upper end of attained SES, genetic influences unique to perceptual speed were amplified and genetic influences on the common pathway were dampened. Accounting for rearing SES did not alter attained SES moderation effects on cognitive performance, suggesting mechanisms germane to adulthood. Our findings suggest the importance of gene-environment mechanisms through which attained SES moderates sources of individual differences in cognitive performance. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Dynamic contribution of chronic conditions to temporal trends in disability among U.S. adults.

BACKGROUND: Although evidence has shown that U.S. late-life disability has been declining, studies have also suggested that there has been an increase in chronic diseases between 1984 and 2007. OBJECTIVES: To further illuminate these potentially contradictory trends, we explicate how the contribution of chronic conditions changes across four common types of disability (ADL, IADL, mobility disability, and functional limitations) by age (A), period (P), and birth cohorts (C) among adults aged 20 and above. METHODS: Our data came from seven cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES). We utilize a cross-classified random effect model (CCREM) to simultaneously estimate age, period, and cohort trends for each disability. Each chronic condition was sequentially then simultaneously added to our base models (sociodemographics only). Reductions in predicted probability from the base model were then calculated for each chronic condition by each temporal dimension (A/P/C) to assess the contribution of each chronic condition. RESULTS: There was increasing age-based contribution of chronic conditions to all disabilities. The period-based contribution remained quite stagnant across years while cohort-based contributions showed a continual decline for recent cohorts. Arthritis showed the greatest contribution to disability of all types which was followed by obesity. Cancer was the least important contributor to disabilities. CONCLUSION: Although chronic conditions are becoming less disabling across recent cohorts, other competing risk factors might suggest prevailing causes of disability.

Black-white disparity in disability among U.S. older adults: age, period, and cohort trends.

OBJECTIVES: This study delineates activities of daily living (ADL) and instrumental activities of daily living (IADL) black-white disparity trends by age, period, and cohort (APC) and explores sociodemographic contributors of cohort-based disparity trends. METHOD: We utilized multiple cross-sectional waves of National Health Interview Survey data (1982-2009) to describe APC trends of ADL and IADL disparities using a cross-classified random effect model. Further, we decomposed the cohort-based disparity trends using Fairlie's decomposition method for nonlinear outcomes. RESULTS: The crossover ADL and IADL disparities (whites > blacks) occurring at age 75 increased with age and reached a plateau at age of 80, whereas period-based ADL and IADL disparities remained constant for the past 3 decades. The cohort disparity trends for both disabilities showed a decline with each successive cohort except for ADL disparity among women. DISCUSSION: We examined the role of aging on racial disparity in disability and found support for the racial crossover effect. Further, the racial disparity in disability will disappear should the observed pattern of declining cohort-based ADL and IADL disparities persist. Although education, income, and marital status are important sociodemographic contributors to cohort disparity trends, future studies should investigate individual behavioral health determinants and cohort-specific characteristics that explain the cohort-based racial difference in ADL and IADL disabilities.

Racial disparities in self-rated health: trends, explanatory factors, and the changing role of socio-demographics.

This paper uses data from the U.S. National Health Interview Surveys (N = 1,513,097) to describe and explain temporal patterns in black-white health disparities with models that simultaneously consider the unique effects of age, period, and cohort. First, we employ cross-classified random effects age-period-cohort (APC) models to document black-white disparities in self-rated health across temporal dimensions. Second, we use decomposition techniques to shed light on the extent to which socio-economic shifts in cohort composition explain the age and period adjusted racial health disparities across successive birth cohorts. Third, we examine the extent to which exogenous conditions at the time of birth help explain the racial disparities across successive cohorts. Results show that black-white disparities are wider among the pre-1935 cohorts for women, falling thereafter; disparities for men exhibit a similar pattern but exhibit narrowing among cohorts born earlier in the century. Differences in socioeconomic composition consistently contribute to racial health disparities across cohorts; notably, marital status differences by race emerge as an increasingly important explanatory factor in more recent cohorts for women whereas employment differences by race emerge as increasingly salient in more recent cohorts for men. Finally, our cohort characteristics models suggest that cohort economic conditions at the time of birth (percent large family, farm or Southern birth) help explain racial disparities in health for both men and women.

Structural stigma and all-cause mortality in sexual minority populations.

Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma-operationalized as living in communities with high levels of anti-gay prejudice-increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR] = 3.03, 95% Confidence Interval [CI] = 1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations.

The relationship between height and neighborhood context across racial/ethnic groups: a multi-level analysis of the 1999-2004 U.S. National Health and Nutrition Examination Survey.

While a growing literature has documented a link between neighborhood context and health outcomes, little is known about the relationship between neighborhood characteristics and height. Using individual data from the 1999-2004 U.S. National Health and Nutrition Examination Survey merged with tract-level data from the U.S. Census, we investigate several neighborhood characteristics, including neighborhood socioeconomic status (NSES), education index of concentration at the extremes (ICE), and population density, as potential predictors of height. Employing a series of two-level random intercept models, we find a one standard deviation increase in NSES to be associated with a 0.6-1.4 cm height advantage for white and foreign-born Mexican-American females and for U.S. born Mexican-American males, net of individual-level controls. Similarly, a 10 point increase in neighborhood education ICE was associated with 0.23-0.32 cm greater height for white and foreign-born Mexican-American females and U.S. born Mexican-American males. Population density was nominally negatively associated with height for foreign-born Mexican-American females. Our findings reveal that lower physical stature for some ethnic and gender groups is clustered within neighborhoods of low SES and education, suggesting that contextual factors may play a role in influencing height above individual-level attributes.

Trends in US older adult disability: exploring age, period, and cohort effects.

OBJECTIVES: We elucidated how US late-life disability prevalence has changed over the past 3 decades. METHODS: We examined activities of daily living (ADL) and instrumental activities of daily living (IADL) disability trends by using age-period-cohort (APC) models among older adults aged 70 years or older who responded to the National Health Interview Survey between 1982 and 2009. We fitted logistic regressions for ADL and IADL disabilities and for each of the 3 APC trends with 2 models: unadjusted and fully adjusted for age, period, cohort, and sociodemographic variables. RESULTS: The unadjusted and adjusted period trends showed a substantial decline in IADL disability, and ADL disability remained stable across time. Unadjusted cohort trends for both outcomes also showed continual declines across successive cohorts; however, increasing cohort trends were evident in the adjusted models. CONCLUSIONS: More recent cohorts of US older adults are becoming more disabled, net of aging and period effects. The net upward cohort trends in ADL and IADL disabilities remain unexplained. Further studies should explore cohort-specific determinants contributing to the increase of cohort-based disability among US older adults.

Neighborhood protective effects on depression in Latinos.

Neighborhood social ecologies may have protective effects on depression in Latinos, after adjusting for demographic risk factors, such as nativity and length of stay in the US. This study examines the effects of neighborhood collective efficacy and linguistic isolation on depression in a heterogeneous urban Latino population from 1,468 adult respondents in Los Angeles County. We used multilevel models to analyze how major depression is associated with socioeconomic background, length of stay in the U.S., neighborhood collective efficacy and linguistic isolation among Latinos. A significant cross-level interaction effect was found between collective efficacy and foreign-born Latinos who resided in the US ≥ 15 years. We report cross-level interaction effects between linguistic isolation and nativity for U.S.-born and nativity and duration of residence for foreign-born Latinos who had lived in the U.S. at least 15 years. The moderating effects reported in this study suggest that the benefits of neighborhood collective efficacy and linguistic isolation vary by Latino subgroup and are conceptually discrete forms of social capital and offer insights for community based interventions.

Neighborhood effects on health: Concentrated advantage and disadvantage.

We investigate an alternative conceptualization of neighborhood context and its association with health. Using an index that measures a continuum of concentrated advantage and disadvantage, we examine whether the relationship between neighborhood conditions and health varies by socio-economic status. Using NHANES III data geocoded to census tracts, we find that while largely uneducated neighborhoods are universally deleterious, individuals with more education benefit from living in highly educated neighborhoods to a greater degree than individuals with lower levels of education.

Neighbourhood socioeconomic status and biological 'wear and tear' in a nationally representative sample of US adults.

OBJECTIVE: To assess whether neighbourhood socioeconomic status (NSES) is independently associated with disparities in biological 'wear and tear' measured by allostatic load in a nationally representative sample of US adults. DESIGN: Cross-sectional study. SETTING: Population-based US survey, the Third National Health and Nutrition Examination Survey (NHANES III), merged with US census data describing respondents' neighbourhoods. PARTICIPANTS: 13,184 adults from 83 counties and 1805 census tracts who completed NHANES III interviews and medical examinations and whose residential addresses could be reliably geocoded to census tracts. MAIN OUTCOME MEASURES: A summary measure of biological risk, incorporating nine biomarkers that together represent allostatic load across metabolic, cardiovascular and inflammatory subindices. RESULTS: Being male, older, having lower income, less education, being Mexican-American and being both black and female were all independently associated with a worse allostatic load. After adjusting for these characteristics, living in a lower NSES was associated with a worse allostatic load (coefficient -0.46; CI -0.079 to -0.012). The relationship between NSES and allostatic load did not vary significantly by gender or race/ethnicity. CONCLUSIONS: Living in a lower NSES in the USA is associated with significantly greater biological wear and tear as measured by the allostatic load, and this relationship is independent of individual SES characteristics. Our findings show that where one lives is independently associated with allostatic load, thereby suggesting that policies that improve NSES may also yield health returns.

Improving disparity estimates for rare racial/ethnic groups with trend estimation and Kalman filtering: an application to the National Health Interview Survey.

OBJECTIVE: Single-year estimates of health disparities in small racial/ethnic groups are often insufficiently precise to guide policy, whereas estimates that are pooled over multiple years may not accurately describe current conditions. While collecting additional data is costly, innovative analytic approaches may improve the accuracy and utility of existing data. We developed an application of the Kalman filter in order to make more efficient use of extant data. DATA SOURCE: We used 1997-2004 National Health Interview Survey data on the prevalence of health outcomes for two racial/ethnic subgroups: American Indians/Alaska Natives and Chinese Americans. STUDY DESIGN: We modified the Kalman filter to generate more accurate current-year prevalence estimates for small racial/ethnic groups by efficiently aggregating past years of cross-sectional survey data within racial/ethnic groups. We compared these new estimates and their accuracy to simple current-year prevalence estimates. PRINCIPAL FINDINGS: For 18 of 19 outcomes, the modified Kalman filter approach reduced the error of current-year estimates for each of the two groups by 20-35 percent-equivalent to increasing current-year sample sizes for these groups by 56-135 percent. CONCLUSIONS: This approach could increase the accuracy of health measures for small groups using extant data, with virtually no additional cost other than those related to analytical processes.

Does mental health history explain gender disparities in insomnia symptoms among young adults?

BACKGROUND: Insomnia is the most commonly reported sleep disorder, characterized by trouble falling asleep, staying asleep, or waking up too early. Previous epidemiological data reveal that women are more likely than men to suffer from insomnia symptoms. We investigate the role that mental health history plays in explaining the gender disparity in insomnia symptoms. METHODS: Using logistic regression, we analyze National Health and Nutritional Examination Survey (NHANES) III interview and laboratory data, merged with data on sociodemographic characteristics of the residential census tract of respondents. Our sample includes 5469 young adults (ages 20-39) from 1429 census tracts. RESULTS: Consistent with previous research, we find that women are more likely to report insomnia symptoms compared to men (16.7% vs. 9.2%). However, in contrast to previous work, we show that the difference between women's and men's odds of insomnia becomes statistically insignificant after adjusting for history of mental health conditions (OR=1.08, p>.05). CONCLUSIONS: The gender disparity in insomnia symptoms may be driven by higher prevalence of affective disorders among women. This finding has implications for clinical treatment of both insomnia and depression, especially among women.

Neighborhood socioeconomic status and fruit and vegetable intake among whites, blacks, and Mexican Americans in the United States.

BACKGROUND: Socioeconomic and racial-ethnic disparities in health status across the United States are large and persistent. Obesity rates are rising faster in black and Hispanic populations than in white populations, and they foreshadow even greater disparities in chronic illnesses such as diabetes and cardiovascular disease in years to come. Factors that influence dietary intake of fruit and vegetables in these populations are only partly understood. OBJECTIVES: We examined associations between fruit and vegetable intake and neighborhood socioeconomic status (SES), analyzed whether neighborhood SES explains racial differences in intake, and explored the extent to which neighborhood SES has differential effects by race-ethnicity of US adults. DESIGN: Using geocoded residential addresses from the Third National Health and Nutrition Examination Survey, we merged individual-level data with county and census tract-level US Census data. We estimated 3-level hierarchical models predicting fruit and vegetable intake with individual characteristics and an index of neighborhood SES as explanatory variables. RESULTS: Neighborhood SES was positively associated with fruit and vegetable intake: a 1-SD increase in the neighborhood SES index was associated with consumption of nearly 2 additional servings of fruit and vegetables per week. Neighborhood SES explained some of the black-white disparity in fruit and vegetable intake and was differentially associated with fruit and vegetable intake among whites, blacks, and Mexican Americans. CONCLUSIONS: The positive association of neighborhood SES with fruit and vegetable intake is one important pathway through which the social environment of neighborhoods affects population health and nutrition for whites, blacks, and Hispanics in the United States.

Sample designs for measuring the health of small racial/ethnic subgroups.

Most national health surveys do not permit precise measurement of the health of racial/ethnic subgroups that comprise <1 per cent of the U.S. population. We identify three potentially promising sample design strategies for increasing the accuracy of national health estimates for a small target subgroup when used to supplement a small probability sample of that group and apply these strategies to American Indians/Alaska Natives (AI/AN) and Chinese using National Health Interview Survey data. These sample design strategies include (1) complete sampling of targets within households, (2) oversampling selected macrogeographic units, and (3) oversampling from an incomplete list frame. Stage (1) is promising for Chinese and AI/AN; (2) works for both groups, but it would be more cost-effective for AI/AN because of their greater residential concentration; (3) is somewhat effective for groups like Chinese with viable surname lists, but not for AI/AN. Both (2) and (3) efficiently improve measurement precision when the supplement is the same size as the existing core sample, with diminishing additional returns as the supplement grows relative to the core sample, especially for (3). To avoid large design effects, the oversampled geographic areas or lists must have good coverage of the target population. To reduce costs, oversampled geographic tracts and lists must consist primarily of targets. These techniques can be used simultaneously to substantially increase effective sample sizes (ESSs). For example, (1) and (2) in combination can be used to multiply the nominal sample size of AI/AN or Chinese by 8 and the ESS by 4.

Non-residential neighborhood exposures suppress neighborhood effects on self-rated health.

In prior research, neighborhood effects have often been weak or inconsistent in predicting specific causes of mortality and morbidity. To determine whether residential neighborhood effects are suppressed by exposure to other environments, we examined the effect on adult self-rated health of non-residential environments that figure in individuals' daily routines. We linked the 2000 US Census data with the Los Angeles Family and Neighborhood Study (L.A.FANS) database, which consists of 3323 adults sampled from neighborhoods in LA County. Characteristics of census tracts where respondents lived, worked, shopped, sought medical care, worshipped and spent "other" time were obtained from the 2000 US Census. Weighted multilevel linear and clustered generalized ordered logistic regressions were used to estimate associations between self-rated health and non-residential neighborhood exposures after adjustment for individual-level factors and exposure to residential neighborhoods. We found that residence in disadvantaged neighborhoods was associated with worse self-rated health. In a dose-response fashion, the greater the exposure to less disadvantaged non-residential neighborhoods in the course of routine activities, the greater the magnitude in improved self-rated health. Models including non-residential neighborhood exposure increase the magnitude and significance of the association between residential neighborhoods and health. In conclusion, individuals' exposure to non-residential neighborhoods confounds and suppresses the association of residential neighborhoods with health and could explain why previous studies may not have found robust associations between residential neighborhood predictors and health.