Neighborhoods, Women and Coronary Heart Disease: A Prospective Study

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DESCRIPTION (provided by applicant): Although research suggests that where one lives affects one's risk of coronary heart disease (CHD), scientists have only begun to explore the pathways through which neighborhoods "get under the skin." Recent studies demonstrate that the built environment affects individual health and health behaviors, but have not examined the relationship between the built environment and cardiovascular health risk or subsequent cardiac events. Moreover, factors influencing the development and clinical manifestations of CHD differ substantially in women and men, and studies suggest that neighborhood social and built environments also affect men and women differently. The overarching objective of the proposed project is to examine the impact of neighborhood factors on women's development of CHD. We aim to identify aspects of the built environment that can be modified through urban planning or public policy and are associated with health benefits. The project will expand on existing research by investigating both the social and built environment and by examining whether behavioral factors, social relationships, and psychological well-being mediate the links between environmental characteristics and CHD development among women. The specific aims of our 3-year project are: 1. To assess whether built and social characteristics of neighborhoods predict the development of CHD after controlling for baseline sociodemographic and biological measures of CHD risk. 2. To evaluate whether aspects of the built and social environment are associated with individual health behaviors, social support, and psychological well-being that are known to be related to CHD in women. 3. To determine whether pathways between environmental characteristics and CHD are mediated by individual health behaviors, social support, and/or psychological well-being. To address these aims this project brings together two unique resources: individual-level data from the Observational Study (OS) and Clinical Trial (CT) arms of the Women's Health Initiative (WHI), a prospective study of 161,809 women ages 50 to 79 at entry, and geocoded, census-tract level contextual data on the sociodemographic and built environment where study subjects reside derived by the RAND Center for Population Health and Health Disparities (CPHHD) data core from the Census and other sources.