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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 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]

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]

This study examined the impact of child neglect during the first 4 years of life on adaptation to school during kindergarten and first grade in the context of neighborhood poverty (NP). Processes related to the development of school competencies were examined, including the mediational role of cognitive functioning and ego-resiliency (ER) in shaping children’s school outcomes. A total of 170 low-income urban children were followed prospectively for 2 years (ages 4–6). Results indicated that neglected children had significantly lower scores on kindergarten classroom behavior and first-grade academic performance than nonneglected children. Children’s cognitive performance at age 4, controlling for maternal intelligence quotient, mediated the relation between severity of neglect and children’s behavior in kindergarten as well as their academic performance in first grade. Moreover, severity of neglect was related to children’s ER at age 4. However, additional ecological adversity in the form of NP moderated the link between ER and classroom behavior, such that at lower levels of poverty, ER mediated the relation between severity of neglect and school adaptation. Conversely, when NP was extreme, the effects of ER were attenuated and ER ceased to predict behavioral performance in kindergarten. The implications of these findings for prevention and intervention are discussed. [ABSTRACT FROM AUTHOR]