Socio-Spatial Determinants of Health (SSDH)

National Institute On Minority Health And Health Disparities

Investigators

Linked publications & trials

Abstract

In FY25, our lab, the Socio-Spatial Determinants of Health (SSDH) laboratory, focused on studying how adverse neighborhood social contexts are related to cardiovascular disease (CVD) risk factors and outcomes. Two postdoctoral fellows and one postbac fellow worked in our SSDH lab and left early in the summer. One postbac fellow recently joined our lab. We have collaborated with intramural and extramural researchers to publish manuscripts on neighborhoods and NCDs. These efforts and accomplishments are described in detail below. Objective 1. In FY25, we continued to work with two postdoc fellows and one postbac fellow. Two postdoc fellows studied how neighborhood isolation index was associated with physical activity and sedentary behavior using NCI's Activities Completed over Time in 24 Hours (ACT24) data. Contrary to what we would expect, higher neighborhood isolation index was related to more time engaging in physical activity among African American women only. There was no association between neighborhood isolation index and sedentary behavior among ACT24 participants. One postbac fellow investigated how perceived neighborhood social environment (e.g., safety and social cohesion) was related to sleep health and depressive symptoms among adolescents from the National Longitudinal Study of Adolescent to Adult Health (Add Health). As expected, higher neighborhood safety was related to a lower risk of short sleep. Additionally, higher neighborhood safety and social cohesion were related to lower scores of depressive symptoms among Add Health participants. Objective 2. The goal of Objective 2 is to investigate how neighborhood physical and social contexts are associated with CVD risk factors and outcomes. To achieve this goal, we sought potential collaborative research projects with intramural and extramural researchers who utilize large cohort studies, such as the Jackson Heart Study (JHS), Multi-Ethnic Study of Atherosclerosis (MESA), UK Biobank, and Midlife in the US (MIDUS) cohorts. First, we investigated the mediating role of physical activity on the associations between neighborhood social environments and the severity of metabolic syndromes stratified by sex. We found that females perceiving greater neighborhood violence and problems had a higher severity of the metabolic syndrome, mediated by low levels of physical activity. Similarly, males perceiving greater neighborhood violence and problems had a higher severity of the metabolic syndrome, mediated by low levels of physical activity. Second, we examined longitudinal associations between perceived neighborhood characteristics and type 2 diabetes (T2D) among MESA participants. We found that those perceiving high favorable walking environments compared to the unfavorable walking environments had a lower risk of developing T2D. Third, we tested the role of the neighborhood deprivation index on all-cause mortality and incident CVD in the UK Biobank cohort. We demonstrated that those residing in the most deprived neighborhoods (compared to the least) had a greater risk of all-cause mortality and incident CVD. Furthermore, the similar adverse effects of deprived neighborhoods were observed by both sexes. Despite these demonstrated associations, the impact of deprived neighborhoods was only revealed among the White cohort, not for the Black and Asian cohorts. Fourth, we investigated how perceived neighborhood social environments (i.e., social cohesion and safety) were directly related to T2D among older adults from the MIDUS cohort, and tested whether health-related factors, psychosocial factors, and inflammatory biomarkers may mediate these associations. We demonstrated that neighborhood social cohesion and safety were associated with T2D, mediated through lower levels of depressive symptoms, higher stress levels, and elevated levels of C-reactive protein. These studies highlighted the importance of interventions to promote better neighborhoods (i.e., lower deprivation and more investment in neighborhoods) and increase physical activity in conjunction with community efforts to reduce neighborhood issues. Objective 3. The goal of Objective 3 is to investigate how adverse neighborhood characteristics (i.e., area-level isolation) are associated with 1) mental health and substance use disorder treatment facilities and 2) the prevalence of diabetes across the US. First, we quantified county-level isolation index for each racial and/or ethnic group: White, Black, Hispanic, and Asian adults. The isolation index measures the degree to which a specific group of people live in geographic units (e.g., a county) that are primarily concentrates. The index ranges from 0 to 1.0. A higher score means that the person from that specific group lives in an area unusually concentrated by the same group of people. In contrast, a lower score represents less concentrated by the same groups of people. This index was created for each racial and/or ethnic group and linked to the mental health facilities and diabetes prevalence in 2020. In the first study, we found that higher county-level isolation of any group (White, Black, Hispanic, and Asian adults) was significantly associated with lower density of mental health facilities. Higher county-level isolation for Asian adults had fewer mental health facilities, followed by White, Hispanic, and Black adults. Irrespective of any racial and/or ethnic groups, greater isolation are related to lower numbers of mental health facilities across the US. Second, we also link the isolation indices to the prevalence of diabetes across US counties in 2020. Higher county-level isolation of any racial and/or ethnic group was significantly related to higher diabetes prevalence. We demonstrated that county-level isolation of Asian adults was associated with a higher diabetes prevalence, followed by White, Hispanic, and Black adults. These may be the first studies to demonstrate a relationship between greater area-level isolation and lower availability of mental health facilities, as well as higher rates of diabetes across U.S. counties. Local efforts to address area-level isolation might elucidate the lack of healthcare facilities for specific U.S. populations as well as elevated diabetes risk. Future studies should replicate these findings with longitudinal data for US populations over time. As a next step, we plan to investigate how area-level isolation may be temporally and locally related mental health facilities and diabetes prevalence across the US counties. Objective 4. The goal of Objective 4 is to simulate the decrease in physical activity disparities between boys and girls in the U.S. In this simulation study using an agent-based model of more than 8 million US children and adolescents (aged 6-17 years), reducing disparities in physical activity prevented over 28,000 cases of overweight and obesity by 18 years of age and approximately 4800 weight-related disease cases during their lifetimes, which eventually saved over several million. Reducing sports participation disparities prevented nearly 50,000 cases of overweight/obesity and weight-related diseases, saving over 1.5 billion. Such cost savings could exceed the cost of physical activity programs and investments for adolescents.