Earth observation data uncover green spaces' role in mental health.

The prevalence of mental health disorders, a key disability cause, is linked to demographic and socioeconomic factors. However, limited data exists on mental health and the urban environment. Urbanization exposes populations to environmental stressors, particularly affecting low-middle-income countries with complex urban arrangements. We used remote sensing and census data to investigate potential connections between environmental factors and mental health disorders. Land cover variables were assessed using the European Space Agency (ESA) global WorldCover product at 10 m resolution together with the database of mental health diagnosed cases (n = 5769) from the Brazilian Unified Health System's Department of Informatics (DATASUS) from every health facility of the city of Porto Alegre. The association of mental health data with land cover was established with machine learning algorithms and polynomial regression models. The results suggest that higher trees cover at neighborhood level was associated with better mental health index. A lower mental health index was also found to be associated with an higher Human Development Index. Our results highlight the potential of greenness in the city environment to achieve substantially better mental health outcomes.

Neighborhood social cohesion and physical disorder in relation to social isolation in older adults: racial and ethnic differences.

BACKGROUND: Neighborhood factors of social isolation have been understudied, hindering efforts to reduce social isolation at the neighborhood level. This study aims to investigate the longitudinal effects of neighborhood social cohesion and physical disorder on social isolation in community-dwelling older adults, as well as to examine whether race/ethnicity moderates the neighborhood-isolation relationship. METHODS: We used 11-year data from the National Health and Aging Trend Study, a longitudinal national study of Medicare beneficiaries aged 65 and older. Social isolation was measured through a summary score across four domains: marital/partner status, family and friend contact, religious attendance, and club participation. A series of weighted mixed-effects logistic regression models were performed to test the study aims. Sample sizes ranged from 7,303 to 7,291 across individual domains of social isolation. RESULTS: Approximately 20% of participants reported social isolation. Findings indicated a negative association between neighborhood social cohesion and social isolation. Higher levels of neighborhood social cohesion were longitudinally associated with lower odds of social isolation (odds ratio [OR] = 0.52, 95% CI: 0.47-0.58). Yet, the presence of neighborhood physical disorder was associated with an increased risk of overall social isolation ([OR] = 1.2, 95% CI: 1.00, 1.44). Race/ethnicity significantly moderated the effects of neighborhood social cohesion and physical disorder on social isolation. The odds of no in-person visits associated with neighborhood social cohesion are smaller among Black adults compared to White adults. Black adults had constantly lower odds of isolation from religious attendance compared to White adults regardless of the level of neighborhood social cohesion. Hispanic adults had decreased odds of having no friends associated with signs of physical disorder, while no associations were found among older White adults. White adults had higher odds of isolation from in-person visits when living in neighborhoods with signs of physical disorder, whereas no association was observed among older Black and Hispanic adults. CONCLUSIONS: This study elucidates the role of neighborhood characteristics in shaping social isolation dynamics among older adults. Furthermore, the observed moderation effects of race/ethnicity suggest the need for culturally sensitive interventions tailored to address social isolation within specific neighborhood and racial contexts.

Dwelling proximity to wildfire and spina bifida risk in offspring.

OBJECTIVE: To evaluate the association between wildfire exposure in pregnancy and spina bifida risk. METHODS: This retrospective cohort study used the California Office of Statewide Health Planning and Development Linked Birth File with hospital discharge data between 2007 and 2010. The Birth File data were merged with the California Department of Forestry and Fire Protection data of the same year. Spina bifida was identified by its corresponding ICD-9 code listed on the hospital discharge of the newborn. Wildfire exposure was determined based on the zip code of the woman's home address. Pregnancy was considered exposed to wildfire if the mother lived within 15 miles of a wildfire during the pregnancy or within 30 days prior to pregnancy. RESULTS: There were 2,093,185 births and 659 cases of spina bifida between 2007 and 2010. The births were analyzed using multivariable logistic regression models and adjusted for potential confounders. Exposure to wildfire in the first trimester was associated with higher odds of spina bifida (aOR= 1.43 [1.11-1.84], p-value = 0.01). Wildfire exposure 30 days before the last menstrual period and during the second and third trimesters were not associated with higher spina bifida risk. CONCLUSION: Wildfire exposure has shown an increased risk of spina bifida during the early stages of pregnancy.

Spatiotemporal variability of the association between greenspace exposure and depression in older adults in South Korea.

BACKGROUND: A number of studies based on young to middle aged adult and child samples have found that exposure to greenspace and bluespace can have a positive impact on mental health and well-being. However, there is limited research among older adults and the extant studies have provided mixed results. The present study was designed to examine how the association between these forms of exposure and depressive symptoms among older adults varies as a function of different spatially and temporally resolved exposure metrics. METHODS: The sample consisted of 617 individuals (46.19% female) aged ≥ 60 years of age. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Individuals' greenspace exposure was quantified using spatially and temporally resolved metrics, including monthly and annual averaged satellite-derived normalized difference vegetation index (NDVI) across multiple buffer distances (250 m to 2,000 m) centered at participants' home address. We also quantified exposure to blue-greenspace from a highly detailed land use and land cover dataset. A multivariable logistic regression model assessed the association between greenspace and blue-greenspace exposure and depressive symptoms, adjusting for age, sex, income, education, marital status, current smoking, alcohol status, medical conditions, temperature, crime rate, population density, and per capita park area. RESULTS: We found a significant association between exposures to greenspace and blue-greenspace and depressive symptoms (CES-D cutoff ≥ 4) among older adults. After adjusting for confounding variables, the odds of depressive symptoms were significantly decreased by an IQR increment in residential exposure to greenspace [odds ratio (OR) = 0.67; 95% confidence interval (95% CI), 0.49 ~ 0.91] and blue-greenspace (OR = 0.59; 95% CI, 0.41 ~ 0.84) measured nearby their home address (i.e., as close as 250 m). When stratified by household income level, the association was only significant among low-income individuals. We also found temporal variation in the association between depressive symptoms and monthly NDVI-based greenspace exposure, in which the odds of depressive symptoms were the lowest for greenspace in cold months (i.e., January, February, and March). CONCLUSIONS: Our findings suggest that neighborhood greenspace may serve as a protective factor against depression among older adults, but the benefits may depend on the spatial and temporal context. More investigation is needed to replicate our findings on the spatial and temporal variations of greenspace exposure metrics and their effects on depressive symptoms.

Community Asset Density and Past-Year Mental Health Symptoms Among Youths.

Importance: Many youths experience mental health challenges. Identifying which neighborhood and community factors may influence mental health may guide health policy and practice. Objective: To explore associations between community assets (eg, schools, parks, libraries, and barbershops) and past-year mental health symptoms among youths. Design, Setting, and Participants: This cross-sectional study leveraged 3 datasets, which were linked by 26 zip codes: the Western Pennsylvania Regional Data Center, the Child Opportunity Index 2.0 database, and the Allegheny County Youth Risk Behavior Survey (YRBS). The YRBS was administered during the study period in 2018 to youths across 13 high schools in Allegheny County, Pennsylvania; the study dates were from October 15 to October 19, 2018. Dates of analysis were from August 1, 2023, to July 15, 2024. Exposures: Asset density in each zip code across 8 asset categories (transportation, education, parks and recreation, faith-based entities, health services, food resources, personal care services, and social infrastructure) was calculated. Main Outcomes and Measures: The main outcomes were mental health measures included in the past 12 months, which comprised feelings of hopelessness (feeing so sad or hopeless that you stopped doing activities), nonsuicidal self-injury (hurt yourself on purpose without wanting to die), and suicidal ideation (seriously considered attempting suicide). All were operationalized to any or none. Data were analyzed using multivariable generalized linear mixed models and were adjusted for age, sex assigned at birth, race and ethnicity, and identification as sexually or gender diverse. Results: Among 6306 students who were eligible for the YRBS based on their enrollment in participating high schools, 4487 students completed surveys, and 2162 were included in the analytic sample (mean [SD] age, 15.8 [1.2] years; 1245 [57.6%] were assigned female sex at birth). Over one-third of the participants (811 [37.5%]) reported past-year feelings of hopelessness; 587 (27.2%), past-year nonsuicidal self-injury; and 450 (20.8%), past-year suicidal ideation. High total asset population density (adjusted odds ratio [AOR], 0.85 [95% CI, 0.75-0.97]; P = .01), as well as population density of transportation assets (AOR, 0.77 [95% CI, 0.66-0.90]; P < .001), educational resources (AOR, 0.78 [95% CI, 0.67-0.92]; P = .002), and health services (AOR, 0.74 [95% CI, 0.60-0.91]; P = .006), were associated with lower odds of past-year hopelessness after adjusting for covariates. There were no correlations between asset density, Child Opportunity Index, and other mental health measures. Conclusions and Relevance: The findings of this cross-sectional study suggest that access to certain community assets was associated with lower odds of feelings of hopelessness among youths. Ongoing work is needed to characterize other forms of social and cultural capital, which may mitigate negative mental health outcomes among adolescent youths.

Neighborhood Child Opportunity and Preterm Birth Rates by Race and Ethnicity.

Importance: In the US, infants born to non-Hispanic Black birthing parents are 50% more likely to be born preterm than those born to non-Hispanic White birthing parents, and individual-level factors do not fully account for this inequity. Neighborhood context, rooted in historic patterns of structural racism, may facilitate understanding patterns of inequity in preterm birth. Objective: To estimate the association between neighborhood opportunity level, measured by the Child Opportunity Index (COI), and preterm birth among infants in Massachusetts. Design, Setting, and Participants: In this cross-sectional, population-based study, Massachusetts birth certificates from 3 large metropolitan areas (Boston, Springfield, and Worcester) were linked to US Census tract-level data from the COI, and log binomial regression models and generalized estimating equations were fit to examine associations of different levels of opportunity with preterm birth. Singleton infants born in Massachusetts between February 1, 2011, and December 31, 2015, were included. Analyses were originally conducted in 2019 and updated in 2024. Exposure: Level of child opportunity (measured by the COI) at the US Census tract level. Race and ethnicity were ascertained from the birth certificate, as reported by the birthing parent. Main Outcomes and Measures: Live birth before 37 completed weeks' gestation. Results: The analytic dataset included 267 553 infants, of whom 18.9% were born to Hispanic, 10.1% to non-Hispanic Asian or Pacific Islander, 10.1% to non-Hispanic Black, and 61.0% to non-Hispanic White birthing parents. More than half of infants born to non-Hispanic Black and Hispanic birthing parents were born into very low opportunity neighborhoods, and in crude models, this was associated with greater prevalence of preterm birth relative to very high opportunity neighborhoods (prevalence ratio, 1.44; 95% CI, 1.37-1.52). After adjustment for covariates, infants born into very low opportunity neighborhoods still had a greater prevalence of preterm birth (prevalence ratio, 1.16; 95% CI, 1.10-1.23). Conclusions and Relevance: In this cross-sectional study of neighborhood opportunity and preterm birth, elevated risk associated with exposure to a very low opportunity neighborhood, coupled with the disproportionate exposure by race and ethnicity, points to a modifiable factor that may contribute to racial and ethnic inequities in preterm birth. Future research should investigate interventions that seek to address neighborhood opportunity.

The association between neighbourhood walkability and blood lipids: a Canadian population study.

We examined the association between walkability and blood lipids in a nationally representative sample of 29,649 participants aged 3-79 years who participated in the Canadian Health Measures Survey (CHMS) cycles 1 to 6. We focused on seven lipid biomarkers: apolipoprotein A (Apo A), apolipoprotein B (Apo B), triglycerides (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), and TC/HDL. Cross-sectional associations were analyzed using generalized linear mixed models incorporating survey-specific sampling weights. An increase in the Canadian Active Living Environments Index, a measure of neighborhood walkability, equivalent to the magnitude of its interquartile range (IQR) was associated with the following percentage (95% confidence intervals (CI)) changes in lipids: decreased TG, -2.85 (-4.77, -0.93) and TC/HDL, -1.68 (-2.80, -0.56), and increased HDL, 1.68 (0.93, 2.42). Significant effects were largely restricted to adults (aged 17 to 79). In the younger age group there were no significant associations between walkability and lipids in the fully adjusted model. Significant associations were more frequently seen in females than males. For females, fully adjusted significant inverse associations were observed for TG, LDL, and TC/HDL, and there were positive associations with HDL and Apo A. Canadians living in more walkable neighborhoods have more favorable lipid profiles, suggesting that the built environment has the potential to influence the risk profile for cardiovascular health, especially among adults and females.

Individual, social and area level factors associated with older people's walking: Analysis of an UK household panel study (Understanding Society).

BACKGROUND: Among older people, walking is a popular and prevalent activity. Walking is key to increasing physical activity levels and resulting physical and mental health. In the context of rapidly ageing populations, it is important to better understand what factors are associated with walking among older people, based on the socioecological model of health. METHODS: We used data from Understanding Society (n:6450), a national panel survey of UK adults aged 65 years and over living in Great Britain. Slope Indices of Inequality (SII) were calculated for weekly walking hours for older people according to individual, social and area characteristics. These include health, loneliness and social isolation, previous walking and sporting activity, residential self-selection, contact with neighbours, number of close friends and social activity. Spatial area-level data described local area crime, walkability, and proximity to retail, greenspace, and public transport amenities. RESULTS: Multivariable models indicated that poor health, particularly requiring help with walking, was the strongest predictor of weekly walking hours (SII (95% CI) comparing those needing help vs. no help: -3.58 (-4.30, -2.87)). However, both prior sporting activity (most vs. least active: 2.30 (1.75, 2.88)) and walking for pleasure (yes vs. no: 1.92 (1.32, 2.53)) were strongly associated with increased walking several years later. Similarly having close friends (most vs. fewest, 1.18 (0.72, 1.77)) and local retail destinations (any vs. none: 0.93 (0.00, 1.86)) were associated with more weekly walking. CONCLUSIONS: Past engagement in physical activity and walking for pleasure are strong predictors of walking behaviour in older people, underscoring the importance of implementing and sustaining walking interventions across the lifespan to ensure continued engagement in later years and the associated health benefits. However, poor health significantly impedes walking in this demographic, emphasising the need for interventions that offer both physical assistance and social support to promote this activity.

Lower regional urbanicity and socioeconomic status attenuate associations of green spaces with hypertension and diabetes mellitus: a national representative cross-sectional study in China.

BACKGROUND: High blood pressure (HBP) and diabetes mellitus (DM) are two of the most prevalent cardiometabolic disorders globally, especially among individuals with lower socio-economic status (SES). Studies have linked residential greenness to decreased risks of HBP and DM. However, there has been limited evidence on whether SES may modify the associations of residential greenness with HBP and DM. METHODS: Based on a national representative cross-sectional study among 44,876 adults, we generated the normalized difference vegetation index (NDVI) at 1 km spatial resolution to characterize individuals' residential greenness level. Administrative classification (urban/rural), nighttime light index (NLI), individual income, and educational levels were used to characterize regional urbanicity and individual SES levels. RESULTS: We observed weaker inverse associations of NDVI with HBP and DM in rural regions compared to urban regions. For instance, along with per interquartile range (IQR, 0.26) increment in residential NDVI at 0∼5 year moving averages, the ORs of HBP were 1.04 (95%CI: 0.94, 1.15) in rural regions and 0.85 (95%CI: 0.79, 0.93) in urban regions (P = 0.003). Along with the decrease in NLI levels, there were continuously decreasing inverse associations of NDVI with DM prevalence (P for interaction <0.001). In addition, weaker inverse associations of residential NDVI with HBP and DM prevalence were found among individuals with lower income and lower education levels compared to their counterparts. CONCLUSIONS: Lower regional urbanicity and individual SES could attenuate the associations of residential greenness with odds of HBP and DM prevalence.

Impact of awareness of sports policies, school, family, and community environmental on physical activity and fitness among children and adolescents: a structural equation modeling study.

BACKGROUND: Understanding the impact of environmental factors on physical activity (PA) and physical fitness (PF) is crucial for promoting a healthy lifestyle among children and adolescents. This study examines how awareness of sports policies, school, family, and community environments influence PA and PF in Chinese youth. METHODS: A cross-sectional study was conducted with 2747 children and adolescents (mean age 12.90 ± 2.49; 48.2% male) from 17 schools across five Chinese cities. Environmental factors were assessed via questionnaires, and PA levels were measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). PF metrics, including BMI, waist-to-height ratio, grip strength, vertical jump, and 20-m shuttle run test (20-mSRT), were measured onsite. Structural Equation Modeling (SEM) was used to explore relationships between environmental factors and PA/PF outcomes. RESULTS: The school environment scored highest (78.0 ± 9.5), while the community environment scored lowest (38.7 ± 18.0). Family environment positively influenced low-intensity PA (LPA) (ß = 0.102, P < 0.001) but negatively affected moderate-to-vigorous PA (MVPA) (ß = -0.055, P = 0.035). Community environment and awareness of sports policies positively impacted MVPA (ß = 0.216, P < 0.001; ß = 0.072, P = 0.009, respectively). Family environment positively influenced BMI reduction (ß = -0.103, P < 0.001) but negatively affected grip strength (ß = -0.063, P = 0.018). Community environment improved grip strength and 20-mSRT performance (ß = 0.088, P = 0.002; ß = 0.065, P = 0.027). CONCLUSIONS: School environments, despite high scores, do not significantly impact PA and PF. Community environments, though scoring lower, positively affect MVPA, grip strength, and 20-mSRT. Awareness of sports policies boosts MVPA, while family environments support LPA and BMI but are inversely related to MVPA and grip strength. Integrated strategies involving community infrastructure, family support, and policy awareness are essential for promoting active lifestyles among children and adolescents.

Building a healthy generation together: parents' experiences and perceived meanings of a family-based program delivered in ethnically diverse neighborhoods in Sweden.

INTRODUCTION AND AIM: Ethnically diverse neighborhoods encounter pronounced inequalities, including housing segregation and limited access to safe outdoor spaces. Residents of these neighborhoods face challenges related to physical inactivity, including sedentary lifestyles and obesity in adults and children. One approach to tackling health inequalities is through family-based programs tailored specifically to these neighborhoods. This study aimed to investigate parents' experiences and perceptions of the family-based Open Activities, a cost-free and drop-in program offered in ethnically diverse and low socioeconomic neighborhoods in Sweden. METHODS: Researchers' engagement in 15 sessions of the Open Activities family-based program during the spring of 2022, and individual interviews with 12 participants were held. Data were analyzed using reflexive thematic analysis. RESULTS: The analysis resulted in three main themes and seven sub-themes representing different aspects of the program's meaning to the participants as parents, their families, and communities. The main themes describe how parents feel valued by the program, which actively welcomes and accommodates families, regardless of cultural differences within these neighborhoods. The themes also show how cultural norms perceived as barriers to participation in physical activity can be overcome, especially by mothers who express a desire to break these norms and support girls' physical activity. Additionally, the themes highlight the importance of parents fostering safety in the area and creating a positive social network for their children to help them resist criminal gang-related influences. CONCLUSIONS: The program's activities allowed parents to connect with their children and other families in their community, and (re)discover physical activity by promoting a sense of community and safety. Implications for practice include developing culturally sensitive activities that are accessible to and take place in public spaces for ethnically diverse groups, including health coordinators that can facilitate communication between groups. To enhance the impact of this program, it is recommended that the public sector support the creation of cost-free and drop-in activities for families who are difficult to reach in order to increase their participation in physical activity, outreach, and safety initiatives.

West African Genetic Ancestry, Neighborhood Deprivation, and Prostate Cancer.

Importance: Racial disparities in prostate cancer are likely the result of complex relationships between both socioeconomic and environmental factors captured by the neighborhood environment and genetic factors, including West African genetic ancestry. However, few studies have examined the combined role of neighborhood environment and genetic ancestry in developing lethal prostate cancer. Objective: To examine the interactions between West African genetic ancestry and neighborhood deprivation in modifying prostate cancer risk and mortality. Design, Setting, and Participants: This case-control study was conducted in the Greater Baltimore area. Participants included men of African and European descent (617 cases with prostate cancer, 852 controls without prostate cancer) enrolled between January 2005 and January 2016. Follow-up was performed through December 31, 2020, using the National Death Index. Analysis was conducted from August 2023 to January 2024. Exposure: Included exposures were West African genetic ancestry, derived from large-scale genotyping, and neighborhood deprivation, defined using 2000 census-tract-level Neighborhood Deprivation Index (NDI) score. Main Outcomes and Measures: Outcomes of interest were prostate cancer and all-cause mortality. Results: Among a total of 1469 participants (mean [SD] age, 64.96 [7.95] years), there were 736 self-identified Black and 733 White men, and the mean (range) proportion of West African genetic ancestry was 0.27 (0.04-0.84) among participants residing in areas with low levels of deprivation and 0.48 (0.07-0.83) among participants residing in areas with high levels of deprivation. Multivariable logistic regression analysis revealed a significant multiplicative interaction of West African genetic ancestry and neighborhood deprivation with the odds of a prostate cancer diagnosis (P for interaction = .02). Among individuals living in neighborhoods with high NDI scores, West African genetic ancestry was associated with increased odds of a prostate cancer diagnosis (age-adjusted odds ratio [OR], 1.98; 95% CI, 1.23-3.19). In contrast, West African genetic ancestry was associated with reduced odds of this diagnosis among individuals residing in areas with medium to low levels of deprivation (age-adjusted OR, 0.22; 95% CI, 0.11-0.44). There was no significant multiplicative interaction between West African genetic ancestry and neighborhood deprivation for all-cause mortality (P for interaction = .44). The positive association of neighborhood deprivation with prostate cancer was independent of West African genetic ancestry (age- and West African ancestry-adjusted OR, 1,70; 95% CI, 1.50-1.94). Conclusions and Relevance: This case-control study of men with West African and European ancestry found that West African genetic ancestry was associated with increased odds of prostate cancer among males who resided in neighborhoods with high deprivation but lower odds in more affluent neighborhoods. Thus, neighborhood environments may play a critical role in defining how genetic ancestry modulates prostate cancer risk.

Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas.

Black neighborhoods in the U.S., historically subjected to redlining, face inequitable access to resources necessary for health, including healthy food options. This study aims to identify the enablers and barriers to promoting equitable healthy food access in small, independently owned carryout restaurants in under-resourced neighborhoods to address health disparities. Thirteen in-depth interviews were conducted with restaurant owners in purposively sampled neighborhoods within Healthy Food Priority Areas (HFPAs) from March to August 2023. The qualitative data were analyzed using inductive coding and thematic analysis with Taguette software (Version 1.4.1). Four key thematic domains emerged: interpersonal, sociocultural, business, and policy drivers. Owners expressed mixed perspectives on customers' preferences for healthy food, with some perceiving a community desire for healthier options, while others did not. Owners' care for the community and their multicultural backgrounds were identified as potential enablers for tailoring culturally diverse menus to meet the dietary needs and preferences of their clientele. Conversely, profit motives and cost-related considerations were identified as barriers to purchasing and promoting healthy food. Additionally, owners voiced concerns about taxation, policy and regulation, information access challenges, and investment disparities affecting small business operations in HFPAs. Small restaurant businesses in under-resourced neighborhoods face both opportunities and challenges in enhancing community health and well-being. Interventions and policies should be culturally sensitive, provide funding, and offer clearer guidance to help these businesses overcome barriers and access resources needed for an equitable, healthy food environment.

Place-based, intersectional variation in caregiving patterns and health outcomes among informal caregivers in the United States.

Introduction: Informal caregiving is a critical component of the healthcare system despite numerous impacts on informal caregivers' health and well-being. Racial and gender disparities in caregiving duties and health outcomes are well documented. Place-based factors, such as neighborhood conditions and rural-urban status, are increasingly being recognized as promoting and moderating health disparities. However, the potential for place-based factors to interact with racial and gender disparities as they relate to caregiving attributes jointly and differentially is not well established. Therefore, the primary objective of this study was to jointly assess the variability in caregiver health and aspects of the caregiving experience by race/ethnicity, sex, and rural-urban status. Methods: The study is a secondary analysis of data from the 2021 and 2022 Behavioral Risk Factor Surveillance System (BRFSS) from the Centers for Disease Control and Prevention. Multivariable logistic regression or Poisson regression models assessed differences in caregiver attributes and health measures by demographic group categorized by race/ethnicity, sex, and rural-urban status. Results: Respondents from rural counties were significantly more likely to report poor or fair health (23.2% vs. 18.5%), have obesity (41.5% vs. 37.1%), and have a higher average number of comorbidities than urban caregivers. Overall, rural Black male caregivers were 43% more likely to report poor or fair health than White male caregivers (OR 1.43, 95% CI 1.21, 1.69). Urban female caregivers across all racial groups had a significantly higher likelihood of providing care to someone with Alzheimer's disease than rural White males (p < 0.001). Additionally, there were nuanced patterns of caregiving attributes across race/ethnicity*sex*rural-urban status subgroups, particularly concerning caregiving intensity and length of caregiving. Discussion: Study findings emphasize the need to develop and implement tailored approaches to mitigate caregiver burden and address the nuanced needs of a diverse population of caregivers.

Uncovering the key working mechanisms of a complex community-based obesity prevention programme in the Netherlands using ripple effects mapping.

BACKGROUND: Much remains unknown about how complex community-based programmes can successfully achieve long-term impact. More insight is needed to understand the key mechanisms through which these programmes work. Therefore, we conducted an in-depth study in five communities that implemented the Healthy Youth, Healthy Future (JOGG) approach, a Dutch community-based obesity prevention programme. We aimed to identify perceived outcomes and long-term impacts among local stakeholders and explore potential causal pathways and working mechanisms. METHODS: We used ripple effects mapping (REM), a qualitative participatory method to map outcomes and identify causal pathways, in five communities. We involved 26 stakeholders, professionals and policy-makers affiliated with the local JOGG approach, spread over eight REM sessions and conducted individual interviews with 24 additional stakeholders. To uncover working mechanisms, we compared outcomes and causal pathways across communities. RESULTS: Over 5-9 years of implementation, participants perceived that JOGG had improved ownership of local stakeholders, health policies, intersectoral collaboration and social norms towards promoting healthy lifestyles. Causal pathways comprised small initial outcomes that created the preconditions to enable the achievement of long-term impact. Although exact JOGG actions varied widely between communities, we identified five common working mechanisms through which the JOGG approach contributed to causal pathways: (1) creating a positive connotation with JOGG, (2) mobilizing stakeholders to participate in the JOGG approach, (3) facilitating projects to promote knowledge and awareness among stakeholders while creating successful experiences with promoting healthy lifestyles, (4) connecting stakeholders, thereby stimulating intersectoral collaboration and (5) sharing stakeholder successes that promote healthy lifestyles, which gradually created a social norm of participation. CONCLUSIONS: The JOGG approach seems to work through activating initial stakeholder participation and bolstering the process towards ownership, policy change, and intersectoral collaboration to promote healthy lifestyles. Key working mechanisms can inform further development of JOGG as well as other complex community-based prevention programmes.

Neighborhood-level deprivation and survival in lung cancer.

BACKGROUND: Despite recent advances in lung cancer therapeutics and improving overall survival, disparities persist among socially disadvantaged populations. This study aims to determine the effects of neighborhood deprivation indices (NDI) on lung cancer mortality. This is a multicenter retrospective cohort study assessing the relationship between NDI and overall survival adjusted for age, disease stage, and DNA methylation among biopsy-proven lung cancer patients. State-specific NDI for each year of sample collection were computed at the U.S. census tract level and dichotomized into low- and high-deprivation. RESULTS: A total of 173 non small lung cancer patients were included, with n = 85 (49%) and n = 88 (51%) in the low and high-deprivation groups, respectively. NDI was significantly higher among Black patients when compared with White patients (p = 0.003). There was a significant correlation between DNA methylation and stage for HOXA7, SOX17, ZFP42, HOXA9, CDO1 and TAC1. Only HOXA7 DNA methylation was positively correlated with NDI. The high-deprivation group had a statistically significant shorter survival than the low-deprivation group (p = 0.02). After adjusting for age, race, stage, and DNA methylation status, belonging to the high-deprivation group was associated with higher mortality with a hazard ratio of 1.81 (95%CI: 1.03-3.19). CONCLUSIONS: Increased neighborhood-level deprivation may be associated with liquid biopsy DNA methylation, shorter survival, and increased mortality. Changes in health care policies that consider neighborhood-level indices of socioeconomic deprivation may enable a more equitable increase in lung cancer survival.

Spatial distribution of residential environment, genetic susceptibility, and psoriasis: A prospective cohort study.

Background: Genetic and environmental factors contribute to psoriasis, but the impact of residential environments on this condition remains uncertain. We aimed to investigate the association of residential environments with psoriasis risk and explore its interaction with genes. Methods: We retrieved data on the spatial distribution of residential environments at 300 and 1000 m buffer zones from the UK Biobank, including the proportions of natural environments, domestic gardens, green spaces, and blue spaces within these zones. We then used Cox hazard models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between residential environments and psoriasis risk. Lastly, we constructed polygenic risk scores to determine genetic susceptibility and further analyse the interaction with residential environments. Results: Overall, 3755 incident cases of psoriasis were documented during a median follow-up of 12.45 years. Compared with the lowest exposure quantile (Q1), Q4 exposure to natural environments (1000 m buffer: HR = 1.16, 95% CI = 1.05-1.29; 300 m buffer: HR = 1.12, 95% CI = 1.02-1.24) and green spaces (1000 m buffer: HR = 1.16, 95% CI = 1.04-1.28; 300m buffer: HR = 1.10, 95% CI = 1.00-1.21) increased the risk of psoriasis, while Q4 exposure to domestic gardens (1000 m buffer: HR = 0.85, 95% CI = 0.77-0.93; 300m buffer: HR = 0.91, 95% CI = 0.83-1.00) and Q3 exposure to blue spaces (1000 m buffer: HR = 0.89, 95% CI = 0.81-0.98) were negatively associated with psoriasis risk. Among participants with a high genetic risk, those exposed to high levels of natural environments (1000 m buffer: HR = 1.49, 95% CI = 1.15-1.93; 300 m buffer: HR = 1.39, 95% CI = 1.10-1.77) and green spaces (300 m buffer: HR = 1.30, 95% CI = 1.04-1.64) had a higher risk of psoriasis, while those exposed to blue spaces (1000 m buffer: HR = 0.78, 95% CI = 0.63-0.98) had a lower risk of psoriasis. We also observed joint effects of genetic risk and residential environments and an antagonistic additive interaction between blue spaces and genetic risk (P = 0.011). Conclusions: We observed that residing in natural environments and green areas increased the risk of psoriasis in our sample, while proximity to blue spaces and domestic gardens was associated to reduced risks. The association of residential environments with psoriasis risk was modified by genetic susceptibility.

Traffic jam by GPS: A systematic analysis of the negative social externalities of large-scale navigation technologies.

The increased usage of navigation technologies has caused conflicts in local traffic management, resulting in congested residential areas among other challenges for residents. This paper uses content analysis to investigate such negative social externalities within local communities and neighbourhoods. Through a corpus of 90 news articles about traffic incidents caused by navigation technologies, we identified negative traffic and safety-related externalities, including congestion, damage, pollution, and accidents. We also report on countermeasures by local communities and governments, including street closures, speed limit reduction, and turn bans. Based on our results, we discuss the implications for designing mobile navigation technologies that reduce negative social externalities.

Citizens' perspectives on healthy weight approaches in low SEP neighborhoods: a qualitative study from a systems perspective.

BACKGROUND: The physical and the social environment are important predictors of healthy weight, especially in low socioeconomic position (SEP) neighborhoods. Many Dutch municipalities have implemented a healthy weight approach (HWA). Yet, there is room for improvement. This system science study examined what influences the utilization of HWA facilities and activities, and what aspects can help to achieve a desired systems change (also called leverage point themes (LPTs)) in the HWA system as perceived by citizens living in low SEP neighborhoods. METHOD: All research phases were performed with four citizens co-researchers. Forty-seven citizens living in low SEP neighborhoods were semi-structurally interviewed about the neighborhood HWA facilities and municipal HWA activities. A rapid coding qualitative analysis approach was applied per topic. The topics were citizens' healthy living description, personal circumstances, and satisfaction with foot and cycle paths, sports facilities, playgrounds, green spaces, museums and theaters, community centers, churches, healthcare, school, food supplies, contact with neighborhood, unfamiliar and/or unused activities, familiar and used activities, unavailable but desired (lacking) activities, and reaching citizens. RESULTS: The utilization of HWA facilities and activities was influenced by the overarching themes of social cohesion, familiarity, reaching citizens, maintenance, safety, physical accessibility, financial accessibility, social accessibility, fit with personal context, and fit with the neighborhood's specific needs. Different overarching themes stood out across different facilities and activities. LPTs indicated the overarching themes needed in combination with one another for a specific activity or facility to increase utilization. For example, the LPT regarding foot and cycle paths was "accessible, safe, and maintained foot and cycle paths". The LPTs regarding familiar and used activities were "customized activities; information provision (e.g., about possibilities to join without paying); social contact, meeting others, and everyone feels included". CONCLUSION: Conducting inclusive qualitative research from a systems perspective among citizens living in low SEP neighborhoods has contributed valuable insights into their needs. This enables practical implementation of HWAs by providing a deeper understanding of the LPTs within the HWA system. LPTs can help HWA stakeholders to further develop current HWAs toward systems approaches. Future research could study the leverage points that may contribute to LPT implementation.