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Bratman GN, Mehta A, Olvera-Alvarez H, Spink KM, Levy C, White MP, Kubzansky LD, Gross JJ. Associations of nature contact with emotional ill-being and well-being: the role of emotion regulation. Cogn Emot 2024; 38:748-767. [PMID: 38362747 DOI: 10.1080/02699931.2024.2316199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/19/2024] [Accepted: 02/03/2024] [Indexed: 02/17/2024]
Abstract
Nature contact has associations with emotional ill-being and well-being. However, the mechanisms underlying these associations are not fully understood. We hypothesised that increased adaptive and decreased maladaptive emotion regulation strategies would be a pathway linking nature contact to ill-being and well-being. Using data from a survey of 600 U.S.-based adults administered online in 2022, we conducted structural equation modelling to test our hypotheses. We found that (1) frequency of nature contact was significantly associated with lesser emotional ill-being and greater emotional well-being, (2) effective emotion regulation was significantly associated with lesser emotional ill-being and greater emotional well-being, and (3) the associations of higher frequency of nature contact with these benefits were partly explained via emotion regulation. Moreover, we found a nonlinear relationship for the associations of duration of nature contact with some outcomes, with a rise in benefits up to certain amounts of time, and a levelling off after these points. These findings support and extend previous work that demonstrates that the associations of nature contact with emotional ill-being and well-being may be partly explained by changes in emotion regulation.
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Affiliation(s)
- Gregory N Bratman
- School of Environmental and Forest Sciences, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Ashish Mehta
- Department of Psychology, Stanford University, Stanford, CA, USA
| | | | | | - Chaja Levy
- School of Environmental and Forest Sciences, University of Washington, Seattle, WA, USA
| | - Mathew P White
- Cognitive Science Hub, University of Vienna, Wien, Austria
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
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2
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Song Y, Liu Y, Bai X, Yu H. Effects of neighborhood built environment on cognitive function in older adults: a systematic review. BMC Geriatr 2024; 24:194. [PMID: 38408919 PMCID: PMC10898015 DOI: 10.1186/s12877-024-04776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/03/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND In the background of an aging population, the risk of cognitive impairment in the older population is prominent. Exposure to complex neighborhood built environments may be beneficial to the cognitive health of older adults, and the purpose of this study was to systematically review the scientific evidence on the effects of neighborhood built environments on cognitive function in older adults. METHODS Keywords and references were searched in Web of Science, Pubmed, PsycINFO, and MEDLINE. Studies examining the relationship between the built environment and cognitive function in older adults were included. The neighborhood built environment as an independent variable was classified according to seven aspects: density, design, diversity, destination accessibility, public transportation distance, blue/green space, and built environment quality. The cognitive function as the dependent variable was classified according to overall cognitive function, domain-specific cognitive function, and incidence of dementia. The quality of the included literature was assessed using the National Institutes of Health's Observational Cohort and Cross-Sectional Study Quality Assessment Tool. RESULTS A total of 56 studies were included that met the inclusion criteria, including 31 cross-sectional studies, 23 longitudinal studies, 1 cross-sectional study design combined with a case-control design, and 1 longitudinal study design combined with a case-control design. Most of the studies reviewed indicate that the built environment factors that were positively associated with cognitive function in older adults were population density, street connectivity, walkability, number of public transportation stops around the residence, land use mix, neighborhood resources, green space, and quality of the neighborhood built environment. Built environment factors that were negatively associated with cognitive function in older adults were street integration, distance from residence to main road. The relationship between residential density, destination accessibility, and blue space with cognitive function in older adults needs to be further explored. CONCLUSION Preliminary evidence suggests an association between the neighborhood built environment and cognitive function in older adults. The causal relationship between the built environment and cognitive function can be further explored in the future using standardized and combined subjective and objective assessment methods, and longitudinal or quasi-experimental study designs. For public health interventions on the cognitive health of older adults, it is recommended that relevant authorities include the neighborhood built environment in their intervention programs.
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Affiliation(s)
- Yiling Song
- Department of Physical Education, Tsinghua University, Beijing, 100084, China
| | - Yunxi Liu
- Graduate School of Commerce, Waseda University, Tokyo, 169-8050, Japan
| | - Xiaotian Bai
- Department of Physical Education, Tsinghua University, Beijing, 100084, China
| | - Hongjun Yu
- Department of Physical Education, Tsinghua University, Beijing, 100084, China.
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3
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Fowler Davis S, Benkowitz C, Nield L, Dayson C. Green spaces and the impact on cognitive frailty: a scoping review. Front Public Health 2024; 11:1278542. [PMID: 38283295 PMCID: PMC10810992 DOI: 10.3389/fpubh.2023.1278542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
Some literature indicates that contact with green spaces can benefit health and wellbeing, but it is unclear whether this is protective of cognitive health in older people. Using Arskey and O'Malley's framework the aim was to investigate ageing, cognitive frailty and the effects of green access including any causality. The evidence was somewhat inconsistent but suggestive for a beneficial role of green space exposure on cognitive functions. Results suggested that globally, the poorer urban environments are high risk for older people's mental health and these places often lack parks and green spaces. There is evidence that the level of activity and social participation may be greater with access to green spaces and therefore reduces health risks. Green spaces seem to have a role in preventing cognitive frailty, especially for more vulnerable older populations living in poorer urban environments.
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Affiliation(s)
- Sally Fowler Davis
- School of Allied Health and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
| | - Charlotte Benkowitz
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Lucie Nield
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Chris Dayson
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
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Yang HW, Wu YH, Lin MC, Liao SF, Fan CC, Wu CS, Wang SH. Association between neighborhood availability of physical activity facilities and cognitive performance in older adults. Prev Med 2023; 175:107669. [PMID: 37595898 DOI: 10.1016/j.ypmed.2023.107669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/20/2023]
Abstract
The existing evidence on the contextual influence of the availability of local facilities for physical activity on the cognitive health of elderly residents is sparse. This study examined the association between neighborhood physical activity facilities and cognitive health in older individuals. A cohort study of community-dwelling older adults was performed using baseline data and follow-up data from the Taiwan Biobank. Cognitive health was measured in 32,396 individuals aged 60-70 years using the Mini-Mental State Examination (MMSE) with follow-up information on 8025 participants. The district was used as the proxy for local neighborhood. To determine neighborhood physical activity facilities, school campuses, parks, activity centers, gyms, swimming pools, and stadiums were included. Multilevel linear regression models were applied to examine the associations of neighborhood physical activity facilities with baseline MMSE and MMSE decline during follow-up, with adjustment for individual factors and neighborhood socioeconomic characteristics. Multilevel analyses revealed that there was a neighborhood-level effect on cognitive health among older adults. After adjusting for compositional and neighborhood socioeconomic characteristics, baseline MMSE was higher in individuals living in the middle- (beta = 0.12, p-value = 0.140) and high-density facility (beta = 0.22, p-value = 0.025) groups than in the low-density group (p-value for trend-test = 0.031). MMSE decline during follow-up was slower in the middle- (beta = 0.15, p-value = 0.114) and high-density facility (beta = 0.27, p-value = 0.052) groups than in the low-density group (p-value for trend-test = 0.032). Greater neighborhood availability of physical activity facilities was associated with better cognitive health among older residents. These findings have implications for designing communities and developing strategies to support cognitive health of an aging population.
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Affiliation(s)
- Hui-Wen Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Yun-Hsuan Wu
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Mei-Chen Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Shu-Fen Liao
- Department of Medical Research, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Fan
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK, USA; Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Yunlin branch, Douliu, Taiwan
| | - Shi-Heng Wang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
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Besser LM, Meyer OL, Streitz M, Farias ST, Olichney J, Mitsova D, Galvin JE. Perceptions of greenspace and social determinants of health across the life course: The Life Course Sociodemographics and Neighborhood Questionnaire (LSNEQ). Health Place 2023; 81:103008. [PMID: 37003018 PMCID: PMC10176197 DOI: 10.1016/j.healthplace.2023.103008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/06/2023] [Accepted: 03/10/2023] [Indexed: 04/03/2023]
Abstract
We developed the Life Course Sociodemographics and Neighborhood Questionnaire (LSNEQ) to query older adults about perceived neighborhood greenspaces across the life course (i.e., distance to park, number of neighborhood parks/playgrounds, and neighborhood greenness) and about characteristics hypothesized to confound or moderate/mediate greenspace-health associations. Six perceived life course indices are derived from the LSNEQ: neighborhood socioeconomic status, neighborhood walking/biking, urbanicity, neighborhood amenities, neighborhood park access, and neighborhood greenness. Older adults from St. Louis, Missouri, and Sacramento, California, completed the LSNEQ in 2020-2021. The indices demonstrated borderline acceptable to good internal consistency (alpha = 0.60-0.79) and good to excellent test-retest reliability (ICC = 0.71-0.96) and detected different patterns of park access and neighborhood greenness by racialized group and location. Individuals with index scores indicating more neighborhood walking/biking and greater presence of neighborhood amenities over their life course were more likely to report neighborhood-based walking in older age. Overall, the LSNEQ is a reliable instrument to assess perceptions of life course social determinants of health including neighborhood greenspaces.
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Affiliation(s)
- Lilah M Besser
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, 7700 W Camino Real, Suite 200, Boca Raton, FL, 33433, USA.
| | - Oanh L Meyer
- Department of Neurology, University of California, Davis, 4860 Y Street, Suite 3900, Sacramento, CA, 95817, USA.
| | - Marissa Streitz
- Department of Neurology, Washington University School of Medicine, 4488 Forest Park, Suite 101, Saint Louis, MO, 63108, USA.
| | - Sarah T Farias
- Department of Neurology, University of California, Davis, 4860 Y Street, Suite 3900, Sacramento, CA, 95817, USA.
| | - John Olichney
- Department of Neurology, University of California, Davis, 4860 Y Street, Suite 3900, Sacramento, CA, 95817, USA.
| | - Diana Mitsova
- Department of Urban and Regional Planning, Florida Atlantic University, 777 Glades Road, SO 284, Boca Raton, FL, 33431, USA.
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, 7700 W Camino Real, Suite 200, Boca Raton, FL, 33433, USA.
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Besser LM, Jimenez MP, Reimer CJ, Meyer OL, Mitsova D, George KM, Adkins-Jackson PB, Galvin JE. Diversity of Studies on Neighborhood Greenspace and Brain Health by Racialized/Ethnic Group and Geographic Region: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5666. [PMID: 37174185 PMCID: PMC10178609 DOI: 10.3390/ijerph20095666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
Studies examining associations between greenspace and Alzheimer's disease and related dementia (ADRD) outcomes are rapidly on the rise, yet no known literature reviews have summarized the racialized/ethnic group and geographic variation of those published studies. This is a significant gap given the known disparities in both greenspace access and ADRD risk between racialized/ethnic groups and between developed versus developing countries. In this rapid literature review, we (1) describe the diversity of published greenspace-brain health studies with respect to racialized/ethnic groups and geographic regions; (2) determine the extent to which published studies have investigated racialized/ethnic group differences in associations; and (3) review methodological issues surrounding studies of racialized/ethnic group disparities in greenspace and brain health associations. Of the 57 papers meeting our inclusion criteria as of 4 March 2022, 21% (n = 12) explicitly identified and included individuals who were Black, Hispanic/Latinx, and/or Asian. Twenty-one percent of studies (n = 12) were conducted in developing countries (e.g., China, Dominican Republic, Mexico), and 7% (n = 4) examined racialized/ethnic group differences in greenspace-brain health associations. None of the studies were framed by health disparities, social/structural determinants of health, or related frameworks, despite the known differences in both greenspace availability/quality and dementia risk by racialized/ethnic group and geography. Studies are needed in developing countries and that directly investigate racialized/ethnic group disparities in greenspace-brain health associations to target and promote health equity.
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Affiliation(s)
- Lilah M. Besser
- Comprehensive Center for Brain Health, Miller School of Medicine, University of Miami, Miami, FL 33433, USA
| | - Marcia Pescador Jimenez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118, USA
| | - Cameron J. Reimer
- Department of Earth & Environment, Boston University, Boston, MA 02118, USA
| | - Oanh L. Meyer
- Department of Neurology, School of Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Diana Mitsova
- School of Urban and Regional Planning, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Kristen M. George
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA 95817, USA
| | - Paris B. Adkins-Jackson
- Departments of Epidemiology and Sociomedical Sciences, Columbia University, New York, NY 10032, USA
| | - James E. Galvin
- Comprehensive Center for Brain Health, Miller School of Medicine, University of Miami, Miami, FL 33433, USA
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Yu W, Esposito M, Li M, Clarke P, Judd S, Finlay J. Neighborhood 'Disamenities': local barriers and cognitive function among Black and white aging adults. BMC Public Health 2023; 23:197. [PMID: 36717795 PMCID: PMC9885664 DOI: 10.1186/s12889-023-15026-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND This study examined the association between cognitive function and three neighborhood 'disamenities' that may pose local barriers to utilizing community resources and increase risk for cognitive decline. METHOD Using national data from 21,165 urban- and suburban-dwelling Black and white adults (mean age: 67 years) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we assessed global cognitive function through a factor score of five cognitive screening tests. General Additive Mixed Models (GAMM) tested whether residing in areas with more polluting sites, highways, and limited walkability was associated with worse cognitive function. RESULTS Limited walkability and the presence of polluting sites had a significant negative association with cognitive function after controlling for individual and neighborhood factors. CONCLUSION Neighborhood disamenities may be linked to cognitive function among aging residents. Identifying neighborhood factors that pose barriers to accessing community resources may inform upstream policy applications to reduce risk for cognitive decline.
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Affiliation(s)
- Wenshan Yu
- Program in Survey and Data Science, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA. .,Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan 426 Thompson Street, Ann Arbor, MI, United States, 48104.
| | - Michael Esposito
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan 426 Thompson Street, Ann Arbor, MI United States 48104 ,grid.4367.60000 0001 2355 7002Department of Sociology, Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Mao Li
- Program in Survey and Data Science, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104 USA ,Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan 426 Thompson Street, Ann Arbor, MI United States 48104
| | - Philippa Clarke
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan 426 Thompson Street, Ann Arbor, MI United States 48104 ,grid.214458.e0000000086837370Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Suzanne Judd
- grid.265892.20000000106344187School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35233 USA
| | - Jessica Finlay
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan 426 Thompson Street, Ann Arbor, MI United States 48104 ,grid.214458.e0000000086837370Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
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Finlay J, Esposito M, Langa KM, Judd S, Clarke P. Cognability: An Ecological Theory of neighborhoods and cognitive aging. Soc Sci Med 2022; 309:115220. [PMID: 35926362 PMCID: PMC9661364 DOI: 10.1016/j.socscimed.2022.115220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/19/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
While a growing body of evidence points to potentially modifiable individual risk factors for dementia, the built and social environments in which people develop and navigate cognitive decline are largely overlooked. This paper proposes a new theoretical concept, Cognability, to conceptualize how supportive an area is to cognitive health among aging residents. Cognability incorporates a constellation of both positive and negative neighborhood features related to physical activity, social interaction and cognitive stimulation in later life. We analyzed data from the REasons for Geographic And Racial Differences in Stroke Study, a national sample of older Black and white adults in the United States (n = 21,151; mean age at assessment = 67; data collected 2006-2017). Generalized additive multilevel models examined how cognitive function varied by neighborhood features. Access to civic and social organizations, recreation centers, fast-food and coffee establishments, arts centers, museums, and highways were significantly associated with cognitive function. Race-, gender-, and education-specific models did not yield substantial improvements to the full-model. Our results suggest that the unequal distribution of amenities and hazards across neighborhoods may help account for considerable inequities observed in cognitive health among older adults. Cognability advances ecological theories of aging through an innovative "whole neighborhood" approach. It aims to identify which specific neighborhood features are most protective of cognitive health among aging adults to inform upstream public health initiatives, community interventions, and policy.
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Affiliation(s)
- Jessica Finlay
- Social Environment and Health Program, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, United States; Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States.
| | - Michael Esposito
- Department of Sociology, Washington University in St. Louis, St. Louis, MO, 63130, United States
| | - Kenneth M Langa
- Department of Internal Medicine, Division of General Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, United States
| | - Suzanne Judd
- School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, United States
| | - Philippa Clarke
- Social Environment and Health Program, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, United States; Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States
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Besser LM, Lovasi GS, Michael YL, Garg P, Hirsch JA, Siscovick D, Hurvitz P, Biggs ML, Galvin JE, Bartz TM, Longstreth WT. Associations between neighborhood greenspace and brain imaging measures in non-demented older adults: the Cardiovascular Health Study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1575-1585. [PMID: 33388800 PMCID: PMC8253869 DOI: 10.1007/s00127-020-02000-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Greater neighborhood greenspace has been associated with brain health, including better cognition and lower odds of Alzheimer's disease in older adults. We investigated associations between neighborhood greenspace and brain-based magnetic resonance imaging (MRI) measures and potential effect modification by sex or apolipoprotein E genotype (APOE), a risk factor for Alzheimer's disease. METHODS We obtained a sample of non-demented participants 65 years or older (n = 1125) from the longitudinal, population-based Cardiovascular Health Study (CHS). Greenspace data were derived from the National Land Cover Dataset. Adjusted multivariable linear regression estimated associations between neighborhood greenspace five years prior to the MRI and left and right hippocampal volume and 10-point grades of ventricular size and burden of white matter hyperintensity. Interaction terms tested effect modification by APOE genotype and sex. CHS data (1989-1999) were obtained/analyzed in 2020. RESULTS Participants were on average 79 years old [standard deviation (SD) = 4], 58% were female, and 11% were non-white race. Mean neighborhood greenspace was 38% (SD = 28%). Greater proportion of greenspace in the neighborhood five years before MRI was borderline associated with lower ventricle grade (estimate: - 0.30; 95% confidence interval: - 0.61, 0.00). We observed no associations between greenspace and the other MRI outcome measures and no evidence of effect modification by APOE genotype and sex. CONCLUSION This study suggests a possible association between greater greenspace and less ventricular enlargement, a measure reflecting global brain atrophy. If confirmed in other longitudinal cohort studies, interventions and policies to improve community greenspaces may help to maintain brain health in older age.
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Affiliation(s)
- Lilah M Besser
- Institute for Human Health and Disease Intervention, Department of Urban and Regional Planning, Florida Atlantic University, 777 Glades Rd, SO-44, Room 284H, Boca Raton, FL, 33431, USA.
| | - Gina S Lovasi
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Yvonne L Michael
- Department of Epidemiology and Biostatistics, Dornslife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Parveen Garg
- Division of Cardiology, Keck School of Medicine, University of Southern California, 1510 San Pablo Street Suite #322, Los Angeles, CA, 90033, USA
| | - Jana A Hirsch
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - David Siscovick
- Division of Research, Evaluation, and Policy, The New York Academy of Medicine, New York, NY, 10029, USA
| | - Phil Hurvitz
- Center for Studies in Demography and Ecology and Urban Form Lab, University of Washington, Seattle, WA, 98195, USA
| | - Mary L Biggs
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, 98195-9775, USA
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Finlay J, Esposito M, Li M, Colabianchi N, Zhou H, Judd S, Clarke P. Neighborhood active aging infrastructure and cognitive function: A mixed-methods study of older Americans. Prev Med 2021; 150:106669. [PMID: 34087319 PMCID: PMC8316307 DOI: 10.1016/j.ypmed.2021.106669] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 01/22/2023]
Abstract
Physical exercise benefits cognitive functioning and can protect against neurodegeneration. Neighborhood environments may be pivotal to physically active aging, and thus help shape older adults' cognitive function. This mixed-methods study investigated where older adults exercised outside the home, and whether availability of these neighborhood sites was associated with cognitive function. We thematically analyzed qualitative data from semi-structured interviews in 2015 with 125 older adults (mean age = 71) in the Minneapolis (MN) metropolitan area. Results identified nearby public parks, fitness/sports amenities, and walkable destinations as motivators for recreational exercise and active transit among participants. These findings informed quantitative analysis of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national sample of older Black and white Americans (n = 21,151; mean age at assessment = 67; data collected 2006-2017). We used generalized additive multilevel models to examine whether neighborhood features that qualitative participants identified as encouraging physical activity were associated with elevated levels of cognitive function. Results indicated that residing in neighborhoods with greater availability of local parks, access to recreational amenities, and business density was associated with higher levels of cognitive function. We found no evidence to suggest a significant association between availability of these neighborhood resources and rate of cognitive decline. This study identifies specific neighborhood active aging infrastructure that may support cognitive function among older adults aging in place.
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Affiliation(s)
- Jessica Finlay
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104, United States; Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Michael Esposito
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104, United States; Department of Sociology, Washington University of St. Louis, St. Louis, MO 63130, United States
| | - Mao Li
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104, United States; Survey Methodology Program, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104, United States
| | - Natalie Colabianchi
- School of Kinesiology, University of Michigan, 1402 Washington Heights, Ann Arbor, MI 48109, United States
| | - Huajun Zhou
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104, United States; Biostatistics Program, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Suzanne Judd
- School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35233, United States
| | - Philippa Clarke
- Social Environment and Health, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104, United States; Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States
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Methods to Address Self-Selection and Reverse Causation in Studies of Neighborhood Environments and Brain Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126484. [PMID: 34208454 PMCID: PMC8296350 DOI: 10.3390/ijerph18126484] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/17/2022]
Abstract
Preliminary evidence suggests that neighborhood environments, such as socioeconomic disadvantage, pedestrian and physical activity infrastructure, and availability of neighborhood destinations (e.g., parks), may be associated with late-life cognitive functioning and risk of Alzheimer’s disease and related disorders (ADRD). The supposition is that these neighborhood characteristics are associated with factors such as mental health, environmental exposures, health behaviors, and social determinants of health that in turn promote or diminish cognitive reserve and resilience in later life. However, observed associations may be biased by self-selection or reverse causation, such as when individuals with better cognition move to denser neighborhoods because they prefer many destinations within walking distance of home, or when individuals with deteriorating health choose residences offering health services in neighborhoods in rural or suburban areas (e.g., assisted living). Research on neighborhood environments and ADRD has typically focused on late-life brain health outcomes, which makes it difficult to disentangle true associations from associations that result from reverse causality. In this paper, we review study designs and methods to help reduce bias due to reverse causality and self-selection, while drawing attention to the unique aspects of these approaches when conducting research on neighborhoods and brain aging.
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Besser L, Chang LC, Evenson KR, Hirsch J, Michael Y, Galvin JE, Rapp SR, Fitzpatrick AL, Heckbert SR, Kaufman JD, Hughes TM. Associations Between Neighborhood Park Access and Longitudinal Change in Cognition in Older Adults: The Multi-Ethnic Study of Atherosclerosis. J Alzheimers Dis 2021; 82:221-233. [PMID: 34024841 PMCID: PMC8579707 DOI: 10.3233/jad-210370] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preliminary evidence suggests associations between neighborhood park access and better late-life cognition and reduced Alzheimer's disease (AD) risk. OBJECTIVE Examine associations between neighborhood park access and longitudinal change in cognition among U.S. older adults without dementia. METHODS We used 2000-2018 observational data from the population-based, multi-site Multi-Ethnic Study of Atherosclerosis (n = 1,733). Measures included proportion of neighborhood park space (park access), distance to nearest park, and 6-year dichotomous and continuous change in scores on the Cognitive Abilities Screening Instrument (CASI; global cognition) and Digit Symbol Coding task (processing speed). Multivariable random intercept models tested main associations and mediation by depressive symptoms, physical activity, and PM2.5 exposure. Effect modification by race (African Americans/Blacks versus Whites) was tested using interaction terms. RESULTS Greater park access (equivalent to 10%more in 1/2-mile around home) was associated with maintained/improved CASI score over six years independent of several covariates including individual- and neighborhood-level socioeconomic status (Odds ratio: 1.04; 95%confidence interval: 1.00-1.08). No other associations were observed with the dichotomous or continuous measures of cognitive change and no mediators were found. While a borderline association was seen between greater park access and maintained/improved CASI for African Americans/Blacks but not for Whites, effect modification was not confirmed by testing interaction terms. CONCLUSION Neighborhood park access may help maintain/improve late-life global cognition. However, our findings need replication in other population-based studies and regions. Additionally, studies are needed to determine if associations between park access and change in cognition vary by race/ethnicity to inform intervention efforts.
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Affiliation(s)
- Lilah Besser
- Institute for Human Health and Disease Intervention (I-HEALTH), Department of Urban and Regional Planning, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431
| | - Lun-Ching Chang
- Department of Mathematical Sciences, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of NC-Chapel Hill, 123 W. Franklin St, Building C, Suite 410, Chapel Hill, NC 27599
| | - Jana Hirsch
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3600 Market St, Room 706, Philadelphia, PA 19104
| | - Yvonne Michael
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornslife School of Public Health, Drexel University, Nesbitt Hall, Room 552, 3215 Market Street, Philadelphia, PA 19104
| | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136
| | - Stephen R. Rapp
- Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, 791 Jonestown Road, Winston-Salem, NC 27103
| | - Annette L. Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, 4225 Roosevelt Way NW, Suite 308, Seattle, WA 98105
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, 1730 Minor Avenue, Suite 1360, Seattle, WA 98101
| | - Joel D. Kaufman
- Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98105
| | - Timothy M. Hughes
- Departments of Internal Medicine and Epidemiology and Prevention, Wake Forest School of Medicine, Med Center Blvd, Winston-Salem, NC 27104
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