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San Diego ERN, West NT, Pichon LC, Jiang Y, Powell TW, Rugless F, Lewis J, Campbell B, McCann L, McNeals S, Harmon BE. Associations Between Sociodemographic Variables, Social Determinants of Health, and Diabetes: Findings From a Congregational Health Needs Assessment. Am J Health Promot 2024; 38:809-819. [PMID: 38395415 DOI: 10.1177/08901171241234662] [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] [Indexed: 02/25/2024]
Abstract
PURPOSE To examine associations between sociodemographic variables, social determinants of health (SDOHs) and diabetes using health needs assessment data. DESIGN Cross-sectional study. SETTING Faith-based communities in the Mid-South U.S. SAMPLE Of the 378 churches, 92 participated in the study (24% response rate); N = 828 church leaders and members completed the survey. MEASURE The Mid-South Congregational Health Survey assessed perceived health-related needs of congregations and the communities they serve. ANALYSIS Generalized linear mixed modeling examined the associations between sociodemographic variables (age, sex, race/ethnicity, educational level), SDOHs (affordable healthcare, healthy food, employment), and diabetes. RESULTS Individuals with less education had lower odds of reporting all SDOHs as health needs compared to individuals with more education (ORrange = .59-.63). Men had lower odds of reporting diabetes as a health need or concern compared to women (OR = .70; 95% CI = .50, .97). African Americans had greater odds of reporting diabetes as a health need compared to individuals in the 'Other' race/ethnicity category (OR = 3.91; 95% CI = 2.20, 6.94). Individuals who reported affordable healthcare (OR = 2.54; 95% CI = 1.73, 3.72), healthy food (OR = 2.24; 95% CI = 1.55, 3.24), and employment (OR = 3.33; 95% CI = 2.29, 4.84) as health needs had greater odds of reporting diabetes as a health need compared to those who did not report these SDOHs as needs. CONCLUSIONS Future studies should evaluate strategies to merge healthcare and faith-based organizations' efforts to address SDOHs impacting diabetes.
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Affiliation(s)
- Emily Rose N San Diego
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Nathan T West
- Institute of Social and Economic Research, University of Alaska, Anchorage, AK, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, University of Memphis School of Public Health, Memphis, TN, USA
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, TN, USA
| | - Terrinieka W Powell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fedoria Rugless
- Population Health Department, Amerigroup, Nashville, TN, USA
| | - Jonathan Lewis
- Community Partnerships, Methodist Le Bonheur Healthcare, Memphis, TN, USA
| | - Bettina Campbell
- Oak Hill Regional Community Development Center, Hernando, MS, USA
| | - Lauren McCann
- Le Bonheur Pediatrics, Le Bonheur Children's Hospital, Memphis, TN, USA
| | | | - Brook E Harmon
- Department of Nutrition and Healthcare Management, Appalachian State University, Boone, NC, USA
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Ganasegeran K, Abdul Manaf MR, Safian N, Waller LA, Abdul Maulud KN, Mustapha FI. GIS-Based Assessments of Neighborhood Food Environments and Chronic Conditions: An Overview of Methodologies. Annu Rev Public Health 2024; 45:109-132. [PMID: 38061019 DOI: 10.1146/annurev-publhealth-101322-031206] [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] [Indexed: 05/22/2024]
Abstract
The industrial revolution and urbanization fundamentally restructured populations' living circumstances, often with poor impacts on health. As an example, unhealthy food establishments may concentrate in some neighborhoods and, mediated by social and commercial drivers, increase local health risks. To understand the connections between neighborhood food environments and public health, researchers often use geographic information systems (GIS) and spatial statistics to analyze place-based evidence, but such tools require careful application and interpretation. In this article, we summarize the factors shaping neighborhood health in relation to local food environments and outline the use of GIS methodologies to assess associations between the two. We provide an overview of available data sources, analytical approaches, and their strengths and weaknesses. We postulate next steps in GIS integration with forecasting, prediction, and simulation measures to frame implications for local health policies.
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Affiliation(s)
- Kurubaran Ganasegeran
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; ,
- Clinical Research Center, Seberang Jaya Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; ,
| | - Nazarudin Safian
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; ,
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Khairul Nizam Abdul Maulud
- Earth Observation Centre (EOC), Institute of Climate Change, Universiti Kebangsaan Malaysia, Selangor Darul Ehsan, Malaysia
- Department of Civil Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia, Selangor Darul Ehsan, Malaysia
| | - Feisul Idzwan Mustapha
- Public Health Division, Perak State Health Department, Ministry of Health Malaysia, Perak, Malaysia
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3
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India-Aldana S, Kanchi R, Adhikari S, Lopez P, Schwartz MD, Elbel BD, Rummo PE, Meeker MA, Lovasi GS, Siegel KR, Chen Y, Thorpe LE. Impact of land use and food environment on risk of type 2 diabetes: A national study of veterans, 2008-2018. ENVIRONMENTAL RESEARCH 2022; 212:113146. [PMID: 35337829 PMCID: PMC10424702 DOI: 10.1016/j.envres.2022.113146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Large-scale longitudinal studies evaluating influences of the built environment on risk for type 2 diabetes (T2D) are scarce, and findings have been inconsistent. OBJECTIVE To evaluate whether land use environment (LUE), a proxy of neighborhood walkability, is associated with T2D risk across different US community types, and to assess whether the association is modified by food environment. METHODS The Veteran's Administration Diabetes Risk (VADR) study is a retrospective cohort of diabetes-free US veteran patients enrolled in VA primary care facilities nationwide from January 1, 2008, to December 31, 2016, and followed longitudinally through December 31, 2018. A total of 4,096,629 patients had baseline addresses available in electronic health records that were geocoded and assigned a census tract-level LUE score. LUE scores were divided into quartiles, where a higher score indicated higher neighborhood walkability levels. New diagnoses for T2D were identified using a published computable phenotype. Adjusted time-to-event analyses using piecewise exponential models were fit within four strata of community types (higher-density urban, lower-density urban, suburban/small town, and rural). We also evaluated effect modification by tract-level food environment measures within each stratum. RESULTS In adjusted analyses, higher LUE had a protective effect on T2D risk in rural and suburban/small town communities (linear quartile trend test p-value <0.001). However, in lower density urban communities, higher LUE increased T2D risk (linear quartile trend test p-value <0.001) and no association was found in higher density urban communities (linear quartile trend test p-value = 0.317). Particularly strong protective effects were observed for veterans living in suburban/small towns with more supermarkets and more walkable spaces (p-interaction = 0.001). CONCLUSION Among veterans, LUE may influence T2D risk, particularly in rural and suburban communities. Food environment may modify the association between LUE and T2D.
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Affiliation(s)
- Sandra India-Aldana
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Rania Kanchi
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Samrachana Adhikari
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Priscilla Lopez
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Mark D Schwartz
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 9th Fl., New York, NY, 10016, USA; VA New York Harbor Healthcare System, 423 E 23rd, New York, NY, 10010, USA
| | - Brian D Elbel
- Division of Health and Behavior, Section on Health Choice, Policy and Evaluation, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 3rd Fl., New York, NY, 10016, USA; NYU Wagner Graduate School of Public Service, 295 Lafayette Street, New York, NY, 10012, USA
| | - Pasquale E Rummo
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Melissa A Meeker
- Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104, USA
| | - Gina S Lovasi
- Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104, USA
| | - Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorna E Thorpe
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA.
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Corona G, Dubowitz T, Troxel WM, Ghosh-Dastidar M, Rockette-Wagner B, Gary-Webb TL. Neighborhood Food Environment Associated with Cardiometabolic Health among Predominately Low-income, Urban, Black Women. Ethn Dis 2021; 31:537-546. [PMID: 34720557 DOI: 10.18865/ed.31.4.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives This study sought to: 1) understand how the perceived food environment (availability, accessibility, and affordability) is associated with cardiometabolic health outcomes in predominately low-income Black residents in urban neighborhoods with limited healthy food access; and 2) examine the association of shopping at specific store types with cardiometabolic health outcomes. Methods We report on cross-sectional data from 459 individuals participating in the Pittsburgh, PA Hill/Homewood Research on Neighborhoods and Health (PHRESH) study. Mean participant age was 60.7 (SD=13.9); 81.7% were female. We used logistic regression to examine associations between three factors (perceived fruit and vegetable availability, quality, and price; primary food shopping store characteristics; and frequency of shopping at stores with low or high access to healthy foods) and cardiometabolic and self-rated health. Results Adjusting for sociodemographic characteristics, participants with higher perceived fruit and vegetable accessibility (AOR:.47, 95%CI: .28-.79, P=.004) and affordability (AOR:.59, 95%CI: .36-.96, P=.034) had lower odds of high blood pressure. Shopping often (vs rarely) at stores with low access to healthy foods was associated with higher odds of high total cholesterol (AOR:3.52, 95%CI: 1.09-11.40, P=.035). Finally, primary food shopping at a discount grocery (vs full-service supermarket) was associated with lower odds of overweight/obesity (AOR:.51, 95%CI: .26-.99, P=.049). Conclusions These results suggest that both perceived accessibility and affordability of healthy foods are associated with reduced cardiometabolic risk factors in this urban, low-income predominantly Black population. Additionally, discount grocery stores may be particularly valuable by providing access and affordability of healthy foods in this population.
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Affiliation(s)
- Gabrielle Corona
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
| | - Tamara Dubowitz
- RAND Corporation, Behavior and Policy Sciences, Pittsburgh, PA
| | - Wendy M Troxel
- RAND Corporation, Behavior and Policy Sciences, Pittsburgh, PA
| | | | - Bonny Rockette-Wagner
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
| | - Tiffany L Gary-Webb
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
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Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, Thornton PL, Haire-Joshu D. Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care 2020; 44:dci200053. [PMID: 33139407 PMCID: PMC7783927 DOI: 10.2337/dci20-0053] [Citation(s) in RCA: 617] [Impact Index Per Article: 154.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Felicia Hill-Briggs
- Department of Medicine, Johns Hopkins University, Baltimore, MD
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Nancy E Adler
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Tiffany L Gary-Webb
- Departments of Epidemiology and Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | - Pamela L Thornton
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, St. Louis, MO
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6
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Dendup T, Feng X, O'Shaughnessy PY, Astell-Burt T. Role of perceived neighbourhood crime in the longitudinal association between perceived built environment and type 2 diabetes mellitus: a moderated mediation analysis. J Epidemiol Community Health 2020; 75:120-127. [PMID: 32967894 DOI: 10.1136/jech-2020-214175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/15/2020] [Accepted: 09/05/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND We examined to what extent perceived neighbourhood crime moderates, associations between type 2 diabetes mellitus (T2DM) and perceived local amenities, recreational facilities, footpaths and public transit, and potential mediation of environmental characteristics-T2DM association by physical activity, social contact, sleep and body mass index (BMI). METHODS The 45 and Up Study data of 36, 224 individuals collected from 2010 to 2015 were analysed in 2019 using multilevel logistic regression to examine the association between T2DM and clustering of unfavourable built environment, and any difference in the association with increasing unfavourable environment and area disadvantage. We performed causal mediation analyses stratified by crime to examine whether crime moderated the strength of identified local amenities-T2DM pathways. RESULTS The results showed that irrespective of crime, perceived lack of local amenities was associated with increased odds of developing T2DM, and BMI mediated 40% and 30.3% of this association among those who reported unsafe and safe daytime crime, respectively. The proportion mediated by BMI among those who reported unsafe and safe night-time crime was 27.3% and 35.1%, respectively. Walking mediated 5.7% of the local amenities-T2DM association among those who reported safe daytime crime. The odds of T2DM increased with rising unfavourable environment and area disadvantage. CONCLUSIONS The results suggest that the availability of neighbourhood amenities may lower T2DM risk by increasing walking and reducing BMI regardless of area crime. Policies to enhance access to local amenities and prevent crime, especially in disadvantaged areas, may support healthy behaviour and physical health that can potentially reduce T2DM risk.
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Affiliation(s)
- Tashi Dendup
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, University of Wollongong, Wollongong, NSW, Australia.,School of Population Health, University of New South Wales, Sydney, NSW, Australia.,Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia.,National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - P Y O'Shaughnessy
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, NSW, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, University of Wollongong, Wollongong, NSW, Australia .,Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia.,National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.,School of Public Health, Peking Union Medical College and The Chinese Academy of Medical Sciences, Beijing, China
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7
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Mann G, Cafer A, Kaiser K, Gordon K. Community resilience in a rural food system: documenting pathways to nutrition solutions. Public Health 2020; 186:157-163. [PMID: 32836005 DOI: 10.1016/j.puhe.2020.06.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/09/2020] [Accepted: 06/19/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe and determine the barriers and facilitators to food-related health behaviors of residents in a rural Mississippi Delta community. STUDY DESIGN Descriptive study of qualitative interviews. METHODS A non-random sample of 34 low-income, food-insecure adults residing in a rural Mississippi Delta community were interviewed using fuzzy cognitive mapping, a mixed methods approach. RESULTS Participants strongly emphasized the time restraints they faced in both procuring and preparing foods, due to substantial travel time required to procure groceries. Participants also identified key facilitators to healthy eating behaviors, including seasonal produce stands, foraging, fishing, home provisioning, and access to the local food pantry. These barriers and facilitators are highly interconnected with other influential factors including poverty, lack of health care, unemployment, and faith-based support systems. CONCLUSIONS While the connection between low food access and poor eating habits is well researched, this novel mixed-method approach details two important elements missing from the literature: (1) other factors often overlooked that mitigate or exacerbate this relationship and (2) the dynamic nature of the relationships between these factors, poor eating habits, and health. Additionally, this research examines these relationships in an underrepresented rural minority population where resources needed to mitigate poor health are often much more limited. Findings from this study are critical to health and food policy in Mississippi and more generally, rural communities.
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Affiliation(s)
- G Mann
- Department of Nutrition and Hospitality Management, University of Mississippi, University, 220 Lenoir Hall, Sorority Row, P.O. Box 1848, MS, 38677, USA.
| | - A Cafer
- Department of Sociology & Anthropology, University of Mississippi, University, 543 Lamar Hall, P.O. Box 1848, MS, 38677, USA.
| | - K Kaiser
- Department of Criminal Justice and Legal Studies, University of Mississippi, University, M302 Mayes Hall, P.O. Box 1848, MS, 38677, USA.
| | - K Gordon
- Department of Nutrition and Hospitality Management, University of Mississippi, University, 108 Lenoir Hall, Sorority Row, P.O. Box 1848, MS, 38677, USA.
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8
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A geospatial analysis of Type 2 Diabetes Mellitus and the food environment in urban New Zealand. Soc Sci Med 2020; 288:113231. [PMID: 32741687 DOI: 10.1016/j.socscimed.2020.113231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/13/2020] [Accepted: 07/16/2020] [Indexed: 11/23/2022]
Abstract
The aim of this research is to analyse the spatial epidemiology of Type 2 Diabetes Mellitus (T2DM) and investigate associations with the built environment in urban New Zealand. Data on T2DM was sourced from the New Zealand Virtual Diabetes Register (2016), and data on environmental variables sourced from the Ministry for Primary Industries and Territorial Authorities (2013-2016). Novel measures of the built environment using an enhanced two-step floating catchment area model were established using data on fast food outlets, takeaways, dairy/convenience stores, supermarkets and fruit/vegetable stores. Rates of T2DM per 1000 population and standardised morbidity ratios were computed and visualised for all urban areas. Getis Ord was used to assess spatial clustering, and Bayesian modelling was used to understand associations between T2DM and environmental variables. Results indicate that T2DM is influenced by demographic factors, spatially clustered and associated with accessibility to environmental exposures. Health-promoting resources, such as fruit/vegetable stores, were shown to have a consistently protective effect on T2DM while those considered detrimental to health showed varying, and largely insignificant, associations. This is the first study in New Zealand to spatially quantify the effects of multiple environmental exposures on population level T2DM for all urban areas using a geospatial approach. It has implications for both policy and future research efforts as a deeper knowledge of local environments forms a basis on which to better understand spatial associations between the built environment and health, as well as formulate policy directed toward environmental influences on chronic health conditions.
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Abstract
PURPOSE OF REVIEW To explore the relationship between the built environment and type 2 diabetes, considering both risk factors and policies to reduce risk. The built environment refers to the physical characteristics of the areas in which people live including buildings, streets, open spaces, and infrastructure. RECENT FINDINGS A review of current literature suggests an association between the built environment and type 2 diabetes, likely driven by two key pathways-physical activity and the food environment. Other hypothesized mechanisms linking the built environment and type 2 diabetes include housing policy, but evidence in these areas is underdeveloped. Policies designed to enhance the built environment for diabetes risk reduction are mechanistically plausible, but as of yet, little direct evidence supports their effectiveness in reducing in type 2 diabetes risk. Future work should rigorously evaluate policies meant to reduce type 2 diabetes via the built environment.
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Affiliation(s)
- Aisha T Amuda
- University of North Carolina School of Medicine, 1001 Bondurant Hall, CB 9535, Chapel Hill, NC, 27599, USA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, Chapel Hill School of Medicine, University of North Carolina, 5034 Old Clinic Bldg. CB 7110, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, University of North Carolina, Chapel Hill, NC, USA.
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Walk Score ® and Its Associations with Older Adults' Health Behaviors and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040622. [PMID: 30791631 PMCID: PMC6406259 DOI: 10.3390/ijerph16040622] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 01/01/2023]
Abstract
This study aimed to investigate the associations between Walk Score® and lifestyle behaviors and health outcomes in older Taiwanese adults. A nationwide survey was conducted through telephone-based interviews with older adults (65 years and older) in Taiwan. Data on Walk Score®, lifestyle behaviors (physical activity, sedentary behavior, healthy eating behavior, alcohol use, and smoking status), health outcomes (overweight/obesity, hypertension, type 2 diabetes, and cardiovascular disease), and personal characteristics were obtained from 1052 respondents. A binary logistic regression adjusting for potential confounders was employed. None of the Walk Score® categories were related to the recommended levels of total physical activity. The categories "very walkable" and "walker's paradise" were positively related to total sedentary time and TV viewing among older adults. No significant associations were found between Walk Score® and other lifestyle health behaviors or health outcomes. While Walk Score® was not associated with recommended levels of physical activity, it was positively related to prolonged sedentary time in the context of a non-Western country. The different associations between the walk score and health lifestyle behaviors and health outcomes in different contexts should be noted.
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11
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Booth GL, Creatore MI, Luo J, Fazli GS, Johns A, Rosella LC, Glazier RH, Moineddin R, Gozdyra P, Austin PC. Neighbourhood walkability and the incidence of diabetes: an inverse probability of treatment weighting analysis. J Epidemiol Community Health 2019; 73:287-294. [PMID: 30696690 DOI: 10.1136/jech-2018-210510] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/04/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND People living in highly walkable neighbourhoods tend to be more physically active and less likely to be obese. Whether walkable urban design reduces the future risk of diabetes is less clear. METHODS We used inverse probability of treatment weighting to compare 10-year diabetes incidence between residents living in high-walkability and low-walkability neighbourhoods within five urban regions in Ontario, Canada. Adults (aged 30-85 years) who were diabetes-free on 1 April 2002 were identified from administrative health databases and followed until 31 March 2012 (n=958 567). Within each region, weights reflecting the propensity to live in each neighbourhood type were created based on sociodemographic characteristics, comorbidities and healthcare utilisation and incorporated into region-specific Cox proportional hazards models. RESULTS Low-walkability areas were more affluent and had more South Asian residents (6.4%vs3.6%, p<0.001) but fewer residents from other minority groups (16.6%vs21.7%, p<0.001). Baseline characteristics were well balanced between low-walkability and high-walkability neighbourhoods after applying individual weights (standardised differences all <0.1). In each region, high walkability was associated with lower diabetes incidence among adults aged <65 years (overall weighted incidence: 8.2vs9.2 per 1000; HR 0.85, 95% CI 0.78 to 0.93), but not among adults aged ≥65 years (weighted incidence: 20.7vs19.5 per 1000; HR 1.01, 95% CI 0.91 to 1.12). Findings were consistent regardless of income and immigration status. CONCLUSIONS Younger adults living in high-walkability neighbourhoods had a lower 10-year incidence of diabetes than similarly aged adults living in low-walkability neighbourhoods. Urban designs that support walking may have important benefits for diabetes prevention.
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Affiliation(s)
- Gillian L Booth
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Maria I Creatore
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jin Luo
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ghazal S Fazli
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Johns
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laura C Rosella
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Glazier
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rahim Moineddin
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Gozdyra
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter C Austin
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Cafer A, Mann G, Ramachandran S, Kaiser M. National Food Affordability: A County-Level Analysis. Prev Chronic Dis 2018; 15:E115. [PMID: 30240570 PMCID: PMC6157262 DOI: 10.5888/pcd15.180079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to explore the sociodemographic factors that contribute to food affordability across space, with specific emphasis on rural and urban differences in the United States. A regression analysis was used to predict food affordability from several predictors in rural and urban areas, with a subanalysis of Appalachian and Delta counties. Rural households had significantly higher food expenditures to income ratios compared with urban counties; Appalachian and Delta counties had the highest on average food expenditure to income ratio. Affordable food buffers vulnerable families against food insecurity and subsequent chronic health issues, which are especially relevant in the Appalachian and Delta counties.
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Affiliation(s)
- Anne Cafer
- Department of Sociology and Anthropology and Center for Population Studies, 543 Lamar Hall, University of Mississippi, University, MS 38677.
| | - Georgianna Mann
- Department of Nutrition and Hospitality Management, University of Mississippi, University, Mississippi
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi, University, Mississippi
| | - Michelle Kaiser
- School of Social Work, The Ohio State University, Columbus, Ohio
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13
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den Braver NR, Lakerveld J, Rutters F, Schoonmade LJ, Brug J, Beulens JWJ. Built environmental characteristics and diabetes: a systematic review and meta-analysis. BMC Med 2018; 16:12. [PMID: 29382337 PMCID: PMC5791730 DOI: 10.1186/s12916-017-0997-z] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). This study systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk/prevalence, worldwide. METHODS We systematically searched PubMed, EMBASE.com and Web of Science from their inception to 6 June 2017. Studies were included with adult populations (>18 years), T2DM or glycaemic markers as outcomes, and physical activity and/or food environment and/or residential noise as independent variables. We excluded studies of specific subsamples of the population, that focused on built environmental characteristics that directly affect the cardiovascular system, that performed prediction analyses and that do not report original research. Data appraisal and extraction were based on published reports (PROSPERO-ID: CRD42016035663). RESULTS From 11,279 studies, 109 were eligible and 40 were meta-analysed. Living in an urban residence was associated with higher T2DM risk/prevalence (n = 19, odds ratio (OR) = 1.40; 95% CI, 1.2-1.6; I2 = 83%) compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence (n = 8, OR = 0.79; 95% CI, 0.7-0.9; I2 = 92%) and more green space tended to be associated with lower T2DM risk/prevalence (n = 6, OR = 0.90; 95% CI, 0.8-1.0; I2 = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence. CONCLUSIONS An important strength of the study was the comprehensive overview of the literature, but our study was limited by the conclusion of mainly cross-sectional studies. In addition to other positive consequences of walkability and access to green space, these environmental characteristics may also contribute to T2DM prevention. These results may be relevant for infrastructure planning.
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Affiliation(s)
- N R den Braver
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.
| | - J Lakerveld
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | | | - J Brug
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Amsterdam School for Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - J W J Beulens
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Zoellner JM, Hedrick VE, You W, Chen Y, Davy BM, Porter KJ, Bailey A, Lane H, Alexander R, Estabrooks PA. Effects of a behavioral and health literacy intervention to reduce sugar-sweetened beverages: a randomized-controlled trial. Int J Behav Nutr Phys Act 2016; 13:38. [PMID: 27000402 PMCID: PMC4802861 DOI: 10.1186/s12966-016-0362-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/10/2016] [Indexed: 01/11/2023] Open
Abstract
Background Despite excessive consumption of sugar-sweetened beverages (SSB), little is known about behavioral interventions to reduce SSB intake among adults, particularly in medically-underserved rural communities. This type 1 effectiveness-implementation hybrid RCT, conducted in 2012–2014, applied the RE-AIM framework and was designed to assess the effectiveness of a behavioral intervention targeting SSB consumption (SIPsmartER) when compared to an intervention targeting physical activity (MoveMore) and to determine if health literacy influenced retention, engagement or outcomes. Methods Guided by the Theory of Planned Behavior and health literacy strategies, the 6 month multi-component intervention for both conditions included three small-group classes, one live teach-back call, and 11 interactive voice response calls. Validated measures were used to assess SSB consumption (primary outcome) and all secondary outcomes including physical activity behaviors, theory-based constructs, quality of life, media literacy, anthropometric, and biological outcomes. Results Targeting a medically-underserved rural region in southwest Virginia, 1056 adult participants were screened, 620 (59 %) eligible, 301 (49 %) enrolled and randomized, and 296 included in these 2015 analyses. Participants were 93 % Caucasian, 81 % female, 31 % ≤ high-school educated, 43 % < $14,999 household income, and 33 % low health literate. Retention rates (74 %) and program engagement was not statistically different between conditions. Compared to MoveMore, SIPsmartER participants significantly decreased SSB kcals and BMI at 6 months. SIPsmartER participants significantly decreased SSB intake by 227 (95 % CI = −326,−127, p < 0.001) kcals/day from baseline to 6 months when compared to the decrease of 53 (95 % CI = −88,−17, p < 0.01) kcals/day among MoveMore participants (p < 0.001). SIPsmartER participants decreased BMI by 0.21 (95 % CI = −0.35,−0.06; p < 0.01) kg/m2 from baseline to 6 months when compared to the non-significant 0.10 (95 % CI = −0.23, 0.43; NS) kg/m2 gain among MoveMore participants (p < 0.05). Significant 0–6 month effects were observed for about half of the theory-based constructs, but for no biological outcomes. Health literacy status did not influence retention rates, engagement or outcomes. Conclusions SIPsmartER is an effective intervention to decrease SSB consumption among adults and is promising for translation into practice settings. SIPsmartER also yielded small, yet significant, improvements in BMI. By using health literacy-focused strategies, the intervention was robust in achieving reductions for participants of varying health literacy status. Trial registration Clinicaltrials.gov; ID: NCT02193009.
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Affiliation(s)
- Jamie M Zoellner
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Blacksburg, VA, 24061, USA.
| | - Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Blacksburg, VA, 24061, USA
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Yvonnes Chen
- School of Journalism, University of Kansas, Lawrence, KS, 66045, USA
| | - Brenda M Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Blacksburg, VA, 24061, USA
| | - Kathleen J Porter
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Blacksburg, VA, 24061, USA
| | - Angela Bailey
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ, 08028, USA
| | - Hannah Lane
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Blacksburg, VA, 24061, USA
| | - Ramine Alexander
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Blacksburg, VA, 24061, USA
| | - Paul A Estabrooks
- Department of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Center, Omaha, NE, 68198-4365, USA
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