Cardiovascular disease (CVD) is a major public health concern that affected 41% of the United States population and cost $555 billion in medical spending and lost productivity in 2016. Prevention strategies that intervene on social determinants of health, such as neighborhood environmental characteristics, are one approach to decreasing the growing burden of CVD. Neighborhood green spaces, including parks, recreational areas, and vegetation, are modifiable and important neighborhood factors have been associated with lower CVD risk and better physiologic outcomes. Green spaces may protect against CVD by mitigating stress through physical activity, relaxation, and positive social interactions that reduce individuals? exposure to stressful social conditions. Neighborhood social disadvantage, measured as neighborhood psychosocial hazards comprised of social disorganization, safety, physical disorder, and economic deprivation, likely provokes a stress response that may lead to hypothalamic?pituitary?adrenocortical (HPA) axis dysfunction with regular exposure. Psychosocial hazards have been associated with increased CVD risk and higher levels of stress sensitive pro-inflammatory biomarkers. The health benefits of neighborhood green space suggest it may serve as a potential resilience factor against neighborhood social disadvantage. The proposed cross-sectional study will examine associations among neighborhood green space, neighborhood social disadvantage, and stress sensitive pro-inflammatory biomarkers in a sample of 624 urban-dwelling, middle-aged and older adults. This study is a secondary data analysis of the Baltimore Memory Study, a cohort study that investigated determinants of cognitive decline in 1,140 Baltimore City residents ages 50 to 70-year-old from 65 contiguous city neighborhoods (R01 AG19604, PI: B. Schwartz). Study data will be paired with satellite maps of vegetated land cover from the United States Geological Service to measure green space.
The specific aims of the proposed study are to test: (1) the association between neighborhood green space and stress sensitive pro-inflammatory biomarkers; (2) the association between neighborhood social disadvantage and stress sensitive pro-inflammatory biomarkers; and (3) whether neighborhood green space modifies the association between neighborhood social disadvantage and stress sensitive pro-inflammatory biomarkers. These findings may help clarify the role of neighborhood green spaces as a modifiable neighborhood resilience factor that can be targeted for community-level interventions to reduce CVD risk. This proposed study aligns with the National Heart, Lung, and Blood Institute?s priorities to investigate factors that account for differences in health among populations and to understand how environmental exposures and social determinants modulate biological systems and promote resilience. The proposed training plan is foundational to a program of research focused on understanding social and environmental contributors to cardiovascular health and developing skills to create targeted interventions that promote heart-healthy lifestyles.

Public Health Relevance

Cardiovascular disease is an escalating health burden that may benefit from prevention strategies aimed at addressing social determinants of health, such as intervening on modifiable physical factors of neighborhood environments. This study will test whether neighborhood green space is associated with lower levels of stress sensitive pro-inflammatory biomarkers and is a resilience factor that attenuates the association between neighborhood social disadvantage and levels of stress sensitive pro-inflammatory biomarkers within urban- dwelling, middle and older-aged adults. Findings have the potential to inform urban planning and community intervention development and may support testing green space exposure as a component of cardiovascular risk- reduction interventions.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Predoctoral Individual National Research Service Award (F31)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Campo, Rebecca A
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Schools of Nursing
United States
Zip Code