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1.
Sci Total Environ ; 805: 150333, 2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-34543794

RESUMO

Estimating environmental lead exposure using ecologic risk models is an inexpensive strategy to inform public health departments and to develop location-based intervention strategies such as targeted screening and mitigation. Importantly, studies in this area have not assessed temporal and spatio-temporal lead exposure risk trends. Due to lead abatement efforts and targeted screening efforts, it is anticipated that lead exposure risk has decreased over time. However, it is unknown if decreases have occurred, and if the decreases are evenly distributed across neighborhoods. Thus, the purpose of this study was to examine the association between neighborhood deprivation and risk of elevated blood lead levels (EBLLs) in both temporal and spatio-temporal contexts within the US state of Maryland in 2005-2015. To consider the temporal dimension of lead risk, we used a novel extension of Bayesian index models to estimate time-varying neighborhood deprivation indices along with time-varying index effects. The results showed that overall EBLL proportion decreased over time, from a high of 0.11 in 2006 to a low of 0.02 in 2015. The association between neighborhood deprivation and EBLL risk was positive and significant annually, but generally diminished over time. The most important variables in the neighborhood deprivation index were percent of houses built before 1940 and median household income. In summary, using Bayesian index models that can account for both temporal and spatio-temporal contexts is a promising approach to inform public health efforts to remediate lead and focus testing efforts and may be useful in studies in other geographic areas and times.


Assuntos
Chumbo , Características de Residência , Teorema de Bayes , Criança , Exposição Ambiental/análise , Humanos , Maryland , Fatores Socioeconômicos
2.
J Public Health Manag Pract ; 28(Suppl 1): S101-S110, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34797267

RESUMO

CONTEXT: The New York City (NYC) Test & Trace Corps (Test & Trace), under New York City Health + Hospitals (NYC H+H), set out to provide universal access to COVID-19 testing. Test & Trace partnered with numerous organizations to direct mobile COVID-19 testing from concept through implementation to reduce COVID-19-related health inequities. PROGRAM: Test & Trace employs a community-informed mobile COVID-19 testing model to deliver testing to the hardest-hit, underserved communities. Community partners, uniquely knowledgeable of the residents they serve, are engaged as decision makers and operational partners in mobile COVID-19 testing delivery. IMPLEMENTATION: Through several mobile testing methods, community partners choose testing locations and tailor outreach to their community. Test & Trace assumes logistical responsibility for mobile testing but defers critical programmatic decisions and community engagement to partners. Integral to the success of this program is responsive, bidirectional communication. EVALUATION: During the reporting period of December 1, 2020, to April 30, 2021, Test & Trace's community-informed mobile COVID-19 testing model provided testing to 150351 unique patients and processed 274083 tests in total. The available outcomes data and qualitative feedback provided by community partners illustrate that this intervention, combined with robust governmental investment, successfully ensured that NYC-identified, low-resource neighborhoods had greater access to COVID-19 testing. DISCUSSION: Making community partners decision makers reduced inequities in access to testing for communities of color. In addition, the model has served as the framework for Test & Trace's community-informed mobile COVID-19 vaccination program, operated in concert with NYC's Vaccine Command Center, and is a foundation for addressing health inequities at scale, including during public health crises.


Assuntos
COVID-19 , Teste para COVID-19 , Vacinas contra COVID-19 , Humanos , Características de Residência , SARS-CoV-2
3.
Environ Pollut ; 292(Pt A): 118347, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34637822

RESUMO

Residential green space and neighborhood walkability are important foundations of a healthy and sustainable city. Yet, their associations with atherosclerosis, the disease underlying clinical coronary heart disease (CHD), is unknown, especially in susceptible populations. We aim to explore the associations of exposure to residential green space and neighborhood walkability with coronary atherosclerosis. In this study of 2021 adults with suspected CHD, we evaluated the associations of exposure to green space (using Normalized Difference Vegetation Index [NDVI] and enhanced vegetation index [EVI] surrounding each participant's home) and neighborhood walkability (using walkability index and number of parks near home) with atherosclerosis (using coronary artery calcium score, CAC) using linear regression model adjusted for individual-level characteristics. Mediation analysis was further applied to explore potential mechanisms through the pathways of physical activity, air pollution, and psychological stress. In the primary model, an interquartile increase in annual mean NDVI and EVI within the 1-km area was associated with -15.8% (95%CI: 28.7%, -0.7%), and -18.6% (95%Cl: 31.3%, -3.6%) lower CAC score, respectively. However, an interquartile increase in the walkability index near home was associated with a 7.4% (95% CI: 0.1%, 15.2%) higher CAC score. The combined exposure to a green space area in a 1-km area and the walkability index were inversely associated with atherosclerosis, albeit with a smaller magnitude than a single-exposure model. The findings from a mediation analysis suggested that increased physical exercise and ameliorated particulate matter <2.5 µm (PM2.5) may partially contribute to the relationship between green space and atherosclerosis, and for walkability index, partially explained by increased PM2.5 exposure. Our study suggested a beneficial association between green space and atherosclerosis, but an adverse association between neighborhood walkability and atherosclerosis. Therefore, urban development that aims to improve neighborhood walkability should jointly account for enhancing green space properties from a public health perspective.


Assuntos
Poluição do Ar , Doença da Artéria Coronariana , Adulto , Poluição do Ar/análise , China/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Exposição Ambiental/análise , Humanos , Parques Recreativos , Material Particulado/análise , Características de Residência
4.
Artigo em Inglês | MEDLINE | ID: mdl-34769621

RESUMO

Work is a key social determinant of health. Community health and well-being may be impacted in neighborhoods with high proportions of people engaged in precarious work situations compounded by health inequities produced by other social determinants associated with their residential geography. However, little is known about how community residents experience work at the neighborhood level nor how work impacts health at the community-level, particularly in communities with a high proportion of residents engaged in precarious work. We sought to understand, through participatory research strategies, how work is experienced at the community level and to identify community interventions to establish a culture of healthy work. As part of a mixed-methods community health assessment, community researchers conducted focus groups with residents in two high social and economic hardship neighborhoods on Chicago's southwest side. Community and academic researchers engaged in participatory data analysis and developed and implemented member-checking modules to engage residents in the data interpretation process. Twelve focus group discussions (77 community resident participants) were completed. Three major themes emerged: systematic marginalization from the pathways to healthy work situations; contextual and structural hostility to sustain healthy work; and violations in the rights, agency, and autonomy of resident workers. Findings were triangulated with findings from the concept-mapping research component of the project to inform the development of a community health survey focused on work characteristics and experiences. Listening to residents in communities with a high proportion of residents engaging in precarious work allows for the identification of nuanced community-informed intervention points to begin to build a culture of healthy work.


Assuntos
Pobreza , Características de Residência , Pesquisa Participativa Baseada na Comunidade , Grupos Focais , Humanos , Percepção , Saúde Pública
5.
Artigo em Inglês | MEDLINE | ID: mdl-34769718

RESUMO

Background: Little is known about the extent to which socioenvironmental characteristics may influence mental health outcomes in smaller population centres or differently among women and men. This study used a gender-based analysis approach to explore individual- and neighbourhood-level sex differences in mental health service use in a context of uniquely smaller urban and rural settlements. Methods: This cross-sectional analysis leveraged multiple person-based administrative health datasets linked with geospatial datasets among the population aged 1 and over in the province of New Brunswick, Canada. We used multinomial logistic regression to examine associations between neighbourhood characteristics with risk of service contacts for mood and anxiety disorders in 2015/2016, characterizing the areal measures among all residents (gender neutral) and by males and females separately (gender specific), and controlling for age group. Results: Among the province's 707,575 eligible residents, 10.7% (females: 14.0%; males: 7.3%) used mental health services in the year of observation. In models adjusted for gender-neutral neighbourhood characteristics, service contacts were significantly more likely among persons residing in the most materially deprived areas compared with the least (OR = 1.09 [95% CI: 1.05-1.12]); when stratified by individuals' sex, the risk pattern held for females (OR = 1.13 [95% CI: 1.09-1.17]) but not males (OR = 1.00 [95% CI: 0.96-1.05]). Residence in the most female-specific materially deprived neighbourhoods was independently associated with higher risk of mental health service use among individual females (OR = 1.08 [95% CI: 1.02-1.14]) but not among males (OR = 1.02 [95% CI: 0.95-1.10]). Conclusion: These findings emphasize that research needs to better integrate sex and gender in contextual measures aiming to inform community interventions and neighbourhood designs, notably in small urban and rural settings, to reduce socioeconomic inequalities in the burden of mental disorders.


Assuntos
Benchmarking , Serviços de Saúde Mental , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Características de Residência , População Rural , Fatores Socioeconômicos , População Urbana
6.
Artigo em Inglês | MEDLINE | ID: mdl-34769749

RESUMO

Few studies have examined the combined effects of affordability, housing conditions and neighborhood characteristics on the housing stability and health of low-income homeowners. We begin to address these gaps through a mixed-method study design that evaluates the Make-it-Home program (MiH) in Detroit, Michigan, aimed at helping low-income tenants become homeowners when their landlords lose their homes to tax foreclosure. We compare the 'intervened group' of MiH homeowners to a 'comparison' group of similarly situated households whose homes experience property tax foreclosure at the same time. The comparison group represents the likely outcomes for the participants had they not participated the program. Participants will be surveyed twice (intervened group), or once (comparison group) per year over a three-year period, regarding their housing and neighborhood conditions, health, life events, and socio-economic status, including income and employment. We will use property and neighborhood census data to further examine the conditions experienced. The findings for policy and program development from this study are timely as the nation faces a chronic shortage of affordable housing for both purchasers and renters. The results suggest ways to improve the MiH program and lay out approaches for researchers to navigate some of the complexities associated with this type of research.


Assuntos
Habitação , Pobreza , Características da Família , Humanos , Renda , Características de Residência
7.
Artigo em Inglês | MEDLINE | ID: mdl-34769752

RESUMO

Systemic racism leads to racial/ethnic residential segregation, which can result in health inequities. We examined if the associations between residential segregation and later-life cognition and dementia differed based on segregation measure and by participant race/ethnicity. Tests of memory (n = 4616), language (n = 4333), visuospatial abilities (n = 4557), and incident dementia (n = 4556) were analyzed in older residents of Northern Manhattan, New York (mean age: 75.7 years). Segregation was measured at the block group-level using three indices: dissimilarity, isolation, and interaction. We fit multilevel linear or Cox proportional hazards models and included a race/ethnicity × segregation term to test for differential associations, adjusting for socioeconomic and health factors. Living in block groups with higher proportions of minoritized people was associated with -0.05 SD lower language scores. Living in block groups with higher potential contact between racial/ethnic groups was associated with 0.06-0.1 SD higher language scores. The findings were less pronounced for other cognitive domains and for incident dementia. Non-Hispanic Black adults were most likely to experience negative effects of neighborhood segregation on cognition (language and memory) and dementia. All indices partly capture downstream effects of structural racism (i.e., unequal distributions of wealth/resources) on cognition. Therefore, desegregation and equitable access to resources have the potential to improve later-life cognitive health.


Assuntos
Demência , Segregação Social , Idoso , Cognição , Demência/epidemiologia , Grupos Étnicos , Humanos , Características de Residência , Fatores Socioeconômicos
8.
Artigo em Inglês | MEDLINE | ID: mdl-34769781

RESUMO

This study examined the association between neighborhood-based social capital (NSC) and depressive symptoms in the context of urban neighborhoods in China, with special attention given to the association heterogeneity across socioeconomic groups. Drawing on cross-sectional data collected from 39 neighborhoods in Guangzhou, this research demonstrated that adults' depressive symptoms were higher among those with lower cognitive (trustworthiness, reciprocity, and cohesion within a neighborhood) and structural (social network and participation) dimensions of NSC. Further analysis showed that the negative association between NSC and depressive symptoms was significantly heterogeneous across socioeconomic groups. Specifically, this negative relationship was more prominent in the lower socioeconomic classes than in the upper socioeconomic classes, indicating that the lower accumulation of NSC among disadvantaged groups may aggravate depression unequally across social classes. In addition, the negative association between social participation and depressive symptoms was stronger for people who are older or unemployed. The findings of this study not only provide new evidence concerning the significance of the beneficial effects of NSC in the Chinese context, but also, more importantly, highlight that NSC plays a crucial role in creating mental health inequality across social classes. Thus, the relevant social interventions including fostering neighborhood relationships and social activities should be carefully tailored against the backdrop of community building during the urbanization process. The implications of our study for urban governance to promote healthy cities are discussed.


Assuntos
Depressão , Capital Social , Adulto , China/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Disparidades nos Níveis de Saúde , Humanos , Características de Residência , Apoio Social
9.
J Aging Stud ; 59: 100969, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34794714

RESUMO

Community is important for late-midlife adults, offering a sense of belonging and opportunities for social engagement during the transition to older age. The current study examines perceptions of community and geographical ties among a sample of older adults aging in place. Using data from the Foley Longitudinal Study of Adulthood (FLSA; N = 163; aged 61-64) and a qualitative GIS approach, major themes were categorized and mapped to create a comprehensive picture of how perceptions of community varied among respondents and neighborhoods. Core themes were connections to place, space, people, and relational benefits gained from community involvement. Residents of a suburban enclave more frequently noted connections to people as being important to community, compared to residents in more densely-populated areas. Implications for future research are discussed.


Assuntos
Vida Independente , Características de Residência , Adulto , Idoso , Envelhecimento , Humanos , Estudos Longitudinais , Percepção , População Urbana
10.
West J Emerg Med ; 22(6): 1283-1290, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34787552

RESUMO

INTRODUCTION: Prevention quality indicators (PQI) are a set of measures used to characterize healthcare utilization for conditions identified as being potentially preventable with high quality ambulatory care. These indicators have recently been adapted for emergency department (ED) patient presentations. In this study the authors sought to identify opportunities to potentially prevent emergency conditions and to strengthen systems of ambulatory care by analyzing patterns of ED utilization for PQI conditions. METHODS: Using multivariable logistic regression, the authors analyzed the relationship of patient demographics and neighborhood-level socioeconomic indicators with ED utilization for PQI conditions based on ED visits at an urban, academic medical center in 2017. We also used multilevel modeling to assess the contribution of these variables to neighborhood-level variation in the likelihood of an ED visit for a PQI condition. RESULTS: Of the included 98,522 visits, 17.5% were categorized as potentially preventable based on the ED PQI definition. On multivariate analysis, age < 18 years, Black race, and Medicare insurance had the strongest positive associations with PQI visits, with adjusted odds ratios (aOR) of 1.41 (95% confidence interval [CI], 1.29, 1.56), 1.40 (95% CI, 1.22, 1.61), and 1.40 (95% CI, 1.28, 1.54), respectively. All included neighborhood-level socioeconomic variables were significantly associated with PQI visit likelihood on univariable analysis; however; only level of education attainment and private car ownership remained significantly associated in the multivariable model, with aOR of 1.13 (95% CI, 1.10, 1.17) and 0.96 (95% CI, 0.93, 0.99) per quartile increase, respectively. This multilevel model demonstrated significant variation in PQI visit likelihood attributable to neighborhood, with interclass correlation decreasing from 5.92% (95% CI, 5.20, 6.73) in our unadjusted model to 4.12% (95% CI, 3.47, 4.87) in our fully adjusted model and median OR similarly decreasing from 1.54 to 1.43. CONCLUSION: Demographic and local socioeconomic factors were significantly associated with ED utilization for PQI conditions. Future public health efforts can bolster efforts to target underlying social drivers of health and support access to primary care for patients who are Black, Latino, pediatric, or Medicare-dependent to potentially prevent emergency conditions (and the need for emergency care). Further research is needed to explore other factors beyond demographics and socioeconomic characteristics driving spatial variation in ED PQI visit likelihood.


Assuntos
Serviço Hospitalar de Emergência , Medicare , Adolescente , Idoso , Criança , Geografia , Humanos , Características de Residência , Fatores Socioeconômicos , Estados Unidos
11.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(11): 1969-1975, 2021 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-34818842

RESUMO

Objective: To estimate physical activity level in residents in Suzhou and explore the association between community environment and physical activity level in local residents. Methods: Through multistage stratified random sampling, residents aged 25-64 years in Suzhou were surveyed by face-to face interview in 2017. Physical activity levels were assessed by the international physical activity questionnaire-long version (IPAQ-L). Perceptions of community environment were assessed by Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A). Results: Among the local residents surveyed in Suzhou,the median of weekly total physical activity level was 3 610.42 MET-min/w. The level of occupational physical activity was higher than that of transportation, household and leisure-time related physical activity levels. After controlling for socio-demographic factors, public service access was negatively associated with the overall physical activity level (OR=0.522,95%CI:0.329-0.830), land-use mix-diversity was negatively associated with the level of occupational physical activity level (OR=0.701,95%CI: 0.492-0.999), infrastructure of walk and cycle ways was positively associated with occupational physical activity level (OR=1.603,95%CI:1.004-2.559); traffic hazards were negatively associated with the transportation physical activity level (OR=0.642,95%CI: 0.416-0.990); residential building density was positively associated with leisure-time physical activity level (OR=1.001,95%CI: 1.000-1.002), and the perceptions level of community environment were positively associated with the occupational, transportation, household and overall physical activity levels (OR=1.889,95%CI: 1.176-3.033;OR=1.671,95%CI: 1.120-2.495;OR=1.775,95%CI: 1.143-2.756;OR=1.593,95%CI: 1.079-2.350). Conclusion: Improving infrastructure of walk and cycle ways and beautifying community environment play an important role in increasing the physical activity level of the residents.


Assuntos
Planejamento Ambiental , Caminhada , Exercício Físico , Humanos , Percepção , Características de Residência , Inquéritos e Questionários , Transportes
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(4): 643-650, 2021 Apr 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814444

RESUMO

Objective: To explore the influence of characteristics of green space on blood pressure control. Methods: Hypertensive patients who were managed by community health centers for one year and aged 35 years old and above were selected as the study subjects in Shenzhen. Multi-stage random sampling method was applied to select a representative sample of 1 200 patients. A total of 1 116 valid questionnaires were collected, with a response rate of 93.0%. From November 2019 to January 2020, well-structured questionnaire, physical examination and laboratory biochemical test were applied for information collection among the 1 116 participants. Binary logistic regression model was used to analyze the relationship between characteristics of green space and blood pressure control. Results: The rate of blood pressure control was 67.8%. Results of binary logistic regression analysis showed that after adjusting confounding factors, health supporting elements, such as fitness areas (OR=1.678, 95%CI:1.231-2.288), collective exercise venues(OR=1.373, 95%CI:1.020-1.848), health knowledge promotion areas (OR=1.416, 95%CI: 1.049-1.911) in green space, were significantly correlated with blood pressure control. Green space safetiness (OR=1.010, 95%CI: 1.000-1.019), comfortableness (OR=1.011, 95%CI: 1.001-1.021) and maintenance status (OR=1.011, 95%CI: 1.001-1.021) also played a role. The rate of blood control among patients with exclusive green space was higher than that of patients without exclusive green space (OR=1.333, 95%CI: 1.009-1.762). Conclusion: Health supporting elements, safety, comfort, maintenance of green space and exclusive green space play an important role in blood pressure controlling.


Assuntos
Hipertensão , Parques Recreativos , Pressão Sanguínea , Exercício Físico , Humanos , Características de Residência , Inquéritos e Questionários
13.
Acad Pediatr ; 21(8S): S184-S193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34740427

RESUMO

If ZIP code is more important than genetic code in determining one's health and opportunities, how can pediatricians enable healthy and opportunity-rich environments for all children? This paper introduces a broad network of organizations, policies, and financial resources that are working to improve ZIP codes by tackling poverty at the neighborhood level. The mission-driven US community development sector began with the War on Poverty in the 1960s and 70s and comprises a network of finance, real estate, and community-based organizations working together to overturn decades of racially motivated disinvestment, revitalize persistently marginalized, low-income communities, and enhance the lives of the people who live in them. Across the country, thousands of community development corporations, community development financial institutions, affordable housing developers, and regulated for-profit banks together invest over $300 billion annually in affordable housing, childcare and early learning facilities, recreation centers, community clinics, grocery stores, small businesses, and financial services for low-income families and neighborhoods. We present successful examples of community development efforts targeting child health and opportunity and highlight opportunities for pediatricians to advise, collaborate, and partner in order to accelerate and maximize the impact of billions of dollars invested in support of healthier neighborhoods where all children can grow and thrive.


Assuntos
Saúde da Criança , Pobreza , Criança , Cuidado da Criança , Habitação , Humanos , Características de Residência
14.
Acad Pediatr ; 21(8S): S194-S199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34740428

RESUMO

Understanding how housing inequities among families with children are rooted in structural racism is important for identifying opportunities to engage in ongoing and collective work as pediatricians to lift children out of poverty. This article discusses the complex mechanisms between housing and child and family health outcomes, and offers potential solutions linking housing, health programs, and policy solutions. Beginning with a review of historical antecedents of housing policy and their impact on health inequities, the authors outlines policies and structures directly linked to disproportionate housing instability and inequities in health outcomes among children. This article examines four key domains of housing - affordability, stability, quality, and neighborhood - and their relationship to child and family health. Finally, the authors present multidimensional solutions for advancing health equity.


Assuntos
Habitação , Racismo , Criança , Saúde da Família , Humanos , Pobreza , Características de Residência
15.
Health Aff (Millwood) ; 40(11): 1784-1791, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34724418

RESUMO

Racial health inequities exemplified during the COVID-19 crisis have awakened a sense of urgency among public health and policy experts to examine contributing factors. One potential factor includes the socioeconomic disadvantage of racially segregated neighborhoods. This study quantified associations of neighborhood socioeconomic disadvantage in Chicago, Illinois, as measured by the Area Deprivation Index (ADI), with racial disparities in COVID-19 positivity. A retrospective cohort included 16,684 patients tested for COVID-19 at an academic medical center and five community-based testing sites during Chicago's "first wave" (March 12, 2020-June 25, 2020). Patients living in Black majority neighborhoods had two times higher odds of COVID-19 positivity relative to those in White majority neighborhoods. The ADI accounted for 20 percent of the racial disparity; however, COVID-19 positivity remained substantially higher at every decile of the ADI in Black relative to White neighborhoods. The remaining disparities (80 percent) suggest a large, cumulative effect of other structural disadvantages in urban communities of color.


Assuntos
COVID-19 , Chicago/epidemiologia , Grupos de Populações Continentais , Humanos , Características de Residência , Estudos Retrospectivos , SARS-CoV-2 , Fatores Socioeconômicos
16.
Maturitas ; 154: 7-12, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34736580

RESUMO

OBJECTIVE: Menopausal symptoms may differ by geography and ethnicity, but the impact of socioeconomic factors is less clear. The purpose of this study was to compare menopausal symptoms in women from areas of Arizona with different socioeconomic resources. STUDY DESIGN: Women aged 40-65 years in two cohorts were surveyed: (1) Phoenix women attending either a clinic for patients who are uninsured or a clinic for people experiencing homelessness; and (2) Scottsdale women living in zip codes with higher average income and neighborhood advantage (surveyed by mail). Surveys included the Greene Climacteric Scale (GCS) and demographic questions. MAIN OUTCOME MEASURES: GCS score by domain and subdomain, corrected for age, race, menopause stage and menopausal hormone therapy (HT). RESULTS: Phoenix participants (N = 104) were 51.2 years old (SD 6.45), Hispanic (54.4%), White (28.2%) or African American (8.7%), and uninsured (53.0%). Scottsdale participants (N = 151) were 52.6 years old (SD 5.52), mostly White (94.7%) and insured (100%). Three percent of Phoenix women were on HT vs. 23.3% in Scottsdale (p < 0.001). Multivariate analysis revealed higher total GCS scores in the Phoenix vs. Scottsdale cohort (39.13 vs 30.14, p < 0.001), which was also seen in the psychological and somatic domains, as well as the anxiety and depression subdomains. No statistically significant differences were seen in the vasomotor or sexual dysfunction domains. CONCLUSION: In a group of women living in Arizona from distinct socioeconomic areas, significant differences were demonstrated in menopausal symptom bother specifically with higher psychological and somatic symptoms in women who were uninsured or experiencing homelessness independent of age, race, menopause stage and HT use. Future studies controlling for co-morbidities associated with lower socioeconomic status such as depression would provide further insight into this population of midlife women.


Assuntos
Climatério , Menopausa/etnologia , Menopausa/fisiologia , Mulheres/psicologia , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Pobreza , Características de Residência , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-34769861

RESUMO

The current study examined how neighborhood environments are related to older adults' perceived control over time. A longitudinal study design was employed using data sampled from the Health and Retirement Study (HRS) 2014 and 2018. In total, 3170 older adults, whose age ranged between 60 and 99 years at the baseline, were followed up with a 4-year lag. Measures included two domains of neighborhood characteristics: social cohesion and physical disorder (at baseline and follow-up) and perceived control (at follow-up). Path coefficients between the latent factors were examined using structural equation modeling. Results showed that there was a significant cross-sectional and longitudinal association between neighborhood social cohesion and older adults' perceived control, while neighborhood physical disorder was cross-sectionally associated with perceived control. Study findings provide evidence for promoting social integration and social capital in their neighborhood that might contribute to older adults' perceived competence and beliefs in control.


Assuntos
Aposentadoria , Capital Social , Estudos Transversais , Estudos Longitudinais , Características de Residência
18.
Artigo em Inglês | MEDLINE | ID: mdl-34769914

RESUMO

Previous studies have shown that natural environments and leisure activities can reduce depression and increase well-being. Urban parks are important for the psychological well-being of middle-aged and older adults. However, it remains unknown whether the relationship between environmental perceptions, leisure activity, and well-being is affected by the quality of park environments. This study uses a cross-level framework to examine the effects of urban park quality on middle-aged and older adults' environmental perceptions, leisure activity, and well-being. The Neighborhood Green Space Tool was used to assess the environmental quality of 19 parks, and 380 individuals aged 55 years and older were interviewed in each park using an on-site questionnaire. The results reveal that the associations between environmental perception and well-being were moderated by the quality of park accessibility, amenities, and incivilities; the effect of environmental perception on depression was moderated by the quality of incivilities in parks; and the effect of frequency of leisure activities on depression was moderated by the quality of park accessibility.


Assuntos
Atividades de Lazer , Parques Recreativos , Idoso , Meio Ambiente , Planejamento Ambiental , Humanos , Pessoa de Meia-Idade , Percepção , Características de Residência , População Urbana
19.
Cien Saude Colet ; 26(suppl 3): 4813-4822, 2021.
Artigo em Português | MEDLINE | ID: mdl-34787177

RESUMO

The aim of this study was to characterize the environments of Curitiba's state schools in relation to commercialization of alcoholic beverages and investigate the association with local socio-economic indicators. A cross-sectional study in commercial establishments was carried out around 30 state-owned schools. We applied a survey to characterize the locations in relation to the availability of alcoholic beverages. Differentiation between school environments regarding income was estimated by multilevel mixed-effects model. We evaluated 200 commercial establishments, 66.0% commercialized alcohol. Of them, 52 (39.4%) were off-premise alcohol outlets and 80 (60.6%) on-premise. In on-premise category, neighborhood markets (16.5%) and gas stations (10.1%) had higher presence and half of schools had this type of this establishment in their environment. These establishment had more variety of alcoholic beverages and lower prices. In school's environments located in lower income's neighborhoods, the number of neighborhood market and bars were higher. It was observed the presence of establishments that commercialized alcoholic beverages and with attendance to the public during the classes period, near the evaluated schools.


Assuntos
Consumo de Bebidas Alcoólicas , Comércio , Bebidas Alcoólicas , Estudos Transversais , Humanos , Características de Residência , Instituições Acadêmicas
20.
Medicine (Baltimore) ; 100(40): e27484, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622879

RESUMO

ABSTRACT: Despite the anticipated growth in the global burden of obesity especially in low-income countries, limited data exist on the contribution of obesity to cardiometabolic diseases in Africa.We examined population-based samples of Kenyan adults who participated in the 2015 national chronic disease risk factor surveillance survey. Weight and height were measured, and body mass index (BMI) was calculated and used as a measure for general obesity. Waist circumference (WC), a clinical measure of central obesity was also measured. Logistic regression was used to assess the association between obesity with hypertension, diabetes, and dyslipidemia risk.Of the 4276 participants, the median (IQR) age was 36 (27-47) years, 41% were men. One-third (37%) of the participants were centrally obese, whereas 10% were generally obese. The odds for overweight and general obesity were highest among females, adults >40 years, and those in the highest wealth quartile. Central and general obesity, assessed by WC and BMI, were associated with hypertension and dyslipidemia but not diabetes for both sexes. Compared with adults of normal weight, individuals with a BMI of ≥30 kg/m2 had an odds ratio of 2.39 (95% confidence interval [CI], 1.82-3.12) for hypertension and 2.24 (95% CI, 1.70-2.96) for dyslipidemia.Obesity prevalence is high in Kenya and is associated with hypertension and dyslipidemia but not diabetes. Our findings indicate an urgent need to develop public health interventions to address obesity and prevent the development of comorbid conditions.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Adulto , Índice de Massa Corporal , Pesos e Medidas Corporais , Dislipidemias/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Quênia/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Características de Residência , Fatores de Risco , Fatores Socioeconômicos
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