Perceived Stress as a Pathway for the Relationship Between Neighborhood Factors and Glycemic Control in Adults With Diabetes

Purpose Neighborhood factors such as crime, discrimination, and violence are increasingly recognized as correlates of poor glycemic control. However, pathways for these relationships are unclear. This study examined stress and self-efficacy as potential pathways for the relationship between neighborhood factors and glycemic control in adults with type 2 diabetes. Design Cross-sectional study. Setting Two primary care clinics in southeastern US. Participants 615 adults aged 18 years and older. Measures Validated measures were used to capture neighborhood factors, stress, and self-efficacy, while hemoglobin A1c (HbA1c) was abstracted from the electronic health record. Analysis Path analysis was used to investigate direct and indirect relationships between neighborhood factors, stress, self-efficacy, and glycemic control. Results In the final model, violence (r = .17, P = .024), discrimination (r = .46, P < .001), and crime (r = .36, P = .046) were directly associated with higher perceived stress. Stress (r = −.5, P < .001) was directly associated with lower self-efficacy. Self-efficacy was directly associated with better general diet (r = .12, P < .001), better specific diet (r = .04, P < .001), more exercise (r = .08, P < .001), and lower HbA1c (r = −.11, P < .001). Stress (r = .05, P < .001), crime (r = .20, P < .001), and discrimination (r = .08, P < .001) were indirectly associated with higher HbA1c. Conclusion Stress and self-efficacy are potential pathways for the relationship between neighborhood factors like violence, discrimination, and crime and glycemic control. Interventions aimed at mitigating stress and improving self-efficacy may improve self-care behaviors and glycemic control.

Housing, Neighborhood Factors, and Cognitive Status of Older Adults Living in Houses Versus Apartments

This study examines associations between housing, neighborhood factors and cognitive status among community-dwelling older adults, and how the associations differ between older adults who live in houses and in apartment buildings. Specifically, using the neighborhood stressor theory, three research questions are examined: 1) What individual-level factors predict late-life cognitive status? 2) After controlling for individual-level factors, what housing and neighborhood factors are significant in predicting older adults’ cognitive status? 3) How do individual, housing, neighborhood predictors of cognitive status differ between house and apartment residents? Using data from the Wave 3 NSHAP, multilevel linear regression analyses are conducted with the total sample. Results suggest that individual-level factors including young-age, female, white, and having a bachelor’s degree are associated with better cognitive status. After controlling for individual-level factors, housing and neighborhood factors including quality maintenance and high level of community safety are associated with higher cognitive scores. In addition to the additive model, we also test the interactive effect between housing type and three level of factors –individual level, housing, and neighborhood factors. Findings suggest that the joint effect of depression and housing type on cognitive status is significant. To explore the last research question, we conduct parallel regression analyses by housing type. Findings suggest that quality maintenance and high level of community safety are associated with higher cognitive scores among house residents only. Findings highlight the predictors of cognitive health vary between older adults living in different residential environments.

At-Homeness Influences the Cognition of Multimorbid Older Adults: Longitudinal Path Analysis Through Loneliness

Approximately two-thirds of older adults’ experience multimorbidity in North America. Challenges of symptoms management and reduced mobility often coincide with late-life depression which is associated with a 2 to 5-fold increased dementia risk. Loneliness and depression are connected in the prodromal phases. We examine the effects of physical environment (e.g., housing and neighborhood factors) and social environment (e.g., social support) on loneliness, depression, and cognition using path analysis, controlling for baseline. Data(n=15,087) was drawn from the Canadian Longitudinal Study on Aging. Measures of housing, neighborhood and life satisfaction were used to construct an index of “at-homeness” based on theory. We found good model fit (TLI=.989; CFI=.999; RMSEA=.026; SRMR=.006). At-homeness(B=-.20, p&lt;.001) rivaled the effect of social environment(B=-.19, p&lt;.001) on loneliness. Together, physical environment and loneliness had as much effect on cognition as depression. If causality is supported, modifying older adults’ satisfaction with their home environment may reduce loneliness and cognitive decline.

Do Objective or Subjective Neighborhood Indicators Protect Against Adversity on Mental Health and Well-Being?

The neighborhood context through which individuals interact is shown to be associated with mental and physical health across adulthood. Much less is known regarding potential underlying reasons why, such as protecting against the deleterious effects of stress. This study explores whether objective and subjective neighborhood factors are associated with maintenance of mental health and well-being in the context of monthly adversity. We use longitudinal data from a sample of midlife (N =362) who completed monthly questionnaires for two years. Results show that experiencing a monthly adversity was associated with poorer mental health and well-being. Living in a neighborhood with more disorder was associated with stronger declines in mental health and well-being when a monthly adversity was reported. Our discussion focuses on why the neighborhood context is relevant for middle-aged adults and the various ways through which neighborhood context has the potential to shape the course of development in adulthood.

Neighborhood Characteristics and Cancer Survivorship: An Overview of the Current Literature on Neighborhood Landscapes and Cancer Care

There is a growing literature on the association between neighborhood contexts and cancer survivorship. To understand the current trends and the gaps in the literature, we aimed to answer the following questions: To what degree, and how, has cancer survivorship research accounted for neighborhood-level effects? What neighborhood metrics have been used to operationalize neighborhood factors? To what degree do the neighborhood level metrics considered in cancer research reflect neighborhood development as identified in the Leadership for Energy and Environmental Design for Neighborhood Development (LEED-ND) guidelines? We first conducted a review guided by PRISMA extension for scoping review of the extant literature on neighborhood effects and cancer survivorship outcomes from January 2000 to January 2021. Second, we categorized the studied neighborhood metrics under six main themes. Third, we assessed the findings based on the LEED-ND guidelines to identify the most relevant neighborhood metrics in association with areas of focus in cancer survivorship care and research. The search results were scoped to 291 relevant peer-reviewed journal articles. Results show that survivorship disparities, primary care, and weight management are the main themes in the literature. Additionally, most articles rely on neighborhood SES as the primary (or only) examined neighborhood level metric. We argue that the expansion of interdisciplinary research to include neighborhood metrics endorsed by current paradigms in salutogenic urban design can enhance the understanding of the role of socioecological context in survivorship care and outcomes.

Individual socioeconomic and neighborhood factors predict changes in sports activity during the transition to retirement

Background There are substantial socioeconomic status (SES) differences in sports activity (SA) during the transition to retirement. In line with social-ecological models, the aim of this longitudinal study was to examine the association of perceptions of social and physical neighborhood factors with changes in SA across the retirement transition and to examine potential interactions with SES factors. Methods Data from 6 waves of the German Ageing Survey (DEAS) provided 710 participants (at baseline: mean age 61.1, 52.9% of men) who retired between baseline (1996, 2002, 2008, 2011) and their 6-year follow-up assessment. Associations between changes in SA (increases and decreases compared to retaining) and individual SES and neighborhood factors were estimated using multinomial logistic regression analysis. Results Increases were observed in 18.45% of participants, decreases in 10%. Occupational prestige was a risk factor for decreases, education a resource for increases in SA. Interactions between household income and several neighborhood factors were observed. Conclusions In line with social-ecological models, individual, neighborhood factors and interacting associations were found. In particular safety perceptions could be a resource for promotion SA in older adults who experience disadvantage.

Greenspace, Air Pollution, Neighborhood Factors, and Preeclampsia in a Population-Based Case-Control Study in California

To investigate preeclampsia etiologies, we examined relationships between greenspace, air pollution, and neighborhood factors. Data were from hospital records and geocoded residences of 77,406 women in San Joaquin Valley, California from 2000 to 2006. Preeclampsia was divided into mild, severe, or superimposed onto pre-existing hypertension. Greenspace within 100 and 500 m residential buffers was estimated from satellite data using normalized difference vegetation index (NDVI). Air quality data were averaged over pregnancy from daily 24-h averages of nitrogen dioxide, particulate matter <10 µm (PM10) and <2.5 µm (PM2.5), and carbon monoxide. Neighborhood socioeconomic (SES) factors included living below the federal poverty level and median annual income using 2000 US Census data. Odds of preeclampsia were estimated using logistic regression. Effect modification was assessed using Wald tests. More greenspace (500 m) was inversely associated with superimposed preeclampsia (OR = 0.57). High PM2.5 and low SES were associated with mild and severe preeclampsia. We observed differences in associations between greenspace (500 m) and superimposed preeclampsia by neighborhood income and between greenspace (500 m) and severe preeclampsia by PM10, overall and among those living in higher SES neighborhoods. Less greenspace, high particulate matter, and high-poverty/low-income neighborhoods were associated with preeclampsia, and effect modification was observed between these exposures. Further research into exposure combinations and preeclampsia is warranted.