Margaret M. Weden

Subjective and objective neighborhood characteristics and adult health

This study examines both objective and subjective assessments of neighborhood conditions, exploring the overlap between different sources of information on neighborhoods and the relative strength of their association with adult self-rated health. Data on perceived neighborhood quality from Wave IV (2001/2002) of the nationally representative U.S. Americans Changing Lives study are merged with neighborhood-level census tract data to measure subjective and objective neighborhood constructs. Structural equation models indicate that subjective and objective constructs are both related to health. However, the subjective construct (perceived neighborhood quality) is most strongly associated with health and mediates associations between health and the objective constructs (neighborhood disadvantage and affluence). Additionally, individual characteristics play an important role in shaping the contribution of neighborhood conditions through selection and mediation. Our results demonstrate the independent associations between both objective and perceived neighborhood quality and health, and highlight the particularly strong association between perceived neighborhood quality and health.

Parent-Reported Height and Weight as Sources of Bias in Survey Estimates of Childhood Obesity

Parental reporting of height and weight was evaluated for US children aged 2-13 years. The prevalence of obesity (defined as a body mass index value (calculated as weight (kg)/height (m)(2)) in the 95th percentile or higher) and its height and weight components were compared in child supplements of 2 nationally representative surveys: the 1996-2008 Children of the National Longitudinal Survey of Youth 1979 Cohort (NLSY79-Child) and the 1997 Child Development Supplement of the Panel Study of Income Dynamics (PSID-CDS). Sociodemographic differences in parent reporting error were analyzed. Error was largest for children aged 2-5 years. Underreporting of height, not overreporting of weight, generated a strong upward bias in obesity prevalence at those ages. Frequencies of parent-reported heights below the Centers for Disease Control and Preventions (Atlanta, Georgia) first percentile were implausibly high at 16.5% (95% confidence interval (CI): 14.3, 19.0) in the NLSY79-Child and 20.6% (95% CI: 16.0, 26.3) in the PSID-CDS. They were highest among low-income children at 33.2% (95% CI: 22.4, 46.1) in the PSID-CDS and 26.2% (95% CI: 20.2, 33.2) in the NLSY79-Child. Bias in the reporting of obesity decreased with childrens age and reversed direction at ages 12-13 years. Underreporting of weight increased with age, and underreporting of height decreased with age. We recommend caution to researchers who use parent-reported heights, especially for very young children, and offer practical solutions for survey data collection and research on child obesity.

Neighborhood Archetypes for Population Health Research: Is There No Place Like Home?

This study presents a new, latent archetype approach for studying place in population health. Latent class analysis is used to show how the number, defining attributes, and change/stability of neighborhood archetypes can be characterized and tested for statistical significance. The approach is demonstrated using data on contextual determinants of health for US neighborhoods defined by census tracts in 1990 and 2000. Six archetypes (prevalence 13-20%) characterize the statistically significant combinations of contextual determinants of health from the social environment, built environment, commuting and migration patterns, and demographics and household composition of US neighborhoods. Longitudinal analyses based on the findings demonstrate notable stability (76.4% of neighborhoods categorized as the same archetype ten years later), with exceptions reflecting trends in (ex)urbanization, gentrification/downgrading, and racial/ethnic reconfiguration. The findings and approach is applicable to both research and practice (e.g. surveillance) and can be scaled up or down to study health and place in other geographical contexts or historical periods.

Prenatal, perinatal, early life, and sociodemographic factors underlying racial differences in the likelihood of high body mass index in early childhood.

OBJECTIVES We investigated early childhood disparities in high body mass index (BMI) between Black and White US children. METHODS We compared differences in Black and White childrens prevalence of sociodemographic, prenatal, perinatal, and early life risk and protective factors; fit logistic regression models predicting high BMI (≥ 95th percentile) at age 4 to 5 years to 2 nationally representative samples followed from birth; and performed separate and pooled-survey estimations of these models. RESULTS After adjustment for sample design-related variables, models predicting high BMI in the 2 samples were statistically indistinguishable. In the pooled-survey models, Black childrens odds of high BMI were 59% higher than White childrens (odds ratio [OR] = 1.59; 95% confidence interval [CI]= 1.32, 1.92). Sociodemographic predictors reduced the racial disparity to 46% (OR = 1.46; 95% CI = 1.17, 1.81). Prenatal, perinatal, and early life predictors reduced the disparity to nonsignificance (OR = 1.18; 95% CI = 0.93, 1.49). Maternal prepregnancy obesity and short-duration or no breastfeeding were among predictors for which racial differences in childrens exposures most disadvantaged Black children. CONCLUSIONS Racial disparities in early childhood high BMI were largely explained by potentially modifiable risk and protective factors.

Intergenerational Relationships Between the Smoking Patterns of a Population-Representative Sample of US Mothers and the Smoking Trajectories of Their Children

OBJECTIVES We assessed intergenerational transmission of smoking in mother-child dyads. METHODS We identified classes of youth smoking trajectories using mixture latent trajectory analyses with data from the Children and Young Adults of the National Longitudinal Survey of Youth (n = 6349). We regressed class membership on prenatal and postnatal exposure to maternal smoking, including social and behavioral variables, to control for selection. RESULTS Youth smoking trajectories entailed early-onset persistent smoking, early-onset experimental discontinued smoking, late-onset persistent smoking, and nonsmoking. The likelihood of early onset versus late onset and early onset versus nonsmoking were significantly higher among youths exposed prenatally and postnatally versus either postnatally alone or unexposed. Controlling for selection, the increased likelihood of early onset versus nonsmoking remained significant for each exposure group versus unexposed, as did early onset versus late onset and late onset versus nonsmoking for youths exposed prenatally and postnatally versus unexposed. Experimental smoking was notable among youths whose mothers smoked but quit before the childs birth. CONCLUSIONS Both physiological and social role-modeling mechanisms of intergenerational transmission are evident. Prioritization of tobacco control for pregnant women, mothers, and youths remains a critical, interrelated objective.

Using Geographic Information Systems to Match Local Health Needs With Public Health Services and Programs

Local health departments (LHDs) play an important role in ensuring essential public health services. Geographic information system (GIS) technology offers a promising means for LHDs to identify geographic gaps between areas of need and the reach of public health services. We examined how large LHDs could better inform planning and investments by using GIS-based methodologies to align community needs and health outcomes with public health programs. We present a framework to drive LHDs in identifying and addressing gaps or mismatches in services or health outcomes.

Can Honorific Awards Give Us Clues about the Connection between Socioeconomic Status and Mortality

Social epidemiologists Marmot and Wilkinson argue that relative deprivation is the dominant mechanism through which socioeconomic status (SES) affects mortality. If such an argument is valid, we would expect to consistently see the influence of relative deprivation in situations where two or more highly qualified and very similar individuals are nominated in a status competition, but only one receives the status boost conferred by winning. We studied mortality experiences of Emmy Award winners, Baseball Hall of Fame inductees, and presidents and vice presidents—comparing each to nominated losers in the same competition. Our findings and results of similar studies fail to show consistent advantages for winners. The association between winning and longevity is sometimes positive, sometimes negative, and sometimes nonexistent. We conclude that the critical processes determining the strength and direction of any status effect on longevity are changes in life circumstances that result from winning or losing, rather than the processes that inexorably flow from one’s relative position in a status hierarchy.

Historical and life course timing of the male mortality disadvantage in Europe: epidemiologic transitions, evolution, and behavior.

Abstract This study employs vital statistics data from Sweden, England, Wales, France, and Spain to examine male:female mortality differentials from 1750 through 2000 and their interrelationship with epidemiological transitions. Across all ages and time periods, the largest relative mortality disadvantages are to young adult men. When crisis mortality from the two world wars is removed, we show that the mortality in this young male age group is about two to three times the level of female mortality across all countries sampled. In addition, we show that the timing of this stabilization in male mortality disadvantages occurs during the last half of the twentieth century, at the same point that our measure of epidemiological change also stabilizes at a new low level. The findings are consistent with an interdisciplinary theoretical model that links social, technological and epidemiological changes that occurred through the first half of the 20th century with the unmasking and accentuation of mortality disadvantages among young adult men.

Epidemiological Paradox or Immigrant Vulnerability? Obesity Among Young Children of Immigrants

According to the “immigrant epidemiological paradox,” immigrants and their children enjoy health advantages over their U.S.-born peers—advantages that diminish with greater acculturation. We investigated child obesity as a potentially significant deviation from this paradox for second-generation immigrant children. We evaluated two alternate measures of mother’s acculturation: age at arrival in the United States and English language proficiency. To obtain sufficient numbers of second-generation immigrant children, we pooled samples across two related, nationally representative surveys. Each included measured (not parent-reported) height and weight of kindergartners. We also estimated models that alternately included and excluded mother’s pre-pregnancy weight status as a predictor. Our findings are opposite to those predicted by the immigrant epidemiological paradox: children of U.S.-born mothers were less likely to be obese than otherwise similar children of foreign-born mothers; and the children of the least-acculturated immigrant mothers, as measured by low English language proficiency, were the most likely to be obese. Foreign-born mothers had lower (healthier) pre-pregnancy weight than U.S.-born mothers, and this was protective against their second-generation children’s obesity. This protection, however, was not sufficiently strong to outweigh factors associated or correlated with the mothers’ linguistic isolation and marginal status as immigrants.

Multiple Imputation For Combined-Survey Estimation With Incomplete Regressors In One But Not Both Surveys.

Within-survey multiple imputation (MI) methods are adapted to pooled-survey regression estimation where one survey has more regressors, but typically fewer observations, than the other. This adaptation is achieved through (1) larger numbers of imputations to compensate for the higher fraction of missing values, (2) model-fit statistics to check the assumption that the two surveys sample from a common universe, and (3) specifying the analysis model completely from variables present in the survey with the larger set of regressors, thereby excluding variables never jointly observed. In contrast to the typical within-survey MI context, cross-survey missingness is monotonic and easily satisfies the missing at random assumption needed for unbiased MI. Large efficiency gains and substantial reduction in omitted variable bias are demonstrated in an application to sociodemographic differences in the risk of child obesity estimated from two nationally representative cohort surveys.