Neighborhood environment and metabolic risk in Hispanics/Latinos from the Hispanic community health study/study of Latinos

Introduction This study examines the associations of neighborhood environments with BMI, HbA1c, and diabetes across 6 years in Hispanic/Latino adults. Methods Participants from the Hispanic Community Health Study/Study of Latinos San Diego site (n=3,851, mean age=39.4 years, 53.3% women, 94.0% Mexican heritage) underwent assessment of metabolic risk factors and diabetes status (categorized as normoglycemia, prediabetes, and diabetes) at baseline (2008–2011) and approximately 6 years later (2014–2017). In the Study of Latinos Community and Surrounding Areas Study ancillary study (2015–2020), participant baseline addresses were geocoded, and neighborhoods were defined using 800-meter circular buffers. Neighborhood variables representing socioeconomic deprivation, residential stability, social disorder, walkability, and greenness were created using Census and other public databases. Analyses were conducted in 2020–2021. Results Complex survey regression analyses revealed that greater neighborhood socioeconomic deprivation was associated with higher BMI (β=0.14, p<0.001) and HbA1c (β=0.08, p<0.01) levels and a higher odds of worse diabetes status (i.e., having prediabetes versus normoglycemia and having diabetes versus prediabetes; OR=1.25, 95% CI=1.06, 1.47) at baseline. Greater baseline neighborhood deprivation also was related to increasing BMI (β=0.05, p<0.01) and worsening diabetes (OR=1.27, 95% CI=1.10, 1.46) statuses, whereas social disorder was related to increasing BMI levels (β=0.05, p<0.05) at Visit 2. There were no associations of expected protective factors of walkability, greenness, or residential stability. Conclusions Neighborhood deprivation and disorder were related to worse metabolic health in San Diego Hispanic/Latino adults of mostly Mexican heritage. Multilevel interventions emphasizing individual and structural determinants may be most effective in improving metabolic health among Hispanic/Latino individuals

Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos

Abstract Background The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods HCHS/SOL participants were age 18–74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). Results Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. Conclusion Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease

Cumulative effects of bullying and racial discrimination on adolescent health in Australia

This study examined how cumulative exposure to racial discrimination and bullying victimization influences the health of Australian adolescents (n=2802) aged 10-11 years (19.3% visible ethnic minorities (non-White, non-Indigenous); 2.6% Indigenous) using data from 3 waves (2010-2014) of the nationally representative Longitudinal Study of Australian Children (LSAC). Cumulative exposure to racial discrimination and bullying victimization had incremental negative effects on socioemotional difficulties. Higher accumulated exposure to both stressors across time was associated with increased BMI z-scores, and risk of overweight/obesity. Studies that examine exposure to single risk factors such as bullying victimization or racial discrimination at 1 time point only are likely to miss key determinants of health for adolescents from stigmatized racial/ethnic backgrounds and under-estimate their stressor burden

Understanding individual health-related social needs in the context of area-level social determinants of health: The case for granularity

Abstract Introduction: Screening for health-related social needs (HRSNs) within health systems is a widely accepted recommendation, however challenging to implement. Aggregate area-level metrics of social determinants of health (SDoH) are easily accessible and have been used as proxies in the interim. However, gaps remain in our understanding of the relationships between these measurement methodologies. This study assesses the relationships between three area-level SDoH measures, Area Deprivation Index (ADI), Social Deprivation Index (SDI) and Social Vulnerability Index (SVI), and individual HRSNs among patients within one large urban health system. Methods: Patients screened for HRSNs between 2018 and 2019 (N = 45,312) were included in the analysis. Multivariable logistic regression models assessed the association between area-level SDoH scores and individual HRSNs. Bivariate choropleth maps displayed the intersection of area-level SDoH and individual HRSNs, and the sensitivity, specificity, and positive and negative predictive values of the three area-level metrics were assessed in relation to individual HRSNs. Results: The SDI and SVI were significantly associated with HRSNs in areas with high SDoH scores, with strong specificity and positive predictive values (∼83% and ∼78%) but poor sensitivity and negative predictive values (∼54% and 62%). The strength of these associations and predictive values was poor in areas with low SDoH scores. Conclusions: While limitations exist in utilizing area-level SDoH metrics as proxies for individual social risk, understanding where and how these data can be useful in combination is critical both for meeting the immediate needs of individuals and for strengthening the advocacy platform needed for resource allocation across communities

Advancing social care integration in health systems with community health workers: an implementation evaluation based in Bronx, New York

Abstract Background In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system’s 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY. Methods We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023. Results There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3–39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2–26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR$134.72 – $202.12). Conclusions We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams