摘要：Objectives. This study sought to determine the relationships between race/ethnicity, socioeconomic status (SES), and cardiovascular health behaviors among youths and whether neighborhood characteristics are associated with such behaviors independently of individual characteristics. Methods. Linear models determined the effects of individual and neighborhood characteristics (SES, social disorganization, racial/ethnic minority concentration, urbanization) on dietary habits, physical activity, and smoking among 8165 youths aged 12 to 21 years. Results. Low SES was associated with poorer dietary habits, less physical activity, and higher odds of smoking. After adjustment for SES, Black race was associated with poorer dietary habits and lower odds of smoking. Hispanic ethnicity was associated with healthier dietary habits, lower levels of physical activity, and lower odds of smoking than non-Hispanic ethnicity. Low neighborhood SES and high neighborhood social disorganization were independently associated with poorer dietary habits, while high neighborhood Hispanic concentration and urbanicity were associated with healthier dietary habits. Neighborhood characteristics were not associated with physical activity or smoking. Conclusions. Changes in neighborhood social structures and policies that reduce social inequalities may enhance cardiovascular health behaviors. (Am J Public Health. 2002;92:428–436) Nearly a third of all women and half of all men younger than 40 years will develop cardiovascular disease (CVD) in the remaining years of their life. 1 Poor dietary habits, 2 physical inactivity, 3 and tobacco smoking 4 have been associated with an increased risk of CVD and named as the top 3 preventable causes of death in the United States. 5 High-risk CVD profiles that include obesity, physical inactivity, and tobacco use are developing at younger ages. 6– 8 This trend is alarming in that poor cardiovascular health behaviors established during youth may contribute to CVD in adulthood. 4, 7, 8 Among adults, relationships documenting cardiovascular health behaviors of racial or ethnic minority groups and those of low socioeconomic status (SES) are established. 9– 12 Racial or ethnic differences, or both, have been reported among youths in regard to body mass index, 13 physical activity, 3 and smoking 6, 13 ; however, these studies did not adequately account for differences in SES, which may lead to biased estimates of racial/ethnic differences in health behaviors. 14– 16 An additional problem is that individually measured SES does not account for exposures to neighborhood context that may affect human behavior. A newer approach to understanding racial/ethnic and SES differences and individual health behaviors has been to include measures of the social environment (e.g., the neighborhood context in which people live) to help explain why members of racial/ethnic minorities or persons of lower SES are more likely to develop high-risk cardiovascular behaviors. Recent studies involving adults have shown that neighborhood context may contribute independently to CVD outcomes after individual-level demographic and socioeconomic characteristics have been taken into account. 17– 19 In addition to demonstrating poor CVD outcomes, adults living in disadvantaged neighborhoods have reported poorer dietary habits, 20 less physical activity, 21 and more tobacco smoking 17, 18 than adults with similar characteristics living in advantaged neighborhoods. To our knowledge, no studies have examined these relationships among young people. Documenting a relationship between neighborhood characteristics and cardiovascular health behaviors would help guide public health interventions and policies aimed at changing health behaviors. The purpose of the current study was 2-fold. First, we sought to determine, among youths, the relationships between race/ethnicity, SES, and cardiovascular health behaviors (dietary habits, physical activity, and tobacco smoking). Second, by linking youth data to census tract characteristics, we investigated whether characteristics of neighborhoods (SES, social disorganization, racial/ethnic minority concentration, and urbanization) were associated with individual cardiovascular health behaviors independently of individual characteristics.
