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Background: Understanding geographic variation in youth drug use is important for both identifying etiologic factors and planning prevention interventions. However, little research has examined spatial clustering of drug use among youths by using rigorous statistical methods.Objectives: The purpose of this study was to examine spatial clustering of youth use of tobacco, alcohol, and marijuana.Methods: Responses on tobacco, alcohol, and marijuana use from 1,292 high school students ages 13–19 who provided complete residential addresses were drawn from the 2008 Boston Youth Survey Geospatial Dataset. Response options on past month use included “none,” “1–2,” “3–9,” and “10 or more.” The response rate for each substance was approximately 94%. Spatial clustering of youth drug use was assessed using the spatial Bernoulli model in the SatScan™ software package.Results: Approximately 12%, 36%, and 18% of youth reported any past-month use of tobacco, alcohol, and/or marijuana, respectively. Two clusters of elevated past tobacco use among Boston youths were generated, one of which was statistically significant. This cluster, located in the South Boston neighborhood, had a relative risk of 5.37 with ap-value of 0.00014. There was no significant localized spatial clustering in youth past alcohol or marijuana use in either the unadjusted or adjusted models.Conclusion: Significant spatial clustering in youth tobacco use was found. Finding a significant cluster in the South Boston neighborhood provides reason for further investigation into neighborhood characteristics that may shape adolescents' substance use behaviors. This type of research can be used to evaluate the underlying reasons behind spatial clustering of youth substance and to target local drug abuse prevention interventions and use. [ABSTRACT FROM PUBLISHER]

Racial/ethnic disparities in the prevalence of type 2 diabetes mellitus (T2DM) are well documented and until recently, research has focused almost exclusively on individual-based determinants as potential contributors to these disparities (health behaviors, biological/genetic factors, and individual-level socio-demographics). Research on the role of neighborhood characteristics in relation to racial/ethnic disparities in T2DM is very limited. Therefore, the aim of this research is to identify and estimate the contribution of specific aspects of neighborhoods that may be associated with racial/ethnic disparities in T2DM. Data from the Boston Area Community Health III Survey (N = 2764) was used in this study, which is a community-based random-sample survey of adults in Boston, Massachusetts from three racial/ethnic groups (Black, Hispanic, and White). We applied two-level random intercepts logistic regression to assess the associations between race/ethnicity, neighborhood characteristics (census tract socioeconomic status, racial composition, property and violent crime, open space, geographic proximity to grocery stores, convenience stores, and fast food, and neighborhood disorder) and prevalent T2DM (fasting glucose > 125 mg/dL, HbA1c ≥ 6.5%, or self-report of a T2DM diagnosis). Black and Hispanic participants had 2.89 times and 1.48 times the odds of T2DM as White participants, respectively. Multilevel models indicated a significant between-neighborhood variance estimate of 0.943, providing evidence of neighborhood variation. Individual demographics (race/ethnicity, age and gender) explained 22.3% of the neighborhood variability in T2DM. The addition of neighborhood-level variables to the model had very little effect on the magnitude of the racial/ethnic disparities and on the between-neighborhood variability. For example, census tract poverty explained less than 1% and 6% of the excess odds of T2DM among Blacks and Hispanics and only 1.8% of the neighborhood variance in T2DM. While the findings of this study overall suggest that neighborhood factors are not a major contributor to racial/ethnic disparities in T2DM, further research is needed including data from other geographic locations. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity remains a prominent public health problem. Walkable built environments may prevent excess weight gain. Objectives: We examined the association of walkable built environment characteristics with body mass index (BMI) z-score among a large sample of children and adolescents. Methods: We used geocoded residential address data from electronic health records of 49,770 children and adolescents 4 to < 19 years of age seen at the 14 pediatric practices of Harvard Vanguard Medical Associates from August 2011 through August 2012. We used eight geographic information system (GIS) variables to characterize walkable built environments. Outcomes were BMI z-score at the most recent visit and BMI z-score change from the earliest available (2008–2011) to the most recent (2011–2012) visit. Multivariable models were adjusted for child age, sex, race/ethnicity, and neighborhood median household income. Results: In multivariable cross-sectional models, living in closer proximity to recreational open space was associated with lower BMI z-score. For example, children who lived in closest proximity (quartile 1) to the nearest recreational open space had a lower BMI z-score (β = –0.06; 95% CI: –0.08, –0.03) compared with those living farthest away (quartile 4; reference). Living in neighborhoods with fewer recreational open spaces and less residential density, traffic density, sidewalk completeness, and intersection density were associated with higher cross-sectional BMI z-score and with an increase in BMI z-score over time. Conclusions: Overall, built environment characteristics that may increase walkability were associated with lower BMI z-scores in a large sample of children. Modifying existing built environments to make them more walkable may reduce childhood obesity. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated racial and socioeconomic disparities in the tobacco retailer landscape in Boston, Massachusetts. It reports study details which include the use of the 2010 U.S. census data for the region, calculation of tobacco retail density, and the spatial analysis performed. It also explores the correlation between tobacco retailer density and neighborhood demographics and possible reasons behind the lack of patterning in tobacco retail stores.

Measurements of neighborhood exposures likely vary depending on the definition of “neighborhood” selected. This study examined the extent to which neighborhood definition influences findings regarding spatial accessibility to tobacco retailers among youth. We defined spatial accessibility to tobacco retailers (i.e., tobacco retail density, closest tobacco retailer, and average distance to the closest 5 tobacco retailers) on the basis of circular and network buffers of 400 m and 800 m, census block groups, and census tracts by using residential addresses from the 2008 Boston Youth Survey Geospatial Dataset (n = 1,292). Friedman tests (to compare overall differences in neighborhood definitions) were applied. There were differences in measurements of youths' access to tobacco retailers according to the selected neighborhood definitions, and these were marked for the 2 spatial proximity measures (both P < 0.01 for all differences). For example, the median average distance to the closest 5 tobacco retailers was 381.50 m when using specific home addresses, 414.00 m when using census block groups, and 482.50 m when using census tracts, illustrating how neighborhood definition influences the measurement of spatial accessibility to tobacco retailers. These analyses suggest that, whenever possible, egocentric neighborhood definitions should be used. The use of larger administrative neighborhood definitions can bias exposure estimates for proximity measures. [ABSTRACT FROM PUBLISHER]

Objectives. We examined whether past-year suicidality among sexual minority adolescents was more common in neighborhoods with a higher prevalence of hate crimes targeting lesbian, gay, bisexual, and transgender (LGBT) individuals. Methods. Participants' data came from a racially/ethnically diverse population-based sample of 9th- through 12th-grade public school students in Boston, Massachusetts (n = 1292). Of these, 108 (8.36%) reported a minority sexual orientation. We obtained data on LGBT hate crimes involving assaults or assaults with battery between 2005 and 2008 from the Boston Police Department and linked the data to the adolescent's residential address. Results. Sexual-minority youths residing in neighborhoods with higher rates of LGBT assault hate crimes were significantly more likely to report suicidal ideation (P = .013) and suicide attempts (P = .006), than were those residing in neighborhoods with lower LGBT assault hate crime rates. We observed no relationships between overall neighborhood-level violent and property crimes and suicidality among sexual-minority adolescents (P > .05), providing evidence for specificity of the results to LGBT assault hate crimes. Conclusions. Neighborhood context (i.e., LGBT hate crimes) may contribute to sexual-orientation disparities in adolescent suicidality, highlighting potential targets for community-level suicide-prevention programs. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether agreement between self-reported and accelerometer-measured physical activity varies by BMI category in a low-income black sample. Methods: Participants completed a questionnaire and wore an accelerometer for 4-6 days. Using one- and 10-minute bouts, accelerometers measured light, moderate, and vigorous physical activity time. Results: Correlations varied by obesity (nonobese: one-minute r=0.41; 10- minute r=0.47; obese: one-minute r=0.21; 10-minute r=0 .14). Agreement was highest among nonobese persons (one-minute kappa = 0.48, 10-minute kappa = 0.023; obese: one-minute kappa = -0.024, 10- minute kappa = -0.020). Conclusions: We found compromised questionnaire performance among obese participants. [ABSTRACT FROM AUTHOR]

Background: Neighborhood safety may be an important social environmental determinant of overweight. We examined the relationship between perceived neighborhood safety and overweight status, and assessed the validity of reported neighborhood safety among a representative community sample of urban adolescents (who were racially and ethnically diverse). Methods: Data come from the 2006 Boston Youth Survey, a cross-sectional study in which public high school students in Boston, MA completed a pencil-and-paper survey. The study used a two-stage, stratified sampling design whereby schools and then 9th-12th grade classrooms within schools were selected (the analytic sample included 1,140 students). Students reported their perceptions of neighborhood safety and several associated dimensions. With self-reported height and weight data, we computed body mass index (BMI, kg/m²) for the adolescents based on CDC growth charts. Chi-square statistics and corresponding p-values were computed to compare perceived neighborhood safety by the several associated dimensions. Prevalence ratios (PRs) and 95% confidence intervals (CI) were calculated to examine the association between perceived neighborhood safety and the prevalence of overweight status controlling for relevant covariates and school site. Results: More than one-third (35.6%) of students said they always felt safe in their neighborhood, 43.9% said they sometimes felt safe, 11.6% rarely felt safe, and 8.9% never felt safe. Those students who reported that they rarely or never feel safe in their neighborhoods were more likely than those who said they always or sometimes feel safe to believe that gang violence was a serious problem in their neighborhood or school (68.0% vs. 44.1%, p < 0.001), and to have seen someone in their neighborhood assaulted with a weapon (other than a firearm) in the past 12 months (17.8% vs. 11.3%, p = 0.025). In the fully adjusted model (including grade and school) stratified by race/ethnicity, we found a statistically significant association between feeling unsafe in one's own neighborhood and overweight status among those in the Other race/ ethnicity group [(PR = 1.56, (95% CI: 1.02, 2.40)]. Conclusion: Data suggest that perception of neighborhood safety may be associated with overweight status among urban adolescents in certain racial/ethnic groups. Policies and programs to address neighborhood safety may also be preventive for adolescent overweight. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity prevalence remains high and racial/ethnic disparities may be widening. Studies have examined the role of health behavioral differences. Less is known regarding neighborhood and built environment mediators of disparities. The objective of this study was to examine the extent to which racial/ethnic disparities in elevated child body mass index (BMI) are explained by neighborhood socioeconomic status (SES) and built environment.Methods: We collected and analyzed race/ethnicity, BMI, and geocoded address from electronic health records of 44,810 children 4 to 18years-old seen at 14 Massachusetts pediatric practices in 2011-2012. Main outcomes were BMI z-score and BMI z-score change over time. We used multivariable linear regression to examine associations between race/ethnicity and BMI z-score outcomes, sequentially adjusting for neighborhood SES and the food and physical activity environment.Results: Among 44,810 children, 13.3% were black, 5.7% Hispanic, and 65.2% white. Compared to white children, BMI z-scores were higher among black (0.43units [95% CI: 0.40-0.45]) and Hispanic (0.38 [0.34-0.42]) children; black (0.06 [0.04-0.08]), but not Hispanic, children also had greater increases in BMI z-score over time. Adjusting for neighborhood SES substantially attenuated BMI z-score differences among black (0.30 [0.27-0.34]) and Hispanic children (0.28 [0.23-0.32]), while adjustment for food and physical activity environments attenuated the differences but to a lesser extent than neighborhood SES.Conclusions: Neighborhood SES and the built environment may be important drivers of childhood obesity disparities. To accelerate progress in reducing obesity disparities, interventions must be tailored to the neighborhood contexts in which families live. [ABSTRACT FROM AUTHOR]

The Harvard Youth Violence Prevention Center has partnered with the city of Boston, Massachusetts to create a data system to track youth violence. The system provides continuing information about fighting, bullying, dating violence and gun carrying. Data from it show that many Boston adolescents are afraid on public transportation (as compared to home, school or street) and that most students widely overestimate the number of their classmates carrying guns. The system also provides data on neighbourhood variables such as collective efficacy. The system has been a success due to the mutual respect shown between the academic and city partners, and the mutual benefits it provides to both. [ABSTRACT FROM AUTHOR]

Background: A key aspect of any intervention to improve obesity is to better understand the environment in which decisions are being made related to health behaviors, including the food environment., Methods: Our aim was to examine the extent to which proximity to six types of food establishments is associated with BMI z-score and explore potential effect modification of this relationship. We used geographical information software to determine proximity from 49,770 pediatric patients' residences to six types of food establishments. BMI z-score obtained from the electronic health record was the primary outcome., Results: In multivariable analyses, living in closest proximity to large (β, -0.09 units; 95% confidence interval [CI], -0.13, -0.05) and small supermarkets (-0.08 units; 95% CI, -0.11, -0.04) was associated with lower BMI z-score; living in closest proximity to fast food (0.09 units; 95% CI, 0.03, 0.15) and full-service restaurants (0.07 units; 95% CI, 0.01, 0.14) was associated with a higher BMI z-score versus those living farthest away. Neighborhood median income was an effect modifier of the relationships of convenience stores and full-service restaurants with BMI z-score. In both cases, closest proximity to these establishments had more of an adverse effect on BMI z-score in lower-income neighborhoods., Conclusions: Living closer to supermarkets and farther from fast food and full-service restaurants was associated with lower BMI z-score. Neighborhood median income was an effect modifier; convenience stores and full-service restaurants had a stronger adverse effect on BMI z-score in lower-income neighborhoods.

Objective: The objective of this study is to examine associations of proximity to food establishments with body mass index (BMI) among preschool-age children., Methods: We used baseline data from 438 children ages 2-6.9 years with a BMI ≥ 85th percentile participating in a RCT in Massachusetts from 2006 to 2009. We used a geographic information system to determine proximity to six types of food establishments: 1) convenience stores, 2) bakeries, coffee shops, candy stores, 3) full service restaurants, 4) large supermarkets, 5) small supermarkets, and 6) fast-food restaurants. The main outcome was child's BMI., Results: Children's mean (SD) BMI was 19.2 (2.4)kg/m(2); 35% lived ≤ 1 mile from a large supermarket, 42% lived >1 to 2 miles, and 22% lived >2 miles. Compared to children living >2 miles from a large supermarket, those who lived within 1 mile had a BMI 1.06 kg/m(2) higher. Adjustment for socioeconomic characteristics and distance to fast-food restaurants attenuated this estimate to 0.77 kg/m(2). Living in any other distance category from a large supermarket and proximity to other food establishments were not associated with child BMI., Conclusions: Living closer to a large supermarket was associated with higher BMI among preschool-age children who were overweight or obese., (Copyright © 2012 Elsevier Inc. All rights reserved.)