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Background: Neighborhood poverty is associated with adiposity in women, though longitudinal designs, annually collected residential histories, objectively collected anthropometric measures, and geographically diverse samples of midlife women remain limited. Objective: To investigate whether longitudinal exposure to neighborhood concentrated poverty is associated with differences in body mass index (BMI) and waist circumference (WC) among 2,328 midlife women (age 42–52 years at baseline) from 6 U.S. cities enrolled in the Study of Women's Health Across the Nation (SWAN) from 1996 to 2007. Methods: Residential addresses and adiposity measures were collected at approximately annual intervals from the baseline visit through a 10-year follow-up. We used census poverty data and local spatial statistics to identify hot-spots of high concentrated poverty areas and cold-spots of low concentrated poverty located within each SWAN site region, and used linear mixed-effect models to estimate percentage differences (95% confidence interval [CI]) in average BMI and WC levels between neighborhood concentrated poverty categories. Results: After adjusting for individual-level sociodemographics, health-related factors, and residential mobility, compared to residents of moderate concentrated poverty communities, women living in site-specific hot-spots of high concentrated poverty had 1.5% higher (95% CI: 0.6, 2.3) BMI and 1.3% higher (95% CI: 0.5, 2.0) WC levels, whereas women living in cold-spots of low concentrated poverty had 0.7% lower (95% CI: −1.2, −0.1) BMI and 0.3% lower (95% CI: −0.8, 0.2) WC. Site-stratified results remained in largely similar directions to overall estimates, despite wide CIs and small sample sizes. Conclusions: Longitudinal exposure to neighborhood concentrated poverty is associated with slightly higher BMI and WC among women across midlife. [ABSTRACT FROM AUTHOR]

Introduction: The role of structural inequalities in the long-term benefits of early childhood programs has not been assessed. Previous findings in the Chicago Longitudinal Study, an early childhood cohort investigation with low-income families, indicate that Child–Parent Center (CPC) participation beginning in preschool was associated with a variety of positive health behaviors. In this secondary analysis, we assessed if structural inequalities (neighborhood poverty, history of discrimination) modified the magnitude of associations between CPC and health and education outcomes (cardiovascular health, body mass index, educational attainment) 30 years later. Method: The Chicago Longitudinal Study cohort of 1,539 children (93% Black, 7% Hispanic) grew up in high-poverty neighborhoods and attended CPCs or the usual district programs. At midlife (ages 32–37, M = 34.9 years, 2012–2017), 1,073 participants completed telephone interviews on structural inequalities, health, and education. Regression analyses were conducted with inverse propensity score weighting. Results: After accounting for structural inequality, CPC participation was significantly associated with outcomes. Mean differences on Framingham risk scores, for example, were significant for CPC preschool at ages 3 and 4 (coefficient = −2.15, p =.004, standardized difference = −0.20). Neighborhood poverty moderated (reduced) the association between CPC and cardiovascular health. Neighborhood poverty and perceived discrimination had independent contributions with outcomes. Discussion: Findings show that structural inequalities, especially poverty, directly influence and/or moderate long-term effects of CPC participation. Increasing neighborhood resources and socioeconomic status may help comprehensive programs sustain their impacts. Early childhood and sociostructural influences reflect the increasing importance of community contexts to health promotion. Public Significance Statement: This study shows evidence that neighborhood poverty in adulthood is associated with a significant reduction in the estimated effect of preschool participation in the Child–Parent Center program on midlife cardiovascular health. Both neighborhood poverty and history of discrimination were detrimental to measured well-being, especially the former. Despite these detrimental influences, the Child–Parent Center program—a large-scale, evidence-based intervention—was associated with beneficial long-term effects on cardiovascular health and educational attainment. Increasing community resources and supports is an important avenue for promoting and sustaining early childhood learning gains. [ABSTRACT FROM AUTHOR]

The long-term effect of neighborhood poverty on internalizing symptoms in adolescents and the biological mechanisms underlying this association remain unclear. We defined neighborhood poverty at the village level in two dimensions: intensity (i.e., poverty rate) and duration. This study investigated how the poverty rate and duration of exposure to neighborhood poverty interact to predict internalizing symptoms in adolescents through biological mechanisms (i.e., allostatic load and early pubertal timing). A total of 418 adolescents (50.2% girls; 11–14 years old; mean age = 12.57 years) living in rural China participated in two waves of data collection. Path analysis was conducted to examine the mediating role of allostatic load and pubertal timing in the relationship between the duration of exposure to neighborhood poverty and internalizing symptoms. Moreover, the interactive effect between the poverty rate and duration of neighborhood poverty on the allostatic load was tested. The positive association between the duration of exposure to neighborhood poverty and internalizing symptoms of adolescents was explained by elevated allostatic load and early pubertal timing after adjusting for gender, age, prior family socioeconomic states and internalizing symptoms. The duration in neighborhood poverty was a stronger predictor of allostatic load for adolescents living in high poverty rate neighborhoods than for those living in low poverty rate neighborhoods. Neighborhood poverty gets "under the skin" through biological pathways and affects internalizing symptoms among adolescents. The findings highlight the importance of considering different dimensions of neighborhood poverty (e.g., intensity and duration) on adolescents' health. [ABSTRACT FROM AUTHOR]

Abstract Individuals living in areas with high rates of poverty are disproportionately affected by posttraumatic stress disorder (PTSD). Despite this association, little is known about how neighborhood poverty rates impact risk for PTSD development. In the current prospective study, we determined the relationship between neighborhood poverty rate and PTSD symptoms 6‐months after experiencing a traumatic event in a sample of varied race, gender, and socioeconomic status. Participants (N = 252) were enrolled in a hospital emergency department after experiencing a traumatic event. Demographic information (including zip code of residence), baseline PTSD symptoms, and baseline trauma history was assessed in the emergency department. PTSD symptoms were again assessed 6‐months posttrauma. Neighborhood poverty rate was determined using the American Community Survey. Correlation analyses revealed that neighborhood poverty was significantly associated with baseline PTSD symptoms (r = 0.181, p = 0.004) and PTSD symptoms 6‐months posttrauma (r = 0.163, p = 0.009). A regression analysis controlling for baseline trauma exposure, clinician‐rated trauma severity, and individual socioeconomic status demonstrated that neighborhood poverty predicted PTSD symptoms six‐months posttrauma (R2 = 0.099, B = 0.15, p = 0.04), but this relationship was no longer significant when baseline PTSD symptoms was added as an additional covariate (R2 = 0.304, B = 0.07, p > 0.05). Overall, results suggest that neighborhood poverty generally increases PTSD symptom severity, and the context in which an individual lives should be considered when conceptualizing risk for PTSD.

Children living in poverty exhibit worse mental health outcomes, and various environmental and neurological risk factors may contribute to or mitigate this relationship. However, previous research has not examined the interplay of neighborhood SES, mental health, and relevant mechanisms. We examined the extent to which neighborhood poverty uniquely contributes to children's internalizing/externalizing disorder symptoms, as well as identified whether brain measures, toxin levels, and neighborhood threat mediated this relationship and whether socioemotional support moderated it. Data were collected from 8623 9–10 year olds as part of the Adolescent Brain Cognitive Development study. Using a secondary data analysis, we found that neighborhood poverty was positively associated with externalizing symptoms and mediated by reduced intracranial volume and parents/children reporting feeling less safe. Parental support (i.e., Parental Monitoring Survey) attenuated this link, but only for children lower in poverty. Consideration of these risk factors for psychopathology could improve the outcome of holistic interventions. [ABSTRACT FROM AUTHOR]

Family poverty has been associated with altered brain structure, function, and connectivity in youth. However, few studies have examined how disadvantage within the broader neighborhood may influence functional brain network organization. The present study leveraged a longitudinal community sample of 538 twins living in low-income neighborhoods to evaluate the prospective association between exposure to neighborhood poverty during childhood (6–10 y) with functional network architecture during adolescence (8–19 y). Using resting-state and task-based fMRI, we generated two latent measures that captured intrinsic brain organization across the whole-brain and network levels – network segregation and network segregation-integration balance. While age was positively associated with network segregation and network balance overall across the sample, these associations were moderated by exposure to neighborhood poverty. Specifically, these positive associations were observed only in youth from more, but not less, disadvantaged neighborhoods. Moreover, greater exposure to neighborhood poverty predicted reduced network segregation and network balance in early, but not middle or late, adolescence. These effects were detected both across the whole-brain system as well as specific functional networks, including fronto-parietal, default mode, salience, and subcortical systems. These findings indicate that where children live may exert long-reaching effects on the organization and development of the adolescent brain.

Black Americans living in urban environments are disproportionately impacted by posttraumatic stress disorder (PTSD). Both racial discrimination and neighborhood poverty are factors that contribute to this health disparity. However, studies focused on the intersection of these two oppressive systems on PTSD symptoms are lacking. To address this gap in the literature, we assessed the interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms in an urban sample of trauma-exposed Black women (N = 300). Simple moderation analysis was used to assess the main and interactive effects of racial discrimination and neighborhood poverty on PTSD symptoms. The overall model significantly predicted PTSD symptoms, with a main effect of racial discrimination (B = 1.87, p =.009) and neighborhood poverty rate (B = 0.29, p =.008), independent of prior trauma exposure and percentage of Black residents in the zip code. More frequent experiences of racial discrimination and higher rates of neighborhood poverty both predicted higher PTSD symptoms. There was also a trending interaction of racial discrimination and neighborhood poverty (B = −0.05, p =.054), where the effect of neighborhood poverty on PTSD symptoms was only present for those who reported fewer experiences of racial discrimination. Our results suggest that people who have experienced more instances of racial discrimination show high levels of PTSD symptoms regardless of neighborhood poverty rates and highlight the importance of considering multiple levels of oppression that Black individuals face while diagnosing and treating stress-related psychopathology. General Scientific Summary: This study demonstrates that experiencing racial discrimination or living in a neighborhood with a high rate of poverty is associated with higher PTSD symptoms in Black women. [ABSTRACT FROM AUTHOR]

Objective: To evaluate differences in emergency department (ED) utilization and subsequent admission among children by Child Opportunity Index (COI). METHODS: We performed a cross-sectional study of pediatric (<18 years) encounters to 194 EDs in Illinois from 2016 to 2020. Each encounter was assigned to quntiles of COI 2.0 by postal code. We described the difference in the percent of encounters between lower (Very Low and Low) and higher (Very High and High) COI overall and among diagnoses with overrepresentation from lower COI groups. We evaluated the association of diagnosis with COI in ordinal models adjusted for demographics. Results: There were 4,653,026 eligible ED encounters classified by COI as Very Low (28.6%), Low (24.8%), Moderate (20.3%), High (15.6%), and Very High (10.8%) (difference between low and high COI encounters 27.0%). Diagnoses with the greatest difference between low and high COI were eye infection, upper respiratory tract infections, and cough. The COI distribution for children admitted from the ED (n = 140,298) was 29.1% Very Low, 19.3% Low, 18.2% Moderate, 17.7% High, and 15.7% Very High (percent difference 15.1%). Diagnoses with the greatest differences between low and high COI among admitted patients were sickle cell crisis, asthma, and influenza. All ED diagnoses and 7/12 admission diagnoses were associated with lower COI in multivariable ordinal models. CONCLUSIONS: Children from lower COI areas are overrepresented in ED and inpatient encounters overall and within certain diagnosis groups. Further research is required to examine how health outcomes may be influenced by the structural and contextual characteristics of a child's neighborhood. [ABSTRACT FROM AUTHOR]

Attachment experiences are thought to contribute to physical health across the lifespan. Evidence suggests that attachment style may serve as a protective factor for individuals' physical health by mitigating the negative effects of social and environmental risk factors. In the present study, we evaluated how attachment styles may moderate the link between African American adolescents' exposure to neighborhood poverty and accelerated cellular aging in young adulthood. Analyses revealed that allostatic load at age 19 mediated the association between neighborhood poverty in adolescence and changes in cellular aging from age 20 to 27. Notably, attachment avoidance (but not attachment anxiety) moderated this association, such that allostatic load was only associated with faster cellular aging for individuals who were high in avoidance. These findings suggest that allostatic load may give rise to faster cellular aging, but these detrimental effects of allostatic load can be offset by young adults' effective use of attachment figures. [ABSTRACT FROM AUTHOR]

Introduction Annually, a significant number of Americans are hospitalized due to heart failure (HF), marking it as an important contributor to morbidity and mortality. It also poses a substantial financial burden and leads to considerable losses in productivity. Socioeconomic disparities may intensify the risk of hospital admissions following HF and worsen patient outcomes.  Objective This study investigates the predictive accuracy of different socioeconomic metrics on the risk and outcomes of HF in Maryland.  Methodology To evaluate the predictive accuracy of various socioeconomic metrics on the risk of HF, we utilized data from the Maryland State Inpatient Database. Our retrospective analysis covered hospital admissions for HF from 2016 to 2020, correlating these with poverty indicators derived from U.S. Census data at the zip code level with socioeconomic metrics like race/ethnicity, insurance, household median income, and neighborhood distress (Distressed Communities Index (DCI)). Multivariate logistic regression models adjusted for confounders and isolated the impact of socioeconomic factors.  Result During the study period, a total of 389,220 cases of HF were reported in the Maryland State Inpatient Database (SID). The majority of these patients were White individuals (56.8%) and female (51.1%), with a median age of 73 years (interquartile range (IQR) 62-82 years). The in-hospital mortality rate was 5.1%, while rates of atrial fibrillation, cardiac arrest, and prolonged hospital stay were 34.4%, 0.3%, and 48.4%, respectively. The studied socioeconomic metrics showed varying predictive power for the risk of HF-related admissions and selected outcomes, with the highest predictive accuracy for neighborhood distress on the risk of HF (AUC = 0.53, 95% CI 0.530-0.532), atrial fibrillation (AUC = 0.479, 95% CI 0.477-0.480), cardiac arrest (AUC = 0.511, 95% CI 0.498-0.525), prolonged hospital stays (AUC = 0.531, 95% CI 0.530-0.532), and mortality (AUC = 0.499, 95% CI 0.496-0.502).  Conclusions The Distressed Communities Index demonstrates significant predictive power for assessing the risk of hospital admissions following HF and outcomes among individuals with HF, exceeding factors like insurance, race/ethnicity, and household median income., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. NA issued approval NA. This study involves analyzing the publicly available SEER database, and it does not include any identifiable patient information. Ethical approval from the institutional review board is not required. Additionally, as this is a retrospective study, informed consent from patients was not necessary. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Akinyemi et al.)

Sexually minoritized men (SMM), transgender women (TW), and particularly Black SMM and Black TW may be disproportionately impacted by alcohol-related problems. Few studies have empirically examined neighborhood factors that may contribute to alcohol use, specifically among these populations. Using data from the N2 longitudinal cohort study in Chicago, IL, survey data from the second wave of longitudinal assessment (n = 126), and GPS mobility data collected during study enrollment were used to evaluate neighborhood alcohol outlet availability, neighborhood disorder, and neighborhood poverty as correlates for individual alcohol use. Neighborhood exposures were measured using 200-m derived activity space areas, created from GPS data, and with publicly accessible geospatial contextual data. Separate multi-variable quasi-poison regression models tested for association between neighborhood alcohol outlet density (AOD), measured separately for on-premise (e.g. bars) and off-premise consumption outlets (e.g. liquor stores), neighborhood poverty (defined as the percentage of neighborhood areas at 150% or greater of the U.S. poverty line), exposure to vacant buildings, and neighborhood violent crime density. Separate analytical models found no significant effect between alcohol use and on-premise neighborhood AOD ( IRR = 0.99, p = 0.35 ), off-premise consumption AOD ( IRR = 0.92 , p = 0.33 ), or neighborhood violent crime ( IRR = 1.00, p = 0.65). Vacant buildings ( IRR = 1.03 , p = 0.05 ) and levels of neighborhood poverty ( 1.05 , p = 0.01 ) were found to be significantly associated with increased alcohol use. Among this population, opposed to geospatial access, neighborhood measurements indicative of disorder and poverty may have greater influence on shaping alcohol use.

Conduct problem is an ongoing concern among youth placed in group homes. The concern could sometimes become more challenging due to negative peer influences. The risks associated with negatively influential peers are well-known across diverse residential treatment contexts in the USA, but not in Canada. This 3-year retrospective cohort study observed the influence of positive and negative peers on conduct problems among 173 youths in Ontario group home care between 2012 and 2016 (initial participation rate = 90.0% and follow-up rate = 95.1%). Having previously observed that group home resources matter (Osei in Peer influences on antisocial and prosocial behaviors in group home foster care: Evidence of greater protections in better resourced homes and higher income neighborhoods, Doctoral thesis, University of Windsor, Windsor, Ontario, Canada, 2019, https://scholar.uwindsor.ca/etd/7727/), here it was hypothesized that neighborhood income also matters. Specifically, that neighborhood income would moderate peer influences such that low-income neighborhoods would be relatively risky places, while higher-income neighborhoods would be relatively protective places. Positive and negative peer influences were, respectively, protective and risky, but the main effect of neighborhood income was null. As hypothesized, a significant negative peer influence by neighborhood income interaction was also observed. Higher income neighborhoods attenuated the negative peer influence-youth conduct problem association. Negative peers were less risky in higher income neighborhoods. The main protective influence of positive peers was robust across socioeconomically diverse neighborhoods. Clinical, policy and future research implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Neighborhood-level characteristics, such as poverty, have been associated with risk factors for heart failure (HF), including hypertension and diabetes mellitus. However, the independent association between neighborhood poverty and incident HF remains understudied. Objective: To evaluate the association between neighborhood poverty and incident HF using a "real-world" clinical cohort. Design: Retrospective cohort study of electronic health records from a large healthcare network. Individuals' residential addresses were geocoded at the census-tract level and categorized by poverty tertiles based on American Community Survey data (2007–2011). Participants: Patients from Northwestern Medicine who were 30–80 years, free of cardiovascular disease at index visit (January 1, 2005–December 1, 2013), and followed for at least 5 years. Main Measures: The association of neighborhood-level poverty tertile (low, intermediate, and high) and incident HF was analyzed using generalized linear mixed effect models adjusting for demographics (age, sex, race/ethnicity) and HF risk factors (body mass index, diabetes mellitus, hypertension, smoking status). Key Results: Of 28,858 patients included, 75% were non-Hispanic (NH) White, 43% were men, 15% lived in a high-poverty neighborhood, and 522 (1.8%) were diagnosed with incident HF. High-poverty neighborhoods were associated with a 1.80 (1.35, 2.39) times higher risk of incident HF compared with low-poverty neighborhoods after adjustment for demographics and HF risk factors. Conclusions: In a large healthcare network, incident HF was associated with neighborhood poverty independent of demographic and clinical risk factors. Neighborhood-level interventions may be needed to complement individual-level strategies to prevent and curb the growing burden of HF. [ABSTRACT FROM AUTHOR]

This study evaluates whether parental provision of transportation for physical activity is associated with child/adolescent moderate-to-vigorous physical activity, while also evaluating community-level poverty. Self- and parental-reported surveys were administered with parents/caregivers and children in the Healthy Communities Study (N = 5138). Associations between individual-level demographics, community-level poverty, parental provision of transportation for physical activity, and moderate-to-vigorous physical activity were examined in multi-level models. Even when accounting for community-level poverty, which was significantly associated with lower moderate-to-vigorous physical activity, parental provision of transportation for physical activity was positively associated with greater moderate-to-vigorous physical activity. This study provides evidence for the importance of considering multiple systems of influence (e.g., community and individual factors) and considering how gaps in physical activity transportation for youth can be addressed in future health policies. [ABSTRACT FROM AUTHOR]

Drawing on the life-course perspective, this study examines the effect of residential histories spent living in poor neighborhoods on the contemporaneous likelihood of moving between poor and non-poor neighborhoods. We use individual-level data from the Panel Study of Income Dynamics from 1970 to 2013 in conjunction with neighborhood-level data derived from four U.S. censuses. Results from logistic regression analyses show that a longer residential history spent in poor neighborhoods both reduces the likelihood of moving from a poor to a non-poor neighborhood and increases the likelihood of moving from a non-poor to a poor neighborhood. A decomposition analysis reveals that a sizeable portion of the racial differences in the likelihood of moving between poor and non-poor neighborhoods is attributable to differences between blacks and whites in the duration of time they have spent living in a poor neighborhood. Our study highlights the salient role of residential histories in perpetuating racial inequality in neighborhood poverty over the life course and across generations. [ABSTRACT FROM AUTHOR]

Both low family socioeconomic status (SES) and low neighborhood SES have been associated with higher levels of childhood obesity. However, little is known about how these two factors operate together. The purpose of this study was to determine if the association between neighborhood SES and obesity varies across household SES. We used the first-grade round of the Early Childhood Longitudinal Study, Kindergarten Class of 2011 (ECLS-K:2011). Household SES was defined based on income, education, and occupation. Neighborhood SES was defined by the percent of households living in poverty in the child’s school district. Log-binomial regression models estimated the association between neighborhood SES and obesity and tested whether this association varied by household SES. We found the association between neighborhood SES and obesity varied significantly by household SES (p-interaction = 0.002). For children in the lowest tertile of neighborhood SES, prevalence of obesity was not statistically significantly different comparing children with low, middle or high household SES (Predicted probability (PP)lowest 0.20 (95% CI: 0.17, 0.23), PPmiddle 0.21 (95%CI: 0.18, 0.24), PPhighest 0.16 (95%CI: 0.12, 0.20)). Conversely, within the highest and the middle tertiles of neighborhood SES, children with high household SES have significantly lower prevalence of obesity compared to children with the lowest household SES (PP: 0.09 (95%CI: 0.07, 0.11) vs 0.19 (0.16, 0.21) and (PP: 0.07 (95%CI: 0.05, 0.09) vs 0.17 (0.13, 0.21) for highest vs lowest household SES in middle and high neighborhood SES, respectively). Hence, low-SES in either variable is enough to be associated with increased prevalence of obesity.

Purpose: Toxic stress has been identified as a key mechanism by which poverty impacts health and empirical evidence on the relationship between poverty and biological markers of toxic stress is accumulating. This study synthesizes the empirical evidence of the relationship between poverty and biomarkers of toxic stress. Method: We conduct a systematic literature review using PRISMA guidelines to assess the relationship between poverty and toxic stress. A total of 56 articles are included in the review assessing 63 poverty and toxic stress relationships. Results: Seventeen of 30 reviewed relationships showed a statistically significant relationship between our measures of poverty and biomarker outcomes. Additionally, 12 of the remaining 13 studies demonstrated partially statistically significant relationship between our poverty measures and biomarker outcomes. Conclusion: Findings demonstrate evidence of the relationship between poverty and toxic stress. Consistently, poverty was related to biological stress and neighborhood poverty was related to physical stress outcomes. [ABSTRACT FROM AUTHOR]

Past research suggests that neighborhood structural and social environments are important contextual factors associated with children's development; however, investigations of the long-term effects of neighborhood environments in early childhood on subsequent adolescents' social and behavioral outcomes remain limited. Further, it is unclear whether and how the home environment as a mediating mechanism links neighborhood conditions and adolescents' outcomes. Using national surveys from multi-stressed families and census datasets, the present study aims to examine the longitudinal associations between neighborhood concentrated poverty and collective efficacy, mothers' parenting stress, exposure to adverse childhood experiences (ACEs), and later adolescent outcomes. Participants included 4898 children (52% boys) and their mothers (48% black, 25 years of age, on average, 64% living in poverty); children born in unmarried families (75% unmarried) were oversampled. The results suggest that neighborhood collective efficacy is associated directly and indirectly (via parenting stress and ACEs) with adolescents' behavior problems and social skills, and indirectly with their delinquency. Neighborhood concentrated poverty was indirectly related to adolescents' behavior problems, delinquency, and social skills transmitted through collective efficacy and family processes. Both mothers' parenting stress and exposure to ACEs were identified as significant mediators. This study highlights the importance of early intervention for high-risk children, programs to build community resilience and reinforce social support for vulnerable families, and policy efforts to create safe and nurturing relationships and environments. [ABSTRACT FROM AUTHOR]

Foreign-born persons living in the US have an increased risk of exposure to HIV and higher rates of HIV diagnosis (Patel-Larson et al. in Poster presented at the 2007 National HIV Prevention Conference, pp 2–5, 2007; Prosser et al. in JAMA 308:601–607, 2012). Foreign-born persons also tend to live in areas with high concentration of immigrants and more often neighborhoods of high poverty, for at least some time (Jargowsky in J Ethn Migr Stud 35:1129–1151, 2009). Using HIV surveillance data in Alameda County, California, we examined whether the association between immigrant status and the four outcomes on the HIV care cascade (late diagnosis, linkage to care within 30 days of diagnosis, retention in HIV care, and viral load status a year after diagnosis) differed by census tract poverty level. We used generalized estimating equations (GEE) adjusted for sex at birth, age, race, and transmission mode. Of 1235 individuals with HIV diagnosis reported between 2011 and 2016, 29% were foreign-born. Foreign-born status was significantly associated with late HIV diagnosis but not with linkage, retention in care, and achievement of undetectable viral load a year after diagnosis. Neighborhood poverty modified the association between immigrant status and retention in care, but not late diagnosis, linkage or viral load status. Our findings suggest that neighborhood resources may buffer against disparities in retention. Thus, immigrants in poorer neighborhoods may require more support to stay in care. [ABSTRACT FROM AUTHOR]

To determine the association between neighborhood poverty and Attention Deficit Hyperactivity Disorder (ADHD) severity among children in a large metropolitan area. This is a secondary analysis of data collected April 2016 to July 2017 at the Children's Hospital of Philadelphia Care Network. We attributed 2015 American Community Survey census tract poverty, defined as percent of individuals with income below poverty level, to each child's residential address. Tracts were grouped from low to high poverty. ADHD severity was determined by Vanderbilt Parent Rating Scale (VPRS) symptom score. We also recorded parent-reported child ADHD medication use. A total of 286 children were linked to 203 unique census tracts. The majority of children from high poverty tracts were black and from disadvantaged households. Higher neighborhood poverty was associated with higher VPRS scores and decreased medication use in bivariate analysis. Poverty was no longer associated with VPRS scores in multivariate analysis, but medication use still had a significant negative association with VPRS score. Post hoc stratification by medication use revealed that neighborhood poverty and VPRS score were significantly associated for children on medication, but not for those off medication. Neighborhood poverty was not associated with ADHD severity in multivariate analysis. This suggests other factors, including medication use, confound the relationship between neighborhood poverty and ADHD severity. Lack of medication treatment was significantly associated with higher symptom burdens for children with access to primary care. Decreased medication use in higher poverty communities warrants exploration and public health interventions to ensure adequate ADHD management for all children. [ABSTRACT FROM AUTHOR]

Many public housing communities are undergoing redevelopment into mixed-income communities, with researchers raising concerns that the redevelopment process may reinforce exclusionary practices and inadequately involve residents in the planning process. These concerns highlight the need to better understand residents' views of public housing communities and the redevelopment process. To fill this gap, we elicited a detailed view of youths' lived experiences within a Boston, Massachusetts, housing development preparing to undergo conversion into a mixed-income community. Using participatory photo mapping and interviews, we partnered with youth co-researchers in an assessment of important community spaces and neighborhood strengths and stressors. Results highlight neighborhood strengths such as social cohesion and stressors such as gun violence. Results also elucidate youths' wishes for the redevelopment, including the creation of formal and informal youth-centered spaces. We discuss implications for policy and practice and consider youths' suggestions in the context of current community development approaches. [ABSTRACT FROM AUTHOR]

This study drew data from a randomized trial of a statewide prekindergarten program in Tennessee and presents new evidence on the impacts of preK on third-grade achievement using administrative data on children's neighborhood environments. Results indicate that preK had no measurable impact on children's third-grade math achievement regardless of children's neighborhood conditions. However, preK significantly improved third-grade reading achievement for children living in high-poverty neighborhoods. The treatment effects on reading achievement were substantial: Among children living in high-poverty neighborhoods, those who took up an experimental assignment to attend preK scored over half a standard deviation higher on average than the control group in third grade. In contrast, preK enrollment had, if anything, a negative effect on third-grade reading achievement among children living in low-poverty neighborhoods. These differential effects were partially explained by alternative childcare options and contextual risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Low-income and racial/ethnic minority preschoolers (aged 2–5 years) are disproportionately affected by obesity and its associated health consequences. Individual-level factors (e.g., diet) and environmental factors (e.g., neighborhood conditions) contribute to these disparities. However, there is limited research examining the role of neighborhood factors on obesity risk specifically among high-risk preschoolers. The objectives of this study are to describe the geographic distribution of preschool patients receiving care at two primary care pediatrics clinics affiliated with an academic medical center, and explore whether exposure to neighborhood crime and poverty is associated with obesity risk among this population.Methods: Cross-sectional multilevel study linking clinical administrative data on patient visits between 2007 and 2012 with data from the American Community Survey and the Baltimore City Police Department. Home addresses of 2–5 year-old patients were geocoded to their neighborhood (i.e., census block group) of residence. We used logistic regression to examine the cross-sectional relationship between obesity and overweight and neighborhood-level factors. All analyses were adjusted for age and gender, and stratified by race/ethnicity (Black, Hispanic, and White).Results: The majority of preschool patients lived in moderate or high crime (84%) or high poverty (54%) neighborhoods. A significantly higher proportion of Black preschoolers lived in high poverty neighborhoods compared to White preschoolers (61% vs. 38%, p < 0.001). Among this clinic-based sample of preschoolers, living in high crime or high poverty neighborhoods was not associated with a clinically significant increased odds of overweight or obesity.Conclusions: This study examines the association between neighborhood factors and obesity and overweight among a clinic-based population of low-income racial/ethnic minority preschoolers. The neighborhoods where preschoolers in this sample lived, on average had higher crime counts and poverty than the citywide average for Baltimore. Our findings also suggest that Black preschoolers are exposed to higher levels of neighborhood poverty compared to Whites. While no meaningful association between these neighborhood factors and odds of obesity or overweight was found in this cross-sectional analysis, our findings suggest avenues for future studies informative to the development of clinic-based obesity management interventions aimed at effectively addressing neighborhood contributors to early childhood obesity disparities.

Background: Lower socioeconomic status (SES) has been associated with higher rates of smoking. Few longitudinal studies have examined indicators of SES at both the neighborhood- and individual-level over time in conjunction with proximal risk factors of cigarette smoking.Purpose: To examine associations of time-varying measures of SES, demographic factors, and proximal risk factors for smoking net of average trajectories of smoking behavior from ages 30 to 39 in a community sample.Methods: Data from the Seattle Social Development Project (N = 752), a theory-driven longitudinal study originating in Seattle, WA, were used to estimate trajectories of smoking from age 30 to 39. Time-varying measures of neighborhood poverty, coworker smoking, partner smoking, depression, anxiety, education, income, marital status, and parenthood were associated with smoking over time using latent growth curve modeling.Results: Results indicated that living in higher poverty neighborhoods was uniquely associated with a greater likelihood of smoking net of average trajectories of smoking from age 30 to 39, gender and race/ethnicity, time-varying measures of SES and demographics, and time-varying measures of proximal risk factors for smoking.Conclusions: Living in higher poverty neighborhoods presents a unique risk for smoking among adults aged 30 to 39 above and beyond multiple aspects of SES and other potential mechanisms relating SES to smoking. [ABSTRACT FROM AUTHOR]

Purpose: Because segregation may shield blacks from discrimination as well as increase their exposure to concentrated poverty, its net impact on the mental well-being of black Americans is unclear. We investigated the intersection between segregation, neighborhood poverty, race, and psychological well-being.Methods: Using data from the nationally representative 2008-2013 National Health Interview Survey merged with U.S. Census data, we examined the association between black-white metropolitan segregation (D-index and P-index) and psychological distress (a binary indicator based on the Kessler 6 score ≥ 13) for blacks and whites. Furthermore, we assessed whether neighborhood poverty explains and/or modifies the association. Logistic regression models were estimated separately for blacks and whites as well as for each segregation index.Results: Higher D- and P-indices were associated with higher odds of psychological distress for blacks. Neighborhood poverty explained some, but not all, of the association. In models that allowed for the impact of metropolitan segregation to vary by neighborhood poverty, higher segregation was found to be detrimental for blacks who resided in high poverty neighborhoods but not for those living in low poverty neighborhoods. We found no evidence that segregation impacts the mental health of whites-either detrimentally or beneficially-regardless of neighborhood poverty level.Conclusions: The impact of segregation differs by neighborhood poverty and race. The psychological harm of structural racism, resulting in segregation and concentrated poverty, is not additive but multiplicative, reflecting a "triple jeopardy" for blacks, whereby their mental health is detrimentally impacted by the compounded effects of both neighborhood distress and racial segregation. [ABSTRACT FROM AUTHOR]

Purpose: The Moving to Opportunity (MTO) study is typically interpreted as a trial of changes in neighborhood poverty. However, the program may have also increased exposure to housing discrimination. Few prior studies have tested whether interpersonal and institutional forms of discrimination may have offsetting effects on mental health, particularly using intervention designs.Methods: We evaluated the effects of MTO, which randomized public housing residents in 5 cities to rental vouchers, or to in-place controls (N = 4248, 1997-2002), which generated variation on neighborhood poverty (% of residents in poverty) and encounters with housing discrimination. Using instrumental variable analysis (IV), we derived two-stage least squares IV estimates of effects of neighborhood poverty and housing discrimination on adult psychological distress and major depressive disorder (MDD).Results: Randomization to voucher group vs. control simultaneously decreased neighborhood % poverty and increased exposure to housing discrimination. Higher neighborhood % poverty was associated with increased psychological distress [BIV = 0.36, 95% confidence interval (CI) 0.03, 0.69] and MDD (BIV = 0.12, 95% CI - 0.005, 0.25). Effects of housing discrimination on mental health were harmful, but imprecise (distress BIV = 1.58, 95% CI - 0.83, 3.99; MDD BIV = 0.57, 95% CI - 0.43, 1.56). Because neighborhood poverty and housing discrimination had offsetting effects, omitting either mechanism from the IV model substantially biased the estimated effect of the other towards the null.Conclusions: Neighborhood poverty mediated MTO treatment on adult mental health, suggesting that greater neighborhood poverty contributes to mental health problems. Yet housing discrimination-mental health findings were inconclusive. Effects of neighborhood poverty on health may be underestimated when failing to account for discrimination. [ABSTRACT FROM AUTHOR]

Family poverty has been associated with altered brain structure, function, and connectivity in youth. However, few studies have examined how disadvantage within the broader neighborhood may influence functional brain network organization. The present study leveraged a longitudinal community sample of 538 twins living in low-income neighborhoods to evaluate the prospective association between exposure to neighborhood poverty during childhood (6–10 y) with functional network architecture during adolescence (8–19 y). Using resting-state and task-based fMRI, we generated two latent measures that captured intrinsic brain organization across the whole-brain and network levels – network segregation and network segregation-integration balance. While age was positively associated with network segregation and network balance overall across the sample, these associations were moderated by exposure to neighborhood poverty. Specifically, these positive associations were observed only in youth from more, but not less, disadvantaged neighborhoods. Moreover, greater exposure to neighborhood poverty predicted reduced network segregation and network balance in early, but not middle or late, adolescence. These effects were detected both across the whole-brain system as well as specific functional networks, including fronto-parietal, default mode, salience, and subcortical systems. These findings indicate that where children live may exert long-reaching effects on the organization and development of the adolescent brain. [ABSTRACT FROM AUTHOR]

We examined racial/ethnic disparities in depressive symptoms during pregnancy among a population-based sample of childbearing women in California (N = 24,587). We hypothesized that these racial/ethnic disparities would be eliminated when comparing women with similar incomes and neighborhood poverty environments. Neighborhood poverty trajectory descriptions were linked with survey data measuring age, parity, race/ethnicity, marital status, education, income, and depressive symptoms. We constructed logistic regression models among the overall sample to examine both crude and adjusted racial/ethnic disparities in feeling depressed. Next, stratified adjusted logistic regression models were constructed to examine racial/ethnic disparities in feeling depressed among women of similar income levels living in similar neighborhood poverty environments. We found that racial/ethnic disparities in feeling depressed remained only among women who were not poor themselves and who lived in long-term moderate or low poverty neighborhoods.

Introduction: Individuals living in areas with high rates of poverty are disproportionately affected by posttraumatic stress disorder (PTSD). Despite this association, little is known about how neighborhood poverty rates impact risk for PTSD development. In the current prospective study, we determined the relationship between neighborhood poverty rate and PTSD symptoms six-months after experiencing a traumatic event in a sample of varied race, gender, and socioeconomic status., Methods: Participants ( N =252) were enrolled in a hospital emergency department after experiencing a traumatic event. Demographic information (including zip code of residence), baseline PTSD symptoms, and baseline trauma history was assessed in the emergency department. PTSD symptoms were again assessed six-months post-trauma. Neighborhood poverty rate was determined using the American Community Survey., Results: Correlation analyses revealed that neighborhood poverty was significantly associated with baseline PTSD symptoms ( r= .181, p= .004) and PTSD symptoms six-months post-trauma ( r= .163, p= .009). A regression analysis controlling for baseline trauma exposure, clinician-rated trauma severity, and individual socioeconomic status demonstrated that neighborhood poverty predicted PTSD symptoms six-months post-trauma (R 2 = 0.099, B = 0.15, p= 0.04), but this relationship was no longer significant when baseline PTSD symptoms was added as an additional covariate (R 2 =.304, B = 0.07, p> 0.05)., Conclusion: Overall, results suggest that neighborhood poverty generally increases PTSD symptom severity, and the context in which an individual lives should be considered when conceptualizing risk for PTSD.

Neighborhoods, as built and social environments, have significant implications for mental health. Children raised in high-poverty neighborhoods, who are disproportionately Black, Indigenous, and people of color, have a greater risk of adverse life outcomes. Neighborhood gentrification is also salient when examining mental health outcomes as neighborhood economic contexts shift around a child. This review scopes, describes, synthesizes, and critiques the existing literature on the relationship between neighborhood poverty/gentrification and mood disorder symptoms among children ages 3-17 in the United States (U.S.). Given the history of structural racism in the creation of U.S. neighborhoods, inclusion criteria required that study samples be racially diverse. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, seven databases and grey literature were searched; 17 studies were included (total n = 122,089). Fourteen studies found significant associations between neighborhood poverty/gentrification and child depression. Three longitudinal studies found significant results suggesting that childhood neighborhood poverty/gentrification may have a lagged effect, with depression emerging later in life. Neighborhood poverty and gentrification require further examination as social determinants of mental health. Researchers should examine neighborhood poverty and gentrification as social determinants of mental health. Policies that reduce neighborhood economic disparities are needed across the U.S.

BACKGROUND Racial residential segregation is associated with higher rates of chronic hypertension, as well as greater risk of preterm birth and low birthweight. However, few studies have examined associations between segregation and hypertensive disorder of pregnancy (HDP). METHODS Electronic health records from 4,748 singleton births among non-Hispanic black women at Prentice Women's Hospital in Chicago, IL (2009–2013) were geocoded to the census tract level. Residential segregation was measured using the Gi* statistic, a z -score measuring the extent to which each individual's neighborhood composition deviates from the composition of the larger surrounding area. Segregation was categorized as low (z < 0), medium (z = 0–1.96) or high (z > 1.96). We estimated cross-sectional associations of segregation with HDP using multilevel logistic regression models with census tract random intercepts. Models adjusted for neighborhood poverty and maternal characteristics. We also examined effect modification by neighborhood poverty. RESULTS Overall, 27.2% of women lived in high segregation, high-poverty neighborhoods. Racial residential segregation was not associated as a main effect with HDP in models adjusting for neighborhood poverty and maternal characteristics. However, at higher levels of neighborhood poverty (>20%), women living in high- and medium-segregated neighborhoods had greater odds of HDP relative to those in low-segregation neighborhoods (P interaction: 0.002). CONCLUSIONS In this sample of non-Hispanic black women in Chicago, racial residential segregation was associated with greater prevalence of HDP among those living in higher poverty neighborhoods. Understanding sources of heterogeneity in the relationship between segregation and health will help refine targeted intervention efforts to reduce disparities. [ABSTRACT FROM AUTHOR]

Despite substantial growth in mixed-race coupling, we know little about their association with neighborhood poverty. To address this gap, I utilize data from the Panel Study of Income Dynamics linked to information from four censuses. With these data, I assess the extent to which mixed-race couples are more likely than monoracial couples to migrate in response to higher percentages of neighborhood poverty; and, once they move, I examine the percentage poverty in their destination neighborhoods. I find that most mixed-race couples are similar to white couples in their out-mobility responses to neighborhood poverty. However, when mixed-race couples with black partners migrate they tend to move to neighborhoods with higher poverty concentrations than couples without a black partner. Mixed-race couples without black partners experience similar percentages of poverty in their destination neighborhoods as whites, providing further evidence of the profound impact of black race on residential stratification. [ABSTRACT FROM AUTHOR]

Neighborhoods provide resources that may affect children's achievement or moderate the influences of other developmental contexts, such as early care and education (ECE). Using a sample (N = 12,430) from the 2010-2011 Early Childhood Longitudinal Study-Kindergarten Cohort, merged with census tract-level poverty data from the 2008-2012 American Community Survey, this article examines associations between center-based ECE participation, neighborhood poverty, and children's academic skills and behavior at kindergarten entry. Findings suggest that children who attend center-based care in the year prior to kindergarten show higher math and reading scores across neighborhood contexts. Results provide limited evidence that neighborhood poverty moderates the associations between either Head Start or other types of center-based ECE participation and children's outcomes at kindergarten, with children in moderate-high poverty neighborhoods showing stronger positive associations between who participated in Head Start or center care participation and math and reading scores, respectively, compared to those participating in low-poverty neighborhoods. Research and policy implications are discussed. [ABSTRACT FROM AUTHOR]

Aims: This study assessed the relationship between spatial social polarization measured by the index of the concentration of the extremes (ICE) and preterm birth (PTB) and infant mortality (IM) in New York City. A secondary aim was to examine the ICE measure in comparison to neighborhood poverty. Methods: The sample included singleton births to adult women in New York City, 2010–2014 (n=532,806). Three ICE measures were employed at the census tract level: ICE − Income (persons in households in the bottom vs top 20th percentile of US annual household income), ICE −Race/Ethnicity (black non-Hispanic vs white non-Hispanic populations), and ICE – Income + Race/Ethnicity combined. Preterm birth was defined as birth before 37 weeks’ gestation. Infant mortality was defined as a death before one year of age. A two-level generalized linear model with random intercept was utilized adjusting for individual-level covariates. Results: Preterm birth prevalence was 7.1% and infant mortality rate was 3.4 per 1000 live births. Women who lived in areas with the least privilege were more likely to have a preterm birth or infant mortality as compared to women living in areas with the most privilege. After adjusting for covariates, this association remained for preterm birth (ICE – Income: Adjusted Odds Ratio (AOR) 1.16 (1.10–1.21); ICE – Race/Ethnicity: AOR 1.41 (1.34–1.49); ICE – Income + Race/Ethnicity: AOR 1.36 (1.29–1.43)) and IM (ICE – Race/Ethnicity (AOR 1.80 (1.43–2.28) and ICE – Income + Race/Ethnicity (AOR 1.54 (1.23–1.94)). High neighborhood poverty was associated with PTB only (AOR 1.09 (1.04–1.14). Conclusions: These results provide preliminary evidence for the use of the ICE measure in examining structural barriers to healthy birth outcomes. [ABSTRACT FROM AUTHOR]

The objective of the study was to examine the independent effects of neighborhood poverty and psychosocial stress on increases in central adiposity over time. Data are from a community sample of 157 Non-Hispanic Black, Non-Hispanic White, and Hispanic adults collected in 2002-2003 and 2007-2008, and from the 2000 Decennial Census. The dependent variable was waist circumference. Independent variables included neighborhood poverty, perceived neighborhood physical environment, family stress, safety stress, everyday unfair treatment, and a cumulative stress index. Weighted 3-level hierarchical linear regression models for a continuous outcome were used to assess the effects of neighborhood poverty and psychosocial stress on central adiposity over time. We also assessed whether psychosocial stress mediated the association between neighborhood poverty and central adiposity. Neighborhood poverty and everyday unfair treatment at baseline were independently associated with increases in central adiposity over time, accounting for the other indicators of stress. Perceptions of the neighborhood physical environment and cumulative stress mediated associations between neighborhood poverty and central adiposity. Results suggest that residing in neighborhoods with higher concentrations of poverty and exposure to everyday unfair treatment independently heighten risk of increased central adiposity over time. Associations between neighborhood poverty and central adiposity were mediated by perceptions of the neighborhood physical environment and by the cumulative stress index. Public health strategies to reduce obesity should consider neighborhood poverty and exposure to multiple sources of psychosocial stress, including everyday unfair treatment. [ABSTRACT FROM AUTHOR]

Current models of neighborhood effects on victimization predominantly assume that residential neighborhoods function independent of their surroundings. Yet, a surprising proportion of violence occurs outside of victims' residential neighborhoods. The current study extends on recent advances in spatial dynamics and neighborhood effects to explore the importance of different geographic scales and relational exposures to poverty for child violent victimization. We examine longitudinal data on over 4400 low-income children from high poverty neighborhoods in five cities, who participated in the Moving to Opportunity randomized intervention. The results suggest that surrounding poverty matters for child victimization beyond the effect of residential poverty. Moreover, moving farther from extreme poverty also seems to buffer against victimization and to amplify the benefits of moving to improved extended (residential and surrounding) neighborhoods. All the children in the study, but especially boys older than 10 years of age, seemed to be affected by the long arm of poverty. [ABSTRACT FROM AUTHOR]

Less than half of young children in the U.S. meet physical activity recommendations. While neighborhood economic context has been shown to be associated with physical activity, it is unknown whether this association varies according to family economic context. This study thus investigates whether neighborhood economic context, measured by poverty concentration and income inequality, are associated with physical activity among poor and non-poor children using data from the Geographic Research on Wellbeing study, California, 2012-2013 (N=2670). Poor children who resided in (a) poor and equal neighborhoods or (b) non-poor and equal neighborhoods were more likely to engage in sufficient physical activity than were children residing in non-poor and unequal neighborhoods. Poor children in (a) non-poor and equal neighborhoods, (b) poor and equal neighborhoods, or (c) poor and unequal neighborhoods were less likely to report insufficient physical activity than those in non-poor and unequal neighborhoods. Neighborhood economic context was not associated with physical activity among non-poor children. Findings suggest that neighborhood economic context presents a social barrier to physical activity among poor children. Increasing physical activity among poor children in non-poor and unequal neighborhoods should be a high policy priority. Perceived social cohesion, perceived neighborhood safety, and park and walkability indicators did not mediate the associations between neighborhood economic context and physical activity. Further research needs to explore the mechanisms by which neighborhood economic context affects physical activity among children. [ABSTRACT FROM AUTHOR]

This paper examines how neighborhood and family poverty predict children's academic skills and classroom behavior at school entry, and whether associations have changed over a period of twelve years spanning the Great Recession. Utilizing the Early Childhood Longitudinal Study–Kindergarten 1998 and 2010 cohorts and combined with data from the U.S. Census and American Community Survey, we find that the proportion of kindergarten children living in moderate and high poverty neighborhoods increased from 1998 to 2010, and that these increases were most pronounced for non-poor and white children. Using OLS and fixed effects regression analyses and holding family poverty constant, we find that children in neighborhoods with higher levels of poverty start school less ready to learn than their peers. Specifically, children from the highest poverty neighborhoods start school almost a year behind children from the lowest poverty neighborhoods in terms of their academic skills. In addition, we find that the academic skills gap between poor- and non-poor children within neighborhood poverty categories grew from 1998 to 2010, particularly in high poverty neighborhoods. These findings appear to be explained both by changes in the composition of families within neighborhood poverty categories and income increases among non-poor families. The findings indicate that neighborhood poverty may be a useful proxy to identify children and families in need of additional support. [ABSTRACT FROM AUTHOR]

Trends in concentrated neighborhood poverty in the United States have been volatile over the past several decades. Using data from the 1980 to 2000 decennial census and the 2010–2014 American Community Survey, we examine the association between concentrated poverty across metropolitan areas in the United States and key proximate factors, including overall changes in poverty, racial residential segregation, and income segregation. One of our unique contributions is assessing the relative contribution of each of these to long-term trends in such poverty using a decomposition analysis. We find that changes in the segregation of the poor explained the largest share of the change in concentrated poverty over most of the time period, with the exception of the 1990s, where the plunge in both black and white poverty rates had the largest role in explaining the considerable decline in concentrated poverty in that decade for both groups. The association between racial segregation and black concentrated poverty is positive but weaker, indicating that without declines in black segregation, concentrated poverty would have been higher. Overall, growing income segregation, along with weak economic performance in recent years, have put more poor people at risk for living in high-poverty communities. [ABSTRACT FROM AUTHOR]

The pathways through which neighborhood poverty can affect resident depression are still unknown. We investigated mechanisms through which neighborhood poverty may influence depression among older adults. Participants were drawn from the New York City Neighborhood and Mental Health in the Elderly Study II, a 3-wave study of adults aged 65-75 (n=3,497) at baseline. Neighborhood poverty and homicide were associated with depressive symptoms at follow-up waves (RR:1.20, 95%CI: 1.05, 1.36; RR: 1.09, 95%CI: 1.02, 1.17, respectively). Homicide accounted for 30% of the effect of neighborhood poverty on depressive symptoms. Neighborhood exposure to violence may be a key mechanism through which neighborhood poverty influences depression among older adults. [ABSTRACT FROM AUTHOR]

This study uses data from the longitudinal Panel Study of Income Dynamics data and its Transition to Adulthood (TA) Study (2005–2017), in conjunction with decades of neighborhood-level data from the U.S. decennial census and American Community Survey, to examine the relationship between individuals' neighborhood poverty exposure trajectories in childhood and the likelihood of obesity in emerging adulthood. Latent growth mixture models reveal that exposure to neighborhood poverty differs considerably for white and nonwhite individuals over their childhood life course. Durable exposure to neighborhood poverty confers greater subsequent obesity risks in emerging adulthood than transitory experiences of neighborhood poverty. Racial differences in the changing and persistent trajectories of neighborhood poverty help explain part of the racial differences in obesity risks. Among nonwhites, and compared to consistent nonpoor neighborhood conditions, both durable and transitory neighborhood poverty exposures are significantly associated with higher obesity risks. This study suggests that a theoretical framework that integrates key elements of the life-course perspective is helpful to uncover the individual and structural pathways through which neighborhood histories in poverty shape population health in general. • Distinctive patterns of stability and change exist in neighborhood poverty exposure throughout the childhood life course. • Cumulative exposure to neighborhood poverty exerts a significant obesity risk in emerging adulthood. • Deterioration of neighborhood socioeconomic conditions is a significant obesity risk in emerging adulthood. [ABSTRACT FROM AUTHOR]

Knowing which demographic groups have higher rates of preventable hospitalizations can help identify geographic areas where improvements in primary care access and quality can be made. This study assessed whether preventable hospitalization rates by neighborhood poverty decreased from 2008 to 2013 and whether the gap between very high and low poverty neighborhoods changed. We examined trends in age-adjusted preventable hospitalization rates and rate ratios by neighborhood poverty overall and by sex using JoinPoint regression. Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality were applied to inpatient hospitalization data from the New York State Department of Health's Statewide Planning and Research Cooperative System. PQIs were classified into composites. From 2008 to 2013, preventable hospitalization rates per 100,000 adults across each poverty group decreased. For very high poverty neighborhoods (ZIP codes with ≥30 % of persons living below the federal poverty level (FPL)), there were significant decreases overall (3430.56 to 2543.10, annual percent change [APC] = -5.91 %), for diabetes (676.15 to 500.83, APC = -5.75 %), respiratory (830.78 to 660.29, APC = -4.85 %), circulatory (995.69 to 701.81, APC = -7.24 %), and acute composites (928.18 to 680.17, APC = -5.62 %). The rate ratios also decreased over time; however, in 2013, the rates for very high poverty neighborhoods were two to four times higher than low poverty neighborhoods (ZIP codes with <10 % of persons below the FPL). While preventable hospitalization rates have decreased over time, disparities still exist. These findings underscore the need to ensure adequate access to quality and timely primary care among individuals living in high poverty neighborhoods. [ABSTRACT FROM AUTHOR]

Introduction: Hispanics in the U.S. historically use tobacco at lower rates than other racial and ethnic groups. Cultural buffering, the process by which aspects of traditional Hispanic culture delay the adoption of unhealthy behaviors, is believed to be a protective factor against tobacco use. Electronic cigarettes (e-cigarettes) are a new tobacco product that have not been extensively studied, and it is unknown if cultural factors that protect against tobacco use will buffer against e-cigarette use among the Hispanic population.Methods: This cross-sectional study was conducted at the emergency department (ED) in a safety-net hospital in 2014. Patients visiting the ED participated in a survey assessing demographics and substance use. Cultural buffering was operationalized as participants' primary language spoken at home. Multivariate logistic regression and generalized estimating equations examined the association between Hispanic cultural buffering and e-cigarette ever-use.Results: Of the 1476 Hispanic ED patients (age: 46.6M±14.5SD, 49.3% male), 7.6% reported e-cigarette ever-use and 11.1% reported current combustible cigarette use. In adjusted models, Spanish speakers were half as likely to report e-cigarette ever-use (O.R.: 0.54, 95% C.I.: 0.34-0.84, p=0.007), compared with English speakers. Combustible cigarette use remained the most significant factor associated with e-cigarette ever-use (O.R.: 9.28, 95% C.I.:7.44-11.56, p<0.001). In higher-income neighborhoods, English speakers reported e-cigarette ever-use at higher rates than Spanish speakers (28.2% vs. 5.9%, p<0.001).Conclusions: Cultural buffering was protective against e-cigarette ever-use, especially in higher-income neighborhoods. These results support research on culturally-sensitive prevention programs for new and emerging tobacco products in Hispanic communities. [ABSTRACT FROM AUTHOR]