Sandra E. Echeverría

Associations of neighborhood problems and neighborhood social cohesion with mental health and health behaviors: The Multi Ethnic Study of Atherosclerosis

Few studies have investigated the specific features implicated in neighborhood-health associations. We examined associations between measures of neighborhood problems and neighborhood social cohesion with depression, smoking, drinking, and walking for exercise in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Neighborhoods were characterized according to participant self-report and aggregated measures based on other MESA participants. Individuals living in the least problematic neighborhoods were significantly less likely to be depressed, to smoke, or to drink. Less socially cohesive neighborhoods were associated with increased depression, smoking, and not walking for exercise. Results persisted after adjusting for individual-level variables. Each measure appeared to capture distinct features of the neighborhood and associations did not differ by race/ethnicity. Results for neighborhood problems were robust to the use of aggregate measures but results for social cohesion generally were not. Future work should determine the health effect of modifying specific features of the neighborhood context.

Cross-Sectional and Longitudinal Associations of Neighborhood Cohesion and Stressors with Depressive Symptoms in the Multiethnic Study of Atherosclerosis

PURPOSE This study examined associations of neighborhood social cohesion, violence, and aesthetic quality with depressive symptoms among 2,619 healthy adults aged 45-84 years enrolled in the Multiethnic Study of Atherosclerosis. METHODS Neighborhood characteristics were estimated by surveying a separate sample of area residents. Measures of aesthetic environment, social cohesion, and violence were combined into a summary score with increasing scores indicating more favorable environments. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. Marginal maximum likelihood estimation was used to assess associations of neighborhood characteristics with CES-D score at baseline and with the odds of developing incident depression (CES-D score >/=16 or use of antidepressants) over a 4-5 year follow-up among persons with CES-D less than 16 at baseline. Models were adjusted for age, income, education, and race/ethnicity. RESULTS Lower levels of social cohesion and aesthetic quality and higher levels of violence were associated with higher mean CES-D scores in men and women (P for trend <0.01, adjusted mean difference in CES-D per 1 SD increase in summary score -1.01 [95% confidence interval = -1.85, -0.17] and -1.08 [95% confidence interval = -1.88, -0.28] in men and women, respectively). Associations of neighborhood characteristics with incident depression were in the expected direction for women but confidence intervals were wide (odds ratio of incident depression = 0.89 [0.63, 1.26]). No association was seen for men (odds ratio = 0.96 [0.74, 1.25]). CONCLUSION Neighborhood social cohesion, aesthetic quality, and violence are associated with the presence of depressive symptoms in residents.

Smoking-Cessation Prevalence Among U.S. Smokers of Menthol Versus Non-Menthol Cigarettes

BACKGROUND The Food and Drug Administration currently is assessing the public health impact of menthol cigarettes. Whether menthol cigarettes pose increased barriers to quitting is a critical issue because previous declines in smoking prevalence have stalled. PURPOSE To explore whether menthol cigarette smokers are less likely to quit than non-menthol smokers at the population level and whether this relationship differs by race/ethnicity. METHODS Cross-sectional analyses of the 2003 and 2006/2007 Tobacco Use Supplement to the Current Population Survey were conducted in 2010. Multiple logistic regressions were used to calculate the adjusted odds of cessation for menthol smoking relative to non-menthol smoking. Five different sample restrictions were used to assess the robustness of the findings. RESULTS In the broadest sample restriction, menthol smokers were less likely to have quit smoking (AOR=0.91, 95% CI=0.87, 0.96). This relationship holds among whites (AOR=0.93, 95% CI=0.88, 0.98) and blacks (AOR=0.81, 95% CI=0.67, 0.98). The magnitude of the relationship among Hispanics was similar to that among whites, but differed by Hispanic origin. Among those of Mexican origin, the AOR for menthol smokers was protective but not significant (AOR=1.29, 95% CI=0.99, 1.61), whereas among those of Puerto Rican origin, menthol smokers were less likely to have quit (AOR=0.57, 95% CI=0.37, 0.87). These findings were robust and significant in four of five sample restrictions. CONCLUSIONS Smoking menthol cigarettes is associated with decreased cessation at the population level, and this association is more pronounced among black and Puerto Rican smokers. These findings support the recent calls to ban menthol flavoring in cigarettes.

Assessing the Feasibility and Sample Quality of a National Random-digit Dialing Cellular Phone Survey of Young Adults

The majority of adults aged 18-34 years have only cellular phones, making random-digit dialing of landline telephones an obsolete methodology for surveillance of this population. However, 95% of this group has cellular phones. This article reports on the 2011 National Young Adult Health Survey (NYAHS), a pilot study conducted in the 50 US states and Washington, DC, that used random-digit dialing of cellular phones and benchmarked this methodology against that of the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Comparisons of the demographic distributions of subjects in the NYAHS and BRFSS (aged 18-34 years) with US Census data revealed adequate reach for all demographic subgroups. After adjustment for design factors, the mean absolute deviations across demographic groups were 3 percentage points for the NYAHS and 2.8 percentage points for the BRFSS, nationally, and were comparable for each census region. Two-sided z tests comparing cigarette smoking prevalence revealed no significant differences between NYAHS and BRFSS participants overall or by subgroups. The design effects of the sampling weight were 2.09 for the NYAHS and 3.26 for the BRFSS. Response rates for the NYAHS and BRFSS cellular phone sampling frames were comparable. Our assessment of the NYAHS methodology found that random-digit dialing of cellular phones is a feasible methodology for surveillance of young adults.

A Local Area Analysis of Racial, Ethnic, and Neighborhood Disparities in Breast Cancer Staging

Few studies have examined the role of neighborhood socioeconomic condition in shaping breast cancer disparities in defined local areas. We tested associations between three measures of neighborhood socioeconomic condition (poverty, median income, and a composite neighborhood score) on breast cancer staging in two urban counties of the state of New Jersey. Data for these counties were obtained from the New Jersey Surveillance, Epidemiology, and End Results tumor registry and were selected because of their large racial/ethnic and socioeconomic diversity and pilot prevention efforts taking place in these areas. Our study population included Black, Latina, and White women (N = 4,589) diagnosed with breast cancer from 1999 to 2004. Each cancer case was geocoded and linked to socioeconomic data obtained from the 2000 U.S. census. Census tracts served as proxies for neighborhoods. Logistic regression models accounting for clustering of individuals within neighborhoods were fitted with Generalized Estimating Equations. Women living in neighborhoods with lower versus higher neighborhood scores were significantly more likely to have advanced-stage disease (odds ratio, 1.6; confidence intervals, 1.1-2.3), after adjusting for age at diagnosis and race/ethnicity. In analyses stratified by race/ethnicity, results remained significant for all neighborhood measures for White and Black women, but not for Latinas. Moreover, neighborhood poverty showed a weaker socioeconomic gradient in breast cancer staging among White women. Our study findings support the use of a multidimensional neighborhood index to better capture differences in cancer staging risk across racial/ethnic groups and provides evidence that population-based cancer data could be used to identify local needs specific to local populations. (Cancer Epidemiol Biomarkers Prev 2009;18(11):3024–9)

A Community Survey on Neighborhood Violence, Park Use and Physical Activity Among Urban Youth

BACKGROUND Neighborhoods can be an important feature of the built environment influencing physical activity; however, neighborhood poverty and violence may pose significant barriers for youth physical activity. We conducted a community survey of 107 households with youth 3-12 years of age in select neighborhoods of the city of Newark, New Jersey, a highly impoverished and racially/ethnically segregated city of the United States. RESULTS The majority of sampled households did not have access to a park, and nearly 60% of youth were not engaged in a team or organized physical activity program. Hearing gunshots and seeing drug deals in the neighborhood were reported by 74% and 56%, respectively, of study participants. In adjusted regression models, a 1-unit increase in self-reported neighborhood safety was associated with perceptions that parks were safe for youth to use (OR = 1.7, CI = 1.3, 2.3) and increased odds of youth using parks (OR = 1.3, CI = 1.0, 1.6). Self-reported neighborhood violence was marginally associated with lower levels of Metabolic Equivalent (MET)-min/week of moderate PA (β = -54.25, P = .05). CONCLUSION To ensure national goals of increased physical activity and use of outdoor spaces, addressing the neighborhood contexts under which the most vulnerable of our youth live will be required.

Social norms and its correlates as a pathway to smoking among young Latino adults

Socially and culturally embedded norms regarding smoking may be one pathway by which individuals adopt smoking behaviors. However, few studies have examined if social norms operate in young adults, a population at high risk of becoming regular smokers. There is also little research examining correlates of social norms in populations with a large immigrant segment, where social norms are likely to differ from the receiving country and could contribute to a better understanding of previously reported acculturation-health associations. Using data from a nationally representative sample of young adults in the United States reached via a novel cell-phone sampling design, we explored the relationships between acculturation proxies (nativity, language spoken and generational status), socioeconomic position (SEP), smoking social norms and current smoking status among Latinos 18-34 years of age (n = 873). Specifically, we examined if a measure of injunctive norms assessed by asking participants about the acceptability of smoking among Latino co-ethnic peers was associated with acculturation proxies and SEP. Results showed a strong gradient in smoking social norms by acculturation proxies, with significantly less acceptance of smoking reported among the foreign-born and increasing acceptance among those speaking only/mostly English at home and third-generation individuals. No consistent and significant pattern in smoking social norms was observed by education, income or employment status, possibly due to the age of the study population. Lastly, those who reported that their Latino peers do not find smoking acceptable were significantly less likely to be current smokers compared to those who said their Latino peers were ambivalent about smoking (do not care either way) in crude models, and in models that adjusted for age, sex, generational status, language spoken, and SEP. This study provides new evidence regarding the role of social norms in shaping smoking behaviors among Latino young adults and suggests distinct influences of acculturation proxies and socioeconomic condition on smoking social norms in this population.

The Role of Poverty Status and Obesity on School Attendance in the United States

PURPOSE Several studies have shown that obesity influences school performance. Little is known about the joint effect of poverty and obesity associated with school attendance. METHODS Data are from the National Survey of Childrens Health (N = 93,151), a nationally representative sample of U.S. youth aged 10-17 years. Our dependent variable was ≥11 days of school days missed per year. Body mass index was classified as normal, overweight, and obese using age- and sex-specific criteria. Federal poverty level (FPL) was classified as <200%, 200%-399%, and ≥400% (high income). Covariates included gender, age, childs race or ethnicity, maternal physical and mental health, childs health, family composition, and household tobacco use. Logistic regression models and prevalence ratios were estimated, accounting for the complex survey design. RESULTS The odds of missing ≥11 days of school among overweight youth was 1.5 times that of normal-weight youth (95% confidence interval (CI) = 1.22-1.85) and 1.7 (95% CI = 1.35-2.13) times among obese youth in fully adjusted models. In joint effects models, the probability of missing school was significantly greater for obese youth in both the <200% FPL group (prevalence ratio = 1.78, CI = 1.36-2.34) and the ≥400% FPL group (prevalence ratio = 2.88, CI = 1.91-4.35), when compared with their normal-weight, higher income peers. Predicted probabilities revealed sharper gradients for higher income youth. CONCLUSIONS Obesity influences school absenteeism across all income categories. Nonetheless, there may be distinct reasons for missing school for lower and higher income youth, and the long-term consequences of school absences may also differ for these populations.

Social engagement and chronic disease risk behaviors: The Multi-Ethnic Study of Atherosclerosis

OBJECTIVE Although engagement in social networks is important to health, multiple different dimensions exist. This study identifies which dimensions are associated with chronic disease risk behaviors. METHODS Cross-sectional data on social support, loneliness, and neighborhood social cohesion from 5381 participants, aged 45-84 from the Multi-Ethnic Study of Atherosclerosis was used. RESULTS After adjusting for individual characteristics and all social engagement variables, social support was associated with lower smoking prevalence (PR=0.88, 95% CI: 0.82, 0.94), higher probability of having quit (PR=1.03, 95% CI: 1.01, 1.06) and a slightly higher probability of achieving physical activity recommendations (PR=1.03, 95% CI: 1.01, 1.06). Neighborhood social cohesion was associated with very slightly higher probability of achieving recommended (PR=1.03, 95% CI: 1.01, 1.05) or any regular (PR=1.0, 95% CI: 1.01, 1.04) physical activity, and a higher probability of consuming at least five daily fruit and vegetable servings (PR=1.05, 95% CI: 1.01, 1.09). CONCLUSIONS Both social support and neighborhood social cohesion, a less commonly considered aspect of social engagement, appear to be important for chronic disease prevention interventions and likely act via separate pathways.

Ethnic enclaves and gestational diabetes among immigrant women in New York City.

Previous research has shown that immigrants living in their own ethnic enclave are at decreased risk of poor health outcomes, but this question has not been studied in relation to gestational diabetes, an important early marker of lifecourse cardiovascular health. We ascertained gestational diabetes, census tract of residence, and individual-level covariates for Sub-Saharan African, Chinese, South Central Asian, Non-Hispanic Caribbean, Dominican, Puerto Rican, Mexican, and Central and South American migrant women using linked birth-hospital discharge data for 89,703 singleton live births in New York City for the years 2001-2002. Using 2000 census data, for each immigrant group we defined a given census tract as part of an ethnic enclave based on the population distribution for the corresponding ethnic group. We estimated odds ratios for associations between living in an ethnic enclave and risk of gestational diabetes adjusted for neighborhood deprivation, percent commercial space, education, age, parity, and insurance status, using multilevel logistic regression. Overall, we found no effect of ethnic enclave residence on gestational diabetes in most immigrant groups. Among South Central Asian and Mexican women, living in a residential ethnic enclave was associated with an increased odds of gestational diabetes. Several explanations are proposed for these findings. Mechanisms explaining an increased risk of gestational diabetes in South Central Asian and Mexican ethnic enclaves should be examined.