Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 10877 CHAPTER 4 | CROSS-NATIONAL HEALTH DISPARITIES AND US DISADVANTAGE behavioral risk factors, education and wealth are not significantly associated with mortality risk. Income remains a significant predictor of mortal- ity, but this effect is largest for those reporting excellent to good health at baseline. Alley et al. (2009) examine associations between material resources and late-life declines in self-rated health and the onset of walking limitations over two years. Material disadvantage includes being uninsured and underinsured, and also taking less medication than prescribed because of cost. Food insufficiency is measured with the following two questions: “In the last two years, have you always had enough money to buy the food you need?” and “In the last two years, has anyone in the household received government food stamps?” Housing disadvantage reflects renting versus owning, housing quality, percent- age of housing cost relative to income, and neigh- borhood safety. All of these aspects of material disadvantage are each associated with declines in self-rated health over two years; multiple material disadvantage is especially deleterious. The associ- ations between Black race, poverty, single marital status, lower education and health declines are largely explained by material disadvantage. Others investigate the role of preventive health services in understanding SES health disparities. Even accounting for insurance coverage, education and other sociodemograph- ic characteristics, the working poor remain significantly less likely to receive breast cancer, prostate cancer and cholesterol screening than the working non-poor, but not less likely to receive cervical cancer screening or influenza vaccination (Ross et al. 2007). Neighborhood Effects Where people live can affect their health. Features of the resi- dential environment can affect how easily individuals are able to walk and engage in other forms of physical activity. Poorer individuals are less likely to engage in physical activity (Tucker- Seeley et al. 2009). After controlling for SES, demographic characteristics, and functional limitations, older adults who perceive their neighborhood as safe are more likely to exercise compared to older adults who perceive their neighborhood as unsafe. Researchers have begun using HRS data linked to information from the US Census and other sources of linked data to add greater depth to characterization of residential environments. Census tract information is commonly used to approximate the concept of neighborhood. Grafova et al. (2008) use information from the 2000 Census linked to the 2002 wave of the HRS to describe the economic and social conditions, and the built environment of neighborhoods where HRS participants reside and the potential impact on BMI. Economic disadvantage of a neighborhood includes the per- centage living in poverty, the percentage over age 65 living in poverty, the percentage of households receiving public assistance, and the unem- ployment rate. Economic advantage is indicated by the value of owner-occupied housing, the percentage of households earning $75,000 or more, and the percentage of adults with a college degree. Living in a neighborhood with a high level of economic advantage is associated with a lower likelihood of being obese for both men and women. Women living in areas of high street connectivity are less likely to be overweight or obese, but are more likely to be obese in areas of high residential stability. Interestingly, men living in areas with a high concentration of immigrants are also more likely to be obese. Other research studies the effect of neigh- borhood on the disablement process, a set of stages from the onset of chronic diseases to impairments in functioning to actual lim- itations in activities (Freedman et al. 2008). Economic conditions and qualities of the built environment are important for physical functioning. Neighborhood economic advan- tage is associated with a reduced risk of lower body limitations for both men and women. For men, neighborhood economic disadvan- tage increases the reporting of personal care limitations, while high street connectivity is Women living in areas of high street connectivity are less likely to be overweight or obese.