AREA-LEVEL POVERTY AND CARDIOMETABOLIC RISK AMONG UNITED STATES ADOLESCENTS: A HIERARCHICAL ANALYSIS OF PATHWAYS TO DISEASE

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dc.contributor.advisorShenassa, Edmonden_US
dc.contributor.authorWilliams, Andrew Daviden_US
dc.contributor.departmentFamily Studiesen_US
dc.contributor.publisherDigital Repository at the University of Marylanden_US
dc.contributor.publisherUniversity of Maryland (College Park, Md.)en_US
dc.date.accessioned2017-06-22T06:01:49Z
dc.date.available2017-06-22T06:01:49Z
dc.date.issued2017en_US
dc.description.abstractBackground: In the United States, 26% of deaths are attributable to cardiometabolic diseases. Cardiometabolic risk in adolescence tracks over time and can presage cardiometabolic health during adulthood. Area-level determinants of cardiometabolic risk among adolescents are underexamined. This study contributes evidence regarding the association between area-level poverty and cardiometabolic risk among U.S. adolescents. Methods: 1999-2012 National Health and Nutrition Examination Survey data was linked via census tract with 2000 Census data and 2005-2009 and 2009-2013 American Community Survey data. The sample included 10,415 adolescents, aged 12-19 years. Area-level poverty was parameterized by percent population living in poverty, grouped into quartiles for analysis. Cardiometabolic risk was parameterized by summing z-scores of systolic and diastolic blood pressure, glycosylated hemoglobin, waist circumference, HDL cholesterol, and total cholesterol. Hierarchical linear models were used to examine the relationship between area-level poverty and cardiometabolic risk. Cotinine levels and physical activity were assessed as mediators. Post-hoc analysis explored associations between area-level poverty and family poverty-to-income ratio. Analyses were conducted for the overall sample and by race/ethnicity. Results: For the overall sample, compared to the first quartile of area-level poverty, residence in second (.218, 95% CI: .012, .424), third (.438, 95% CI: .213, .665), and fourth (.451, 95% CI: .204, .698) quartiles of area-level poverty was associated with increased cardiometabolic risk. Area-level poverty was associated with cardiometabolic risk among non-Hispanic Whites and Mexican Americans, but not among non-Hispanic Blacks. No evidence of mediation was observed. In post-hoc analysis, overall mean family Poverty-income-ratio declined from 3.34 in quartile 1 to 1.42 in quartile 4 (p< .001), however, this differed by race/ethnicity. Discussion: Residence in the highest area-level poverty quartiles was associated with increased cardiometabolic risk. Race/ethnicity specific analyses are consistent with literature on the Hispanic Paradox, and exposure to adversity among non-Hispanic blacks. Evidence suggests specific biomarker choice results in different cardiometabolic profiles within the same racial/ethnic group. Post-hoc analyses suggest the effect of area-level poverty on family PIR is greatest among non-Hispanic whites. Efforts to improve cardiometabolic health and reduce racial/ethnic disparities in cardiometabolic diseases should include targeted community-level investments aimed to improve the social conditions for all residents.en_US
dc.identifierhttps://doi.org/10.13016/M2D87S
dc.identifier.urihttp://hdl.handle.net/1903/19388
dc.language.isoenen_US
dc.subject.pqcontrolledEpidemiologyen_US
dc.subject.pqcontrolledPublic healthen_US
dc.subject.pquncontrolledAdolescenten_US
dc.subject.pquncontrolledCardiometabolicen_US
dc.subject.pquncontrolledNeighborhooden_US
dc.subject.pquncontrolledPlace and Healthen_US
dc.subject.pquncontrolledPovertyen_US
dc.subject.pquncontrolledPreclinicalen_US
dc.titleAREA-LEVEL POVERTY AND CARDIOMETABOLIC RISK AMONG UNITED STATES ADOLESCENTS: A HIERARCHICAL ANALYSIS OF PATHWAYS TO DISEASEen_US
dc.typeDissertationen_US
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