title: Double-jeopardy: The joint impact of neighborhood disadvantage and low social cohesion on cumulative risk of disease among African American men and women in the Jackson Heart Study.
abstract: OBJECTIVE
  Few studies have examined the joint impact of neighborhood disadvantage and low social cohesion on health. Moreover, no study has considered the joint impact of these factors on a cumulative disease risk profile among a large sample of African American adults. Using data from the Jackson Heart Study, we examined the extent to which social cohesion modifies the relationship between neighborhood disadvantage and cumulative biological risk (CBR)-a measure of accumulated risk across multiple physiological systems.
  
  
  METHODS
  Our analysis included 4408 African American women and men ages 21-85 residing in the Jackson, MS Metropolitan Area. We measured neighborhood disadvantage using a composite score of socioeconomic indicators from the 2000 US Census and social cohesion was assessed using a 5-item validated scale. Standardized z-scores of biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were combined to create a CBR score. We used two-level linear regression models with random intercepts adjusting for socio-demographic and behavioral covariates in the analysis. A three-way interaction term was included to examine whether the relationship between neighborhood disadvantage and CBR differed by levels of social cohesion and gender.
  
  
  RESULTS
  The interaction between neighborhood disadvantage, social cohesion and gender was statistically significant (p = 0.05) such that the association between living in a disadvantaged neighborhood and CBR was strongest for men living in neighborhoods with low levels of social cohesion (B = 0.63, SE: 0.32). In gender-specific models, we found a statistically significant interaction between neighborhood disadvantage and social cohesion for men (p = 0.05) but not for women (p = 0.50).
  
  
  CONCLUSIONS
  Neighborhoods characterized by high levels of economic disadvantage and low levels of social cohesion contribute to higher cumulative risk of disease among African American men. This suggests that they may face a unique set of challenges that put them at greater risk in these settings.
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Avenue, 7th Floor, Boston, MA 02115, United States. Electronic address: smb483@drexel.edu.
authors.forename: Sharrelle
authors.initials: S
authors.lastname: Barber
authors.affiliation: University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, United States; My Brother's Keeper, Inc., Rigeland, MS, United States.
authors.forename: DeMarc A
authors.initials: DA
authors.lastname: Hickson
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Avenue, 7th Floor, Boston, MA 02115, United States.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Avenue, 7th Floor, Boston, MA 02115, United States.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Avenue, 7th Floor, Boston, MA 02115, United States.
authors.forename: Felton
authors.initials: F
authors.lastname: Earls
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054624:Health Status Disparities; D006331:Heart Diseases / Q000208:ethnology*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D011204:Poverty Areas; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution; D055815:Young Adult
keywords: African Americans; Cumulative biological risk; Health inequities; Neighborhoods; United States