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1.  Do observed or perceived characteristics of the neighborhood environment mediate associations between neighborhood poverty and cumulative biological risk? 
Health & place  2013;24:10.1016/j.healthplace.2013.09.005.
Objective
To examine contributions of observed and perceived neighborhood characteristics in explaining associations between neighborhood poverty and cumulative biological risk (CBR) in an urban community.
Methods
Multilevel regression analyses were conducted using cross-sectional data from a probability sample survey (n=919), and observational and census data. Dependent variable: CBR. Independent variables: Neighborhood disorder, deterioration and characteristics; perceived neighborhood social environment, physical environment, and neighborhood environment. Covariates: Neighborhood and individual demographics, health-related behaviors.
Results
Observed and perceived indicators of neighborhood conditions were significantly associated with CBR, after accounting for both neighborhood and individual level socioeconomic indicators. Observed and perceived neighborhood environmental conditions mediated associations between neighborhood poverty and CBR.
Conclusions
Findings were consistent with the hypothesis that neighborhood conditions associated with economic divestment mediate associations between neighborhood poverty and CBR.
doi:10.1016/j.healthplace.2013.09.005
PMCID: PMC3837295  PMID: 24100238
allostatic load; neighborhood environment; urban health inequalities; neighborhood poverty
2.  Independent and Joint Associations between Multiple Measures of the Built and Social Environment and Physical Activity in a Multi-Ethnic Urban Community 
Physical activity is associated with reduced risk of a number of health outcomes, yet fewer than half of adults in the United States report recommended levels of physical activity. Analyses of structural characteristics of the built environment as correlates of physical activity have yielded mixed results. We examine associations between multiple aspects of urban neighborhood environments and physical activity in order to understand their independent and joint effects, with a focus on the extent to which the condition of the built environment and indicators of the social environment modify associations between structural characteristics and physical activity. We use data from a stratified, multi-stage proportional probability sample of 919 non-Hispanic Black, non-Hispanic White, and Hispanic adults in an urban community, observational data from their residential neighborhoods, and census data to examine independent and joint associations of structural characteristics (e.g., street network connectivity), their condition (e.g., sidewalk condition), and social environments (e.g., territoriality) with physical activity. Our findings suggest that sidewalk condition is associated with physical activity, above and beyond structural characteristics of the built environment. Associations between some structural characteristics of the built environment and physical activity were conditional upon street condition, physical deterioration, and the proportion of parks and playgrounds in good condition. We found modest support for the hypothesis that associations between structural characteristics and physical activity are modified by aspects of the social environment. Results presented here point to the value of and need for understanding and addressing the complexity of factors that contribute to the relationships between the built and social environments and physical activity, and in turn, obesity and co-morbidities. Bringing together urban planners, public health practitioners and policy makers to understand and address aspects of urban environment associated with health outcomes is critical to promoting health and health equity.
doi:10.1007/s11524-013-9793-z
PMCID: PMC3795195  PMID: 23435574
Built environment; Social environment; Physical activity
3.  Neighborhood food environment role in modifying psychosocial stress-diet relationships 
Appetite  2013;65:170-177.
Exposure to highly palatable foods may increase eating in response to stress, but this behavioral response has not been examined in relation to the neighborhood food environment. This study examined whether the neighborhood food environment modified relationships between psychosocial stress and dietary behaviors. Probability-sample survey (n=460) and in-person food environment audit data were used. Dietary behaviors were measured using 17 snack food items and a single eating-out-of-home item. Chronic stress was derived from five subscales; major life events was a count of 9 items. The neighborhood food environment was measured as availability of large grocery stores, small grocery stores, and convenience stores, as well as proportion of restaurants that were fast food. Two-level hierarchical regression models were estimated. Snack food intake was positively associated with convenience store availability and negatively associated with large grocery store availability. The measures of chronic stress and major life events were generally not associated with either dietary behavior overall, although Latinos were less likely to eat out at high levels of major life events than African Americans. Stress-neighborhood food environment interactions were not statistically significant. Important questions remain regarding the role of the neighborhood food environment in the stress-diet relationship that warrant further investigation.
doi:10.1016/j.appet.2013.02.008
PMCID: PMC3622780  PMID: 23415977
Neighborhood; Food environment; Psychosocial stress; Eating out; Fast food; Snack; Diet
4.  Feasibility of Using Global Positioning Systems (GPS) with Diverse Urban Adults: Before and After Data on Perceived Acceptability, Barriers, and Ease of Use 
Background
Global positioning systems (GPS) have emerged as a research tool to better understand environmental influences on physical activity. This study examined the feasibility of using GPS in terms of perceived acceptability, barriers, and ease of use in a racially/ethnically diverse sample of lower socioeconomic position (SEP).
Methods
Data were from two pilot studies involving a total of 170 African American, Hispanic, and White urban adults with a mean (standard deviation) age of 47.8 (±13.1) years. Participants wore a GPS for up to seven days. They answered questions about GPS acceptability, barriers (wear-related concerns), and ease of use, before and after wearing the GPS.
Results
We found high ratings of GPS acceptability and ease of use and low levels of wear-related concerns, which were maintained after data collection. While most were comfortable with their movements being tracked, older participants (p<0.05) and African Americans (p<0.05) reported lower comfort levels. Participants who were younger, with higher education, and low incomes were more likely to indicate that the GPS made the study more interesting (p<0.05). Participants described technical and wear-related problems, but few concerns related to safety, loss, or appearance.
Conclusions
Use of GPS was feasible in this racially/ethnically diverse, lower SEP sample.
PMCID: PMC3397153  PMID: 21952361
Global positioning system; Environment; Physical activity; Feasibility; Perceptions
5.  “You have to hunt for the fruits, the vegetables”: Environmental Barriers and Adaptive Strategies to Acquire Food in a Low-Income African-American Neighborhood 
This qualitative study sought to understand food acquisition behaviors and environmental factors that influence those behaviors among women in a low-income African American community with limited food resources. We drew upon in-depth interviews with 30 women ages 21 to 45 recruited from a community health center in Chicago, Illinois. Data were analyzed using qualitative content analysis. Emergent themes revealed that women identified multiple environmental barriers—material, economic, and social-interactional—to acquiring food in an acceptable setting. In response, they engaged in several adaptive strategies to manage or alter these challenges including optimizing, settling, being proactive, and advocating. These findings indicate that efforts to improve neighborhood food environments should address not only food availability and prices, but also the physical and social environments of stores as well.
doi:10.1177/1090198110372877
PMCID: PMC3709968  PMID: 21511955
Neighborhood; Food environment; African Americans; Nutrition; Food shopping
6.  Inter-Rater Reliability of the Food Environment Audit for Diverse Neighborhoods (FEAD-N) 
Studies have shown that neighborhood food environments are important influences on dietary intake and may contribute to health disparities. While instruments with high reliability have been developed to assess food availability, price, and quality, few measures to assess items associated with the physical and social features of food stores have been developed. Yet, recent qualitative studies have documented aspects associated with such features of urban food stores that are barriers to food acquisition. We assessed the reliability of measures to assess multiple components of the food environment—including physical and social store features—in three geographically distinct and diverse communities in Detroit, Michigan, using the Food Environment Audit for Diverse Neighborhoods (FEAD-N). Using the FEAD-N, four trained observers conducted observations of 167 food stores over a 10-week period between October and December 2008. To assess inter-rater reliability, two trained observers independently visited, on the same day, a random subset of 44 food stores. Kappa statistics and percent agreement were used to evaluate inter-rater reliability. Overall, the instrument had mostly high inter-rater reliability with more than 75% of items with kappa scores between 0.80 and 1.00, indicating almost perfect reliability. More than half of the physical store features and 47% of the social store features had almost perfect reliability and about 37% and 47%, respectively, had substantial reliability. Measuring factors associated with the physical and social environment of food stores with mostly high reliability is feasible. Systematic documentation of the physical and social features of food stores using objective measures may promote a more comprehensive understanding of how neighborhood food environments influence health.
doi:10.1007/s11524-011-9657-3
PMCID: PMC3368052  PMID: 22350513
Inter-rater reliability; Food environment; Physical store features; Social store features; Community-based participatory research
7.  Activity Space Environment and Dietary and Physical Activity Behaviors: A Pilot Study 
Health & place  2011;17(5):1150-1161.
This study examined relationships among individual demographics, environmental features (e.g., fast food outlet density, park land use) of residential neighborhoods and activity spaces, and obesity-related behaviors (diet, physical activity). Participants’ movement was tracked for seven days using global positioning systems (GPS). Two activity space measures (one standard deviation ellipse, daily path area) were derived from the GPS data. Activity spaces were generally larger than residential neighborhoods; environmental features of residential neighborhoods and activity spaces were weakly associated; and some activity space environmental features were related to dietary behaviors. Activity spaces may provide new insights into environmental influences on obesity-related behaviors.
doi:10.1016/j.healthplace.2011.05.001
PMCID: PMC3224849  PMID: 21696995
Global positioning system; Activity space; Neighborhood; Diet; Physical activity; Environment
8.  Availability of commonly consumed and culturally specific fruits and vegetables in African-American and Latino neighborhoods 
Although the importance of culture in shaping individual dietary behaviors is well documented, cultural food preferences have received limited attention in research on the neighborhood food environment. The purpose of this study was to assess the availability of commonly consumed and culturally specific fruits and vegetables in retail food stores located in majority African-American and Latino neighborhoods in southwest Chicago. A cross-sectional survey of 115 stores (15% grocery stores, 85% convenience/corner stores) in African-American neighborhoods and 110 stores (45% grocery stores, 55% convenience/corner stores) in Latino neighborhoods was conducted between May and August 2006. Chi-square tests were used to test for differences in the availability (presence/absence) of commonly consumed (n=25) and culturally specific fruits and vegetables for African-Americans (n=16 varieties) and Latinos (n=18 varieties). Stores located in neighborhoods in which the majority of residents were African-American or Latino residents were more likely to carry fresh fruits and vegetables that were culturally relevant to the dominant group. For example, grocery stores located in Latino neighborhoods were more likely to carry chayote (82.0% vs. 17.6%, p <0.05), while grocery stores located in African-American neighborhoods were more likely to carry black-eyed peas (52.9% vs. 20%, p<0.05). Most stores, however, carried less than 50% of commonly consumed or culturally specific fruits and vegetables. Findings from this study highlight that limited availability of culturally specific as well as commonly consumed fruits and vegetables in the neighborhood may serve as a barrier to fruit and vegetable consumption among African-Americans and Latinos.
doi:10.1016/j.jada.2010.02.008
PMCID: PMC3427830  PMID: 20430136
fruits; vegetables; African-American; Latinos; neighborhoods
9.  ASSOCIATIONS BETWEEN NEIGHBORHOOD AVAILABILITY AND INDIVIDUAL CONSUMPTION OF DARK-GREEN AND ORANGE VEGETABLES AMONG ETHNICALLY DIVERSE ADULTS IN DETROIT 
Diets rich in dark-green and orange vegetables have been associated with a reduction in chronic diseases. However, most Americans do not consume the number of daily servings recommended by the 2005 Dietary Guidelines for Americans. An increasing number of studies suggest that changes to the neighborhood food environment may be critical to achieving population-wide improvements in eating. The objective of this study was to examine the relationship between observed neighborhood availability and individual consumption of dark-green and orange vegetables among low- to moderate-income and ethnically diverse adults in Detroit. This study used a cross-sectional design that drew upon a 2002–2003 community survey and 2002 in-person audit of food stores. A total of 919 adults (mean age 46.3 years, 52.2% female) including African Americans (56.7 %), Latinos (22.2%), and whites (18.7%) residing in three Detroit communities participated in the survey. Two-level weighted, hierarchical linear regression was used to analyze the data. On average, survey respondents ate 0.61 daily servings of dark-green and orange vegetables. Residents of neighborhoods with no stores carrying five or more varieties of dark-green and orange vegetables were associated with an average of 0.17 fewer daily servings of these foods compared with residents of neighborhoods with two stores carrying five or more varieties of dark-green and orange vegetables (P=0.047). These findings suggest that living in a neighborhood with multiple opportunities to purchase dark-green and orange vegetables may make an important contribution toward meeting recommended intakes.
doi:10.1016/j.jada.2010.10.044
PMCID: PMC3369621  PMID: 21272702
10.  Classification bias in commercial business lists for retail food stores in the U.S. 
Background
Aspects of the food environment such as the availability of different types of food stores have recently emerged as key modifiable factors that may contribute to the increased prevalence of obesity. Given that many of these studies have derived their results based on secondary datasets and the relationship of food stores with individual weight outcomes has been reported to vary by store type, it is important to understand the extent to which often-used secondary data correctly classify food stores. We evaluated the classification bias of food stores in Dun & Bradstreet (D&B) and InfoUSA commercial business lists.
Methods
We performed a full census in 274 randomly selected census tracts in the Chicago metropolitan area and collected detailed store attributes inside stores for classification. Store attributes were compared by classification match status and store type. Systematic classification bias by census tract characteristics was assessed in multivariate regression.
Results
D&B had a higher classification match rate than InfoUSA for supermarkets and grocery stores, while InfoUSA was higher for convenience stores. Both lists were more likely to correctly classify large supermarkets, grocery stores, and convenience stores with more cash registers and different types of service counters (supermarkets and grocery stores only). The likelihood of a correct classification match for supermarkets and grocery stores did not vary systemically by tract characteristics whereas convenience stores were more likely to be misclassified in predominately Black tracts.
Conclusion
Researches can rely on classification of food stores in commercial datasets for supermarkets and grocery stores whereas classifications for convenience and specialty food stores are subject to some systematic bias by neighborhood racial/ethnic composition.
doi:10.1186/1479-5868-9-46
PMCID: PMC3425161  PMID: 22512874
Commercial business lists; Food stores; Classification error
11.  Associations of Supermarket Characteristics with Weight Status and Body Fat: A Multilevel Analysis of Individuals within Supermarkets (RECORD Study) 
PLoS ONE  2012;7(4):e32908.
Purpose
Previous research on the influence of the food environment on weight status has often used impersonal measures of the food environment defined for residential neighborhoods, which ignore whether people actually use the food outlets near their residence. To assess whether supermarkets are relevant contexts for interventions, the present study explored between-residential neighborhood and between-supermarket variations in body mass index (BMI) and waist circumference (WC), and investigated associations between brands and characteristics of supermarkets and BMI or WC, after adjustment for individual and residential neighborhood characteristics.
Methods
Participants in the RECORD Cohort Study (Paris Region, France, 2007–2008) were surveyed on the supermarket (brand and exact location) where they conducted their food shopping. Overall, 7 131 participants shopped in 1 097 different supermarkets. Cross-classified multilevel linear models were estimated for BMI and WC.
Results
Just 11.4% of participants shopped for food primarily within their residential neighborhood. After accounting for participants' residential neighborhood, people shopping in the same supermarket had a more comparable BMI and WC than participants shopping in different supermarkets. After adjustment for individual and residential neighborhood characteristics, participants shopping in specific supermarket brands, in hard discount supermarkets (especially if they had a low education), and in supermarkets whose catchment area comprised low educated residents had a higher BMI/WC.
Conclusion
A public health strategy to reduce excess weight may be to intervene on specific supermarkets to change food purchasing behavior, as supermarkets are where dietary preferences are materialized into definite purchased foods.
doi:10.1371/journal.pone.0032908
PMCID: PMC3319546  PMID: 22496738
12.  Neighborhood Retail Food Environment and Fruit and Vegetable Intake in a Multiethnic Urban Population 
Purpose
To examine relationships between the neighborhood food environment and fruit and vegetable intake in a multiethnic urban population.
Design
Analysis of cross-sectional survey and observational data.
Setting
146 neighborhoods within three large geographic communities of Detroit, Michigan.
Subjects
Probability sample of 919 African-American, Latino, and White adults.
Measures
The dependent variable was mean daily fruit and vegetable servings measured using a modified Block 98 food frequency questionnaire. Independent variables included the neighborhood food environment: store availability (large grocery, specialty, convenience, liquor, small grocery), supermarket proximity (street-network distance to nearest chain grocer), and perceived and observed neighborhood fresh fruit and vegetable supply (availability, variety, quality, affordability).
Analysis
Weighted multilevel regression.
Results
Presence of a large grocery store in the neighborhood was associated with, on average, 0.69 more daily fruit and vegetable servings in the full sample. Relationships between the food environment and fruit and vegetable intake did not differ between Whites and African-Americans. However, Latinos compared with African-Americans with a large grocery store in their neighborhood consumed 2.20 more daily servings of fruits and vegetables. Presence of a convenience store in the neighborhood was associated with 1.84 fewer daily fruit and vegetable servings among Latinos than African-Americans.
Conclusion
The neighborhood food environment influences fruit and vegetable intake, and the size of this relationship may vary for different racial/ethnic subpopulations.
doi:10.4278/ajhp.071204127
PMCID: PMC3305995  PMID: 19288847
African Americans; Diet; Hispanic Americans; Residence Characteristics; Urban Population; Format: Research; Purpose: Modeling/relationship testing; Design: Non-experimental; Outcome: Behavioral; Setting: Local community; Health focus: Nutrition; Strategy: Built environment; Age: Adults; Population circumstances: Range of education and income levels, 3 geographic communities in Detroit, Michigan, African-Americans, Latinos, and non-Hispanic Whites
13.  Short-Term Temporal Stability in Observed Retail Food Characteristics 
Objective
Use of direct observation to characterize neighborhood retail food environments is increasing but to date most studies have relied on a single observation. If food availability, prices, and quality vary over short time periods, repeated measures may be needed to portray these food characteristics. This study evaluated short-term (2-week), within-season temporal stability in retail food availability, prices, and quality.
Design
In-person observations of retail food stores at 2 time points, 2 weeks apart.
Setting
Southwest Chicago, IL.
Sample
157 food stores.
Main Outcome Measures
Availability and prices of foods selected from the following food groups: fruits, vegetables, grains, meats and beans, and dairy, as well as fresh produce quality.
Analysis
Temporal stability was tested for availability using a McNemar test and for price and quality using a Wilcoxon signed rank test.
Results
We found that measures of food availability and prices as well as fresh produce quality at stores were generally stable at the 2 time points.
Conclusions and Implications
This study suggests that a single observation may be sufficient to accurately characterize within-season food availability, food prices, and fresh produce quality.
doi:10.1016/j.jneb.2009.01.005
PMCID: PMC2913966  PMID: 20129186
14.  NEIGHBORHOOD IMMIGRANT CONCENTRATION, ACCULTURATION, AND CULTURAL ALIENATION IN FORMER SOVIET IMMIGRANT WOMEN 
Journal of community psychology  2009;37(1):88-105.
Several acculturation theories note the importance of surrounding context, but few studies describe neighborhood influences on immigrant adaptation. The purpose of this study was to examine relationships among neighborhood immigrant concentration, acculturation, and alienation for 151 women aged 44–80 from the former Soviet Union who lived in the US fewer than 13 years. Participants resided in 65 census tracts in the Chicago area with varying concentrations of Russian-speaking and diverse immigrants. Results from self-report questionnaires suggest that the effect of acculturation on alienation varies depending on neighborhood characteristics. The study also demonstrates the complexity of individual and contextual influences on immigrant adoption. Understanding these relationships is important for developing community-based and neighborhood-level interventions to enhance the mental health of immigrants.
doi:10.1002/jcop.20272
PMCID: PMC2994587  PMID: 21127738
15.  Multilevel Correlates of Satisfaction with Neighborhood Availability of Fresh Fruits and Vegetables 
Background
Little is known about influences on perceptions of neighborhood food environments, despite their relevance for food-shopping behaviors and food choices.
Purpose
This study examined relationships between multilevel factors (neighborhood structure, independently observed neighborhood food environment, individual socioeconomic position) and satisfaction with neighborhood availability of fruits and vegetables.
Methods
The multilevel regression analysis drew on data from a community survey of urban adults, in-person audit and mapping of food stores, and the 2000 Census.
Results
Satisfaction with neighborhood availability of fruits and vegetables was lower in neighborhoods that were further from a supermarket and that had proportionately more African-American residents. Neighborhood poverty and independently observed neighborhood fruit and vegetable characteristics (variety, prices, quality) were not associated with satisfaction. Individual education modified relationships between neighborhood availability of smaller food stores (small grocery stores, convenience stores, liquor stores) and satisfaction.
Conclusions
Individual-level and neighborhood-level factors affect perceptions of neighborhood food environments.
doi:10.1007/s12160-009-9106-7
PMCID: PMC2809777  PMID: 19809859
Food environment; Neighborhood effects on health; Socioeconomic status; Urban populations; Fruits; Vegetables
16.  Neighborhood Characteristics, Adherence to Walking, and Depressive Symptoms in Midlife African American Women 
Journal of Women's Health  2009;18(8):1201-1210.
Abstract
Background
African American women have more symptoms of depressed mood than white women. Adverse neighborhood conditions may contribute to these symptoms. Although reductions in depressive symptoms with physical activity have been demonstrated in white adults, little research has examined the mental health benefits of physical activity in African American women. Further, it is unknown whether physical activity can offset the effects of living in disadvantaged neighborhoods on depressive symptoms. The purpose of this study was to examine the relationships among neighborhood characteristics, adherence to a physical activity intervention, and change over time in depressive symptoms in midlife African American women.
Methods
Two hundred seventy-eight women participated in a home-based, 24-week moderate-intensity walking intervention. Either a minimal treatment (MT) or enhanced treatment (ET) version of the intervention was randomly assigned to one of the two community health centers. Walking adherence was measured as the percentage of prescribed walks completed. Objective and perceived measures of neighborhood deterioration and crime were included.
Results
Adjusting for demographics, body mass index (BMI), and depressive symptoms at baseline, walking adherence and objective neighborhood deterioration were associated with significantly lower depressive symptoms, whereas perceived neighborhood deterioration was associated with significantly higher depressive symptoms at 24 weeks.
Conclusions
Adherence to walking as well as aspects of the environment may influence depressive symptoms in African American women. In addition to supporting active lifestyles, improving neighborhood conditions may also promote mental health among African American women.
doi:10.1089/jwh.2008.1168
PMCID: PMC2825683  PMID: 19630546
17.  How Neighborhood Environments Contribute to Obesity 
The American journal of nursing  2009;109(7):61-64.
doi:10.1097/01.NAJ.0000357175.86507.c8
PMCID: PMC2789291  PMID: 19546647
18.  Characteristics of Mammography Facility Locations and Stage of Breast Cancer at Diagnosis in Chicago 
In the United States, despite substantial investment in public health initiatives to promote early detection of breast cancer through screening mammography, the proportion of female breast cancers that have advanced beyond the localized stage by the time of diagnosis remains high. Our objective in this exploratory study was to investigate whether stage of breast cancer at diagnosis among Chicago residents is associated with characteristics of the neighborhoods in which proximate mammography facilities are located. Those characteristics may influence likelihood of utilizing the service routinely and partly explain differences in stage at diagnosis. We used a retrospective cohort design and combined 3 years of data from the Illinois State Cancer Registry (ISCR) with information on locations of mammography facilities, public transportation service, crime, and area demographic and economic characteristics. Using a Geographic Information System (GIS), we identified the five facilities located nearest to each case’s residence. Estimates of the association between characteristics of mammography facility locations and breast cancer stage at diagnosis were obtained using the partial proportional odds regression model. We found that the number of homicides in areas in which the nearest mammography facilities were located was associated with increased odds of later stage diagnosis. This effect was independent of age, race, and residential area education and income. We found no effect on stage of distance, public transportation service, or measures of neighborhood social similarity. The “spatial dynamics” of health may involve geographies beyond the immediate neighborhood. The results of our study suggest that areas in which the nearest mammography facilities are located may be one such geography. We hope that this study will spark research interest in the impact of health service locations on utilization.
doi:10.1007/s11524-008-9320-9
PMCID: PMC2648885  PMID: 18972211
Breast cancer; Stage; Mammography; GIS; Crime; Neighborhoods
19.  Neighborhood Environment and Adherence to a Walking Intervention in African-American Women 
This secondary analysis examined relationships between the environment and adherence to a walking intervention among 252 urban and suburban midlife African-American women. Participants received an enhanced or minimal behavioral intervention. Walking adherence was measured as the percentage of prescribed walks completed. Objective measures of the women’s neighborhoods included: walkability (land use mix, street intersection density, housing unit density, public transit stop density), aesthetics (physical deterioration, industrial land use), availability of outdoor (recreational open space) and indoor (recreation centers, shopping malls) walking facilities/spaces, and safety (violent crime incidents). Ordinary least squares regression estimated relationships. We found presence of one and especially both types of indoor walking facilities were associated with greater adherence. No associations were found between adherence and the other environmental variables. The effect of the enhanced intervention on adherence did not differ by environmental characteristics. Aspects of the environment may influence African-American women who want to be more active.
doi:10.1177/1090198108321249
PMCID: PMC2726823  PMID: 18669878
African Americans; Neighborhood; Walking
20.  Do Neighborhood Economic Characteristics, Racial Composition, and Residential Stability Predict Perceptions of Stress Associated with the Physical and Social Environment? Findings from a Multilevel Analysis in Detroit 
As the body of evidence linking disparities in the health of urban residents to disparate social, economic and environmental contexts grows, efforts to delineate the pathways through which broader social and economic inequalities influence health have burgeoned. One hypothesized pathway connects economic and racial and ethnic inequalities to differentials in stress associated with social and physical environments, with subsequent implications for health. Drawing on data from Detroit, Michigan, we examined contributions of neighborhood-level characteristics (e.g., poverty rate, racial and ethnic composition, residential stability) and individual-level characteristics (e.g., age, gender) to perceived social and physical environmental stress. We found that neighborhood percent African American was positively associated with perceptions of both social and physical environmental stress; neighborhood percent poverty and percent Latino were positively associated with perceived physical environmental stress; and neighborhood residential stability was negatively associated with perceived social environmental stress. At the individual level, whites perceived higher levels of both social and physical environmental stress compared to African American residents of the same block groups, after accounting for other variables included in the models. Our findings suggest the importance of understanding and addressing contributions of neighborhood structural characteristics to perceptions of neighborhood stress. The consistency of the finding that neighborhood racial composition and individual-level race influence perceptions of both social and physical environments suggests the continuing importance of understanding the role played by structural conditions and by personal and collective histories that vary systematically by race and ethnicity within the United States.
doi:10.1007/s11524-008-9288-5
PMCID: PMC2527427  PMID: 18481182
Perceived social environmental stress; Perceived physical environmental stress; Residential stability; Urban health
21.  Engaging Urban Residents in Assessing Neighborhood Environments and Their Implications for Health 
Researchers have worked to delineate the manner in which urban environments reflect broader social processes, such as those creating racially, ethnically and economically segregated communities with vast differences in aspects of the built environment, opportunity structures, social environments, and environmental exposures. Interdisciplinary research is essential to gain an enhanced understanding of the complex relationships between these stressors and protective factors in urban environments and health. The purpose of this study was to examine the ways that multiple factors may intersect to influence the social and physical context and health within three areas of Detroit, Michigan. We describe the study design and results from seven focus groups conducted by the Healthy Environments Partnership (HEP) and how the results informed the development of a survey questionnaire and environmental audit tool. The findings from the stress process exercise used in the focus groups described here validated the relevance of a number of existing concepts and measures, suggested modifications of others, and evoked several new concepts and measures that may not have been captured without this process, all of which were subsequently included in the survey and environmental audit conducted by HEP. Including both qualitative and quantitative methods can enrich research and maximize the extent to which research questions being asked and hypotheses being tested are driven by the experiences of residents themselves, which can enhance our efforts to identify strategies to improve the physical and social environments of urban areas and, in so doing, reduce inequities in health.
doi:10.1007/s11524-006-9053-6
PMCID: PMC1482932  PMID: 16739052
Community-based participatory research; Neighborhood assessment; Qualitative and quantitative methods; Stress process model
22.  Engaging Urban Residents in Assessing Neighborhood Environments and Their Implications for Health 
Researchers have worked to delineate the manner in which urban environments reflect broader social processes, such as those creating racially, ethnically and economically segregated communities with vast differences in aspects of the built environment, opportunity structures, social environments, and environmental exposures. Interdisciplinary research is essential to gain an enhanced understanding of the complex relationships between these stressors and protective factors in urban environments and health. The purpose of this study was to examine the ways that multiple factors may intersect to influence the social and physical context and health within three areas of Detroit, Michigan. We describe the study design and results from seven focus groups conducted by the Healthy Environments Partnership (HEP) and how the results informed the development of a survey questionnaire and environmental audit tool. The findings from the stress process exercise used in the focus groups described here validated the relevance of a number of existing concepts and measures, suggested modifications of others, and evoked several new concepts and measures that may not have been captured without this process, all of which were subsequently included in the survey and environmental audit conducted by HEP. Including both qualitative and quantitative methods can enrich research and maximize the extent to which research questions being asked and hypotheses being tested are driven by the experiences of residents themselves, which can enhance our efforts to identify strategies to improve the physical and social environments of urban areas and, in so doing, reduce inequities in health.
doi:10.1007/s11524-006-9053-6
PMCID: PMC1482932  PMID: 16739052
Community-based participatory research; Neighborhood assessment; Qualitative and quantitative methods; Stress process model
23.  Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods 
Journal of Urban Health   2006;83(2):195-210.
Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low- or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African–Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low- or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures—distance and public transportation travel time—is less strong in African–American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African–American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African–American residents. Thus, it appears that the spatial accessibility of low- and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.
doi:10.1007/s11524-005-9023-4
PMCID: PMC2527168  PMID: 16736369
African–American; Geographic information system (GIS); Health care accessd; Mammography; Neighborhood; Poverty; Urban health

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