Invited Commentary: Advancing Theory and Methods for Multilevel Models of Residential Neighborhoods and Health

O’Campo, Patricia

doi:10.1093/aje/kwf171

Cited by 284 publications

(228 citation statements)

References 67 publications

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“…Our measures of segregation employ census tracts as proxies for neighborhoods within MSAs; however, census tracts may not accurately represent residents_ experiences of neighborhood boundaries or the social distance between racial/ethnic groups. 76,77 Finally, our results may reflect selection bias arising from the process through which individuals choose to live in neighborhoods with particular normative or structural characteristics.…”

Section: Discussionmentioning

confidence: 90%

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

et al. 2007

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Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born AfricanAmerican women (n=403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important sociodemographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

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Section: Discussionmentioning

confidence: 90%

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

et al. 2007

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“…Understanding how widowed individuals might possibly compensate for the loss of the spouse and exploring new links therefore takes on special significance in view of the non-trivial prevalence of widowhood. In recent years, there has been a substantial increase in theorizing regarding neighborhoods as determinants of health outcomes (Kawachi & Berkman, 2003;Kawachi & Subramanian, 2007;Sampson, 2003;Subramanian, Kubzansky, Berkman, Fay, & Kawachi, 2006), along with substantial empirical research (Diez Roux, 2001;O'Campo, 2003); yet there has not been much conceptual or empirical work looking at ways that neighborhoods modify the effects of individual risk factors. Rather, the focus has thus far been on estimating the main effect of neighborhood factors on health outcomes, including mortality.…”

Section: Resultsmentioning

confidence: 99%

“…While recent research has begun to document individual-level effect heterogeneity in the widowhood effect, for example with respect to race (Elwert & Christakis, 2006) and cause of death (Elwert & Christakis, in press;Johnson, Backlund, Sorlie, & Loveless, 2000), we are not aware of any research to investigate differences in the widowhood effect according to the environment in which individuals experience bereavement. Yet, contextual factors are widely recognized to be relevant to differences in mortality O'Campo, 2003;Pickett & Pearl, 2001;Wen & Christakis, 2005). Given that the postulated mechanisms linking widowhood and mortality are primarily social, it seems reasonable to anticipate that the broader contextual circumstances of bereaved individuals may buffer or intensify the social processes that make widowhood a strong risk factor for mortality in the first place.…”

Section: Introductionmentioning

confidence: 99%

Widowhood and mortality among the elderly: The modifying role of neighborhood concentration of widowed individuals

Subramanian

Elwert

Christakis

2008

Social Science & Medicine

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The effect of death of a spouse on the mortality of the survivor (the "widowhood effect") is wellestablished. We investigated how the effect of widowhood on mortality depends on the neighborhood concentration of widowed individuals in the United States. We developed a large, nationally representative, and longitudinal dataset from Medicare claims and other data sources characterizing 200,000 elderly couples, with nine years of follow-up (1993-2002), and estimated multilevel grouped discrete-time hazard models. In neighborhoods with a low concentration of widowed individuals, widowhood increased the odds of death for men by 22% and for women by 17%, compared to 17% for men, and 15% for women in neighborhoods with a high concentration of widowed individuals. Our findings suggest that neighborhood structural contexts -that provide opportunities for interacting with others and favoring new social engagements -could be potential modifiers of the widowhood effects and as such requires more systematic consideration in future research of widowhood effects on well-being and mortality.

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“…schools) or political boundaries (e.g., states), it can be more challenging in other cases-especially with regard to neighborhoods. The bounding or definition of neighborhoods in neighborhood health research has garnered a lot of recent academic attention (O'Campo, 2003;Galea and Ahern, 2006). As with any exposure, bias can result if the neighborhood construct of interest (in this case education inequality) does not map onto the units chosen for operationalizing neighborhoods and their constructs.…”

Section: Discussionmentioning

confidence: 99%

“…If we are interested in social exposures that affect health, as we are in this paper, then resident perceptions or definitions of neighborhood may be more relevant for that examination than in the sudy of other factors such as, for example, formal policies which are operationalized according to administrative boundaries (Diez Roux, 2001). Also, some processes occurring in neighborhoods that we may hypothesize to affect health are not necessarily contained within any given spatial boundary (O'Campo, 2003). Although the challenges for operationalizing relevant neighborhoods are important to consider as we weigh choosing a level of analysis, this operationalization should not paralyze empiric investigation (Diez Roux, 2001).…”

Section: Discussionmentioning

confidence: 99%

Education inequality and use of cigarettes, alcohol, and marijuana

Galea

Ahern

Tracy

et al. 2007

Drug and Alcohol Dependence

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Education inequality at the neighborhood-level may influence population health and health behavior. We assessed the relations between education inequality and substance use in 59 New York City (NYC) neighborhoods. We used Gini coefficients of education to describe neighborhood education inequality and data from a random-digit-dial phone survey of adult residents of NYC to assess use of substances. Among 1355 respondents (female=56.2%; white=35.7%; mean age=40.4), 23.9% (95% confidence interval [CI]=20.3-27.5) reported smoking, 39.4% (95% CI=35.3-43.4) drinking, and 5.4% (95% CI=3.6-7.3) using marijuana in the previous 30 days. In multilevel models controlling for neighborhood education, neighborhood income inequality, and individual covariates, living in a neighborhood with high education inequality was associated with a greater prevalence of drinking (p=0.02) and of smoking marijuana (p=0.004) but among current drinkers it was associated (p=0.03) with having fewer drinks. The odds of alcohol use (OR=1.70) and marijuana use (OR=3.49) were greater in neighborhoods in the 75 th percentile of education Gini compared to neighborhoods in the 25 th percentile of education Gini. Statisical interactions suggest that there may be a stronger relation between education inequality and marijuana use in neighborhoods with low mean education than in neighborhoods with higher mean levels of education. These findings, taken together, suggest a complex relation between education inequality and substance use; likelihood of the use of alcohol and marijuana was higher in areas with higher education inequality suggesting potential roles for substance use norms and availability, whereas quantity used among drinkers was higher in areas with low education inequality, suggesting potential roles for both disadvantage and norms.

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Invited Commentary: Advancing Theory and Methods for Multilevel Models of Residential Neighborhoods and Health

Cited by 284 publications

References 67 publications

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

Widowhood and mortality among the elderly: The modifying role of neighborhood concentration of widowed individuals

Education inequality and use of cigarettes, alcohol, and marijuana

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