{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:55:39Z","timestamp":1790740539254,"version":"4.1.0"},"reference-count":78,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Chronic stress has been posited to contribute to racial disparities in cardiovascular health. Investigation of whether neighborhood- and individual-level stressors mediate this disparity is needed.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine whether racial differences in ideal cardiovascular health (ICH) are attenuated by experiences with neighborhood- and individual-level stressors within a racially and geographically diverse population sample.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study examined data from 7720 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study who completed the second in-home visit (2013-2016). The REGARDS study is a population-based, longitudinal study of 30\u202f239 non-Hispanic Black and non-Hispanic White adults aged 45 years or older at baseline (2003-2007). Data for the present study were analyzed from June to July 2021 and in March 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Neighborhood physical environment (eg, excessive noise, violence; scored from 7-28, with higher scores indicating more problems), neighborhood safety (scored as very safe, safe, or not safe), neighborhood social cohesion (eg, shared values; scored from 5-25, with higher scores indicating higher cohesion), perceived stress (eg, coping; scored from 0-16, with higher scores indicating greater perceived stress), and the experience of discrimination (yes or no).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Ideal cardiovascular health (ICH), measured as a composite of 4 health behaviors (cigarette smoking, diet, physical activity, body mass index) and 3 health factors (blood pressure, cholesterol, and glucose levels).<\/jats:p><\/jats:sec>Results<\/jats:title>The sample included 7720 participants (mean [SD] age, 71.9 [8.3] years; 4390 women [56.9%]; 2074 Black participants [26.9%]; and 5646 White participants [73.1%]). Black participants compared with White participants reported higher perceived stress (mean [SD] score, 3.2 [2.8] vs 2.8 [2.7]) and more often reported discrimination (77.0% vs 24.0%). Black participants also reported poorer neighborhood physical environment (mean [SD] score, 11.2 [3.8] vs 9.8 [2.9]) and social cohesion (mean [SD] score, 15.5 [2.0] vs 15.7 [1.9]) and more often reported their neighborhoods were unsafe (54.7% vs 24.3%). The odds of having a high total ICH score (ie, closer to ideal) were lower for Black adults compared with White adults, both overall (adjusted odds ratio [AOR], 0.53; 95% CI, 0.45-0.61) and by gender (men: AOR, 0.73 [95% CI, 0.57-0.93]; women: AOR, 0.45 [95% CI, 0.37-0.54]). In mediation analyses, the racial disparity in total ICH score was attenuated by neighborhood physical environment (5.14%), neighborhood safety (6.27%), neighborhood social cohesion (1.41%), and discrimination (11.01%). In stratified analyses, the factors that most attenuated the racial disparity in total ICH scores were neighborhood safety among men (12.32%) and discrimination among women (14.37%). Perceived stress did not attenuate the racial disparity in total ICH scores.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cross-sectional study of Black and White US adults aged 45 years and older, neighborhood-level factors, including safety and physical and social environments, and individual-level factors, including discrimination, attenuated racial disparities in cardiovascular health. Interventional approaches to improve ICH that separately target neighborhood context and discrimination by gender and race are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.36207","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T15:33:47Z","timestamp":1696001627000},"page":"e2336207","source":"Crossref","is-referenced-by-count":54,"title":["Neighborhood Factors, Individual Stressors, and Cardiovascular Health Among Black and White Adults in the US"],"prefix":"10.1001","volume":"6","author":[{"given":"Anika L.","family":"Hines","sequence":"first","affiliation":[{"name":"Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle A.","family":"Albert","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica P.","family":"Blair","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deidra C.","family":"Crews","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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