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2.  Applying novel methods for assessing individual- and neighborhood-level social and psychosocial environment interactions with genetic factors in the prediction of depressive symptoms in the Multi-Ethnic Study of Atherosclerosis 
Behavior genetics  2015;46(1):89-99.
Complex illnesses, like depression, are thought to arise from the interplay between psychosocial stressors and genetic predispositions. Approaches that take into account both personal and neighborhood factors and that consider gene regions as well as individual SNPs may be necessary to capture these interactions across race and ethnic groups.
We used novel gene-region based analysis methods (Sequence Kernel Association Test (SKAT) and meta-analysis (MetaSKAT), Gene-Environment Set Association Test (GESAT)), as well as traditional linear models to identify gene region and SNP × psychosocial factor interactions at the individual- and neighborhood-level, across multiple race/ethnicities.
Multiple regions identified in SKAT analyses showed evidence of a significant gene-region association with averaged depressive symptom scores across race/ethnicity (MetaSKAT p-values < 0.001). One region × neighborhood-environment interaction was significantly associated with averaged depressive symptom score across race/ethnicity after multiple testing correction (chr 18:21454070-21494070, Fisher's combined p-value = 0.001).
The examination of gene regions jointly with environmental factors measured at multiple levels (individuals and their contexts) may shed light on the etiology of depressive illness across race/ethnicities.
PMCID: PMC4720563  PMID: 26254610
Gene × environment; depressive symptoms; GESAT; gene-set testing; gene environment set association testing
3.  Spatially Modelling the Association Between Access to Recreational Facilities and Exercise: The ‘Multi-Ethnic Study of Atherosclerosis’ 
Numerous studies have investigated the relationship between the built environment and physical activity. However these studies assume that these relationships are invariant over space. In this study, we introduce a novel method to analyze the association between access to recreational facilities and exercise allowing for spatial heterogeneity. In addition, this association is studied before and after controlling for crime, a variable that could explain spatial heterogeneity of associations. We use data from the Chicago site of the Multi-Ethnic Study of Atherosclerosis of 781 adults aged 46 years and over. A spatially varying coefficient Tobit regression model is implemented in the Bayesian setting to allow for the association of interest to vary over space. The relationship is shown to vary over Chicago, being positive in the south but negative or null in the north. Controlling for crime weakens the association in the south with little change observed in northern Chicago. The results of this study indicate that spatial heterogeneity in associations of environmental factors with health may vary over space and deserve further exploration.
PMCID: PMC4751045  PMID: 26877598
Physical activity; Environment; Spatially varying coefficients; Tobit regression
4.  Air Pollution, Cardiovascular Outcomes, and Social Disadvantage: The Multi-ethnic Study of Atherosclerosis 
Social factors may enhance health effects of air pollution, yet empirical support is inconsistent. The interaction of social and environmental factors may only be evident with long-term exposures and outcomes that reflect long-term disease development
We used cardiac magnetic resonance imaging data from the Multi-Ethnic Study of Atherosclerosis to assess left-ventricular mass index (LVMI) and left-ventricular ejection fraction (LVEF). We assigned residential concentrations of fine particulate matter (PM2.5), oxides of nitrogen (NOx), and nitrogen dioxide (NO2) in the year 2000 to each participant in 2000 using prediction models. We examined modifying roles of four measures of adversity: race/ethnicity, racial/ethnic residential segregation, and socioeconomic status (SES) and psychosocial adversity as composite indices on the association between air pollution and LVMI or LVEF.
Compared to whites, blacks showed a stronger adjusted association between air pollution and LVMI. For example, for each 5 μg/m3 greater PM2.5 level, whites showed a 1.0 g/m2 greater LVMI (95%CI: -1.3, 3.1) while blacks showed an additional 4.0 g/m2 greater LVMI (95%CI: 0.3, 8.2). Results were similar for NOx and NO2 with regard to black race and LVMI. However, we found no evidence of a modifying role of other social factors or ethnic groups. Furthermore, we found no evidence of a modifying role for any social factors or racial/ethnic groups on the association between air pollution and LVEF.
Our results suggest that racial group membership may modify the association between air pollution and cardiovascular disease.
PMCID: PMC4937221  PMID: 26618771
5.  Psychosocial Factors and Risk of Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis (MESA) 
Circulation. Heart failure  2015;9(1):e002243.
Heart failure is a major source of morbidity and mortality in the United States. Psychosocial factors have frequently been studied as risk factors for coronary heart disease, but not for heart failure.
Methods and Results
We examined the relationship between psychological status and incident heart failure among 6,782 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Anger, anxiety, chronic stress, depressive symptoms, and hostility were measured using validated scales and physician reviewers adjudicated incident heart failure events. Cox proportional hazards models were used to adjust for relevant demographic, behavioral, and physiological covariates. Interactions by age, race, sex, and self-reported health were examined in exploratory analyses. During a mean follow up of 9.3 years, 242 participants developed incident heart failure. There was no association between psychosocial factors and heart failure hazard ratios (95% CI) for highest vs. lowest quartile: anger=1.14 (0.81-1.60), anxiety=0.74 (0.51-1.07), chronic stress=1.25 (0.90-1.72), depressive symptoms=1.19 (0.76-1.85), and hostility=0.95 (0.62-1.42). In exploratory analysis, among the participants reporting fair/poor health at baseline, those reporting high vs. low levels of anxiety, chronic stress, and depressive symptoms had 2-fold higher risk of incident heart failure, but there was no association for those with good/very good/excellent self-reported health.
Overall these psychosocial factors were not significantly associated with incident heart failure. However, for participants reporting poor health at baseline, there was evidence that anxiety, chronic stress, and depressive symptoms were associated with increased risk of heart failure. Future research with greater statistical power is necessary to replicate these findings and seek explanations.
PMCID: PMC4692172  PMID: 26699386
epidemiology; heart failure; anxiety; depression; stress
6.  Associations of Alcohol Availability and Neighborhood Socioeconomic Characteristics With Drinking: Cross-Sectional Results From the Multi-Ethnic Study of Atherosclerosis (MESA) 
Substance use & misuse  2015;50(12):1606-1617.
Living in neighborhoods with a high density of alcohol outlets and socioeconomic disadvantage may increase residents’ alcohol use. Few researchers have studied these exposures in relation to multiple types of alcohol use, including beverage-specific consumption, and how individual demographic factors influence these relationships.
To examine the relationships of alcohol outlet density and neighborhood disadvantage with alcohol consumption, and to investigate differences in these associations by race/ethnicity and income.
Using cross-sectional data (N=5,873) from the Multi-ethnic Study of Atherosclerosis in 2002, we examine associations of residential alcohol outlet density and neighborhood socioeconomic disadvantage with current, total weekly and heaviest daily alcohol use in gender specific regression models, as well as moderation by race/ethnicity and income.
Drinking men living near high densities of alcohol outlets had 23–29% more weekly alcohol use than men in low density areas. Among women who drank, those living near a moderate density of alcohol outlets consumed approximately 40% less liquor each week than those in low density areas, but higher outlet densities were associated with more wine consumption (35–49%). Living in highly or moderately disadvantaged neighborhoods was associated with a lower probability of being a current drinker, but with higher rates of weekly beer consumption. Income moderated the relationship between neighborhood context and weekly alcohol use.
Neighborhood disadvantage and alcohol outlet density may influence alcohol use with effects varying by gender and income. Results from this research may help target interventions and policy to groups most at risk for greater weekly consumption.
PMCID: PMC4802501  PMID: 26579610
alcohol use; neighborhood; alcohol availability; alcohol outlet; neighborhood disadvantage; race/ethnicity; income
7.  Job strain, occupational category, and hypertension prevalence: The Multi-Ethnic Study of Atherosclerosis 
To assess associations of occupational categories and job characteristics with prevalent hypertension.
We analyzed 2,517 Multi-Ethnic Study of Atherosclerosis (MESA) participants, working 20+ hours per week, in 2002–4.
Higher job decision latitude was associated with a lower prevalence of hypertension, prevalence ratio (PR)=0.78 (95% CI 0.66–0.91) for the top vs. bottom quartile of job decision latitude. However, associations differed by occupation: decision latitude was associated with a higher prevalence of hypertension in healthcare support occupations (interaction p=.02). Occupation modified associations of gender with hypertension: a higher prevalence of hypertension in women (vs men) was observed in healthcare support and in blue-collar occupations (interaction p=.03).
Lower job decision latitude is associated with hypertension prevalence in many occupations. Further research is needed to determine reasons for differential impact of decision latitude and gender on hypertension across occupations.
PMCID: PMC4636023  PMID: 26539765
job strain; occupation; blood pressure; hypertension
8.  A Common Spatial Factor Analysis Model for Measured Neighborhood-Level Characteristics: The Multi-Ethnic Study of Atherosclerosis 
Health & place  2015;36:35-46.
The purpose of this study was to reduce the dimensionality of a set of neighborhood-level variables collected on participants in the Multi-Ethnic Study of Atherosclerosis (MESA) while appropriately accounting for the spatial structure of the data. A common spatial factor analysis model in the Bayesian setting was utilized in order to properly characterize dependencies in the data. Results suggest that use of the spatial factor model can result in more precise estimation of factor scores, improved insight into the spatial patterns in the data, and the ability to more accurately assess associations between the neighborhood environment and health outcomes.
PMCID: PMC4679666  PMID: 26372887
Bayesian analysis; Factor analysis; Spatial statistics; Body mass index
9.  Perceived Discrimination is Associated with Health Behaviors among African Americans in the Jackson Heart Study* 
Using Jackson Heart Study data, we examined associations of multiple measures of perceived discrimination with health behaviors among African Americans (AA).
The cross-sectional associations of everyday, lifetime, and burden of discrimination with odds of smoking and mean differences in physical activity, dietary fat, and sleep were examined among 4,939 35–84 year old participants after adjustment for age and socioeconomic status (SES).
Men reported slightly higher levels of everyday and lifetime discrimination than women and similar levels of burden of discrimination as women. After adjustment for age and SES, everyday discrimination was associated with more smoking and a greater percentage of dietary fat in men and women (OR for smoking: 1.13, 95%CI 1.00,1.28 and 1.19, 95%CI 1.05,1.34; mean difference in dietary fat: 0.37, p<.05 and 0.43, p<.01, in men and women, respectively). Everyday and lifetime discrimination were associated with fewer hours of sleep in men and women (mean difference for everyday discrimination: −0.08, p<.05 and −0.18, p<.001, respectively; and mean difference for lifetime discrimination: −0.08, p<.05, and −0.24, p<.001, respectively). Burden of discrimination was associated with more smoking and fewer hours of sleep in women only.
Higher levels of perceived discrimination were associated with select health behaviors among men and women. Health behaviors offer a potential mechanism through which perceived discrimination affects health in AA.
PMCID: PMC5014355  PMID: 26417003
social epidemiology; epidemiology of cardiovascular disease; health behavior; psychological stress
10.  Disparities in Physical Activity Resource Availability in Six US Regions 
Preventive medicine  2015;78:17-22.
We conducted an ecologic study to determine physical activity resource availability overall and by sociodemographic groups in parts of six states (CA, IL, MD, MN, NC, NY). Data on parks and recreational facilities were collected from 3 sources in 2009–2012. Three measures characterized park and recreational facility availability at the census tract level: presence of ≥1 resource, number of resources, and resource kernel density. Associations between resource availability and census tract characteristics (predominant racial/ethnic group, median income, and proportion of children and older adults) were estimated using linear, binomial, and zero-inflated negative binomial regression in 2014. Pooled and stratified analyses were conducted. The study included 7,139 census tracts, comprising 9.5% of the 2010 US population. Overall the availability of parks and recreational facilities was lower in predominantly minority relative to non-Hispanic white census tracts. Low-income census tracts and those with a higher proportion of children had an equal or greater availability of park resources but fewer recreational facilities. Stratification revealed substantial variation in resource availability by state. The availability of physical activity resources varied by sociodemographic characteristics and across regions. Improved knowledge of resource distribution can inform strategies to provide equitable access to parks and recreational facilities.
PMCID: PMC4547867  PMID: 26067479
parks and recreation; physical activity; geographic information systems (GIS); policy; environment
11.  Perceived Discrimination and Incident Cardiovascular Events 
American Journal of Epidemiology  2015;182(3):225-234.
Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45–84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000–2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1–standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults.
PMCID: PMC4517694  PMID: 26085044
cardiovascular disease; discrimination; race/ethnicity; risk factors
12.  Associations of Anger, Anxiety and Depressive symptoms with Carotid Arterial Wall Thickness: the Multi-Ethnic Study of Atherosclerosis 
Psychosomatic medicine  2012;74(5):517-525.
Carotid arterial wall thickness, measured as intima-media thickness (IMT), is an early subclinical indicator of cardiovascular disease. Few studies have investigated the association of psychological factors with IMT across multiple ethnic groups and by gender.
We included 6,561 men and women (2,541 whites, 1,790 African Americans, 1,436 Hispanics, and 794 Chinese) aged 45 to 84 years who took part in the first examination of the Multi-Ethnic Study of Atherosclerosis. Associations of trait anger, trait anxiety, and depressive symptoms with mean values of common carotid artery (CCA) and internal carotid artery (ICA) IMTs were investigated using multivariable regression and logistic models.
In age, gender, race/ethnicity-adjusted analyses, the trait anger score was positively associated with CCA and ICA IMTs (mean differences per one SD increment of trait anger score were 0.014 (95% CI, 0.003–0.025, p=0.01) and 0.054 (0.017–0.090, p=0.004) for CCA and ICA IMTs respectively). Anger was also associated with the presence of carotid plaque (age, gender, and race/ethnicity-adjusted odds ratio per one SD increase in trait anger: 1.27 (95%CI, 1.06–1.52)). The associations of the trait anger score with thicker IMT was attenuated after adjustment for covariates, but remained statistically significant. Associations were stronger in men than in women and in whites than in other race/ethnic groups but heterogeneity was only marginally statistically significant by race/ethnicity. There was no association of depressive symptoms or trait anxiety with IMT.
Only one of the three measures examined was associated with IMT and the patterns appeared to be heterogeneous across race/ethnic groups.
PMCID: PMC4966673  PMID: 22511725
Anger; Anxiety; Carotid artery wall thickness; Depressive symptoms; Intima-media thickness; Race/Ethnicity
13.  Changes in Walking Associated with Perceived Neighborhood Safety and Police-Recorded Crime: The Multi-Ethnic Study of Atherosclerosis 
Preventive medicine  2015;73:88-93.
To explore the association of changes in perceived safety and police-recorded crime with changes in transport and leisure walking using longitudinal data from Chicago residents participating in the Multi-Ethnic Study of Atherosclerosis (2000–2012).
Main exposures included perceived safety (self-reported as feeling safe walking in the neighborhood and reporting violence to be a problem in the neighborhood), and one-year counts of police-recorded crime occurring within a one-mile buffer of participants’ residencies. Main outcomes included transport and leisure walking (self-reported and calculated as total minutes/week across four study visits). Fixed effects models assessed the association of change in perceived safety and police-recorded crime with changes in transport and leisure walking over a 10-year period for 796 adults.
No associations were found between changes in perceived safety and either changes in transport or leisure walking. Residing in areas with increases in murder was associated with decreases in transport walking. However, no other associations were found with police-recorded crime.
There continues to be a need to continue exploring the benefits of cultivating safe neighborhoods that enhance resident health and well-being. Research should continue examining how community initiatives may build safe environments and community identity that promote walking.
PMCID: PMC4937793  PMID: 25625690
14.  Examining the cross-sectional and longitudinal association between diurnal cortisol and neighborhood characteristics: Evidence from the Multi-Ethnic Study of Atherosclerosis 
Health & place  2015;34:199-206.
We examined cross-sectional and longitudinal associations between neighborhood socioeconomic status, social cohesion and safety and features of the diurnal cortisol curve including: area under the curve (AUC), wake-to-bed slope, wake-up, cortisol awakening response (CAR, wake-up to 30 minutes post-awakening), early decline (30 minutes to 2 hours post-awakening) and late decline (2 hours post-awakening to bed time). In cross-sectional analyses, higher neighborhood poverty was associated with a flatter early decline and a flatter wake-to-bed slope. Higher social cohesion and safety were associated with higher wake-up cortisol, steeper early decline and steeper wake-to-bed slope. Over 5 years, wake-up cortisol increased, CAR, early decline, late decline and wake-to-bed slope became flatter and AUC became larger. Higher poverty was associated with less pronounced increases in wake-up and AUC, while higher social cohesion was associated with greater increases in wake-up and AUC. Adverse neighborhood environments were cross-sectionally associated with flatter cortisol profiles, but associations with changes in cortisol were weak and not in the expected direction.
PMCID: PMC4599439  PMID: 26073509
Neighborhood poverty; social cohesion; safety; cortisol; stress; Hypothalmic-Pituitary-Adrenal axis
15.  Loneliness, Depression, and Inflammation: Evidence from the Multi-Ethnic Study of Atherosclerosis 
PLoS ONE  2016;11(7):e0158056.
Both objective and subjective aspects of social isolation have been associated with alterations in immune markers relevant to multiple chronic diseases among older adults. However, these associations may be confounded by health status, and it is unclear whether these social factors are associated with immune functioning among relatively healthy adults. The goal of this study was to examine the associations between perceived loneliness and circulating levels of inflammatory markers among a diverse sample of adults.
Data come from a subset of the Multi-Ethnic Study of Atherosclerosis (n = 441). Loneliness was measured by three items derived from the UCLA Loneliness Scale. The association between loneliness and C-reactive protein (CRP) and fibrinogen was assessed using multivariable linear regression analyses. Models were adjusted for demographic and health characteristics.
Approximately 50% of participants reported that they hardly ever felt lonely and 17.2% felt highly lonely. Individuals who were unmarried/unpartnered or with higher depressive symptoms were more likely to report being highly lonely. There was no relationship between perceived loneliness and ln(CRP) (β = -0.051, p = 0.239) adjusting for demographic and health characteristics. Loneliness was inversely associated with ln(fibrinogen) (β = -0.091, p = 0.040), although the absolute magnitude of this relationship was small.
These results indicate that loneliness is not positively associated with fibrinogen or CRP among relatively healthy middle-aged adults.
PMCID: PMC4930171  PMID: 27367428
16.  Lack of significant association between type 2 diabetes mellitus with longitudinal change in diurnal salivary cortisol: the multiethnic study of atherosclerosis 
Endocrine  2016;53(1):227-239.
Cross-sectional association has been shown between type 2 diabetes and hypothalamic–pituitary–adrenal (HPA) axis dysregulation; however, the temporality of this association is unknown. Our aim was to determine if type 2 diabetes is associated with longitudinal change in daily cortisol curve features. We hypothesized that the presence of type 2 diabetes may lead to a more blunted and abnormal HPA axis profile over time, suggestive of increased HPA axis dysregulation. This was a longitudinal cohort study, including 580 community-dwelling individuals (mean age 63.7 ± 9.1 years; 52.8 % women) with (n = 90) and without (n = 490) type 2 diabetes who attended two MultiEthnic Study of Atherosclerosis Stress ancillary study exams separated by 6 years. Outcome measures that were collected were wake-up and bedtime cortisol, cortisol awakening response (CAR), total area under the curve (AUC), and early, late, and overall decline slopes. In univariate analyses, wake-up and AUC increased over 6 years more in persons with as compared to those without type 2 diabetes (11 vs. 7 % increase for wake-up and 17 vs. 11 % for AUC). The early decline slope became flatter over time with a greater flattening observed in diabetic compared to non-diabetic individuals (23 vs. 9 % flatter); however, the change was only statistically significant for wake-up cortisol (p-value: 0.03). Over time, while CAR was reduced more, late decline and overall decline became flatter, and bedtime cortisol increased less in those with as compared to those without type 2 diabetes, none of these changes were statistically significant in adjusted models. We did not identify any statistically significant change in cortisol curve features over 6 years by type 2 diabetes status.
PMCID: PMC4902713  PMID: 26895003
Diabetes; Stress; Cortisol; HPA axis; Epidemiology
17.  Modeling spatial segregation and travel cost influences on utilitarian walking: Towards policy intervention 
We develop an agent-based model of utilitarian walking and use the model to explore spatial and socioeconomic factors affecting adult utilitarian walking and how travel costs as well as various educational interventions aimed at changing attitudes can alter the prevalence of walking and income differentials in walking. The model is validated against US national data. We contrast realistic and extreme parameter values in our model and test effects of changing these parameters across various segregation and pricing scenarios while allowing for interactions between travel choice and place and for behavioral feedbacks. Results suggest that in addition to income differences in the perceived cost of time, the concentration of mixed land use (differential density of residences and businesses) are important determinants of income differences in walking (high income walk less), whereas safety from crime and income segregation on their own do not have large influences on income differences in walking. We also show the difficulty in altering walking behaviors for higher income groups who are insensitive to price and how adding to the cost of driving could increase the income differential in walking particularly in the context of segregation by income and land use. We show that strategies to decrease positive attitudes towards driving can interact synergistically with shifting cost structures to favor walking in increasing the percent of walking trips. Agent-based models, with their ability to capture dynamic processes and incorporate empirical data, are powerful tools to explore the influence on health behavior from multiple factors and test policy interventions.
PMCID: PMC4342617  PMID: 25733776
Agent-based model; Utilitarian walking; Travel costs; Spatial segregation; Socioeconomic disparities; Behavior feedback
18.  Long-term Exposure to Air Pollution and Markers of Inflammation, Coagulation, and Endothelial Activation 
Epidemiology (Cambridge, Mass.)  2015;26(3):310-320.
Air pollution is associated with cardiovascular disease, and systemic inflammation may mediate this effect. We assessed associations between long- and short-term concentrations of air pollution and markers of inflammation, coagulation, and endothelial activation.
We studied participants from the Multi-Ethnic Study of Atherosclerosis from 2000 to 2012 with repeat measures of serum C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, D-dimer, soluble E-selectin, and soluble Intercellular Adhesion Molecule-1. Annual average concentrations of ambient fine particulate matter (PM2.5), individual-level ambient PM2.5 (integrating indoor concentrations and time–location data), oxides of nitrogen (NOx), nitrogen dioxide (NO2), and black carbon were evaluated. Short-term concentrations of PM2.5 reflected the day of blood draw, day prior, and averages of prior 2-, 3-, 4-, and 5-day periods. Random-effects models were used for long-term exposures and fixed effects for short-term exposures. The sample size was between 9,000 and 10,000 observations for CRP, IL-6, fibrinogen, and D-dimer; approximately 2,100 for E-selectin; and 3,300 for soluble Intercellular Adhesion Molecule-1.
After controlling for confounders, 5 µg/m3 increase in long-term ambient PM2.5 was associated with 6% higher IL-6 (95% confidence interval = 2%, 9%), and 40 parts per billion increase in long-term NOx was associated with 7% (95% confidence interval = 2%, 13%) higher level of D-dimer. PM2.5 measured at day of blood draw was associated with CRP, fibrinogen, and E-selectin. There were no other positive associations between blood markers and short- or long-term air pollution.
These data are consistent with the hypothesis that long-term exposure to air pollution is related to some markers of inflammation and fibrinolysis.
PMCID: PMC4455899  PMID: 25710246
19.  Associations of chronic individual- and neighborhood-level stressors with incident coronary heart disease: The Multi-Ethnic Study of Atherosclerosis 
Several individual-level stressors have been linked to incident coronary heart disease (CHD), but less attention has focused on the influence of neighborhood-level sources of stress. In this study we examined prospective associations of individual- and neighborhood-level stressors with incident CHD.
Multi-Ethnic Study of Atherosclerosis participants aged 45–84 years at baseline (2000–2002) with complete data were included in the analyses (n=6678 for individual-level and n=6105 for neighborhood-level stressors). CHD was defined as nonfatal myocardial infarction, resuscitated cardiac arrest, or CHD death. Median follow-up was 10.2 years. Multivariable Cox proportional hazards models were fitted to estimate associations of individual- and neighborhood-level stressors (categorized into approximate tertiles) with incident CHD.
Higher reported individual-level stressors were associated with higher incident CHD. Participants in the high individual-level stressor category had 65% higher risk of incident CHD (95% confidence interval (CI): 1.23, 2.22) than those in the low category after adjusting for sociodemographics (P for trend = 0.002). This association weakened but remained significant with further adjustment for behavioral and biological risk factors. There was a nonlinear relationship between neighborhood-level stressors and incident CHD (P for quadratic term=0.01). Participants in the medium category had 49% higher CHD risk (95% CI: 1.06, 2.10) compared with those in the low category; those in the high category had only 27% higher CHD risk (95% CI: 0.83, 1.95). These associations persisted with adjustment for risk factors and individual-level stressors.
Individual-level and neighborhood-level stressors were independently associated with incident CHD, though the nature of the relationships differed.
PMCID: PMC4806779  PMID: 25271247
stress; coronary heart disease; neighborhoods
20.  Long-Term Exposure to Air Pollution and Type 2 Diabetes Mellitus in a Multiethnic Cohort 
American Journal of Epidemiology  2015;181(5):327-336.
Although air pollution has been suggested as a possible risk factor for type 2 diabetes mellitus (DM), results from existing epidemiologic studies have been inconsistent. We investigated the associations of prevalence and incidence of DM with long-term exposure to air pollution as estimated using annual average concentrations of particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) and nitrogen oxides at baseline (2000) in the Multi-Ethnic Study of Atherosclerosis. All participants were aged 45–84 years at baseline and were recruited from 6 US sites. There were 5,839 participants included in the study of prevalent DM and 5,135 participants without DM at baseline in whom we studied incident DM. After adjustment for potential confounders, we found significant associations of prevalent DM with PM2.5 (odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.00, 1.17) and nitrogen oxides (OR = 1.18, 95% CI: 1.01, 1.38) per each interquartile-range increase (2.43 µg/m3 and 47.1 ppb, respectively). Larger but nonsignificant associations were observed after further adjustment for study site (for PM2.5, OR = 1.16, 95% CI: 0.94, 1.42; for nitrogen oxides, OR = 1.29, 95% CI: 0.94, 1.76). No air pollution measures were significantly associated with incident DM over the course of the 9-year follow-up period. Results were partly consistent with a link between long-term exposure to air pollution and the risk of type 2 DM. Additional studies with a longer follow-up time and a greater range of air pollution exposures, including high levels, are warranted to evaluate the hypothesized association.
PMCID: PMC4339386  PMID: 25693777
air pollution; diabetes; nitrogen oxides; particulate matter; prospective cohort study
21.  Ambient air pollution and racial/ethnic differences in carotid intima-media thickness in the Multi-Ethnic Study of Atherosclerosis (MESA) 
In the USA, ethnic disparities in atherosclerosis persist after accounting for known risk factors. Ambient air pollution is associated with increased levels of atherosclerosis and differs in the USA by race/ethnicity. We estimated the influence of ambient air pollution exposure to ethnic differences in common carotid intima-media thickness (IMT).
We cross-sectionally studied 6347 Caucasian-American, African-American, Hispanic and Chinese adults across 6 US cities in 2000–2002. Annual ambient air pollution concentrations (fine particulate matter [PM2.5] and oxides of nitrogen [NOX]) were estimated at each participant’s residence. IMT was assessed by ultrasound.
The mean IMT was 19.4 and 37.6 μm smaller for Hispanic women and men, 53.6 and 7.1 μm smaller for Chinese women and men, and 23.4 and 38.7 μm higher for African-American women and men compared with Caucasian-American women and men. After adjustment for PM2.5, the differences in IMT remained similar for Hispanic and African-American participants but was even more negative for Chinese participants (mean IMT difference of −58.4 μm for women and −15.7 μm for men) compared with Caucasian-American participants. The IMT difference in Chinese participants compared with Caucasian-American participants related to their higher PM2.5 exposures was 4.8 μm (95% CI 0.2 to 10.8) for women and 8.6 μm (95% CI 3.4 to 15.3) for men. NOX was not related to ethnic differences in IMT.
The smaller carotid IMT levels in Chinese participants were even smaller after accounting for higher PM2.5 concentrations in Chinese participants compared with Caucasian-American participants. Air pollution was not related to IMT differences in African-American and Hispanic participants compared with Caucasian-American participants.
PMCID: PMC4763882  PMID: 26142402
22.  Social Engagement and Chronic Disease Risk Behaviors: The Multi-Ethnic Study of Atherosclerosis 
Preventive medicine  2014;0:61-66.
Although engagement in social networks is important to health, multiple different dimensions exist. This study identifies which dimensions are associated with chronic disease risk behaviors.
Cross-sectional data on social support, loneliness, and neighborhood social cohesion from 5381 participants, aged 45–84 from the Multi-Ethnic Study of Atherosclerosis was used.
After adjusting for individual characteristics and all social engagement variables, social support was associated with lower smoking prevalence (PR=0.88, 95% CI: 0.82, 0.94), higher probability of having quit (PR=1.03, 95% CI: 1.01, 1.06) and a slightly higher probability of achieving physical activity recommendations (PR=1.03, 95% CI: 1.01, 1.06). Neighborhood social cohesion was associated with very slightly higher probability of achieving recommended (PR=1.03, 95% CI: 1.01, 1.05) or any regular (PR=1.0, 95% CI: 1.01, 1.04) physical activity, and a higher probability of consuming at least five daily fruit and vegetable servings (PR=1.05, 95% CI: 1.01, 1.09).
Both social support and neighborhood social cohesion, a less commonly considered aspect of social engagement, appear to be important for chronic disease prevention interventions and likely act via separate pathways.
PMCID: PMC4329061  PMID: 25524614
social engagement; social support; neighborhood social cohesion; physical activity; smoking
23.  Assessing the need for a new nationally representative household panel survey in the United States 
We introduce this special issue on the critical matter of whether the existing household panel surveys in the U.S. are adequate to address the important emerging social science and policy questions of the next few decades. We summarize the conference papers which address this issue in different domains. The papers detail many new and important emerging research questions but also identify key limitations in existing panels in addressing those questions. To address these limitations, we consider the advantages and disadvantages of initiating a new, general-purpose omnibus household panel in the U.S. We also discuss the particular benefits of starting new panels that have specific targeted domains such as child development, population health and health care. We also develop a list of valuable enhancements to existing panels which could address many of their limitations.
PMCID: PMC4678926  PMID: 26688609
Survey; economics; sociology; health research
24.  Neighborhood Ethnic Composition, Spatial Assimilation, and Change in Body Mass Index Over Time Among Hispanic and Chinese Immigrants: Multi-Ethnic Study of Atherosclerosis 
American journal of public health  2014;104(11):2138-2146.
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.
We used Multi-Ethnic Study of Atherosclerosis data over a median 9-year follow-up (2000–2002 to 2010–2012) among Chinese (n = 642) and Hispanic (n = 784) immigrants aged 45 to 84 years at baseline. We incorporated information about residential moves and used econometric fixed-effects models to control for confounding by time-invariant characteristics. We characterized neighborhood racial/ethnic composition with census tract–level percentage Asian for Chinese participants and percentage Hispanic for Hispanic participants (neighborhood coethnic concentration).
In covariate-adjusted longitudinal fixed-effects models, results suggested associations between decreasing neighborhood coethnic concentration and increasing weight, although results were imprecise: within-person BMI increases associated with an interquartile range decrease in coethnic concentration were 0.15 kilograms per meters squared (95% confidence interval [CI] = 0.00, 0.30) among Chinese and 0.17 kilograms per meters squared (95% CI = −0.17, 0.51) among Hispanic participants. Results did not differ between those who did and did not move during follow-up.
Residential neighborhoods may help shape chronic disease risk among immigrants.
PMCID: PMC4192094  PMID: 25211724
25.  Neighborhood Built Environment Change and Change in BMI and Waist Circumference: Multi-Ethnic Study of Atherosclerosis 
Obesity (Silver Spring, Md.)  2014;22(11):2450-2457.
To examine longitudinal associations of the neighborhood built environment with objectively measured body mass index (BMI) and waist circumference (WC) in a geographically and racial/ethnically diverse group of adults.
Design and Methods
This study used data from 5,506 adult participants in the Multi-Ethnic Study of Atherosclerosis, aged 45–84 years in 2000 (baseline). BMI and WC were assessed at baseline and four follow-up visits (median follow-up 9.1 years). Time-varying built environment measures (population density, land-use, destinations, bus access, and street characteristics) were created using Geographic Information Systems. Principal components analysis was used to derive composite scores for three built environment factors. Fixed-effects models, tightly controlling for all time-invariant characteristics, estimated associations between change in the built environment and change in BMI and WC.
Increases in the intensity of development (higher density of walking destinations and population density, and lower percent residential) were associated with less pronounced increases or decreases over time in BMI and WC. Changes in connected retail centers (higher percent retail, higher street connectivity) and public transportation (distance to bus) were not associated with changes in BMI or WC.
Longitudinal changes in the built environment, particularly increased density, are associated with decreases in BMI and WC.
PMCID: PMC4224985  PMID: 25136965
Environmental Factors; Body Mass Index-BMI; Waist Circumference; Longitudinal; Public Health

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