UCLA

In the face of global health, economic, and climate crises, scholars in the fields of urban planning and public health are converging again to study how the spatial context—the arrangement of neighborhoods and their characteristics—affects the health outcomes of residents. This dissertation consists of three essays—each based on alternative modeling approaches found in the literature—that examine the relationship between individual and neighborhood characteristics and three health-related outcomes: cardiovascular disease, lifetime asthma, and walking. The neighborhood measures include demographic composition, economic position, the chemical environment, the human-made built environment, and access to neighborhood resources. I pay particular attention to the role of race and ethnicity (ethnorace) at the individual and neighborhood levels, which are both primary social determinants of health. Data for the outcomes of interest come from the 2013‒2014 and 2015‒2016 California Health Interview Survey. The data for the independent variables come from various sources, including the American Community Survey.

The first essay uses an ecological framework and aggregate data to assess the relationship between ZIP Code‒level health-related outcomes and neighborhood contextual independent variables. I find that neighborhood’s ethnorace is a better predictor of the prevalence of heart disease than it is for predicting walking and heart disease. Furthermore, while Latino neighborhoods experience inequalities that can lead to greater health risks, such as primary care availability and significant disparities in income and education, these characteristics are not necessarily associated with a greater prevalence of heart disease and asthma. The second essay uses individual-level data to examine the strength of five types of independent variables (demographic, socioeconomic characteristics, medical insurance coverage, health behaviors, and comorbidity with other chronic diseases) in predicting walking, heart disease, and lifetime asthma. The findings show that an individual’s ethnorace is a better predictor for asthma than the other dependent variables, and that as Latinos assimilate into American culture, the odds of lifetime asthma increase, as does the adoption of a more sedentary lifestyle. The third essay again uses individual-level data—this time with geographic identifiers that allow individual-level data to be matched with their respective neighborhood characteristics—to examine the multilevel relationship between individual-level outcomes of interest.

The results show that ethnorace continues to be a more important predictor for heart disease than for the other outcomes of interest, and that patterns between assimilation and the odds of walking continue to hold true. A significant finding across all essays is that neighborhood-effects are of secondary importance compared to more proximal individual and household-level effects, particularly for lifetime asthma and heart disease. These findings have implications for place-based interventions, as these alone may not lead to anticipated health benefits if they do not consider how to simultaneously incorporate programs and activities that address individual risk factors.