Few studies have examined how social and physical features of neighborhoods interact with individual factors, e.g., health behaviors and socioeconomic status (SES), to influence disparities in health. Primary Aims: The investigators propose to test the independent and interrelated effects of the neighborhood social environment (e.g., neighborhood SES, social disorganization, Hispanic concentration, crime rates), neighborhood physical environment (e.g., housing conditions, availability of goods and services such as licensed alcohol distributors, fast food restaurants, grocery stores, gun shops, educational resources, recreational facilities, banking/lending institutions), and individual risk factors in predicting all-cause and cardiovascular disease (CVD) mortality in women and men. Design/methods: The investigators will conduct a prospective mortality follow-up study of 8,847 white (non-Hispanic) and Hispanic women and men who participated in the Stanford Heart Disease Prevention Program (SHDPP), also referred to as the Stanford Five-City Project. This population-based CVD study included a random sample of women and men aged 25-74 who participated in one of five cross-sectional surveys (1979-1990) and were from four socioeconomically diverse California cities. The SHDPP is recognized for its comprehensive and well-standardized survey and physiologic measures that include SES (education, income, occupation), CVD risk factors (e.g., smoking, high cholesterol and saturated fat), psychosocial factors, and other health-related measures. The investigators propose to match survey data to death records for all-cause and CVD mortality endpoints, and link geocoded addresses to census data and archival data for measures of the neighborhood social and physical environment. They anticipate 824 deaths by 2000 and 1690 deaths by 2005. This work would create a new database where individuals' SES and health indicators are linked with characteristics of their specific neighborhoods. Based on their empirical findings, they will identity neighborhoods currently at high and low risk for mortality, then conduct focus groups and map neighborhood environments (e.g., social, physical, and service features) to create a geographic information system (GIS). These two activities will hopefully extend their empirical findings, generate new hypotheses, and guide the development of their Community Outreach and Education Program (COEP). Dissemination: The COEP will build on their collaborative partnerships with members of the study cities, health advocates, and health agencies that serve low SES and medically under served populations. With the involvement of these partners, they will integrate their empirical findings with knowledge from existing studies and disseminate results via the Internet, media, targeted mailings, and programs offered by the California State and local county health departments in the four study cities.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Application #
Study Section
Special Emphasis Panel (ZES1-JPM-B (HD))
Program Officer
Pratt, Charlotte
Project Start
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Stanford University
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Wang, May C; Cubbin, Catherine; Ahn, Dave et al. (2008) Changes in neighbourhood food store environment, food behaviour and body mass index, 1981--1990. Public Health Nutr 11:963-70
Wang, May C; Kim, Soowon; Gonzalez, Alma A et al. (2007) Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index. J Epidemiol Community Health 61:491-8
Lee, Rebecca E; Cubbin, Catherine; Winkleby, Marilyn (2007) Contribution of neighbourhood socioeconomic status and physical activity resources to physical activity among women. J Epidemiol Community Health 61:882-90
Yen, Irene H; Scherzer, Teresa; Cubbin, Catherine et al. (2007) Women's perceptions of neighborhood resources and hazards related to diet, physical activity, and smoking: focus group results from economically distinct neighborhoods in a mid-sized U.S. city. Am J Health Promot 22:98-106
Cubbin, Catherine; Winkleby, Marilyn A (2007) Food availability, personal constraints, and community resources. J Epidemiol Community Health 61:932
Taylor, C Barr; Ahn, David; Winkleby, Marilyn A (2006) Neighborhood and individual socioeconomic determinants of hospitalization. Am J Prev Med 31:127-34
Winkleby, Marilyn; Cubbin, Catherine; Ahn, David (2006) Effect of cross-level interaction between individual and neighborhood socioeconomic status on adult mortality rates. Am J Public Health 96:2145-53
Cubbin, Catherine; Winkleby, Marilyn A (2005) Protective and harmful effects of neighborhood-level deprivation on individual-level health knowledge, behavior changes, and risk of coronary heart disease. Am J Epidemiol 162:559-68
Chuang, Ying-Chih; Cubbin, Catherine; Ahn, David et al. (2005) Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking. J Epidemiol Community Health 59:568-73
Pollack, Craig Evan; Cubbin, Catherine; Ahn, David et al. (2005) Neighbourhood deprivation and alcohol consumption: does the availability of alcohol play a role? Int J Epidemiol 34:772-80

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