Individual and neighborhood-level socioeconomic characteristics in relation to smoking prevalence among black and white adults in the Southeastern United States: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Low individual-level socioeconomic status (SES) is associated with higher prevalence of cigarette smoking. Recent work has examined whether neighborhood-level SES may affect smoking behavior independently from individual-level measures. However, few comparisons of neighborhood-level effects on smoking by race and gender are available.</p> <p>Methods</p> <p>Cross-sectional data from adults age 40-79 enrolled in the Southern Community Cohort Study from 2002-2009 (19, 561 black males; 27, 412 black females; 6, 231 white males; 11, 756 white females) were used in Robust Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CI) for current smoking in relation to individual-level SES characteristics obtained via interview and neighborhood-level SES characteristics represented by demographic measures from US Census block groups matched to participant home addresses.</p> <p>Results</p> <p>Several neighborhood-level SES characteristics were modestly associated with increased smoking after adjustment for individual-level factors including lower percentage of adults with a college education and lower percentage of owner-occupied households among blacks but not whites; lower percentage of households with interest, dividends, or net rental income among white males; and lower percentage of employed adults among black females.</p> <p>Conclusions</p> <p>Lower neighborhood-level SES is associated with increased smoking suggesting that cessation programs may benefit from targeting higher-risk neighborhoods as well as individuals.</p

A multi-stage approach to maximizing geocoding success in a large population-based cohort study through automated and interactive processes

To enable spatial analyses within a large, prospective cohort study of nearly 86,000 adults enrolled in a 12-state area in the southeastern United States of America from 2002-2009, a multi-stage geocoding protocol was developed to efficiently maximize the proportion of participants assigned an address level geographic coordinate. Addresses were parsed, cleaned and standardized before applying a combination of automated and interactive geocoding tools. Our full protocol increased the non-Post Office (PO) Box match rate from 74.5% to 97.6%. Overall, we geocoded 99.96% of participant addresses, with only 5.2% at the ZIP code centroid level (2.8% PO Box and 2.3% non-PO Box addresses). One key to reducing the need for interactive geocoding was the use of multiple base maps. Still, addresses in areas with population density 920 persons/km2 (odds ratio (OR) = 5.24; 95% confidence interval (CI) = 4.23, 6.49), as were addresses collected from participants during in-person interviews compared with mailed questionnaires (OR = 1.83; 95% CI = 1.59, 2.11). This study demonstrates that population density and address ascertainment method can influence automated geocoding results and that high success in address level geocoding is achievable for large-scale studies covering wide geographical area

Suicides, homicides, accidents, and other external causes of death among blacks and whites in the Southern Community Cohort Study.

Prior studies of risk factors associated with external causes of death have been limited in the number of covariates investigated and external causes examined. Herein, associations between numerous demographic, lifestyle, and health-related factors and the major causes of external mortality, such as suicide, homicide, and accident, were assessed prospectively among 73,422 black and white participants in the Southern Community Cohort Study (SCCS). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated in multivariate regression analyses using the Cox proportional hazards model. Men compared with women (HR = 2.32; 95% CI: 1.87-2.89), current smokers (HR = 1.74; 95% CI: 1.40-2.17), and unemployed/never employed participants at the time of enrollment (HR = 1.67; 95% CI 1.38-2.02) had increased risk of dying from all external causes, with similarly elevated HRs for suicide, homicide, and accidental death among both blacks and whites. Blacks compared with whites had lower risk of accidental death (HR = 0.46; 95% CI: 0.38-0.57) and suicide (HR = 0.55; 95% CI: 0.31-0.99). Blacks and whites in the SCCS had comparable risks of homicide death (HR = 1.05; 95% CI: 0.63-1.76); however, whites in the SCCS had unusually high homicide rates compared with all whites who were resident in the 12 SCCS states, while black SCCS participants had homicide rates similar to those of all blacks residing in the SCCS states. Depression was the strongest risk factor for suicide, while being married was protective against death from homicide in both races. Being overweight/obese at enrollment was associated with reduced risks in all external causes of death, and the number of comorbid conditions was a risk factor for iatrogenic deaths. Most risk factors identified in earlier studies of external causes of death were confirmed in the SCCS cohort, in spite of the low SES of SCCS participants. Results from other epidemiologic cohorts are needed to confirm the novel findings identified in this study

Rate ratios for external causes of death among the population age 40 and over in the 12 SCCS states, and in the SCCS population, by race and sex.

<p><b>Abbreviations</b>: CI, Confidence Interval; ICD, International Classification of Diseases; SMR, Standardized Mortality Ratio; SCCS, Southern Community Cohort Study</p><p>Panel A: Ratio of the directly standardized rate in the 12 SCCS states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia) to the directly standardized rate in the remaining 38 states.</p><p>Panel B: Standardized mortality ratio of SCCS population relative to mortality rates in the 12 SCCS states.</p><p>Rate ratios for external causes of death among the population age 40 and over in the 12 SCCS states, and in the SCCS population, by race and sex.</p

Distribution of demographic, lifestyle, and health-related variables for Southern Community Cohort Study participants by race and sex.

<p><b>Abbreviations</b>: CHC, Community Health Center; GP, General Population; ICD, International Classification of Diseases; SD, Standard deviation.</p>a<p>Response to question, “Has a doctor ever told you that you have depression or have you been treated for depression?”</p>b<p>Response to question, “How much is religion, faith, or God a source of strength and comfort to you?”</p><p>Distribution of demographic, lifestyle, and health-related variables for Southern Community Cohort Study participants by race and sex.</p

Hazard ratios for risk of death by specific causes corresponding to demographic, health-related, and lifestyle variables in the Southern Community Cohort Study.

<p><b>Abbreviations:</b> CI, Confidence Interval; CHC, Community Health Center; GP, General Population; HR, Hazard Ratio; ICD, International Classification of Diseases.</p>a<p>Hazard Ratios adjusted for age (as time-scale), race, sex, enrollment source, alcohol use, depression, smoking, income, education, marital status, employment status, BMI, height, comorbidity index, faith comfort.</p>b<p>Response to question, “Has a doctor ever told you that you have depression or have you been treated for depression?”</p>c<p>Hazard ratio is undefined – no deaths from homicide in the general population enrollees.</p>d<p>Response to question, “How much is religion, faith, or God a source of strength and comfort to you?”</p><p>Hazard ratios for risk of death by specific causes corresponding to demographic, health-related, and lifestyle variables in the Southern Community Cohort Study.</p

Healthy Eating and Risks of Total and Cause-Specific Death among Low-Income Populations of African-Americans and Other Adults in the Southeastern United States: A Prospective Cohort Study

Background: A healthy diet, as defined by the US Dietary Guidelines for Americans (DGA), has been associated with lower morbidity and mortality from major chronic diseases in studies conducted in predominantly non-Hispanic white individuals. It is unknown whether this association can be extrapolated to African-Americans and low-income populations. Methods and Findings: We examined the associations of adherence to the DGA with total and cause-specific mortality in the Southern Community Cohort Study, a prospective study that recruited 84,735 American adults, aged 40–79 y, from 12 southeastern US states during 2002–2009, mostly through community health centers that serve low-income populations. The present analysis included 50,434 African-Americans, 24,054 white individuals, and 3,084 individuals of other racial/ethnic groups, among whom 42,759 participants had an annual household income less than US$15,000. Usual dietary intakes were assessed using a validated food frequency questionnaire at baseline. Adherence to the DGA was measured by the Healthy Eating Index (HEI), 2010 and 2005 editions (HEI-2010 and HEI-2005, respectively). During a mean follow-up of 6.2 y, 6,906 deaths were identified, including 2,244 from cardiovascular disease, 1,794 from cancer, and 2,550 from other diseases. A higher HEI-2010 score was associated with lower risks of disease death, with adjusted hazard ratios (HRs) of 0.80 (95% CI, 0.73–0.86) for all-disease mortality, 0.81 (95% CI, 0.70–0.94) for cardiovascular disease mortality, 0.81 (95% CI, 0.69–0.95) for cancer mortality, and 0.77 (95% CI, 0.67–0.88) for other disease mortality, when comparing the highest quintile with the lowest (all p-values for trend 0.50). Several component scores in the HEI-2010, including whole grains, dairy, seafood and plant proteins, and ratio of unsaturated to saturated fatty acids, showed significant inverse associations with total mortality. HEI-2005 score was also associated with lower disease mortality, with a HR of 0.86 (95% CI, 0.79–0.93) when comparing extreme quintiles. Given the observational study design, however, residual confounding cannot be completely ruled out. In addition, future studies are needed to evaluate the generalizability of these findings to African-Americans of other socioeconomic status. Conclusions: Our results showed, to our knowledge for the first time, that adherence to the DGA was associated with lower total and cause-specific mortality in a low-income population, including a large proportion of African-Americans, living in the southeastern US