Cubbin C, Hadden WC, Winkleby MA. Neighborhood context and cardiovascular disease risk factors: the contribution of material deprivation

Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, California, USA.
Ethnicity & disease (Impact Factor: 0.92). 02/2001; 11(4):687-700.
Source: PubMed

ABSTRACT This paper investigates whether neighborhood material deprivation is associated with cardiovascular disease (CVD) risk factors (physical inactivity, diabetes, smoking, body mass index, blood pressure, cholesterol) independent of individual socioeconomic status (SES) in Black, Mexican-American, and White women and men aged 25-64 using data from the Third National Health and Nutrition Examination Survey (1988-1994, N = 9,961). The data were linked to 1990 Census tract characteristics (unemployment, car ownership, rented housing, crowded housing), which were used to construct a neighborhood-level material deprivation index. Results are stratified by gender and race/ethnicity. Multiple logistic and linear regression models were specified using SUDAAN to account for the clustered design. In general, residence in a deprived neighborhood increased the probability of having an adverse CVD risk profile, independent of an individual's SES. For example, after adjusting for SES, Black women living in deprived neighborhoods were at increased risk of being diabetic, being a smoker, and having a higher body mass index and blood pressure compared to Black women living in less deprived neighborhoods (P values <.05). Stronger associations were found between neighborhood deprivation and CVD risk factors in Blacks than in Mexican Americans despite living in similarly deprived neighborhoods. Neighborhood deprivation may influence CVD risk factors through a variety of mechanisms including the availability of healthy environments, municipal services, and political/cultural characteristics. Policies and interventions that address the socioeconomic context in which people live might reduce inequalities in CVD risk factors.

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    • "Residents of lower income areas have been shown to be more susceptible to conditions such as psychological distress and depression (Hill et al., 2005; Ross, 2000) obesity (Mujahid et al., 2008) and chronic disease (Cubbin et al., 2001; Murray et al., 2010). The mechanisms linking disadvantage to disease are varied and not always well understood; however, lower income groups that are also disproportionately composed of ethno racial minorities, including immigrants, are more likely to live in residentially segregated neighborhoods (Acevedo-Garcia and Lochner, 2003; Massey and Denton, 1998), areas of higher crime and with greater alcohol and fast food outlet density (Block et al., 2004; Cohen et al., 2008; Kwate et al., 2009), as well as areas with less access to municipal services like recreational facilities or walkable sidewalks that may promote health (Cubbin et al., 2001; Holmes and Marcelli, 2011; Lovasi et al., 2009a). "
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    ABSTRACT: We estimate cross-sectional associations of neighborhood-level disorder, socioeconomic characteristics and social capital with individual-level systemic inflammation, measured as high C-reactive protein (CRP), using Boston Metropolitan Immigrant Health & Legal Status Survey (BM-IHLSS) data-a sample of relatively young, healthy foreign-born Brazilian adults. Logistic regression analyses suggest high CRP is positively associated with neighborhood disorder and negatively related to neighborhood social capital. Although we find no significant associations between other neighborhood socioeconomic variables and high CRP; males, those who were born in an urban area and those who had been graduated from high school were less likely to have had high CRP. Unauthorized Brazilian adults, those who smoked cigarettes daily and those who had a higher body mass index were more likely to have had high CRP. Our findings suggest that investigating sociogeographic stressors and social support may be important for understanding physiological dysregulation even among relatively healthy U.S. sub-populations.
    Health & Place 01/2012; 18(3):683-93. DOI:10.1016/j.healthplace.2011.11.006 · 2.44 Impact Factor
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    • "There is also a need to examine the heterogeneous impact of the neighborhood alcohol environment according to gender or sex. While few studies have reported community or neighborhood differences across sexes, a growing body of evidence suggests that neighborhood social and built environments can and do affect men and women differently (Bird & Rieker, 1999; Cubbin, Hadden, & Winkleby, 2000; Do et al., 2007; Macintyre, Hunt, & Sweeting, 1996; Molinari, Ahern, & Hendryx, 1998). Males and females differ in their response to stress (Ross, 2000; Taylor, Repetti, & Seeman, 1997) and are also differently affected by social control processes (Ramirez-Valles, Zimmerman, & Juarez, 2002). "
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    ABSTRACT: Our objective was to examine whether components of the neighborhood alcohol environment-liquor store, on-premise outlet, convenience store, and supermarket densities-are positively associated with at-risk alcohol consumption among African-American drinkers. A multilevel cross-sectional sample of 321 African-American women and men ages 21 to 65 years recruited from April 2002 to May 2003 from three community-based healthcare clinics in New Orleans, Louisiana, was studied. The alcohol environment had a significant impact on at-risk alcohol consumption among African-American drinkers, specifically liquor store density (adjusted OR = 3.11, 95% CI = 1.87, 11.07). Furthermore, the influence of the alcohol environment was much stronger for African-American female drinkers (adjusted OR = 6.96, 95% CI = 1.38, 35.08). Treatment and prevention programs should take into account the physical environment, and the concentration of outlets in minority neighborhoods must be addressed as it poses potential health risks to the residents of these neighborhoods.
    Alcoholism Clinical and Experimental Research 02/2011; 35(5):996-1003. DOI:10.1111/j.1530-0277.2010.01430.x · 3.31 Impact Factor
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    • "Environmental conditions have been extensively explored as contributing factors in promoting health disparities (Lee, 2002; Sexton, 2000). It is widely accepted that racial/ethnic minority neighborhoods are disproportionately affected by increased rates of morbidity, mortality and adverse health outcomes (Cubbin et al., 2001; Deaton and Lubotsky, 2003). These disparities are believed to be associated with factors, including residential segregation, poverty and neighborhood deprivation (Gee and Payne-Sturges, 2004), which can lead to adverse health outcomes. "
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    ABSTRACT: Increasingly, studies are focusing on the role the local food environment plays in residents' ability to purchase affordable, healthy and nutritious foods. In a food desert, an area devoid of a supermarket, access to healthy food is limited. We conducted a systematic review of studies that focused on food access and food desert research in the United States. The 31 studies identified utilized 9 measures to assess food access. Results from these studies can be summarized primarily into four major statements. Findings from other countries offer insight into ways, in which future research, policy development and program implementation in the U.S. may continue to be explored.
    Health & Place 04/2010; 16(5):876-84. DOI:10.1016/j.healthplace.2010.04.013 · 2.44 Impact Factor
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