key: cord-0055709-5nd4vgwe
authors: Akingbade, Ololade; Peek, Monica E.; Tung, Elizabeth L.
title: Network Size or Proximity? Association of Network Characteristics with Violence-Related Stress and PTSD Among Racial/Ethnic Minorities in Chicago
date: 2021-01-27
journal: J Gen Intern Med
DOI: 10.1007/s11606-021-06607-w
sha: 46e7b87b12a7f08fb92022c54dd0949520aeba79
doc_id: 55709
cord_uid: 5nd4vgwe

nan

Heart Study and Primary Care-PTSD Screen. Detailed study methods are described in prior work. 4 We used logistic regression models to assess stress due to violence and PTSD as independent functions of network size and proximity, 5 controlling for age, gender, race/ethnicity, education, insurance status, and clinic location.

Among the subset of participants reporting prior exposure to community violence (n = 297; Table 1 ), the majority were female (69%) and non-Hispanic Black (75%). Two-thirds were direct victims of robbery or assault (66%); one-third (31%) screened positive for PTSD. The median number of network confidants was 2. Larger network size alone was not associated with stress due to violence or PTSD (Table 2) . However, having a larger network size (> 3 confidants) within 30 min from home was significantly associated with 67% lower adjusted odds of PTSD (95% CI, 0.12-0.96), compared to those with no confidants within 30 minutes from home. Associations with stress due to violence were not statistically significant (Table 2) .

In this sample of high-risk, racial/ethnic minority adults in Chicago, we found that network proximity, rather than network size alone, was associated with lower odds of PTSD. This study is among the first, to our knowledge, to compare network size and proximity, and their respective associations with the psychosocial consequences of violence. Our findings raise the possibility that close proximity to network confidants may be a key factor for mitigating the harmful effects of community violence. One possible reason is that physical proximity may facilitate a type of "extended kinship," providing reliable socioeconomic and emotional resources that are responsive to neighborhood events and conditions. 6 Neither network size nor proximity was associated with reductions in violence-related stress. We theorize that while stress may be more pervasive in populations with chronic exposure to violence, PTSD, which is more closely associated with personal exposure to violence, may be more responsive to the benefits of local networks. For instance, individuals with PTSD may rely on close confidants to navigate daily activities and regulate hypervigilance symptoms. This is a limited cross-sectional study that can support theory and measurement development. Currently, network proximity is not included in most validated tools to measure network characteristics. We were unable to account for whether participants knew each other due to survey anonymity; however, eligibility criteria and the large size of each site may have mitigated this concern. Moreover, network proximity was measured using self- reported rather than empiric travel time. Despite these limitations, this is one of the first studies to examine both network size and proximity in comparative analyses. Network proximity may be an important consideration, in addition to network size, for future research. We found that network proximity was associated with lower odds of PTSD in a sample of racial/ethnic minority adults who reported traumatic exposure to community violence. In an era of growing social isolation despite enhanced digital connection, further study is needed on the role of local networks in mitigating the harmful health effects of violence.

Publisher's Note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Logistic regression models were used to estimate differences between groups; adjusted for age, gender, race/ethnicity, educational attainment, insurance type, and clinic location (academic medical center or federally-qualified health center). b Based on the number of unique confidants, participants were asked to sequentially list confidants (i.e., "Looking back over the past year, who are the people that you most often discussed important things with?"), starting with the most important person. c Network proximity was measured among participants who reported at least 1 network confidant; however, all survey participants reporting no confidants were included in the referent category. *p < 0.05

Experiences of community violence among adults with chronic conditions: Qualitative findings from Chicago

Social pathways to health: On the mediating role of the social network in the relation between socio-economic position and health. SSM -Popul Heal

The Brief Trauma Questionnaire

Social isolation, loneliness, and violence exposure in older adults

City planning and population health: a global challenge

Family resources as protective factors for low-income youth exposed to community violence

This study was approved by the University of Chicago Institutional Review Board with written documentation of informed consent.

The authors declare that they do not have a conflict of interest.