Recent epidemiologic studies have found that living in socioeconomically disadvantaged neighborhoods is associated with increased prevalence and incidence of coronary heart disease, even after controlling for measures of personal income, education, and occupation. There is also abundant evidence of important differences in neighborhood environments by race and ethnicity. For example, African Americans are significantly more likely to live in disadvantaged neighborhoods than whites, even when persons of similar personal income and education are compared. Predominantly African-American neighborhoods (and disadvantaged neighborhoods generally) have been shown to have greater density of tobacco advertising and greater availability of tobacco products. The availability and quality of recreational spaces and the availability and quality of healthy foods may also differ across neighborhoods. These data suggest that neighborhood characteristics, and access to health community environments generally, may contribute to race and ethnic differences in cardiovascular risk. Neighborhood differences may also be relevant in understanding differences in cardiovascular health among other race/ethnic groups. The proposed project will build on existing research in both cardiovascular disease epidemiology and neighborhood effects at Columbia, allowing increased focus on the examination of neighborhood effects on cardiovascular disease in minority populations and on the contributions of neighborhood differences to disparities in cardiovascular health. This increased focus will include (1) enhanced analyses of neighborhood effects on cardiovascular health in minority groups using existing cohort data and data from the US Census, (2) support for the development of operational measures of neighborhood characteristics including both survey-based and geographic information-based (GIS) approaches, and (3) support for methodological approaches which will enhance our ability to more rigorously examine neighborhood effects as well as the contribution of neighborhood differences to health disparities in cardiovascular diseae. Confirming that neighborhood characteristics are relevant to disease risk (through health damaging or health enhancing features of neighborhoods) could have important implications for the prevention of cardiovascular disease and for the reduction of persistent (and often increasing) social and race/ethnic disparities.
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