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González F, Baeza F, Valdebenito R, Sánchez BN, Diez-Roux A, Vives A. Improvements in habitability and housing satisfaction after dwelling regeneration in social housing complexes. The RUCAS study. Soc Sci Med 2024; 355:117090. [PMID: 39018996 PMCID: PMC11364156 DOI: 10.1016/j.socscimed.2024.117090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 07/19/2024]
Abstract
Housing is a pressing problem worldwide and a key determinant of health and wellbeing. The right to adequate housing, as a pillar of the right to an adequate standard of living, means more than a roof to live under. Adequate means the dwelling must fulfill material functions and psychosocial functions, thus contributing to dwellers health and wellbeing. Social housing policies aim to fulfill the right to housing, but frequently fail in fulfilling the right to it being adequate. This study capitalizes on the implementation of a national urban regeneration program in two social housing villas in central Chile (one in Santiago, in the central valley, the other in Viña del Mar, a coastal city) to run a natural experiment assessing the impact of dwelling renovation on several dimensions of perceived habitability and housing satisfaction among the -mostly female-household homemakers. We use 5 waves of survey data collected with a step-wedge design to estimate the association between a time-varying exposure status (the intervention) and 7 binary outcomes for habitability and 5 for housing dissatisfaction, including overall housing satisfaction. We use Poisson regression models with robust variance and a random intercept at the respondent level. At baseline, reports of poor habitability and dissatisfaction across all features were markedly high, the highest levels of dissatisfaction being with acoustic insulation and dwelling size in both villas, and with indoor temperature in Santiago. The intervention resulted in statistically significant and markedly large improvements in reported habitability and dissatisfaction relative to those housing components targeted by the intervention, as well as with overall dwelling satisfaction in both study cases. Implications are, first, that the policy response to quantitative housing deficits must not overlook housing quality; second, that housing renovation appears as a promising intervention for qualitative housing crises; third, that while improvements in habitability and satisfaction are specific to the interventions in place, overall housing satisfaction can improve in more limited, tailored, dwelling renovation interventions. Social housing renovation in Latin America appears as a promising intervention to improve quality of life among the urban poor dwellers and reduce inequalities in health related to housing conditions.
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Affiliation(s)
- F González
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - F Baeza
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Chile; Institute of Geography, Pontificia Universidad Católica de Chile, Chile
| | - R Valdebenito
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - B N Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - A Diez-Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - A Vives
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Chile; Centre for Sustainable Urban Development, CEDEUS, Chile.
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Bartoll-Roca X, López MJ, Pérez K, Artazcoz L, Borrell C. Short-term health effects of an urban regeneration programme in deprived neighbourhoods of Barcelona. PLoS One 2024; 19:e0300470. [PMID: 38630702 PMCID: PMC11023398 DOI: 10.1371/journal.pone.0300470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
Urban regeneration programmes are interventions meant to enhance the wellbeing of residents in deprived areas, although empirical evidence reports mixed results. We evaluated the health impact of a participatory and neighbourhood-wide urban regeneration programme, Pla de Barris 2016-2020, in Barcelona. A pre-post with a comparison group study design. Using data from a cross-sectional survey performed in 2016 and 2021. The health outcomes analysed were mental health, alcohol and psychotropic drug use, perceived health status, physical activity and obesity. Depending on the investment, two intervention groups were defined: moderate- and high-intensity intervention groups. The analysis combined difference-in-difference estimation with an inverse weighting derived from a propensity score to reduce potential biases. The impact of the intervention in percentages and its confidence interval were estimated with a linear probability model with clustered adjusted errors. The intervention had a positive impact on health outcomes in women in the high-intensity intervention group: a reduction of 15.5% in the relative frequency of those experiencing poor mental health, and of 21.7% in the relative frequency of those with poor self-perceived health; and an increase of 13.7% in the relative frequency of those doing physical activity. No positive impact was observed for men, but an increase of 10.3% in the relative frequency of those using psychotropic drugs in the high-intensity intervention group. This study shows positive short-term effects of the urban regeneration programme Pla de Barris 2016-2020 on health outcomes in women in the high-intensity intervention group. These results can guide future interventions in other areas.
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Affiliation(s)
- Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Catalunya, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - María José López
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Catalunya, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Catalunya, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Lucía Artazcoz
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Catalunya, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Catalunya, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Valdebenito R, Angelini F, Schmitt C, Baeza F, Cortinez-O'Ryan A, González F, Vives-Vergara A. [Developing tools to study the health impact of urban transformations in high vulnerability contexts: the RUCAS study]. CAD SAUDE PUBLICA 2023; 39:e00148322. [PMID: 37132718 DOI: 10.1590/0102-311xes148322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/02/2023] [Indexed: 05/04/2023] Open
Abstract
This article describes the design and characteristics of a questionnaire and an intradomiciliary observation tool developed to assess the housing-neighborhood-health relationship both cross-sectionally and longitudinally in the context of urban transformations carried out in populations of high socio-territorial vulnerability. The instruments were developed for the multi-method longitudinal study RUCAS (Urban Regeneration, Quality of Life and Health), a natural experiment aiming to assess the quality of life and health impact of a comprehensive Urban Regeneration Program in two social housing complexes in Chile. The design of the instruments followed four main stages: (1) narrative review of the literature to define the dimensions of the study, and of existing measurement instruments to identify appropriate items for measuring them; (2) content validation with experts; (3) pre-test; and (4) pilot study. The resulting questionnaire, composed of 262 items, considers the different stages of the life course and gender issues. The intradomiciliary observation tool (77 items) is applied by the interviewer. The instruments assess (i) characteristics of the current residential situation that are known to affect health and will be intervened by the program; (ii) dimensions of health potentially affected by the residential situation and/or by the intervention within the time frame of the study (4 years); (iii) other health and health-related conditions that are relevant, even if changes will not be modified within the time frame of the study; and (iv) relevant socioeconomic, occupational and demographic dimensions. The instruments have shown to be capable of addressing the multidimensionality of urban transformation processes in contexts of urban poverty in formal housing.
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Affiliation(s)
- Roxana Valdebenito
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Flavia Angelini
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Schmitt
- Escuela de Arquitectura, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Geografía, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Baeza
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Educación Física, Deportes y Recreación, Universidad de la Frontera, Temuco, Chile
| | - Andrea Cortinez-O'Ryan
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
- Facultad de Arquitectura, Artes y Diseño, Universidad Católica de Temuco, Temuco, Chile
| | - Francisca González
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Vives-Vergara
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Desarrollo Urbano Sustentable, Pontificia Universidad Católica de Chile, Santiago, Chile
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Nygaard SS, Høj Jørgensen TS, Srivarathan A, Brønnum-Hansen H, Kivikoski C, Kristiansen M, Lund R. Association Between Urban Regeneration and Healthcare-Seeking Behavior of Affected Residents: A Natural Experiment in two Multi-Ethnic Deprived Housing Areas in Denmark. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022:207314221126283. [PMID: 36121903 DOI: 10.1177/00207314221126283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Area regeneration of deprived neighborhoods is being used to reduce health inequality, socioeconomic deprivation and ethnic segregation. This quasi-experimental study examines if long-term graded exposure to urban regeneration is associated with primary healthcare-seeking behavior among residents. We compared general practitioner (GP) contacts from 2015-2020 in two adjacent, deprived social housing areas, one exposed to area regeneration. Populations were into Western and non-Western males and females aged 15 years and older (N = 3,960). Mean annual GP contact frequency for each group were estimated and a difference-in-difference (DiD) analysis was conducted with adjustments for propensity scores based on baseline characteristics. GP contact frequency increased for all groups across time with a systematically higher level and faster increase in the control groups. In particular, the mean difference between the exposed and control area for non-Western women more than doubled from -0.61 to -1.47 annual contacts across the period. The mean differences in contact frequency increased for all groups but results of the DiD analyses were insignificant. In conclusion, an emerging gap in GP contact frequency, with the highest levels in the control area, was observed for all comparisons across time. More long-term research is needed to understand how the emerging gaps evolve.
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Affiliation(s)
- Siv Steffen Nygaard
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Terese Sara Høj Jørgensen
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Abirami Srivarathan
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Brønnum-Hansen
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Kivikoski
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Faculty of Health and Medical Sciences, Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Ruijsbroek A, Wong A, den Hertog F, Droomers M, van den Brink C, Kunst AE, van Oers HAM, Stronks K. Do inhabitants profit from integrating a public health focus in urban renewal programmes? A Dutch case study. PLoS One 2022; 17:e0270367. [PMID: 35749511 PMCID: PMC9232143 DOI: 10.1371/journal.pone.0270367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Urban renewal traditionally involves policy sectors such as housing, transport, and employment, which potentially can enhance the health of residents living in deprived areas. Additional involvement of the public health sector might increase the health impact of these urban renewal activities. This study evaluates the health impact of an additional focus on health, under the heading of Healthy District Experiments (HDE), within districts where an urban renewal programme was carried out. Methods We evaluated changes in health outcomes before the start of the HDE and after implementation, and compared these changes with health changes in control areas, e.g. districts from the urban renewal programme where no additional HDE was implemented. Additionally, we gathered information on the content of the experiments to determine what types of activities have been implemented. Results The additional activities from the HDE were mostly aimed at strengthening the health care in the districts and at promoting physical activity. When we compared the prevalence in general health, mental health, overweight, obesity, smoking, and physical activity during the study period between the HDE districts and control districts, we found no significant differences in the rate of change. The study is limited by a small sample size and the cross-sectional nature of the data. These and other limitations are discussed. Conclusion We found no evidence for a beneficial health impact of the activities that were initiated with a specific focus on health, within a Dutch urban renewal programme. Specific attention for network management and the integration of such activities in the wider programme, as well as an allocated budget might be needed in order to sort a health impact.
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Affiliation(s)
- Annemarie Ruijsbroek
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- * E-mail:
| | - Albert Wong
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Frank den Hertog
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mariël Droomers
- Department of Public Health, Municipality of Utrecht, Utrecht, The Netherlands
| | - Carolien van den Brink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Anton E. Kunst
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans A. M. van Oers
- Tranzo, Faculty of Social Sciences, University of Tilburg, Tilburg, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Baeza F, Vives Vergara A, González F, Orlando L, Valdebenito R, Cortinez-O’Ryan A, Slesinski C, Diez Roux AV. The Regeneración Urbana, Calidad de Vida y Salud - RUCAS project: a Chilean multi-methods study to evaluate the impact of urban regeneration on resident health and wellbeing. BMC Public Health 2021; 21:728. [PMID: 33858373 PMCID: PMC8047526 DOI: 10.1186/s12889-021-10739-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The available evidence of the health effects of urban regeneration is scarce In Latin America, and there are no studies focused on formal housing that longitudinally evaluate the impact of housing and neighborhood interventions on health. The "Regeneración Urbana, Calidad de Vida y Salud" (Urban Regeneration, Quality of Life, and Health) or RUCAS project is a longitudinal, multi-method study that will evaluate the impact of an intervention focused on dwellings, built environment and community on the health and wellbeing of the population in two social housing neighborhoods in Chile. METHODS RUCAS consists of a longitudinal study where inhabitants exposed and unexposed to the intervention will be compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms. Proximal and more distal intervention effects will be measured with five instruments, implemented pre- and post-interventions between 2018 and 2021: a household survey, an observation tool to evaluate dwelling conditions, hygrochrons for measuring temperature and humidity inside dwellings, systematic observation of recreational areas, and qualitative interviews. Survey baseline data (956 households, 3130 individuals) is presented to describe sociodemographics, housing and health characteristics of both cohorts, noting that neighborhoods studied show worse conditions than the Chilean population. DISCUSSION RUCAS' design allows for a comprehensive evaluation of the effects that the intervention could have on various dimensions of health and health determinants. RUCAS will face some challenges, like changes in the intervention process due to adjustments of the master plan, exogenous factors -including COVID-19 pandemic and associated lockdowns- and lost to follow-up. Given the stepped wedge design, that the study capitalizes on within household changes over time, the possibility of adjusting data collection process and complementarity of methods, RUCAS has the flexibility to adapt to these circumstances. Also, RUCAS' outreach and retention strategy has led to high retention rates. RUCAS will provide evidence to inform regeneration processes, highlighting the need to consider potential health effects of regeneration in designing such interventions and, more broadly, health as a key priority in urban and housing policies.
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Affiliation(s)
- Fernando Baeza
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
- Institute of Geography, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, 7820436 Santiago, Chile
| | - Alejandra Vives Vergara
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
- Centre for Sustainable Urban Development (CEDEUS), Los Navegantes 1963, 7520246 Santiago, Chile
| | - Francisca González
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
| | - Laura Orlando
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
| | - Roxana Valdebenito
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
| | - Andrea Cortinez-O’Ryan
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
- Department of Physical Education, Sports and Recreation, Universidad de La Frontera, Moneda 673, 8320216 Santiago, Chile
| | - Claire Slesinski
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104 USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104 USA
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Kearns A, Ghosh S, Mason P, Egan M. Urban regeneration and mental health: Investigating the effects of an area-based intervention using a modified intention to treat analysis with alternative outcome measures. Health Place 2020; 61:102262. [PMID: 32329728 DOI: 10.1016/j.healthplace.2019.102262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
Abstract
A quasi-experimental study of the mental health impacts of regeneration was carried out across fifteen communities in Glasgow, UK, grouped into five and then four types of intervention area. Regression modelling was undertaken to examine the effects of living in each type of area upon mental health (MCS-12 and SF-12 MH) and mental wellbeing (WEMWBS). Living in regeneration areas had no impacts on mental health or wellbeing, possibly due to incomplete implementation. Positive impacts from living in areas of housing improvement were not evident separately for areas of high-rise housing. Areas surrounding regeneration areas exhibited gains in mental health and wellbeing, contrary to notions of negative spillover. Moving between areas had negative effects, especially for those moving beyond the study areas. Changes in mental wellbeing appear less substantial compared with changes in mental health.
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Affiliation(s)
- Ade Kearns
- Urban Studies, School of Social and Political Sciences, University of Glasgow, 25 Bute Gardens, Glasgow, G12 0NU, UK.
| | - Seemanti Ghosh
- Urban Studies, School of Social and Political Sciences, University of Glasgow, 25 Bute Gardens, Glasgow, G12 0NU, UK.
| | - Phil Mason
- School of Education, Room 7/403, Urban Big Data Centre, 7 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Matt Egan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, Room 146, LSHTM, 15-17, Tavistock Place, London, WC1H 9SH, UK.
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Buregeya JM, Loignon C, Brousselle A. Contribution to healthy places: Risks of equity free health impact assessment. EVALUATION AND PROGRAM PLANNING 2019; 73:138-145. [PMID: 30622062 DOI: 10.1016/j.evalprogplan.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/09/2018] [Accepted: 12/22/2018] [Indexed: 06/09/2023]
Abstract
While health equity is central to health impact assessment [HIA], in reality, less is known about potential impacts of equity-free HIA on social inequalities. We assessed equity-free HIA case in a small city east of Montreal, which took place in a context of urban revitalization. We applied a combination of a quantitative review of community characteristics with a qualitative descriptive approach based on in-depth semi-structured interviews and a focus group with multiple stakeholders to shed light on the pitfalls of equity-free HIA. Our results pointed to gentrification process with a gradual relocation of low-income residents in the end. To mitigate mediating circumstances of gentrification and displacement, the municipality should support social housing or at least should ensure rent stabilization ordinance.
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Affiliation(s)
- Jean Marie Buregeya
- Clinical Sciences Program at the Research Centre Charles-LeMoyne - Saguenay-Lac-Saint-Jean, Faculty of Medicine and Health Sciences, Sherbrooke University, Longueuil Campus, Canada.
| | - Christine Loignon
- Department of Family Medicine at the Faculty of Medicine and Health Sciences, Sherbrooke University, Research Centre Charles-LeMoyne - Saguenay-Lac-Saint-Jean, Longueuil, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria -Victoria, Canada, Department of Community Health, Faculty of Medicine and Health Sciences, Sherbrooke University, Research Centre Charles-LeMoyne - Saguenay-Lac-Saint-Jean, Longueuil, Canada
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Does selective migration bias the health impact assessment of urban regeneration programmes in cross-sectional studies? Findings from a Dutch case study. Health Place 2018; 55:155-164. [PMID: 30591231 DOI: 10.1016/j.healthplace.2018.11.007] [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] [Received: 07/09/2018] [Revised: 11/01/2018] [Accepted: 11/21/2018] [Indexed: 11/21/2022]
Abstract
We examined if the assessment of the health impact of a national Dutch regeneration programme depends on using either a repeated cross-sectional or longitudinal study design. This is important as only the latter design can incorporate migration patterns. For both designs, we compared trends in medication use between target and control districts. We found differences in medication use trends to be modest under the longitudinal design, and not demonstrable under the repeated cross-sectional design. The observed differences were hardly influenced by migration patterns. We conclude that in the Netherlands migration patterns had little effect on the health impact assessment of this national urban regeneration programme, so either the cross-sectional or longitudinal evaluation study design will do.
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Moore THM, Kesten JM, López-López JA, Ijaz S, McAleenan A, Richards A, Gray S, Savović J, Audrey S. The effects of changes to the built environment on the mental health and well-being of adults: Systematic review. Health Place 2018; 53:237-257. [PMID: 30196042 DOI: 10.1016/j.healthplace.2018.07.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
There is increasing interest in the influence of place on health, and the need to distinguish between environmental and individual level factors. For environmental-level factors, current evidence tends to show associations through cross-sectional and uncontrolled longitudinal analyses rather than through more robust study designs that can provide stronger causal evidence. We restricted this systematic review to randomised (or cluster) randomised controlled trials and controlled before-and-after studies of changes to the built environment. Date of search was December 2016. We identified 14 studies. No evidence was found of an effect on mental health from 'urban regeneration' and 'improving green infrastructure' studies. Beneficial effects on quality-of-life outcomes from 'improving green infrastructure' were found in two studies. One 'improving green infrastructure' study reported an improvement in social isolation. Risk-of-bias assessment indicated robust data from only four studies. Overall, evidence for the impact of built environment interventions on mental health and quality-of-life is weak. Future research requires more robust study designs and interdisciplinary research involving public health, planning and urban design experts.
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Affiliation(s)
- T H M Moore
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - J M Kesten
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, Bristol Medical School, University of Bristol, UK
| | - J A López-López
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S Ijaz
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - A McAleenan
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - A Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK
| | - S Gray
- Department of Health and Applied Social Science, University of the West of England, Bristol BS16 1QY, UK
| | - J Savović
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - S Audrey
- Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
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Clark C, Smuk M, Cummins S, Eldridge S, Fahy A, Lewis D, Moore DG, Smith N, Taylor SJC, Stansfeld SA. An Olympic Legacy? Did the Urban Regeneration Associated With the London 2012 Olympic Games Influence Adolescent Mental Health? Am J Epidemiol 2018; 187:474-483. [PMID: 28595334 DOI: 10.1093/aje/kwx205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 03/21/2017] [Indexed: 11/13/2022] Open
Abstract
Public expenditure on large events such as the London 2012 Olympic Games is often justified by the potential legacy of urban regeneration and its associated health and well-being benefits for local communities. In the Olympic Regeneration in East London Study, we examined whether there was an association between urban regeneration related to the 2012 Games and improved mental health in young people. Adolescents aged 11-12 years attending schools in the Olympic host borough of Newham in London or in 3 adjacent comparison London boroughs completed a survey before the 2012 Games and 6 and 18 months after the Games (in 2013 and 2014, respectively). Changes in depressive symptoms and well-being between baseline and each follow-up were examined. A total of 2,254 adolescents from 25 randomly selected schools participated. Adolescents from Newham were more likely to have remained depressed between baseline and the 6- and 18-month follow-up surveys (for 6-month follow-up, relative risk = 1.78, 95% confidence interval: 1.12, 2.83; for 18-month follow-up, relative risk = 1.93, 95% confidence interval: 1.01, 3.70) than adolescents from the comparison boroughs. No differences in well-being were observed. There was little evidence that urban regeneration had any positive influence on adolescent mental health and some suggestion that regeneration may have been associated with maintenance of depressive symptoms. Such programs may have limited short-term impact on the mental health of adolescents.
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Affiliation(s)
- Charlotte Clark
- Centre for Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Melanie Smuk
- Centre for Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Amanda Fahy
- Centre for Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Daniel Lewis
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Derek G Moore
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Neil Smith
- Centre for Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Stephen A Stansfeld
- Centre for Psychiatry, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
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Lake AA, Henderson EJ, Townshend TG. Exploring planners’ and public health practitioners’ views on addressing obesity: lessons from local government in England. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23748834.2017.1393243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Amelia A. Lake
- Department of Science, School of Science, Engineering and Design, Teesside University , Middlesbrough, UK
- Fuse – UKCRC Centre for Translational Research in Public Health , Newcastle, UK
| | - Emily J. Henderson
- Fuse – UKCRC Centre for Translational Research in Public Health , Newcastle, UK
- Institute of Health and Society, Newcastle University , Newcastle upon Tyne, UK
| | - Tim G. Townshend
- School of Architecture, Planning and Landscape, Newcastle University , Newcastle upon Tyne, UK
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13
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Panter J, Guell C, Prins R, Ogilvie D. Physical activity and the environment: conceptual review and framework for intervention research. Int J Behav Nutr Phys Act 2017; 14:156. [PMID: 29141646 PMCID: PMC5688667 DOI: 10.1186/s12966-017-0610-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 11/01/2017] [Indexed: 01/19/2023] Open
Abstract
Background Changing the physical environment is one way to promote physical activity and improve health, but evidence on intervention effectiveness is mixed. The theoretical perspectives and conceptual issues discussed or used in evaluative studies and related literature may contribute to these inconsistencies. We aimed to advance the intervention research agenda by systematically searching for and synthesising the literature pertaining to these wider conceptual issues. Methods We searched for editorials, commentaries, reviews, or primary qualitative or quantitative studies in multiple disciplines by electronic searches of key databases (MEDLINE and MEDLINE In-Process, Web of Science, Cochrane Reviews, ProQuest for dissertations, Health Evidence, EPPI-Centre, TRID and NICE) and snowballing. We extracted theoretical and conceptual material and used thematic analysis in an in-depth, configurative narrative approach to synthesis. Results Our initial searches identified 2760 potential sources from fields including public health, sociology, behavioural science and transport, of which 104 were included. By first separating out and then drawing together this material, we produced a synthesis that identified five high-level conceptual themes: one concerning outcomes (physical activity as a behaviour and a socially embedded practice), one concerning exposures (environmental interventions as structural changes) and three concerning how interventions bring about their effects (the importance of social and physical context; (un) observable mechanisms linking interventions and changes in physical activity; and interventions as events in complex systems). These themes are inter-related but have rarely been considered together in the disparate literatures. Drawing on these insights, we present a more generalisable way of thinking about how environmental interventions work which could be used in future evaluation studies. Conclusions Environmental and policy interventions are socially embedded and operate within a system. Evaluators should acknowledge this, and the philosophical perspective taken in their evaluation. Across disciplinary fields, future studies should seek to understand how interventions work through considering these systems, the context in which interventions take place, and the (un) observable mechanisms that may operate. This will help ensure that findings can be more easily interpreted and widely applied by policymakers. We hope that highlighting these conceptual issues will help others to interpret and improve upon a somewhat contested evidence base. Electronic supplementary material The online version of this article (doi: 10.1186/s12966-017-0610-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenna Panter
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), Box 285, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SR, UK.
| | - Cornelia Guell
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), Box 285, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Rick Prins
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), Box 285, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SR, UK
| | - David Ogilvie
- MRC Epidemiology Unit & Centre for Diet and Activity Research (CEDAR), Box 285, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SR, UK
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14
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Serrano E, Larrañaga I, Morteruel M, Baixas de Ros MD, Basterrechea M, Martinez D, Aldasoro E, Bacigalupe A. Urban regeneration as population health intervention: a health impact assessment in the Bay of Pasaia (Spain). Int J Equity Health 2016; 15:145. [PMID: 27628650 PMCID: PMC5024480 DOI: 10.1186/s12939-016-0424-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background An important health issue in urban areas is how changes arising from the regeneration of city-areas affect social determinants of health and equity. This paper examines the impacts attributable to a new fish market and to delays in the regeneration of a port area in a deteriorated region of the Bay of Pasaia (Spain). Potential differential impacts on local residents and socially vulnerable groups were evaluated to determine health inequalities. Methods An in-depth, prospective and concurrent Health-Impact-Assessment (HIA) focused on equity was conducted by the regional Public Health Department, following the Merseyside guidelines. Data from different sources was triangulated and impacts were identified using qualitative and quantitative methods. Results The intervention area is characterised by poor social, environmental, and health indicators. The distinctness of the two projects generates contrasting health and inequality impacts: generally positive for the new fish market and negative for the port area. The former creates recreational spaces and improves urban quality and social cohesion. By contrast, inaction and stagnation of the project in the port area perpetuates deterioration, a lack of safety, and poor health, as well as increased social frustration. Conclusions In addition to assessing the health impacts of both projects this HIA promoted intersectoral partnerships, boosted a holistic and positive view of health and incorporated health and equity into the political discourse. Community-level participatory action enabled public health institutions to respond to new urban planning challenges and responsibilities in a more democratic manner.
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Affiliation(s)
- Elena Serrano
- Public Health and Addictions Division of Gipuzkoa, Regional Public Health Centre Bidasoa, Basque Government, Avd. Navarra, 41-20302, Irún, Spain.
| | - Isabel Larrañaga
- Public Health and Addictions Division of Gipuzkoa, Basque Government, Avd. Navarra 4, 20013, San Sebastian, Spain.,BIODONOSTIA Health Research Institute, San Sebastian, Spain
| | | | | | - Mikel Basterrechea
- Public Health and Addictions Division of Gipuzkoa, Basque Government, Avd. Navarra 4, 20013, San Sebastian, Spain.,BIODONOSTIA Health Research Institute, San Sebastian, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Barcelona, Spain
| | - Dolores Martinez
- BIODONOSTIA Health Research Institute, San Sebastian, Spain.,Department of Environment and Regional Planning, Basque Government, c/Infanta Cristina. 11- Villa Begoña, 20008, San Sebastian, Gipuzkoa, Spain
| | - Elena Aldasoro
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), Barcelona, Spain.,Public Health and Addictions Directorate, Basque Government, Vitoria-Gasteiz, Spain
| | - Amaia Bacigalupe
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain.,OPIK- Research Group Social Determinants of Health and Demographic Change, Leioa, Spain
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15
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Friche AADL, Dias MADS, Reis PBD, Dias CS, Caiaffa WT. Urban upgrading and its impact on health: a "quasi-experimental" mixed-methods study protocol for the BH-Viva Project. CAD SAUDE PUBLICA 2016; 31 Suppl 1:51-64. [PMID: 26648363 DOI: 10.1590/0102-311x00079715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/09/2015] [Indexed: 11/21/2022] Open
Abstract
There is little scientific evidence that urban upgrading helps improve health or reduce inequities. This article presents the design for the BH-Viva Project, a "quasi-experimental", multiphase, mixed-methods study with quantitative and qualitative components, proposing an analytical model for monitoring the effects that interventions in the urban environment can have on residents' health in slums in Belo Horizonte, Minas Gerais State, Brazil. A preliminary analysis revealed intra-urban differences in age-specific mortality when comparing areas with and without interventions; the mortality rate from 2002 to 2012 was stable in the "formal city", increased in slums without interventions, and decreased in slums with interventions. BH-Viva represents an effort at advancing methodological issues, providing learning and theoretical backing for urban health research and research methods, allowing their application and extension to other urban contexts.
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Affiliation(s)
| | | | - Priscila Brandão Dos Reis
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Cláudia Silva Dias
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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16
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Egan M, Kearns A, Katikireddi SV, Curl A, Lawson K, Tannahill C. Proportionate universalism in practice? A quasi-experimental study (GoWell) of a UK neighbourhood renewal programme's impact on health inequalities. Soc Sci Med 2016; 152:41-9. [PMID: 26829008 DOI: 10.1016/j.socscimed.2016.01.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/17/2015] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
Recommendations to reduce health inequalities frequently emphasise improvements to socio-environmental determinants of health. Proponents of 'proportionate universalism' argue that such improvements should be allocated proportionally to population need. We tested whether city-wide investment in urban renewal in Glasgow (UK) was allocated to 'need' and whether this reduced health inequalities. We identified a longitudinal cohort (n = 1006) through data linkage across surveys conducted in 2006 and 2011 in 14 differentially disadvantaged neighbourhoods. Each neighbourhood received renewal investment during that time, allocated on the basis of housing need. We grouped neighbourhoods into those receiving 'higher', 'medium' or 'lower' levels of investment. We compared residents' self-reported physical and mental health between these three groups over time using the SF-12 version 2 instrument. Multiple linear regression adjusted for baseline gender, age, education, household structure, housing tenure, building type, country of birth and clustering. Areas receiving higher investment tended to be most disadvantaged in terms of baseline health, income deprivation and markers of social disadvantage. After five years, mean mental health scores improved in 'higher investment' areas relative to 'lower investment' areas (b = 4.26; 95% CI = 0.29, 8.22; P = 0.036). Similarly, mean physical health scores declined less in high investment compared to low investment areas (b = 3.86; 95% CI = 1.96, 5.76; P < 0.001). Relative improvements for medium investment (compared to lower investment) areas were not statistically significant. Findings suggest that investment in housing-led renewal was allocated according to population need and this led to modest reductions in area-based inequalities in health after five years. Study limitations include a risk of selection bias. This study demonstrates how non-health interventions can, and we believe should, be evaluated to better understand if and how health inequalities can be reduced through strategies of allocating investment in social determinants of health according to need.
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Affiliation(s)
- Matt Egan
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ade Kearns
- Urban Studies, University of Glasgow, Glasgow, UK.
| | - Srinivasa V Katikireddi
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Angela Curl
- Urban Studies, University of Glasgow, Glasgow, UK.
| | - Kenny Lawson
- College of Public Health, Medical & Vet Sciences, James Cook University, Queensland, Australia.
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17
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Fernandes AP, Andrade ACDS, Ramos CGC, Friche AADL, Dias MADS, Xavier CC, Proietti FA, Caiaffa WT. Leisure-time physical activity in the vicinity of Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil: the impact of a health promotion program on the community. CAD SAUDE PUBLICA 2015; 31 Suppl 1:195-207. [DOI: 10.1590/0102-311x00104514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/14/2014] [Indexed: 11/22/2022] Open
Abstract
Abstract This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the program’s potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.
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Affiliation(s)
- Amanda Paula Fernandes
- Universidade Federal de Minas Gerais, Brasil; Observatório de Saúde Urbana de Belo Horizonte, Brasil
| | | | | | | | | | - César Coelho Xavier
- Observatório de Saúde Urbana de Belo Horizonte, Brasil; Faculdade de Saúde e Ecologia Humana, Brasil
| | | | - Waleska Teixeira Caiaffa
- Universidade Federal de Minas Gerais, Brasil; Observatório de Saúde Urbana de Belo Horizonte, Brasil
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