Neighborhood Concentrated Disadvantage and Smoking among Young Adults in Greater New Orleans

Publication Date

July 2019

Location

LSU Health Medical Education Building

Document Type

Abstract

Start Date

26-7-2019 9:00 AM

End Date

26-7-2019 12:00 PM

Description

Concentrated disadvantage is a robust concept of neighborhood environment in public health and behavioral research. Neighborhood concentrated disadvantage has been shown to be an environmental risk for a number of public health outcomes, from crime to cardiovascular disease, as well as health behaviors like diet and physical activity. While rates of smoking have decreased dramatically in the US over the past few decades, the smoking epidemic is still responsible for a large burden of preventable disease. The objective of this study is to develop an index of neighborhood concentrated disadvantage for the Greater New Orleans area and assess the relationship between neighborhood concentrated disadvantage and current smoking rates in young adults. We derived a composite index of neighborhood concentrated disadvantage for the Greater New Orleans area using US Census American Community Survey (2012-2016) 5-year estimates of ten census-tract level socioeconomic measures. We evaluated the association between concentrated disadvantage and smoking in a retrospective study of young adults. Data was collected from electronic medical health records for young adults (18-30 years) presenting to the emergency department of a major health system in the Greater New Orleans area between January 2013 and December 2016. Smoking status was modeled using multilevel logistic regression models of individuals nested within census tracts. Regression models were stratified by race/ethnicity and adjusted for age, gender, insurance, marital status, religion and primary care provider. Statistical analyses were completed in SAS version 9.4. The study area encompassed 387 census tracts. An exploratory factor analysis identified a dimension of concentrated disadvantage for which measures of census tract poverty, education, public assistance, female-headed households, unemployment, abandoned houses and lack of vehicle loaded highly. The study dataset included 51,733 young adults in the study area. The majority (55%) were non-Hispanic black, 35.6% were non-Hispanic white, 7.8% were Hispanic and 1.6% were of other race/ethnicity. Rates of smoking were highest in non-Hispanic whites (38.6%). Neighborhood concentrated disadvantage index was significantly associated with smoking status for non-Hispanic whites (p<.0001), non-Hispanic blacks (0.0188) and other race/ethnicities (p=0.0306) but not for Hispanics. The association between concentrated disadvantage and smoking status among young adults was strongest in non-Hispanic whites, where the odds of smoking were 30% greater high disadvantaged tracts compared to low disadvantaged tracts [OR 1.30 (1.11,1.50)]. Smoking is a risk behavior that is most often established before the age of 25. The results of this study indicate there are subgroups of young adults in the Greater New Orleans area for which significant rates of smoking persist. While rates differ by race/ethnicity, we found that after controlling for individual characteristics, greater neighborhood concentrated disadvantage was associated with higher rates of smoking.

Comments

Mentor: Denise Danos, PhD, Behavioral and Community Health Sciences Program, School of Public Health

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Jul 26th, 9:00 AM Jul 26th, 12:00 PM

Neighborhood Concentrated Disadvantage and Smoking among Young Adults in Greater New Orleans

LSU Health Medical Education Building

Concentrated disadvantage is a robust concept of neighborhood environment in public health and behavioral research. Neighborhood concentrated disadvantage has been shown to be an environmental risk for a number of public health outcomes, from crime to cardiovascular disease, as well as health behaviors like diet and physical activity. While rates of smoking have decreased dramatically in the US over the past few decades, the smoking epidemic is still responsible for a large burden of preventable disease. The objective of this study is to develop an index of neighborhood concentrated disadvantage for the Greater New Orleans area and assess the relationship between neighborhood concentrated disadvantage and current smoking rates in young adults. We derived a composite index of neighborhood concentrated disadvantage for the Greater New Orleans area using US Census American Community Survey (2012-2016) 5-year estimates of ten census-tract level socioeconomic measures. We evaluated the association between concentrated disadvantage and smoking in a retrospective study of young adults. Data was collected from electronic medical health records for young adults (18-30 years) presenting to the emergency department of a major health system in the Greater New Orleans area between January 2013 and December 2016. Smoking status was modeled using multilevel logistic regression models of individuals nested within census tracts. Regression models were stratified by race/ethnicity and adjusted for age, gender, insurance, marital status, religion and primary care provider. Statistical analyses were completed in SAS version 9.4. The study area encompassed 387 census tracts. An exploratory factor analysis identified a dimension of concentrated disadvantage for which measures of census tract poverty, education, public assistance, female-headed households, unemployment, abandoned houses and lack of vehicle loaded highly. The study dataset included 51,733 young adults in the study area. The majority (55%) were non-Hispanic black, 35.6% were non-Hispanic white, 7.8% were Hispanic and 1.6% were of other race/ethnicity. Rates of smoking were highest in non-Hispanic whites (38.6%). Neighborhood concentrated disadvantage index was significantly associated with smoking status for non-Hispanic whites (p<.0001), non-Hispanic blacks (0.0188) and other race/ethnicities (p=0.0306) but not for Hispanics. The association between concentrated disadvantage and smoking status among young adults was strongest in non-Hispanic whites, where the odds of smoking were 30% greater high disadvantaged tracts compared to low disadvantaged tracts [OR 1.30 (1.11,1.50)]. Smoking is a risk behavior that is most often established before the age of 25. The results of this study indicate there are subgroups of young adults in the Greater New Orleans area for which significant rates of smoking persist. While rates differ by race/ethnicity, we found that after controlling for individual characteristics, greater neighborhood concentrated disadvantage was associated with higher rates of smoking.