Recent Selected Publications

Introduction

Little is known about whether neighborhood social and built environments influence Alzheimer's disease (AD) dementia risk in South Asian individuals.

Methods

We used data on 745 South Asian individuals living in the United States (US) who were ≥40 years old. Neighborhood characteristics included percentage of Asian residents, Walk Score (walkability), and neighborhood social cohesion. We calculated an AD dementia risk score from age, gender, education, diabetes, hypertension, current smoking, low high-density lipoprotein, and high waist-to-hip ratio. Multivariable linear regression examined associations between neighborhood characteristics and AD dementia risk scores; interaction terms tested for differences by gender.

Results

Greater neighborhood social cohesion was associated with lower AD dementia risk scores in the overall sample. Stratifying by gender, the beneficial association was only observed for women and not men (interaction p-value: 0.01).

Conclusion

Policies and interventions promoting neighborhood social cohesion may help reduce AD dementia risk among South Asian middle and older-age women in the United States.

Objective

This study investigates how local policy stakeholders viewed and used research evidence, data, and (mis)information in county policy discussions during the COVID-19 pandemic.

Method

We employed document and exploratory content analysis methods to examine Board of Supervisor materials (N = 534 policy documents) from general and special/emergency meetings (March 2020 – December 2022). We purposefully selected three jurisdictions from California, USA with varying socio-demographic, political, and health care characteristics as case studies.

Results

Many residents who commented during local policy discussions contested the: 1) validity of health data provided (i.e., mortality rates), and 2) efficacy of proposed preventive measures like mask wearing and vaccine receipt. While government officials and healthcare personnel referenced research evidence and data as justification for these measures, several stakeholders expressed skepticism about the information presented in all three counties. Perceptions of misinformation included statements by residents that questioned the COVID-19 information provided by government officials or reflected a belief that federal and state government agencies (e.g., Centers for Disease Control and Prevention, CDC) were sources of misinformation. An emergent finding was that many residents voiced uncertainty and requested more information about local pandemic conditions and policy mitigation strategies.

Conclusions

Results reveal a distrust of public health and government officials and data/information shared in local policymaking debates during the COVID-19 pandemic. Local health departments may benefit from investing in efforts to increase their credibility as trusted sources of health information among community members. Local government agencies should develop transparent health promotion campaigns to identify and dispel misinformation.

In this research brief, we describe how the HOPe Lab (UC Merced), Faith in the Valley (Fresno), and Cultiva Central Valley (Merced) are collaborating to address housing-related disparities within California’s culturally diverse Central Valley. Focused on the transformative role of Local Organizing Committees (LOCs), our research employs an anti-racist research praxis to actively engage residents, enhance leadership capacity, and foster communication between residents and elected officials. Drawing on several theory-of-change statements and the practical insights gained from “field experts” carrying out ongoing initiatives, this report explores the positive impact of LOCs on meaningful community involvement, empowerment, engagement, accountability, and policy changes.

Substantial research has focused on how social networks help individuals navigate the illness experience. Sociologists have begun to theorize beyond the binary of strong and weak social network ties (e.g., compartmental, elastic, and disposable ties), citing the social, economic, and health conditions that shape their formation. However, limited research has employed mixed social network methods, which we argue is especially critical for examining the “non-traditional” social support networks of marginalized individuals. We employ quantitative social network methods (i.e., the egocentric network approach) in addition to in-depth interviews and observations, with a novel tool for capturing network data about social groups, to surface these kinds of supportive relationships. Using the case of “nameless ties”—non-kin, non-provider ties who were unidentifiable by given name or were grouped by context or activity rather than individually distinguished—we show how mixed social network methods can illuminate supporters who are commonly overlooked when only using traditional social network analysis. We conclude with a proposal for mixed methods and group alter approaches to successfully observe liminal support ties that is ideal for research about individuals experiencing chronic disability, poverty, housing insecurity, and other forms of social marginalization.

Activating social ties is a critical mechanism for satisfying individuals’ social, emotional, and material needs. Researchers have offered a number of hypotheses around tie activation about when and why particular supporters step in to help, ranging from strategic activation via functional specificity to opportunistic mobilization. To date, few studies have examined multiple tie activation strategies in tandem. This project focuses on people facing complex, compounding health and social problems, who may have to rely on multiple forms of activation to get their support needs met. We draw on a sample of 92 participants who are affiliated with one of two Care Management programs in the Western United States. Using name generators in a survey, we elicit participants’ social networks and find they utilize a number of methods to secure critical support needs, including calling on kin ties to borrow money and help with daily tasks, relying on strong and proximal ties for almost all types of support, and using functional specificity for health support. We then draw on qualitative interviews to gain a deeper understanding of the ways alters provide support and why egos elicit support from some alters and not others. Future research should continue assessing this population’s social networks with the aim of leveraging social support to help manage chronic conditions, provide access to resources, and increase their sense of belonging.

In this article, we explore the experiences of older adults living in public housing undergoing renovations and its associated impacts on their perceived sense of well-being. We also consider the ways in which affordable housing developers contemplate residents’ health and wellness into renovation plans and processes. Following the conventions of hermeneutic analysis, we conducted open-ended in-depth interviews with older adults living in public housing undergoing renovations (n = 21) and representatives of a variety of affordable housing developers (n = 12). Our analysis demonstrates that residents had strong attachments to their individual living spaces prior to renovations and were fiercely protective of them. Renovations created a sense of unease among older residents as the familiar features of their homes were altered. The processes and the outcomes of renovations and new management strategies raised fears that their lived environments were becoming institutionalized. Developers acknowledged that a tension exists between residents’ desires for personalized private space, and their responsibilities as landlords to prioritize the physical safety of residents and the fiduciary obligations to maintain building longevity.

As part of a larger project focused on the intersection of educational and health trajectories over the life course, we use in-depth interviews with 28 adults who experienced multiple non-promotional school changes during the course of their K-12 schooling in three U.S. urban centers to advance understanding of frequent student mobility. Prior research focuses predominantly on isolating the impact of student mobility while saying little about processes through which mobility influences educational trajectories in particular contexts. Frequent student mobility was intertwined with adverse childhood experiences and access to coping resources, and these forces shaped participants’ trajectories in patterned ways. Supporting frequently mobile students, almost a third of school-age children in the United States, will require greater attention to the reasons for, processes of, and contexts of student mobility.

The study objective was to investigate the effects of childhood residential mobility on older adult physical and mental health. In REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we used linear regression models to investigate if number of moves during childhood predicted mental and physical health (SF-12 MCS, PCS), adjusting for demographic covariates, childhood socioeconomic status (SES), childhood social support, and adverse childhood experiences (ACEs). We investigated interaction by age, race, childhood SES, and ACEs. People who moved more during childhood had poorer MCS scores, β = −0.10, SE = 0.05, p = 0.03, and poorer PCS scores, β = −0.25, SE = 0.06, p < 0.0001. Effects of moves on PCS were worse for Black people compared to White people (p = 0.06), those with low childhood SES compared to high childhood SES (p = 0.02), and high ACEs compared to low ACEs (p = 0.01). As family instability accompanying residential mobility, family poverty, and adversity disproportionately affect health, Black people may be especially disadvantaged.

As medicine integrates social and structural determinants into health care, some health workers redefine housing as medical treatment. This article discusses how health workers in two U.S. urban safety-net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply stratified housing economy. Analyzing in-depth interviews and observations, we show how health workers: (1) understood housing as health care and navigated limits of individual care in a structurally produced housing crisis; and (2) developed and enacted practices of biomedical and sociopolitical stabilization, including eligibilizing and data-tracking work. We discuss how health workers bridged individually focused techniques of clinical care with structural critiques of stratified housing economies despite contradictions in this approach. Finally, we analyze the implications of providers’ extension of medical stabilization into social, economic, and political realms, even as they remained caught in the structural dynamics they sought to address.

Background: Higher educational attainment predicts lower hypertension. Yet, associations between nontraditional educational trajectories (e.g., interrupted degree programs) and hypertension are less well understood, particularly among structurally marginalized groups who are more likely to experience these non-traditional trajectories.

Methods: In National Longitudinal Survey of Youth 1979 cohort data (N = 6 317), we used sequence and cluster analyses to identify groups of similar educational sequences—characterized by timing and type of terminal credential—that participants followed from age 14–48 years. Using logistic regression, we estimated associations between the resulting 10 educational sequences and hypertension at age 50. We evaluated effect modification by individual-level indicators of structural marginalization (race, gender, race and gender, and childhood socioeconomic status [cSES]).

Results: Compared to terminal high school (HS) diploma completed at traditional age, terminal GED (OR: 1.32; 95%CI: 1.04, 1.66) or Associate degree after <HS (OR: 1.93; 95%CI: 1.11, 3.35) was associated with higher hypertension. There was some evidence of effect modification. Hypertension associated with delayed HS diploma versus HS diploma at a traditional age (the reference) was lower for Black men than White men (interaction term: 0.44; 95%CI: 0.21, 0.91); similarly, hypertension associated with <HS versus completing HS at a traditional age was lower for people with low cSES than people with high cSES (interaction term: 0.52; 95%CI: 0.30, 0.90).

Conclusions: Both type and timing to terminal credential matter for hypertension but effects may vary by experiences of structural marginalization. Documenting the nuanced ways in which complex educational trajectories are associated with health could elucidate underlying mechanisms and inform systems-level interventions for health equity.