Laurie Lachance

We examined relationships between neighborhood poverty and allostatic load in a low- to moderate-income multiracial urban community. We tested the hypothesis that neighborhood poverty is associated with allostatic load, controlling for household poverty. We also examined the hypotheses that this association was mediated by psychosocial stress and health-related behaviors. We conducted multilevel analyses using cross-sectional data from a probability sample survey in Detroit, Michigan (n = 919) and the 2000 US Census. The outcome measure was allostatic load. Independent variables included neighborhood and household poverty, psychosocial stress, and health-related behaviors. Covariates included neighborhood and individual demographic characteristics. Neighborhood poverty was positively associated with allostatic load (P < .05), independent of household poverty and controlling for potential confounders. Relationships between neighborhood poverty were mediated by self-reported neighborhood environment stress but not by health-related behaviors. Neighborhood poverty is associated with wear and tear on physiological systems, and this relationship is mediated through psychosocial stress. These relationships are evident after accounting for household poverty levels. Efforts to promote health equity should focus on neighborhood poverty, associated stressful environmental conditions, and household poverty.

ABSTRACT This 1 year study of 23 women examined osteoporosis in postmenopausal women with Down syndrome. The participants had their bone mineral density measured in three sites (lumbar spine, hip and forearm) using dual energy X-ray absorptiometry. Each participant also completed a medical history self-report questionnaire. The findings indicate that the women tended to be inactive and they frequently had coexistent conditions (i.e., thyroid disease and seizure disorders) whose treatments may contribute to a reduction in bone mineral density. The results from the bone scans revealed Z -scores that were strikingly different from what would be expected in women in the US general population of the same age and ethnicity. Corresponding to the Z -scores were elevated relative risks for fracture. Eighty-seven per cent of the participants had osteopenia or osteoporosis in at least one of the three sites measured. The results highlight the need for intervention efforts targeted to ageing women with Down syndrome

To examine contributions of observed and perceived neighborhood characteristics in explaining associations between neighborhood poverty and cumulative biological risk (CBR) in an urban community. Multilevel regression analyses were conducted using cross-sectional data from a probability sample survey (n=919), and observational and census data. Dependent variable: CBR. neighborhood disorder, deterioration and characteristics; perceived neighborhood social environment, physical environment, and neighborhood environment. Covariates: neighborhood and individual demographics, health-related behaviors. Observed and perceived indicators of neighborhood conditions were significantly associated with CBR, after accounting for both neighborhood and individual level socioeconomic indicators. Observed and perceived neighborhood environmental conditions mediated associations between neighborhood poverty and CBR. Findings were consistent with the hypothesis that neighborhood conditions associated with economic divestment mediate associations between neighborhood poverty and CBR.

We assessed changes in asthma-related health care use by low-income children in communities across the country where 6 Allies Against Asthma coalitions (Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA) mobilized stakeholders to bring about policy changes conducive to asthma control. Allies intervention zip codes were matched with comparison communities by median household income, asthma prevalence, total population size, and race/ethnicity. Five years of data provided by the Center for Medicare and Medicaid Services on hospitalizations, emergency department (ED) use, and physician urgent care visits for children were analyzed. Intervention and comparison sites were compared with a stratified recurrent event analysis using a Cox proportional hazard model. In most of the assessment years, children in Allies communities were significantly less likely (P < .04) to have an asthma-related hospitalization, ED visit, or urgent care visit than children in comparison communities. During the entire period, children in Allies communities were significantly less likely (P < .02) to have such health care use. Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities.

We evaluated C-reactive protein (C-RP), a quantitative marker of the acute phase response, as a potential biomarker of prevalent and incident osteoarthritis of the knee (OAK). Serum C-reactive protein concentrations were characterized with ultrasensitive rate nephelometry in a population-based sample of 1025 women (318 African-American and 707 Caucasian) who are enrollees in a study of musculoskeletal conditions at the mid-life. Assignment of OAK was based on Kellgren-Lawrence (K-L) scores of 2 or more on radiographs. Prevalent OAK was based on the baseline (1996) score while the classification of incident OAK was based on a score of 2 or greater at the follow-up examination 2.5 years later amongst those with a baseline K-L scores of 0 or 1. At baseline, the prevalence of radiographic OAK was 12% in participants who were aged 27-53 years and 18% in the subgroup of women aged 40-53 years. The mean C-RP value was 2.31 mg/L, with values ranging from below detection (0.3 mg/L) to 47.4 mg/L. Higher C-RP concentrations were associated with both prevalent and incident OAK (P < 0.0001, and P < 0.0001, respectively). For each K-L score increase from 0 to 3, there was a significantly higher mean C-RP value. Compared to women without incident OAK, women who developed OAK in the 2.5-year follow-up had significantly higher baseline C-RP concentrations. Women with bilateral OAK had higher C-RP concentrations than women with unilateral OAK (6.65 mg/L +/- 0.56 vs 3.63 mg/L +/- 0.42, P < 0.007). BMI was highly correlated with C-RP (r = 0.58) and obesity was an effect modifier with respect to OAK and C-RP concentrations. When stratified according presence or absence of OAK and obesity (BMI > 30 kg/m2), mean C-RP values were: obesity and OAK, 6.3 +/- 0.4 mg/L; obesity but not OAK, 4.3 mg/L +/- 0.2; no obesity but OAK, 1.7 mg/L +/- 0.8; and neither obesity nor OAK, 1.3 mg/L +/- 0.2 mg/L. These stratum means were significantly different from each other, indicating a higher C-RP with OAK after accounting for obesity. C-RP, as a measure of an acute phase response and inflammation, is highly associated with OAK; however, its high correlation with obesity limits its utility as an exclusive marker for OAK.