Abstract 003: Neighborhood Characteristics And Arterial Stiffness Among Black Adults - Results From The Jackson Heart Study & Morehouse Emory Center For Health Equity

Introduction: Poor quality neighborhoods are independent risk factors for cardiovascular disease (CVD) but are understudied in Blacks, who face large CVD health disparities. Arterial stiffness (AS) precedes development of hypertension and adverse CVD events but the effect of neighborhood on AS among Blacks remain unknown. Objective: We compared the association between neighborhood environment and AS among Blacks in Jackson, MS and Atlanta, GA. Methods: We studied 1592 Blacks (age 58 ± 10, 38% male) living in Jackson, MS from the Jackson Heart Study (JHS) and 451 Blacks (age 53 ± 10, 39% male) living in Atlanta, GA from the Morehouse/Emory Center for Health Equity (MECA) study, without known CVD. Neighborhood problems (includes measures of aesthetic quality, walking environment, food access), social cohesion (includes activity with neighbors), and violence/safety were assessed using validated questionnaires. AS was measured as pulse wave velocity (PWV) using MRI in JHS and as PWV and augmentation index (AIx) using applanation tonometry (Sphygmocor Inc) in MECA. Multivariable linear regression models were used to examine the association between neighborhood characteristics and AS, adjusting for potential confounders. Results: Improved social characteristics, measured as social cohesion in JHS (β = -0.32 [-0.63, - 0.02], p=0.04) and activity with neighbors (β = -0.23 [-0.40, - 0.05] p=0.01) in MECA, were associated with lower PWV in both cohorts and lower AIx (β = -1.74 [-2.92, - 0.56], p=0.004) in MECA, after adjustment for CVD risk factors and income. Additionally, in MECA better food access (β = -1.18 [-2.35, - 0.01], p=0.05) was associated with lower AIx, and in JHS, lower neighborhood problems (β = -0.33 [-0.64, - 0.02], p=0.04) and lower violence (β = -0.30 [-0.61, 0.002], p=0.05) were associated with lower PWV (Fig). Conclusion: Neighborhood social characteristics show an independent association with vascular health of Blacks, findings that were reproducible in two distinct American cities.

Compound Disadvantage between Economic Declines at the City and Neighborhood Levels for Older Americans’ Depressive Symptoms

American cities and neighborhoods vary in their residents’ typical levels of mental health. Despite scholarship emphasizing that we cannot thoroughly understand city and neighborhood problems without investigating how they are intertwined, limited research examines how city and neighborhood effects interact as they impact health. I investigate these interactions through a study of the effects of the Great Recession of 2007–2009. Using Waves 1 (2005–2006) and 2 (2010–2011) of the National Social Life, Health, and Aging Project survey ( N = 1,341) and in accordance with the compound disadvantage model, I find through fixed-effects linear regression models that city- and neighborhood-level economic declines combine multiplicatively as they impact older Americans’ depressive symptoms. I furthermore find that this effect is only partly based on personal socioeconomic changes, suggesting contextual channels of effect. My results show that we cannot fully understand the effects of city-level changes without also considering neighborhood-level changes.

Participatory Representation in a Non-Western Context: The Case of Homeowner Associations in Beijing

This article examines the concept and practices of “participatory representation” in the Chinese context, a subset of substantive representation that emphasizes “authenticity” and participatory engagement in solving neighborhood problems. Through examining Chinese homeowner associations (HOAs), we explain how representation operates at the neighborhood level in a grassroots organizational context without a Western style of democracy, identifying the determinants and capacities of participatory representation. By proposing a model of representational capacity and using logistic regression analysis, we find that four factors have an impact on the quality of participatory representation: (1) homeowner attributes (i.e., gender, occupation, and length of residence), (2) problem-solving effectiveness of representative organizations, (3) transparent and open elections, and (4) level of homeowner participation. We further suggest that in a transitional society like China, these representative organizations, namely, HOAs, act as important training grounds for democratic skills, through which participatory citizen engagement is being learned and cultivated. This study contributes to contemporary accounts of participatory representation by identifying the informal representation patterns within HOAs and their potential to foster civic participation and social democracy in China in the coming decades.

Abstract P240: Discrimination Mediates the Adverse Effect of Neighborhood Problems on Cardiometabolic Risk Among Latino/a Adults

Introduction: Latino/as in the US on average present with low high-density lipoprotein (HDL) cholesterol and high body-mass index (BMI), putting them at higher risk for future cardiometabolic disease. Neighborhoods have been implicated, directly and indirectly, in poorer cardiometabolic health among ethnic minorities. US Latino/as often live in neighborhoods where they may not have access to engage in positive health behaviors, such as proper diet and physical activity. However, the mediating role of discrimination experienced in these neighborhoods has hardly been examined within the context of Latino/a cardiometabolic health. Methods: We analyzed data from the Texas City Stress and Health Study. Participants were self-identified Latino/a/Hispanic ( N = 500, 61.8% female, M age = 49.08, SD age = 15.80) who reported on their perceived experience of discrimination (higher scores reflecting more discrimination) and their perception of their neighborhood (higher scores reflecting more positive environment) validated survey measures. A trained phlebotomist drew blood in a clinic or in the participant’s home between 8 and 11 AM after fasting for HDL (mg/dL). Blood samples were centrifuged to obtain plasma, which was stored at –70°C until testing. All specimen were batch analyzed and read blind-coded. Additionally, they took clinical measures of participant’s height and weight, to calculate BMI (adjusted for sex). To estimate the mediating effect of discrimination through perception of neighborhood on cardiometabolic risk, path analysis with bootstrapped linear regression models were conducted. We conducted analyses unadjusted and adjusted for age, sex, education, and nativity. All analyses were conducted in the PROCESS macro in SPSS. Results: Participants on average had high HDL levels ( M mg/dL = 51.00, SD = 15.59). Males on average were overweight ( M BMI = 29.78, SD = 5.49) and females ( M BMI = 31.42, SD = 7.27) on average were obese. Bootstrapped estimates showed that perception of neighborhood fully mediated the effect of discrimination on HDL (b = -.43, SE = .18 p = .015) and BMI (b = .02, SE = .01, p = .023), unadjusted for covariates. Although the fully mediated model for BMI withstood adjustment for covariates, the model for HDL did not withstand adjustment. Conclusion: Discrimination accounts for the negative impact that neighborhood problems have on poor cardiometabolic health among adult Latino/as. Future research should examine how positive neighborhood interactions (e.g., walking clubs or playgroups) can mitigate the adverse effects on cardiometabolic health among this at-risk population.

Diseases of Poverty

Beyond its work on sanitation, the Young Lords responded to a series of other neighborhood problems that fell within the scope of public health. In the fall, the group launched its first children’s breakfast program alongside the Black Panthers. In tandem with community groups and hospital medical and administrative staff, the group was thrust into a larger political debate about the changing structure of healthcare in the city to which it contributed a document called the Young Lords’ 10-Point Health Program and Platform. In what is perhaps the Young Lords’ most enduring legacy, the group brought militancy to a pre-existing campaign against childhood lead poisoning that pressured City Hall to take action on a silent public health crisis. But, why health? Close analysis of this lesser-known campaign reveals that larger forces steered the Young Lords’ turn to health. They were, in part, following the example of the Cuban Revolution, which made dignified healthcare-for-all a signature aspiration of revolutionaries around the world. They were also propelled by post-war changes in the structure of medical care in the U.S. as well as by high rates of illness among the new migrants and the unintended consequences of their greater access to healthcare in the age of civil rights, which ironically also increased the incidence of medical discrimination.

The Longitudinal Associations of Perceived Neighborhood Disorder and Lack of Social Cohesion With Depression Among Adults Aged 50 Years or Older: An Individual-Participant-Data Meta-Analysis From 16 High-Income Countries

Although residential environment might be an important predictor of depression among older adults, systematic reviews point to a lack of longitudinal investigations, and the generalizability of the findings is limited to a few countries. We used longitudinal data collected between 2012 and 2017 in 3 surveys including 15 European countries and the United States and comprising 32,531 adults aged 50 years or older. The risk of depression according to perceived neighborhood disorder and lack of social cohesion was estimated using 2-stage individual-participant-data meta-analysis; country-specific parameters were analyzed by meta-regression. We conducted additional analyses on retired individuals. Neighborhood disorder (odds ratio (OR) = 1.25) and lack of social cohesion (OR = 1.76) were significantly associated with depression in the fully adjusted models. In retirement, the risk of depression was even higher (neighborhood disorder: OR = 1.35; lack of social cohesion: OR = 1.93). Heterogeneity across countries was low and was significantly reduced by the addition of country-level data on income inequality and population density. Perceived neighborhood problems increased the overall risk of depression among adults aged 50 years or older. Policies, especially in countries with stronger links between neighborhood and depression, should focus on improving the physical environment and supporting social ties in communities, which can reduce depression and contribute to healthy aging.

Psychosocial Stressors, Depression, and Physical Activity among African Americans

Objectives: To examine how racial discrimination and neighborhood perceptions relate to physical activity and sedentary behavior mediated through depression symptoms. Methods: Data were from the first year of a longitudinal cohort study, Project Creating a Higher Understanding of cancer Research and Community Health (CHURCH), based on a convenience community sample of church-attending African Americans collected between April 2012 and March 2013 (N = 370) in Houston, Texas. Measures included racial discrimination, perceived neighborhood problems and vigilance, depression (CES-D), physical activity (IPAQ-short), and sedentary behavior. Results: Main effects from the structural equation model showed that racial discrimination (b = .20, p < .01) was related to greater depression symptoms. The same pattern emerged for neighborhood problems, but the effect was not significant (b = .20, p = .07). Further, depression symptoms were related to less physical activity (b = -.62, p = .03) and greater sedentary behavior (b = .64, p < .01). Indirect effects showed that depression mediated the relationship between racial discrimination and neighborhood problems on physical activity and sedentary behavior. Conclusions: Depression symptoms are an important mechanism by which racial discrimination and perceived neighborhood problems impact physical activity and sedentary behavior.

Association of Social Adversity with Comorbid Diabetes and Depression Symptoms in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study: A Syndemic Framework

BackgroundU.S. Hispanics/Latinos experience high lifetime risk for Type 2 diabetes and concurrent psychological depression. This comorbidity is associated with poorer self-management, worse disease outcomes, and higher mortality. Syndemic theory is a novel social epidemiological framework that emphasizes the role of economic and social adversity in promoting disease comorbidity and health disparities.PurposeInformed by the syndemic framework, this study explored associations of socioeconomic and psychosocial adversity (low income/education, trauma history, adverse childhood experiences, ethnic discrimination, neighborhood problems [e.g., violence]) with comorbidity of diabetes and depression symptoms in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and Sociocultural Ancillary Study.MethodsParticipants were 5,247 Latino adults, aged 18–74, enrolled in four U.S. cities from 2008 to 2011. Participants completed a baseline physical exam and measures of depression symptoms and psychosocial adversity. Multinomial logistic regression analyses were conducted to examine associations of adversity variables with comorbid diabetes and high depression symptoms.ResultsHousehold income below $30,000/year was associated with higher odds of diabetes/depression comorbidity (odds ratio [OR] = 4.61; 95% confidence interval [CI]: 2.89, 7.33) compared to having neither condition, as was each standard deviation increase in adverse childhood experiences (OR = 1.41; 95% CI: 1.16, 1.71), ethnic discrimination (OR = 1.23; 95% CI: 1.01, 1.50), and neighborhood problems (OR = 1.53; 95% CI: 1.30, 1.80).ConclusionLow household income, adverse childhood experiences, ethnic discrimination, and neighborhood problems are related to comorbid diabetes and depression in U.S. Latinos. Future studies should explore these relationships longitudinally.