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Magalhães AS, Andrade ACDS, Moreira BDS, Lopes AADS, Caiaffa WT. Physical and social neighborhood disorder in Latin American cities: a scoping review. CAD SAUDE PUBLICA 2023; 39:e00038423. [PMID: 37729304 PMCID: PMC10513154 DOI: 10.1590/0102-311xpt038423] [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: 02/28/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 09/22/2023] Open
Abstract
Neighborhood disorder is an important aspect that may influence the health of residents in urban areas. The aims of this study were to map and systematize methods for measuring physical and social neighborhood disorder in studies conducted in Latin American cities. By means of a scoping review, articles published from 2000 in English, Spanish, and Portuguese with the following descriptors were mapped: neighborhood, physical disorder, and social disorder. Searches were conducted in MEDLINE (PubMed), LILACS (Virtual Health Library), Scopus, Web of Science, and Cochrane Library. Information on authorship, year, study type, locality, data source, target population, outcome, dominion, indicator, method, geographic unit, and unit of analysis was extracted. Variables from the disorder-related studies were extracted and grouped by similarity of content and themes. A total of 22 articles were identified, all published between 2012 and 2022, the majority in Brazil (n = 16). The perception of the individual was the most used method. The most frequent theme addressed in the physical disorder dominion was public streets (n = 20) and security (n = 15), in the social disorder dominion. A lack of consensus in the literature regarding variables used to measure physical and social neighborhood disorder in Latin American cities was detected. In addition to the need for standardization of the theme, studies to verify the sustainability of proposed measurement methods relevant to dynamically classify and compare urban neighborhoods and health impacts based on levels of exposure to physical and social disorder, are recommended.
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Affiliation(s)
- Amanda Silva Magalhães
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Amanda Cristina de Souza Andrade
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Instituto de Saúde Coletiva, Universidade Federal de Mato Grosso, Cuiabá, Brasil
| | - Bruno de Souza Moreira
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Universidade Federal de Minas Gerais/Fundação Oswaldo Cruz, Belo Horizonte, Brasil
| | - Adalberto Aparecido Dos Santos Lopes
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
- Grupo de Estudos e Pesquisa em Ambiente Urbano & Saúde, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Motoc I, Hoogendijk EO, Timmermans EJ, Deeg D, Penninx BWJH, Huisman M. Social and physical neighbourhood characteristics and 10-year incidence of depression and anxiety in older adults: Results from the Longitudinal Aging Study Amsterdam. Soc Sci Med 2023; 327:115963. [PMID: 37207380 DOI: 10.1016/j.socscimed.2023.115963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE A growing literature suggests that neighbourhood characteristics are associated with mental health outcomes, but the evidence in older adults is inconsistent. We investigated the association of neighbourhood characteristics, pertaining to demographic, socio-economic, social and physical environment domains, with the subsequent 10-year incidence of depression and anxiety, in Dutch older adults. METHODS In the Longitudinal Aging Study Amsterdam depressive and anxiety symptoms were assessed four times between 2005/2006 and 2015/2016, using the Center for Epidemiological Studies Depression Scale (n = 1365) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (n = 1420). Neighbourhood-level data on urban density, percent population over 65 years of age, percent immigrants, average house price, average income, percent low-income earners, social security beneficiaries, social cohesion, safety, proximity to retail facilities, housing quality, percent green space, percent water coverage, air pollution (particulate matter (PM2.5)), and traffic noise, were obtained for study baseline years 2005/2006. Cox proportional hazard regression models, clustered within neighbourhood, were used to estimate the association between each neighbourhood-level characteristic and the incidence of depression and anxiety. RESULTS The incidence of depression and anxiety was 19.9 and 13.2 per 1000 person-years, respectively. Neighbourhood characteristics were not associated with the incidence of depression. However, various neighbourhood characteristics were associated with an increased incidence of anxiety, including: higher urban density level, higher percent immigrants, greater proximity to retail facilities, lower housing quality score, lower safety score, higher PM2.5 levels and less green space. CONCLUSION Our results indicate that several neighbourhood characteristics are associated with anxiety but not with depression incidence in older age. Several of these characteristics have the potential to be modifiable and thus could serve as a target for interventions at the neighbourhood-level in improving anxiety, provided that future studies replicate our findings and provide further evidence for a causal effect.
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Affiliation(s)
- Irina Motoc
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands.
| | - Emiel O Hoogendijk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands
| | - Erik J Timmermans
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dorly Deeg
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Martijn Huisman
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands; Department of Sociology, VU University, Amsterdam, the Netherlands
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Kleopa D, Panayiotou A, Kouta C, Kaiafa C, Middleton N. Profiling the variability and inequity in the residential environment in Cyprus according to citizens' ratings: a cross-sectional internet-based "Place Standard" survey. BMC Public Health 2022; 22:267. [PMID: 35139845 PMCID: PMC8830016 DOI: 10.1186/s12889-022-12706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The “Place Standard Tool” (PST) offers a practical framework for structuring conversations about physical and social dimensions of Place which impact on health and well-being. The aim of this study was to survey citizens’ perceptions of Place across diverse settings in Cyprus. While the PST has been extensively used in the context of community engagement, its properties as a measurement tool haven’t been explored. Methods An open call was addressed to citizens to rate their neighbourhood environment across the 14 PST items (1: large to 7: little room for improvement). Exploratory factor, cluster and regression analyses were used to explore the dimensionality of the scale, depict neighbourhood profiles and explore differences in ratings according to socio-demographic characteristics, area-level census indicators and residents’ assessment of neighbourhood social position (10-step ladder). Results With the exception of safety (M = 4.4, SD = 1.7), 492 participants (mean age 42, 50% residents for > 10 years) from 254 postcodes (21.7% islandwide) did not rate other features favourably, with lowest scores for “influence and sense of control” and “public transport”. A stepwise pattern of dissatisfaction was observed along the social position continuum both for features rated less as well as more favourably (e.g. social contact). For instance, among participants who placed their neighbourhood at the three top steps of the ladder, 48.8% gave a low rating for “influence and sense of control”, while the equivalent figure was 81.0% at the bottom three steps (OR = 4.5, 95% CI 2.3, 8.6). A clear dimensionality of Built (6 items, Cronbach’s α = 0.798), Physical (3 items, α = 0.765), Social (2 items, α = 0.749) and Service (3 items, α = 0.58) environment was identified. A social gradient was evident according to census measures of socio-economic disadvantage (e.g. pre-1980 housing, single-parent households) with larger differences in terms of the built than the social environment. Conclusions The study profiled the variability and documented the inequity in the health-related neighbourhood environment across Cypriot communities. The readily interpretable dimensionality of the scale supports its construct validity, allowing calculation of composite scores. The PST can be used as measurement tool in research as well as public health practice to advocate for neighbourhood initiatives which support and enhance citizens’ participation. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12706-y.
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Affiliation(s)
- Daphne Kleopa
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.,Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andrie Panayiotou
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Christiana Kouta
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Chrystalla Kaiafa
- WHO Healthy Cities Cyprus Network Coordinating Office, Cyprus Ministry of Health, Nicosia, Cyprus
| | - Nicos Middleton
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
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Shin JH, Dennis S, Mohammed H. Mental Health Outcome Measures in Environmental Design Research: A Critical Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:331-357. [PMID: 33942674 DOI: 10.1177/1937586721999787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM During the last several decades, researchers have produced abundant evidence of the environmental impacts on stress, attention, and physical activity. More recently, scholars have turned their focus to the influence environments have on mental wellness. Therefore, a critical review of this more recent research is both timely and crucial for setting the future research agenda. METHODS In this article, we examined 65 papers published between 2008 and 2019 that examined the environmental correlates of a wide variety of mental health outcomes. We coded each study by type of environment, research design, mental health measurement scale used, and p-value. RESULTS We categorized the research studies into six groups based on mental health outcomes: emotions, moods, vitality, executive function, stress, and general well-being. Our review revealed several trends among the studies, including a heavy focus on nature and outdoor environments with little attention to workplace or residential environments; a lack of consensus on how to operationalize the environment; a heavy reliance on self-reported ratings using a wide variety of scales, many focused on the same outcome; and a disproportionate focus on short-term health effects. CONCLUSIONS There is a need for greater consensus on research constructs and health outcome measurements, focused on a wider variety of environmental settings and scales, in order to better inform evidence-based environmental design practice.
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Affiliation(s)
- Jung-Hye Shin
- Department of Design Studies, 5228University of Wisconsin, Madison, WI, USA
| | - Samuel Dennis
- Department of Planning and Landscape Architecture, 5228University of Wisconsin, Madison, WI, USA
| | - Hassnaa Mohammed
- Department of Design Studies, 5228University of Wisconsin, Madison, WI, USA
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Daoud N, Alfayumi-Zeadna S, Tur-Sinai A, Geraisy N, Talmud I. Residential segregation, neighborhood violence and disorder, and inequalities in anxiety among Jewish and Palestinian-Arab perinatal women in Israel. Int J Equity Health 2020; 19:218. [PMID: 33298060 PMCID: PMC7726910 DOI: 10.1186/s12939-020-01339-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/30/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Residential segregation can foster health inequality mechanisms by increasing stress related to neighborhood violence and disorder. AIMS We studied the association between neighborhood violence and disorder and inequalities in anxiety between two groups of perinatal Israeli women (Jewish, Palestinian-Arab) living in ethno-nationally segregated neighborhoods, and explored the influence of neighborhood characteristics; social support and chronic stress to this inequality. METHODS We linked survey data on neighborhood violence and disorder, neighborhood social characteristics (collective efficacy, social capital and social support) and aggregate discrimination to neighborhood SES census data. The survey data was obtained from the "Family Relations, Violence and Health" study (2014-2015) and included a stratified national sample of women (Palestinian-Arab = 436, Jewish = 965) residing in 63 segregated neighborhoods. We conducted multi-variable logistic regression analysis for anxiety (measured based on State-trait Anxiety Inventory) using generalized estimating equation (GEE) to estimate odds ratios of the association with neighborhood violence and disorder (total score for 10 problems) while considering neighborhood characteristics (SES; social characteristics; aggregate discrimination), social support and chronic stress in different models for the total sample, and separately for Palestinian-Arab and Jewish women. RESULTS Palestinian-Arab women had higher anxiety (60.5% vs. 42.1%, respectively) and higher severity of neighborhood violence and disorder (49.5% vs. 16.2%, respectively) compared to Jewish women. After considering individual and neighborhood variables, adjusted odds ratio (AOR) and 95% confidence intervals (CI) = 1.63, 1.04-2.56. The association between neighborhood violence and disorder and anxiety was significant for low vs. no problems in the final model for the total sample (AOR, 95%CI = 1.28, 1.00-1.64). Similarly, significant association was found only for low severity vs. no problems for Jewish women (1.40, 1.07-1.86). While among Palestinian-Arab women the association between neighborhood violence and disorder and anxiety rendered insignificant in the final model. Neighborhood social cohesion and social support were protective factors from anxiety in both groups, high neighborhood SES was protective factor only among Jewish women, and neighborhood aggregate discrimination was a risk factor only in Palestinian-Arab women. CONCLUSIONS Inequalities in anxiety related to neighborhood violence and disorder in ethno-national perinatal groups of women likely reflect residential segregation. Policies entrenching segregation might have affected neighborhood mechanisms (SES inequalities, aggregate discrimination and low social cohesion) that lead to higher stress and ethno-national inequalities in anxiety among perinatal women.
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Affiliation(s)
- Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel.
| | - Samira Alfayumi-Zeadna
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Nabil Geraisy
- Department of Psychiatry, EMMS Nazareth Hospital, Nazareth, Israel
| | - Ilan Talmud
- Department of Sociology, University of Haifa, Haifa, Israel
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Vaz C, Andrade AC, Silva U, Rodríguez D, Wang X, Moore K, Friche AA, Diez-Roux AV, Caiaffa WT. Physical Disorders and Poor Self-Rated Health in Adults Living in Four Latin American Cities: A Multilevel Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238956. [PMID: 33276424 PMCID: PMC7730272 DOI: 10.3390/ijerph17238956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022]
Abstract
Considering that urban environments may affect self-rated health through behavioral and psychosocial mechanisms, the aim of this study was to investigate the association between self-rated health and perceived urban environment characteristics among adults living in four Latin American cities. Data is from a population-based survey by Development Bank of Latin America, encompassing adults between 20 and 60 years old in Buenos Aires, Lima, Mexico City, and Panama City. Self-rated health was measured using a single question and the response options were categorized as poor and good. The explanatory variables were empirical Bayes estimates of self-reported area physical disorder, social disorder, access to services, and access to leisure spaces derived from the survey. The covariates were: individual age, sex, education, wealth index, and length of residency in the neighborhood; and an area social environment index. Multilevel logistic regressions with two levels (individual and sub-city areas) were fitted. Poor self-rated health was reported by 34.73% (95% CI: 33.17 to 36.29) of the participants and was associated with physical disorder (OR = 1.16 per SD; 95% CI: 1.02 to 1.32). Our findings suggest that public policies to promote population health should consider area urban environment factors, especially those associated with disorder.
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Affiliation(s)
- Camila Vaz
- Department of Physical Therapy, Federal University of Juiz de Fora, Rua São Paulo 745, Governador Valadares 35010-180, Brazil
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte 30130-100, Brazil; (A.C.A.); (U.S.); (A.A.F.); (W.T.C.)
- Correspondence: ; Tel.: +55-(31)99701-5146
| | - Amanda Cristina Andrade
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte 30130-100, Brazil; (A.C.A.); (U.S.); (A.A.F.); (W.T.C.)
- Institute of Public Health, Federal University of Mato Grosso, Avenida Fernando Corrêa 2367, Cuiabá 78060-900, Brazil
| | - Uriel Silva
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte 30130-100, Brazil; (A.C.A.); (U.S.); (A.A.F.); (W.T.C.)
| | - Daniel Rodríguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, 228 Wurster Hall, Berkeley, CA 94720, USA;
| | - Xize Wang
- Department of Real State, National University of Singapore, 4 Architecture Drive, Singapore 117566, Singapore;
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA; (K.M.); (A.V.D.-R.)
| | - Amélia Augusta Friche
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte 30130-100, Brazil; (A.C.A.); (U.S.); (A.A.F.); (W.T.C.)
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte 30130-100, Brazil
| | - Ana Victoria Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA 19104, USA; (K.M.); (A.V.D.-R.)
| | - Waleska Teixeira Caiaffa
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte 30130-100, Brazil; (A.C.A.); (U.S.); (A.A.F.); (W.T.C.)
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte 30130-100, Brazil
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Pérez E, Braën C, Boyer G, Mercille G, Rehany É, Deslauriers V, Bilodeau A, Potvin L. Neighbourhood community life and health: A systematic review of reviews. Health Place 2020; 61:102238. [PMID: 31735517 DOI: 10.1016/j.healthplace.2019.102238] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/17/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022]
Abstract
Neighbourhood community life has been widely recognized as an important determinant of population health. This systematic review of reviews provides an overview of the evidence for the ecological correlation between neighbourhood community life and population health. Nine databases were searched from 2008 to 2018 in order to identify systematic reviews of studies examining the association between neighbourhood community life and population health in urban neighbourhoods within the Organisation for Economic Co-operation and Development countries. Two reviewers completed selection and data extraction, then assessed the methodological quality of reviews using the Measurement Tool to Assess Systematic Reviews. We identified three high quality reviews and five of moderate quality. The reviews vary in quality of methodology, concepts, and measures. Most of the reviews examined the influence of social cohesion, social capital, and social interactions on health. Reviews found evidence supporting a consistently favourable correlation between social cohesion and physical activity, as well as a favourable trend in the relationship between social cohesion and healthy weight. They also found evidence of a favourable trend in the correlation between social capital and healthy weight. Reviews identified studies supporting a consistently favourable correlation between social interaction and depression. We identify evidence of a positive association between neighbourhood community life and several population health outcomes. Future research should define and conceptualize neighbourhood community life factors and health indicators to improve the comparison between studies and the process of evidence synthesis. This will also enable policy makers to take appropriate decisions.
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Affiliation(s)
- Elsury Pérez
- École de santé publique de l'Université de Montréal, Canada.
| | - Caroline Braën
- École de santé publique de l'Université de Montréal, Canada
| | - Ginette Boyer
- Chaire de recherche du Canada Approches communautaires et inégalités de santé (CACIS), Canada
| | | | - Émilie Rehany
- Centre de recherche Léa-Roback sur les inégalités sociales de santé de Montréal, Canada
| | | | | | - Louise Potvin
- École de santé publique de l'Université de Montréal and Director, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), Canada
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Crawford ND, Haardöerfer R, Cooper H, McKinnon I, Jones-Harrell C, Ballard A, von Hellens SS, Young A. Characterizing the Rural Opioid Use Environment in Kentucky Using Google Earth: Virtual Audit. J Med Internet Res 2019; 21:e14923. [PMID: 31588903 PMCID: PMC6800460 DOI: 10.2196/14923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/25/2022] Open
Abstract
Background The opioid epidemic has ravaged rural communities in the United States. Despite extensive literature relating the physical environment to substance use in urban areas, little is known about the role of physical environment on the opioid epidemic in rural areas. Objective This study aimed to examine the reliability of Google Earth to collect data on the physical environment related to substance use in rural areas. Methods Systematic virtual audits were performed in 5 rural Kentucky counties using Google Earth between 2017 and 2018 to capture land use, health care facilities, entertainment venues, and businesses. In-person audits were performed for a subset of the census blocks. Results We captured 533 features, most of which were images taken before 2015 (71.8%, 383/533). Reliability between the virtual audits and the gold standard was high for health care facilities (>83%), entertainment venues (>95%), and businesses (>61%) but was poor for land use features (>18%). Reliability between the virtual audit and in-person audit was high for health care facilities (83%) and entertainment venues (62%) but was poor for land use (0%) and businesses (12.5%). Conclusions Poor reliability for land use features may reflect difficulty characterizing features that require judgment or natural changes in the environment that are not reflective of the Google Earth imagery because it was captured several years before the audit was performed. Virtual Google Earth audits were an efficient way to collect rich neighborhood data that are generally not available from other sources. However, these audits should use caution when the images in the observation area are dated.
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Affiliation(s)
- Natalie Danielle Crawford
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Regine Haardöerfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Hannah Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Izraelle McKinnon
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Carla Jones-Harrell
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - April Ballard
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - April Young
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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de Souza Andrade AC, Mingoti SA, da Silva Costa DA, Xavier CC, Proietti FA, Caiaffa WT. Built and Social Environment by Systematic Social Observation and Leisure-Time Physical Activity Report among Brazilian Adults: a Population-Based Study. J Urban Health 2019; 96:682-691. [PMID: 31399814 PMCID: PMC6814682 DOI: 10.1007/s11524-019-00381-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to investigate the relationship between built and social environment and leisure-time physical activity (LTPA) among adults living in an urban center. The individual data was from the household survey and the environmental data was assessed through systematic social observation by trained observers on street segments of respondents' residences. The relationship between environmental factors and LTPA was examined using multilevel logistic regression. The prevalence of LTPA was 30.2% (95% CI 27.4-32.9%). Individuals living in census tracts with higher walking environment indicators (OR = 1.20; 95% CI 1.02 to 1.40) and safety (OR = 1.18; 95% CI 1.01 to 1.38) were more likely to be active during leisure time, even after adjusting for individual variables. Improving the built and social environment is an important step for achieving higher levels of LTPA in the population in a middle-income country.
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Affiliation(s)
- Amanda Cristina de Souza Andrade
- Observatory for Urban Health in Belo Horizonte (OSUBH), School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. .,Department of Public Health, Federal University of Mato Grosso, Avenida Fernando Corrêa, 2367, Cuiabá, Mato Grosso, 78060-900, Brazil.
| | - Sueli Aparecida Mingoti
- Department of Statistics, Institute of Exact Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Dário Alves da Silva Costa
- Observatory for Urban Health in Belo Horizonte (OSUBH), School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - César Coelho Xavier
- Faculty of Health and Human Ecology, Federal University of Minas Gerais, Minas Gerais, Brazil
| | | | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte (OSUBH), School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Hanibuchi T, Nakaya T, Inoue S. Virtual audits of streetscapes by crowdworkers. Health Place 2019; 59:102203. [PMID: 31521005 DOI: 10.1016/j.healthplace.2019.102203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/19/2019] [Accepted: 09/05/2019] [Indexed: 11/19/2022]
Abstract
Audits have been used to provide objective ratings of neighborhood environments. Physical audits, however, are time- and resource-intensive. This study examines the efficiency and reliability of virtual auditing using Google Street View and crowdsourcing to conduct walkability audits of streets in Japan. Overall, 830 street segments were physically and virtually audited by two trained auditors; 300 untrained crowdworkers also virtually audited 3 street segments. Statistical analysis found good inter-source and inter-rater reliability. This study helps establish crowdsourced virtual auditing as a valuable method of measuring neighborhood walkability, reducing audit costs as well as enabling large-scale auditor recruitment while maintaining reliability.
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Affiliation(s)
- Tomoya Hanibuchi
- School of International Liberal Studies, Chukyo University, 101-2 Yagoto-honmachi, Showa-ku, Nagoya, 466-8666, Japan; Department of Geography, Portland State University, Portland, OR, USA.
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
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11
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Using street view data and machine learning to assess how perception of neighborhood safety influences urban residents' mental health. Health Place 2019; 59:102186. [PMID: 31400645 DOI: 10.1016/j.healthplace.2019.102186] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
Abstract
Previous studies have shown that perceptions of neighborhood safety are associated with various mental health outcomes. However, scant attention has been paid to the mediating pathways by which perception of neighborhood safety affects mental health. In addition, most previous studies have evaluated perception of neighborhood safety with questionnaires or field audits, both of which are labor-intensive and time-consuming. This study is the first attempt to measure perception of neighborhood safety using street view data and a machine learning approach. Four potential mediating pathways linking perception of neighborhood safety to mental health were explored for 1029 participants from 35 neighborhoods of Guangzhou, China. The results of multilevel regression models confirm that perception of neighborhood safety is positively associated with mental health. More importantly, physical activity, social cohesion, stress and life satisfaction mediate this relationship. The results of a moderation analysis suggest that the beneficial effects of physical activity and social cohesion on mental health are strengthened by a perception of neighborhood safety. Our findings suggest the need to increase residents' perception of neighborhood safety to maintain mental health in urban areas of China.
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Remigio RV, Zulaika G, Rabello RS, Bryan J, Sheehan DM, Galea S, Carvalho MS, Rundle A, Lovasi GS. A Local View of Informal Urban Environments: a Mobile Phone-Based Neighborhood Audit of Street-Level Factors in a Brazilian Informal Community. J Urban Health 2019; 96:537-548. [PMID: 30887375 PMCID: PMC6890882 DOI: 10.1007/s11524-019-00351-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Street-level environment characteristics influence the health behaviors and safety of urban residents, and may particularly threaten health within informal communities. However, available data on how such characteristics vary within and among informal communities is limited. We sought to adapt street audit strategies designed to characterize the physical environment for use in a large informal community, Rio das Pedras (RdP) located in Rio de Janeiro, Brazil. A smartphone-based systematic observation protocol was used to gather street-level information for a high-density convenience sample of street segments (N = 630, estimated as 86% of all street segments in the community). We adapted items related to physical disorder and physical deterioration. Measures selected to illustrate the approach include the presence of the following: (1) low-hanging or tangled wires, (2) litter, (3) structural evidence of sinking, and (4) an unpleasant odor. Intercept-only spatial generalized additive models (GAM) were used to evaluate and visualize spatial variation within the RdP community. We also examined how our estimates and conclusions about spatial variation might have been affected by lower-density sampling from random subsets street observations. Random subsets were selected to determine the robustness of study results in scenarios with sparser street sampling. Selected characteristics were estimated to be present for between 18% (unpleasant odor) to 59% (low-hanging or tangled wires) of the street segments in RdP; estimates remain similar (± 6%) when relying on a random subset created to simulate lower-density spatial sampling. Spatial patterns of variation based on predicted probabilities across RdP differed by indicator. Structural sinking and low-hanging or tangled wires demonstrated relatively consistent spatial distribution patterns across full and random subset sample sizes. Smartphone-based systematic observations represent an efficient and potentially feasible approach to systematically studying neighborhood environments within informal communities. Future deployment of such tools will benefit from incorporating data collection across multiple time points to explore reliability and quantify neighborhood change. These tools can prove useful means to assess street-level exposures that can be modifiable health determinants across a wide range of informal urban settings. Findings can contribute to improved urban planning and provide useful information for identifying potential locations for neighborhood-scaled interventions that can improve living conditions for residents in Rio das Pedras.
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Affiliation(s)
- Richard V Remigio
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA. .,Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland-College Park, College Park, MD, USA.
| | - Garazi Zulaika
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Renata S Rabello
- Escola Nacional de Saúde Publica (ENSP)/Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - John Bryan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Daniel M Sheehan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Marilia S Carvalho
- Programa de Computação Científica (PROCC), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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13
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Wang R, Liu Y, Lu Y, Yuan Y, Zhang J, Liu P, Yao Y. The linkage between the perception of neighbourhood and physical activity in Guangzhou, China: using street view imagery with deep learning techniques. Int J Health Geogr 2019; 18:18. [PMID: 31345233 PMCID: PMC6659285 DOI: 10.1186/s12942-019-0182-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/19/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Neighbourhood environment characteristics have been found to be associated with residents' willingness to conduct physical activity (PA). Traditional methods to assess perceived neighbourhood environment characteristics are often subjective, costly, and time-consuming, and can be applied only on a small scale. Recent developments in deep learning algorithms and the recent availability of street view images enable researchers to assess multiple aspects of neighbourhood environment perceptions more efficiently on a large scale. This study aims to examine the relationship between each of six neighbourhood environment perceptual indicators-namely, wealthy, safe, lively, depressing, boring and beautiful-and residents' time spent on PA in Guangzhou, China. METHODS A human-machine adversarial scoring system was developed to predict perceptions of neighbourhood environments based on Tencent Street View imagery and deep learning techniques. Image segmentation was conducted using a fully convolutional neural network (FCN-8s) and annotated ADE20k data. A human-machine adversarial scoring system was constructed based on a random forest model and image ratings by 30 volunteers. Multilevel linear regressions were used to examine the association between each of the six indicators and time spent on PA among 808 residents living in 35 neighbourhoods. RESULTS Total PA time was positively associated with the scores for "safe" [Coef. = 1.495, SE = 0.558], "lively" [1.635, 0.789] and "beautiful" [1.009, 0.404]. It was negatively associated with the scores for "depressing" [- 1.232, 0.588] and "boring" [- 1.227, 0.603]. No significant linkage was found between total PA time and the "wealthy" score. PA was further categorised into three intensity levels. More neighbourhood perceptual indicators were associated with higher intensity PA. The scores for "safe" and "depressing" were significantly related to all three intensity levels of PA. CONCLUSIONS People living in perceived safe, lively and beautiful neighbourhoods were more likely to engage in PA, and people living in perceived boring and depressing neighbourhoods were less likely to engage in PA. Additionally, the relationship between neighbourhood perception and PA varies across different PA intensity levels. A combination of Tencent Street View imagery and deep learning techniques provides an accurate tool to automatically assess neighbourhood environment exposure for Chinese large cities.
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Affiliation(s)
- Ruoyu Wang
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
- Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
| | - Ye Liu
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
- Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, SAR China
| | - Yuan Yuan
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
- Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
| | - Jinbao Zhang
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
- Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
| | - Penghua Liu
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
- Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275 China
| | - Yao Yao
- School of Geography and Information Engineering, China University of Geosciences, Wuhan, 430074 China
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Jivraj S, Norman P, Nicholas O, Murray ET. Are there sensitive neighbourhood effect periods during the life course on midlife health and wellbeing? Health Place 2019; 57:147-156. [PMID: 31051326 DOI: 10.1016/j.healthplace.2019.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 11/25/2022]
Abstract
Since the turn of the century there has been an explosion in the number of epidemiological studies that have analysed neighbourhood effects on health and wellbeing. The vast majority of these studies are cross-sectional in nature and assume that a contemporaneous place of residence captures a meaningful neighbourhood effect. Over the same time frame, social epidemiology has focussed increasingly on life course effects. This paper aims to bring these two areas of study together and tests whether there a certain ages during the life course when neighbourhoods are more important for our health and wellbeing than others. We use two British birth cohort studies (1958 National Child Development Study and British Cohort Study 1970) each comprising approximately 6,000 sample members at midlife linked to historic census measures used to derived Townsend neighbourhood deprivation scores over the life course. We find little evidence to support our hypothesis that adolescence is a key period of neighbourhood effect, rather we find late-early-adulthood neighbourhood deprivation and midlife neighbourhood deprivation are more strongly related to mid-life health and wellbeing. We are not able to conclude whether these effects are causal and encourage further investigation of selection mechanisms into neighbourhoods and mediation throughout the life course using our newly created dataset.
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Affiliation(s)
- Stephen Jivraj
- UCL Institute of Epidemiology and Health Care, London, UK.
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | | | - Emily T Murray
- UCL Institute of Epidemiology and Health Care, London, UK
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15
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Ussery EN, Omura JD, Paul P, Orr J, Spoon C, Geremia C, Carlson SA. Sampling Methodology and Reliability of a Representative Walkability Audit. JOURNAL OF TRANSPORT & HEALTH 2019; 12:75-85. [PMID: 37179540 PMCID: PMC10174213 DOI: 10.1016/j.jth.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background Physical inactivity is a public health concern in the US Virgin Islands (USVI). A contributing factor may be a lack of pedestrian infrastructure and other environmental supports for walking. In this manuscript, we describe the methods used to conduct a walkability audit of environmental features related to physical activity in the USVI. Methods In 2016, volunteer auditors conducted the audit using a modified version of the Microscale Audit of Pedestrian Streetscapes tool. A two-stage sampling method was developed using publicly available census data to select a sample of estates (n=46) and street segments (n=1,550; 99.2 km) across the USVI. A subset of segments was audited by two independent auditors, and inter-rater reliability was assessed using Cohen's kappa and percent agreement. Results Audits were completed on 1,114 segments (94.6 km), and estimates were weighted to represent accessible public street length in the study area (1,155.9 km). Most items on the audit tool (62.7%) demonstrated good to excellent reliability. We found that it was feasible to conduct a reliable audit of environmental features related to physical activity across a large sample of streets in the USVI. Conclusions These methods can be replicated in other settings to collect comprehensive data that can be used to guide strategies to improve the walkability of communities.
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Affiliation(s)
- Emily N Ussery
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology, and Laboratory Services, Atlanta, Georgia
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Physical Activity and Health Branch, Atlanta, Georgia
| | - John D Omura
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology, and Laboratory Services, Atlanta, Georgia
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Physical Activity and Health Branch, Atlanta, Georgia
| | - Prabasaj Paul
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Physical Activity and Health Branch, Atlanta, Georgia
| | - John Orr
- US Virgin Islands Department of Health, Christiansted, St. Croix, US Virgin Islands
| | - Chad Spoon
- University of California at San Diego, Active Living Research, San Diego, California
| | - Carrie Geremia
- University of California at San Diego, Department of Family and Preventive Medicine, San Diego, California
| | - Susan A Carlson
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Physical Activity and Health Branch, Atlanta, Georgia
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16
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The role of individual characteristics and municipalities in social inequalities in perceived health (Italy, 2010–2012): a multilevel study. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-018-0933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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17
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Hofland ACL, Devilee J, van Kempen E, den Broeder L. Resident participation in neighbourhood audit tools - a scoping review. Eur J Public Health 2019; 28:23-29. [PMID: 29346663 PMCID: PMC5881759 DOI: 10.1093/eurpub/ckx075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Healthy urban environments require careful planning and a testing of environmental quality that goes beyond statutory requirements. Moreover, it requires the inclusion of resident views, perceptions and experiences that help deepen the understanding of local (public health) problems. To facilitate this, neighbourhoods should be mapped in a way that is relevant to them. One way to do this is participative neighbourhood auditing. This paper provides an insight into availability and characteristics of participatory neighbourhood audit instruments. Methods A scoping review in scientific and grey literature, consisting of the following steps: literature search, identification and selection of relevant audit instruments, data extraction and data charting (including a work meeting to discuss outputs), reporting. Results In total, 13 participatory instruments were identified. The role of residents in most instruments was as 'data collectors'; only few instruments included residents in other audit activities like problem definition or analysis of data. The instruments identified focus mainly on physical, not social, neighbourhood characteristics. Paper forms containing closed-ended questions or scales were the most often applied registration method. Conclusions The results show that neighbourhood auditing could be improved by including social aspects in the audit tools. They also show that the role of residents in neighbourhood auditing is limited; however, little is known about how their engagement takes place in practice. Developers of new instruments need to balance not only social and physical aspects, but also resident engagement and scientific robustness. Technologies like mobile applications pose new opportunities for participative approaches in neighbourhood auditing.
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Affiliation(s)
- Aafke C L Hofland
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jeroen Devilee
- National Institute for Public Health and the Environment (RIVM), Center for Sustainability and Health, Bilthoven, The Netherlands and
| | - Elise van Kempen
- National Institute for Public Health and the Environment (RIVM), Center for Sustainability and Health, Bilthoven, The Netherlands and
| | - Lea den Broeder
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands
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18
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Reboussin BA, Johnson RM, Green KM, Debra M Furr-Holden C, Ialongo NS, Milam AJ. Neighborhood context and transitions in marijuana use among urban young adults. Subst Use Misuse 2019; 54:1075-1085. [PMID: 30849926 PMCID: PMC6483858 DOI: 10.1080/10826084.2018.1528461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In emerging adulthood when many youth are maturing out of marijuana use, Blacks continue to have high rates of use and disorder. Theory suggests that factors tied to neighborhood disadvantage may partially explain this phenomenon but research is limited. OBJECTIVES This study examines the influence of neighborhood physical and social disorder on transitions in marijuana use during emerging adulthood in a low-income urban sample. METHODS 379 primarily Black young adults residing in low-income neighborhoods in Baltimore City were followed-up annually from ages 18 to 21. Neighborhood environment was evaluated using a valid and reliable field-rater assessment of the residential block. Longitudinal latent class and latent transition analyses were performed. RESULTS Fit indices supported three-classes of marijuana use: no use, infrequent use and frequent use. Between ages 18 and 21, young adults tended to transition toward lower levels of use. However, neighborhood physical disorder was associated with transitioning to increased marijuana use (no use to frequent use; AOR = 2.712; p = .023) while positive neighborhood social activity was associated with a decreased risk (AOR = 0.002; p = .013). Neighborhood social activity was also associated with decreases in use (frequent to infrequent use; AOR = 2.342; p = .020). Conclusions/Importance: These findings demonstrate that physical disorder within the context of a low-income urban neighborhood adversely impacts marijuana use. However, even in the presence of physical disorder, interventions that foster collective efficacy among residents through positive social activity may prevent initiation and progression of marijuana use.
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Affiliation(s)
- Beth A Reboussin
- a Wake Forest School of Medicine , Winston-Salem , North Carolina, USA
| | - Renee M Johnson
- b Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland, USA
| | - Kerry M Green
- c University of Maryland , College Park, Maryland, USA
| | | | - Nicholas S Ialongo
- b Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland, USA
| | - Adam J Milam
- b Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland, USA
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19
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de Almeida Célio F, Friche AADL, Jennings MZ, Andrade ACDS, Xavier CC, Proietti F, Coulton CJ, Caiaffa WT. Contextual characteristics associated with the perceived neighbourhood scale in a cross-sectional study in a large urban centre in Brazil. BMJ Open 2018; 8:e021445. [PMID: 30127050 PMCID: PMC6104762 DOI: 10.1136/bmjopen-2017-021445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Health outcomes have been associated with physical and social characteristics of neighbourhoods, but little is known about the relationship between contextual factors and perceived neighbourhood scale. OBJECTIVE To identify the contextual factors associated with self-perceived neighbourhood scale. METHODS We analysed data from a cross-sectional population-based study in Belo Horizonte, Brazil, that took place in 2008-2009. The dependent variable was perceived neighbourhood, encoded as an ordinal scale based on a brief description of the concept of the neighbourhood, and two independent scales relating distance, expressed in terms of geography and time. Street connectivity, demographic density and residents' perceptions of the neighbourhoods' physical and social environment were used as contextual predictors. Individual characteristics were used as covariates. Multilevel ordinal logistic regression models estimated the association between perceived neighbourhood scale and contextual characteristics. RESULTS Residents that perceive better walkability (OR 2.96; 95% CI 1.29 to 3.82) and high amounts of violence (OR 1.35; 95% CI 1.12 to 1.62) perceived their neighbourhoods to be larger, even after adjusting for individual characteristics. CONCLUSION There are contextual factors that are associated with self-perceived neighbourhood scale. Careful definition of neighbourhood scale is a key factor in improving the results of eco-epidemiological studies. Although these findings must be further explored in other studies, these results can contribute to a better understanding of an appropriate choice of neighbourhood scale, especially for cities in Latin America.
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Affiliation(s)
- Fabiano de Almeida Célio
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Amélia Augusta de Lima Friche
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M Zane Jennings
- School of Applied Social Sciences, Case Western Reserve University Jack Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, Ohio, USA
| | | | | | - Fernando Proietti
- Faculdade de Saúde e Ecologia Humana, Vespasiano, Brazil
- Epidemiology, Centro de Pesquisas René Rachou, Belo Horizonte, Minas Gerais, Brazil
| | - Claudia J Coulton
- School of Applied Social Sciences, Case Western Reserve University Jack Joseph and Morton Mandel School of Applied Social Sciences, Cleveland, Ohio, USA
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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20
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Landscape care of urban vacant properties and implications for health and safety: Lessons from photovoice. Health Place 2017; 46:219-228. [PMID: 28570993 DOI: 10.1016/j.healthplace.2017.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 11/21/2022]
Abstract
Care of vacant properties in urban environments is of particular interest to planners and residents alike. We report on a photovoice project completed by community leaders, researchers, and residents in two Detroit neighborhoods experiencing longtime systemic disinvestment. Participants photographed and discussed examples of care in a series of three focus groups in each neighborhood. Analyses highlight how acts of landscape care and visible cues to care contribute to changes in physical and social environments, and explore various links to health. We suggest theoretical and practical applications of residents' perspectives on landscape care and identify implications for well-being and neighborhood stability.
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Mirowsky JE, Devlin RB, Diaz-Sanchez D, Cascio W, Grabich SC, Haynes C, Blach C, Hauser ER, Shah S, Kraus W, Olden K, Neas L. A novel approach for measuring residential socioeconomic factors associated with cardiovascular and metabolic health. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:281-289. [PMID: 27649842 PMCID: PMC5373927 DOI: 10.1038/jes.2016.53] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/18/2016] [Indexed: 05/22/2023]
Abstract
Individual-level characteristics, including socioeconomic status, have been associated with poor metabolic and cardiovascular health; however, residential area-level characteristics may also independently contribute to health status. In the current study, we used hierarchical clustering to aggregate 444 US Census block groups in Durham, Orange, and Wake Counties, NC, USA into six homogeneous clusters of similar characteristics based on 12 demographic factors. We assigned 2254 cardiac catheterization patients to these clusters based on residence at first catheterization. After controlling for individual age, sex, smoking status, and race, there were elevated odds of patients being obese (odds ratio (OR)=1.92, 95% confidence intervals (CI)=1.39, 2.67), and having diabetes (OR=2.19, 95% CI=1.57, 3.04), congestive heart failure (OR=1.99, 95% CI=1.39, 2.83), and hypertension (OR=2.05, 95% CI=1.38, 3.11) in a cluster that was urban, impoverished, and unemployed, compared with a cluster that was urban with a low percentage of people that were impoverished or unemployed. Our findings demonstrate the feasibility of applying hierarchical clustering to an assessment of area-level characteristics and that living in impoverished, urban residential clusters may have an adverse impact on health.
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Affiliation(s)
- Jaime E. Mirowsky
- Curriculum in Toxicology, University of North Carolina, Chapel Hill, North Carolina, USA
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert B. Devlin
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA
| | - David Diaz-Sanchez
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA
| | - Wayne Cascio
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA
| | - Shannon C. Grabich
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA
| | - Carol Haynes
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Colette Blach
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth R. Hauser
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Svati Shah
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - William Kraus
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
- Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Kenneth Olden
- National Center for Environmental Assessment, US Environmental Protection Agency, Chapel Hill, North Carolina, USA
| | - Lucas Neas
- National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA
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Knapp EA, Nau C, Brandau S, DeWalle J, Hirsch AG, Bailey-Davis L, Schwartz BS, Glass TA. Community Audit of Social, Civil, and Activity Domains in Diverse Environments (CASCADDE). Am J Prev Med 2017; 52:530-540. [PMID: 28209283 PMCID: PMC5495104 DOI: 10.1016/j.amepre.2016.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/18/2016] [Accepted: 11/04/2016] [Indexed: 01/01/2023]
Abstract
There are currently no direct observation environmental audit tools that measure diverse aspects of the obesity-related environment efficiently and reliably in a variety of geographic settings. The goal was to develop a new instrument to reliably characterize the overall properties and features of rural, suburban, and urban settings along multiple dimensions. The Community Audit of Social, Civil, and Activity Domains in Diverse Environments (CASCADDE) is an iPad-based instrument that incorporates GPS coordinates and photography and comprises 214 items yielding seven summary indices. A comprehensive spatial sampling strategy, training manual, and supporting data analysis code were also developed. Random geospatial sampling using GIS was used to capture features of the community as a whole. A single auditor collected 510 observation points in 30 communities (2013-2015). This analysis was done in 2015-2016. Correlation coefficients were used to compare items and indices to each other and to standard measures. Multilevel unconditional means models were used to calculate intraclass correlation coefficients to determine if there was significant variation between communities. Results suggest that CASCADDE measures aspects of communities not previously captured by secondary data sources. Additionally, seven summary indices capture meaningful differences between communities based on 15 observations per community. Community audit tools such as CASCADDE complement secondary data sources and have the potential to offer new insights about the mechanisms through which communities affect obesity and other health outcomes.
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Affiliation(s)
- Emily A Knapp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Claudia Nau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sy Brandau
- Geisinger Center for Health Research, Danville, Pennsylvania
| | - Joseph DeWalle
- Geisinger Center for Health Research, Danville, Pennsylvania
| | | | | | - Brian S Schwartz
- Geisinger Center for Health Research, Danville, Pennsylvania; Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas A Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Poortinga W, Calve T, Jones N, Lannon S, Rees T, Rodgers SE, Lyons RA, Johnson R. Neighborhood Quality and Attachment: Validation of the Revised Residential Environment Assessment Tool. ENVIRONMENT AND BEHAVIOR 2017; 49:255-282. [PMID: 28260806 PMCID: PMC5316962 DOI: 10.1177/0013916516634403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Various studies have shown that neighborhood quality is linked to neighborhood attachment and satisfaction. However, most have relied upon residents' own perceptions rather than independent observations of the neighborhood environment. This study examines the reliability and validity of the revised Residential Environment Assessment Tool (REAT 2.0), an audit instrument covering both public and private spaces of the neighborhood environment. The research shows that REAT 2.0 is a reliable, easy-to-use instrument and that most underlying constructs can be validated against residents' own neighborhood perceptions. The convergent validity of the instrument, which was tested against digital map data, can be improved for a number of miscellaneous urban form items. The research further found that neighborhood attachment was significantly associated with the overall REAT 2.0 score. This association can mainly be attributed to the property-level neighborhood quality and natural elements components. The research demonstrates the importance of private spaces in the outlook of the neighborhood environment.
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Affiliation(s)
- Wouter Poortinga
- Cardiff University, Wales, UK
- Wouter Poortinga, Welsh School of Architecture, Cardiff University, Bute Building, King Edward VII Avenue, Cardiff CF10 3NB, Wales, UK.
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Patching GR, Rahm J, Jansson M, Johansson M. A New Method of Random Environmental Walking for Assessing Behavioral Preferences for Different Lighting Applications. Front Psychol 2017; 8:345. [PMID: 28337163 PMCID: PMC5341101 DOI: 10.3389/fpsyg.2017.00345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/23/2017] [Indexed: 11/30/2022] Open
Abstract
Accurate assessment of people’s preferences for different outdoor lighting applications is increasingly considered important in the development of new urban environments. Here a new method of random environmental walking is proposed to complement current methods of assessing urban lighting applications, such as self-report questionnaires. The procedure involves participants repeatedly walking between different lighting applications by random selection of a lighting application and preferred choice or by random selection of a lighting application alone. In this manner, participants are exposed to all lighting applications of interest more than once and participants’ preferences for the different lighting applications are reflected in the number of times they walk to each lighting application. On the basis of an initial simulation study, to explore the feasibility of this approach, a comprehensive field test was undertaken. The field test included random environmental walking and collection of participants’ subjective ratings of perceived pleasantness (PP), perceived quality, perceived strength, and perceived flicker of four lighting applications. The results indicate that random environmental walking can reveal participants’ preferences for different lighting applications that, in the present study, conformed to participants’ ratings of PP and perceived quality of the lighting applications. As a complement to subjectively stated environmental preferences, random environmental walking has the potential to expose behavioral preferences for different lighting applications.
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Affiliation(s)
| | - Johan Rahm
- Department of Architecture and Built Environment, Lund University Lund, Sweden
| | - Märit Jansson
- Department of Landscape Architecture, Planning and Management, Swedish University of Agricultural Sciences Alnarp, Sweden
| | - Maria Johansson
- Department of Architecture and Built Environment, Lund University Lund, Sweden
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Kepper MM, Sothern MS, Theall KP, Griffiths LA, Scribner RA, Tseng TS, Schaettle P, Cwik JM, Felker-Kantor E, Broyles ST. A Reliable, Feasible Method to Observe Neighborhoods at High Spatial Resolution. Am J Prev Med 2017; 52:S20-S30. [PMID: 27989289 PMCID: PMC5233427 DOI: 10.1016/j.amepre.2016.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Systematic social observation (SSO) methods traditionally measure neighborhoods at street level and have been performed reliably using virtual applications to increase feasibility. Research indicates that collection at even higher spatial resolution may better elucidate the health impact of neighborhood factors, but whether virtual applications can reliably capture social determinants of health at the smallest geographic resolution (parcel level) remains uncertain. This paper presents a novel, parcel-level SSO methodology and assesses whether this new method can be collected reliably using Google Street View and is feasible. METHODS Multiple raters (N=5) observed 42 neighborhoods. In 2016, inter-rater reliability (observed agreement and kappa coefficient) was compared for four SSO methods: (1) street-level in person; (2) street-level virtual; (3) parcel-level in person; and (4) parcel-level virtual. Intra-rater reliability (observed agreement and kappa coefficient) was calculated to determine whether parcel-level methods produce results comparable to traditional street-level observation. RESULTS Substantial levels of inter-rater agreement were documented across all four methods; all methods had >70% of items with at least substantial agreement. Only physical decay showed higher levels of agreement (83% of items with >75% agreement) for direct versus virtual rating source. Intra-rater agreement comparing street- versus parcel-level methods resulted in observed agreement >75% for all but one item (90%). CONCLUSIONS Results support the use of Google Street View as a reliable, feasible tool for performing SSO at the smallest geographic resolution. Validation of a new parcel-level method collected virtually may improve the assessment of social determinants contributing to disparities in health behaviors and outcomes.
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Affiliation(s)
- Maura M Kepper
- Behavioral and Community Health Sciences Department, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
| | - Melinda S Sothern
- Behavioral and Community Health Sciences Department, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Katherine P Theall
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Lauren A Griffiths
- Behavioral and Community Health Sciences Department, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Richard A Scribner
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Tung-Sung Tseng
- Behavioral and Community Health Sciences Department, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Paul Schaettle
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jessica M Cwik
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Erica Felker-Kantor
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Stephanie T Broyles
- Contextual Risk Factors Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
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Affiliation(s)
- Mariana F. Almeida
- University of Lisbon, Institute of Social Sciences, Instituto do Envelhecimento, Lisbon, Portugal
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Nykiforuk CI, McGetrick JA, Crick K, Johnson JA. Check the score: Field validation of Street Smart Walk Score in Alberta, Canada. Prev Med Rep 2016; 4:532-539. [PMID: 27752462 PMCID: PMC5065046 DOI: 10.1016/j.pmedr.2016.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/06/2016] [Accepted: 09/25/2016] [Indexed: 11/30/2022] Open
Abstract
Walk Score® is a proprietary walkability metric that ranks locations by proximity to destinations, with emerging health promotion applications for increasing walking as physical activity. Currently, field validations of Walk Score® have only occurred in metropolitan regions of the United States; moreover, many studies employ an earlier Walk Score® version utilizing straight line distance. To address this gap, we conducted a field validation of the newest, network-based metric for three municipal types along a rural-urban continuum in Alberta, Canada. In 2015, using street-level systematic observations collected in Bonnyville, Medicine Hat, and North Central Edmonton in 2008 (part of the Community Health and the Built Environment (CHBE) project), we reverse engineered 2181 scores with the network Walk Score® algorithm. We computed means, 95% confidence intervals, and t-tests (α = 0.05) for both sets of scores. Applying the Clifford-Richardson adjustment for spatial autocorrelation, we calculated Spearman's Rank Correlation Coefficients (rho, rs) and adjusted p-values to measure the strength of association between the derived scores and original network scores provided by Walk Score®. Spearman's rho for scores were very high for Bonnyville (rs = 0.950, adjusted p < 0.001), and high for Medicine Hat (rs = 0.790, adjusted p < 0.001) and North Central Edmonton (rs = 0.763, adjusted p < 0.001). High to very high correlations between derived scores and Walk Scores® field validated this metric across small, medium, and large population centres in Alberta, Canada. However, we suggest caution in interpreting Walk Score® for planning and evaluating health promotion interventions, since the strength of association between destinations and walking may vary across different municipal types.
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Key Words
- ABL, Average Block Length
- BMI, Body Mass Index
- CHBE, Community Health and the Built Environment
- CI, Confidence Interval
- CSRS, Canadian Spatial Reference System
- Chronic disease
- GIS, Geographic Information System
- Geographic mapping
- Health promotion
- ID, Intersection Density
- IMI, Irvine-Minnesota Inventory
- NAD, North American Datum
- NC, North Central
- NRN, National Road Network
- SS, Street Smart
- TM, Transverse Mercator
- Validation studies
- Walking
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Affiliation(s)
- Candace I.J. Nykiforuk
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9, Canada
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O'Campo P, Schetter CD, Guardino CM, Vance MR, Hobel CJ, Ramey SL, Shalowitz MU. Explaining racial and ethnic inequalities in postpartum allostatic load: Results from a multisite study of low to middle income woment. SSM Popul Health 2016; 2:850-858. [PMID: 29082305 PMCID: PMC5659269 DOI: 10.1016/j.ssmph.2016.10.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Racial and ethnic inequalities in women's health are widely documented, but not for the postpartum period, and few studies examine whether neighborhood, psychosocial, and biological factors explain these gaps in women's health. METHODS Using prospective longitudinal data collected from 1766 low to middle income women between 2008 and 2012 by the Community Child Health Network (CCHN), we tested the extent to which adjustment for neighborhood, economic, psychological, and medical conditions following a birth explained differences between African American, Latina, and White women in an indicator of physiological dysregulation allostatic load (AL), at one year postpartum as measured by 10 biomarkers: Body Mass Index, Waist Hip Ratio, systolic and diastolic blood pressure, high sensitivity C-reactive protein, Hemoglobin A1c, high-density lipoprotein and cholesterol ratio, and diurnal cortisol. RESULTS Mean postpartum AL scores were 4.65 for African American, 4.57 for Latina and 3.86 for White women. Unadjusted regression estimates for high AL for African American women (with White as the reference) were 0.80 (SD = 0.11) and 0.53 (SD = 0.15) for Latina women. Adjustment for household poverty, neighborhood, stress, and resilience variables resulted in a reduction of 36% of the excess risk in high AL for African Americans versus Whites and 42% of the excess risk for Latinas compared to Whites. CONCLUSIONS Racial and ethnic inequalities in AL were accounted for largely by household poverty with additional contributions by psychological, economic, neighbourhood and medical variables. There remained a significant inequality between African American, and Latina women as compared to Whites even after adjustment for this set of variables. Future research into health inequalities among women should include a fuller consideration of the social determinants of health including employment, housing and prepregnancy medical conditions.
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Affiliation(s)
- Patricia O'Campo
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Christine M Guardino
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Calvin J Hobel
- UCLA and Cedar Sinai Health System, Los Angeles, CA, USA
| | - Sharon Landesman Ramey
- Virginia Tech Carilion Research Institute, Virginia Tech, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Madeleine U Shalowitz
- NorthShore University Health System and University of Chicago Pritzker School of Medicine, Evanston, IL, USA
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Pliakas T, Hawkesworth S, Silverwood RJ, Nanchahal K, Grundy C, Armstrong B, Casas JP, Morris RW, Wilkinson P, Lock K. Optimising measurement of health-related characteristics of the built environment: Comparing data collected by foot-based street audits, virtual street audits and routine secondary data sources. Health Place 2016; 43:75-84. [PMID: 27902960 PMCID: PMC5292100 DOI: 10.1016/j.healthplace.2016.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 10/06/2016] [Accepted: 10/29/2016] [Indexed: 11/25/2022]
Abstract
The role of the neighbourhood environment in influencing health behaviours continues to be an important topic in public health research and policy. Foot-based street audits, virtual street audits and secondary data sources are widespread data collection methods used to objectively measure the built environment in environment-health association studies. We compared these three methods using data collected in a nationally representative epidemiological study in 17 British towns to inform future development of research tools. There was good agreement between foot-based and virtual audit tools. Foot based audits were superior for fine detail features. Secondary data sources measured very different aspects of the local environment that could be used to derive a range of environmental measures if validated properly. Future built environment research should design studies a priori using multiple approaches and varied data sources in order to best capture features that operate on different health behaviours at varying spatial scales. This study compares multiple data collection methods for measuring built environment features. Virtual street audits are reliable for more objective built environment measures. Street-based audits are superior for collecting fine detail environmental features. Routine secondary data sources need less resources but must be properly validated. Appropriate methods for health studies vary depending on the research question and resources.
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Affiliation(s)
- Triantafyllos Pliakas
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Sophie Hawkesworth
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kiran Nanchahal
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Grundy
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Armstrong
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Juan Pablo Casas
- Faculty of Population Health Sciences, University College London, UK
| | - Richard W Morris
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Wilkinson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Lock
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Older People's External Residential Assessment Tool (OPERAT): a complementary participatory and metric approach to the development of an observational environmental measure. BMC Public Health 2016; 16:1022. [PMID: 27682428 PMCID: PMC5041557 DOI: 10.1186/s12889-016-3681-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background The potential for environmental interventions to improve health and wellbeing has assumed particular importance in the face of unprecedented population ageing. However, presently observational environmental assessment tools are unsuitable for ‘all ages’. This article describes the development of the Older People’s External Residential Assessment Tool (OPERAT). Methods Potential items were identified through review and consultation with an Expert Advisory Group. Items were ranked according the importance ascribed to them by older people who responded to a survey distributed by 50+ forum in Wales (N = 545). 40 highly ranked items were selected for the OPERAT pilot. An observational assessment was conducted in 405 postcodes in Wales. Items validated with data from a survey of older residents (N = 500) in the postcode areas were selected for statistical modelling (Kendall’s Tau-b, p < .05). Data reduction techniques (exploratory factor analysis with Geomin rotation) identified the underlying factor structure of OPERAT. Items were weighted (Thurstone scaling approach) and scores calculated for each domain. Internal consistency: all items were tested for scale-domain total correlation (Spearman’s rank). Construct validity: correlation analysis examined the associations between domains and the extent to which participants enjoyed living in the area, felt that it was a desirable place to live, or felt safe at night or during the day (Spearman’s rank). Usability: analysis of variance compared mean OPERAT domain scores between neighbourhoods that were homogenous in terms of (a) deprivation (quintiles of the Townsend Index) and (b) geographic settlement type. Inter-rater reliability: Krippendorff’s alpha was used to evaluate inter-rater consistency in ten postcode areas. Results A four factor model was selected as the best interpretable fit to the data. The domains were named Natural Elements, Incivilities and Nuisance; Navigation and Mobility; and Territorial Functioning. Statistical tests demonstrated good internal consistency, convergent validity, utility and inter-rater reliability. Conclusions Participatory approaches to research and robust statistical testing are not mutually exclusive. OPERAT can be used to assess the suitability of external residential environments for older people with different physical and cognitive capacities, living in rural or urban areas. OPERAT can be used to help plan residential environments that are friendly for all ages. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3681-x) contains supplementary material, which is available to authorized users.
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31
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Rodrigues DE, César CC, Xavier CC, Caiaffa WT, Proietti FA. The place where you live and self-rated health in a large urban area. CAD SAUDE PUBLICA 2016; 31 Suppl 1:246-56. [PMID: 26648378 DOI: 10.1590/0102-311x00166714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/29/2015] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine and quantify the association between one's perception of the place of residence and self-rated health. 4,048 adult residents of Belo Horizonte, Minas Gerais State, Brazil, participated in the study in 2008 and 2009. Ordinal logistic regression was used to estimate the magnitude of the association. Health was rated as good or very good, fair, or poor or very poor by 65.7%, 27.8%, and 6.5% of the subjects, respectively. Better self-rated health was associated with the following neighborhood characteristics: positive evaluation of aesthetics and mobility, better quality of public services, less physical and social disorder. The perception of violence had a borderline statistically significant association with worse self-rated health. These associations persisted after controlling for potential confounding demographic, socioeconomic, health, and health behavior variables. The results indicate that public and health policies should incorporate interventions that address the physical and social environment in addition to policies focused on individuals.
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Affiliation(s)
| | - Cibele Comini César
- Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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32
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Strominger J, Anthopolos R, Miranda ML. Implications of construction method and spatial scale on measures of the built environment. Int J Health Geogr 2016; 15:15. [PMID: 27121615 PMCID: PMC4849096 DOI: 10.1186/s12942-016-0044-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/18/2016] [Indexed: 02/02/2023] Open
Abstract
Background Research surrounding the built environment (BE) and health has resulted in inconsistent findings. Experts have identified the need to examine methodological choices, such as development and testing of BE indices at varying spatial scales. We sought to examine the impact of construction method and spatial scale on seven measures of the BE using data collected at two time points. Methods The Children’s Environmental Health Initiative conducted parcel-level assessments of 57 BE variables in Durham, NC (parcel N = 30,319). Based on a priori defined variable groupings, we constructed seven mutually exclusive BE domains (housing damage, property disorder, territoriality, vacancy, public nuisances, crime, and tenancy). Domain-based indices were developed according to four different index construction methods that differentially account for number of parcels and parcel area. Indices were constructed at the census block level and two alternative spatial scales that better depict the larger neighborhood context experienced by local residents: the primary adjacency community and secondary adjacency community. Spearman’s rank correlation was used to assess if indices and relationships among indices were preserved across methods. Results Territoriality, public nuisances, and tenancy were weakly to moderately preserved across methods at the block level while all other indices were well preserved. Except for the relationships between public nuisances and crime or tenancy, and crime and housing damage or territoriality, relationships among indices were poorly preserved across methods. The number of indices affected by construction method increased as spatial scale increased, while the impact of construction method on relationships among indices varied according to spatial scale. Conclusions We found that the impact of construction method on BE measures was index and spatial scale specific. Operationalizing and developing BE measures using alternative methods at varying spatial scales before connecting to health outcomes allows researchers to better understand how methodological decisions may affect associations between health outcomes and BE measures. To ensure that associations between the BE and health outcomes are not artifacts of methodological decisions, researchers would be well-advised to conduct sensitivity analysis using different construction methods. This approach may lead to more robust results regarding the BE and health outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12942-016-0044-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Strominger
- School of Natural Resources and the Environment, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Rebecca Anthopolos
- Children's Environmental Health Initiative, Rice University, Houston, TX, 77005, USA
| | - Marie Lynn Miranda
- Children's Environmental Health Initiative, Rice University, Houston, TX, 77005, USA. .,Department of Statistics, Rice University, 6100 Main Street, MS-2, Houston, TX, 77005, USA. .,Department of Pediatrics, University of Michigan, Ann Arbor, MI, 48109, USA. .,Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA. .,Department of Pediatrics, Duke University, Durham, NC, 27708, USA.
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Baek J, Sanchez-Vaznaugh EV, Sánchez BN. Hierarchical Distributed-Lag Models: Exploring Varying Geographic Scale and Magnitude in Associations Between the Built Environment and Health. Am J Epidemiol 2016; 183:583-92. [PMID: 26888753 DOI: 10.1093/aje/kwv230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 08/24/2015] [Indexed: 11/13/2022] Open
Abstract
It is well known that associations between features of the built environment and health depend on the geographic scale used to construct environmental attributes. In the built environment literature, it has long been argued that geographic scales may vary across study locations. However, this hypothesized variation has not been systematically examined due to a lack of available statistical methods. We propose a hierarchical distributed-lag model (HDLM) for estimating the underlying overall shape of food environment-health associations as a function of distance from locations of interest. This method enables indirect assessment of relevant geographic scales and captures area-level heterogeneity in the magnitudes of associations, along with relevant distances within areas. The proposed model was used to systematically examine area-level variation in the association between availability of convenience stores around schools and children's weights. For this case study, body mass index (weight kg)/height (m)2) z scores (BMIz) for 7th grade children collected via California's 2001-2009 FitnessGram testing program were linked to a commercial database that contained locations of food outlets statewide. Findings suggested that convenience store availability may influence BMIz only in some places and at varying distances from schools. Future research should examine localized environmental or policy differences that may explain the heterogeneity in convenience store-BMIz associations.
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34
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Milam AJ, Johnson RM, Nesoff ED, Reboussin BA, Furr-Holden CD. Evaluating Nighttime Observational Measures of Neighborhood Disorder: Validity of the Nighttime NIfETy Assessment. JOURNAL OF ENVIRONMENTAL PSYCHOLOGY 2016; 45:97-102. [PMID: 28979058 PMCID: PMC5624718 DOI: 10.1016/j.jenvp.2015.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
While there are a growing number of observational instruments to assess the built and social dimensions of the neighborhood environment, there are few reliable and validated instruments; there are no instruments that assess the neighborhood environment during nighttime hours, a potential peak period of health and safety risk. The purpose of this investigation is to establish the metric properties of Neighborhood Inventory for Environmental Typology (NIfETy) Instrument nighttime ratings. Reliability of the scale was measured by internal consistency reliability and test re-test correlation. Validity was evaluated through correlation with the daytime NIfETy rating and regression models with local violent crime data. The nighttime items had good internal consistency (α = .81-82) for the total scale and acceptable internal consistency for a seven-item nighttime disorder scale (α = .66-.71). Future investigations will examine the nighttime NIfETy and its association with specific risk behaviors to evaluate changes in neighborhood environment.
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Affiliation(s)
- Adam J Milam
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 N. Broadway; Baltimore, MD; 21205
- Wayne State University; School of Medicine; 320 E. Canfield St; Detroit, MI, 48201
| | - Renee M Johnson
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 N. Broadway; Baltimore, MD; 21205
| | - Elizabeth D Nesoff
- Johns Hopkins Bloomberg School of Public Health; Department of Health, Behavior and Society; 624 N. Broadway; Baltimore, MD; 21205
| | - Beth A Reboussin
- Wake Forest University School of Medicine, Division of Public Health Sciences, Department of Biostatistical Sciences, and Department of Social Sciences and Health Policy; Medical Center Boulevard, Winston-Salem, NC, 27157
| | - C Debra Furr-Holden
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 N. Broadway; Baltimore, MD; 21205
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Morrison C, Lee JP, Gruenewald PJ, Mair C. The Reliability of Naturalistic Observations of Social, Physical and Economic Environments of Bars. ADDICTION RESEARCH & THEORY 2016; 24:330-340. [PMID: 27695393 PMCID: PMC5042343 DOI: 10.3109/16066359.2016.1145674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Drinking in bars contributes to numerous public health problems, including violence and motor vehicle crashes. In order to formulate effective preventive interventions it is essential to identify which specific features of bar environments are related to increased risks. Unobtrusive ethnographic observations are one approach that has been used to characterize these features; however no studies have assessed reliability in a representative sample of bars. We performed brief scouting assessments in all 165 bars in six purposively selected California cities, followed by unobtrusive observations from a subsequent representative sample of 97 bars which were located in low and high bar density areas of the cities. Inter-rater reliability between two independent observers assessed individual item reliability, and principal components analyses assessed the reliability of a series of scales describing the physical, social, and economic characteristics of the bars. For the scouting assessment, items exhibited at least moderate reliability (κ or r ≥ 0.40). For the unobtrusive observations, items assessing physical and economic environments (e.g., pool table present, κ = 0.90; index beer cost, r = 0.82) had moderate to outstanding reliability (κ or r > 0.80). Items describing the social environment generally had poorer reliability, though group aspects (e.g., patron count, r = 0.78; patron circulation, r = 0.64) had better reliability than individual behaviors (e.g., derogatory speech, κ = 0.12). Scales constructed from specific sets of items exhibited modest reliability. The individual metrics and principal components we present will enable future studies seeking to disaggregate relationships between bar characteristics and public health problems.
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Affiliation(s)
- Christopher Morrison
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Juliet P. Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Paul J. Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Christina Mair
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh Pennsylvania
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Glanz K, Handy SL, Henderson KE, Slater SJ, Davis EL, Powell LM. Built environment assessment: Multidisciplinary perspectives. SSM Popul Health 2016; 2:24-31. [PMID: 29349125 PMCID: PMC5757767 DOI: 10.1016/j.ssmph.2016.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/05/2016] [Accepted: 02/04/2016] [Indexed: 01/25/2023] Open
Abstract
Context As obesity has become increasingly widespread, scientists seek better ways to assess and modify built and social environments to positively impact health. The applicable methods and concepts draw on multiple disciplines and require collaboration and cross-learning. This paper describes the results of an expert team׳s analysis of how key disciplinary perspectives contribute to environmental context-based assessment related to obesity, identifies gaps, and suggests opportunities to encourage effective advances in this arena. Evidence acquisition A team of experts representing diverse disciplines convened in 2013 to discuss the contributions of their respective disciplines to assessing built environments relevant to obesity prevention. The disciplines include urban planning, public health nutrition, exercise science, physical activity research, public health and epidemiology, behavioral and social sciences, and economics. Each expert identified key concepts and measures from their discipline, and applications to built environment assessment and action. A selective review of published literature and internet-based information was conducted in 2013 and 2014. Evidence synthesis The key points that are highlighted in this article were identified in 2014–2015 through discussion, debate and consensus-building among the team of experts. Results focus on the various disciplines׳ perspectives and tools, recommendations, progress and gaps. Conclusions There has been significant progress in collaboration across key disciplines that contribute to studies of built environments and obesity, but important gaps remain. Using lessons from interprofessional education and team science, along with appreciation of and attention to other disciplines׳ contributions, can promote more effective cross-disciplinary collaboration in obesity prevention. Gaps in collaboration in studies of built environments and obesity remain. Lessons from interprofessional education can promote more effective collaboration. More attention to other disciplines’ contributions will yield greater health impact.
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Affiliation(s)
- Karen Glanz
- Department of Biostatistics and Epidemiology, Perelman School of Medicine and School of Nursing, University of Pennsylvania, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, United States
| | - Susan L Handy
- Department of Environmental Science and Policy, University of California at Davis, 2130 Wickson Hall, Davis, CA 95616, United States
| | | | - Sandy J Slater
- Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, 492 Westside Research Office Building, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Erica L Davis
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 813 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, United States
| | - Lisa M Powell
- Health Policy and Administration and Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, 448 Westside Research Office Building, 1747 West Roosevelt Road, Chicago, IL 60608, United States
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Gupta AK, Ladusingh L. An Assessment of Association between Neighborhood Socioeconomic Status and Infant Mortality in High Focus States in India. Health (London) 2016. [DOI: 10.4236/health.2016.87066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hoffman GJ, Rodriguez HP. Examining Contextual Influences on Fall-Related Injuries Among Older Adults for Population Health Management. Popul Health Manag 2015; 18:437-48. [PMID: 25919228 PMCID: PMC4688459 DOI: 10.1089/pop.2014.0156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objectives were to assess the associations between fall-related injuries (FRIs) treated in the emergency department (ED) among older adults in California and contextual county-level physical, social, and economic characteristics, and to assess how county-level economic conditions are associated with FRIs when controlling for other county-level factors. Data from 2008 California ED discharge, Medicare Impact File, and County Health Rankings were used. Random effects logistic regression models estimated contextual associations between county-level factors representing economic conditions, the built environment, community safety, access to care, and obesity with patient-level FRI treatment among 1,712,409 older adults, controlling for patient-level and hospital-level characteristics. Patient-level predictors of FRI treatment were consistent with previous studies not accounting for contextual associations. Larger and rural hospitals had higher odds of FRI treatment, while teaching and safety net hospitals had lower odds. Better county economic conditions were associated with greater odds (ß=0.73, P=0.001) and higher county-level obesity were associated with lower odds (ß=-0.37, P=0.004), but safer built environments (ß=-0.31, P=0.38) were not associated with FRI treatment. The magnitude of association between county-level economic conditions and FRI treatment attenuated with the inclusion of county-level obesity rates. FRI treatment was most strongly and consistently related to more favorable county economic conditions, suggesting differences in treatment or preferences for treatment for FRIs among older individuals in communities of varying resource levels. Using population health data on FRIs, policy makers may be able to remove barriers unique to local contexts when implementing falls prevention educational programs and built environment modifications.
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Affiliation(s)
- Geoffrey J. Hoffman
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Hector P. Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California
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Schmöker A, Nkulu Kalengayi FK. Female genital mutilation – why does it still exist in Africa? SCIENCEOPEN RESEARCH 2015. [DOI: 10.14293/s2199-1006.1.sor-med.acoxmi.v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the external female genitalia for non-medical reasons. FGM is practised in many parts of the world – including 28 African countries, some countries in the Middle East and Asia, and some population groups in Central and South America. Its prevalence rates range from 0.6% up to 97.9%, and it has been classified as a violation of human and children’s rights. Consequently, several countries have passed laws against the practice and many international programmes have been implemented to abandon it. Yet, FGM still prevails in many countries. This literature review aimed at identifying the underlying reasons for the perpetuation of FGM, ascertaining forces that foster its promotion and persistence and who is responsible for pushing its continuation. The main goal was to try to understand the underlying causes that make FGM resistant against initiatives and campaigns targeting its elimination. A literature search was carried out using several databases. All sources that approached the topic of FGM were incorporated including literature reviews, systematic reviews, qualitative and quantitative as well as mixed-method studies that described attitudes towards FGM and factors associated with its practice. Different factors that were interlinked could be identified at the individual, interpersonal, organisational/institutional as well as the community/societal level as the underlying causes of the perpetuation for FGM. These factors varied within and between different settings, and include individual characteristics such as parents’ level of education, place of residence, personal beliefs (aesthetics, health benefits, hygiene) about FGM as well as the medicalisation of FGM and the involvement of health care professionals at the institutional level. Cultural factors like gender inequality, social norms and pressure also played an important role. Surprisingly, no evidence that supported religious motives could be found in any of the three monotheistic religions. This review suggests that the reasons behind the performance of FGM differ between and within countries and contexts, but cannot be found in the scriptures even though it is mainly practiced by Muslims. Girls with low education living in small Muslim communities, in rural areas in Africa and whose parents especially the mother had a low educational level, were at increased risk of undergoing FGM. Successful actions to eliminate this practice require a balance between respect of culture and human rights. Practising communities should be involved in each step of every programme. Finally, it is crucial to target the young generations through education, women empowerment and reduction of gender inequality.
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Affiliation(s)
- Annika Schmöker
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Global Health Next Generation Network, Barcelona, Spain
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Measuring physical neighborhood quality related to health. Behav Sci (Basel) 2015; 5:190-202. [PMID: 25938692 PMCID: PMC4493443 DOI: 10.3390/bs5020190] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 11/23/2022] Open
Abstract
Although sociodemographic factors are one aspect of understanding the effects of neighborhood environments on health, equating neighborhood quality with socioeconomic status ignores the important role of physical neighborhood attributes. Prior work on neighborhood environments and health has relied primarily on level of socioeconomic disadvantage as the indicator of neighborhood quality without attention to physical neighborhood quality. A small but increasing number of studies have assessed neighborhood physical characteristics. Findings generally indicate that there is an association between living in deprived neighborhoods and poor health outcomes, but rigorous evidence linking specific physical neighborhood attributes to particular health outcomes is lacking. This paper discusses the methodological challenges and limitations of measuring physical neighborhood environments relevant to health and concludes with proposed directions for future work.
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Célio FDA, Xavier CC, Andrade ACDS, Camargos VP, Caiaffa WT, Friche AADL, Cortês MG, Proietti FA. [Individual characteristics associated with perception of the local neighborhood's territory]. CAD SAUDE PUBLICA 2015; 30:1935-46. [PMID: 25317522 DOI: 10.1590/0102-311x00176112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/19/2014] [Indexed: 11/22/2022] Open
Abstract
There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual's definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study's results can help produce more significant neighborhood definitions that are more consistent with residents' own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.
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Interactive and independent associations between the socioeconomic and objective built environment on the neighbourhood level and individual health: a systematic review of multilevel studies. PLoS One 2015; 10:e0123456. [PMID: 25849569 PMCID: PMC4388459 DOI: 10.1371/journal.pone.0123456] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 03/03/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The research question how contextual factors of neighbourhood environments influence individual health has gained increasing attention in public health research. Both socioeconomic neighbourhood characteristics and factors of the built environment play an important role for health and health-related behaviours. However, their reciprocal relationships have not been systematically reviewed so far. This systematic review aims to identify studies applying a multilevel modelling approach which consider both neighbourhood socioeconomic position (SEP) and factors of the objective built environment simultaneously in order to disentangle their independent and interactive effects on individual health. METHODS The three databases PubMed, PsycINFO, and Web of Science were systematically searched with terms for title and abstract screening. Grey literature was not included. Observational studies from USA, Canada, Australia, New Zealand, and Western European countries were considered which analysed simultaneously factors of neighbourhood SEP and the objective built environment with a multilevel modelling approach. Adjustment for individual SEP was a further inclusion criterion. RESULTS Thirty-three studies were included in qualitative synthesis. Twenty-two studies showed an independent association between characteristics of neighbourhood SEP or the built environment and individual health outcomes or health-related behaviours. Twenty-one studies found cross-level or within-level interactions either between neighbourhood SEP and the built environment, or between neighbourhood SEP or the built environment and individual characteristics, such as sex, individual SEP or ethnicity. Due to the large variation of study design and heterogeneous reporting of results the identification of consistent findings was problematic and made quantitative analysis not possible. CONCLUSIONS There is a need for studies considering multiple neighbourhood dimensions and applying multilevel modelling in order to clarify their causal relationship towards individual health. Especially, more studies using comparable characteristics of neighbourhood SEP and the objective built environment and analysing interactive effects are necessary to disentangle health impacts and identify vulnerable neighbourhoods and population groups.
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Wu YT, Prina AM, Brayne C. The association between community environment and cognitive function: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2015; 50:351-62. [PMID: 25087013 PMCID: PMC4322216 DOI: 10.1007/s00127-014-0945-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/28/2014] [Indexed: 12/05/2022]
Abstract
PURPOSES The aim of this study is to review the published evidence on the association between community environment and cognitive function in older people, focusing on the findings and a critique of the existing studies. METHODS A literature search was conducted to identify studies linking the community environment and cognitive function in older people. The results and methodological factors, including the definition of community, individual level characteristics and the measurements of cognitive function and community environment were extracted from each study. The measurements of community environment were mainly categorized into two types: compositional, generated by aggregating individual and household data (community-level socioeconomic status, deprivation index) and contextual, targeting at the features of built or social environment in local areas (green space, street conditions, crime rate). RESULTS Fourteen of the fifteen studies used compositional measurements such as community-level socioeconomic status and deprivation index and significant associations were found in eleven studies. Some individual level factors (ethnicity, genotype and socioeconomic status) were found to modify the association between community environment and cognitive function. Few contextual measurements were included in the existing studies. A conceptual framework for the pathway from community environment to cognitive function of older people is provided in this review. CONCLUSIONS To disentangle the additional effect of place from individual risk factors and investigate the casual direction of community environment and cognition in later life, longitudinal studies with measurements targeting built and social environments of community and change of cognitive functions over time need to be included in future studies.
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Affiliation(s)
- Yu-Tzu Wu
- Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK,
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Does territoriality modify the relationship between perceived neighborhood challenges and physical activity? A multilevel analysis. Ann Epidemiol 2014; 25:107-12. [PMID: 25533154 DOI: 10.1016/j.annepidem.2014.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/24/2014] [Accepted: 11/06/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Individuals who perceive more neighborhood challenges are less physically active. Territoriality, an observable positive marker of social presence and defensible space in the neighborhood, may influence the association between neighborhood challenges and physical activity (PA). We hypothesized that greater territoriality would reduce the negative effects of neighborhood challenges on PA levels. METHODS Data were collected by the Healthy Environments Partnership in an urban Midwestern city. Multilevel regressions were used to test associations in a sample of 696 white, black, and Hispanic adults older than 25 years. RESULTS Territoriality moderated associations between residents' perceptions of neighborhood challenges and PA. Contrary to our hypothesis, individuals who perceived more neighborhood challenges and lived in areas with more territoriality markers (e.g., buildings with decorations, buildings with security signage, and neighborhood watch signs) were less physically active than other respondents (b = -2.41, standard error = 0.84, P < .01). CONCLUSIONS Our findings suggest that associations between perceived neighborhood challenges and PA are shaped by the context in which the individual lives. Our study provides empirical evidence that individual perceptions and observed neighborhood characteristics are joint contributors to PA and suggest the need for continued research to characterize the complexity of individual and contextual factors that contribute to PA.
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Michael YL, Yen IH. Aging and place--neighborhoods and health in a world growing older. J Aging Health 2014; 26:1251-60. [PMID: 25502240 DOI: 10.1177/0898264314562148] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The articles in this special issue make it clear that there are interesting and policy-relevant research to identify place-based strategies to improve health and reduce health disparities among older adults. The articles also reveal important areas of future research and policy innovation that are needed related to place and aging.
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Affiliation(s)
- Yvonne L Michael
- Drexel University School of Public Health, Philadelphia, PA, USA
| | - Irene H Yen
- University of California, San Francisco, Departments of Medicine and Epidemiology & Biostatistics, San Francisco, CA USA
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Chow CK, Corsi DJ, Lock K, Madhavan M, Mackie P, Li W, Yi S, Wang Y, Swaminathan S, Lopez-Jaramillo P, Gomez-Arbelaez D, Avezum Á, Lear SA, Dagenais G, Teo K, McKee M, Yusuf S. A novel method to evaluate the community built environment using photographs--Environmental Profile of a Community Health (EPOCH) photo neighbourhood evaluation tool. PLoS One 2014; 9:e110042. [PMID: 25369366 PMCID: PMC4219679 DOI: 10.1371/journal.pone.0110042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 09/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background Previous research has shown that environments with features that encourage walking are associated with increased physical activity. Existing methods to assess the built environment using geographical information systems (GIS) data, direct audit or large surveys of the residents face constraints, such as data availability and comparability, when used to study communities in countries in diverse parts of the world. The aim of this study was to develop a method to evaluate features of the built environment of communities using a standard set of photos. In this report we describe the method of photo collection, photo analysis instrument development and inter-rater reliability of the instrument. Methods/Principal Findings A minimum of 5 photos were taken per community in 86 communities in 5 countries according to a standard set of instructions from a designated central point of each community by researchers at each site. A standard pro forma derived from reviewing existing instruments to assess the built environment was developed and used to score the characteristics of each community. Photo sets from each community were assessed independently by three observers in the central research office according to the pro forma and the inter-rater reliability was compared by intra-class correlation (ICC). Overall 87% (53 of 60) items had an ICC of ≥0.70, 7% (4 of 60) had an ICC between 0.60 and 0.70 and 5% (3 of 60) items had an ICC ≤0.50. Conclusions/Significance Analysis of photos using a standardized protocol as described in this study offers a means to obtain reliable and reproducible information on the built environment in communities in very diverse locations around the world. The collection of the photographic data required minimal training and the analysis demonstrated high reliability for the majority of items of interest.
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Affiliation(s)
- Clara K Chow
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; The George Institute for Global Health and Westmead Hospital Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Daniel J Corsi
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Harvard Center for Population & Development Studies, Cambridge, MA, United States of America
| | - Karen Lock
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Madhavan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pam Mackie
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Wei Li
- Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sun Yi
- Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sumathi Swaminathan
- St. John's Research Institute, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Patricio Lopez-Jaramillo
- Research Direction, Fundacion Oftalmologica de Santander-Clinica Carlos Arila Lulle and Medical School, Universidad de Santander, Bucaramanga, Colombia
| | - Diego Gomez-Arbelaez
- Research Direction, Fundacion Oftalmologica de Santander-Clinica Carlos Arila Lulle and Medical School, Universidad de Santander, Bucaramanga, Colombia
| | - Álvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University and Division of Cardiology, Providence Health Care, Vancouver, B.C., Canada
| | - Gilles Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval), Quebec City, Quebec, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Martin McKee
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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The relative influence of neighbourhood incivilities, cognitive social capital, club membership and individual characteristics on positive mental health. Health Place 2014; 28:187-93. [PMID: 24911971 DOI: 10.1016/j.healthplace.2014.04.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 03/03/2014] [Accepted: 04/20/2014] [Indexed: 11/23/2022]
Abstract
Previous research indicates that residents׳ perceptions of their neighbourhoods can have an adverse influence on their health and wellbeing over and above the influence of structural disadvantage. Contrary to most prior research, this study employed an indicator of positive wellbeing and assessed the impact of individual characteristics, perceived social and environmental incivilities, indicators of cognitive and structural social capital, and perceived safety. Analyses of data from a large regional UK representative study (n=8237; 69.64% response rate) found the most influential determinants of wellbeing were physical health problems, age, SES and cognitive social capital. Smaller, significant effects were also found for environmental and social incivilities, and for perceived safety. The effect of cognitive social capital was moderated by age, with a stronger effect found among those aged 65 years and over than among younger participants. Findings indicate that the promotion of positive mental health within communities may be facilitated by efforts to foster a greater sense of belonging among residents, and that older adults may benefit most from such efforts.
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Jongeneel-Grimen B, Droomers M, van Oers HAM, Stronks K, Kunst AE. The relationship between physical activity and the living environment: a multi-level analyses focusing on changes over time in environmental factors. Health Place 2014; 26:149-60. [PMID: 24448404 DOI: 10.1016/j.healthplace.2013.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
There is limited evidence on the causality of previously observed associations between neighborhood characteristics and physical activity (PA). We aimed to assess whether individual-level PA was associated with changes in fear of crime, social cohesion, green spaces, parking facilities, social disorder, and physical disorder that occurred over the past 3 years. In general, in neighborhoods where residents had more favorable perceptions of the environment in 2006, residents were more likely to be physically active in 2009. In addition, improvements between 2006 and 2009 with respect to perceived social cohesion, green spaces, social disorder, and physical disorder were associated with increased odds of being active in 2009. For both the levels in 2006 and trends in the period 2006-2009, the associations were somewhat stronger among women than among men, but associations did not vary by age or length of residence. For several environmental factors, we observed that not only the levels at a certain point in time, but also recent improvements over time were related to PA. These results provide new support for a causal relationship between these environmental factors and PA.
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Affiliation(s)
- Birthe Jongeneel-Grimen
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Mariël Droomers
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Hans A M van Oers
- Centre for Public Health Status and Forecasting, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Academic Collaborative Centre for Public Health Brabant, Tranzo, Faculty of Social Sciences, University of Tilburg, P.O Box 90153, 5000 LE Tilburg, The Netherlands.
| | - Karien Stronks
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Curtis JW, Curtis A, Mapes J, Szell AB, Cinderich A. Using Google Street View for systematic observation of the built environment: analysis of spatio-temporal instability of imagery dates. Int J Health Geogr 2013; 12:53. [PMID: 24298903 PMCID: PMC3923560 DOI: 10.1186/1476-072x-12-53] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, Google Street View (GSV) has been examined as a tool for remotely conducting systematic observation of the built environment. Studies have found it offers benefits over in-person audits, including efficiency, safety, cost, and the potential to expand built environment research to larger areas and more places globally. However, one limitation has been the lack of documentation on the date of imagery collection. In 2011, Google began placing a date stamp on images which now enables investigation of this concern. This study questions the spatio-temporal stability in the GSV date stamp. Specifically, is the imagery collected contemporaneously? If not, how frequently and where is imagery from different time periods woven together to represent environmental conditions in a particular place. Furthermore, how much continuity exists in imagery for a particular time period? Answering these questions will provide guidance on the use of GSV as a tool for built environment audits. METHODS GSV was used to virtually "drive" five sites that are a part of the authors' ongoing studies. Each street in the sites was "driven" one mouse-click at a time while observing the date stamp on each image. Every time the date stamp changed, this "disruption" was marked on the map. Every street segment in the site was coded by the date the imagery for that segment was collected. Spatial query and descriptive statistics were applied to understand the spatio-temporal patterns of imagery dates. RESULTS Spatio-temporal instability is present in the dates of GSV imagery. Of the 353 disruptions, 82.4% occur close to (<25 m) intersections. The remainder occurs inconsistently in other locations. The extent of continuity for a set of images collected with the same date stamp ranged from 3.13 m to 3373.06 m, though the majority of continuous segments were less than 400 m. CONCLUSION GSV offers some benefits over traditional built environment audits. However, this investigation empirically identifies a previously undocumented limitation in its application for research. Imagery dates can change often and without warning. Caution should be used at intersections where these disruptions are most likely to occur, though caution should be used everywhere when using GSV as a data collection tool.
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Affiliation(s)
- Jacqueline W Curtis
- GIS Health & Hazards Lab, Department of Geography, Kent State University, Kent, OH 44242, USA.
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Andresen EM, Malmstrom TK, Schootman M, Wolinsky FD, Miller JP, Miller DK. Observer ratings of neighborhoods: comparison of two methods. BMC Public Health 2013; 13:1024. [PMID: 24168373 PMCID: PMC3840667 DOI: 10.1186/1471-2458-13-1024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022] Open
Abstract
Background Although neighborhood characteristics have important relationships with health outcomes, direct observation involves imperfect measurement. The African American Health (AAH) study included two observer neighborhood rating systems (5-item Krause and 18-item AAH Neighborhood Assessment Scale [NAS]), initially fielded at two different waves. Good measurement characteristics were previously shown for both, but there was more rater variability than desired. In 2010 both measures were re-fielded together, with enhanced training and field methods implemented to decrease rater variability while maintaining psychometric properties. Methods AAH included a poor inner city and more heterogeneous suburban areas. Four interviewers rated 483 blocks, with 120 randomly-selected blocks rated by two interviewers. We conducted confirmatory factor analysis of scales and tested the Krause (5-20 points), AAH 18-item NAS (0-28 points), and a previous 7-item and new 5-item versions of the NAS (0-17 points, 0-11 points). Retest reliability for items (kappa) and scales (Intraclass Correlation Coefficient [ICC]) were calculated overall and among pre-specified subgroups. Linear regression assessed interviewer effects on total scale scores and assessed concurrent validity on lung and lower body functions. Mismeasurement effects on self-rated health were also assessed. Results Scale scores were better in the suburbs than in the inner city. ICC was poor for the Krause scale (ICC=0.19), but improved if the retests occurred within 10 days (ICC=0.49). The 7- and 5-item NAS scales had better ICCs (0.56 and 0.62, respectively), and were higher (0.71 and 0.73) within 10 days. Rater variability for the Kraus and 5- and 7-item NAS scales was 1-3 points (compared to the supervising rater). Concurrent validity was modest, with residents living in worse neighborhood conditions having worse function. Unadjusted estimates were biased towards the null compared with measurement-error corrected estimates. Conclusions Enhanced field protocols and rater training did not improve measurement quality. Specifically, retest reliability and interviewer variability remained problematic. Measurement error partially reduced, but did not eliminate concurrent validity, suggesting there are robust associations between neighborhood characteristics and health outcomes. We conclude that the 5-item AAH NAS has sufficient reliability and validity for further use. Additional research on the measurement properties of environmental rating methods is encouraged.
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Affiliation(s)
- Elena M Andresen
- Institute on Development & Disability, Oregon Health & Science University, Portland, OR, USA.
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