A Biopsychosocial Examination of the Residential Environment as a Social Determinant of Cardiometabolic Risk: The Role of Latino Ethnicity
Open Access
- Author:
- Armendariz, Marina
- Graduate Program:
- Biobehavioral Health
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- August 20, 2020
- Committee Members:
- Linda A. Wray, Dissertation Advisor/Co-Advisor
Linda A. Wray, Committee Chair/Co-Chair
Lindsay Fernandez-Rhodes, Committee Member
Shedra Amy Snipes, Committee Member
Stephen Augustus Matthews, Outside Member
Thomas J Gould, Program Head/Chair - Keywords:
- neighborhood characteristics
Latinos
aging
obesity
diabetes
inflammation - Abstract:
- Background: Hispanic/Latinos account for 18.5% of the U.S. population. The substantial growth of Latinos is expected to contribute to the nation’s racial/ethnic diversity, aging population age structure, and of utmost importance—population health disparities. Scholars are challenged with characterizing salient physical health risks that disproportionately affect Latinos. For example, social, environmental and biological forces shape Latinos’ vulnerability to high rates of obesity, diabetes, and undiagnosed or late-stage diagnosed diseases. Limited work, however, has examined the residential environment as a social determinant of cardiometablic risk and dysregulation among Latinos. Particularly, there is scant research detailing within-group ethnic differences among Latino subpopulations regarding place-based health effects. Aims: The overarching goal of the dissertation was to explore potential social and environmental factors with attention to biopsychosocial pathways linking the residential environment to cardiometabolic conditions, and inflammatory risk among U.S. Latinos. To address the following three dissertation aims, the dissertation was comprised of three studies and a theoretically-driven conceptual framework: Aim 1: Develop a theoretically-driven conceptual framework to describe potential factors and pathways linking the residential environment to obesity, diabetes, and inflammatory risk; Aim 2: Examine racial/ethnic differences between midlife and older NHW and Latino adults; and Aim 3: Examine within-group ethnic differences among midlife and older Latinos. Methods: Data were derived from the Health and Retirement Study (HRS) across five waves (2006-2014) and examined cross-sectionally. The sample was comprised of 11,943 NHW (n=10,447) and Latino (n=1,496) respondents with complete data on key variables of interest. Key independent variables included race, Latino ethnicity (i.e. Mexican-origin vs non-Mexican Latinos), nativity status (i.e. foreign-born vs U.S.-born), and perceived neighborhood characteristics, as measured by perceptions of neighborhood physical disorder and negative social cohesion. Key outcomes of interest captured cardiometabolic and inflammatory risk and included body mass index (BMI), glycosylated hemoglobin (HbA1c), and C-reactive protein (CRP)—all risk factors for cardiovascular disease. Results: Stark socioeconomic and socioenvironmental racial/ethnic differences are documented in Aim 2. Greater negative social cohesion was positively associated with higher BMI and HbA1c, in fully adjusted models. Physical disorder was independently associated with higher CRP levels in unadjusted models, but SES accounted for this association. The limited results from Aim 3 provide preliminary evidence that health effects may differ by Latino ethnicity. Among Latinos, Mexican-origin Latinos experienced poorer cardiometabolic (i.e. BMI) and inflammatory outcomes (i.e. CRP), compared to non-Mexican Latinos, in the association between social isolation (i.e. “don’t belong in the area”) and physical health. Conclusion: This work sheds light on the socioenvironmental exposures experienced by midlife/older Latinos in relation to physical and physiological health outcomes—an emergent area of study. Although limited, there is some evidence to suggest perceived negative exposure to physical and social neighborhood conditions are adversely related to BMI, HbA1c, and CRP. However, these findings must be replicated using larger sample sizes, as well as among younger Latino populations. The projected growth of Latinos in the U.S. and their heterogeneous geographic patters across the U.S. landscape merit attention, particularly in population health studies. Subsequently, I conclude by calling for research that carefully considers structural, socioenvironmental, and ethnic factors to improve health inequalities that disproportionately affect racial/ethnic minority populations across the life course.