Children Left Behind: How Metropolitan Areas Are Failing America's Children

Presents findings from the Diversity Data project, an online resource measuring social indicators of quality of life in U.S. metropolitan areas. Focuses on racial and ethnic disparities with a particular emphasis on children and their well-being

Direct and Proxy Recall of Childhood Socio‐Economic Position and Health

Background The utility of proxy reporting within the life course framework has not been adequately assessed; therefore we sought to assess the magnitude and type of agreement that exists between index and proxy reports for bodyweight, health, and socio‐economic position ( SEP ) in childhood. Methods Participants were enrolled as part of an ongoing study of preterm birth in African American women in M etro D etroit. Post‐partum women and their mothers ( n  = 333 pairs) provided retrospective reports about the woman's childhood bodyweight, health, and SEP . Agreement was assessed using kappa, weighted kappa (κ), and intraclass correlation coefficients ( ICC ). Log‐linear models were used to describe the pattern of agreement for ordinal data. Results Birthweight and weight at age 18 was reported with a high level of agreement ( ICC  = 0.86 and 0.71, respectively). Kappa indicated moderate agreement for early and late childhood/adolescent weight. Log‐linear models suggested that there was diagonal agreement plus linear by linear association for early childhood weight and linear by linear association in late childhood/adolescence. Reports of childhood medical problems and hospitalisations had only moderate agreement. Agreement for SEP in both early (κ = 0.14) and late childhood/adolescence (κ = 0.20) was poor. Log‐linear models suggest a linear by linear association, indicating a positive association between the responses. Conclusions Results suggest that proxy reports may be utilised in conjunction with an index report to provide an estimate of the accuracy of report or to more fully capture experiences over the life course. This may be particularly useful when multiple developmental periods are examined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97462/1/ppe12045.pd

Assets and Unmet Needs of Diverse Older Adults: Perspectives of community-based service providers in Minnesota

This paper examines assets and unmet needs of diverse older adults and highlights the need for programs and policies that address the social determinants of health. The United States is undergoing an unprecedented demographic shift, becoming increasingly diverse and aging rapidly. Given these changing demographics, it is important to understand the strengths and needs of our diverse population of older adults. This study captures perspectives of diverse service providers who work with older adults in communities, to identify existing assets as well as unmet needs and challenges facing diverse older adults in Minnesota. Qualitative data were collected using key informant interviews with community-based service providers (N=15) as part of a year-long engagement project. Participants were purposively selected to represent African American, East African, American Indian, Southeast Asian, Latino, and lesbian, gay, bisexual, and transgender (LGBT) communities. Interviews were recorded, transcribed verbatim, and analyzed using Braun and Clarke’s approach to thematic analysis. Results indicate a number of assets supporting Minnesota’s diverse older adults. Assets of cultural communities include culturally specific services, faith communities, and close-knit families. Assets of older adults include their cultural and historical knowledge, wisdom, experience, and resilience. Despite the many assets supporting diverse older adults, results indicate seven primary categories of unmet needs: (1) health (2) healthcare, (3) transportation, (4) housing, (5) education, (6) social support, and (7) financial security. All unmet needs sub-themes address health or social determinants of health, indicating the need for a broad range of policies and programs. As the U.S. population grows increasingly older and more diverse, it is critical that these unmet needs are addressed to ensure equity for aging well

Immigrant assimilation and BMI and waist size: A longitudinal examination among hispanic and chinese participants in the multi‐ethnic study of atherosclerosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99611/1/oby20104.pd

Life-Course Individual and Neighborhood Socioeconomic Status and Risk of Dementia in the Atherosclerosis Risk in Communities Neurocognitive Study

We examined associations of individual-and neighborhood-level life-course (LC) socioeconomic status (SES) with incident dementia in the Atherosclerosis Risk in Communities cohort. Individual-and neighborhood-level SES were assessed at 3 life epochs (childhood, young adulthood, midlife) via questionnaire (2001-2002) and summarized into LC-SES scores. Dementia was ascertained through 2013 using cognitive exams, telephone interviews, and hospital and death certificate codes. Cox regression was used to estimate hazard ratios of dementia by LC-SES scores in race-specific models. The analyses included data from 12,599 participants (25% Black) in the United States, with a mean age of 54 years and median follow-up of 24 years. Each standard-deviation greater individual LC-SES score was associated with a 14% (hazard ratio (HR) = 0.86, 95% confidence interval (CI): 0.81, 0.92) lower risk of dementia in White and 21% (HR = 0.79, 95% CI: 0.71, 0.87) lower risk in Black participants. Education was removed from the individual LC-SES score and adjusted for separately to assess economic factors of LC-SES. A standard-deviation greater individual LC-SES score, without education, was associated with a 10% (HR = 0.90, 95% CI: 0.84, 0.97) lower dementia risk in White and 15% (HR = 0.85, 95% CI: 0.76, 0.96) lower risk in Black participants. Neighborhood LC-SES was not associated with dementia. We found that individual LC-SES is a risk factor for dementia, whereas neighborhood LC-SES was not associated

Neighborhood Ethnic Composition, Spatial Assimilation, and Change in Body Mass Index Over Time Among Hispanic and Chinese Immigrants: Multi-Ethnic Study of Atherosclerosis

Objectives. We investigated relations between changes in neighborhood ethnic composition and changes in body mass index (BMI) and waist circumference among Chinese and Hispanic immigrants in the United States

Is neighborhood racial/ethnic composition associated with depressive symptoms? The multi-ethnic study of atherosclerosis.

The racial/ethnic composition of a neighborhood may be related to residents' depressive symptoms through differential levels of neighborhood social support and/or stressors. We used the Multi-Ethnic Study of Atherosclerosis to investigate cross-sectional associations of neighborhood racial/ethnic composition with the Center for Epidemiologic Studies-Depression (CES-D) scale in adults aged 45-84. The key exposure was a census-derived measure of the percentage of residents of the same racial/ethnic background in each participant's census tract. Two-level multilevel models were used to estimate associations of neighborhood racial/ethnic composition with CES-D scores after controlling for age, income, marital status, education and nativity. We found that living in a neighborhood with a higher percentage of residents of the same race/ethnicity was associated with increased CES-D scores in African American men (p < 0.05), and decreased CES-D scores in Hispanic men and women and Chinese women, although these differences were not statistically significant. Models were further adjusted for neighborhood-level covariates (social cohesion, safety, problems, aesthetic quality and socioeconomic factors) derived from survey responses and census data. Adjusting for other neighborhood characteristics strengthened protective associations amongst Hispanics, but did not change the significant associations in African American men. These results demonstrate heterogeneity in the associations of race/ethnic composition with mental health and the need for further exploration of which aspects of neighborhood environments may contribute to these associations.http://deepblue.lib.umich.edu/bitstream/2027.42/78333/1/MairDiezRoux2010_SocSciMedicine.pd

Neighborhood health‐promoting resources and obesity risk (the multi‐ethnic study of atherosclerosis)

Objective: While behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence. Design and Methods: Data came from 4,008 adults aged 45‐84 at baseline who participated in a neighborhood ancillary study of the Multi‐Ethnic Study of Atherosclerosis. Participants were enrolled at six study sites at baseline (2000‐2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a 1‐mile buffer area. Obesity was defined as BMI ≥ 30 kg/m 2 . Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression. Results: Among 4,008 nonobese participants, 406 new obesity cases occurred during 5 years of follow‐up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per s.d. increase in neighborhood score. The association persisted after adjustment for baseline BMI and individual‐level covariates (hazard ratio (HR) 0.88, 95% confidence interval (CI): 0.79, 0.97), and for correlated features of the walking environment but CIs widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI: 0.84, 1.15). Conclusions: Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97459/1/20255_ftp.pd

Change in waist circumference with longer time in the United States among Hispanic and Chinese immigrants: the modifying role of the neighborhood built environment

We examined whether living in neighborhoods supportive of healthier diets and more active lifestyles may buffer immigrants against the unhealthy weight gain that is purported to occur with longer length of US residence

Socioeconomic Variation in the Prevalence, Introduction, Retention, and Removal of Smoke-Free Policies among Smokers: Findings from the International Tobacco Control (ITC) Four Country Survey

Introduction: Exposure to secondhand smoke causes premature death and disease in non-smokers and indoor smoke-free policies have become increasingly prevalent worldwide. Although socioeconomic disparities have been documented in tobacco use and cessation, the association between socioeconomic status (SES) and smoke-free policies is less well studied. Methods: Data were obtained from the 2006 and 2007 Waves of the International Tobacco Control Four Country Survey (ITC-4), a prospective study of nationally representative samples of smokers in Canada, the United States, the United Kingdom, and Australia. Telephone interviews were administered to 8,245 current and former adult smokers from October 2006 to February 2007. Between September 2007 and February 2008, 5,866 respondents were re-interviewed. Self-reported education and annual household income were used to create SES tertiles. Outcomes included the presence, introduction, and removal of smoke-free policies in homes, worksites, bars, and restaurants. Results: Smokers with high SES had increased odds of both having [OR: 1.54, 95% CI: 1.27–2.87] and introducing [OR: 1.49, 95% CI: 1.04–2.13] a total ban on smoking in the home compared to low SES smokers. Continuing smokers with high SES also had decreased odds of removing a total ban [OR: 0.44, 95% CI: 0.26–0.73]. No consistent association was observed between SES and the presence or introduction of bans in worksites, bars, or restaurants. Conclusions: The presence, introduction, and retention of smoke-free homes increases with increasing SES, but no consistent socioeconomic variation exists in the presence or introduction of total smoking bans in worksites, bars, or restaurants. Opportunities exist to reduce SES disparities in smoke-free homes, while the lack of socioeconomic differences in public workplace, bar, and restaurant smoke-free policies suggest these measures are now equitably distributed in these four countries