Relationship between midwifery educators' quality of life and students' clinical training quality.

Neighborhoods are central to where people live, learn, work, and grow, and thus are highly influential determinants of health (; ; ). The social and environmental characteristics of neighborhoods, such as access to quality education, employment opportunities, exposure to pollution, involvement in social networks, and much more, play important roles in promoting healthy living (; ; ). However, the quality and ease of access to these factors vary significantly across neighborhoods. These variations are not randomly distributed, but the result of historical and structural policies and practices that have systematically shaped access to opportunities and resources (; ). For example, the legacy of redlining—a practice of the 1930s through which residents of minoritized communities were denied financial services, under the assumption they were too “high-risk” for investment—continues to shape contemporary neighborhood conditions (). The qualities of a neighborhood can be measured using “neighborhood opportunity” scores, which reflect access to goods, services, and resources (). Although redlining has been illegal since 1968, areas that were previously redlined by banks tend to have lower neighborhood opportunity scores compared to “greenlined,” historically privileged neighborhoods (). These persistent inequities in neighborhood resourcing create environments that can fundamentally shape residents’ health and wellbeing. As such, it is no surprise that residing in disinvested neighborhoods is associated with elevated risk for a wide range of health conditions, including cardiovascular disease (; ), poor mental health (; ), and overall mortality (). However, the pathways through which neighborhood characteristics may elicit biological consequences and contribute to increased disease risk remain unclear. Neighborhood opportunity may influence health outcomes through social signal transduction, a process by which psychosocial stressors triggered by adversity are translated into systemic biological changes (, ; ). While the body is evolutionarily equipped to manage acute stressors via the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, chronic exposure to adverse conditions can precipitate long-term immune dysregulation by altering cell signaling cascades and gene regulation (). The neighborhood serves as a primary site of such exposure: living in under-resourced, disinvested, or heavily surveilled environments can induce a state of chronic perceived threat, repeatedly activating environmental danger appraisal systems in the brain (; ). These persistent threat signals initiate molecular cascades that can result in downstream biological consequences, such as dysregulated inflammatory gene expression that contributes to impaired immune cell production and function (; ).