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Growing up in a disadvantaged neighborhood is related to children’s brain structure and neurocognitive performance, according to a study published May 3, 2021 in the journal JAMA Pediatrics. It is associated with the brain’s cortical structure and volume as well as how children pay attention, their executive function, reading, flexible thinking, and other tasks that support learning.
These differences could potentially contribute to other inequities during adolescence as well as later in life for these children, though there is no evidence that such neighborhood-related differences are fixed or immutable. Children’s brains exhibit plasticity, meaning that they can change and grow in response to learning and experience. The study’s findings shine a spotlight on the larger population trend and do not serve as a predictor of any individual child’s outcome.
“This points to the importance of investing in policies and programs that help improve local neighborhoods and to support and empower communities to promote children’s neurodevelopment and long-term health and well-being,” said Daniel A. Hackman, assistant professor at the USC Suzanne Dworak-Peck School of Social Work and lead author of the study. Researchers from the USC Suzanne Dworak-Peck School of Social Work and the Keck School of Medicine of USC used data from the Adolescent Brain and Cognitive Development (ABCD) Study, collected from October 2016 – 2018. The ABCD Study is the largest long-term study of brain development and child health ever conducted in the United States.
“Disadvantaged neighborhoods may lack quality health services, access to nutritional foods, and well-maintained parks and rec facilities,” said Megan Herting, assistant professor in the department of preventive medicine at the Keck School of Medicine at USC and senior author of the study. “They may also expose residents to more pollutants or social stressors.” In addition to Hackman and Herting, study authors include Dora Cserbik, Jiu-Chiuan Chen, and Rob McConnell of the department of preventive medicine at Keck School of Medicine; Bita Minaravesh of the USC Dornsife Spatial Sciences Institute; and Kiros Berhane of the Department of Biostatistics at Columbia University Mailman School of Public Health.
Neighborhood disadvantage and the brain The study participants were 8,598 nine- to eleven-year-old children in 21 sites from the ABCD Study, and includes youth from diverse backgrounds, family income levels and neighborhood environments. Using this ABCD data, the multidisciplinary team of researchers tested whether neighborhood disadvantage is associated with neurocognition and brain structure through the National Institute of Health Toolbox Cognition Battery and magnetic resonance imaging (MRI) scans.
Neurocognition refers to specific cognitive functions related to particular neural systems, such as executive function, memory, problem-solving and perception. Executive function is the set of cognitive functions that allows people to select behaviors, make efforts to regulate or control their behavior or thinking in given situations, and to focus on goals despite distractions. Brain structure refers to global and regional measures of the brain’s cortex and subcortex, such as volume and surface area.
The researchers found that neighborhood disadvantage was associated with worse neurocognitive performance on nearly all tasks and smaller cortical surface area, as well as cortical volumes and subcortical volumes, across the whole brain. The associations remain after adjusting for family socioeconomic status and largely remain after adjusting for perceptions of neighborhood safety.
“Our findings aren't specific to the child's home life, as we accounted for socioeconomic factors at each child's home,” Herting said. “But the research suggests neighborhoods may have different levels of social and educational resources and opportunities that can impact a child's neurodevelopment.”
Disadvantaged neighborhoods are those in which people generally have lower levels of income, employment and education. Growing up in these conditions can be stressful for children and adults. However, comparing disadvantaged neighborhoods across the country is challenging to social work researchers, who understand that when looking at national samples they may pick up regional differences for which they must account.
Neighborhood similarities and differences The impressive scope and scale of the ABCD study made it possible for these researchers to delve into rich local data that enabled them to understand the similarities and differences of disadvantaged neighborhoods within the context of their cities. Hackman, whose research interests include understanding neighborhoods and the context that children and adolescents grow up in, wanted to be able to look at the research question from both the national perspective as well as the local perspective.
“This is the first large, national study of neurodevelopment to determine that the role of neighborhood disadvantage is similar across all regions of the country, and we found that what mattered most were the local differences in neighborhood disadvantage within each city, rather than how cities differ from each other overall” Hackman said. “This highlights the broad relevance of neighborhood disadvantage, and the importance of unique local conditions. His interest was even more piqued when he saw a clear narrative emerge from the data. “The consistency of the data was so compelling,” Hackman said. Though disadvantaged neighborhoods may vary from city to city, the researchers found the associations were largely consistent across 21 metropolitan areas within the U.S.
For policymakers, a takeaway is that neighborhoods were related to these important aspects of child development everywhere, and that though each city is different, the unique local conditions are important to address. In addition, the global relationship between neighborhood and overall brain structure and neurocognitive performance suggest that intervention approaches may be most successful if they are comprehensive and focused on improving children’s contexts, rather than narrowly targeted to the development of particular cognitive skills.
“This research is important as it not only highlights that neighborhoods matter, but it also suggests that promoting neighborhood equity based on the unique local conditions within cities could be important for the short and longer-term health and overall development of children and adolescents,” Hackman said.
According to the study, although the magnitudes of association between disadvantaged neighborhoods and neurocognition and brain structure are statistically small, they are potentially meaningful. One reason is because even small effects may have large consequences as they accumulate over time at a population level. Another reason is because these are comparable to, but smaller, than effect sizes for family socioeconomic status in these models.
“There is also considerable evidence of resilience,” Hackman noted, as the authors caution that these associations are not predictive at the individual level. In particular, many youth from disadvantaged neighborhoods outperform their peers from more affluent neighborhoods, and also have larger cortical surface area and subcortical volume as well. In other words, living in a disadvantaged neighborhood is not deterministic and does not automatically predict any pattern of neurocognition and brain structure for any individual. Instead, the association uncovered by these researchers points to more reasons why improvements to neighborhoods can bring positive change.
“Future research is needed to determine if our findings are, in fact, attributable to differences in community-based resources or differences in quality of schooling,” Herting said. “However, our findings do add to a growing literature suggesting the importance of neighborhoods and how they may contribute to place-based disparities in health and well-being in America.”
When I heard the verdict read at the trial of Derek Chauvin, I was relieved that a change had been made in how excessive violence by police officers has been viewed and treated in courts. This gave me some hope that a door had finally been opened to create change. A single verdict does not even begin to erase all the lives lost over decades of police violence based on prejudice and discrimination. It does however signal that change is happening, or is at least possible, if we are vigilant. It can be a step taken toward ending systemic discrimination by race in how our judicial system considers the actions of police. The wisdom of George Floyd’s seven-year-old daughter, who stated that her dad “changed the world,” has been validated. We also recognize the wisdom and courage of Darnella Frazier, the Minnesota teenager who filmed the event, knowing that what she was witnessing was wrong.
When the verdict came in, I was with a group of community activists from three California counties around Los Angeles. While group members expressed some elation for an episode of justice realized, some cautioned that this victory does not mean that all is well. Racism, and the discrimination that it engenders, continues to run rampant through our judicial system. Within the last week we have added the names of Daunte Wright and Adam Toledo to our protests and vigils. We hope this verdict is a turning point, but we will need to work to assure it.
It is worth reading a publication from 2018 to understand the role that social work needs to play in ensuring effective and lasting change to our judicial system. In their paper entitled “The Futile Fourth Amendment,” Professor Osagie Obasogie and Postdoctoral Researcher Zachary Newman examine the Supreme Court case that established the standard for court adjudication of excessive force by police, and how this has perpetuated excessive use of force in many communities of color. Protesting alone will not create the change we want to see. It will require change in policy and practices to establish equal protection for all under the law.
This is a moment for us as social workers to seize. We must not wait to act until there is another incident of police brutality or an unfair trial. We should use this moment to move forward with renewed conviction in our beliefs, using our training in policy, community organizing, management and planning, and clinical practice. We should always be the voices demanding equality under the law, saying that an end to systemic racism is possible. The world is ready for change and social work should be leading it, with those whom we serve. We should be the champions of social justice for the well-being of individuals, families and communities through innovative teaching of evidence-informed and practice-based skills, and pioneering transformative research. If not us, then who?
Sarah Gehlert
Dean
Tens of thousands of Americans die from drug use and addiction every year, with overdoses killing over 63,000 people in America in 2016, according to the National Institute on Drug Abuse. Add in deaths linked to alcohol overuse and tobacco, and the number climbs above half a million Americans.
The collective work of several researchers at the USC Suzanne Dworak-Peck School of Social Work, in collaboration with other USC faculty and outside organizations, is advancing knowledge of substance use disorders. Social work has become a hub where researchers and practitioners drive understanding and improve treatment for this disease that impacts millions of families each year.
“Either as a cause or consequence, addiction relates to every problem we deal with in social work,” said John Clapp, professor and associate dean for research and faculty development at the USC Suzanne Dworak-Peck School of Social Work. Addiction’s complexity The social work field is uniquely poised to help effect change because of its holistic approach to individual well-being and the public good. According to Clapp, substance use disorder problems are inherently ecological, impacting and being impacted by individuals, families, peers, neighborhoods, communities and public policy in complex and dynamic ways. Untangling those causes and effects and interdependencies is one part of the solution. The other part is understanding that simple solutions may stay out of reach.
“We will not find a one-size-fits-all answer,” said Clapp. Looking at addiction as a genetic, psychological or sociological issue only shows one piece of the overall cause. A comprehensive approach is essential, he said, especially when statistics from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) show alcohol use disorders alone as the third leading cause of preventable death in the world. A hub for addiction science The need for a transdisciplinary response to this worldwide crisis was behind the 2018 creation of the USC Institute on Addiction Science (IAS), a joint venture between social work and the Keck School of Medicine of USC, with membership from 10 different schools, colleges and hospitals. Its vision is to strengthen the discipline of addiction science and improve the lives of those touched by the disease. Clapp is co-director of the institute and one of its founding architects.
IAS is quickly becoming the foremost place for a broad effort focused on addiction that brings together researchers from the fields of public health, social work, law, public policy, mathematicians, computer engineers and others in recognition of the promise of new approaches to longstanding problems.
The USC Suzanne Dworak-Peck School of Social Work has eight faculty making substantial contributions to the prevention of addiction-related disorders as members of the IAS: Professor Avalardo Valdez, associate professors Julie Cederbaum and Alice Cepeda, and assistant professors Jordan Davis, Shannon Dunn, Jungeun Olivia Lee, Danielle Madden, and Hans Oh. “Social work brings one of the broadest perspectives on the underpinnings and solutions to the addiction crisis,” said Adam Leventhal, director of IAS and professor of preventive medicine and psychology at Keck. “By approaching addiction as a health condition and a social justice issue, social work brings to the table the opportunity for high-impact, multi-modal intervention and social policy approaches, which are needed to address the addiction epidemic.”
A holistic approach Social work faculty are raising the bar in addiction science research, developing new and novel approaches to improving outcomes for those affected by addiction. In a study recently published in Addiction, a multidisciplinary team lead by Davis and Clapp found gender differences in the risk factors for relapse following treatment for opioid use disorder. The study was the first in this field to use machine learning techniques to process large data sets and identify risk factors for relapse, said Davis, who also serves as associate director of the USC Center for Artificial Intelligence in Society (CAIS). The findings may result in more personalized treatment for opioid use disorder with lasting results.
This dovetails with additional research Davis is conducting with computer science engineers at CAIS to collect and input neighborhood and census data into their models in an effort to better understand how these macro variables affect relapse. “We are finding that data points such as crime statistics, population density and concentrated poverty tend to be some of the most important predictors of relapse, over and above individual-level predictors such as impulsivity, motivation or gender,” Davis said.
These findings echo Clapp’s description of addiction as ecological and point to the need for holistic solutions. “These machine learning techniques are helping us gain an apparent picture of what the most important factors are surrounding someone’s recovery,” Davis said. “Environment matters greatly.”
Davis is also collaborating closely with Eric Pedersen, associate professor at Keck School of Medicine at USC, on several research efforts examining substance use among veterans. Most recently, they have assembled a survey group of approximately 1,200 veterans whom they survey quarterly about their well-being. A recently conducted survey of the group found that veterans with PTSD prior to the COVID-19 pandemic were now managing their symptoms with more frequent alcohol and cannabis use. Another joint research endeavor between the two is examining the use of mindfulness smart phone apps to help reduce substance use in Operation Enduring Freedom/Operation Iraqi Freedom veterans with PTSD and alcohol use disorder.
Where well-being and inequalities intersect Jungeun Olivia Lee also seeks to decode the network of relationships between socioeconomic status, adverse childhood experiences and drug use. Her experience as a social work practitioner working directly with clients drives her motivation to demonstrate to policymakers what she sees as a linkage between unemployment, economic stress and substance use disorders. She is lead author on a paper published in Nicotine & Tobacco Research that found unemployment may advance nicotine addiction among young adults, rather than the idea that nicotine addiction may lead to unemployment.
Lee’s research interests lie at the intersection of substance use and co-occurring mental health, social inequalities (such as poverty and low socioeconomic status), and adverse childhood experiences. She is interested in combining these three areas of inquiry to explore their influence on addictive behavior that can persist over generations of at-risk families, such as adolescent mothers and their children.
Her memories of working directly with clients struggling with the impact of addiction remain clear in her mind. When Lee hears policymakers and others suggest that individual willpower will solve substance use disorder problems, she has a straightforward response: “People are not born with addiction.” In her view, many factors contribute to the triggered distress, including socioeconomic status and adverse childhood experiences.
Lee is exploring an idea with other IAS researchers to investigate the relationship between financial strain and employment uncertainty and addiction. “Individual circumstances, such as losing a job, certainly influence substance use, but policy-level decisions, such as the generosity of unemployment insurance, can mitigate the impact,” she said. Transdisciplinary collaboration with social scientists, psychologists and medical researchers at IAS and across the USC campus enriches and amplifies her work. “We are breaking down discipline-specific silos and bringing new and valuable perspectives to this work,” she said. “The synergy is both useful and inspiring.”
Looking ahead Researchers also hope to spark interest in the field among the next generation. A new minor for undergraduate students in addiction science was introduced at USC in Fall 2020. The minor is an interdisciplinary collaboration of the Keck School of Medicine, the USC Suzanne Dworak-Peck School of Social Work, the USC School of Pharmacy and the USC Dornsife College of Letters, Arts, and Sciences. It is designed to provide students with a transdisciplinary approach to understanding and treatment of the broad spectrum of addiction-related problems.
The goal of addiction science research and education is to improve the long-term effect of addiction treatment and save lives. As society’s understanding of the cause of addiction grows, researchers like those in the school of social work and the IAS strive to bridge the gap between science, practice and policy to positively impact outcomes for those affected by addiction.
