Behavior-Opportunity Gaps and Midlife Cognitive Health: Geographical Linkages to Enrich an Ongoing Longitudinal Family Study of Dementia Risk in a Minoritized Population

PROJECT SUMMARY
Approximately 40% of Alzheimer’s Disease (AD) cases in the U.S. (and 56% in Latin America) are due to
modifiable lifestyle factors such as hypertension, obesity, physical inactivity, heavy alcohol use, and smoking.
People who engage in more physical activity, eat healthier meals, avoid substance use, and get preventative
check-ups, tend to have better cognitive health, slower cognitive decline, and are at lower risk for late detection
of disease and AD diagnosis. Yet, comprehensive theories of self-regulation and healthy aging suggest that
engaging in healthy behaviors is promoted by environmental opportunities (or hindered by constraints). This
potential discrepancy between health behaviors and environmental opportunities is referred to as a behavior-
opportunity gap, which can be characterized as matched (level of health behavior and opportunity match),
vulnerable (less health behavior than expected given opportunities), and resilient (more health behavior than
expected given opportunities). Identifying the direction of behavior-opportunity gaps is critical because it impacts
potential targets for effectively preventing AD: increasing health behavior uptake vs. policy changes to increase
accessibility to healthy amenities. Despite recognized importance, the present proposal is among the first to
identify associations between behavior-opportunity gaps and cognitive health, due to a dearth of longitudinal
data containing both individual-level health behaviors and geographical-level environmental opportunities. This
is a particularly pressing need for minoritized populations, who face disproportionate barriers in accessing
environmental resources, stronger associations between modifiable lifestyle factors and AD risk, and spend more
living years cognitively impaired. The long-term goal of this research is to identify how to effectively promote
healthy cognitive aging in place for diverse older adults. The objectives for this application are to conduct
geographical linkages to maximize the scientific value of an existing NIA-funded longitudinal family study of
Mexican-origin immigrants living in the U.S. (Aim 1) and to identify associations between behavior-opportunity
gaps and midlife cognitive health (Aim 2). Aim 1 will geocode 17 years of annual address data for 1,784
individuals and link to publicly-available geographical data containing indicators of environmental opportunities.
Aim 2 will combine geographical data with extant health behavior and cognitive function data to identify
associations among behavior-opportunity gaps and midlife cognitive health among Mexican-origin immigrants.
The central hypothesis is that larger behavior-opportunity gaps will be associated with worse cognitive health
over and above main effects of the behavior and environmental characteristic, such that vulnerable individuals
will have worse cognitive function compared to matched and resilient individuals. This work will lead to new
knowledge about the intersection of health behaviors and environmental opportunities as prevention and
intervention targets for promoting healthy cognitive aging in place among minoritized adults.

Grant Number: 1R21AG088948-01
NIH Institute/Center: NIH
Principal Investigator: Olivia Atherton