Green space and cognitive health: the role of structural racism in environmental and health disparities.

项目总结 2020年，估计有580万美国人患有阿尔茨海默病(AD)，这是 痴呆症，这一数字预计到2050年将达到1380万。阿尔茨海默病及相关疾病 痴呆症(ADRD)对受影响的个人及其照顾者造成了巨大的损失。因为疾病- 修改疗法已被证明在很大程度上无效，当务之急是找到防止这种情况的方法 使人衰弱的疾病。这对美国黑人来说尤其重要，因为他们有更大的贫困风险 认知老化与非西班牙裔美国白人的比较，无论是以临床痴呆症或更低的标准衡量 晚年的认知功能。因为社区设计因素可以在人口水平上进行修改 通过政策和监管，它们是一个有吸引力的干预领域。绿地是一个社区 可能与认知功能相关的设计元素，因为接触它可能会减少压力， 改善情绪，促进体力活动，并提供社交机会，所有这些都 与更好的认知健康有关。有色人种社区更有可能生活在 绿色空间低于白人社区和结构性种族主义，通过过去的歧视性政策 这种不公平的绿地分配与居住隔离有关。认识到 这些不平等导致了最近在历史上增加绿地数量和质量的努力 通过公园改善项目、行道树种植和空地来帮助弱势社区 修复。虽然这些举措可能有打击数十年来撤资的意图植根于 相反，结构性种族主义可能最终加强按种族和/或社会经济地位进行的隔离 由于士绅化，资源不足的社区被开发并经历了这样一个过程 富裕的新来者的迁入。因此，目前还不清楚改善绿地是有害的还是 有利于有色人种社区，特别是正在进行复兴的社区。在 拟议的工作，我们将(1)评估绿色变化之间的横向和纵向关联 (A)总体上20年间的空间和认知功能、认知能力下降和痴呆症 人口和(B)种族/族裔；(2)估计结构性种族主义之间的联系(以 历史红线空间模式)和认知功能、认知衰退和痴呆症；并确定 这种关联是通过绿地暴露来调节的；(3)确定(A)绿色空间之间的关联 空间和认知功能、认知功能下降和痴呆症通过绅士化得到缓和；以及(B)有 士绅化与心理社会应激源、心理健康和知觉之间的独立关联 社区特色；以及(4)与以地方环境正义为导向的国家网络合作 组织探索改善绿地和缓解流离失所问题的障碍和促进者 由于士绅化。这项工作有可能为改善认知健康公平性提供指导。

PROJECT SUMMARY In 2020, an estimated 5.8 million Americans had Alzheimer’s disease (AD), the most common cause of dementia, and this number is expected to reach 13.8 million by 2050. Alzheimer’s Disease and related dementias (ADRD) take an enormous toll on individuals affected, as well as their caregivers. Because disease- modifying therapies have proved largely ineffective, a priority is placed on finding ways to prevent this debilitating disease. This is particularly important for Black Americans who have a greater risk for poor cognitive aging compared to non-Hispanic White Americans, whether measured as clinical dementia or lower cognitive function in late life. Because neighborhood design factors can be modified at the population level through policy and regulation, they are an attractive area for intervention. Green space is one neighborhood design element that may be associated with cognitive function because exposure to it may reduce stress, improve mood, promote physical activity, and provide opportunities for social engagement, all of which have been associated with better cognitive health. Communities of color are more likely to live in neighborhoods with lower green space than white communities and structural racism, through past discriminatory policies leading to residential segregation, has been implicated in this inequitable distribution of green space. Recognition of these inequities has led to recent efforts to increase the amount and quality of green space in historically disadvantaged communities through park improvement projects, street tree plantings, and vacant lot restoration. While these initiatives may have the intention of combatting decades of disinvestment rooted in structural racism, they may, instead, end up reinforcing segregation by race and/or socioeconomic status because of gentrification, a process by which under-resourced neighborhoods are developed and experience in-migration of affluent newcomers. Therefore, it is unclear if green space improvements are harmful or beneficial to communities of color, particularly in neighborhoods that are undergoing revitalization. In the proposed work, we will (1) assess the cross-sectional and longitudinal association between changes in green space and cognitive function, cognitive decline, and dementia over a 20-year period in the (a) overall population and (b) by race/ethnicity; (2) estimate the association between structural racism (as measured by historical redlining spatial patterns) and cognitive function, cognitive decline, and dementia; and determine if this association is mediated by green space exposure; (3) determine if (a) the association between green space and cognitive function, cognitive decline, and dementia is moderated by gentrification; and (b) there is an independent association between gentrification and psychosocial stressors, mental health, and perceived neighborhood characteristics; and (4) partner with a national network of local environmental justice-oriented organizations to explore barriers and facilitators to green space improvements and mitigation for displacement due to gentrification. This work has the potential to provide guidance to improve cognitive health equity.