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

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

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

The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women

<p>Abstract</p> <p>Background</p> <p>In the US, foreign-born Hispanics tend to live in socioeconomic conditions typically associated with later stage of breast cancer diagnosis, yet they have lower breast cancer mortality rates than their US-born counterparts. We evaluated the impact of nativity (US- versus foreign-born), neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants) on breast cancer stage at diagnosis and survival among Hispanics.</p> <p>Methods</p> <p>We studied 37,695 Hispanic women diagnosed from 1988 to 2005 with invasive breast cancer from the California Cancer Registry. Nativity was based on registry data or, if missing, imputed from case Social Security number. Neighborhood variables were developed from Census data. Stage at diagnosis was analyzed with logistic regression, and survival, based on vital status determined through 2007, was analyzed with Cox proportional hazards regression.</p> <p>Results</p> <p>Compared to US-born Hispanics, foreign-born Hispanics were more likely to be diagnosed at an advanced stage of breast cancer (adjusted odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.09-1.20), but they had a somewhat lower risk of breast cancer specific death (adjusted hazard ratio (HR) = 0.94, 95% CI: 0.90-0.99). Living in low SES and high enclave neighborhoods was associated with advanced stage of diagnosis, while living in a lower SES neighborhood, but not Hispanic enclave, was associated with worse survival.</p> <p>Conclusion</p> <p>Identifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.</p

Are immigrant enclaves healthy places to live? The Multi-ethnic Study

The growing size and changing composition of the foreign-born population in the USA highlights the importance of examining the health consequences of living in neighborhoods with higher proportions of immigrants. Using data from the Multi-ethnic Study of Atherosclerosis in four US cities, we examined whether neighborhood immigrant composition was associated with health behaviors (diet, physical activity) among Hispanic and Chinese Americans (n ¼ 1902). Secondarily we tested whether neighborhoods with high proportions of immigrants exhibited better or worse neighborhood quality, and whether these dimensions of neighborhood quality were associated with healthy behaviors. Neighborhood immigrant composition was defined based on the Census 2000 tract percent of foreign-born from Latin-America, and separately, percent foreign-born from China. After adjustment for age, gender, income, education, neighborhood poverty, and acculturation, living in a tract with a higher proportion of immigrants was associated with lower consumption of high-fat foods among Hispanics and Chinese, but with being less physically active among Hispanics. Residents in neighborhoods with higher proportions of immigrants reported better healthy food availability, but also worse walkability, fewer recreational exercise resources, worse safety, lower social cohesion, and lower neighborhood-based civic engagement. Associations of neighborhood immigrant composition with diet persisted after adjustment for reported neighborhood characteristics, and associations with physical activity were attenuated. Respondent-reported neighborhood healthy food availability, walkability, availability of exercise facilities and civic participation remained associated with behaviors after adjusting for immigrant composition and other covariates. Results show that living in an immigrant enclave is not monolithically beneficial and may have different associations with different health behaviors.supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with MESA investigators. MESA is supported by contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute. This work was supported in part by R01 HL071759 and P60 MD002249 (Dr Diez Roux). Funding for this analysis for Drs. Osypuk and Hadley was provided by the Robert Wood Johnson Foundation Health and Society Scholar program at University of Michigan.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63444/1/Osypuk_2009_SocialScienceandMedicine.pd