b'CHAPTER 4 | CROSS-NATIONAL HEALTH DISPARITIES AND US DISADVANTAGEbehavioral risk factors, education and wealth areNeighborhood Effects Economic disadvantage of a not significantly associated with mortality risk.Where people live canneighborhood includes the per-Income remains a significant predictor of mortal- affect their health.centage living in poverty, the ity, but this effect is largest for those reportingFeatures of the resi- percentage over age 65 living excellent to good health at baseline.dential environmentin poverty, the percentage of Alley et al. (2009) examine associationscan affect how easilyhouseholds receiving public between material resources and late-life declinesindividuals are ableassistance, and the unem-in self-rated health and the onset of walkingto walk and engageployment rate. Economic limitations over two years. Material disadvantagein other forms ofadvantage is indicated by includes being uninsured and underinsured,physical activity.the value of owner-occupied and also taking less medication than prescribedPoorer individuals arehousing, the percentage of because of cost. Food insufficiency is measuredless likely to engage inhouseholds earning $75,000 with the following two questions: In the last twophysical activity (Tucker- or more, and the percentage of years, have you always had enough money to buySeeley et al. 2009). Afteradults with a college degree. Living in the food you need? and In the last two years,controlling for SES, demographica neighborhood with a high level of economic has anyone in the household received governmentcharacteristics, and functional limitations, olderadvantage is associated with a lower likelihood food stamps? Housing disadvantage reflectsadults who perceive their neighborhood as safeof being obese for both men and women. Women renting versus owning, housing quality, percent- are more likely to exercise compared to olderliving in areas of high street connectivity are less age of housing cost relative to income, and neigh- adults who perceive their neighborhood as unsafe.likely to be overweight or obese, but are more borhood safety. All of these aspects of materialResearchers have begun using HRS datalikely to be obese in areas of high residential disadvantage are each associated with declines inlinked to information from the US Census andstability. Interestingly, men living in areas with self-rated health over two years; multiple materialother sources of linked data to add greater deptha high concentration of immigrants are also disadvantage is especially deleterious. The associ- to characterization of residential environments.more likely to be obese.ations between Black race, poverty, single maritalCensus tract information is commonly usedOther research studies the effect of neigh-status, lower education and health declines areto approximate the concept of neighborhood.borhood on the disablement process, a set of largely explained by material disadvantage.Grafova et al. (2008) use information from thestages from the onset of chronic diseases to Others investigate the role of preventive2000 Census linked to the 2002 wave of the HRSimpairments in functioning to actual lim-health services in understanding SES healthto describe the economic and social conditions,itations in activities (Freedman et al. 2008). disparities. Even accounting for insuranceand the built environment of neighborhoodsEconomic conditions and qualities of the coverage, education and other sociodemograph- where HRS participants reside and the potentialbuilt environment are important for physical ic characteristics, the working poor remainimpact on BMI.functioning. Neighborhood economic advan-significantly less likely to receive breast cancer,tage is associated with a reduced risk of lower prostate cancer and cholesterol screening thanbody limitations for both men and women. the working non-poor, but not less likely toWomen living in areas of highFor men, neighborhood economic disadvan-receive cervical cancer screening or influenzastreet connectivity are less likelytage increases the reporting of personal care vaccination (Ross et al. 2007).to be overweight or obese. limitations, while high street connectivity is 77'