Neighborhood Environment and Health of Injured Urban Black Men
Urban black males are at disproportionately high risk of poor health outcomes; thus, we need to measure neighborhood environments appropriately in order to understand aspects of neighborhoods that influence their mental and physical health. We explored associations between physical and mental health of injured, urban black men with objectively measured and perceived neighborhood characteristics.
In 2017–2018, we analyzed data from 486 black, adult males in Philadelphia admitted to a trauma center with injury between January 2013 and February 2017. Area-level measures of social, economic, and built environments were obtained from multiple sources. At enrollment, participants answered questions about neighborhood environment and self-reported physical and mental health 30 days before injury. We conducted factor analysis to identify neighborhood characteristics, then estimated odds of poor physical or mental health, accounting for spatial correlation of participants.
Poor physical and mental health was reported by 12% and 22% of participants, respectively. In participants’ neighborhoods, 29% of adults lived in poverty. Individually, 73% of men reported abandoned buildings, and 31% reported not feeling safe walking around their neighborhood. Physical health was associated with neighborhood poverty and disconnectedness. Mental health was associated with neighborhood economics and individual perceptions of social disorder and safety. Individual-level factors were not correlated with area-level factors.
We found both area-level and individual-level measures were associated with health, perhaps operating through different mechanisms, but individual experiences may not be easily extrapolated from area-level data. By identifying important components of neighborhood environments, we may better understand how neighborhoods contribute to health in vulnerable populations.
KeywordsNeighborhood environment Neighborhood perception Mental health Physical health Black men Injury
The authors acknowledge Jessica Webster, Andrew Robinson, and Vicky Tam for their assistance in data collection and management.
Dr. Palumbo conceived of the study and led the analysis and write-up. Dr. Wiebe provided statistical analysis support; Dr. Kassam-Adams and Dr. Richmond provided subject matter expertise and guidance based on knowledge of study population. All authors provided substantial input into analysis and final write-up of results and have approved this manuscript.
Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR013503 (PI: Richmond). Dr. Palumbo was supported in part by the Penn Injury Science Center and the Centers for Disease Control (grant no. R49CE002474).
Compliance with Ethical Standards
The study was approved by the Institutional Review Board at the University of Pennsylvania (IRB Protocol #814745).
Conflict of Interest
The authors declare that they have no conflict of interest.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Centers for Disease Control.
- 7.Izumi BT, Zenk SN, Schulz AJ, Mentz GB, Wilson C. Associations between neighborhood availability and individual consumption of dark-green and orange vegetables among ethnically diverse adults in Detroit. J Am Diet Assoc. 2011;111:274–9. https://doi.org/10.1016/j.jada.2010.10.044.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Bird CE, Seeman TE, Escarce JJ, Basurto-Davila R, Finch BK, Dubowitz T, et al. Neighbourhood socioeconomic status and biological “wear and tear” in a nationally representative sample of US adults. J Epidemiol Community Health. 2010;64:860–5. https://doi.org/10.1136/jech.2008.084814.CrossRefPubMedGoogle Scholar
- 10.Yen IH, Syme SL. The social environment and health: a discussion of the epidemiologic literature. Annu Rev Public Health. 1999;20:287–308. https://doi.org/10.1146/annurev.publhealth.20.1.287.CrossRefPubMedGoogle Scholar
- 11.Sampson RJ, Morenoff JD, Gannon-Rowley T. Assessing “neighborhood effects”: social processes and new directions in research. Annu Rev Sociol. 2002;28:443–78. https://doi.org/10.1146/annurev.soc.28.110601.141114.CrossRefGoogle Scholar
- 16.Subramanian SV, Chen JT, Rehkopf DH, Waterman PD, Krieger N. Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts. Am J Public Health. 2005;95:260–5. https://doi.org/10.2105/AJPH.2003.034132.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, Iandorio TJ, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 2006;3:e260. https://doi.org/10.1371/journal.pmed.0030260.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Adler NE, Rehkopf DH. U.S. disparities in health: descriptions, causes, and mechanisms. Annu Rev Public Health. 2008;29:235–52. https://doi.org/10.1146/annurev.publhealth.29.020907.090852.CrossRefPubMedGoogle Scholar
- 23.Sampson RJ, Raudenbush SW. Seeing disorder : neighborhood stigma and the social construction of “Broken Windows” Author ( s ): Robert J . Sampson and Stephen W . Raudenbush Published by : American Sociological Association Stable URL : http://www.jstor.org/stable/3649091. Soc Psychol Q. 2004;67:319–42.CrossRefGoogle Scholar
- 26.Feldman PJ, Steptoe A. How neighborhoods and physical functioning are related: the roles of neighborhood socioeconomic status, perceived neighborhood strain, and individual health risk factors. Ann Behav Med Publ Soc Behav Med. 2004;27:91–9. https://doi.org/10.1207/s15324796abm2702_3.CrossRefGoogle Scholar
- 27.Franzini L, Caughy M, Spears W, Fernandez Esquer ME. Neighborhood economic conditions, social processes, and self-rated health in low-income neighborhoods in Texas: a multilevel latent variables model. Soc Sci Med. 2005;61:1135–50. https://doi.org/10.1016/j.socscimed.2005.02.010.CrossRefPubMedGoogle Scholar
- 28.Schulz AJ, Mentz G, Lachance L, Zenk SN, Johnson J, Stokes C, et al. Do observed or perceived characteristics of the neighborhood environment mediate associations between neighborhood poverty and cumulative biological risk? Health Place. 2013;24:147–56. https://doi.org/10.1016/j.healthplace.2013.09.005.CrossRefPubMedGoogle Scholar
- 29.Wen M, Hawkley LC, Cacioppo JT. Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: an analysis of older adults in Cook County, Illinois. Soc Sci Med. 2006;63:2575–90. https://doi.org/10.1016/j.socscimed.2006.06.025.CrossRefPubMedGoogle Scholar
- 32.Orstad SL, McDonough MH, Stapleton S, Altincekic C, Troped PJ. A systematic review of agreement between perceived and objective neighborhood environment measures and associations with physical activity outcomes. Environ Behav. 2017;49:904–32. https://doi.org/10.1177/0013916516670982.CrossRefGoogle Scholar
- 35.U.S. Census Bureau. American Community Survey 2015: B02001 - race. Am. FactFinder. Available from: http://factfinder2.census.gov.
- 36.U.S. Census Bureau. American Community Survey 2011–2015: B17001 - Poverty status in the past 12 months by sex and age. Am. FactFinder. Available from: http://factfinder2.census.gov.
- 37.National Center for Health Statistics. Life expectancy at birth, at age 65, and at age 75, by sex, race, and Hispanic origin: United States, selected years 1900–2014. Available from: https://www.cdc.gov/nchs/data/hus/2015/015.pdf.
- 41.Centers for Disease Control and Prevention (CDC). Behavioral risk factor surveillance system survey questionnaire. Atlanta, GA;Google Scholar
- 44.Muthén LK, Muthén BO. MPlus User’s guide. 7th ed. Muthén & Muthén; 2012.Google Scholar
- 48.Richardson J, Mitchell B, Franco J. Shifting neighborhoods: gentrification and cultural displacement in American cities. Washington, D.C.; 2019.Google Scholar
- 49.Ding L, Hwang J, Divringi E. Gentrification and residential mobility in Philadelphia Lei Ding Federal Reserve Bank of Philadelphia. Philadelphia, PA.Google Scholar