Deborah Cohen M.D., M.P.H., Senior Natural Scientist, RAND , 1700 Main Street, PO Box 2138 Santa Monica, CA 90407-2138 deborah_cohen@rand.org
Abstract
The proposed study will address Priority MCH Research Agenda Area IV, to investigate causes of class, ethnic, racial disparities in physical, mental health, and access to and use of services. We will use data collected from the Los Angeles Family and Neighborhood Survey (LAFANS), a study carried out in a representative sample of 65 neighborhoods in Los Angeles County. In each neighborhood, LAFANS includes (1) a household survey, including interviews with adults and children, and (2) a neighborhood survey with key informants and social service providers and independent observations of neighborhood physical conditions. The dataset includes information from 3,491 families on health behaviors and utilization of healthy care services reported by parents, caregivers and children, and measures of "collective efficacy," informal social controls and social cohesion. Our focus will be on health problems that are of increasing importance to youth and adolescents: obesity, injury, asthma, and teen pregnancy. All of these disproportionately affect low income populations of minority status and may, in part, be related to neighborhood level factors. We will also obtain data from the US Census 2000, land use information including alcohol outlet locations and health department surveillance data on injury mortality and teen pregnancy at the census tract level. We will then determine whether 1) communities with higher rates of collective efficacy will have youth that are less likely to engage in risk behaviors (e.g. unprotected sex, substance use, and weapon carrying) more likely to engage in health promoting behaviors (e.g. exercise, routine health check ups). 2) collective efficacy will be associated with lower rates of injury mortality and teen pregnancy at the census tract level, 3) communities with fewer opportunities for youth supervision, lower perceived safety, more alcohol outlets, more boarded up homes and physical disorder, lower residential stability, and more low achieving schools will have more youth who are overweight or obese and have asthma and 4) collective efficacy mediates the relationship between boarded up housing and physical disorder, neighborhood stability, alcohol outlets, and utilization of routine versus emergency health care services. This study will be among the first to test whether neighborhood structural variables, defined and measured independently of the neighborhood residents, are associated with social processes, with individual level health risk behaviors, with health care utilization and with population level health outcomes.
Cohen DA, Taylor SL, Zonta M, Vestal KD, Schuster MA. Availability of high school extracurricular sports programs and high-risk behaviors. J Sch Health. 2007 Feb; 77(2): 80-6.
Cohen DA, Inagami S, Finch B. The Built Environment and Collective Efficacy. Health & Place (in press, 2007). Available online 16 June 2007.
Inagami S, Cohen DA, Finch BK, Asch SM. You are where you shop: grocery store locations, weight, and neighborhoods. Am J Prev Med. 2006 Jul; 31(1): 10-7.
Way S, Finch B, Cohen DA. Hispanic Concentration and the Conditional Influence of Collective Efficacy on Adolescent Childbearing. Archives of Pediatrics & Adolescent Medicine, 2006 Sep; 160(9): 925-30.
Cohen DA, Finch BK, Bower A, Sastry N. Collective efficacy and obesity: the potential influence of social factors on health. Soc Sci Med. 2006 Feb; 62 (3): 769-78.
