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

项目摘要 在2020年，估计有580万美国人患有阿尔茨海默病（AD），这是最常见的原因。 痴呆症，预计到2050年这一数字将达到1380万。阿尔茨海默病和相关 痴呆症（ADRD）对受影响的个人及其照顾者造成巨大损失。因为疾病- 修改疗法已被证明在很大程度上无效，优先考虑的是找到预防这种情况的方法 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。 与非西班牙裔白色美国人相比，认知老化，无论是以临床痴呆或更低的程度衡量 老年人的认知功能因为邻里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。绿色空间是一个邻域 可能与认知功能相关的设计元素，因为暴露于它可以减少压力， 改善情绪，促进身体活动，并提供社会参与的机会，所有这些都具有 与更好的认知健康有关。有色人种社区更有可能生活在 低绿色空间比白色社区和结构性种族主义，通过过去的歧视性政策导致 到居住隔离，都与这种绿色空间的不公平分配有关。承认 这些不平等导致了最近的努力，以增加绿色空间的数量和质量， 通过公园改善项目、行道树种植和空地， 修复虽然这些举措的目的可能是打击几十年来的撤资， 相反，它们可能最终会加强种族和/或社会经济地位的隔离 由于中产阶级化，一个资源不足的社区发展和经历的过程， 富裕新移民的迁入。因此，目前还不清楚绿色空间的改善是否有害， 有利于有色人种社区，特别是正在经历复兴的社区。在 建议的工作，我们将（1）评估横向和纵向之间的联系变化绿色 空间和认知功能，认知能力下降和痴呆症在20年的时间内，在（a）总体 人口和（B）种族/民族;（2）估计结构性种族主义之间的关联（如通过 历史红线空间模式）和认知功能、认知衰退和痴呆;并确定 这种关联由绿色空间暴露介导;（3）确定（a）绿色 空间和认知功能，认知能力下降和痴呆是由中产阶级化缓和;和（B）有 中产阶级化与心理社会压力源，心理健康和感知之间的独立关联 邻里特点;（4）与面向地方环境正义的国家网络合作 各组织探讨改善绿色空间和缓解流离失所问题的障碍和促进因素 由于中产阶级化。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.