The results reported here are consistent with the hypothesis that everyday encounters with discrimination are causally associated with poor mental and physical health outcomes. In this sample of African American women, this association holds above and beyond the effects of income and education.

Purpose To examine relationships between the neighborhood food environment and fruit and vegetable intake in a multiethnic urban population. Design Analysis of cross-sectional survey and observational data. Setting 146 neighborhoods within three large geographic communities of Detroit, Michigan. Subjects Probability sample of 919 African-American, Latino, and White adults. Measures The dependent variable was mean daily fruit and vegetable servings measured using a modified Block 98 food frequency questionnaire. Independent variables included the neighborhood food environment: store availability (large grocery, specialty, convenience, liquor, small grocery), supermarket proximity (street-network distance to nearest chain grocer), and perceived and observed neighborhood fresh fruit and vegetable supply (availability, variety, quality, affordability). Analysis Weighted multilevel regression. Results Presence of a large grocery store in the neighborhood was associated with, on average, 0.69 more daily fruit and vegetable servings in the full sample. Relationships between the food environment and fruit and vegetable intake did not differ between Whites and African-Americans. However, Latinos compared with African-Americans with a large grocery store in their neighborhood consumed 2.20 more daily servings of fruits and vegetables. Presence of a convenience store in the neighborhood was associated with 1.84 fewer daily fruit and vegetable servings among Latinos than African-Americans. Conclusion The neighborhood food environment influences fruit and vegetable intake, and the size of this relationship may vary for different racial/ethnic subpopulations.

Objective 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 a) psychosocial stress and b) health related behaviors. Methods Multilevel analyses were conducted using cross sectional data from a probability sample survey in Detroit, Michigan (n=919) and 2000 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. Results 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. Conclusions Findings are consistent with the hypothesis that neighborhood poverty is associated with wear and tear on physiological systems, and that 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 and associated stressful environmental conditions, as well as household poverty.

Recent studies have suggested a link between exposure to ambient particulate matter <2.5μm in diameter (PM2.5) and adverse cardiovascular outcomes. The objective of this study was to examine the effects of differing community-level exposure to PM2.5 on daily measures of blood pressure (BP) among an adult population. During the period May 2002 through April 2003, BP was examined at two time points for 347 adults residing in three distinct communities of Detroit, MI. Exposure to PM2.5 was assessed in each community during this period, along with multivariate associations between PM2.5 and BP. In models combining all three communities, PM2.5 was significantly associated with systolic pressure (SP); a 10 μg/m3 increase in daily PM2.5 was associated with a 3.2 mm Hg increase in SP (p=0.05). However, in models that added a location interaction, larger effects were observed for SP within the community with highest PM2.5 levels; a 10 μg/m3 increase in daily PM2.5 was associated with a 8.6 mm Hg increase in SP (p=0.01). We also found young age (<55 years) and not taking BP medications to be significant predictors of increased BP effects. Among those taking BP medications, the PM2.5 effect on BP appeared to be mitigated, partially explaining the age effect, as those participants less than 55 years were less likely to take BP medications. Short-term increases in exposure to ambient PM2.5 are associated with acute increases in BP in adults, especially within communities with elevated levels of exposure.

This article describes the evaluation of a community-based participatory research (CBPR) community health worker (CHW) intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. After randomization to an intervention or control group, 298 households in Detroit, Michigan, with a child, aged 7 to 11, with persistent asthma symptoms participated. The intervention was effective in increasing some of the measures of lung function (daily nadir Forced Expiratory Volume at one second [p = .03] and daily nadir Peak Flow [p = .02]), reducing the frequency of two symptoms ("cough that won't go away," "coughing with exercise"), reducing the proportion of children requiring unscheduled medical visits and reporting inadequate use of asthma controller medication, reducing caregiver report of depressive symptoms, reducing concentrations of dog allergen in the dust, and increasing some behaviors related to reducing indoor environmental triggers. The results suggest a CHW environmental intervention can improve children's asthma-related health, although the pathway for improvement is complex.