Neighbourhood food environment and gestational diabetes in New York City

Janevic T, Borrell LN, Savitz DA, Herring AH, Rundle A. Neighbourhood food environment and gestational diabetes in New York City. Paediatric and Perinatal Epidemiology 2010; 24 : 249–254. The association between neighbourhood characteristics and gestational diabetes has not been examined previously. We investigated the relationship between the number of healthy food outlets (supermarkets; fruit/vegetable and natural food stores), and unhealthy food outlets (fast food; pizza; bodegas; bakeries; convenience, candy/nut and meat stores) in census tract of residence, and gestational diabetes in New York City. Gestational diabetes, census tract and individual‐level covariates were ascertained from linked birth‐hospital data for 210 926 singleton births from 2001 to 2002 and linked to commercial data on retail food outlets. Adjusted odds ratios (aOR) were estimated using a multilevel logistic model. No association between food environment measures and gestational diabetes was found, with aORs ranging from 0.95 to 1.04. However, an increased odds of pre‐pregnancy weight >200 lbs for women living in a given neighbourhood with no healthy food outlets [aOR = 1.14, 95% CI 1.07, 1.21] or only one healthy food place [aOR = 1.10, 95% CI 1.04, 1.18] relative to two or more healthy food outlets was found. Due to probable misclassification of neighbourhood food environment and pre‐pregnancy obesity results are likely to be biased towards the null. Future research, including validity studies, on the neighbourhood food environment, obesity during pregnancy and gestational diabetes is warranted.     

Clashing paradigms: an empirical examination of cultural proxies and socioeconomic condition shaping Latino health

ObjectiveMuch debate exists regarding the role of culture versus socioeconomic position in shaping the health of Latino populations. We propose that both may matter for health and explicitly test their independent and joint effects on smoking and physical activity.MethodsWe used the 2010 National Health Interview Survey, a population-based survey of the U.S. population, to estimate the prevalence of smoking and physical activity by language use (cultural proxy) and education among Latino adults (n = 4929). We fit log binomial regression models to estimate prevalence ratios and test for interaction.ResultsEnglish-language use and educational attainment were each independently associated with smoking and physical activity. Joint effect models showed that individuals with both greater use of the English language and low levels of education were nearly three times more likely to smoke (prevalence ratio, 2.59; 95% confidence interval, 1.83-3.65) than those with low English language use and high education (referent group); high acculturation and high education were jointly associated with increased activity (prevalence ratio 2.24, 95% confidence interval, 1.79-2.81).ConclusionsCultural proxies such as language use and educational attainment are both important determinants of health among Latinos. Their joint effect suggests the need to simultaneously consider Latinos' socioeconomic position and their increased risk of adopting health-damaging behaviors while addressing culturally-specific factors that may mitigate risk.     

Social networks among blacks and whites: the interaction between race and age

OBJECTIVES: This study examined the main and interactive effects of age and race on the core characteristics of social networks including size, frequency of contact, geographical proximity, and composition of network. METHODS: Respondents were drawn from a stratified probability sample of people aged 20-93 in the greater Detroit metropolitan area. Approximately 30% of the sample were African American, and people aged 60 and older were over-sampled (n = 1.382). The authors used hierarchical regression analysis to estimate the influence of race and age on each component of social network, controlling for marital status, gender, and education. An interaction term (Race x Age) was added to explore the extent to which age moderates any detected race differences. RESULTS: Older age was associated with smaller, less frequently seen, and less proximal networks that had a higher proportion of kin. Blacks and Whites were similar with regard to proximity, but Blacks had smaller networks, more contact with network members, and more family members in their networks. Race differences in frequency of contact and proportion of kin were moderated by age, such that the differences in these variables diminished with increasing age. DISCUSSION: A systematic analysis of how age, race, and their interaction influence the characteristics of social networks furnishes important empirical knowledge about social networks among diverse groups. Such data may provide a context for how, and some explanation for why, support exchanges occur.     

The social relations-physical health connection: a comparison of elderly samples from the United States and Japan

Cross-national comparison of the social relations-physical health association in the elderly can broaden our understanding of the implications of social relationships in this age group. Using representative cross-sectional samples of adults aged 60-93 years from metropolitan areas in the United States and Japan (n = 1005), we used analysis of variance to examine between-country differences in the association of illness with measures of network structure, social support, and negative relations. One significant between-country difference in this association was found: in Japan only, ill women reported more available financial help from their child than did non-ill women (p < .05). Ill women in both countries reported less sick care available from their spouse than did ill men (p < .05) and more negative relations with their child than did non-ill women (p < .05). These results suggest the primacy of gender, rather than cultural context, in shaping the association between social relations and health.     

Longitudinal effects of social support on the health and functioning of older women with heart disease

This study examined the effects of: 1) four dimensions of social support, 2) the number of close social ties, and 3) marital status on the physical and psychological health and functioning of 471 women aged 60 years and over with heart disease. Linear mixed models were used to assess the impact of each baseline social relations predictor on health outcomes at four-, 12-, and 18-month follow-up intervals. A second set of models examined the association between change in support variables over time with concomitant change in health outcomes. Results indicated that baseline emotional/ informational support, positive social interaction, affectionate support, tangible support, number of close friends and relatives, and marital status all significantly predicted (p < .05) one or more health outcomes over time. Increases in positive social interaction and emotional support over time were significantly associated with concurrent improvement in all self-reported physical and psychological health outcomes. Interventions that enhance the availability of emotional/informational support and promote social interaction are needed for this population.     

The effect of social relations with children on the education-health link in men and women aged 40 and over

Accumulated evidence demonstrates a strong relationship between socioeconomic status (SES) and health. Our examination of this relationship focuses on education, an established indicator of SES, and tests whether social relations, particularly with children, mediate and/or moderate the education-health link for middle-aged and older parents. The data are drawn from a regionally representative sample of adults (aged 40-93) in the Detroit area, USA. All analyses are stratified by gender (N=males: 330; females: 468). A series of multiple regression analyses were performed to test whether social relations mediate the association between education and health. Although analyses revealed no mediation effect, both men and women with less education were found to have smaller social networks. Women with more education confided less in their children than women with less education did. A series of hierarchical regression analyses were performed to test whether social relations variables moderate the relationship between education and health. Separate analyses by gender indicated that men, but not women, with less education who had larger networks and who perceived emotional, financial and sick care support to be available from a child had lower scores on a health problems index. Findings indicate that the health of lower-educated men in the presence of key social supports parallels the advantaged health status of men with higher levels of education. These findings suggest that social relationships may be a protective factor for the health of men in the lower socioeconomic strata.