American Journal of Epidemiology Advance Access originally published online on August 10, 2005
American Journal of Epidemiology 2005 162(6):559-568; doi:10.1093/aje/kwi250
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ORIGINAL CONTRIBUTIONS |
Protective and Harmful Effects of Neighborhood-Level Deprivation on Individual-Level Health Knowledge, Behavior Changes, and Risk of Coronary Heart Disease
From the Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
Reprint requests to Dr. Catherine Cubbin, Department of Family and Community Medicine, University of California at San Francisco, 500 Parnassus Avenue, MU-3E, Box 0900, San Francisco, CA 94143-0900 (e-mail: cubbinc{at}fcm.ucsf.edu).
The authors examined associations between neighborhood-level deprivation and cardiovascular disease-related health knowledge and behavior changes, as well as the estimated 12-year probability of experiencing a coronary heart disease event. Primary analyses included multilevel regression models among 8,197 women and men living in 82 neighborhoods in four northern California cities who were interviewed in one of five surveys conducted between 1979 and 1990. After controlling for age, gender, marital status, race/ethnicity, city, and time, the authors found that adults living in high-deprivation neighborhoods had significantly lower health knowledge and a higher probability of no positive behavior changes than did adults in moderately deprived neighborhoods (i.e., harmful effects). Conversely, those living in low-deprivation neighborhoods had significantly higher health knowledge and lower probabilities of no positive behavior changes and estimated risk of coronary heart disease (i.e., protective effects). The association between high neighborhood deprivation and no positive behavior changes remained statistically significant after additional adjustment for a composite measure of individual-level socioeconomic status. Associations with neighborhood deprivation did not vary by individual-level socioeconomic status. These results suggest that focusing exclusively on changing individuals' behaviors will have a limited effect unless contextual influences at the neighborhood level are also addressed.
adult; California; cardiology; coronary disease; health behavior; health knowledge, attitudes, practice; residence characteristics; social class
Abbreviations: SES, socioeconomic status/position; SHDPP, Stanford Heart Disease Prevention Program
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