Associations between neighbourhood characteristics and depression: a twin study.

BACKGROUND: Depression is an important contributor to the global burden of disease. Besides several known individual-level factors that contribute to depression, there is a growing recognition that neighbourhood environment can also profoundly affect mental health. This study assessed associations between three neighbourhood constructs-socioeconomic deprivation, residential instability and income inequality-and depression among adult twin pairs. The twin design is used to examine the association between neighbourhood constructs and depression, controlling for selection factors (ie, genetic and shared environmental factors) that have confounded purported associations. METHODS: We used multilevel random-intercept Poisson regression among 3738 same-sex twin pairs from a community-based twin registry to examine the association between neighbourhood constructs and depression. The within-pair association controls for confounding by genetic and environmental factors shared between twins within a pair, and is the main parameter of interest. Models were adjusted for individual-level income, education and marital status, and further by neighbourhood-level population density. RESULTS: When twins were analysed as individuals (phenotypic model), all neighbourhood constructs were significantly associated with depression. However, only neighbourhood socioeconomic deprivation showed a significant within-pair association with depression. A 10-unit within-pair difference in neighbourhood socioeconomic deprivation was associated with 6% greater depressive symptoms (1.06, 95% CI 1.01 to 1.11); the association did not substantially change in adjusted models. CONCLUSION: This study provides new evidence linking neighbourhood socioeconomic deprivation with greater depression. Future studies should employ longitudinal designs to better test social causation versus social selection

Bioavailable insulin-like growth factor-I as mediator of racial disparity in obesity-relevant breast and colorectal cancer risk among postmenopausal women

Bioavailable insulin-like growth factor (IGF)-I interacts with obesity and exogenous estrogen in a racial disparity in obesity-related cancer risk, yet their interconnected pathways are not fully characterized. We investigated whether circulating bioavailable IGF-I acted as a mediator of the racial disparity in obesity-related cancers such as breast and colorectal (CR) cancers and how obesity and estrogen use regulate this relationship

Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities

Health inequities inhibit global development and achievement of the Sustainable Development Goals. One gendered health area, Menstrual Health & Hygiene (MHH), has received increasing attention in Low- and Middle-Income Countries as a barrier to health, wellbeing, and gender equity. Recent anecdotal evidence in Australia highlights that MHH also present challenges to High Income Countries, particularly among underrepresented populations, such as Indigenous Australian peoples, people from low socio-economic backgrounds, or communities that are remotely located. In this article, we chart the emergence of attention to MHH in the Australian context and highlight key considerations for the conduct of research with Aboriginal and Torres Strait Islander Peoples within the culturally- and gender-sensitive area of MHH. Further we draw on insights offered by a partnership between female Aboriginal and Torres Strait Islander leaders, NGO stakeholders, and non-Indigenous researchers. Through a convening (yarning circle) held in March 2018, the group identified multiple socioecological considerations for MHH research and practice, including: affordability and access to menstrual products, barriers to knowledge and culturally sensitive education, infrastructure and supply chain challenges, and the necessity of Indigenous-led research and community-driven data collection methods in addressing the sensitive topic. We draw together these insights to develop recommendations for future research, advocacy, and action in Australia

Neighborhood environment, stress, and obesogenic behaviors among adults

Thesis (Ph.D.)--University of Washington, 2012Background: Socio-ecologic models convey a conceptualization of how levels of environment surrounding individuals impact health behaviors and subsequent health outcomes. Neighborhood context, defined as area-level social or physical systems or structures, has been recognized as an important social determinant of many health outcomes across the lifespan. The overall goal of this dissertation was to evaluate the effects of worksite and home neighborhood contexts on biobehavioral pathways associated with stress. In particular, this dissertation evaluates whether workplace neighborhood context contributed to obesity-related behaviors, as most research to date has been in relation to the home neighborhood. It also examines how neighborhood contexts of the home and workplace influence levels of stress, a hypothesized pathway for the embodiment of contextual effectson chronic disease processes. Methods: Chapters 1 and 2 used Promoting Changes in Activity and Eating (PACE) data, which included approximately 2400 individuals at follow-up within randomly selected smaller worksites in Seattle, to evaluate associations. Chapter 3 evaluated associations among 510 non-Hispanic white women in Seattle who represented a broad range of individual and neighborhood-level socioeconomic status (SES). Chapter 4 evaluated associations among 541 older professional white men and women within the British civil service. To evaluate neighborhood and individual-level associations, all analyses used models that accounted for multiple sources of variance (i.e. random effects models, generalized estimating equations (GEE)) and included relevant covariates. Results: We found in chapter 1 that higher worksite-level SES was significantly associated with more walking for at least 10 minutes in the previous week among employees. Built environment attributes were also significantly and independently associated with obesity-related behaviors. Specifically, higher residential density around the worksite was significantly associated with walking and eating 5 or more servings of fruits and vegetables, independent of worksite-level SES. More food and activity destinations as well as more intersections around the worksite were also significantly associated with more walking before accounting for worksite-level SES. We also found that higher residential density mediated the association of higher worksite-level SES with eating 5 or more servings of fruit and vegetables and with walking. Chapter 2 evaluated associations between social and built environment attributes surrounding worksites, perceived global and work-related stress, and C-Reactive Protein (CRP), a biomarker of inflammation that is associated with stress. We concluded that worksite context was not significantly associated with perceived stress or CRP in these data. Worksite contextual variables were associated with work demands and worker social support, however, and these relationships varied by gender. Specifically, work demands varied significantly by both worksite-level SES and surrounding residential density among men. White-collar worksite class was also associated with fewer work demands and greater social support. Among women, a significant linear trend between higher residential density and greater work demands was demonstrated. Worker social support also varied significantly by residential density. Chapter 3 evaluated associations between home neighborhood SES and general perceptions of stress and found relationships which depended on individual-level SES. Specifically, measures of higher neighborhood SES were associated with lower stress among lower educated women whereas the opposite was suggested for higher educated women. Similar relationships were suggested when using family income as a measure of individual-level SES, albeit not as consistent. Strong associations between perceived neighborhood characteristics and stress were exhibited for all women. Specifically, greater neighborhood problems and dissatisfaction as well as lower perceived walkability were all highly significantly associated with greater stress. Chapter 4 evaluated associations between home neighborhood SES (i.e. income and employment deprivation), perceived neighborhood characteristics (i.e. social control, neighborhood threat, fear of crime), and stress reactivity (i.e. cortisol). Income and employment deprivation were significantly associated with lower social control, higher neighborhood threat and greater fear of crime after accounting for individual demographic characteristics. Fully adjusted models also indicated that higher levels of socioeconomic deprivation were associated with cortisol non-response, an indicator of a "blunted" cortisol profile which has been associated with chronic disease risk. Perceived neighborhood characteristics were also significantly associated with cortisol non-response independent of individual-level demographic covariates. Mediation analyses indicated that the association between neighborhood SES and cortisol non-response was partially mediated by social control and neighborhood threat. Conclusion: These studies contribute to the collective understanding of how environments may impact health behaviors and subsequent risk of disease among adults through the stress process. Importantly, findings indicate that multiple neighborhood contexts may be salient to biobehavioral processes associated with stress. Perceived measures of the neighborhood are important determinants of stress which not only work independently, but also mediate relationships between neighborhood-level SES and the stress process. These more modifiable factors may provide targets for addressing neighborhood disparities in health associated with stress

Worksite neighborhood and obesogenic behaviors: findings among employees in the Promoting Activity and Changes in Eating (PACE) trial

Understanding mechanisms linking neighborhood context to health behaviors may provide targets for increasing lifestyle intervention effectiveness. Although associations between home neighborhood and obesogenic behaviors have been studied, less is known about the role of worksite neighborhood. To evaluate associations between worksite neighborhood context at baseline (2006) and change in obesogenic behaviors of adult employees at follow-up (2007-2009) in a worksite randomized trial to prevent weight gain. Worksite property values were used as an indicator of worksite neighborhood SES (NSES). Worksite neighborhood built environment attributes associated with walkability were evaluated as explanatory factors in relationships among worksite NSES, diet, and physical activity behaviors of employees. Behavioral data were collected at baseline (2005-2007) and follow-up (2007-2009). Multilevel linear and logistic models were constructed adjusting for covariates and accounting for clustering within worksites. Product-of-coefficients methods were used to assess mediation. Analyses were performed after study completion (2011-2012). Higher worksite NSES was associated with more walking (OR=1.16, 95% CI=1.03, 1.30, p=0.01). Higher density of residential units surrounding worksites was associated with more walking and eating five or more daily servings of fruits and vegetables, independent of worksite NSES. Residential density partially explained relationships among worksite NSES, fruit and vegetable consumption, and walking. Worksite neighborhood context may influence employees' obesogenic behaviors. Furthermore, residential density around worksites could be an indicator of access to dietary and physical activity-related infrastructure in urban areas. This may be important given the popularity of worksites as venues for obesity prevention efforts

Environmental and Individual Predictors of Healthy Dietary Behaviors in a Sample of Middle Aged Hispanic and Caucasian Women

The objective of this effort is to gather data to tailor interventions appropriately. Greater understanding of the correlates of socioeconomic status and obesogenic dietary behaviors was the focus of this manuscript. Using multistage sampling, women with varied education levels completed a baseline assessment in a longitudinal study of women aged 30 to 50 years. This study was conducted in low-SES areas of South King County, Washington State. This study included 530 Caucasian and 510 Hispanic women. Fruit and vegetable consumption was positively associated and soft drink consumption inversely associated with the level of education in Caucasian women. In contrast, percentage calories from fat was positively associated with the level of education in Hispanic women. In Hispanic women, level of education interacted significantly with food security in relation to percentage calories from fat, and with eating norms in relation to soft drink consumption. Neighborhood presence of ethnic food stores was associated with outcomes for Hispanic women, but for Caucasians, presence of fast food restaurants was important. Education was consistently associated with two of the three obesogenic dietary behaviors studied among Caucasian women. Education played a moderating role in the associations of food security and eating norms, independent of area level food availability, in two of three obesogenic dietary behaviors studied. However, these patterns differed for Hispanic women, indicating the need for more research into important variables to support change in Hispanic women. Women of differing ethnic groups did not respond similarly to environmental conditions and policy-relevant surroundings. These data have meaning for considering urban policy that impacts obesity levels in the population

Bioavailable insulin-like growth factor-I as mediator of racial disparity in obesity-relevant breast and colorectal cancer risk among postmenopausal women

ObjectiveBioavailable insulin-like growth factor-I (IGF-I) interacts with obesity and exogenous estrogen (E) in a racial disparity in obesity-related cancer risk, yet their interconnected pathways are not fully characterized. We investigated whether circulating bioavailable IGF-I acted as a mediator of the racial disparity in obesity-related cancers such as breast and colorectal (CR) cancers and how obesity and E use regulate this relationship.MethodsA total of 2,425 white and 164 African American (AA) postmenopausal women from the Women's Health Initiative Observational Study were followed from October 1, 1993 through August 29, 2014. To assess bioactive IGF-I as a mediator of race-cancer relationship, we used the Baron-Kenny method and quantitative estimation of the mediation effect.ResultsCompared with white women, AA women had higher IGF-I levels; their higher risk of CR cancer, after accounting for IGF-I, was no longer significant. IGF-I was associated with breast and CR cancers even after controlling for race. Among viscerally obese (waist/hip ratio >0.85) and overall nonobese women (body mass index <30), IGF-I was a strong mediator, reducing the racial disparity in both cancers by 30% and 60%, respectively. In E-only users and nonusers, IGF-I explained the racial disparity in CR cancer only modestly.ConclusionsBioavailable IGF-I is potentially important in racial disparities in obesity-related breast and CR cancer risk between postmenopausal AA and white women. Body fat distribution and E use may be part of the interconnected hormonal pathways related to racial difference in IGF-I levels and obesity-related cancer risk