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Introduction: The COVID-19 pandemic has had a wide-ranging impact on mental health. Diverse populations experienced the pandemic differently, highlighting pre-existing inequalities and creating new challenges in recovery. Understanding the effects across diverse populations and identifying protective factors is crucial for guiding future pandemic preparedness. The objectives of this study were to (1) describe the specific COVID-19-related impacts associated with general well-being, (2) identify protective factors associated with better mental health outcomes, and (3) assess racial disparities in pandemic impact and protective factors., Methods: A cross-sectional survey of Louisiana residents was conducted in summer 2020, yielding a sample of 986 Black and White adults. The exposure was overall pandemic impact, measured using the Epidemic-Pandemic Impacts Inventory, and the outcome was general well-being (GWB), measured with the General Well-Being Schedule. Potential protective factors included social support, resilience, and social cohesion. Linear regression models were constructed to examine the association between pandemic impact and GWB, with each protective factor added as an effect modifier. These relationships were further assessed for differences by race., Results: Pandemic stressors can be grouped into social, health, work, finance, and family-related impacts. Black persons displayed higher levels of pandemic impact as well as lower levels of social support, resilience, and social cohesion ( p  < 0.0001), highlighting existing racial disparities, though Black respondents and White respondents exhibited no differences in general-well being. Social support, resilience, and social cohesion were identified as protective factors for both groups ( p  < 0.0001, respectively), but these protective effects deteriorated as pandemic impacts increased. The addition of a pandemic impact by race interaction term was also significant in each model ( p  = 0.0020, p  < 0.0001, and p  = 0.0095, respectively) and showed that the protective effects of social support and resilience deteriorated more rapidly for Black persons than White persons, while the protective effects of social cohesion deteriorated more rapidly for White persons than Black persons., Discussion: This study emphasizes the importance of psychosocial resources in buffering the mental health impact of pandemics. It also suggests greater vulnerability for marginalized communities lacking access to crucial support systems. Findings underscore the need for targeted interventions that bolster access to social support, promote resilience, and strengthen social cohesion, particularly within minority groups. Additionally, policymakers should consider proactive measures to assist in recovery and mitigate the disproportionate impact of future crises on vulnerable populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rung, Oral, Prusisz and Peters.)

Importance: Disasters experienced by an entire community provide opportunities to understand individual differences in risk for adverse health outcomes over time. DNA methylation (DNAm) differences may help to distinguish individuals at increased risk following large-scale disasters., Objective: To examine the association of epigenetic age acceleration with probable posttraumatic stress disorder (PTSD) and PTSD symptom severity in women., Design, Setting, and Participants: This prospective cohort study examined data from participants in the Women and Their Children's Health cohort, who were characterized longitudinally following the Deepwater Horizon oil spill (DHOS) in 2010 and through numerous hurricanes in the Gulf Coast region of the US. Wave 1 occurred August 6, 2012, through June 26, 2014, and wave 2 occurred September 2, 2014, through May 27, 2016. Data were analyzed between August 18 and November 4, 2023. Address-based sampling was used to recruit women aged 18 to 80 years and residing in 1 of the 7 Louisiana parishes surrounding the DHOS-affected region. Recruitment consisted of 2-stage sampling that (1) undersampled the 2 more urban parishes to maximize probability of participant oil exposure and (2) proportionally recruited participants across census tracts in the 5 other parishes closest to the spill., Exposure: Posttraumatic stress subsequent to the DHOS., Main Outcome and Measures: Epigenetic age acceleration was measured by DNAm assayed from survey wave 1 blood samples. Posttraumatic stress disorder was assessed using the PTSD Checklist for DSM-5 at survey wave 2, and lifetime trauma exposure was assessed using the Life Events Checklist for DSM-5. General linear models were used to examine the association between wave 1 DNAm age and wave 2 probable PTSD diagnosis and symptom severity., Results: A total of 864 women (mean [SD] age, 47.1 [12.0] years; 328 Black [38.0%], 19 American Indian [2.2%], 486 White [56.3%], and 30 of other racial groups, including uknown or unreported [3.5%]) were included. Black and American Indian participants had a higher age acceleration at wave 1 compared with White participants (β = 1.64 [95% CI, 1.02-2.45] and 2.34 [95% CI, 0.33-4.34], respectively), and they had higher PTSD symptom severity at wave 2 (β = 7.10 [95% CI, 4.62-9.58] and 13.08 [95% CI, 4.97-21.18], respectively). Epigenetic age acceleration at wave 1 was associated with PTSD symptom severity at wave 2 after adjusting for race, smoking, body mass index, and household income (β = 0.38; 95% CI, 0.11-0.65)., Conclusions and Relevance: In this cohort study, epigenetic age acceleration was higher in minoritized racial groups and associated with future PTSD diagnosis and severity. These findings support the need for psychoeducation about traumatic responses to increase the likelihood that treatment is sought before years of distress and entrenchment of symptoms and comorbidities occur.

Introduction: Financial toxicity (FT) is a growing concern among cancer survivors that adversely affects the quality of life and survival. Individuals diagnosed with aggressive cancers are often at a greater risk of experiencing FT. The objectives of this study were to estimate FT among prostate cancer (PCa) survivors after 10-15 years of diagnosis, assess the relationship between PCa aggressiveness at diagnosis and FT, and examine whether current cancer treatment status mediates the relationship between PCa aggressiveness and FT., Methods: PCa patients enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP) were recontacted for long-term follow-up. The prevalence of FT in the PCaP cohort was estimated. FT was estimated using the COmprehensive Score for Financial Toxicity, a validated measure of FT. The direct effect of PCa aggressiveness and an indirect effect through current cancer treatment on FT was examined using causal mediation analysis., Results: More than one-third of PCa patients reported experiencing FT. PCa aggressiveness was significantly independently associated with high FT; high aggressive PCa at diagnosis had more than twice the risk of experiencing FT than those with low or intermediate aggressive PCa (adjusted odds ratio [aOR] = 2.13, 95% CI = 1.14-3.96). The proportion of the effect of PCa aggressiveness on FT, mediated by treatment status, was 10%, however, the adjusted odds ratio did not indicate significant evidence of mediation by treatment status (aOR = 1.05, 95% CI = 0.95-1.20)., Conclusions: Aggressive PCa was associated with high FT. Future studies should collect more information about the characteristics of men with high FT and identify additional risk factors of FT., (© 2022 The Authors. The Prostate published by Wiley Periodicals LLC.)

Background: The overall survival rate of prostate cancer (PCa) has improved over the past decades. However, huge socioeconomic and racial disparities in overall and prostate cancer-specific mortality exist. The neighborhood-level factors including socioeconomic disadvantage and lack of access to care may contribute to disparities in cancer mortality. This study examines the impact of neighborhood deprivation on mortality among PCa survivors., Methods: North Carolina-Louisiana Prostate Cancer Project (PCaP) data were used. A total of 2113 men, 1046 AA and 1067 EA, with PCa were included in the analysis. Neighborhood deprivation was measured by the Area Deprivation Index (ADI) at the census block group level using data from the US Census Bureau. Quintiles of ADI were created. Cox proportional hazards and competing risk models with mixed effects were performed to estimate the effect of neighborhood deprivation on all-cause and PCa-specific mortality adjusted for age, race, study site, insurance status, and comorbidities., Results: Participants living in the most deprived neighborhoods had an increased risk for all-cause mortality (quintiles 4 + 5: adjusted hazard ratio [aHR] = 1.51, 95% confidence interval [CI] = 1.16-1.96) compared to those in the least deprived (quintile 1) neighborhoods. The risk of prostate cancer-specific mortality was also higher among those living in the deprived neighborhoods (quintiles 4 + 5: aHR = 1.90, 95% CI = 1.10-3.50) than those in the least deprived neighborhood., Conclusions: The findings suggest neighborhood-level resources or health interventions are essential to improve survival among men with PCa. Additional research should focus on the mechanisms of how the neighborhood environment affects mortality., (© 2022 The Authors. The Prostate published by Wiley Periodicals LLC.)

Objective: To examine the association between the Centers for Disease Control and Prevention (CDC)'s Social Vulnerability Index (SVI) and COVID-19 incidence among Louisiana census tracts. Methods: An ecological study comparing the CDC SVI and census tract-level COVID-19 case counts was conducted. Choropleth maps were used to identify census tracts with high levels of both social vulnerability and COVID-19 incidence. Negative binomial regression with random intercepts was used to compare the relationship between overall CDC SVI percentile and its four sub-themes and COVID-19 incidence, adjusting for population density. Results: In a crude stratified analysis, all four CDC SVI sub-themes were significantly associated with COVID-19 incidence. Census tracts with higher levels of social vulnerability were associated with higher COVID-19 incidence after adjusting for population density (adjusted RR: 1.52, 95% CI: 1.41-1.65). Conclusions: The results of this study indicate that increased social vulnerability is linked with COVID-19 incidence. Additional resources should be allocated to areas of increased social disadvantage to reduce the incidence of COVID-19 in vulnerable populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer LC declared a shared affiliation with one of the authors, PM at time of review., (Copyright © 2021 Biggs, Maloney, Rung, Peters and Robinson.)

The intersection of work and family life can be a source of burden (negative) and a source of growth (positive). Negative work-to-family and family-to-work spillover have been linked to poor mental health, while positive work-to-family and family-to-work spillover have been linked to improved health outcomes. Less is known about these relationships in racial subgroups. Louisiana, USA, has a large proportion of African Americans, providing a unique population in which to study these relationships. The objectives of this study were to examine, among a sample of women in southern Louisiana in 2017, levels of work-family spillover by race and how the relationship between work-family spillover and depressive symptoms varies by race. 284 employed women (61% White, 39% Black) met eligibility criteria and participated in a survey to collect information on work-family spillover (positive and negative) and depressive symptoms. White women experienced higher levels of both kinds of negative spillover (work-to-family and family-to-work) as well as higher levels of positive work-to-family spillover compared to Black women. There were no differences between White and Black women with respect to positive family-to-work spillover. Higher levels of negative work-to-family spillover were related to greater depressive symptoms among both Blacks and Whites. But higher levels of negative family-to-work spillover were related to higher levels of depressive symptoms among Black women only. A protective relationship from positive family-to-work spillover for depressive symptoms was observed among White women only. This study fills an important gap in the literature on racial differences in the relationship between work-family spillover and depression., Competing Interests: The authors assert no conflicts of interest or financial disclosures., (© 2020 The Authors.)

Background: Louisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana., Methods: The Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed., Results: Neighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and -33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods., Conclusion: While the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation., Competing Interests: The authors have declared that no competing interests exist.

Background: Traditional mindfulness-based stress reduction programs are resource intensive for providers and time- and cost-intensive for participants, but the use of mobile technologies may be particularly convenient and cost-effective for populations that are busy, less affluent, or geographically distant from skilled providers. Women in southern Louisiana live in a vulnerable, disaster-prone region and are highly stressed, making a mobile program particularly suited to this population., Objective: This study aimed to (1) assess the feasibility and acceptability of a mobile mindfulness app in real-world conditions in a pilot study of a community sample of women residing in southern Louisiana, (2) describe predictors of app usage, and (3) assess the effect of the app on secondary health outcomes., Methods: Women were recruited from an oil spill study on health. A total of 236 women completed a baseline survey, were offered the mobile mindfulness program, and completed a follow-up survey. Subjects were asked to download and use the app for at least 30 days for 10 min. All study procedures were completed on the web. Primary outcomes were feasibility and acceptability of the app and characteristics of app utilization. Secondary outcomes included mindfulness, depression, perceived stress, sleep quality, physical activity, BMI, and healthy eating., Results: Overall, 74.2% (236/318) of subjects completed the follow-up survey, and 13.5% (43/318) used the app. The main barrier to app usage was lack of time, cited by 37% (16/43) of users and 48.7% (94/193) of nonusers of the app. Women who chose to use the app were more highly educated (16/43, 63% had a college education vs 65/193, 33.7% of nonparticipants; P<.001), had higher incomes (23/43, 58% had incomes >US $50,000 per year vs 77/193, 43.0% of nonparticipants), and were employed (34/43, 79% vs 122/193, 63.2% of nonparticipants; P=.047). Those who engaged with the app did so at high levels, with 72% (31/43) of participants self-reporting the completion of some or all sessions and 74% (32/43) reporting high levels of satisfaction with the app. Participation with the app had a beneficial impact on depression (odds ratio [OR] 0.3, 95% CI 0.11-0.81), sleep quality (OR 0.1, 95% CI 0.02-0.96), sleep duration (OR 0.3, 95% CI 0.07-0.86), sleep latency (OR 0.3, 95% CI 0.11-0.81), and physical activity (2.8 95% CI 1.0-7.8), but mindfulness scores did not change from baseline to follow-up., Conclusions: The Headspace mobile mindfulness app was easy and cost-effective to implement and acceptable to those who participated, but few women elected to try it. The unique characteristics of this southern Louisiana population suggest that more intense promotion of the benefits of mindfulness training is needed, perhaps in conjunction with some therapist or researcher support. Several short-term benefits of the app were identified, particularly for depression and sleep., (©Ariane Lisann Rung, Evrim Oral, Lara Berghammer, Edward S Peters. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 02.06.2020.)

Increasing in frequency and impact in the United States and worldwide, disasters can lead to serious mental health consequences. Although US census data are essential for disaster preparedness and the identification of community-level risk factors for adverse postdisaster mental health outcomes, the US Census Bureau faces many challenges as we approach 2020 Decennial Census data collection. Despite the utility of the information provided by the Census and American Community Survey (ACS), the 2020 US Census and subsequent ACS data face threats to validity. As a result, public health funding could be misallocated, and disaster preparedness and response efforts misinformed; this can also contribute to the worsening of mental health inequities, particularly in the context of disaster. Undercutting the Census and the ACS, rich data sources that allow representation of all people in the United States, is a step backward in our effort to mitigate the population mental health consequences of disasters.

Background: Few prior studies have investigated the latent class structure of PTSD using DSM-5 symptoms., Methods: To describe latent PTSD profiles among women who resided in Deepwater Horizon Oil Spill (DHOS)-affected coastal Louisiana communities, we used data from women enrolled in The Women and Their Children's Health (WaTCH) Study. Latent profile analysis was performed on the 20-item PTSD Checklist for DSM-5 (PCL-5) and model fit statistics for 2-class through 6-class solutions were compared. The pseudo-class draws method was employed on the best class solution to compare key covariates (including demographics, mental health indicators, DHOS exposure indicators, and trauma exposures) across classes., Results: Among 1997 women (mean age 46.63 ± 12.14 years, 56.8% white, mean trauma categories 6.09 ± 2.98, 9.55% previously diagnosed with PTSD), model fit statistics supported a five-class solution: low symptoms (mean PCL-5 = 4.10), moderate without mood alterations (mean = 19.73), moderate with mood alterations (mean = 34.24), severe without risk-taking (mean = 55.75), and severe with risk-taking (mean = 53.80). Women in the low-symptom class were significantly more likely to be white, have finished high school, have an income of at least $40,001 per year, be married or living with a partner, and endorse fewer trauma categories than women in the four symptomatic classes. Women with moderate to severe symptoms often had co-morbid depressive symptoms and no prior PTSD diagnosis., Limitations: This study was limited by use of self-reported data and one-time assessment of PTSD symptoms., Discussion: Five distinct latent profiles of DSM-5 PTSD symptoms consisted of notably different individuals. Most affected women did not report prior PTSD diagnosis. Future research and practice identifying and addressing barriers to care for trauma-affected women in these communities is warranted., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The purpose of the study is to describe changes in mental health among women following an oil spill and to examine their association with the Deepwater Horizon oil spill (DHOS)., Methods: The Women and Their Children's Health study followed 2038 women in Louisiana after the DHOS. Subjects were interviewed in 2012-2014 and 2014-2016. Oil spill exposure was characterized using survey items about economic and physical exposures. Outcomes were depressive symptoms and mental distress., Results: After adjustment for relevant demographics, depressive symptoms increased over 2 time points following the DHOS, whereas symptoms of mental distress decreased. For every year increase in time since the DHOS, the rate ratio for depressive symptoms increased by a factor of 1.08. In contrast, the rate ratio for mental distress decreased by a factor of 0.97. In addition, initial associations between economic and physical exposure to the DHOS persisted up to 6 years after the spill; women who were more highly exposed experienced higher levels of depressive symptoms (rate ratios ranged from 1.08 to 1.11) and mental distress (rate ratios from 1.05 to 1.11) at each time point than women who were less exposed., Conclusion: A better understanding of recovery patterns following an oil spill can help direct critical mental health response efforts. (Disaster Med Public Health Preparedness. 2019;13:183-190).

We compared geographic information system (GIS)- and Census-based approaches for measuring the physical and social neighborhood environment at the census tract-level versus and audit approach on associations with body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Data were used from the 2012-2014 Women and Their Children's Health (WaTCH) Study ( n =940). Generalized linear models were used to obtain odds ratios (ORs) for BMI (≥30 kg/m 2 ), WC (>88 cm), and WHR (>0.85). Using an audit approach, more adverse neighborhood characteristics were associated with a higher odds of WC (OR: 1.10; 95% CI: 1.05, 1.15) and WHR (OR: 1.09; 95% CI: 1.05, 1.14) after adjustment for age, race/ethnicity, income, and oil spill exposure. There were no significant associations between GIS- and Census- based measures with obesity in adjusted models. Quality aspects of the neighborhood environment captured by audits at the individual-level may be more relevant to obesity than physical or social aspects at the census-tract level., Competing Interests: Conflict of interest None declared.

Purpose: The severity of the stress response to experiencing disaster depends on individual exposure and background stress prior to the event. To date, there is limited research on the interaction between neighborhood environmental stress and experiencing an oil spill, and their effects on depression. The objective of the current study was to assess if the association between exposure to the Deepwater Horizon Oil Spill (DHOS) and depressive symptoms varied by neighborhood characteristics., Methods: US Census data (2010) and longitudinal data collected in two waves (2012-2014 and 2014-2016) from female residents [N = 889 (Wave I), 737 (Wave II)] of an area highly affected by the DHOS were analyzed. Multilevel and individual-level negative binomial regressions were performed to estimate associations with depressive symptoms in both waves. An interaction term was included to estimate effect modification of the association between DHOS exposure and depressive symptoms by neighborhood characteristics. Generalized estimating equations were applied to the negative binomial regression testing longitudinal associations., Results: Census tract-level neighborhood characteristics were not associated with depressive symptoms. Exposure to the DHOS and neighborhood physical disorder were associated with depressive symptoms cross-sectionally. There was no evidence of effect modification; however, physical/environmental exposure to the DHOS was associated with increased depressive symptoms only among women living in areas with physical disorder. Exposure to the DHOS remained associated with depressive symptoms over time., Conclusions: Findings support the enduring consequences of disaster exposure on depressive symptoms in women and identify potential targets for post-disaster intervention based on residential characteristics.

Purpose: The Deepwater Horizon Oil Spill is the largest marine oil spill in US history. Few studies have evaluated the potential health effects of this spill on the Gulf Coast community. The Women and Their Children's Health (WaTCH) study is a prospective cohort designed to investigate the midterm to long-term physical, mental and behavioural health effects of exposure to the oil spill., Participants: Women were recruited by telephone from pre-existing lists of individuals and households using an address-based sampling frame between 2012 and 2014. Baseline interviews obtained information on oil spill exposure, demographics, physical and mental health, and health behaviours. Women were also asked to provide a household roster, from which a child between 10 and 17 years was randomly selected and recruited into a child substudy. Telephone respondents were invited to participate in a home visit in which blood samples, anthropometrics and neighbourhood characteristics were measured. A follow-up interview was completed between 2014 and 2016., Findings to Date: 2852 women completed the baseline interview, 1231 of whom participated in the home visit, and 628 children participated in the child's health substudy. The follow-up interview successfully reinterviewed 2030 women and 454 children., Future Plans: WaTCH continues to conduct follow-up surveys, with a third wave of interviews planned in 2017. Also, we are looking to enhance the collection of spatially related environmental data to facilitate assessment of health risks in the study population. In addition, opportunities to participate in behavioural interventions for subsets of the cohort have been initiated. There are ongoing studies that examine the relationship between genetic and immunological markers with mental health., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The mental health consequences of disasters, including oil spills, are well known. The goal of this study is to examine whether social capital and social support mediate the effects of exposure to the Deepwater Horizon oil spill on depression among women. Data for the analysis come from the first wave of data collection for the Women and Their Children's Health Study, a longitudinal study of the health effects of women exposed to the oil spill in southern Louisiana, USA. Women were interviewed about their exposure to the oil spill, depression symptoms, structural social capital (neighborhood organization participation), cognitive social capital (sense of community and informal social control), and social support. Structural equation models indicated that structural social capital was associated with increased levels of cognitive social capital, which were associated with higher levels of social support, which in turn were associated with lower levels of depression. Physical exposure to the oil spill was associated with greater economic exposure, which in turn was associated with higher levels of depression. When all variables were taken into account, economic exposure was no longer associated with depression, and social support and cognitive social capital mediated the effect of economic exposure on depression, explaining 67% of the effect. Findings support an extension of the deterioration model of social support to include the additional coping resource of social capital. Social capital and social support were found to be beneficial for depression post-oil spill; however, they were themselves negatively impacted by the oil spill, explaining the overall negative effect of the oil spill on depression. A better understanding of the pathways between the social context and depression could lead to interventions for improved mental health in the aftermath of a disaster., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Introduction: Oil spill exposures are associated with increased levels of depression, which is often measured using continuous scores or dichotomous cut points on screening tools in population-based studies. Latent profile analysis can overcome analytic limitations such as 1) masking of heterogeneity in outcomes among people within dichotomous categories and 2) loss of information about symptom patterns among those with the same continuous score. This study examined variation in depressive symptoms and assessed the associations between depressive symptomatology and oil spill exposure, socioeconomic risk factors, and social capital., Methods: Between 2012 and 2014, we interviewed 2852 women in southeastern Louisiana. We performed latent profile analysis then tested the adjusted associations between sociodemographic characteristics, oil spill exposure and latent class membership., Results: Results indicated a three-class solution in which classes varied by symptom severity as the best fit. The strongest associations were among women with the most severe depressive symptoms, who were less educated, were more economically vulnerable, and had the least social support compared to women with no depressive symptoms., Limitations: This study is limited by its cross-sectional design and the self-reported nature of exposures and depressive symptoms, but results are consistent with prior literature., Conclusions: Our results support the conventional use of screening tools to estimate depressive symptomatology. Nevertheless, the identification of subgroups within study participants highlights an important finding: the subgroups were comprised of characteristically different women with varying levels of depressive symptoms, a discovery that would have been overlooked if the CES-D was used conventionally., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Psychological sequelae are among the most pronounced effects in populations following exposure to oil spills. Women in particular represent a vulnerable yet influential population but have remained relatively understudied with respect to the Deepwater Horizon oil spill (DHOS)., Objective: To describe the relationship between oil spill exposure and mental health among women living in the southern coastal Louisiana parishes affected by the DHOS., Methods: The Women and Their Children's Health Study administered telephone interviews to a population-based sample of 2,842 women between 2012 and 2014 following the DHOS. Participants were asked about depression, mental distress, domestic conflict, and exposure to the oil spill., Results: Over 28% of the sample reported symptoms of depression, 13% reported severe mental distress, 16% reported an increase in the number of fights with their partners, and 11% reported an increase in the intensity of partner fights. Both economic and physical exposure were significantly associated with depressive symptoms and domestic conflict, whereas only physical exposure was related to mental distress., Conclusions: This large, population-based study of women in southern coastal Louisiana, a particularly disaster-prone area of the country, revealed high rates of poor mental health outcomes. Reported exposure to the DHOS was a significant predictor of these outcomes, suggesting avenues for future disaster mitigation through the provision of mental health services., Citation: Rung AL, Gaston S, Oral E, Robinson WT, Fontham E, Harrington DJ, Trapido E, Peters ES. 2016. Depression, mental distress, and domestic conflict among Louisiana women exposed to the Deepwater Horizon Oil Spill in the WaTCH Study. Environ Health Perspect 124:1429-1435; http://dx.doi.org/10.1289/EHP167., Competing Interests: The authors declare they have no actual or potential competing financial interests.

Background: The Deepwater Horizon Oil Spill (DHOS) is the largest oil spill in U.S. history, negatively impacting Gulf Coast residents and the surrounding ecosystem. To date, no studies have been published concerning physical health outcomes associated with the DHOS in the general community., Objectives: We characterized individual DHOS exposure using survey data and examined the association between DHOS exposure and physical health., Methods: Baseline data from 2,126 adult women residing in southern Louisiana and enrolled in the Women and Their Children's Health study were analyzed. Exploratory factor analysis was used to characterize DHOS exposure. Odds ratios and 95% confidence intervals for the associations between DHOS exposure and physical health symptoms were estimated using multivariate logistic regression., Results: A two-factor solution was identified as the best fit for DHOS exposure: physical-environmental exposure and economic exposure. High physical-environmental exposure was significantly associated with all of the physical health symptoms, with the strongest associations for burning in nose, throat, or lungs (OR = 4.73; 95% CI: 3.10, 7.22), sore throat (OR = 4.66; 95% CI: 2.89, 7.51), dizziness (OR = 4.21; 95% CI: 2.69, 6.58), and wheezing (OR = 4.20; 95% CI: 2.86, 6.17). Women who had high-economic exposure were significantly more likely to report wheezing (OR = 1.92; 95% CI: 1.32, 2.79); headaches (OR = 1.81; 95% CI: 1.41, 2.58); watery, burning, itchy eyes (OR = 1.61; 95% CI: 1.20, 2.16); and stuffy, itchy, runny nose (OR = 1.56; 95% CI: 1.16, 2.08)., Conclusions: Among southern Louisiana women, both physical-environmental and economic exposure to the DHOS were associated with an increase in self-reported physical health outcomes. Additional longitudinal studies of this unique cohort are needed to elucidate the impact of the DHOS on short- and long-term human health., Citation: Peres LC, Trapido E, Rung AL, Harrington DJ, Oral E, Fang Z, Fontham E, Peters ES. 2016. The Deepwater Horizon Oil Spill and physical health among adult women in southern Louisiana: the Women and Their Children's Health (WaTCH) study. Environ Health Perspect 124:1208-1213; http://dx.doi.org/10.1289/ehp.1510348.

Although many studies have reported associations between characteristics of the neighborhood environment and obesity, little is understood about the pathways or mechanisms through which these associations operate. The purpose of this study was to examine possible behavioral and stress pathways hypothesized to mediate the association between neighborhood environments and obesity and whether pathways contribute to different obesity outcomes. Cross-sectional data were used from the 2012-2014 Women and Their Children's Health Study (WaTCH) in Louisiana (N = 909). Participants' neighborhoods, body mass index (BMI) and waist circumference (WC) were objectively measured. The causal inference approach to mediation analysis was used to obtain indirect estimates for self-reported measures of physical activity, low access to food, and depression. The mean BMI was 32.0 kg/m(2) and the mean WC was 98.6 cm. The (adverse) neighborhood environment was significantly associated BMI (β = 0.17 kg/m(2); 95% Confidence Interval (CI): 0.03, 0.31) and WC (β = 0.64; 95% CI: 0.34, 0.95, after adjusting for covariates. Neither depression, physical activity, nor low food access mediated those associations. Further research that investigates and uses better measures of the behavioral and stress pathways through which the neighborhood environment influences obesity is warranted.

Objective: To examine possible associations between perceived neighborhood environments and obesity among a U.S. nationally representative sample of Afro-Caribbean, African American, and Non-Hispanic white adults., Methods: Data was used from the 2001-2003 National Survey of American Life (NSAL). All measures including neighborhood characteristics, height, and weight were self-reported. Multivariate logistic regression was used to compute odds ratios (ORs) of obesity (body mass index (BMI) ≥ 30 kg/m(2)) based on perceived neighborhood physical and social characteristics., Results: The odds of obesity were significantly lower for adults who reported involvement in clubs, associations, or help groups (odds ratio (OR): 0.62; 95% confidence interval (CI): 0.44, 0.85) and perceived that they had a park, playground, or open space in their neighborhood (odds ratio (OR): 0.68; 95% confidence interval (CI): 0.47, 0.98). These associations remained significant after adjusting for leisure-time physical activity. Race/ethnicity appeared to modify the association between involvement in clubs, associations, or help groups and obesity., Conclusions: Providing parks, playgrounds, or open space or increasing the perception of those amenities may assist in the prevention of obesity, especially in ethnically diverse neighborhoods in the United States. More research is needed to investigate how perceptions of the neighborhood environment influence obesity and whether perceptions of the neighborhood environment differ between individuals within the same neighborhoods., (Copyright © 2014 Elsevier Inc. All rights reserved.)

To effectively address medication adherence and improve cardiovascular health among older adults, a deeper understanding is needed of the barriers that this age group faces and approaches that would be most effective and feasible for improving adherence. We conducted a focus group study (n=25) in a diverse population of older adults with hypertension recruited from the Cohort Study of Medication Adherence in Older Adults (CoSMO). A structured guide was used to collect feedback on barriers to adherence and acceptability and feasibility of intervention strategies. The final coding framework outlines factors at the individual, relationship, health care system, and environmental or policy level which affect adherence in older adults, including memory, knowledge, attitudes and beliefs, side effects, social support, interaction with health care providers, and cost and convenience of medication filling. Patient responses highlighted the varied nature of barriers and the need for interventions which are both multi-faceted and tailored.

Background: Neighborhood parks play an important role in promoting physical activity. We examined the effect of activity area, condition, and presence of supporting features on number of park users and park-based physical activity levels., Methods: 37 parks and 154 activity areas within parks were assessed during summer 2008 for their features and park-based physical activity. Outcomes included any park use, number of park users, mean and total energy expenditure. Independent variables included type and condition of activity area, supporting features, size of activity area, gender, and day of week. Multilevel models controlled for clustering of observations at activity area and park levels., Results: Type of activity area was associated with number of park users, mean and total energy expenditure, with basketball courts having the highest number of users and total energy expenditure, and playgrounds having the highest mean energy expenditure. Condition of activity areas was positively associated with number of basketball court users and inversely associated with number of green space users and total green space energy expenditure. Various supporting features were both positively and negatively associated with each outcome., Conclusions: This study provides evidence regarding characteristics of parks that can contribute to achieving physical activity goals within recreational spaces.

Background: Neighborhood parks play an important role in promoting physical activity. We examined the effect of activity area, condition, and presence of supporting features on number of park users and park-based physical activity levels., Methods: 37 parks and 154 activity areas within parks were assessed during summer 2008 for their features and park-based physical activity. Outcomes included any park use, number of park users, mean and total energy expenditure. Independent variables included type and condition of activity area, supporting features, size of activity area, gender, and day of week. Multilevel models controlled for clustering of observations at activity area and park levels., Results: Type of activity area was associated with number of park users, mean and total energy expenditure, with basketball courts having the highest number of users and total energy expenditure, and playgrounds having the highest mean energy expenditure. Condition of activity areas was positively associated with number of basketball court users and inversely associated with number of green space users and total green space energy expenditure. Various supporting features were both positively and negatively associated with each outcome., Conclusions: This study provides evidence regarding characteristics of parks that can contribute to achieving physical activity goals within recreational spaces.

Background: Parks have been proposed as a feature of the built environment that may promote increased physical activity. Little, if any, research has investigated the role of the park social environment in promoting physical activity within parks, however., Purpose: To examine whether social capital is a collective feature of the park environment and whether it is associated with park use and park-based physical activity., Methods: Adult park users (n=222) were surveyed in 27 neighborhood parks in New Orleans LA in July-August 2008. Direct observation methods were used to count the numbers and activity levels of all park users in these parks on weekdays during the hours of 4:00-7:00(PM). Multilevel linear regression models were used to calculate the intraclass correlation (ICC), which measures the variation in perceived social capital attributable to differences among parks and to test whether park use and physical activity outcomes differed between parks with high versus low levels of social capital. Analyses were conducted in 2009-2010., Results: In study parks, 27% of perceived social capital was attributable to differences among parks (ICC=0.27). Parks with higher levels of social capital had higher daily numbers of observed park users (42.5 vs 12.1, p=0.0044) and had more energy expended within the park (3200.3 vs 721.2 MET-minutes across all park users, p=0.0087)., Conclusions: Interventions to improve park social environments should be conducted to determine if they promote increased physical activity among park users., (Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Neighbourhood parks may serve as a coping resource in post-disaster communities, yet little is known about the impact of large-scale disasters on park use. The objective of this study is to explore the impact of Hurricane Katrina (August 2005) on park use by visitors from flooded areas of New Orleans, Louisiana, compared to visitors from non-flooded areas. In 2006 and 2007, following Hurricane Katrina, 201 adults who visited 27 New Orleans parks were interviewed. Visitors from flooded neighbourhoods used their parks less often and were less likely to engage in animal interaction than visitors from non-flooded neighbourhoods. They placed more importance on escape and physically-active motivations than visitors from non-flooded areas. Social reasons were also more important to visitors from flooded areas, but these differences disappeared after adjusting for race. Neighbourhood parks are a community asset that may play a role in the post-disaster recovery process by providing opportunities for escape and physical activity., (© 2011 The Author(s). Disasters © Overseas Development Institute, 2011.)

Purpose: Walking to and from school contributes to total physical activity levels. This study investigated whether perceived and actual neighborhood features were associated with walking to or from school among adolescent girls., Methods: A sample of geographically diverse eighth-grade girls (N = 890) from the Trial of Activity in Adolescent Girls (TAAG) study living within 1.5 miles of their middle school was recruited. Participants completed a self-administered survey on their neighborhood and walking behavior. Geographic information system data were used to assess objective neighborhood features. Nested multivariable logistic regression analyses were conducted to determine the contribution of perceived and objective measures of walking to or from school., Results: Fifty-six percent (n = 500) of the girls walked to or from school for at least 1 d in a week. White (42%) girls walked more frequently than Hispanic (25%) and African American (21%) girls. Girls were nearly twice as likely to walk to or from school if they perceived their neighborhoods as safe and perceived that they had places they liked to walk, controlling for other potential confounders. In addition, girls who lived closer to school, had more active destinations in their neighborhood, and had smaller-sized blocks were more likely to walk to or from school than those who did not., Conclusions: Safety, land use, and school location issues need to be considered together when designing interventions to increase walking to and from school.

Objective: The factorial validity and measurement equivalence/invariance of scales used to measure social-cognitive correlates of physical activity among adolescent girls were examined., Methods: Confirmatory factor analysis was applied to questionnaire responses obtained from a multi-ethnic sample (N = 4885) of middle-school girls from six regions of the United States. A cohort of 1893 girls completed the scales in both sixth and eighth grades, allowing longitudinal analysis., Results: Theoretically and statistically sound models were developed for each scale, supporting the factorial validity of the scales in all groups. Multi-group and longitudinal invariance was confirmed across race/ethnicity groups, age within grade, BMI categories, and the 2-year period between grades., Conclusions: The scores from the scales provide valid assessments of social-cognitive variables that are putative mediators or moderators of change in physical activity. The revised scales can be used in observational studies of change or interventions designed to increase physical activity among girls during early adolescence.

Background: With limited opportunities for physical activity during school hours, it is important to understand the contexts of physical activities done outside of school time. Given the importance of physical and social aspects of environments, the purpose of this study was to describe where and with whom girls participate in physical activities outside of school., Methods: Participants were 1925 sixth-grade girls in the Trial of Activity for Adolescent Girls (TAAG). At baseline, they completed a 3-day physical activity recall (3DPAR), reporting the main activity performed during 30-minute intervals and the physical and social contexts of physical activities., Results: The most frequently reported physical activities done outside of school time were house chores, walking (for transportation or exercise), dance, basketball, playing with younger children, and running or jogging. The most common location for these activities was at home or in the neighborhood. With the exception of household chores, these activities were typically done with at least one other person., Conclusions: Interventions that promote physical activities that can be done at or around home or developing supportive social networks for physical activity would be consistent with the current physical activity contexts of adolescent girls.

Background: Parks provide environments for physical activity, yet little is known about how natural disasters affect them or how these disasters alter physical activity. Our objectives were to (1) describe the development of an instrument to assess park conditions following a hurricane and (2) document the conditions of New Orleans' parks 3 and 6 months after Hurricane Katrina., Methods: A Post-Hurricane Assessment (PHA) instrument was developed and implemented in 54 parks 3 and 6 months post-hurricane., Results: Summary scores of the Park Damage Index and the Neighborhood Damage Index showed improvement between 3 and 6 months of data collection. Parks and neighborhoods most affected by the hurricane were located in the most- and least-affluent areas of the city., Conclusion: The PHA proved to be a promising tool for assessing park conditions in a timely manner following a natural disaster and allowed for the creation of summary damage scores to correlate to community changes.

Objective: The purposes of this study were to describe the types and availability of commercial facilities for physical activity (PA) in six diverse geographic areas (Washington DC and Maryland; South Carolina; Minnesota; Louisiana; Arizona; and California) and to assess the relationship between those facilities and the non-school PA of adolescent girls., Methods: A total of 1556 6th grade girls participating in the Trial of Activity for Adolescent Girls (TAAG) wore accelerometers for 7 days providing 6 days of complete data, completed questionnaires in 2003 and had their residential addresses geocoded. Nearby commercial facilities available to provide PA (i.e. dance studios, youth organizations) within a 1-mile radius of participants' residences were identified and geocoded. The association between the presence of any commercial PA facility and girls' PA was determined using a multi-level design and controlling for demographic characteristics and other potential confounders. Analyses were conducted in 2005-2006., Results: Sixty-eight percent of the girls had at least one commercial PA facility near their homes. Availability and types of commercial PA facilities differed by where participants lived. Girls who lived near one or more commercial PA facilities had higher non-school MET-weighted moderate-to-vigorous PA than girls who had none near their homes., Conclusions: The findings suggest that commercial PA facilities are important contributors to the accumulation of PA among adolescent girls.

Background: Preliminary evidence suggests that the physical environment and transportation are associated with youth physical activity levels. Only a few studies have examined the association of physical environmental factors on walking and bicycling to school. Therefore, the purpose of this study was (1) to examine the test-retest reliability of a survey designed for youth to assess perceptions of physical environmental factors (e.g. safety, aesthetics, facilities near the home) and transportation, and (2) to describe the associations of these perceptions with both physical activity and active transport to school., Methods: Test and retest surveys, administered a median of 12 days later, were conducted with 480 sixth- and eighth-grade girls in or near six U.S. communities. The instrument consisted of 24 questions on safety and aesthetics of the perceived environment and transportation and related facilities. Additionally, girls were asked if they were aware of 14 different recreational facilities offering structured and unstructured activities, and if so, whether they would visit these facilities and the ease with which they could access them. Test-retest reliability was determined using kappa coefficients, overall and separately by grade. Associations with physical activity and active transport to school were examined using mixed model logistic regression (n = 610), adjusting for grade, race/ethnicity, and site., Results: Item-specific reliabilities for questions assessing perceived safety and aesthetics of the neighborhood ranged from 0.31 to 0.52. Reliabilities of items assessing awareness of and interest in going to the 14 recreational facilities ranged from 0.47 to 0.64. Reliabilities of items assessing transportation ranged from 0.34 to 0.58. Some items on girls' perceptions of perceived safety, aesthetics of the environment, facilities, and transportation were important correlates of physical activity and, in some cases, active transport to school., Conclusion: This study provides some psychometric support for the use of the questionnaire on physical environmental factors and transportation for studying physical activity and active transport to school among adolescent girls. Further work can continue to improve reliability of these self-report items and examine their association of these factors with objectively measured physical activity.

Background: The study's purpose is to describe the development and evaluate the reliability (inter-observer agreement) and validity (rater agreement with a gold standard) of a direct observation instrument to assess park characteristics that may be related to physical activity., Methods: A direct observation instrument of 181 items was developed based on a conceptual model consisting of the following domains: features, condition, access, esthetics, and safety. Fifteen pairs of observers were trained and sent to two parks simultaneously to assess two Target Areas each., Results: Overall domain reliability was 86.9%, and overall geographic area reliability was 87.5%. Overall domain validity was 78.7% and overall geographic area validity was 81.5%., Conclusions: Inter-rater reliability and validity were generally good, although validity was slightly lower than reliability. Objective items showed the highest reliability and validity. Items that are time-sensitive may need to be measured on multiple occasions, while items asking for subjective responses may require more supervised practice.

Physical activity levels in girls decline dramatically during adolescence, most profoundly among minorities. To explore ethnic and racial variation in attitudes toward physical activity, semistructured interviews (n = 80) and physical activity checklists (n = 130) are conducted with African American, Hispanic, and Caucasian middle school girls in six locations across the United States. Girls from all groups have similar perceptions of the benefits of physical activity, with staying in shape as the most important. Girls have similar negative perceptions of physical activity, including getting hurt, sweating, aggressive players, and embarrassment. Chores, running or jogging, exercises, and dance are common activities for girls regardless of ethnicity. Basketball, swimming, running, and dance are commonly cited favorite activities, although there are slight differences between ethnic groups. The results suggest that factors other than ethnicity contribute to girls' physical activity preferences and that distinct interventions may not be needed for each ethnic group.

Objective: To describe factors related to reproductive decision-making among HIV-infected women., Materials and Methods: A sample of HIV-infected women (N=104) who received care at an HIV clinic in the southern United States were interviewed about their reproductive decision-making. Women who became pregnant subsequent to HIV diagnosis were compared to women who did not become pregnant, and women who underwent a sterilization procedure subsequent to HIV diagnosis were compared to women who did not get sterilized., Results: Compared to women who did not get pregnant after receiving an HIV diagnosis, women who became pregnant were more likely to be young, single, diagnosed earlier in the epidemic and to have more recently used a noninjecting drug. Among women who did not get pregnant, 63% reported their diagnosis greatly affected that decision. Having a partner who wants more children was not associated with pregnancy. Compared to women who did not get sterilized after learning their HIV status, women who did get sterilized tended to be Baptist and already had a prior live birth. Neither a woman's desire nor her partner's desire for more children was associated with sterilization., Conclusions: HIV is an important influence on HIV-infected women's reproductive choices, regardless of the decision being made. Reproductive counseling by HIV care providers needs to be sensitive to all the issues faced by these women.

Background: Self-efficacy theory proposes that girls who have confidence in their capability to be physically active will perceive fewer barriers to physical activity or be less influenced by them, be more likely to pursue perceived benefits of being physically active, and be more likely to enjoy physical activity. Self-efficacy is theorized also to influence physical activity through self-management strategies (e.g., thoughts, goals, plans, and acts) that support physical activity, but this idea has not been empirically tested., Methods: Confirmatory factor analysis was used to test the factorial validity of a measure of self-management strategies for physical activity. Next, the construct validity of the measure was tested by examining whether self-management strategies mediated the relationship between self-efficacy and self-reported physical activity, independently of several social-cognitive variables (i.e., perceived barriers, outcome expectancy value, and enjoyment), among cross-sectional samples of 6th grade (n=309) and 8th grade (n=296) girls tested between February 14 and March 17, 2002. Data were analyzed in 2004., Results: Consistent with theory, self-efficacy had direct effects on the social-cognitive variables. The primary novel finding is that self-management strategies mediated the association of self-efficacy with physical activity in both samples., Conclusions: The measure of self-management strategies for physical activity yields valid scores among adolescent girls and warrants experimental study as a mediator of the influence of efficacy beliefs on physical activity.

Park-based physical activity is a promising means to satisfy current physical activity requirements. However, there is little research concerning what park environmental and policy characteristics might enhance physical activity levels. This study proposes a conceptual model to guide thinking and suggest hypotheses. This framework describes the relationships between park benefits, park use, and physical activity, and the antecedents/correlates of park use. In this classification scheme, the discussion focuses on park environmental characteristics that could be related to physical activity, including park features, condition, access, aesthetics, safety, and policies. Data for these categories should be collected within specific geographic areas in or around the park, including activity areas, supporting areas, the overall park, and the surrounding neighborhood. Future research should focus on how to operationalize specific measures and methodologies for collecting data, as well as measuring associations between individual physical activity levels and specific park characteristics. Collaboration among many disciplines is needed.

Obesity is a major public health problem in the United States and in Louisiana in particular. The prevalence of both overweight and obesity has increased in the past two decades. National studies and studies conducted in Louisiana in adults and children have shown that overweight and obesity are related to conditions such as hypertension, diabetes, stroke, and insulin resistance syndrome. Obesity tracks over time, with obese children and adolescents being more likely to become obese adults. Numerous intervention models to modify eating and exercise behaviors have been conducted with children in Louisiana and have shown that it is possible to reduce fat and saturated fat intakes and increase the amount of moderate to vigorous daily physical activity. More research is needed, however, in both health education programs and environmental influences if we are to be effective in making the necessary changes in eating and physical activity habits of children, adolescents, and adults to reduce the prevalence of obesity.