A Geospatial Analysis of Health, Mental Health, and Stressful Community Contexts in Los Angeles County.

INTRODUCTION: Despite numerous federal investments, chronic disease continues to disproportionately affect certain communities across the United States. Understanding the regional distribution (including any overlaps) of factors that extend beyond built and food environments, especially factors that may adversely affect chronic disease-related behaviors, is important. This case study of Los Angeles County's geospatial landscape sought to address these gaps in research and practice. METHODS: We examined the distributions and geographic overlaps between economic hardship, psychological distress, soda consumption, and availability of publicly funded mental health facilities in 8 Service Planning Areas in Los Angeles County. We categorized the geospatial presence of each variable as low, intermediate, or high. We imported all data, collected during 2014-2018, into ArcGIS Pro version 2.3.3 to create 5 bivariate choropleth maps. RESULTS: Levels of economic hardship were not equally distributed across communities; the county was characterized by intermediate levels of soda consumption and psychological distress. Most areas had low or intermediate availability of publicly funded mental health facilities. We also found some discordance between psychological distress and availability of publicly funded mental health facilities, and between economic hardship and availability of these facilities. CONCLUSION: The need exists to address disparities in economic hardship and to increase access to publicly funded mental health supports and providers in Los Angeles County. The information collected in this case study has policy implications for health, public health, and mental health services planning at the local level.

Race and income moderate the association between depressive symptoms and obesity.

Complex interrelationships between race, sex, obesity and depression have been well-documented. Because of differences in associations between socioeconomic status (SES) and health by race, determining the role of SES may help to further explicate these relationships. The aim of this study was to determine how race and income interact with obesity on depression. Combining data from the 2007-2014 National Health and Nutrition Examination Survey, depressive symptoms was measured with the Patient Health Questionnaire-9 and obesity was assessed as body mass index ≥30 kg/m2. Three-way interactions between race, income and obesity on depressive symptoms were determined using ordered regression models. Significant interactions between race, middle income and obesity (OR = 0.66, 95% CI = 0.22-1.96) suggested that, among white women, obesity is positively associated with depressive symptoms across income levels, while obesity was not associated with depression for African American women at any income level. Obesity was only associated with depressive symptoms among middle-income white men (OR = 1.44, 95% CI = 1.02-2.03) and among high-income African American men (OR = 4.65, 95% CI = 1.48-14.59). The associations between obesity and depressive symptoms vary greatly by race and income. Findings from this study underscore the importance of addressing obesity and depression among higher income African American men.

Is the Black-White Mental Health Paradox Consistent Across Gender and Psychiatric Disorders?

This study assessed whether the black-white mental health epidemiologic paradox (i.e., blacks' lower or similar rates of mental disorder relative to whites) extends across 12 lifetime and past-year psychiatric disorders and whether it varies with gender. We used data from the National Comorbidity Survey Replication and the National Survey of American Life, 2001-2003 (n = 4,584 black and 6,668 non-Hispanic white persons). Results showed overwhelming evidence of the paradox across lifetime and past-year disorders for women and men. In addition, blacks' mental health advantage over whites widened after adjusting for socioeconomic factors. There was one exception: Black women experienced higher risk of lifetime posttraumatic stress disorder compared with white women. These findings provide strong evidence for the "black-white mental health paradox"; however, additional research is needed to understand black women's heightened risk for posttraumatic stress disorder.

Discrimination, Serious Psychological Distress, and Church-Based Emotional Support Among African American Men Across the Life Span.

Objective: This study tested whether church-based social support buffers the negative effects of discrimination on serious psychological distress (SPD) among three age groups-early, middle, and late adulthood-of African American men. Methods: Negative binominal regression analyses for discrimination and SPD were performed using data from 1,271 African American men from the National Survey of American Life. Results: Discrimination was positively associated with SPD for all age groups. An interaction between church-based support and discrimination indicated that under conditions of high levels of support from congregants, discrimination, and SPD were positively correlated. However, discrimination and SPD were unrelated for low levels of church-based support. Further, the interaction was significant for men aged 18-34 and 55 or older but not significant for men aged 35-54. Discussion: This is the first study to document relationships among discrimination, SPD, and church-based support in a nationally representative sample of African American men. Overall, rather than revealing a stress-buffering function, findings were consistent with the resource mobilization perspective of social support, indicating that higher levels of assistance from church networks are provided when individuals experience high levels of both discrimination and SPD.

Discrimination and Depressive Symptoms Among African American Men Across the Adult Lifecourse.

Objectives: A lifecourse framework was used to examine the association between major and everyday measures of perceived discrimination and depressive symptoms among African American men and to evaluate whether these relationships differed for young, middle-aged, and older men. Method: The association between both major and everyday discrimination and depressive symptoms, as measured by the Center for Epidemiologic Studies Depression (CES-D) scale, was assessed among 296 African American men in the 2011-2014 Nashville Stress and Health Study (NSAHS) using ordinary least squares regression. Interactive associations between major and everyday discrimination and age patterns in the discrimination-depressive symptoms relationship were also investigated. Results: Everyday, but not major discrimination was associated with depressive symptoms among African American men. This relationship was stronger among middle-aged men and diminished among older men. However, major discrimination, but not everyday discrimination, was associated with depressive symptoms of older men (age 55+), with greatest depressive symptomatology among those reporting both forms of discrimination. Discussion: Everyday discrimination is a more consistent predictor, relative to major discrimination, of depressive symptoms among African American men across the lifecourse, although there were age and/or cohort differences. Findings also demonstrate the synergistic, or additive, impact of multiple forms of discrimination on mental health.

Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age.

This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.

Childhood adversity and adult health: Evaluating intervening mechanisms.

Substantial evidence has accumulated supporting a causal link between childhood adversity and risk for poor health years and even decades later. One interpretation of this evidence is that this linkage arises largely or exclusively from a process of biological embedding that is not modifiable by subsequent social context or experience - implying childhood as perhaps the only point at which intervention efforts are likely to be effective. This paper considers the extent to which this long-term association arises from intervening differences in social context and/or environmental experiences - a finding that would suggest that post-childhood prevention efforts may also be effective. Based on the argument that the selected research definition of adult health status may have implications for the early adversity-adult health linkage, we use a representative community sample of black and white adults (N = 1252) to evaluate this relationship across three health indices: doctor diagnosed illnesses, self-rated health, and allostatic load. Results generally indicate that observed relationships between childhood adversity and dimensions of adult health status were totally or almost totally accounted for by variations in adult socioeconomic position (SEP) and adult stress exposure. One exception is the childhood SEP-allostatic load association, for which a statistically significant relationship remained in the context of adult stress and SEP. This lone finding supports a conclusion that the impact of childhood adversity is not always redeemable by subsequent experience. However, in general, analyses suggest the likely utility of interventions beyond childhood aimed at reducing exposure to social stress and improving social and economic standing. Whatever the effects on adult health that derive from biological embedding, they appear to be primarily indirect effects through adult social context and exposure.

Self-identified race, socially assigned skin tone, and adult physiological dysregulation: Assessing multiple dimensions of "race" in health disparities research.

Despite a general acceptance of "race" as a social, rather than biological construct in the social sciences, racial health disparities research has given less consideration to the dimensions of race that may be most important for shaping persistent disparities in adult physical health status. In this study, we incorporate the social constructionist view that race is multidimensional to evaluate the health significance of two measures of race, racial self-identification and the socially perceived skin tone of black Americans, in a sample of black and white adults in the Nashville Stress and Health Study (N=1186). First, we use the approach most common in disparities research-comparing group differences in an outcome-to consider self-identified racial differences in allostatic load (AL), a cumulative biological indicator of physical dysregulation. Second, we examine intragroup variations in AL among blacks by skin tone (i.e. light, brown, or dark skin). Third, we assess whether the magnitude of black-white disparities are equal across black skin tone subgroups. Consistent with prior research, we find significantly higher rates of dysregulation among blacks. However, our results also show that racial differences in AL vary by blacks' skin tone; AL disparities are largest between whites and dark-skinned blacks and smallest between whites and light-skinned blacks. This study highlights the importance of blacks' skin tone as a marker of socially-assigned race for shaping intragroup and intergroup variations in adult physiological dysregulation. These results demonstrate the importance of assessing multiple dimensions of race in disparities research, as this approach may better capture the various mechanisms by which "race" continues to shape health.