Neighborhood effects on primary care access in Los Angeles

Individual health outcomes differ greatly between neighborhoods, and recent research has begun to examine how neighborhood environment affects individual health. A common hypothesis is that the inequitable distribution of healthcare resources limits access to health care for individuals in disadvantaged neighborhoods, causing poorer long-term health. Yet, research has not examined if neighborhood environment actually affects an individual's ability to access primary care. Data from the Los Angeles Family and Neighborhood Survey suggests there is significant variation between neighborhoods in an individual's ability to access primary care. This neighborhood-level effect is not explained by the composition of individuals living in the neighborhood. Four mechanisms through which neighborhood environment could affect an individual's ability to access primary care are examined: (1) neighborhood information networks, (2) neighborhood health behavior norms, (3) neighborhood social capital and (4) neighborhood healthcare resources. Social capital and healthcare resources significantly predict an individual's primary care access. Since differences in primary care access may explain individual-level health disparities between neighborhoods, policies designed to improve primary care access must account for both individual and neighborhood effects.     

Neighborhood racial composition,social capital and black all-cause mortality in Philadelphia

Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia.     

Local services and amenities, neighborhood social capital, and health

Recent work on health and place has examined the impact of the environment on health. At the local level, research has followed several strands, such as contextual effects of neighborhoods, the impact of differential access to services and amenities, effects of a neighborhood's collective efficacy, and the relationship between social capital and health. Of these four approaches, social capital has generated the most debate; some scholars discuss social capital as a key epidemiological variable, while others discount or dismiss its utility. We undertook this research to assess whether the concept of social capital could increase our understanding of the impact of neighborhoods on residents' health. We utilized key informant interviews and focus groups to understand ways in which residents of diverse neighborhoods in one large California city perceived that their local communities were affecting health. We argue in this paper that using the term "social capital" to discuss social resources and their mobilization in a particular neighborhood highlights the ways in which social resources can vary in relation to economic resources, and that residents of neighborhoods with differing levels of services and amenities face different issues when mobilizing to improve their neighborhoods. Additionally, the projects that people invest in vary by neighborhood socioeconomic status. We draw on the paired concepts of "bridging" and "bonding" social capital, and discuss that while stores of bonding social capital may be more uniform across neighborhoods of varying SES, bridging social capital tends to be found in greater amounts in neighborhoods of higher SES which allows them greater success when mobilizing to improve their neighborhoods.     

Neighborhood economic conditions, social processes, and self-rated health in low-income neighborhoods in Texas: a multilevel latent variables model

This paper develops and tests a comprehensive model to explain the relationships of neighborhood economic indicators to multiple dimensions of neighborhood social and physical organization as well as the pathways through which neighborhood social and physical characteristics influence individual health outcomes. We hypothesized that neighborhood poverty would be associated with lower collective efficacy, lower social capital, higher degrees of social and physical disorder, worse social processes pertaining to children such as trust, and higher degrees of fear of crime and racism. Neighborhood social and physical characteristics were hypothesized to mediate the effect of neighborhood poverty on self-rated health, both directly and indirectly through their influence on neighborhood differences in social support and health behaviors, which in turn affect individual health. The results, based on data from low-income neighborhoods in Texas, USA generally supported the model and indicated that the effect of neighborhood impoverishment on health is mediated by social and physical neighborhood characteristics.     

When being alone might be better: neighborhood poverty,social capital,and child mental health

Public health researchers have provided a growing body of evidence on the salutary effects of social capital for individual well being. The importance of these findings for social epidemiology, however, may have precluded so far a full examination of the complex association between neighborhood social processes and the well being of individual residents, including the often acknowledged potential "downside" of social capital. In this study, we examine the association between attachment to community, an indicator of social capital, in a sample of African American parents, and the presence of behavior problems in their preschool children. Participants were recruited from a socioeconomically diverse set of neighborhoods. Attachment to community was assessed using a multi-item scale comprised of two subscales, general sense of community and how well one knew one's neighbors. Results indicated that the association between how well a parent knew her neighbors and the presence of child behavior problems differed depending on the degree of economic impoverishment of the neighborhood. In wealthy neighborhoods, children whose parent reported knowing few of the neighbors had higher levels of internalizing problems such as anxiety and depression compared to those who knew many of their neighbors. In contrast, in poor neighborhoods, children whose parent reported knowing few of the neighbors had lower levels of internalizing problems compared to those who knew many of their neighbors. These results are discussed in terms of furthering the study of the contextual nature of the social capital in explaining community inequalities in mental health among children.     

Neighborhood social capital and crime victimization: Comparison of spatial regression analysis and hierarchical regression analysis

Crime is an important determinant of public health outcomes, including quality of life, mental well-being, and health behavior. A body of research has documented the association between community social capital and crime victimization. The association between social capital and crime victimization has been examined at multiple levels of spatial aggregation, ranging from entire countries, to states, metropolitan areas, counties, and neighborhoods. In multilevel analysis, the spatial boundaries at level 2 are most often drawn from administrative boundaries (e.g. Census tracts in the U.S.). One problem with adopting administrative definitions of neighborhoods is that it ignores spatial spillover. We conducted a study of social capital and crime victimization in one ward of Tokyo city, using a Spatial Durbin Model with an inverse-distance weighting matrix that assigned each respondent a unique level of "exposure" to social capital based on all other residents' perceptions. The study is based on a postal questionnaire sent to 20-69 years old residents of Arakawa Ward, Tokyo. The response rate was 43.7%. We examined the contextual influence of generalized trust, perceptions of reciprocity, two types of social network variables, as well as two principal components of social capital (constructed from the above four variables). Our outcome measure was self-reported crime victimization in the last five years. In the Spatial Durbin Model, we found that neighborhood generalized trust, reciprocity, supportive networks and two principal components of social capital were each inversely associated with crime victimization. By contrast, a multilevel regression performed with the same data (using administrative neighborhood boundaries) found generally null associations between neighborhood social capital and crime. Spatial regression methods may be more appropriate for investigating the contextual influence of social capital in homogeneous cultural settings such as Japan.     

Social capital and neighborhood mortality rates in Chicago

Several empirical studies have suggested that neighborhood characteristics influence health, with most studies having focused on neighborhood deprivation or aspects of the physical environment, such as services and amenities. However, such physical characteristics are not the only features of neighborhoods that potentially affect health. Neighborhoods also matter because of the nature of their social organization. This study examined social capital as a potential neighborhood characteristic influencing health. Using a cross-sectional study design which linked counts of death for persons 45-64 years by race and sex to neighborhood indicators of social capital and poverty for 342 Chicago neighborhoods in the USA, we tested the ecological association between neighborhood-level social capital and mortality rates, taking advantage of the community survey data collected as part of the Project on Human Development in Chicago Neighborhoods. We estimated a hierarchical generalized linear model to examine the association of race and sex specific mortality rates to social capital. Overall, neighborhood social capital-as measured by reciprocity, trust, and civic participation-was associated with lower neighborhood death rates, after adjustment for neighborhood material deprivation. Specifically, higher levels of neighborhood social capital were associated with lower neighborhood death rates for total mortality as well as death from heart disease and "other" causes for White men and women and, to a less consistent extent, for Blacks. However, there was no association between social capital and cancer mortality. Although, the findings from this study extend the state-level findings linking social capital to health to the level of neighborhoods, much work remains to be carried out before social capital can be widely applied to improve population health, including establishing standards of measurement, and exploring the potential "downsides" of social capital.     

Social capital at work as a predictor of employee health: multilevel evidence from work units in Finland

The majority of previous research on social capital and health is limited to social capital in residential neighborhoods and communities. Using data from the Finnish 10-Town study we examined social capital at work as a predictor of health in a cohort of 9524 initially healthy local government employees in 1522 work units, who did not change their work unit between 2000 and 2004 and responded to surveys measuring social capital at work and health at both time-points. We used a validated tool to measure social capital with perceptions at the individual level and with co-workers' responses at the work unit level. According to multilevel modeling, a contextual effect of work unit social capital on self-rated health was not accounted for by the individual's socio-demographic characteristics or lifestyle. The odds for health impairment were 1.27 times higher for employees who constantly worked in units with low social capital than for those with constantly high work unit social capital. Corresponding odds ratios for low and declining individual-level social capital varied between 1.56 and 1.78. Increasing levels of individual social capital were associated with sustained good health. In conclusion, this longitudinal multilevel study provides support for the hypothesis that exposure to low social capital at work may be detrimental to the health of employees.     

Perceptions of neighborhood social environment and drug dependence among incarcerated women and men: a cross-sectional analysis

ABSTRACT: BACKGROUND: Perception of neighborhood social environment can influence an individual's susceptibility to drug dependence. However, this has never been examined with a jailed sample, where frequent transitions between local jails and disadvantaged neighborhoods are common. Understanding these associations could aid in the design of targeted programs to decrease drug dependence and recidivism among the incarcerated. METHODS: For this study, 596 women and men from three Kansas City jails were surveyed over the course of six months in 2010. Drug dependence was assessed with DSM-IV criteria. Independent variables included fear of one's neighborhood, perceived level of neighborhood violence, and social capital. All data were self-reported and were analyzed using logistic regression. RESULTS: Controlling for gender and age, fear of neighborhood violence was associated with increased odds of having drug dependence (OR = 1.27, CI 1.02, 1.58) and a higher level of social capital prior to incarceration was associated with lower odds of drug dependence (OR = 0.65, CI 0.44, 0.96). Mental health problem diagnosis and past year intimate partner violence were significant mediating factors. Gender and race/ethnicity were significant moderating factors between neighborhood disadvantage and drug dependence. CONCLUSIONS: Our study suggests that drug dependence programs for women and men who cycle between jails and communities require both individual- and community-level interventions. To be most effective, programs at the community-level should focus on helping specific groups navigate their communities, as well as address individual health needs associated with drug dependence.     

Living Environment Matters: Relationships Between Neighborhood Characteristics and Health of the Residents in a Dutch Municipality

Characteristics of an individual alone cannot exhaustively explain all the causes of poor health, and neighborhood of residence have been suggested to be one of the factors that contribute to health. However, knowledge about aspects of the neighborhood that are most important to health is limited. The main objective of this study was to explore associations between certain features of neighborhood environment and self-rated health and depressive symptoms in Maastricht (The Netherlands). A large amount of routinely collected neighborhood data were aggregated by means of factor analysis to 18 characteristics of neighborhood social and physical environment. Associations between these characteristics and self-rated health and presence of depressive symptoms were further explored in multilevel logistic regression models adjusted for individual demographic and socio-economic factors. The study sample consisted of 9,879 residents (mean age 55 years, 48 % male). Residents of unsafe communities were less likely to report good health (OR 0.88 95 % CI 0.80–0.97) and depressive symptoms (OR 0.81 95 % CI 0.69–0.97), and less cohesive environment was related to worse self-rated health (OR 0.81 95 % CI 0.72–0.92). Residents of neighborhoods with more car traffic nuisance and more disturbance from railway noise reported worse mental health (OR 0.79 95 % CI 0.68–0.92 and 0.85 95 % CI 0.73–0.99, respectively). We did not observe any association between health and quality of parking and shopping facilities, facilities for public or private transport, neighborhood aesthetics, green space, industrial nuisance, sewerage, neighbor nuisance or satisfaction with police performance. Our findings can be used to support development of integrated health policies targeting broader determinants of health. Improving safety, social cohesion and decreasing traffic nuisance in disadvantaged neighborhoods might be a promising way to improve the health of residents and reduce health inequalities.     

Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study.

Recent reports suggest the importance of associations between residential area characteristics and health status, but most research uses only census data to measure these characteristics. The current research examined the effect of overall neighborhood social environment on 11-year risk of death. On the basis of data, the authors developed a three-component neighborhood social environment scale: 1) commercial stores; 2) population socioeconomic status; and 3) environment/housing. Data from the 1983 wave of the Alameda County Study (n = 1,129) and deaths over 11 years were analyzed with two-level logistic regression models. Age- and sex-adjusted risk of death was higher for residents in low social environment neighborhoods (odds ratio = 1.58, 95% confidence interval 1.15-2.18). Mortality risks were significantly higher in neighborhoods with a low social environment, even after account was taken of individual income level, education, race/ethnicity, perceived health status, smoking status, body mass index, and alcohol consumption. When each component of the neighborhood social environment characteristics score was examined separately, each was found to be associated with higher risk for mortality, independent of individual risk factors. These findings demonstrate the role of area characteristics as a health risk factor and point to the need for more focused attention to the meaning and measurement of neighborhood quality.     

Bonding Social Capital in Low‐Income Neighborhoods

Abstract: Social capital has recently become a guiding theoretical framework for family interventions in low‐income neighborhoods. In the context of the Annie E. Casey Foundation's Making Connections initiative, this research uses hierarchical linear modeling to examine how neighborhood characteristics and resident participation affect bonding social capital in low‐income neighborhoods. Findings demonstrate that participation, homeownership, and neighborhood stability are associated with bonding social capital. Additionally, significant interactions exist between individual characteristics and neighborhood income on bonding social capital.     

Gender differences in relationships between social capital and individual smoking and drinking behavior in Taiwan

Despite the concept of social capital receiving great attention in the area of health research, few studies have analyzed the differential effects of social capital between genders. This article assesses gender differences in the relationships between social capital and smoking and drinking behavior in Taiwan. Data on individual sociodemographic characteristics, smoking, drinking, and social capital were obtained from the Taiwan Social Change Survey conducted in 1995 and in 2000. The overall response rate was 67%. In total, 3713 women and men aged over 20 years living in 204 neighborhoods were interviewed. Social capital indicators were aggregated at the neighborhood level, and included neighborhood closeness, political influence, social contact, social trust, and social participation. The data were analyzed with multilevel binomial regression models. Gender differences were found in some aspects of social capital. Stronger effects of social trust on smoking were found for women than for men, whereas stronger effects of neighborhood closeness on drinking were found for women than for men. Social participation was positively associated with drinking in both genders. The findings of this study provide new evidence for the differential effects of social capital by gender in Taiwan, suggesting that more studies are needed to understand social capital's effects in Asian societies and the mechanisms by which the effects may vary with gender.     

Social capital and the built environment: the importance of walkable neighborhoods

OBJECTIVES: I sought to examine whether pedestrian-oriented, mixed-use neighborhoods encourage enhanced levels of social and community engagement (i.e., social capital). METHODS: The study investigated the relationship between neighborhood design and individual levels of social capital. Data were obtained from a household survey that measured the social capital of citizens living in neighborhoods that ranged from traditional, mixed-use, pedestrian-oriented designs to modern, car-dependent suburban subdivisions in Galway, Ireland. RESULTS: The analyses indicate that persons living in walkable, mixed-use neighborhoods have higher levels of social capital compared with those living in car-oriented suburbs. Respondents living in walkable neighborhoods were more likely to know their neighbors, participate politically, trust others, and be socially engaged. CONCLUSIONS: Walkable, mixed-use neighborhood designs can encourage the development of social capital.     

Walking, exercising, and smoking: does neighborhood matter?

Neighborhood context could affect health behaviors because of structure or contagion. We expected that residents of US neighborhoods where a high percentage of residents are poor and do not have college degrees would be more likely to smoke and less likely to walk and exercise. We examined the hypotheses using multi-level data in which survey information from a representative sample of Illinois residents is linked to census-tract information about poverty and education in their neighborhood. Contrary to expectations we found that residents of poor neighborhoods were more likely to walk than those in less disadvantaged places, adjusting for individual poverty, household income, education, race, ethnicity, sex, age, and marital status. This was the case despite the fact that residents of poor neighborhoods were more afraid to leave the house and feared being victimized on the streets. Consistent with expectations we found that residents of neighborhoods where a high percentage of residents are college educated are more likely to walk. Thus, the two aspects of neighborhood socioeconomic status had opposite effects on walking. Neighborhood context had no effect on the likelihood of exercising strenuously. Men in poor neighborhoods were more likely to smoke than those in less disadvantaged places, but neighborhood context had no significant effect on women's likelihood of smoking.     

Neighborhood effects on posthospitalization mortality: a population-based cohort study of the elderly in Chicago

CONTEXT: Place of residence is associated with health outcomes. OBJECTIVE: To examine neighborhood effects on mortality after the onset of serious disease and to assess whether these effects vary for different sociodemographic or diagnostic subgroups. DESIGN, SETTING, PATIENTS: Our sample consists of a complete cohort of 10,557 elderly Medicare beneficiaries throughout the city of Chicago newly diagnosed and hospitalized for the first time with one of five common serious diseases in 1993 (stroke, myocardial infarction, congestive heart failure, hip fracture, and lung cancer) followed until 1999. Attributes of 51 zip code neighborhoods were obtained both from census data (1990) and from a comprehensive social survey of neighborhood residents (1994-1995). Cox proportional hazards models with robust standard errors were specified. MAIN OUTCOME MEASURE: Survival after hospitalization. RESULTS: People who lived in neighborhoods with higher socioeconomic status (SES) or with a better social environment had significantly longer survival after disease onset. We evaluated the differential impact of neighborhood attributes on survival depending on gender, race, and poverty using interaction terms. Only the interaction terms between neighborhood social-structural factors and individual poverty were significant, suggesting that neighborhood SES and social environment were especially helpful for people with higher income. Neighborhood attributes did not differ in their impact depending on the race or sex of the subjects. Analyses of cause-specific mortality showed that myocardial infarction was the primary force driving the associations between neighborhood attributes and mortality. CONCLUSIONS: Where people live matters with respect to posthospitalization mortality, but how neighborhoods affect this outcome depends on individual demographic and diagnostic characteristics. Myocardial infarction in particular may be a "neighborhood sensitive" condition. Individuals' health may depend not just on individuals' characteristics but also on their neighborhoods'.     

Social capital and core network ties: a validation study of individual-level social capital measures and their association with extra- and intra-neighborhood ties, and self-rated health

Research on social capital and health has assumed that measures of trust, participation, and perceived cohesion capture aspects of people's neighborhood social connections. This study uses data on the personal networks of 2707 Montreal adults in 300 different neighborhoods to examine the association of socio-demographic and social capital variables with the likelihood of having core ties, core neighborhood ties, and high self-rated health (SRH). Persons with higher household income were more likely to have core ties, but less likely to have core neighborhood ties. Persons with greater diversity in extra-neighborhood network capital were more likely to have core ties, and persons with greater diversity in intra-neighborhood network capital were more likely to have core neighborhood ties. Generalized trust, perceived neighborhood cohesion, and extra-neighborhood network diversity were shown associated with high SRH. Conventional measures of social capital may not capture network mechanisms. Findings suggest a critical appraisal of the mechanisms linking social capital and health, and the further delineation of network and psychosocial mechanisms in understanding these links.     

Segmented assimilation theory and perinatal health disparities among women of Mexican descent

A higher prevalence of infant low birth weight (<2500 g) has been observed among more acculturated mothers of Mexican descent living in the U.S. when compared to their less acculturated counterparts. Tests of the “acculturation hypothesis” have established that disparities in certain risks for low birth weight exist between subgroups of women of Mexican-origin. However, disparities observed by neighborhood of residence have yet to be explained. Most tests of the acculturation hypothesis assume a classical path of assimilation, whereby Mexican American health is expected to deteriorate with time spent residing in the U.S. and across the generations. The theory of segmented assimilation suggests that alternative paths are possible depending upon individual characteristics and the context of the neighborhood into which immigrant families and their children reside. This study tested the theory of segmented assimilation as a framework for examining the geographic, cultural, and socioeconomic underpinnings of population differences in infant low birth weight among women of Mexican descent in California using the 2000 U.S. Census and population-based data from the Maternal and Infant Health Assessment (1999–2005) (n = 6442). Little support was found for the theory's hypotheses. Rather, increased odds for infant low birth weight were observed for English speakers residing in Latino immigrant neighborhoods when compared to English speakers in other neighborhoods, an effect attenuated for Spanish speakers. Elevated odds of low birth weight were also observed among English speakers residing in Latino immigrant neighborhoods when compared to Spanish speakers in the same neighborhoods. Findings suggest the transfer of health-specific social capital in ethnic neighborhoods may depend upon sociocultural consonance between individuals and neighborhood residents. The authors call for additional research that sheds light on the sociocultural dynamics of maternal and infant health at multiple levels.