1. E FFECT OF NEIGHBORHOOD WALKABILITY AND CRIME ON THE MENTAL HEALTH OF WOMEN LIVING IN LOW - INCOME NEIGHBORHOODS Pamela B. DeGuzman, PhD, RN 1 ; Elizabeth I. Merwin, PhD, RN, FAAN 2, & Cheryl Bourguignon, PhD, RN 1 1 University of Virginia School of Nursing; 2 Duke University School of Nursing S UMMARY : The purpose of this study was to determine the influence of population density, distance to public transportation and perception of crime on the symptoms of depression, anxiety and somatization of women living in low- income neighborhoods in Boston, San Antonio and Chicago. The two walkability metrics did not have a significant impact on symptoms. Only perception of neighborhood problems impacted mental health symptoms. B ACKGROUND M ETHODS M ULTILEVEL F RAMEWORK D ESCRIPTION OF S AMPLE C ONCLUSIONS NEIGHBORHOOD INDIVIDUAL Walkability of the Built Environment Residential Density Access to Public Transit Walkability of the Built Environment Residential Density Access to Public Transit Health Outcomes Mental Health Symptoms Health Outcomes Mental Health Symptoms Health Behaviors Dietary Practices Physical Activity Health Behaviors Dietary Practices Physical Activity Stressors Perception of Neighborhood conditions Stressors Perception of Neighborhood conditions Social & Economic conditions Income Education Social & Economic conditions Income Education REGION City of Residence City of Residence From: DeGuzman, Pamela B., and Pamela A. Kulbok. "Changing health outcomes of vulnerable populations through nursing's influence on neighborhood built environment: A framework for Nursing Research." Journal of Nursing Scholarship 44.4 (2012): 341-348. Variable Metric Individual-level Age in years, mean (sd)38.4 ( 9.7) Prior month income in US$, mean (sd)1263 (817) Neighborhood problem scale, mean (sd)19.0 (6.1) Race Non-Hispanic Black, n (%)716 (42.2) Non-Hispanic White, n (%)134 ( 7.9) Hispanic, Any race, n (%)816 (48.1) Other race, n (%)31 ( 1.9) Education Less than high school diploma or GED, n (%)615 (36.2) High school diploma or GED, n (%)559 (32.9) More than high school diploma or GED, n (%)523 (30.8) City of residence Chicago, n (%)589 (34.7) Boston, n (%)599 (35.3) San Antonio, n (%)509 (30.0) Neighborhood- level Distance from public transportation (feet), mean (sd) 1434 (5327) Residential density (person/mi 2 ), mean (sd)18410 (14838) Black population (% of CBG), mean (sd)36.7 (34.2) High School educated (% of CBG), mean (sd)62.6 (15.7) Median Income, mean (sd)28863 (13284) R ESULTS DeGuzman, Pamela B., Elizabeth I. Merwin, and Cheryl Bourguignon. "Population Density, Distance to Public Transportation, and Health of Women in Low‐Income Neighborhoods." Public Health Nursing (2013). Data Sources : Women, Children and Families: A Three-Cities Study; Census (2000) Sample/ Setting : 1697 female caregivers in Boston, San Antonio and Chicago Measures : Mental Health Symptoms were measured using the BSI-18, a measure of symptoms of depression, anxiety and somatization. Neighborhood was measured as Census block group. Distance to public transportation was measured using ArcMAP v.9.1. and was measured as the distance from the closest bus or train stop to the centroid of the residential census block group. Population density was measured at the CBG level. Perception of crime was measured using a Neighborhood Problem Scale. Residents were asked to rate the number and severity of problems such as neighborhood drug dealing and street safety. Analysis : Multi-level models were tested using SAS PROC MIXED, to determine the impact of perception of crime and walkability on mental health symptoms, controlling for city of residence, race, income and educational level at the individual and neighborhood levels. The best fit model was determined -2 log likelihood and degrees of freedom in a chi-squared analysis. Walkability was not a factor in the best fit model. In the best fit model perception of crime was the only significant predictor of mental health symptoms. City of residence,(living in Boston compared with living in San Antonio), neighborhood-level percent of African Americans, individual-level education all showed trends in their ability to predict mental health symptoms. Recent studies have suggested that features of the residential built environment can affect health of neighborhood residents, specifically the perception of neighborhood conditions and walkability. Fear of crime is associated with lower neighborhood satisfaction and higher depressive symptoms. When fear of crime increases so does the incidence of depression, and physical and mental health functioning decrease. Fear of crime may tend to be higher in women than in men, suggesting the need to understand the perception of neighborhood problems and the implications for women’s mental health. Negative neighborhood perceptions may be a barrier to participation in health –promoting physical and social activities. Walkability--the extent to which the built environment is pedestrian friendly—may also affect mental health, because of the link between exercise and depression. Selected Fixed Effects for Best Fit Model Effectp- value Individual-level Neighborhood problem index<.001 Black Race.093 Education (Ref = More than High School Education Less than high school education High school education.076.880 Income.178 Neighborhood –level City of Residence (Ref =San Antonio) Chicago Boston.137.060 Neighborhood problem index neighborhood mean.700 Percent African American.063 Percent with High School Diploma.130 Median Income.653 Our study found that individual perceptions of neighborhood problems were correlated with mental health symptoms in a sample of women living in poor urban neighborhoods. Walkability was not found to be related to mental health symptoms in this sample. The results also suggest that living in Boston, living in an neighborhood with more African Americans, and having more education may provide protection against mental health symptoms. These results suggest that neighborhood-level interventions targeted at improving mental health may not be effective, and that individually targeted interventions may be necessary to improve mental health. References available upon request The authors wish to thank Emily Koyen for her assistance with this work.