Perceived Neighborhood Disorder, Social Cohesion, and Depressive Symptoms among Spousal Caregivers

Most prior research on caregivers’ mental health focused on individual or household factors, we know much less about the influence of neighborhood factors on mental health of spousal caregivers. The current study fills the gap in our knowledge by examining the association of neighborhood characteristics (i.e., perceived neighborhood disorder and neighborhood social cohesion) and depressive symptoms among spousal caregivers. We used data from 2006 to 2016 waves of the Health and Retirement Study, which includes 2,362 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood disorder and neighborhood social cohesion with depressive symptoms. A greater perceived neighborhood disorder was associated with higher CES-D scores, which indicates more depressive symptoms. On the other hand, a higher level of neighborhood social cohesion was associated with lower CES-D scores. When they were included in the same model, the association between neighborhood disorder and depression disappeared, while respondents who reported higher levels of neighborhood social cohesion continue to exhibit lower CES-D scores than those lived in less cohesive neighborhoods. This study highlights the importance of neighborhood contexts in understanding caregivers’ well-being. Findings of this study suggest that neighborhood social cohesion may attenuate the negative effects of neighborhood disorder. Therefore, enhancing positive characteristics of the neighborhood may promote well-being of spousal caregivers.

Does Cognitive Status Moderate the Relationship between Environmental Factors and Self-Reported Health?

Using data from NHATS Round 9, the present study examines the relationships between environmental factors and self-reported health among older adults with dementia, mild cognitive impairment (MCI), and normal cognition. Based on neighborhood stress process theory, we investigate the following questions: 1) Are there associations between dwelling safety hazards and neighborhood environments and self-reported health? 2) Is cognitive status a moderator between the relationship? 3) How do these associations differ between older adults with varying cognitive status (i.e., dementia, MCI, and normal cognition)? A hierarchical linear regression analyses are conducted. Results indicate that better quality of sidewalk surface and neighborhood social cohesion are associated with better self-reported health, after taking into account sociodemographic, health, and social factors. Interaction terms are then used to examine the moderating effects of cognitive status on the associations; four interactions terms are found to be statistically significant. Lastly, separate linear regression analyses are implemented for the dementia, MCI, and normal cognition groups. Findings show that the predicting power of environmental factors vary by cognitive status of older adults. For individuals with dementia, tripping hazards, cluttered home, and community disconnectedness are associated with poor self-reported health. However, no significant relationship was found for older adults with MCI. For older adults with normal cognition, better quality of sidewalk surface and neighborhood social cohesion predict better self-rated health scores. Findings of this study illuminate the important role of a hazard-free home, community walkability, and socially cohesive neighborhood environments in predicting better health status of older adults.

Subjective Aging in Context: Neighborhood Social Environment and Self-perceptions of Aging among Older Adults

Self-perception of aging (SPA), one’s attitude toward one’s own aging, has been associated with health and well-being in later life. Whereas existing literature identifies individual-level predictors of SPA (e.g., education and health), little is known about the role of neighborhood context. The present study examines whether 1) neighborhood social environment is related to SPA and 2) age moderates this relationship. Our analytic sample includes 11,394 adults aged 50+ from the 2014 and 2016 waves of the Health and Retirement Study (Mean Age=68, SD=10.14, range 50-98). Indicators of neighborhood social environment include (a) perceived neighborhood social cohesion (the trust and social ties among community residents), (b) neighborhood friends, and (c) relatives living in the neighborhood. Regression analyses were performed to investigate the associations of each neighborhood-level indicator with the positive and negative dimensions of SPA. The models controlled for demographic, socio-economic, and health covariates. Greater neighborhood social cohesion (B=0.13, SE=0.01, p<.001) and having neighborhood friends (B=0.14, SE=0.02, p<0.001) were associated with higher levels of the positive SPA. As for the negative dimension of SPA, neighborhood social cohesion was the only significant predictor (B=-0.13, SE=0.01, p<0.001). Furthermore, we found significant interaction effects between neighborhood social cohesion and age: higher neighborhood cohesion was associated with more positive (B=-.003, SE=.00, p<.001) and less negative SPA ratings (B=-.003, SE=.00, p<.001) at younger ages than older ages. Our findings provide insights into how neighborhood social context shapes subjective aging, suggesting that a socially cohesive neighborhood may promote more favorable perceptions of aging, particularly for younger residents.

Neighborhood Cohesion and Mobility Limitations Among Older Americans: The Roles of Depressive Symptoms and Mastery

Neighborhood environment has been playing an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have been rarely examined. This study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 and older were selected from the Health and Retirement Study. Using ordinary least squares (OLS) regressions, this study shows that neighborhood social cohesion is negatively associated with mobility limitations, and this association is mediated by depressive symptoms and mastery respectively. Specifically, neighborhood social cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. The findings have implications for developing community measures to promote neighborhood social cohesion and applying psychosocial interventions to reduce depressive symptoms and improve mastery among older adults.

Social Isolation and Suicidal Ideation of Older People: The Buffering Effects of Neighborhood Social Cohesion

This study aimed to examine the buffering effect of neighborhood social cohesion on the association of social isolation and suicidal ideation among Korean older people. The sample was older adults who were 65 years old or older and participated in the Korea Health Survey 2017 collected by the Center for Disease and Prevention (N=67,835). Social isolation was measured with three indicators: living-alone, contact isolation (less than weekly contact with family, friends, or neighbors), and participation isolation (less than monthly social organization attendance). Neighborhood social cohesion was measured with two indicators: trust in neighbors and the welfare budget ratio to represent social capital and social inclusion capabilities, respectively. Multilevel logistic regression analyses were performed to estimate the dynamic relationships between social isolation, neighborhood social cohesion, and suicidal ideation. Results of the main effect indicated that social isolation is a significant risk factor for suicidal ideation and neighborhood social cohesion works as a protective factor against suicidal ideation. Results of cross-level interactions showed that the welfare budget ratio moderated the association between participation isolation and suicidal ideation (OR=0.960, p<.001). The negative effect of participation isolation was reduced as the welfare budget ratio of the neighborhood increased. Neighborhood social cohesion indicators did not moderate the association between the remaining types of social isolation and suicidal ideation. The evidence from this study highlights the importance of social welfare expenditures when building suicide prevention interventions and age-friendly communities.

Communications through contemporary tools of information and communication technology: Health among separated family members (Preprint)

BACKGROUND Currently, the number of single-living workers who are separated from spouses and families has been increasing due to the development of information and communication technology (ICT) and the achievement of mobility. At the same time, concerns have emerged about the mental and physical health status of solitary members living apart from family members. The development of media for interpersonal communication through ICT tools and the Internet system has been remarkable and has enabled two-way communication across distances and borders. Thus, easy access to this simultaneous form of communication has been expected to contribute to and mitigate the psychosocial status of isolated individuals. OBJECTIVE This study aims to elucidate the health benefits of ICT by providing a psychosocial health assessment and determining the characteristics of ICT tools and the frequency of communication. METHODS This study is cross-sectional in nature. The study subjects are adults living separately from family members or those who have such family members living separately due to work and other reasons. The participants were requested to fill up a web response-system questionnaire about the status of their ICT use and health status and their evaluation of life and society. They were divided into two groups according to their communication tools and frequency of use and statistically compared in terms of living alone, health, and psychosocial status. RESULTS In total, 15 of 73 participants were categorized in the highly skilled in ICT tools (HSI) group, which uses two types of ICT tools, namely, live, such as video chat and voice call, and text, such as short message service and e-mail, to communicate frequently. A simple comparison between the HSI and reference groups exhibited significant differences in neighborhood social cohesion, perceived social position, and life satisfaction but not in health, lifestyle, and dyadic trust in families with members living separately. Multivariate regression analysis was adjusted for confounding factors, such as level of education, age, gender, and job status. The results indicate that poor subjective health tended to show an odds ratio of less than 1 (OR = 0.17, 95% CI: 0.03–1.02). Moreover, the HCT group demonstrated significant positive relationships with neighborhood social cohesion (β = 2.40, 95% CI: 0.56–4.24), perceived social position (β = 1.17, 95% CI: 0.11–2.23), and life satisfaction (β = 1.46, 95% CI: 0.58–2.34) using the same multivariate regression model. CONCLUSIONS The findings study suggested that people who frequently communicate with separated family members by taking advantage of various ICT tools can maintain a positive mental state and better social relations among those living alone and away from their families.

Pathways between objective and perceived neighborhood factors among Black breast cancer survivors

Background Mounting evidence supports associations between objective neighborhood disorder, perceived neighborhood disorder, and health, yet alternative explanations involving socioeconomic and neighborhood social cohesion have been understudied. We tested pathways between objective and perceived neighborhood disorder, perceived neighborhood social cohesion, and socioeconomic factors within a longitudinal cohort. Methods Demographic and socioeconomic information before diagnosis was obtained at interviews conducted approximately 10 months post-diagnosis from participants in the Women’s Circle of Health Follow-up Study – a cohort of breast cancer survivors self-identifying as African American or Black women (n = 310). Neighborhood perceptions were obtained during follow-up interviews conducted approximately 24 months after diagnosis. Objective neighborhood disorder was from 9 items audited across 23,276 locations using Google Street View and scored to estimate disorder values at each participant’s residential address at diagnosis. Census tract socioeconomic and demographic composition covariates were from the 2010 U.S. Census and American Community Survey. Pathways to perceived neighborhood disorder were built using structural equation modelling. Model fit was assessed from the comparative fit index and root mean square error approximation and associations were reported as standardized coefficients and 95% confidence intervals. Results Higher perceived neighborhood disorder was associated with higher objective neighborhood disorder (β = 0.20, 95% CI: 0.06, 0.33), lower neighborhood social cohesion, and lower individual-level socioeconomic factors (final model root mean square error approximation 0.043 (90% CI: 0.013, 0.068)). Perceived neighborhood social cohesion was associated with individual-level socioeconomic factors and objective neighborhood disorder (β = − 0.11, 95% CI: − 0.24, 0.02). Conclusion Objective neighborhood disorder might be related to perceived disorder directly and indirectly through perceptions of neighborhood social cohesion.

Association between neighborhood social cohesion, awareness of chronic diseases, and participation in healthy behaviors in a community cohort

Background Neighborhood social cohesion (NSC) is the network of relationships as well as the shared values and norms of residents in a neighborhood. Higher NSC has been associated with improved cardiovascular health, largely among Whites but not African Americans. In a bi-racial cohort, we aimed to study the association between NSC and chronic disease awareness and engagement in healthy self-management behaviors, two potential mechanisms by which NSC could impact cardiovascular health outcomes. Methods Using the Healthy Aging in Neighborhoods of Diversity Across the Lifespan Study (HANDLS), we cross-sectionally examined the association between NSC and awareness of three chronic conditions (diabetes, chronic kidney disease (CKD), and hypertension) and engagement in healthy self-management behaviors including physical activity, healthy eating, and cigarette avoidance. Results Study participants (n = 2082) had a mean age of 56.5 years; 38.7% were White and 61.4% African American. Of the participants, 26% had diabetes, 70% had hypertension and 20.2% had CKD. Mean NSC was 3.3 (SD = 0.80) on a scale of 1 (lowest score) to 5 (highest score). There was no significant association between NSC and any chronic disease awareness, overall or by race. However, each higher point in mean NSC score was associated with less cigarette use and healthier eating scores, among Whites (adjusted odds ratio [aOR], 95% confidence interval [CI]: =0.76, 0.61–0.94; beta coefficient [βc]:, 95% CI: 1.75; 0.55–2.97, respectively) but not African Americans (aOR = 0.95, 0.79–1.13; βc: 0.46, − 0.48–1.39, respectively; Pinteraction = 0.08 and 0.06). Among both Whites and African Americans, higher NSC scores were associated with increases in self-reported physical activity (βc: 0.12; 0.08–0.16; Pinteraction = 0.40). Conclusions Community engagement and neighborhood social cohesion may be important targets for promotion of healthy behaviors and cardiovascular disease prevention. More research is needed to understand the different associations of NSC and healthy behaviors by race.

Does Neighborhood Cohesion Moderate the Association between Cancer and Psychological Distress?

The purpose of this study is to examine (a) the association between cancer diagnosis and psychological distress and (b) the extent to which this association is moderated by perceptions of neighborhood social cohesion. Data are drawn from the 2013 wave of the National Health Interview Survey (NHIS), a nationally representative survey on broad health topics. We employ ordinary least squares (OLS) regression to examine the links between cancer, neighborhood cohesion, and distress. Findings reveal no statistically significant difference in psychological distress between women with breast and cervical cancer. However, neighborhood social cohesion does moderate the effect of cancer on distress. While perceptions of neighborhood cohesion do not affect levels of psychological distress among women with breast cancer, perceived connectedness with neighbors translates into significantly lower levels of mental distress among women diagnosed with cervical cancer.