American Journal of Epidemiology Advance Access published online on August 10, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi250
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 From the Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
* To whom correspondence should be addressed. 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.
Received August 10, 2004
Accepted April 28, 2005
Article
Protective and Harmful Effects of Neighborhood-Level Deprivation on Individual-Level Health Knowledge, Behavior Changes, and Risk of Coronary Heart Disease
Catherine Cubbin, E-mail: cubbinc{at}fcm.ucsf.edu
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Stafford, D. Gimeno, and M. G. Marmot Neighbourhood characteristics and trajectories of health functioning: a multilevel prospective analysis Eur J Public Health, December 1, 2008; 18(6): 604 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Riva, L. Gauvin, and T. A Barnett Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998 J Epidemiol Community Health, October 1, 2007; 61(10): 853 - 861. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C Wang, S. Kim, A. A Gonzalez, K. E MacLeod, and M. A Winkleby Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index J Epidemiol Community Health, June 1, 2007; 61(6): 491 - 498. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Chaix, M. Rosvall, and J. Merlo Recent Increase of Neighborhood Socioeconomic Effects on Ischemic Heart Disease Mortality: A Multilevel Survival Analysis of Two Large Swedish Cohorts Am. J. Epidemiol., January 1, 2007; 165(1): 22 - 26. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Galea and J. Ahern Invited Commentary: Considerations about Specificity of Associations, Causal Pathways, and Heterogeneity in Multilevel Thinking Am. J. Epidemiol., June 15, 2006; 163(12): 1079 - 1082. [Full Text] [PDF]
|
|