Residential and Activity Space Racial Composition and Ambulatory Blood Pressure in Black Women: An examination of potential neighborhood- and individual-level protective factors Restricted; Files Only
McKinnon, Izraelle (Spring 2022)
Published
Abstract
For Black adults, residential segregation, or racial/ethnic density, is believed to be a fundamental driver of the socioeconomic, environmental, and psychosocial inequalities that contribute to the disproportionately high rates of cardiovascular disease (CVD) in this group. However, this is not the case for other racial/ethnic minority groups, where racial/ethnic density is hypothesized to increase the potential availability of health-promoting psychosocial resources associated with living in minority communities, often referred to as ethnic enclaves. This dissertation seeks to determine whether associations between ethnic density and CVD risk are more consistent with a residential segregation or racial/ethnic enclaves framework, in a cohort of young to middle-aged Black women in the southeast US. First, we estimated associations between residential racial composition and activity space racial composition and ambulatory blood pressure (ABP) outcomes. We found higher Black racial/ethnic density across activity spaces was associated with a higher risk of daytime hypertension, and neither residential nor activity space racial composition were associated with nighttime blood pressure. Second, we estimated moderating effects of neighborhood-level psychosocial resources related to ethnic enclaves, neighborhood social cohesion and activities with neighbors, on associations between residential and activity space Black racial/ethnic density and ABP outcomes. While neighborhood social cohesion showed modest protective effects, contrary to our hypotheses, more activities with neighbors were associated with higher risk for daytime hypertension, and results indicate higher Black racial/ethnic density had more adverse effects among those reporting more activities. Finally, we estimated moderating effects of dimensions of individual-level racial identity as protective resources related to racial/ethnic enclaves, shown to have protective associations with mental health outcomes. Contrary to hypotheses, results indicate holding race more central to one’s identity was associated with higher risk for daytime hypertension. Effect sizes driving all associations were small. Our findings contribute to studies of Black communities and health outcomes by highlighting potential health implications of the spaces where individuals conduct their activities beyond home. However, our findings suggest that the adverse conditions associated with being Black in the US and/or living in segregated Black neighborhoods may override protective features related to living in racially/ethnically dense communities in the southeast US.
Table of Contents
Table of Contents
Chapter 1. Background and Significance. 8
New and worsening concerns: Cardiovascular health among young and middle-aged Black women. 8
Residential Segregation: A fundamental determinant of poor CVD health among Black populations. 9
Activity Spaces Segregation: Integrating a “spatial polygamy framework” into studies of place and health. 11
Ethnic Enclaves: Evidence of positive CVD outcomes in racially/ethnically-isolated communities. 12
Psychosocial Resources in Ethnic Enclaves: The protective effects of strong community ties. 14
Psychosocial Resources in Ethnic Enclaves: Strong, positive racial identity. 17
Ambulatory Blood Pressure: A gold standard measure of hypertension. 19
Research Motivation. 19
Specific Aims. 20
Chapter 2. Residential and activity space racial composition and ambulatory blood pressure among young and middle-aged Black women in the Southeast US. 22
Introduction. 22
Methods. 25
Results. 31
Discussion. 35
Conclusions. 39
Chapter 3. Spatial segregation, neighborhood social environment, and ambulatory blood pressure among young and middle-aged Black women in the Southeast US. 40
Introduction. 40
Methods. 44
Results. 51
Discussion. 56
Conclusions. 64
Chapter 4. Spatial segregation, racial identity, and ambulatory blood pressure among young and middle-aged Black women in the Southeast US. 65
Introduction. 65
Methods. 70
Results. 76
Discussion. 80
Conclusions. 86
Chapter 5. Conclusions and Future Directions. 87
Dissertation Aim 1. 88
Dissertation Aim 2. 89
Dissertation Aim 3. 91
Tables. 94
Table 1. Characteristics of analytic sample by high/low residential segregation groups. 94
Table 2. Characteristics of analytic sample by high/low activity space segregation groups. 95
Table 3. Adjusted Associations between Residential and Activity Space Segregation (per 20% Increase in Proportion of Black Residents) and Daytime Systolic and Diastolic Blood Pressure in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 96
Table 4. Adjusted Associations between Residential and Activity Space Segregation (per 20% Increase in Proportion of Black Residents) and Nighttime Systolic and Diastolic Blood Pressure in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 97
Table 5. Adjusted Prevalence Ratios for Associations between Residential and Activity Space Segregation (per 20% Increase in Proportion of Black Residents) and Daytime and Nighttime Hypertension in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 98
Table 6. Characteristics of analytic sample by high/low neighborhood social cohesion groups. 99
Table 7. Characteristics of analytic sample by high/low activities with neighbors groups. 100
Table 8. Adjusted Associations between Neighborhood Social Cohesion (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) Study. 101
Table 9. Adjusted Associations between Activities with Neighbors (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) Study. 102
Table 10. Characteristics of analytic sample by high/low racial centrality groups. 103
Table 11. Characteristics of analytic sample by high/low racial private regard groups. 104
Table 12. Characteristics of analytic sample by high/low racial public regard groups. 105
Table 13. Adjusted Associations between Centrality (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 106
Table 14. Adjusted Associations between Private Regard (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 107
Table 15. Adjusted Associations between Public Regard (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 108
Figures. 109
Figure 1. Counts of Mechanisms Underlying the impact of Stress and Emotions (MUSE) study participants across census tracts in the metro-Atlanta area by approximate tertiles. 109
Figure 2. Racial Composition (% Black residents) across census tracts among participants of the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study participants by quintiles. 110
References. 111
Supplement 121
Supplementary Table 1. Characteristics of activity space locations by high/low residential segregation groups. 121
Supplementary Table 2. Adjusted Associations between Residential and Activity Space Segregation (per 20% Increase in Proportion of Black Residents) and Daytime Systolic and Diastolic Blood Pressure in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study: Among those not taking antihypertensive medications. 122
Supplementary Table 3. Adjusted Associations between Residential and Activity Space Segregation (per 20% Increase in Proportion of Black Residents) and Nighttime Systolic and Diastolic Blood Pressure in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study: Among those not taking antihypertensive medications. 123
Supplementary Table 4. Adjusted Prevalence Ratios for Associations between Residential and Activity Space Segregation (per 20% Increase in Proportion of Black Residents) and Daytime and Nighttime Hypertension in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study: Among those not taking antihypertensive medications. 124
Supplementary Table 5. Adjusted Associations between Residential Racial Composition (per 20% Increase) and Systolic Blood Pressure in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) Study Among High and Low Activities with Neighbors Groups. 125
Supplementary Table 6. Adjusted Associations between Residential Racial Composition (per 20% Increase) and Diastolic Blood Pressure in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) Study Among High and Low Activities with Neighbors Groups. 126
Supplementary Table 7. Adjusted Associations between Neighborhood Social Cohesion (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) Study: Among those not taking antihypertensive medication in the past 12 months. 127
Supplementary Table 8. Adjusted Associations between Activities with Neighbors (per 1 point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) Study: Among those not taking antihypertensive medication in the past 12 months. 128
Supplementary Table 9. Adjusted Associations between Centrality (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 129
Supplementary Table 10. Adjusted Associations between Private Regard (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 130
Supplementary Table 11. Adjusted Associations between Public Regard (per 1-point Increase in Average Score) and Ambulatory Blood Pressure Outcomes in the Mechanisms Underlying the impact of Stress and Emotions (MUSE) study. 131
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