Neighborhood cohesion is associated with reduced risk of stroke mortality.
ABSTRACT Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence.
Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence.
Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5).
Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.
Article: Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998.[show abstract] [hide abstract]
ABSTRACT: To map out area effects on health research, this study had the following aims: (1) to inventory multilevel investigations of area effects on self rated health, cardiovascular diseases and risk factors, and mortality among adults; (2) to describe and critically discuss methodological approaches employed and results observed; and (3) to formulate selected recommendations for advancing the study of area effects on health. Overall, 86 studies were inventoried. Although several innovative methodological approaches and analytical designs were found, small areas are most often operationalised using administrative and statistical spatial units. Most studies used indicators of area socioeconomic status derived from censuses, and few provided information on the validity and reliability of measures of exposures. A consistent finding was that a significant portion of the variation in health is associated with area context independently of individual characteristics. Area effects on health, although significant in most studies, often depend on the health outcome studied, the measure of area exposure used, and the spatial scale at which associations are examined.Journal of Epidemiology & Community Health 11/2007; 61(10):853-61. · 3.19 Impact Factor
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ABSTRACT: Many young people do not meet recommended levels of participation in physical activity. Neighborhoods may play a role in supporting healthy behavior via social and physical environmental features. We examine whether neighborhood-levels of social cohesion, range of youth services and educational attainment were associated with participation in recreational programs and general physical activity among young people. Hierarchical regression analyses were carried out using data from 680 young people (ages 11-15 years at baseline) participating in the Project on Human Development in Chicago Neighborhoods. The participants' primary caregiver reported recreational program participation at baseline and self-reported general physical activity were assessed at follow-up 2-3 years later. Neighborhood-level characteristics were obtained from census data and via a community survey. Neighborhood social cohesion was inversely associated with participation in recreational programs at baseline, controlling for availability of neighborhood services for youth, neighborhood education status, race/ethnicity, individual-level parental education, overweight status, sex, and age. Residing in an area with greater social cohesion was directly associated with frequency of reported general physical activity, independent of previously reported participation in recreational programs and other neighborhood and individual-level covariates. The present findings suggest that neighborhood social cohesion influences participation in physical activity.Social Science [?] Medicine 12/2008; 68(3):427-35. · 2.70 Impact Factor
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ABSTRACT: : The goal of this study was to investigate cross-sectional associations between features of neighborhoods and hypertension and to examine the sensitivity of results to various methods of estimating neighborhood conditions. : We used data from the Multi-Ethnic Study of Atherosclerosis on 2612 individuals 45-85 years of age. Hypertension was defined as systolic blood pressure above 140 mm Hg, diastolic pressure above 90 mm Hg, or use of antihypertensive medications. Neighborhood (census tract) conditions potentially related to hypertension (walking environment, availability of healthy foods, safety, social cohesion) were measured using information from a separate phone survey conducted in the study neighborhoods. For each neighborhood we estimated scale scores by aggregating residents' responses using simple aggregation (crude means) and empirical Bayes estimation (unconditional, conditional, and spatial). These estimates of neighborhood conditions were linked to each study participant based on the census tract of residence. Two-level binomial regression methods were used to estimate adjusted associations between neighborhood conditions and hypertension. : Residents of neighborhoods with better walkability, availability of healthy foods, greater safety, and more social cohesion were less likely to be hypertensive (relative prevalence [95% confidence interval] for 90th vs. 10th percentile of conditional empirical Bayes estimate = 0.75 [0.64-0.88], 0.72 [0.61-0.85], 0.74 [0.63-0.86], and 0.69 [0.57-0.83]), respectively, after adjusting for site, age, sex, income, and education. Associations were attenuated and often disappeared after additional adjustments for race/ethnicity. : Neighborhood walkability, food availability, safety, and social cohesion may be mechanisms that link neighborhoods to hypertension.Epidemiology (Cambridge, Mass.) 08/2008; 19(4):590-8. · 5.51 Impact Factor