The Influence of Gentrification on Adverse Birth Outcomes in California.

Evidence has documented the effects of place on perinatal outcomes, but less is known about the sociopolitical mechanisms, such as gentrification, that shape neighborhood context and produce spatialized inequities in adverse birth outcomes. Leveraging a diverse sample in California, we assessed the associations between gentrification and birth outcomes: preterm birth, small-for-gestational-age, and low birth weight. Gentrification was measured using the Freeman method and the Displacement and Gentrification Typology. Descriptive analysis assessed outcome prevalence and race and ethnicity distribution by exposure and participant characteristics. Overall and race and ethnicity-stratified mixed effects logistic models examined associations between gentrification and birth outcomes, sequentially adjusting for sociodemographic status and pregnancy factors, with a random intercept to account for clustering by census tract. In a sample of 5,116,131 births, outcome prevalence ranged from 1.0% for very preterm birth, 5.0% for low birth weight, 7.9% for preterm birth, and 9.4% for small-for-gestational-age. Adjusting for individual-level factors, gentrification was associated with increased odds of preterm birth (Freeman OR = 1.09, 95% CI 1.07-1.10; Displacement and Gentrification Typology OR = 1.11, 95% CI 1.09-1.13). While Displacement and Gentrification Typology-measured gentrification was consistently associated with greater odds of adverse outcomes, Freeman-measured gentrification was associated with slightly lower odds of small-for-gestational-age and low birth weight. Furthermore, gentrification was associated with birth outcome odds across multiple racial and ethnic groups, but the directions and magnitudes of the associations varied depending on the gentrification assessment methodology and the outcome assessed. Results demonstrate that gentrification plays a role in shaping adverse birth outcomes in California.

Covid-19 Impacts on Physical Activity among Community-dwelling Older Adults with Memory Problems: The Moderating Role of Walkable Neighborhood Destinations.

BACKGROUND AND OBJECTIVES: The number of people with memory problems who desire or are forced to age in place has been growing rapidly. COVID-19 has brought significant challenges to the ability of those with memory problems to stay active and age in place. This study investigated the roles of neighborhood environments in helping community-dwelling people with memory problems maintain physical activity during the COVID-19 pandemic. RESEARCH DESIGN AND METHODS: We used retrospective online survey data from 75 caregivers who responded on behalf of their care recipients with memory problems living in Texas communities. We used difference-in-difference (DID) estimations based on zero-inflated negative binomial regression models to examine the changes in recreational walking and moderate-to-strenuous exercise before and during the COVID-19 pandemic and whether such changes vary by diversity of walkable neighborhood destinations. RESULTS: In the total sample, there was a significant reduction in both recreational walking (Δ change=-45.16 min/week, p<0.001) and exercise (Δ change=-36.28 min/week, p=0.03) after the COVID-19 outbreak. The pandemic's impact on exercise varied by diversity of neighborhood destinations (DID=0.81, p=0.03). Those living in neighborhoods with diverse walkable destinations experienced less decline in physical activity compared to those living in areas with limited destinations. DISCUSSION AND IMPLICATIONS: These findings suggest that the impact of the COVID-19 pandemic on physical activity among people with memory problems may be partially explained by neighborhood land use characteristics. Destination-rich, mixed-use neighborhood environments can help people with memory problems stay active even during pandemics such as COVID-19 in the U.S. and potentially elsewhere.

Neighborhood Safety Concerns and the Onset of Depressive Symptoms Among Women: A Population-based Prospective Cohort Study in South Korea.

Neighborhood safety is crucial for the well-being of residents; however, longitudinal evidence is scarce. This study explored the association between neighborhood safety concerns and depressive symptoms among women. A nationally representative sample of 10,008 women was surveyed in 2016. Six dimensions of neighborhood safety concerns were assessed: crime, food, safety at night, traffic accidents, building and facility, and general safety. The total score for neighborhood safety concerns ranged from 6 to 24, with higher scores indicating greater concerns. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiologic Studies Depression. For cross-sectional analyses, we explored how neighborhood safety concerns were associated with concurrent depressive symptoms at baseline. For the longitudinal analyses, we explored how they were associated with depressive symptom onset at the 2-year follow-up (2018) among women without depressive symptoms at baseline (n = 7,643). Logistic regressions were employed. The mean (standard deviation [SD]) of the neighborhood safety concern score was 12.7 (3.3). In the cross-sectional analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.23-fold (95% CI: 1.13-1.35) increase in the odds of concurrent depressive symptoms at the baseline year. In the longitudinal analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.15-fold (95% CI: 1.03-1.29) increase in the odds of experiencing the onset of depressive symptoms at the follow-up year. This study suggests that neighborhood safety concerns are risk factors for the development of depressive symptoms of female residents. Policy efforts are necessary to ensure community safety.

Examining the importance of neighborhood natural, and built environment factors in predicting older adults' mental well-being: An XGBoost-SHAP approach.

BACKGROUND: Previous studies have shown that urban neighborhood environmental factors significantly influence the health outcomes of urban older adults. However, most cross-sectional studies exploring the health effects of these factors have failed to quantify the relative importance of each factor. METHODS: We use XGBoost machine learning techniques and SHAPley Additive Interpretation (SHAP) to rank the importance of urban neighborhood environmental factors in shaping the mental health of urban older adults. To address self-selection bias in housing choice, we distinguish older adults living in private housing from those living in public as residents in private housing have more freedom to choose where to live. RESULTS: The results show that both natural and built environmental factors in urban neighborhoods are important predictors of mental well-being scores. Five natural environmental factors (blue space, perceived greenery quantity, NDVI, street view greenness, aesthetic quality) and three built environmental factors (physical activity facilities quality, physical activity facilities quantity, neighborhood disorder) had considerable predictive power for mental well-being scores in two groups. Among them, blue space, perceived greenery quantity and street view greenness quantity became less important after controlling for self-selection bias, possibly because of the unequal distribution of quantity and quality, and the performance of neighborhood disorder, aesthetic quality and physical activity facilities quality was more sensitive in public housing. CONCLUSIONS: These results highlight the nuanced and differential effects of neighborhood environmental exposures on mental well-being outcomes, depending on housing preferences. The results of this study can provide support for decision makers in urban planning, landscape design and environmental management in order to improve the mental well-being status of urban older adults.

Neighborhood Environments and Healthy Life Expectancy in Older Adults: A 6-year Longitudinal Cohort Study Based on Data from the Japan Gerontological Evaluation Study.

Introduction: A well-established association exists between health and neighborhood land use patterns, including parks, roads, and other physical environments, also called the built environment. Previous studies have demonstrated that the built environment influences health, particularly among older populations, because the scope of activities in such populations is limited. Herein, we investigated the association between specific neighborhood environments and the healthy life expectancy of older individuals. Methods: Data at two time points (2013 and 2019) from the Japan Gerontological Evaluation Study were used in this study. The study comprised a sample of 8,956 residents aged ≥65 years who were not certified for long-term care. Information on the presence or absence of eight types of neighborhood environments was collected using a questionnaire. A multistate life table analysis was conducted to determine the association between perceived neighborhood environments and healthy life expectancy. Results: Significant differences were observed in the "parks and sidewalks suitable for exercise and walking" category. The group that perceived "parks and sidewalks suitable for exercise and walking" had an approximately 1.2-year longer healthy life expectancy than the group that did not perceive such parks and sidewalks. In addition, individuals who lived within walking distance of a park were more physically active than those who did not. Conclusions: Safe, walkable neighborhoods with excellent parks may encourage physical activity among older adults and extend their healthy lifespan. Future research is warranted to identify the underlying mechanisms.

The relationship between the environment and physical activity-related motivational trajectories.

The study explores motivational profiles for physical activity, using self-determination theory's full continuum of motivational regulations, and examines their stability over three months. Furthermore, it investigates whether physical environment and community characteristics are associated with transitioning between profiles, as well as the sociodemographic differences in these motivational transition pathways. Data were collected from 305 U.S. residents at three time points. The three profiles-'low in motivation' (23.5 % of the sample in wave 1), 'self-determined motivation' (41.4 %), and 'ambivalent motivation' (35.0 %)-were relatively stable. Staying in the low-in-motivation profile was negatively associated with being active in social settings, community support, perceived environmental restorativeness, and availability of physical activity opportunities. Having a higher education and income, being male, employed, married or in a partnership, and identifying as White were associated with being in a motivationally positive profile in the last wave of the study. These profiles reported higher activity and life satisfaction.

Assessing Physical Therapists' Outdoor Walking Recommendations and Neighborhood Walkability for Older Adults.

BACKGROUND/OBJECTIVES: Neighborhood walkability is the extent to which built and social environments support walking. Walkability influences older adults' participation in outdoor physical activity. Identifying factors that influence physical therapists' (PTs) decisions about prescribing outdoor walking is needed, especially for those who are aging in place. The purpose of this study is to describe the neighborhood walkability knowledge, perceptions, and assessment practices of PTs who work with community-dwelling older adults. METHODS: A cross-sectional survey was sent via email to 5,000 PTs nationwide. The 40-item survey assessed walking prescriptions, walkability perceptions and assessments, and gathered demographic data. Categorical variables were compared using Chi-square analyses. RESULTS: Using a total of 122 PTs who worked in outpatient geriatric physical therapy settings, a significant difference was found between perceptions of whether PTs should assess walkability and whether they actually assess walkability (χ2 = 78.7, p < .001). Decisions to prescribe outdoor walking were influenced by the availability (n = 79, 64.8%) and maintenance (n = 11, 9.0%) of sidewalks, crime (n = 9, 7.4%), terrain (n = 7, 5.7%), and aesthetics (n = 6, 4.9%). Objective walkability measures were not used by the respondents. CONCLUSION: When considering the assessment of walkability, PTs prioritize the built environment over the social environment. Although most believe it is the responsibility of the PT to assess walkability, most do not. Significance/Implications: Assessment of walkability may allow PTs to identify barriers and make more informed recommendations concerning outdoor walking for older adults. Objective measures are available for PTs when prescribing outdoor walking.

Childhood maltreatment and alcohol and tobacco use trajectories in rural Chinese adolescents.

BACKGROUND: There is a high prevalence of childhood maltreatment among Chinese children and adolescents, but little is known about its impact on alcohol and tobacco use trajectories and how positive school and neighborhood environments moderate the associations. The objective of this study was to assess the association between multiple forms of childhood maltreatment and longitudinal alcohol and tobacco use trajectories, and to assess the possibility that perceived connections to school and neighborhood moderate these associations. METHODS: This longitudinal cohort study included 2594 adolescents (9 to 13 years) from a low-income rural area in China. Childhood exposure to abuse and neglect was assessed using the Childhood Trauma Questionnaire. Participants reported past-month alcohol and tobacco use at three time points over 1 year. RESULTS: Growth curve models revealed that childhood sexual abuse was associated with a higher risk of past-month drinking (OR = 1.53, 95% CI 1.19-2.03, p < 0.001) and smoking (OR = 1.82, 95% CI 1.30-2.55, p < 0.001). Neglect was associated with a higher risk of past-month drinking (OR = 1.52, 95% CI 1.06-1.90, p < 0.05) and smoking (OR = 2.02, 95% CI 1.34-3.02, p < 0.001). None of the maltreatment forms predicted a faster increase in either drinking or smoking. These associations were found independent of personal, family, and contextual characteristics. School and neighborhood connection moderated the association between physical abuse and past-month drinking, such that physical abuse was associated with a greater risk of drinking only for youth who perceived low school or neighborhood connections. CONCLUSIONS: Findings demonstrate the importance of early experiences of childhood maltreatment for adolescent alcohol and tobacco use. Enhancing school and neighborhood connectedness for physically abused youth may help protect them from alcohol use.

Influence of parental nativity and perceived neighborhood environment on physical activity and screen time of United States youth.

OBJECTIVE: This study assessed how parental nativity and perceived environment are associated with physical activity and screen time of U.S. children and adolescents. METHODS: Data originated from the 2020-21 U.S. National Survey of Children's Health. We conducted multivariable Poisson regression to assess the cross-sectional association of parental nativity and perceived neighborhood environment variables on parental reports of youth meeting national physical activity and screen time guidelines. We tested interactions of parental nativity and neighborhood environment variables on both outcomes. Analyses were conducted using STATA v17 and p < 0.05 indicated statistical significance. RESULTS: The sample of 24,928 children and 30,951 adolescents was 11.6 years of age, on average, with approximately 39% under 200% of the federal poverty level. About one-third of the sample (27.5%) had foreign-born parents. In adjusted models, we found that compared to youth with U.S.-born parents, those with foreign-born parents had a lower prevalence of meeting physical activity guidelines. Youth whose parents reported living in safe neighborhoods had a higher prevalence of meeting guidelines for physical activity (children: PR = 1.20, 95%CI 1.14, 1.27; adolescents: PR = 1.23, 95%CI 1.14, 1.32) and screen time (children: PR = 1.19, 95%CI 1.13, 1.26; adolescents: PR = 1.16, 95%CI 1.06, 1.28) than youth whose parents reported unsafe neighborhoods. We found similar associations between neighborhoods considered supportive or with many amenities and meeting physical activity and screen time guidelines. CONCLUSIONS: Youth whose parents are foreign-born have a lower prevalence of sufficient activity, and perceived parental neighborhood safety and support may be significant influences on youth physical activity and screen time.

Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study.

BACKGROUND: Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China). METHODS: The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes. RESULTS: Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants. CONCLUSION: Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.