The sociospatial context of health disparities

A key aim of the proposed research will be to tie neighborhood level factors to health outcomes drawing on extant theories of the social context of health disparities.  Specifically, we will link a social capital/collective efficacy perspective on neighborhood functioning with key processes such as the development of "allostatic load," behavioral adaptations to neighborhood environments, and the availability and use of health-relevant institutional resources (e.g., access to higher quality care).  This approach suggests that neighborhoods with limited structural resources suffer from weak norms encouraging the social control of public space and, more generally, pro-social (including health enhancing) activities.  For instance, the capacity of neighborhood residents to act on behalf of health-relevant goals such as safe public streets and parks, and correspondingly reduced crime levels, may contribute to the health status of local adults through a number of mechanisms. Normative orientations encouraging safe public space and reduced crime levels at the neighborhood level may limit the development of "allostatic load" and corresponding exposure to a variety of potentially health­ compromising stress mediators (e.g., catecholamines and cortisol) (McEwen 1998).  Adults who reside in neighborhoods  with strong pro-social norms may also be more likely to use outdoor space for recreational activity and exercise, reducing the likelihood of a range of poor health outcomes.   Finally, neighborhoods that can mobilize effectively on behalf of a healthy environment may more effectively draw high quality health services and disseminate information regarding access to care.

 

The  collective efficacy perspective (Sampson, Raudenbush,  and Earls 1997) and has been fruitfully applied to understanding contextual variation in adult self-rated health (Browning and Cagney 2002, 2003) and all-cause mortality (Browning, Wallace, Feinberg, and Cagney 2006) in the context of Chicago.  The DHS offers an opportunity to examine the impact of collective efficacy and related features of neighborhood context (such as perceptions of local crime and safety) in an alternative urban context and to examine its impact on carefully measured biomarkers longitudinally.  The DHS is also specifically designed to examine the extent to which social context and individual level factors help to explain racial and ethnic disparities in health.

 

Accordingly, we will examine the contribution of neighborhood characteristics to explanation of differences in health outcomes for African American, European American, and Latino respondents.  In addition, the sampling strategy of the DHS captured residents of most Dallas census tracts, allowing for an assessment of the effects of residing in residentially segregated regions of the city on health status.  Our preliminary specific aims are as follows:

1)  Aim 1: Examine the associations between neighborhood structural factors (poverty, residential instability, ethnic heterogeneity, and population density), collective efficacy, crime, and adult health outcomes.

a.   Does neighborhood  structural disadvantage exert independent influence on adult health outcomes (including blood pressure/hypertension,  cholesterol, obesity, and related cardiovascular  health measures), above and beyond a host of family and individual level predictors?  Does neighborhood level collective efficacy predict adult health and account for any observed associations between neighborhood  structure and health status?  Do neighborhood  crime rates predict health outcomes, particularly obesity and hypertension?

b.   Does the effect of neighborhood  context depend on characteristics of individuals?  For instance, does any observed effect of collective efficacy on health outcomes depend on individual level social support?

2)   Aim 2: Consider the relationship between race/ethnic disparities in health outcomes and neighborhood structural and social environments.

a.  Are African American residents of Dallas more likely to reside in low collective efficacy and high crime neighborhoods than European Americans?  Do levels of structural disadvantage, collective efficacy and crime account for any observed health disparities between African Americans and European Americans, above and beyond that accounted for by individual level factors such as socioeconomic status?

b.   Do Latino residents of Dallas (particularly foreign-born Latinos) exhibit the well-documented tendency to report better health outcomes than both African American and European American adults?  Are Latino neighborhoods-particularly high concentration Latino communities (or ethnic enclaves)­ characterized by higher levels of collective efficacy and lower levels of crime?  Do these neighborhood level factors account for a proportion of any observed health advantage among Latinos?

3) Aim 3: Is residential segregation associated with health outcomes, above and beyond the characteristics of individuals and the internal characteristics of their neighborhoods?   To what extent does living in a cluster of disadvantaged neighborhoods  (with respect to poverty, crime, collective efficacy) confer an additional health penalty.