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Childhood Neighborhood Disadvantage, Parenting, and Adult Health

      Introduction

      Growing up in disadvantaged neighborhoods is associated with poor adult health indicators. Consistent and supportive parenting plays a key role in life-long health, but it is not known whether positive parenting can mitigate the relationship between neighborhood adversity and poor health. This study examines parenting as a moderator of the links between childhood neighborhood characteristics and adult health indicators.

      Methods

      A sample of 305 individuals (61% female; 82% African American, 18% Caucasian) were assessed in childhood (T1; age 11 years; 2003‒2004) and adulthood (T2; age 27 years; 2018‒2021). At T1, neighborhood poverty was derived from census data; neighborhood disorder was reported by parents. Children reported on parental harsh discipline, inconsistent discipline, and parental nurturance. At T2, health outcomes included BMI, serum cortisol and C-reactive protein (CRP), and salivary DNA methylation index related to CRP. Regression models predicted T2 health outcomes from T1 neighborhood and parenting variables and their interactions, adjusting for clustering and confounders. Data were analyzed in 2021.

      Results

      Neighborhood poverty was associated with lower cortisol, whereas neighborhood disorder was linked with CRP‒related DNA methylation. Multiple interactions between neighborhood and parenting variables emerged, indicating that adverse neighborhood conditions were only related to poor adult health when combined with inconsistent discipline and low parental nurturance. By contrast, warm and supportive parenting, consistent discipline, and to a lesser extent harsh discipline buffered children from poor health outcomes associated with neighborhood disadvantage.

      Conclusions

      Interventions enhancing consistent and nurturing parenting may help to reduce the long-term associations of neighborhood disadvantage with poor health.

      INTRODUCTION

      Adverse childhood experiences show strong associations with adult health through obesity, inflammation, and endocrine disruptions.
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      This dysregulation also involves epigenetic changes in gene expression through DNA methylation,
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      which then contributes to cardiovascular disease, diabetes, cancers, and other age-related diseases.
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      Adverse neighborhoods disproportionately affect African American youth, who are more likely to grow up in racially segregated urban neighborhoods characterized by poverty, crime, drug use, and violence.
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      Polyvictimization: children’s exposure to multiple types of violence, crime, and abuse.
      These racial inequalities in exposure to neighborhood stressors contribute to profound racial disparities in chronic diseases.
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      Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults.
      By young adulthood, African Americans already show higher levels of poor health indicators, including elevated BMI and inflammation markers, than non-Hispanic Whites.
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      Although policies and interventions designed to reduce neighborhood poverty and disorder are needed to improve health and reduce disparities,
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      Evaluating strategies for reducing health disparities by addressing the social determinants of health.
      it is also important to identify the protective factors that may mitigate the negative associations between neighborhood disadvantage and health. Multiple prospective studies show the importance of consistent and supportive parenting for better adult health, including lower BMI and inflammation.
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      Some of these relationships appear mediated by differential DNA methylation in inflammation-related genes.
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      Higher levels of protective parenting are associated with better young adult health: exploration of mediation through epigenetic influences on pro-inflammatory processes.
      Consistent and supportive parenting also buffer the links between adverse neighborhoods and poor mental health, delinquency, brain development, and academic outcomes.
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      However, few studies have investigated parenting as a moderator of the associations between childhood neighborhood adversity and adult health.
      This study examines whether children's perceptions of parenting moderate the prospective relationship between childhood neighborhood adversity and adult health indicators. The sample represents mostly urban African Americans who carry a disproportionate burden of neighborhood adversity and poor health.
      • Finkelhor D
      • Turner H
      • Hamby SL
      • Ormrod R.
      Polyvictimization: children’s exposure to multiple types of violence, crime, and abuse.
      ,
      • Quiñones AR
      • Botoseneanu A
      • Markwardt S
      • et al.
      Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults.
      To identify the most relevant dimensions that can guide the development of targeted interventions, we examine 2 aspects of neighborhood disadvantage (concentrated poverty and neighborhood disorder) and 3 dimensions of parenting (harsh discipline, inconsistent discipline, and nurturance). Because chronic stress dysregulates multiple physiologic systems, the study includes health indicators associated with the stress response (cortisol), metabolism (BMI), and inflammation (C-reactive protein [CRP]). To elucidate the underlying biological mechanisms, a DNA methylation index related to higher CRP levels
      • Ligthart S
      • Marzi C
      • Aslibekyan S
      • et al.
      DNA methylation signatures of chronic low-grade inflammation are associated with complex diseases.
      is also included. We hypothesize that childhood neighborhood poverty and disorder will be associated with lower cortisol, higher BMI, and higher CRP and CRP-related DNA methylation in adulthood but that these associations will be attenuated by parental nurturance and lower harsh and inconsistent discipline experienced in childhood.

      METHODS

      Study Sample

      This study includes 305 participants from the Birmingham Youth Violence Study who were assessed in childhood (T1) and adulthood (T2). Children and their caregivers were recruited from 5th-grade classrooms in 17 public schools in Birmingham, Alabama and completed individual interviews at T1 in 2003‒2004. Approximately 16 years later (in 2018‒2021), the children (now adults) participated in a T2 interview where they provided blood and saliva samples. Height and weight were measured at both T1 and T2. All interviews were conducted by trained interviewers utilizing computer-assisted interview procedures. Informed consent was obtained from adults and caregivers; children provided informed assent. Participants received financial compensation. All procedures were approved by the University of Alabama at Birmingham IRB.

      Measures

      Neighborhood poverty was measured with Census data tied to participants’ geocoded addresses at T1. Consistent with previous research,
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      • Wadsworth ME
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      Socioeconomic status, neighborhood disadvantage, and poverty-related stress: prospective effects on psychological syndromes among diverse low-income families.
      • Alvarado SE.
      Neighborhood disadvantage and obesity across childhood and adolescence: evidence from the NLSY children and young adults cohort (1986-2010).
      4 indicators of poverty were extracted from the 2000 U.S. Census for each of the 28 represented census tracts: percentage of unemployed adult males, percentage of households below poverty level, percentage of single-parent households, and percentage of renter-occupied households. These variables were standardized and averaged (Cronbach's α=0.88).
      Neighborhood disorder was measured with caregiver report at T1 using 11 items from the Neighborhood/Block Conditions scale.
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      • Florin P
      • Rich RC
      • Wandersman A
      • Chavis DM.
      Participation and the social and physical environment of residential blocks: crime and community context.
      ,
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      Prenatal maternal stress and cord blood innate and adaptive cytokine responses in an inner-city cohort.
      This scale evaluates the degree of social (e.g., drug dealing, organized gangs, physical assaults, fighting, gunshots, feeling unsafe) and physical (e.g., property damage, inadequate city services) disorder in the neighborhood. For each item, caregivers stated whether it is No problem (0), a Minor problem (1), or a Serious problem (2) in their neighborhood. The responses were averaged (α=0.92).
      Harsh discipline was assessed at T1. Children responded to 3 questions about the frequency of their parents yelling, spanking, and hitting them on a 5-point scale ranging from Never (0) to Always (4).
      • Ge X
      • Conger RD
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      Parents’ stressful life events and adolescent depressed mood.
      ,
      • Brody GH
      • Ge X
      • Conger R
      • et al.
      The influence of neighborhood disadvantage, collective socialization, and parenting on African American children's affiliation with deviant peers.
      The items were averaged (α=0.67).
      Inconsistent discipline was assessed at T1 with child report; 4 questions asked how often punishment depends on caregiver's mood, how often punishment is inconsistent from one time to another, or how often requests and punishments are not followed through.
      • Ge X
      • Conger RD
      • Lorenz FO
      • Simons RL.
      Parents’ stressful life events and adolescent depressed mood.
      ,
      • Brody GH
      • Ge X
      • Conger R
      • et al.
      The influence of neighborhood disadvantage, collective socialization, and parenting on African American children's affiliation with deviant peers.
      The items were rated on a 5-point scale from Never (0) to Always (4) and averaged (α=0.67).
      Parental nurturance was assessed at T1 by child report. Children were asked 5 questions about their parents’ nurturing behavior and close parent–child relationship (parents praising and encouraging child; giving physical affection, advice, and guidance; doing enjoyable things together; child discussing problems with parents).
      • Brody GH
      • Ge X
      • Conger R
      • et al.
      The influence of neighborhood disadvantage, collective socialization, and parenting on African American children's affiliation with deviant peers.
      ,
      • Barnes GM
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      The items were rated on a 3-point scale from Almost never (0) to Almost always (2) and averaged (α=0.57).
      Serum CRP and cortisol levels came from blood samples drawn at T2 from the forearm vein in glass gold-topped vacuum tubes without anticoagulants. Time of sample acquisition was recorded and used as a covariate for cortisol analyses. Samples were allowed to clot for 30 minutes and then were centrifuged (1,100g‒1,300g for 10 minutes). Serum was aliquoted and stored at ‒80°C. CRP was measured on a Stanbio Sirus (Boerne, TX) analyzer using Pointe Scientific (Canton, MI) turbidometric reagent following the manufacturer's instructions. The interassay coefficient of variation was 5.33%; the intra-assay coefficient of variation was 7.49%. Minimum detectable serum concentrations were 0.5 mg/L. Cortisol was measured on a Tosoh Bioscience AIA900 (South San Francisco, CA) using immunofluorescence following the manufacturer's instructions. The interassay coefficient of variation was 1.66%; the intra-assay coefficient of variation was 5.19%. Minimum detectable serum concentrations were 5.52 nmol/L. CRP levels reflect systemic inflammation,
      • Karadag F
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      The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease.
      whereas cortisol levels reflect acute stress response.
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      • Bauer K
      • Sack U.
      The impact of acute stress on hormones and cytokines, and how their recovery is affected by music-evoked positive mood.
      DNA methylation was derived from saliva samples collected at T2 with Oragene DNA OG-500 kits. DNA was extracted using the PureGene extraction method (Qiagen, Hilden, Germany) following the manufacturer's specifications. All samples yielded more than 2.1 μg of high-quality DNA. Methylation analysis of DNA was performed with the Illumina Infinium MethylationEPIC BeadChip. Normalization and quality control (QC) were conducted in the R package minfi
      • Aryee MJ
      • Jaffe AE
      • Corrada-Bravo H
      • et al.
      Minfi: a flexible and comprehensive Bioconductor package for the analysis of Infinium DNA methylation microarrays.
      and included probe level QC, sample level QC, background correction, within-array normalization, Types I and II chemistry correction, and batch/plate/chip adjustment. Total methylation levels were quantified as Beta-values, defined as the ratio of methylated fluorescent intensity and overall intensity.
      • Bibikova M
      • Lin Z
      • Zhou L
      • et al.
      High-throughput DNA methylation profiling using universal bead arrays.
      The reference-based deconvolution method
      • Houseman EA
      • Accomando WP
      • Koestler DC
      • et al.
      DNA methylation arrays as surrogate measures of cell mixture distribution.
      was utilized to correct for differences in cell composition.
      The CRP methylations index was derived from candidate CpG associations, with CRP levels reported in a recent meta-analysis
      • Ligthart S
      • Marzi C
      • Aslibekyan S
      • et al.
      DNA methylation signatures of chronic low-grade inflammation are associated with complex diseases.
      and validated in an independent sample.
      • Barker ED
      • Cecil CAM
      • Walton E
      • et al.
      Inflammation-related epigenetic risk and child and adolescent mental health: a prospective study from pregnancy to middle adolescence.
      A total of 6 CpG sites spanning 7 genes that showed the strongest evidence of a functional association with CRP levels were used. To enhance robustness, weights from z-statistics in the meta-analysis and the validation study were combined using the METASOFT program
      • Han B
      • Eskin E.
      Random-effects model aimed at discovering associations in meta-analysis of genome-wide association studies.
      and used to weigh methylation values at each CpG. The index was standardized and inverted so that higher scores are associated with higher CRP levels.
      • Ligthart S
      • Marzi C
      • Aslibekyan S
      • et al.
      DNA methylation signatures of chronic low-grade inflammation are associated with complex diseases.
      ,
      • Barker ED
      • Cecil CAM
      • Walton E
      • et al.
      Inflammation-related epigenetic risk and child and adolescent mental health: a prospective study from pregnancy to middle adolescence.
      These scores reflect an epigenetic profile associated with inflammation.
      Covariates included parent reports of the child's sex, ethnicity, and date of birth; their own highest education completed; marital status; and annual household income at T1. BMI was calculated for children and caregivers at T1 and for adults at T2 from the average of 2 measurements. For children, BMI percentiles were derived on the basis of age and sex. Because tobacco smoking is associated with cortisol levels
      • Badrick E
      • Kirschbaum C
      • Kumari M.
      The relationship between smoking status and cortisol secretion.
      and DNA methylation,
      • Zeilinger S
      • Kühnel B
      • Klopp N
      • et al.
      Tobacco smoking leads to extensive genome-wide changes in DNA methylation.
      we included current smoking for cortisol and history of smoking (at T2 and age 18 years) for DNA methylation. The estimated cell proportions of cell types found in the saliva samples were measured.

      Statistical Analysis

      Descriptive statistics and bivariate correlations were examined. Main analyses were conducted in Mplus 8.6 using hierarchical regression models predicting BMI, cortisol, CRP, and CRP methylation index at T2 from neighborhood and parenting variables at T1. Step 1 included neighborhood poverty, neighborhood disorder, harsh discipline, inconsistent discipline, parental nurturance, and covariates. Step 2 added interactions between neighborhood poverty and each parenting variable (Step 2a) or between neighborhood disorder and each parenting variable (Step 2b). Significant interactions were followed by visualization
      • McCabe CJ
      • Kim DS
      • King KM.
      Improving present practices in the visual display of interactions.
      and tests of simple slopes for neighborhood effects at average, low, and high levels of parenting (1 SD below and above the mean).
      • Hayes AF
      • Rockwood NJ.
      Regression-based statistical mediation and moderation analysis in clinical research: observations, recommendations, and implementation.
      Covariates used in all the models were child sex, race, parental education, household income; single-parent household; child BMI percentile and parent BMI at T1; and adult age at T2. Models for cortisol, CRP, and CRP methylation index also controlled for adult BMI at T2. Cortisol models controlled for time of day and current smoking. CRP methylation models controlled for history of smoking and saliva cell types
      • Turinsky AL
      • Butcher DT
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      • Weksberg R
      • Brudno M.
      Don't brush off buccal data heterogeneity.
      (granulocytes, CD4+T, CD8+T, B cells, and monocytes; natural killer cells were not present). In all models, parameter estimates and SEs were adjusted for clustering of participants within neighborhoods at T1. Because some variables were not normally distributed, the maximum likelihood estimator with robust SEs was used. Missing data (3.45% of data points) were handled with full information maximum likelihood, which reduces bias and preserves the overall sample size.
      • Graham JW
      • Cumsille PE
      • Shevock AE.
      Methods for handling missing data.
      Thus, all available data from the full sample of 305 participants were analyzed.

      RESULTS

      The T1 sample included 704 children, of which 305 (43%) were retained at T2. The retained participants did not differ from those lost to attrition at T1 age, household income, BMI percentile, neighborhood poverty or disorder, and any of the parenting variables. Retained participants had higher parental education (M=4.29 vs 4.01, p=0.031) and were more likely to be female (61% vs 37%, p<0.001) and African American (82% vs 75%, p=0.014).
      Descriptive statistics are in shown Table 1. The sample included 61% females, 82% African Americans, and 18% Caucasians. Average ages were 11.71 years (SD=0.77) at T1 and 27.37 years (SD=1.19) at T2. Although the sample overrepresented low-income urban African American families, household annual income ranged from <$5,000 to >$90,000 (median=$25,000–$30,000), and caregiver education ranged from <9th grade to graduate degree (median=some college); 53% of caregivers were single.
      Table 1Descriptive Statistics
      VariablesMean (SD)
      Female, n (%)183 (61)
      African American, n (%)249 (82)
      Single parent household, n (%)153 (53)
      Age, T111.71 (0.77)
      Age, T227.37 (1.19)
      Parental education
      Scores ranged from 1 (less than high school) to 8 (graduate or professional degree).
      , T1
      4.28 (1.70)
      Household income
      Scores ranged from 1 (<$5,000 a year) to 13 (>$90,000 a year).
      , T1
      6.49 (3.78)
      Neighborhood disorder, T10.32 (0.45)
      Neighborhood % males unemployed, T14.78 (3.46)
      Neighborhood % renter occupied, T134.25 (17.17)
      Neighborhood % poverty, T118.43 (11.97)
      Neighborhood % single parent, T124.64 (12.07)
      Harsh discipline, T10.91 (0.80)
      Inconsistent discipline, T10.69 (0.72)
      Parental nurturance, T11.58 (0.39)
      Parent BMI, T133.62 (8.41)
      Child BMI %, T174.43 (27.34)
      Adult BMI, T231.53 (11.46)
      C-reactive protein (mg/L), T24.75 (8.14)
      Cortisol (µg/dL), T210.93 (4.44)
      a Scores ranged from 1 (less than high school) to 8 (graduate or professional degree).
      b Scores ranged from 1 (<$5,000 a year) to 13 (>$90,000 a year).
      Bivariate correlations revealed that T1 neighborhood poverty was associated with greater neighborhood disorder (r=0.37, p<0.001) and lower T2 cortisol (r = −0.20, p<0.001). T1 harsh discipline, inconsistent discipline, and low parental nurturance were intercorrelated (r = −0.15 to 0.40, p<0.05). T2 BMI was related to higher CRP (r=0.39, p<0.001) and CRP methylation (r=0.22, p<0.001). CRP was modestly associated with CRP methylation (r=0.27, p<0.001).
      Standardized coefficients from the hierarchical regression models are shown in Table 2. After adjusting for covariates and clustering, neighborhood poverty at T1 was uniquely associated with lower cortisol levels at T2, whereas neighborhood disorder predicted higher CRP methylation. In Step 2, all the 3 T1 parenting variables interacted with neighborhood poverty in predicting CRP. Neighborhood poverty also interacted with inconsistent discipline in predicting cortisol and with parental nurturance in predicting CRP methylation. Finally, inconsistent discipline interacted with neighborhood disorder for BMI, CRP, and CRP methylation.
      Table 2Regression Models Predicting Adult Outcomes From Childhood Neighborhood Characteristics and Parenting
      VariablesCortisol βBMI βCRP βCRP methylation index β
      Step 1
      Neighborhood poverty−0.19***−0.080.10−0.04
      Neighborhood disorder0.020.00−0.060.11**
      Harsh discipline−0.050.020.01−0.03
      Inconsistent discipline−0.050.020.030.02
      Parental nurturance−0.010.050.03−0.02
      Step 2a
      N poverty Χ harsh−0.020.07−0.10*0.01
      N poverty Χ inconsistent0.10*0.050.09*0.00
      N poverty Χ nurturance0.04−0.07−0.14***−0.09*
      Step 2b
      N disorder Χ harsh0.04−0.03−0.02−0.01
      N disorder Χ inconsistent0.030.07*0.17**0.08*
      N disorder Χ nurturance0.06−0.02−0.050.00
      Note: Boldface indicates statistical significance (*p<0.05, **p<0.01, ***p<0.001).
      N=305. All models adjusted for sex, race, parental education, family income, single-parent household, child BMI percentile, and parent BMI in childhood as well as age and BMI in adulthood. Cortisol models also adjust for current smoking and time of day; methylation models adjust for history of smoking and cell types in saliva samples.
      CRP, C-Reactive Protein.
      Examples of the significant interactions are visualized in Figures 1 and 2. Simple slope analyses indicated that neighborhood poverty was related to lower cortisol at low and average inconsistent discipline (βlow= −0.29, p<0.001; βmean= −0.20, p<0.001) but only marginally related at high inconsistent discipline (β= −0.12, p=0.091). Neighborhood poverty was associated with greater CRP levels at low harsh parenting (β=0.22, p=0.027), high inconsistent parenting (β=0.30, p=0.030), and low nurturance (β=0.26, p=0.001); marginally related at average levels of all types of parenting (β=0.12, p=0.062); and unrelated at high harsh parenting (β=0.03, p=0.614), low inconsistent parenting (β=0.05, p=0.459), and high nurturance (β= −0.01, p=0.847). Neighborhood poverty was associated with lower CRP methylation at high parental nurturance (β= −0.12, p=0.042) but unrelated at average (β= −0.04, p=0.464) or low (β=0.05, p=0.437) parental nurturance. Neighborhood poverty became related to higher methylation at more extreme levels of low parental nurturance (e.g., at 2.5 SD below the mean β=0.18, p=0.048).
      Figure 1
      Figure 1Parental inconsistent discipline moderates the relationship between neighborhood poverty and cortisol.
      PTCL, percentile.
      Figure 2
      Figure 2Parental inconsistent discipline moderates the relationship between neighborhood poverty and CRP levels.
      CRP, C-Reactive Protein; PTCL, percentile.
      Neighborhood disorder predicted higher CRP methylation at high and average inconsistent discipline (βhigh=0.18, p<0.001; βmean=0.10, p=0.019) but not at low inconsistent discipline (β=0.03, p=0.599). Neighborhood disorder was related to lower CRP at low inconsistent discipline (β= −0.26, p=0.002) but unrelated at average or high inconsistent discipline (βmean= −0.05, p=0.333; βhigh=0.11, p=0.244). Finally, neighborhood disorder was unrelated to BMI at low, average, or high inconsistent discipline (βlow= −0.07, p=0.495; βmean=0.00, p=1.000; βhigh=0.07, p=0.359). Only at more extreme levels of inconsistent discipline did the impacts of neighborhood disorder on BMI approach significance (e.g., at 3 SD above the mean β=0.20, p=0.078).

      DISCUSSION

      This is the first investigation that has examined childhood parenting as a moderator of the associations between childhood neighborhood disadvantage and adult health indicators. Using a cohort of mostly urban African American youth followed over 16 years, the results showed that objectively assessed neighborhood poverty in childhood was associated with lower cortisol levels in adulthood. In addition, greater parent-reported neighborhood social and physical disorder in childhood was related to a proinflammatory DNA methylation profile in adulthood. Importantly, the relationships between childhood neighborhood characteristics and adult health varied by parental discipline and nurturance in childhood, so the relationships between adverse neighborhood conditions and poor adult health were exacerbated by inconsistent discipline and low parental nurturance. By contrast, supportive parenting, consistent discipline, and, to a lesser extent, harsh discipline buffered children from the long-term associations between neighborhood poverty and disorder and poor adult health.
      Childhood neighborhood poverty was related to lower cortisol in adulthood, consistent with lower cortisol levels among adults residing in more disadvantaged and disordered neighborhoods.
      • Karb RA
      • Elliott MR
      • Dowd JB
      • Morenoff JD.
      Neighborhood-level stressors, social support, and diurnal patterns of cortisol: the Chicago Community Adult Health Study.
      Studies with young children linked community disadvantage with higher cortisol
      • Finegood ED
      • Rarick JRD
      • Blair C
      Family Life Project Investigators. Exploring longitudinal associations between neighborhood disadvantage and cortisol levels in early childhood.
      but also blunted diurnal cortisol patterns,
      • Thompson SF
      • Zalewski M
      • Kiff CJ
      • Lengua LJ.
      A state-trait model of cortisol in early childhood: contextual and parental predictors of stable and time-varying effects.
      ,
      • Gartstein MA
      • Seamon E
      • Thompson SF
      • Lengua LJ.
      Featured article: community crime exposure and risk for obesity in preschool children: moderation by the hypothalamic-pituitary-adrenal-axis response.
      suggesting that neighborhood disadvantage leads to blunted cortisol responses to acute stress.
      • Janusek LW
      • Tell D
      • Gaylord-Harden N
      • Mathews HL.
      Relationship of childhood adversity and neighborhood violence to a proinflammatory phenotype in emerging adult African American men: an epigenetic link.
      The pattern of blunted cortisol responses is consistent with the lower cortisol levels among adults exposed to neighborhood poverty in childhood observed in this study. The stronger relationship between neighborhood poverty and lower cortisol at low levels of inconsistent discipline suggests that cortisol blunting may be an adaptive response that is supported by consistent parenting.
      Contrary to the findings of some previous research,
      • Alvarado SE.
      The indelible weight of place: childhood neighborhood disadvantage, timing of exposure, and obesity across adulthood.
      this study did not find links between neighborhood disadvantage and adult BMI. It is possible that this association is more consistently present in national samples that cover a broader range of neighborhood conditions
      • Alvarado SE.
      The indelible weight of place: childhood neighborhood disadvantage, timing of exposure, and obesity across adulthood.
      because neighborhood factors do not seem consistently related to obesity among disadvantaged populations.
      • Johnson KA
      • Showell NN
      • Flessa S
      • et al.
      Do neighborhoods matter? A systematic review of modifiable risk factors for obesity among low socio-economic status Black and Hispanic children.
      In this study, parental inconsistent discipline moderated the link between neighborhood disorder and BMI so that neighborhood disorder marginally predicted higher BMI only at very high levels of inconsistent discipline. One other study tested the interaction of neighborhood and parenting characteristics on obesity, finding that positive parenting mitigated the association between neighborhood crime and higher BMI in children aged 5 years.
      • Gartstein MA
      • Seamon E
      • Thompson SF
      • Lengua LJ.
      Parenting matters: moderation of biological and community risk for obesity.
      CRP was positively associated with BMI (r=0.39, p<0.001), consistent with the finding of previous research (r=0.36 in a meta-analysis of 51 studies).
      • Choi J
      • Joseph L
      • Pilote L.
      Obesity and C-reactive protein in various populations: a systematic review and meta-analysis.
      This study extends previous work linking elevated CRP levels with both neighborhood disadvantage
      • Broyles ST
      • Staiano AE
      • Drazba KT
      • Gupta AK
      • Sothern M
      • Katzmarzyk PT.
      Elevated C-reactive protein in children from risky neighborhoods: evidence for a stress pathway linking neighborhoods and inflammation in children.
      ,
      • Cozier YC
      • Albert MA
      • Castro-Webb N
      • et al.
      Neighborhood socioeconomic status in relation to serum biomarkers in the black women's health study.
      ,
      • Roberts LC
      • Schwartz BS
      • Samuel LJ.
      Neighborhood characteristics and cardiovascular biomarkers in middle-aged and older adults: the Baltimore Memory Study.
      and nurturing parenting
      • Byrne ML
      • Badcock PB
      • Simmons JG
      • et al.
      Self-reported parenting style is associated with children's inflammation and immune activation.
      • Byrne ML
      • Horne S
      • O'Brien-Simpson NM
      • et al.
      Associations between observed parenting behavior and adolescent inflammation two and a half years later in a community sample.
      • Jones JD
      • Ehrlich KB
      • Brett BE
      • et al.
      Perceptions of parental secure base support in African American adolescents and young adults: a preliminary study of predictive links to adult C-reactive protein.
      • Lyons ER
      • Norman Wells J
      • Scholtes CM
      • Mintz B
      • Giuliano RJ
      • Skowron EA
      Recollections of positive early caregiving relate to sympathetic nervous system activation and chronic inflammation in subsequent generations.
      by showing that the relationship between neighborhood disadvantage in childhood and systemic inflammation in adulthood is buffered by consistent and supportive parenting and exacerbated by inconsistent and unsupportive parenting. These findings are consistent with research showing that positive parenting mitigates the long-term associations between childhood adversities and poor adult health.
      • Cohen S
      • Chiang JJ
      • Janicki-Deverts D
      • Miller GE.
      Good relationships with parents during childhood as buffers of the association between childhood disadvantage and adult susceptibility to the common cold.
      • Carroll JE
      • Gruenewald TL
      • Taylor SE
      • Janicki-Deverts D
      • Matthews KA
      • Seeman TE.
      Childhood abuse, parental warmth, and adult multisystem biological risk in the coronary artery risk development in young adults study.
      • Brody GH
      • Yu T
      • Chen E
      • Miller GE.
      Family-centered prevention ameliorates the association between adverse childhood experiences and prediabetes status in young black adults.
      Moreover, at low inconsistent discipline, neighborhood disorder was related to lower instead of higher adult CRP, suggesting a compensatory effect. Harsh discipline also emerged as a protective factor against the relationship between childhood neighborhood poverty and adult inflammation. Although seemingly counterintuitive, this result is consistent with research showing that harsh discipline is adaptive in disadvantaged, high-crime neighborhoods.
      • McLoyd VC
      • Hardaway CR
      • Jocson RM.
      African American parenting.
      • Deater-Deckard K
      • Dodge KA
      • Bates JE
      • Pettit GS.
      Physical discipline among African American and European American mothers: links to children's externalizing behaviors.
      • Lansford JE
      • Deater-Deckard K
      • Dodge KA
      • Bates JE
      • Pettit GS.
      Ethnic differences in the link between physical discipline and later adolescent externalizing behaviors.
      Indeed, high parental control was associated with better immune functioning in adults exposed to high neighborhood risk as children.
      • Corallo KL
      • Lyle SM
      • Murphy MLM
      • vanDellen MR
      • Ehrlich KB.
      Recalled neighborhood environments, parental control, and cytokine-mediated response to viral challenge.
      Finally, this study showed that inconsistent discipline exacerbates the relationship between neighborhood disorder and inflammation-related DNA methylation. This finding extends previous research linking neighborhood disadvantage and less supportive and consistent parenting with inflammation-related DNA methylation
      • Reuben A
      • Sugden K
      • Arseneault L
      • et al.
      Association of neighborhood disadvantage in childhood with DNA methylation in young adulthood.
      ,
      • McDade TW
      • Ryan C
      • Jones MJ
      • et al.
      Social and physical environments early in development predict DNA methylation of inflammatory genes in young adulthood.
      ,
      • Beach SR
      • Lei MK
      • Brody GH
      • et al.
      Parenting, socioeconomic status risk, and later young adult health: exploration of opposing indirect effects via DNA methylation.
      and supports DNA methylation as a biological mechanism through which adverse neighborhoods and parenting affect adult inflammation. The results suggest that parental interventions targeting consistent and nurturing parenting in disadvantaged communities may improve children's health into adulthood. Indeed, parenting interventions reduced children's inflammation in adulthood
      • Miller GE
      • Brody GH
      • Yu T
      • Chen E.
      A family-oriented psychosocial intervention reduces inflammation in low-SES African American youth.
      and buffered the impact of childhood adversities on adult health.
      • Brody GH
      • Yu T
      • Chen E
      • Miller GE.
      Family-centered prevention ameliorates the association between adverse childhood experiences and prediabetes status in young black adults.
      ,
      • Brody GH
      • Yu T
      • Chen E
      • Beach SR
      • Miller GE
      Family-centered prevention ameliorates the longitudinal association between risky family processes and epigenetic aging.
      ,
      • Brody GH
      • Yu T
      • Chen E
      • Miller GE.
      Prevention moderates associations between family risks and youth catecholamine levels.

      Limitations

      The study limitations include attrition, with only 43% of T1 participants taking part in T2. Females and African Americans were more likely to be retained, so the results may be less generalizable to other groups. Health outcomes were only measured in adulthood, so their previous levels could not be controlled, and causal inferences cannot be made. Children's reports of parenting had low internal consistency, similar to previous studies using the same measures,
      • Brody GH
      • Ge X
      • Conger R
      • et al.
      The influence of neighborhood disadvantage, collective socialization, and parenting on African American children's affiliation with deviant peers.
      ,
      • Brody GH
      • Ge X
      • Kim SY
      • et al.
      Neighborhood disadvantage moderates associations of parenting and older sibling problem attitudes and behavior with conduct disorders in African American children.
      which may have contributed to the results not being consistent across all dimensions of parenting. Replication with more reliable measures is needed. Finally, DNA methylation was derived from salivary DNA, so replication in other tissues would be informative.
      • Thompson TM
      • Sharfi D
      • Lee M
      • Yrigollen CM
      • Naumova OY
      • Grigorenko EL.
      Comparison of whole-genome DNA methylation patterns in whole blood, saliva, and lymphoblastoid cell lines.

      CONCLUSIONS

      In conclusion, this was one of the first studies to investigate whether parenting moderates long-term associations between childhood neighborhood disadvantage and adult health. The study used a prospective design that followed a community sample of mostly African American children for more than 16 years, utilizing multisource data to assess neighborhood characteristics, parenting, and health outcomes. The results provide strong evidence that consistent and supportive parenting mitigates the associations between growing up in disadvantaged neighborhoods and multisystem markers of chronic disease in young adulthood―whereas inconsistent and unsupportive parenting exacerbates them―and that these relationships may be explained by inflammation-related DNA methylation. Interventions enhancing consistent and nurturing parenting may help to reduce the long-term links between neighborhood disadvantage and health and reduce health disparities.

      ACKNOWLEDGMENTS

      The study sponsors had no role in study design; collection, analysis, and interpretation of data; writing of the report; and submission for publication. The research presented in this paper is that of the authors and does not reflect the official policy of the sponsors.
      This project was supported by the National Institute on Minority Health and Health Disparities through Grant U54MD000502 and by the Centers for Disease Control and Prevention through Grant R49-CCR418569.
      No financial disclosures were reported by the authors of this paper.

      CREDIT AUTHOR STATEMENT

      Sylvie Mrug: Conceptualization, Formal analysis, Funding Acquisition, Methodology, Supervision, Writing – original draft. Malcolm Barker-Kamps: Data curation, Formal analysis, Project administration, Writing – original draft. Catheryn A. Orihuela: Methodology, Project administration, Writing – review & editing. Amit Patki: Data curation, Writing – review & editing. Hemant K. Tiwari: Methodology, Supervision, Writing – review & editing.

      SUPPLEMENT NOTE

      This article is part of a supplement entitled Obesity-Related Health Disparities: Addressing the Complex Contributors, which is sponsored by the National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH), U.S. Department of Health and Human Services (HHS). The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of NIMHD, NIH, or HHS.

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