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Papers by Amy DeSantis

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I nvesting in lower-income and disadvantaged neighborhoods, when done with community involvement ... more I nvesting in lower-income and disadvantaged neighborhoods, when done with community involvement and support, may translate into health and economic gains for residents. To support better policy decisions about neighborhood investment and understand the policy levers that contribute to successful community development, it is important to measure the eff ects of such investments on residents' health and neighborhood satisfaction.

Ethnicity & Health, 2018

Background: Research has demonstrated the adverse impact that discrimination has on physical and ... more Background: Research has demonstrated the adverse impact that discrimination has on physical and mental health. However, few studies have examined the association between discrimination and symptoms of posttraumatic stress disorder (PTSD). There is evidence that African Americans experience higher rates of PTSD and are more likely to develop PTSD following trauma exposure than Whites, and discrimination may be one reason for this disparity. Purpose: To examine the association between discrimination and PTSD among a cross-sectional sample largely comprising African American women, controlling for other psychosocial stressors (psychological distress, neighborhood safety, crime). Methods: A sample of 806 participants was recruited from two lowincome predominantly African American neighborhoods. Participants completed self-report measures of PTSD symptoms, perceived discrimination, perceived safety, and psychological distress. Information on neighborhood crime was obtained through data requested from the city. Multivariate linear regression models were estimated to assess adjusted relationships between PTSD symptoms and discrimination. Results: Discrimination was significantly associated with PTSD symptoms with a small effect size, controlling for relevant sociodemographic variables. This association remained consistent after controlling for psychological distress, perceived safety, and total neighborhood crime. There was no evidence of a gender by discrimination interaction. Participants who experienced any discrimination were significantly more likely to screen positive for PTSD. Conclusions: Discrimination may contribute to the disparate rates of PTSD experienced by African Americans. PTSD is associated with a range of negative consequences, including poorer physical health, mental health, and quality of life. These results suggest the importance of finding ways to promote resilience in this at-risk population.

SSM - Population Health, 2018

Social support and social networks can elucidate important structural and functional aspects of s... more Social support and social networks can elucidate important structural and functional aspects of social relationships that are associated with health-promoting behaviors, including Physical Activity (PA) and weight. A growing number of studies have investigated the relationship between social support, social networks, PA and obesity specifically among African Americans; however, the evidence is mixed and many studies focus exclusively on African American women. Most studies have also focused on either functional or structural aspects of social relationships (but not both) and few have objectively measured moderate-to-vigorous physical activity (MVPA) and body mass index (BMI). Cross-sectional surveys of adult African American men and women living in two low-income predominantly African American neighborhoods in Pittsburgh, PA (N = 799) measured numerous structural features as well as functional aspects of social relationships. Specifically, structural features included social isolation, and social network size and diversity. Functional aspects included perceptions of social support for physical activity from the social network in general as well as from family and friends specifically. Height, weight, and PA were objectively measured. From these, we derived Body Mass Index (BMI) and moderate-to-vigorous physical activity (MVPA). All regression models were stratified by gender, and included age, income, education, employment, marital status, physical limitations, and a neighborhood indicator. Greater social isolation was a significant predictor of lower BMI among men only. Among women only, social isolation was significantly associated with increased MVPA whereas, network diversity was significantly associated with reduced MVPA. Future research would benefit from in-depth qualitative investigations to understand how social networks may act to influence different types of physical activity among African Americans, as well as understand how they can be possible levers for health promotion and prevention. PA guidelines compared to 52.9% for White adults (Ward, Clarke, Nugent & Schiller, 2016). An even smaller percentage of African American women (13.6%) achieve recommended PA levels, representing one of the lowest prevalence for any race and sex demographic group (U.S. Department of Health and Human Services, 2017). This difference constitutes an important racial disparity that warrants further research because a proportion of the observed difference may result from unfair, unjust, or inequitable access to resources for certain racial/ ethnic minorities in the U.S. (Institute of Medicine, 2003). Indeed, disparities related to physical activity have been attributed to a myriad of obstacles faced by African Americans, including greater

Sleep Health, 2019

Objectives: While multiple individual sleep measures (e.g., sleep duration, satisfaction) have be... more Objectives: While multiple individual sleep measures (e.g., sleep duration, satisfaction) have been linked to a wide range of physical and mental health conditions, scant research has examined how individual sleep dimensions may act independently or additively to influence health. The current study investigates associations of five sleep dimensions (duration, satisfaction, efficiency, timing, and regularity), analyzed separately and simultaneously, with psychological distress, body mass index, and physical functioning among a low-income, predominantly African American population. Design: We constructed a composite Sleep Health (SH) score from the sum of scores, representing "good' and "poor" ranges of five sleep measures (Range = 0-5). Setting: Two low-income, predominantly African American neighborhoods in Pittsburgh. Participants: Participants included 738 community-dwelling adults (78% female and 98% Black).

Annals of Epidemiology, 2017

To estimate the impacts of a new supermarket in a low-income desert, on residents' economic statu... more To estimate the impacts of a new supermarket in a low-income desert, on residents' economic status and health. Methods: We surveyed a randomly selected cohort in two low-income Pittsburgh neighborhoods before and about 1 year following the opening of a supermarket. We used difference-indifference approach to test changes across the two neighborhoods in residents' food security, United States Department of Agriculture Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women Infant and Children participation, employment, income, and self-reported health/chronic disease diagnoses. Results: We observed declines in food insecurity (À11.8%, P < .01), Supplemental Nutrition Assistance Program participation (À12.2%, P < .01), and fewer new diagnoses of high cholesterol (À9.6%, P ¼ .01) and arthritis (À7.4%, P ¼ .02) in the neighborhood with the new supermarket relative to residents of the comparison neighborhood. We also found suggestive evidence that residents' incomes increased more ($1550, P ¼ .09) and prevalence of diabetes increased less in the neighborhood with the supermarket than in the comparison neighborhood (À3.6%, P ¼ .10). Conclusions: Locating a new supermarket in a low-income neighborhood may improve residents' economic well-being and health. Policymakers should consider broad impacts of neighborhood investment that could translate into improved health for residents of underserved neighborhoods.

Military Medicine, 2017

Introduction: Changes in the frequency, duration, and nature of military deployments over the pas... more Introduction: Changes in the frequency, duration, and nature of military deployments over the past 14 years have spurred efforts to understand the effects of deployment on the health of military service members and their spouses. However, few studies have examined the impact of deployments on health outcomes in both veterans and their partners. This study aims to examine the association between deployment length and health, including ambulatory blood pressure (BP) and stress-related markers of inflammation, in military veterans and their spouses. Materials and Methods: This study includes 32 male veterans and 29 female civilian partners. Veterans reported about their deployment and military experiences, including deployment length, combat exposure, and post-traumatic stress disorder (PTSD) symptoms. Plasma measures of inflammatory markers, C-reactive protein (CRP) and interleukin 6 (IL-6), were collected from veterans and spouses. Participants also completed 48 hours of BP monitoring for calculation of mean arterial pressure (MAP) during wakefulness and sleep, and sleep/wake MAP ratio, as an indicator BP nondipping. Regression models examined the association between deployment length and each outcome in the combined sample of veterans and their spouses, including tests of interactions between gender and deployment length, controlling for age, gender, waist circumference, current PTSD, and combat exposure. Results: Longer deployment length was associated with higher CRP levels in veterans and their spouses, although this effect became nonsignificant when limiting analyses to individuals with CRP ≤10 mg/L. There was a significant gender by deployment length interaction effect on MAP ratio, such that longer deployments were associated with higher MAP ratios in female spouses. There was no significant effect of combat exposure in these models. Conclusion: Longer deployments are associated with health-related markers in military veterans as well as their spouses. These results suggest the importance of monitoring health during and postdeployment, and of finding ways to mitigate the adverse impact of deployment on health in both members of military couples.

This document and trademark(s) contained herein are protected by law. This representation of RAND... more This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.

Annals of Behavioral Medicine, 2017

Background-Emerging research has begun to examine associations between relationship functioning a... more Background-Emerging research has begun to examine associations between relationship functioning and sleep. However, these studies have largely relied on self-reported evaluations of relationships and/or of sleep, which may be vulnerable to bias. Purpose-To examine associations between relationship functioning and sleep in military couples. This is the first research to examine associations between observed relationship behaviors and subjective and polysomnographically-measured sleep in a sample at-risk for both sleep and relationship problems. Methods-The sample included 35 military veterans and their spouses/partners. Marital functioning was coded from a videotaped conflict interaction. Analyses focused on behavioral codes of hostility and relationship-enhancing attributions. Sleep was assessed via self-report and in-home polysomnography. Results-Greater hostility was associated with poorer sleep efficiency for oneself (b=−0.195, p=. 013). In contrast, greater relationship-enhancing attributions were associated with higher percentages of Stage N3 sleep (b=0.239, p=.028). Partners' hostility was also positively associated with higher percentages of stage N3 sleep (b=0.272, p=.010). Neither hostility nor relationshipenhancing attributions was associated with self-reported sleep quality, percentage of REM sleep, or total sleep time.

BMC public health, Jan 19, 2017

Low-income African American adults are disproportionately affected by obesity and are also least ... more Low-income African American adults are disproportionately affected by obesity and are also least likely to engage in recommended levels of physical activity (Flegal et al. JAMA 303(3):235-41, 2010; Tucker et al. Am J Prev Med 40(4):454-61, 2011). Moderate-to-vigorous physical activity (MVPA) is an important factor for weight management and control, as well as for reducing disease risk (Andersen et al. Lancet 368(9532):299-304, 2006; Boreham and Riddoch J Sports Sci 19(12):915-29, 2001; Carson et al. PLoS One 8(8):e71417, 2013). While neighborhood greenspace and walkability have been associated with increased MVPA, evidence also suggests that living in areas with high rates of crime limits MVPA. Few studies have examined to what extent the confluence of neighborhood greenspace, walkability and crime might impact MVPA in low-income African American adults nor how associations may vary by age and sex. In 2013 we collected self-reported data on demographics, functional limitations, obje...

Health Psychology, 2017

Objective: Our goal was to examine the association between marital conflict and nocturnal blood p... more Objective: Our goal was to examine the association between marital conflict and nocturnal blood pressure dipping (NBP) in Iraq/Afghanistan healthy veterans and their partners and to determine whether sleep disturbances mediate such associations. Method: The sample consisted of 25 heterosexual couples comprised of male veterans and their female civilian spouses/partners. Blood pressure was measured across 48 hr, and NBP was calculated as the ratio of sleep/wake mean arterial pressure (MAP). Marital conflict was assessed by questionnaire. Sleep was assessed via in-home polysomnography (PSG). Posttraumatic stress disorder (PTSD) diagnosis was determined via clinician interview and was included as a covariate in all analyses, along with body mass index, age, gender, and deployment characteristics. Results: Higher marital conflict was associated with higher MAP ratios (␤ ϭ .74, p Ͻ .01), with the effect stronger among women (␤ ϭ Ϫ0.68, p Ͻ .05, for gender interaction). Among women only, for each SD increase in marital conflict there was a .82 increase in MAP ratio (p Ͻ .01). This association was reduced to nonsignificance after adjustment for PSG-assessed sleep efficiency. Conclusions: Consistent with limited prior work in civilian samples, higher marital conflict in military couples was associated with blunted NBP, particularly among women. These findings highlight the importance of considering the health and well-being of both veterans and their partners in the aftermath of war, as well as the importance of considering nighttime physiological pathways that are relevant to cardiovascular disease risk.

Sleep Health, 2016

Neighborhood characteristics have consistently been linked to physical and mental health outcomes... more Neighborhood characteristics have consistently been linked to physical and mental health outcomes and overall mortality (1, 2). Specifically, individuals living in neighborhood environments of lower socioeconomic status and/or with higher levels of adverse characteristics (e.g., neighborhood disorder, or lower levels of safety or social cohesion) have been found to have higher body mass index (BMI) (3, 4), diabetes (5), and hypertension (6, 7), among other risk factors. However, the specific mechanisms linking neighborhood characteristics to residents' health outcomes are not fully understood.

PloS one, 2016

Both objective and subjective aspects of social isolation have been associated with alterations i... more Both objective and subjective aspects of social isolation have been associated with alterations in immune markers relevant to multiple chronic diseases among older adults. However, these associations may be confounded by health status, and it is unclear whether these social factors are associated with immune functioning among relatively healthy adults. The goal of this study was to examine the associations between perceived loneliness and circulating levels of inflammatory markers among a diverse sample of adults. Data come from a subset of the Multi-Ethnic Study of Atherosclerosis (n = 441). Loneliness was measured by three items derived from the UCLA Loneliness Scale. The association between loneliness and C-reactive protein (CRP) and fibrinogen was assessed using multivariable linear regression analyses. Models were adjusted for demographic and health characteristics. Approximately 50% of participants reported that they hardly ever felt lonely and 17.2% felt highly lonely. Indivi...

by Amy DeSantis and Malavika Subramanya

American journal of human biology : the official journal of the Human Biology Council, Jan 7, 2015

Low socioeconomic status (SES) is associated with increased psychosocial stress among low-income ... more Low socioeconomic status (SES) is associated with increased psychosocial stress among low-income persons, which could contribute to differences in activity of the HPA axis (assessed by diurnal cortisol profiles). The current article investigates associations of SES from different developmental stages with cortisol profiles. Using data from a large, socioeconomically diverse birth cohort (N = 1,490) in Cebu, Philippines, the current study compares the relative and joint contributions of SES from five developmental periods, between the prenatal/birth period and early adulthood, to adult cortisol, and examines the effects of chronic exposure to low SES. Chronically low SES from infancy through early adulthood predicts the highest bedtime cortisol levels, lowest cortisol awakening responses (CARs), lowest total cortisol levels across the day (area under curve or AUC), and the flattest cortisol rhythms between wake up and bedtime, a profile associated with poorer health. Results indicate...

Obesity, 2013

Neuroendocrine abnormalities, such as activation of the hypothalamic-pituitary-adrenal (HPA) axis... more Neuroendocrine abnormalities, such as activation of the hypothalamic-pituitary-adrenal (HPA) axis, are associated with obesity; however, few large-scale population-based studies have examined HPA axis and markers of obesity. We examined the cross-sectional association of the cortisol awakening response (CAR) and diurnal salivary cortisol curve with obesity. The Multi-Ethnic Study of Atherosclerosis (MESA) Stress Study includes 1,002 White, Hispanic, and Black men and women (mean age 65±9.8 years) who collected up to 18 salivary cortisol samples over 3 days. Cortisol profiles were modeled using regression spline models that incorporated random parameters for subject-specific effects. Cortisol curve measures included awakening cortisol, CAR (awakening to 30 minutes post-awakening), early decline (30 minutes to 2 hours post-awakening), late decline (2 hours post-awakening to bedtime), and the corresponding areas under the curve (AUC). Body-mass-index (BMI) and waist circumference (WC) were used to estimate adiposity. Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

The Journal of Clinical Endocrinology & Metabolism, 2011

Context: Prior research has identified associations between social-environmental factors and meta... more Context: Prior research has identified associations between social-environmental factors and metabolic syndrome (MetS) components. The physiological mechanisms underlying these associations are not fully understood, but alterations in activity of the hypothalamic-pituitary-adrenal axis, a stress-responsive biological system, have been hypothesized to play a role. Objective: The aim of the study was to determine whether MetS diagnosis and specific clusters of MetS components (waist circumference, high-density lipoproteins, glucose, and blood pressure) are associated with cortisol levels. Design and Setting: We conducted cross-sectional analyses of data from the Multi-Ethnic Study of Atherosclerosis (MESA) study in the general community. Patients or Other Participants: We studied a population-based sample of 726 adults (ages 48 to 89 yr) who do not have clinical diabetes. Intervention(s): There were no interventions. Main Outcome Measure(s): Cortisol awakening response, cortisol decline across the waking day, and total cortisol output were analyzed (using 18 timed measures of salivary cortisol over 3 d). Results: Overall, we found little evidence that the presence of MetS or its components is related to cortisol output or patterns. Contrary to expectation, the presence of MetS was associated with lower rather than higher area under the curve, and no consistent pattern was observed when MetS components or subsets of components were examined in relation to cortisol. Conclusions: Our findings do not support the hypothesis that differences in level or diurnal pattern of salivary cortisol output are associated with MetS among persons without clinical diabetes. (J Clin Endocrinol Metab 96: 3483-3492, 2011) N umerous studies have identified associations between social or psychosocial factors, such as lower socioeconomic status and increased work stress, and metabolic syndrome (MetS) components (1, 2). The physiological mechanisms underlying these associations have not been fully explained, but alterations in activity of the hypothalamic-pituitary-adrenal (HPA) axis, a stress-responsive biological system, have been proposed as a potential con

American Journal of Public Health, 2006

Objectives. We investigated associations between local food environment and neighborhood racial/e... more Objectives. We investigated associations between local food environment and neighborhood racial/ethnic and socioeconomic composition. Methods. Poisson regression was used to examine the association of food stores and liquor stores with racial/ethnic composition and income in selected census tracts in North Carolina, Maryland, and New York. Results. Predominantly minority and racially mixed neighborhoods had more than twice as many grocery stores as predominantly White neighborhoods (for predominantly Black tracts, adjusted stores per population ratio [SR]=2.7; 95% confidence interval [CI]=2.2, 3.2; and for mixed tracts, SR=2.2; 95% CI=1.9, 2.7) and half as many supermarkets (for predominantly Black tracts, SR=0.5; 95% CI=0.3, 0.7; and for mixed tracts, SR=0.7; 95% CI=0.5, 1.0, respectively). Low-income neighborhoods had 4 times as many grocery stores as the wealthiest neighborhoods (SR=4.3; 95% CI=3.6, 5.2) and half as many supermarkets (SR=0.5; 95% CI=0.3, 0.8). In general, poorer ...

Psychoneuroendocrinology, 2014

Collection of salivary cortisol has become increasingly popular in large population-based studies... more Collection of salivary cortisol has become increasingly popular in large population-based studies. However, the impact of protocol compliance on day-today reliabilities of measures, and the extent to which reliabilities differ systematically according to socio-demographic characteristics, has not been well characterized in large-scale population-based studies to date. Using data on 935 men and women from the Multi-ethnic Study of Atherosclerosis, we investigated whether sampling protocol compliance differs systematically according to socio-demographic factors and

Hormones and Behavior, 2012

Racial/ethnic minorities experience persistent health disparities due in part to their exposure t... more Racial/ethnic minorities experience persistent health disparities due in part to their exposure to chronic SES and psychosocial risk. The hypothalamic-pituitary-adrenal axis and its hormonal end product, cortisol, are believed to mediate the associations between chronic stress and poor health. In this study, racial/ethnic differences in diurnal salivary cortisol rhythms in 179 preadolescent youths and the contributing roles of SES risk, psychosocial risk, perceived discrimination, harsh parenting, and parental monitoring were examined. The analyses revealed racial/ethnic differences in diurnal cortisol rhythms, with African Americans having significantly flatter morning-toevening cortisol slopes than Caucasians and with Latinos having significantly lower evening cortisol levels than Caucasians. Greater psychosocial risk and less parental monitoring were associated with flatter cortisol slopes. Racial/ethnic differences on the cortisol measures persisted when controlling for SES, psychosocial risk, and parenting quality. The need to assess chronic risk across the lifespan and disentangle possible genetic from environmental contributors is discussed.