Winkleby Lab In the Prevention Research Center

Grants - Neighborhood-Level Influences on All-Cause Mortality

Title: Neighborhood-Level Influences on All-Cause Mortality.
Investigators: Marilyn Winkleby Ph.D., C. Barr Taylor, M.D., Catherine Cubbin, Ph.D., David Ahn, Ph.D.
Abstract: Background: Few studies have examined how social and physical features of neighborhoods interact with indi­vidual factors, e.g. health behaviors, socioeconomic status (SES), to influence disparities in health.

Primary Aims: We will test the independent and interrelated effects of the neighborhood social environment (e.g., neighborhood SES, social disorganization, Hispanic concentration, crime rates), neighborhood physical environment (e.g., housing conditions, availability of goods and services such as licensed alcohol distributors, fast food restaurants, grocery stores; educational resources, recreational facilities; banking/lending institutions), and individual risk factors in predicting all-cause and CVD mortality in women and men.

Design/methods: We will conduct a prospective mortality follow-up study of 8,847 white (non-Hispanic) and Hispanic women and men who participated in the Stanford Heart Disease Prevention Program (SHDPP), also referred to as the Stanford Five-City Project. This population-based cardiovascular disease (CVD) study included a random sample of women and men aged 25-74 who participated in one of five cross-sectional surveys (1979-1990) and were from four socioeconomically diverse California cities The SHDPP is recognized for its comprehensive and well-standardized survey and physiologic measures that include: SES (education, income, occupation), CVD risk factors (e.g., smoking, high cholesterol and saturated fat), psychosocial factors, and other health-related measures. We will match survey data to death records for all-cause and CVD mortality endpoints, and link geocoded addresses to census data and archi­val data for measures of the neighborhood social and physical environment. We anticipate 824 deaths by 2000 and 1690 deaths by 2005. This work will create a rich new database where individuals' SES and health indicators are linked with characteristics of their specific neighborhoods. Based on our empirical findings, we will identify neighborhoods currently at high and low risk for mortality. We will then conduct focus groups and map neighborhood environments (e.g., social, physical, and service features) to create a geographic information system (GIS). These two activities will extend our empirical findings, generate new hypotheses, and guide the development of our Community Outreach and Education Program (COEP). Dissemination: Our COEP will build on our long-standing collaborative partnerships with members of the study cities, health advocates, and health agen­cies that serve low SES and medically underserved populations. With their active involvement, we will integrate our empirical findings with knowledge from existing studies and disseminate results via the internet, media, tar­geted mailings, and programs offered by the California State and local County Health Departments in the four study cities.

 

 

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