Purpose: Examine (1) the distribution of experiencing the death of a parent or sibling (family death) by race/ethnicity and (2) how a family death affects attaining a college degree. Methods: Participants (n = 8984) were from National Longitudinal Survey of Youth 1997 aged 13–17 at baseline in 1997 and 29–32 in 2013. We examined the prevalence of family deaths by age group and race/ethnicity and used covariate-adjusted logistic regression to assess the relationship between a family death and college degree attainment. Results: A total of 4.2% of white youth experienced a family death, as did 5.0% of Hispanics, 8.3% of Blacks, 9.1% of Asians, and 13.8% of American Indians (group test P < .001). A family death from ages 13–22 was associated with lower odds of obtaining a bachelor's degree by ages 29–32 (OR = 0.65, 95% CI = 0.50, 0.84), compared with no family death. The effect of a death was largest during college years (age 19–22) (OR = 0.57, 95% CI = 0.39, 0.82). Conclusions: Young people of color are more likely to have a sibling or parent die; and family death during college years is associated with reduced odds of obtaining a college degree. Racial disparities in mortality might affect social determinants of health of surviving relatives, and college policies are a potential intervention point.

This study investigated whether changes in neighborhood context induced by neighborhood relocation mediated the impact of the Moving to Opportunity (MTO) housing voucher experiment on adolescent mental health. Mediators included participant-reported neighborhood safety, social control, disorder, and externally-collected neighborhood collective efficacy. For treatment group members, improvement in neighborhood disorder and drug activity partially explained MTO's beneficial effects on girls' distress. Improvement in neighborhood disorder, violent victimization, and informal social control helped counteract MTO's adverse effects on boys' behavioral problems, but not distress. Housing mobility policy targeting neighborhood improvements may improve mental health for adolescent girls, and mitigate harmful effects for boys.

This study prospectively examined the relationship of home yard-size to objectively measured physical activity over three years among a cohort of 531 low-income pre-school-aged children. An adjusted total-effect association of 12.72 additional minutes per week of moderate/vigorous physical activity (MVPA) was observed for each additional hectare of yard-size. The direct-effect association, adjusting for previous year MVPA, was not statistically significant. This study provides evidence that the private or semi-private space around the house may impact children's’ physical activity. Public health and urban planning practitioners should consider these results to identify built environment solutions for improving MVPA among low-income minority children.

<p>Using the Moving to Opportunity (MTO) experiment (1994-2002), this study examined how a multidimensional measure of neighborhood quality over time influenced adolescent psychological distress, using instrumental variable (IV) analysis. Neighborhood quality was operationalized with an independently-validated 19-indicator child opportunity index (COI), linked to MTO family addresses over 4-7 years. We examined if being randomized to receive a housing subsidy (versus remaining in public housing) predicted neighborhood quality across time. Using IV analysis, we tested if experimentally induced differences in COI across time predicted psychological distress (N=2829; Mean(standard deviation (SD)) = -.04(1.12)). The MTO voucher treatment improved neighborhood quality for children compared to in-place controls. A one-SD change in COI since baseline predicted 0.32 point lower psychological distress for girls (B(95%CI)= -0.32 (-0.61, -0.03)). Results were comparable but less precisely estimated when operationalizing neighborhood quality as simply average post-random assignment COI, (B(95%CI)= -0.36(-0.74, 0.02). Effect estimates based on a COI excluding poverty and on the most recent COI measure were slightly larger than other operationalizations of neighborhood quality. Improving a multidimensional measure of neighborhood quality led to reductions in low-income girls’ psychological distress, and this was estimated with high internal validity using IV methods.</p>

Background and Purpose— It is unclear whether disparities in mortality among stroke survivors exist long term. Therefore, the purpose of the current study is to describe rates of longer term mortality among stroke survivors (ie, beyond 30 days) and to determine whether socioeconomic disparities exist. Methods— This analysis included 1329 black and white participants, aged ≥45 years, enrolled between 2003 and 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) who suffered a first stroke and survived at least 30 days after the event. Long-term mortality among stroke survivors was defined in person-years as time from 30 days after a first stroke to date of death or censoring. Mortality rate ratios (MRRs) were used to compare rates of poststroke mortality by demographic and socioeconomic characteristics. Results— Among adults who survived ≥30 days poststroke, the age-adjusted rate of mortality was 82.3 per 1000 person-years (95% CI, 75.4–89.2). Long-term mortality among stroke...

Weight among immigrants in the United States (US) is lower than among the US-born on average, but higher among long-term immigrants than the newly arrived. Neighborhood coethnic concentration—the proportion of neighborhood residents of the same ethnic background—may influence weight among immigrants via behavioral norms and market-driven community resources. However, the relevant exposure timeframe may be far longer than is captured by existing cross-sectional and short-term studies. Using detailed historical residential address information on 1449 older Latino and Chinese long-term immigrants, we investigated associations of 10–20-year neighborhood coethnic concentration trajectories with current waist circumference and weight-related behaviors (diet, physical activity, and sedentary time). Among Chinese participants, compared to persistent low coethnic concentration, increasing coethnic concentration was associated with higher waist circumference (difference = 1.45 cm [0.51, 2.39]). In contrast, both increasing coethnic concentration and persistent high coethnic concentration were associated with a healthier diet. Among Latino participants, trajectories characterized by higher coethnic concentration were associated with higher waist circumference (e.g., difference = 2.11 cm [0.31, 3.91] for persistent high vs. persistent low) and low physical activity. Long-term patterns of neighborhood coethnic concentration may affect weight-related outcomes among immigrants in complex ways that differ by ethnicity and outcome.

Intimate partner violence (IPV) against women is highly prevalent globally, and is associated with adverse health outcomes, including depression. Though women living in low- and middle-income countries (LMICs) face a larger burden of IPV, little is known about whether IPV increases the risk of depression among non-pregnant women and in contexts of high prevalence. Within the setting of rural Bangladesh, this study examined the relationship between the severity of marital IPV against women and the risk of depression. Data were drawn from a nationally-representative study focused on individual and contextual determinants of IPV among married women aged 16-37 years in rural Bangladesh, collected through a multistage, stratified sample in 77 villages in 2014 (n=3290). Multivariable log-binomial regression models were used to estimate the association between the severity of IPV (operationalized as the frequency of different acts of psychological, physical, and sexual abuse, as well as injury due to IPV) and risk of major depressive episode (MDE) using the Edinburgh Postnatal Depression Scale (EPDS). One in six women (16.8%) met the criteria for MDE. Past year IPV was endemic; psychological (77.2%) was most common, followed by sexual (58.8%) and physical (44.4%). Nearly a third of women experienced IPV-related injury. There was a positive dose-response relationship between severity of each type of IPV and MDE above the lowest level of exposure. In adjusted models, the highest levels of psychological (RR=2.27, 95% CI: 1.62, 3.17), physical (RR=2.44, 95% CI: 1.94, 3.08), and sexual (RR=1.65, 95% CI: 1.08, 2.52) IPV severity remained significantly associated with MDE, as well as experiencing IPV-related injury (RR=1.72, 95% CI: 1.23, 2.40). In rural Bangladesh, the severity of all types of marital IPV against women is strongly related to increased risk of MDE. Results suggest the limited utility of standard dichotomous IPV indicators in high prevalence settings.

The etiology of childhood cancers remains largely unknown, especially regarding environmental and behavioral risk factors. Unpacking the association between socioeconomic status (SES) and incidence may offer insight into such etiology. We tested associations between SES and childhood cancer incidence in a population-based case-cohort study (source cohort: Minnesota birth registry, 1989-2014). Cases, ages 0-14 years, were linked from the Minnesota Cancer Surveillance System to birth records through probabilistic record linkage. Controls were 4:1 frequency matched on birth year (2,947 cases and 11,907 controls). We tested associations of individual-level (maternal education) and neighborhood-level (census tract composite index) SES using logistic mixed models. In crude models, maternal education was positively associated with incidence of acute lymphoblastic leukemia (odds ratio (OR) = 1.10, 95% confidence interval (CI): 1.02, 1.19), central nervous system tumors (OR = 1.12, 95% CI: 1.04, 1.21), and neuroblastoma (OR = 1.15, 95% CI: 1.02, 1.30). Adjustment for established risk factors-including race/ethnicity, maternal age, and birth weight-substantially attenuated these positive associations. Similar patterns were observed for neighborhood-level SES. Conversely, higher maternal education was inversely associated with hepatoblastoma incidence (adjusted OR = 0.70, 95% CI: 0.51, 0.98). Overall, beyond the social patterning of established demographic and pregnancy-related exposures, SES is not strongly associated with childhood cancer incidence.

Background: Since 1975, childhood cancer incidence rates have gradually increased in theUnited States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this studywas to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order.We also consid- ered temporal trends in sociodemographic characteristics including race/ethnicity and poverty. Procedure:We conducted a time series county-level ecologic analysis using linked population- based data from Surveillance, Epidemiology, and EndResults cancer registries (1975–2013), birth data from the National Center for Health Statistics (1970–2013), and sociodemographic data from theUSCensus (1970–2010).We estimated unadjusted and adjusted average annual percent changes (AAPCs) in incidence of combined (all diagnoses) and individual types of cancer among children, ages 0–4 years, from Poisson mixed models. Results: There was a statistically significant unadjusted temporal rise in incidence of combined childhood cancers (AAPC = 0.71%; 95% CI = 0.55–0.86), acute lymphoblastic leukemia (0.78%; 0.49–1.07), acute myeloid leukemia (1.86%; 1.13–2.59), central nervous system tumors (1.31%; 0.94–1.67), and hepatoblastoma (2.70%; 1.68–3.72). Adjustment for county-level maternal age reduced estimated AAPCs between 8% (hepatoblastoma) and 55% (combined).However, adjust- mentfor other county characteristics did not attenuate AAPCs, andAAPCsremained significantly above0%in models fully adjusted for county-level characteristics. Conclusion: Although rising maternal age may account for some of the increase in childhood cancer incidence over time, other factors, not considered in this analysis, may also contribute to temporal trends.

Background: Since 1975, childhood cancer incidence rates have gradually increased in theUnited States; however, few studies have conducted analyses across time to unpack this temporal rise. The aim of this studywas to test the hypothesis that increasing cancer incidence rates are due to secular trends in pregnancy characteristics that are established risk factors for childhood cancer incidence including older maternal age, higher birthweight, and lower birth order.We also consid- ered temporal trends in sociodemographic characteristics including race/ethnicity and poverty. Procedure:We conducted a time series county-level ecologic analysis using linked population- based data from Surveillance, Epidemiology, and EndResults cancer registries (1975–2013), birth data from the National Center for Health Statistics (1970–2013), and sociodemographic data from theUSCensus (1970–2010).We estimated unadjusted and adjusted average annual percent changes (AAPCs) in incidence of combined (all diagnoses) and individual types of cancer among children, ages 0–4 years, from Poisson mixed models. Results: There was a statistically significant unadjusted temporal rise in incidence of combined childhood cancers (AAPC = 0.71%; 95% CI = 0.55–0.86), acute lymphoblastic leukemia (0.78%; 0.49–1.07), acute myeloid leukemia (1.86%; 1.13–2.59), central nervous system tumors (1.31%; 0.94–1.67), and hepatoblastoma (2.70%; 1.68–3.72). Adjustment for county-level maternal age reduced estimated AAPCs between 8% (hepatoblastoma) and 55% (combined).However, adjust- mentfor other county characteristics did not attenuate AAPCs, andAAPCsremained significantly above0%in models fully adjusted for county-level characteristics. Conclusion: Although rising maternal age may account for some of the increase in childhood cancer incidence over time, other factors, not considered in this analysis, may also contribute to temporal trends.

BACKGROUND Evidence suggests that aspects of the neighborhood environment may influence risk of problematic drug use among adolescents. Our objective was to examine mediating roles of aspects of the school and peer environments on the effect of receiving a Section 8 housing voucher and using it to move out of public housing on adolescent substance use outcomes. METHODS We used data from the Moving to Opportunity (MTO) experiment that randomized receipt of a Section 8 housing voucher. Hypothesized mediators included school climate, safety, peer drug use, and participation in an after-school sport or club. We applied a doubly robust, semiparametric estimator to longitudinal MTO data to estimate stochastic direct and indirect effects of randomization on cigarette use, marijuana use, and problematic drug use. Stochastic direct and indirect effects differ from natural direct and indirect effects in that they do not require assuming no posttreatment confounder of the mediator-outcome relationship. Such an assumption would be at odds with any causal model that reflects an intervention affecting a mediator and outcome through adherence to treatment assignment. RESULTS Having friends who use drugs and involvement in after-school sports or clubs partially mediated the effect of housing voucher receipt on adolescent substance use (e.g., stochastic indirect effect 0.45% [95% confidence interval: 0.12%, 0.79%] for having friends who use drugs and 0.04% [95% confidence interval: -0.02%, 0.10%] for involvement in after-school sports or clubs mediating the relationship between housing voucher receipt and marijuana use among boys). However, these mediating effects were small, contributing only fractions of a percent to the effect of voucher receipt on probability of substance use. No school environment variables were mediators. CONCLUSIONS Measured school- and peer-environment variables played little role in mediating the effect of housing voucher receipt on subsequent adolescent substance use.

Residential mobility is one documented stressor contributing to higher delinquency and worse educational outcomes. Sensitive period life course models suggest that certain developmental stages make individuals more susceptible to the effects of an exposure, like residential mobility, on outcomes. However, most prior research is observational, and has not examined heterogeneity across age or gender that may inform sensitive periods, even though it may have important implications for the etiology of adolescent development. Moreover, there are important translational implications for identifying the groups most vulnerable to residential mobility to inform how to buffer adverse effects of moving. In this study, low-income families were randomized to residential mobility out of public housing into lower poverty neighborhoods using a rental subsidy voucher ("experimental voucher condition"), and were compared to control families remaining in public housing. The sample was comprised of 2829 youth (51% female; 62% Non-Hispanic Black, 31% Hispanic, 7% other race). At baseline, youth ranged from 5 to 16 years old. This study hypothesized that random assignment to the housing voucher condition would generate harmful effects on delinquency and educational problems, compared to the control group, among boys who were older at baseline. The results confirmed this hypothesis: random assignment to the experimental voucher condition generating residential mobility caused higher delinquency among boys who were 13-16 years old at baseline, compared to same-age, in-place public housing controls. However, residential mobility did not affect delinquency among girls regardless of age, or among boys who were 5-12 years old at baseline. The pattern of results for educational problems was similar but weaker. Families with teenage boys are particularly vulnerable to residential transitions. Incorporating additional supports into housing programs may help low-income, urban families to successfully transition to lower poverty neighborhoods.

BACKGROUND The Moving To Opportunity (MTO) experiment manipulated neighborhood context by randomly assigning housing vouchers to volunteers living in public housing to use to move to lower poverty neighborhoods in five US cities. This random assignment overcomes confounding limitations that challenge other neighborhood studies. However, differences in MTO's effects across the five cities have been largely ignored. Such differences could be due to population composition (e.g., differences in the racial/ethnic distribution) or to context (e.g., differences in the economy). METHODS Using a nonparametric omnibus test and a multiply robust, semiparametric estimator for transportability, we assessed the extent to which differences in individual-level compositional characteristics that may act as effect modifiers can account for differences in MTO's effects across sites. We examined MTO's effects on marijuana use, behavioral problems, major depressive disorder, and generalized anxiety disorder among black and Latino adolescent males, where housing voucher receipt was harmful for health in some sites but beneficial in others. RESULTS Comparing point estimates, differences in composition partially explained site differences in MTO effects on marijuana use and behavioral problems but did not explain site differences for major depressive disorder or generalized anxiety disorder. CONCLUSIONS Our findings provide quantitative, rigorous evidence for the importance of context or unmeasured individual-level compositional variables in modifying MTO's effects.

The Moving to Opportunity (MTO) experiment was a housing mobility program begun in the mid-nineties that relocated volunteer low income families from public housing to rental units in higher opportunity neighborhoods in 5 US cities, using the Section 8 affordable housing voucher program. Compared to the control group who stayed behind in public housing, the MTO voucher group exhibited a harmful main effect for boys’ mental health, and a beneficial main effect for girls’ mental health. But no studies have examined how this social experiment caused these puzzling, opposite gender effects. The present study tests potential mediating mechanisms of the MTO voucher experiment on adolescent mental health (n=2829, aged 12–19 in 2001–2002). Using Inverse Odds Ratio Weighting causal mediation, we tested whether adolescent substance use comorbidity, social networks, or family mental health acted as potential mediators. Our results document that comorbid substance use (e.g. past 30day alcohol use, cigarette use, and number of substances used) significantly partially mediated the effect of MTO on boys’ behavior problems, resulting in -13% to -18% percent change in the total effect. The social connectedness domain was a marginally significant mediator for boys’ psychological distress. Yet no tested variables mediated MTO's beneficial effects on girls’ psychological distress. Confounding sensitivity analyses suggest that the indirect effect of substance use for mediating boys’ behavior problems was robust, but social connectedness for mediating boys’ psychological distress was not robust. Understanding how housing mobility policies achieve their effects may inform etiology of neighborhoods as upstream causes of health, and inform enhancement of future affordable housing programs.