Lifecourse Community Contexts and Health Behaviors as Drivers of Disparities in Risk of Alzheimer's Disease and Related Dementias

Lifecourse Community Contexts and Health Behaviors as Drivers of Disparities in Risk of Alzheimer's Disease and Related Dementias - PROJECT SUMMARY/ABSTRACT Alzheimer's disease and related dementias (ADRD) are a pressing public health issue with substantial disparities. ADRD can only be addressed by minimizing the impact of modifiable risk factors – especially health behaviors. However, evidence suggests that health behaviors are shaped by the community contexts (i.e. built and social environments) in which we live, work, play, and age. Failure to understand and account for community- level contextual factors in ADRD risk reduction may minimize the impact of public health measures to reduce the risk of ADRD and worsen health disparities. Investigating pathways that connect community contextual factors, health behavior engagement, and disparities in ADRD risk is an untapped opportunity to advance the science ADRD risk reduction, and is aligned with NIA's strategic goals by “illuminat(ing) the pathways by which social, psychological, economic, and behavioral factors affect health,” and “understand(ing) environmental, social, cultural, behavioral, and biological factors that create and sustain health disparities.” This study leverages data from two innovative projects funded by the NIH (Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE); Neighborhood Atlas) and the PolicyMap database to identify when and how community contextual factors shape health behaviors and ADRD risk and disparities. This project will link KHANDLE participants' residential histories from birth to late-life with the validated Area Deprivation Indices available via the Neighborhood Atlast from 1910 to present, and geocoded measures of the built environment available via PolicyMap. This proposal seeks to define: 1) how the timing or duration of exposure to community contexts is associated with late-life cognitive/brain health; 2) if individual health behaviors mediate relationships between community contexts and cognitive/brain health; 3) if these pathways differ by race/ethnicity or gender. This research is complimented by a detailed training plan at the University of California Davis guided by a mentorship team comprised of nationally and internationally recognized scholars. The training will build upon the applicant's background in social epidemiology, health promotion, and healthy brain aging research to incorporate new training in causal inference methods, geospatial analysis, modeling neuroimaging biomarkers, and translational epidemiology. The combined research and training will prepare the applicant for a successful independent research career focused on understanding and addressing modifiable pathways for ADRD disparities. Findings from the proposed research are critical for advancing population based ADRD risk reduction strategies that eliminate, rather than exacerbate, health disparities.