Irene H. Yen

Income inequality and mortality in metropolitan areas of the United States.

OBJECTIVES This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority.

Poverty area residence and changes in physical activity level: evidence from the Alameda County Study.

OBJECTIVES Evidence from the Alameda County Study indicated that residential area has an independent effect on mortality risk. The current research examined the effect of poverty area residence on change in physical activity (n = 1737). METHODS Data were from a longitudinal population-based cohort. Multiple linear regression analyses were used. RESULTS Age- and sex-adjusted change scores between 1965 and 1974 for physical activity were 0.67 units lower for people living in poverty areas (P = .0001). Independent of individual income, education, smoking status, body mass index, and alcohol consumption, poverty area residence remained associated with physical activity change. CONCLUSION These results further support the hypothesis that place affects health behaviors.

Childhood obesity and the built environment

Purpose of review Neighborhood factors are increasingly examined for their role in the childhood obesity epidemic. Whereas studies on the impacts of neighborhood factors on adult obesity are relatively common, studies examining these same factors on childhood obesity are far fewer. Recent findings Using the Ecological Systems Theory (EST) as a model, we sought to examine the strength of the literature with respect to neighborhood factors as outlined in EST. This includes factors related to the family and the school, which are embedded in larger social contexts of the community and society. These factors are often referred to in the literature as the ‘built environment’ which encompasses the entire range of structural elements in a residential setting including, for example, housing mix, transportation networks, public resources, and presence of sidewalks or trails. Summary Whereas progress has been made with respect to the body of evidence supporting the role of neighborhood factors on childhood obesity and obesity-related behaviors, much work remains to be done to enhance our understanding of neighborhood level factors. As the body of evidence grows, these studies will inform multilevel interventions which are urgently needed to tackle the growing epidemic of childhood obesity in the US.

The association between subjective social status and mental health among Asian immigrants: Investigating the influence of age at immigration

This paper examines how age at immigration influences the association between adult subjective social status and mental health outcomes. The age when people immigrate shapes the capacity and efficiency at which they learn and use a new language, the opportunities to meet and socialize with a wide range of people, and respond to healthy or stressful environments. We hypothesize that adult subjective social status will be more predictive of health outcomes among immigrants who arrive in the US in mid- to late-adulthood compared with immigrants who arrive earlier. To investigate this hypothesis, data on immigrants are drawn from the US first national survey of mental health among Asian Americans (N=1451). Logistic regression is used to estimate the relationships between adult subjective social status and mood dysfunction, a composite of anxiety and affective disorder symptoms. As predicted, age at immigration moderated the relationship between adult subjective social status and mood dysfunction. Adult subjective social status was related to health among immigrants arriving when they were 25 years and older, but there was no association between subjective social status and mental health among immigrants arriving before the age of 25 years.

Perceived Neighborhood Problems and Quality of Life, Physical Functioning, and Depressive Symptoms Among Adults With Asthma

OBJECTIVES We investigated associations between perceived neighborhood problems and quality of life (QOL), physical functioning, and depressive symptoms among adults with asthma. METHODS Using cross-sectional data from adults with asthma in northern California (n=435), we examined associations between 5 types of perceived neighborhood problems (traffic, noise, trash, smells, and fires) and asthma-specific QOL (Marks instrument), physical functioning (Short Form-12 physical component summary), and depressive symptoms (Center for Epidemiological Studies-Depression). We used multivariate regression analysis. RESULTS When asthma severity and sociodemographics were taken into account, people reporting a score of 8 or higher on a scale of 0 to 25 for serious problems (the top quartile of seriousness) in their neighborhoods had significantly poorer QOL scores (mean difference=5.91; standard error [SE]=1.63), poorer physical functioning (mean difference=-3.04; SE=1.27), and almost a fivefold increase in depressive symptoms (odds ratio=4.79; 95% confidence interval=2.41, 9.52). CONCLUSIONS A high level of perceived neighborhood problems was associated with poorer QOL, poorer physical functioning, and increased depressive symptoms among people with asthma when disease severity and sociodemographic factors were taken into account.

Area-level socio-economic status and health status among adults with asthma and rhinitis

Socio-economic status (SES) may affect health status in airway disease at the individual and area level. In a cohort of adults with asthma, rhinitis or both conditions, questionnaire-derived individual-level SES and principal components analysis (PCA) of census data for area-level SES factors were used. Regression analysis was utilised to study the associations among individual- and area-level SES for the following four health status measures: severity of asthma scores and the Short Form-12 Physical Component Scale (SF-12 PCS) (n = 404); asthma-specific quality of life (QoL) scores (n = 340); and forced expiratory volume in one second (FEV1) per cent predicted (n = 218). PCA yielded a two-factor solution for area-level SES. Factor 1 (lower area-level SES) was significantly associated with poorer SF-12 PCS and worse asthma QoL. These associations remained significant after adding individual-level SES. Factor 1 was also significantly associated with severity of asthma scores, but not after addition of the individual-level SES. Factor 2 (suburban area-level SES) was associated with lower FEV1 per cent predicted in combined area-level and individual SES models. In conclusion, area-level socio-economic status is linked to some, but not all, of the studied health status measures after taking into account individual-level socio-economic status.

Integration of Social Epidemiology and Community-Engaged Interventions to Improve Health Equity

The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.

The impact of neighborhood social and built environment factors across the cancer continuum: Current research, methodological considerations, and future directions.

Neighborhood social and built environments have been recognized as important contexts in which health is shaped. The authors reviewed the extent to which these neighborhood factors have been addressed in population‐level cancer research by scanning the literature for research focused on specific social and/or built environment characteristics and their association with outcomes across the cancer continuum, including incidence, diagnosis, treatment, survivorship, and survival. The commonalities and differences in methodologies across studies, the current challenges in research methodology, and future directions in this research also were addressed. The assessment of social and built environment factors in relation to cancer is a relatively new field, with 82% of the 34 reviewed articles published since 2010. Across the wide range of social and built environment exposures and cancer outcomes considered by the studies, numerous associations were reported. However, the directions and magnitudes of associations varied, in large part because of the variation in cancer sites and outcomes studied, but also likely because of differences in study populations, geographic regions, and, importantly, choice of neighborhood measures and geographic scales. The authors recommend that future studies consider the life‐course implications of cancer incidence and survival, integrate secondary and self‐report data, consider work neighborhood environments, and further develop analytical and statistical approaches appropriate to the geospatial and multilevel nature of the data. Incorporating social and built environment factors into research on cancer etiology and outcomes can provide insights into disease processes, identify vulnerable populations, and generate results with translational impact of relevance for interventionists and policy makers. Cancer 2015;121:2314–2330.

Impact of the home indoor environment on adult asthma and rhinitis

Objective: We sought to study the combined effects of multiple home indoor environmental exposures in adult asthma and rhinitis. Methods: We studied 226 adults with asthma and rhinitis by structured interviews and home assessments. Environmental factors included dust allergen, endotoxin and glucan concentrations, and indoor air quality (IAQ) variables. Outcomes included forced expiratory volume in 1 second (FEV1) percent predicted, Severity of Asthma Score (SAS), Short-Form (SF)-12 Physical Component Scale (PCS), and asthma Quality of Life (QOL) score. Results: House dust-associated exposures together with limited IAQ variables were related to FEV1 % predicted (R2 = 0.24; P = 0.0001) and SAS (R2 = 0.18; P = 0.007). IAQ and limited dust variables were associated with SF-12 PCS (R2 = 0.15; P = 0.02), but not QOL (R2 = 0.13; P = 0.16). Conclusions: The home environment is strongly linked to lung function, health status, and disease severity in adult asthma and rhinitis.

Gender, Race, Class, and Aging: Advances and Opportunities

Key debates in social science and health research have centered on how to increase the inclusiveness of such research and hence its relevance for understanding the intersections of race, class, gender, and aging. This article uses gerontology as a case in point, examining the challenges of inclusivity and interlocking oppressions/intersectionality for better apprehending how broad structural factors shape and determine the experience of aging and growing old. The authors discuss alternative hypotheses being used to explore inequalities in the aging experience and the limitations of current concepts and methods. Promising new developments in sociology, epidemiology, and other fields are described in terms of their relevance for better understanding the dynamic interplay of race, class, gender, and aging.