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Gripko M, Joseph A. The Role of the Built Environment in Supporting Older Adults' Engagement: A Narrative Literature Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241250320. [PMID: 38738947 DOI: 10.1177/19375867241250320] [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: 05/14/2024]
Abstract
OBJECTIVE This literature review aimed to summarize the existing knowledge surrounding the role of the built environment in supporting older adults' physical and social engagement and identify opportunities for future research and design that facilitates older adults' engagement at multiple environmental scales: from interior spaces to neighborhoods. BACKGROUND Physical environments can support or impede older adults' physical and social engagement: willful, motivated involvement in meaningful activity or occupation. Research shows that engagement is a core component of health and well-being and relates to positive health outcomes, including reduced disease risk, better mental health, and improved physical and cognitive function. Thus, designing supportive built environments for engagement can yield significant, positive health and well-being impacts. METHODS A systematized search of five databases, a hand search, and an iterative screening process identified 55 studies for inclusion in this review. Through inductive thematic analysis, this review summarizes findings regarding the built environment's role in physical and social engagement in older age and design strategies to facilitate engagement and support health and well-being. RESULTS Evidence indicates that built environment characteristics can influence older people's physical and social engagement in homes, neighborhoods, and care settings. The thematic analysis of the included studies identified three key themes concerning the relationships of built environment characteristics to older adults' engagement across multiple environmental scales: connection, access, and security. CONCLUSIONS Built environments influence older people's physical and social engagement, significantly affecting their health, well-being, abilities, and longevity. Numerous design strategies can support older adults' engagement, but more research is needed.
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Affiliation(s)
- Monica Gripko
- Center for Health Facilities Design and Testing, Clemson University, Clemson, SC, USA
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, Clemson University, Clemson, SC, USA
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Anderson DC, DeCaro RE, Chadalavada M, Marin A, Di Crosta A, Ceccato I, Malva PL, Mammarella N, Di Domenico A, Turk KW, Palumbo R, Budson AE. Characteristics of Home and Neighborhood Built Environments During COVID-19 for Older Adults in the United States and Italy. JOURNAL OF AGING AND ENVIRONMENT 2023; 2023:1-37. [PMID: 39055175 PMCID: PMC11271746 DOI: 10.1080/26892618.2023.2269552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
The home and neighborhood environments impact the social and mental health of older adults, yet little research has addressed the various contexts that can affect these relationships, such as community culture, built and natural elements, and demographics. This survey-based study examined community-dwelling older adults' access and use of transitional outdoor/indoor space (i.e., porches, gardens, windows, etc.), and how that use was related to health variables and changed with the pandemic in two available samples of older adults in the United States and Italy. Use of both outdoor and indoor space was found to be more individualistic in Boston, in the United States, than in Chieti, Italy, where use of these areas with others was more common. Results suggest that window viewing from within the home may be an activity that individuals in Italy engage in when feeling lonely. Changes in the use of home and community space after COVID-19 were minimal; only in the United States did individuals report greater time indoors since the onset of the pandemic. Use of the built environment in and around the home by older adults was found to have multidimensional characteristics between the United States and Italy, with the potential to foster connections and improve well-being.
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Affiliation(s)
- Diana C. Anderson
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Renée E. DeCaro
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Myna Chadalavada
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Anna Marin
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Irene Ceccato
- G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | | | | | - Katherine W. Turk
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rocco Palumbo
- G. d’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Andrew E. Budson
- Center for Translational Cognitive Neuroscience, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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3
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Nesoff ED, Wiebe DJ, Martins SS. City streetscapes and neighborhood characteristics of fatal opioid overdoses among people experiencing homelessness who use drugs in New York City, 2017-2019. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103904. [PMID: 36370513 PMCID: PMC9832470 DOI: 10.1016/j.drugpo.2022.103904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND While housing is a critical social determinant of nonprescription opioid overdose, little is known about how place impacts fatal overdose for people experiencing homelessness (PEH) who use drugs beyond the public versus private domains. This study investigated patterns of neighborhood environment features at locations of fatal overdoses among PEH. METHODS We remotely visited locations of opioid-involved fatal overdoses provided by the New York City Office of the Chief Medical Examiner, 2017-2019 (n=3276), with Google Street View and used systematic social observation to assess characteristics of the street block related to drug exposures. We cross-referenced home address with city shelters and supportive housing to identify PEH (n=503). We used the differences of K functions from the spatial point patterns and kernel ratio function maps to identify geographic clusters. We then used logistic regression to identify significant individual-, block-, and neighborhood-level covariates (neighborhood deprivation, segregation, population density). RESULTS Over half (55.9%, n=281) of fatal overdoses among PEH occurred in supportive housing or shelters, and 15.5% (n=78) occurred in public spaces (e.g., parks). Spatial analyses identified areas of significant concentrated fatal overdoses among PEH in Manhattan, the South Bronx, and Brooklyn. We identified several significant indicators of physical and social order and disorder associated with increased odds of experiencing homelessness at time of fatal overdose, including construction/renovation, graffiti, traffic calming features, and loitering. CONCLUSION Harm reduction services should be co-located in facilities that serve PEH and targeted to street blocks with indicators of physical and social disorder. While supportive housing is a crucial step in preventing fatal opioid overdoses among PEH, identifying neighborhoods for intervention services delivery and harm reduction outreach for PEH is necessary.
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Affiliation(s)
- Elizabeth D Nesoff
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA 19104, USA.
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA 19104, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W168th St, 5th floor, New York, NY 10032, USA
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4
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Wei Q, Shang Q, Bu Q. Consequences of living environment insecurity on health and well-being in southwest China: The role of community cohesion and social support. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6414-e6427. [PMID: 36269061 DOI: 10.1111/hsc.14084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/04/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Growing populations in developing countries have exacerbated inequality in the spatial distribution of living environments. As a result, whether living environment factors matter to health and well-being is increasingly attracting policy and scholarly attention. Yet, crucial knowledge gaps remain regarding the implications, consequences and mechanisms of one's living environment on health and well-being in developing countries. This study examined the association between living environment and psychological distress, self-rated health and satisfaction with life among Chinese adults. Furthermore, it also explored the moderating role of community cohesion and the mediating role of social support on these factors. Using probability proportionate to size sampling methods, 3765 respondents and 148 community organisers were recruited from 160 communities in Yunnan, China, in 2018. Ordinary least squares regression and structural equation modelling were conducted. The findings indicate that residents who lived in communities with higher levels of environment insecurity had lower levels of subjective health and well-being (psychological distress: β = 1.088, p < 0.001; self-rated health: β = -0.104, p < 0.01; satisfaction with life: β = -0.164, p < 0.001). Moreover, community cohesion played a moderating role in the relationship between living environment insecurity and self-rated health (β = 0.212, p < 0.05) and satisfaction with life (β = 0.183, p < 0.05); however, it had no significant effects on psychological distress. Furthermore, the moderated effects of community cohesion on living environment insecurity were mediated through perceived social support for self-rated health (proportion of total effect mediated = 11%) and satisfaction with life (proportion of total effect mediated = 29%). The present findings have implications for policy makers and community committees who can work towards social inequality in developing countries. The integrated programmes of improving living conditions and strengthening community capacity are crucial to residents' health and well-being.
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Affiliation(s)
- Qingong Wei
- National Academy of Development and Strategy, Renmin University of China, Beijing, China
| | - Qiaoqiong Shang
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Qingping Bu
- Department of Sociology, Wuhan University of Technology, Hubei, China
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5
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Yue X, Antonietti A, Alirezaei M, Tasdizen T, Li D, Nguyen L, Mane H, Sun A, Hu M, Whitaker RT, Nguyen QC. Using Convolutional Neural Networks to Derive Neighborhood Built Environments from Google Street View Images and Examine Their Associations with Health Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12095. [PMID: 36231394 PMCID: PMC9564970 DOI: 10.3390/ijerph191912095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Built environment neighborhood characteristics are difficult to measure and assess on a large scale. Consequently, there is a lack of sufficient data that can help us investigate neighborhood characteristics as structural determinants of health on a national level. The objective of this study is to utilize publicly available Google Street View images as a data source for characterizing built environments and to examine the influence of built environments on chronic diseases and health behaviors in the United States. Data were collected by processing 164 million Google Street View images from November 2019 across the United States. Convolutional Neural Networks, a class of multi-layer deep neural networks, were used to extract features of the built environment. Validation analyses found accuracies of 82% or higher across neighborhood characteristics. In regression analyses controlling for census tract sociodemographics, we find that single-lane roads (an indicator of lower urban development) were linked with chronic conditions and worse mental health. Walkability and urbanicity indicators such as crosswalks, sidewalks, and two or more cars were associated with better health, including reduction in depression, obesity, high blood pressure, and high cholesterol. Street signs and streetlights were also found to be associated with decreased chronic conditions. Chain link fence (physical disorder indicator) was generally associated with poorer mental health. Living in neighborhoods with a built environment that supports social interaction and physical activity can lead to positive health outcomes. Computer vision models using manually annotated Google Street View images as a training dataset were able to accurately identify neighborhood built environment characteristics. These methods increases the feasibility, scale, and efficiency of neighborhood studies on health.
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Affiliation(s)
- Xiaohe Yue
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA
| | | | - Mitra Alirezaei
- Department of Electrical and Computer Engineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Tolga Tasdizen
- Department of Electrical and Computer Engineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Dapeng Li
- Department of Geography and Geospatial Sciences, South Dakota State University, Brookings, SD 57007, USA
| | - Leah Nguyen
- Department of Health Policy and Management, University of Maryland School, College Park, MD 20742, USA
| | - Heran Mane
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA
| | - Abby Sun
- Public Health Science Program, University of Maryland School, College Park, MD 20742, USA
| | - Ming Hu
- School of Architecture, Planning & Preservation, University of Maryland School, College Park, MD 20742, USA
| | - Ross T. Whitaker
- School of Computing, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Quynh C. Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA
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Mao S, Lu N, Xiao C. Perceived neighborhood environment and depressive symptoms among older adults living in Urban China: The mediator role of social capital. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1977-e1990. [PMID: 34725894 DOI: 10.1111/hsc.13631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/09/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
An increasing number of studies have focused on the relationship between neighbourhood environment and depressive symptoms among older people. However, the underlying mechanisms are still unclear. This study examined the association between neighbourhood environment and depressive symptoms among older urban Chinese adults and the mediator role of social capital in this association. Using a quota sampling approach, 472 respondents aged 60 years or older were recruited from 23 urban communities of Shanghai, China, in 2020. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale. Social capital was measured by two latent constructs: cognitive social capital (e.g., trust, reciprocity, belongingness) and structural social capital (e.g., memberships, social participation). Perceived physical neighbourhood environment was assessed in terms of health care, security, and public transportation status. Structural equation modelling was conducted to test the study hypotheses. Health care services in the community had a direct effect on depressive symptoms (β = -0.097, p < .05). Cognitive social capital played a mediator role in the relationship between physical neighbourhood environment and depressive symptoms (community health care: β = -0.124, p < .01; community security: β = -0.284, p < .01). The mediator effect of structural social capital in the relationship between physical neighbourhood environment and depressive symptoms was not significant. The findings highlight the role of physical neighbourhood environment in fostering community-based social capital and promoting mental health among older adults in urban China. Policy strategies could focus on improving community health care and security to promote mental health.
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Affiliation(s)
- Shan Mao
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Nan Lu
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Chunhui Xiao
- Department of Spanish Language and Literature, School of Foreign Languages, Renmin University of China, Beijing, China
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7
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The home environment: influences on the health of young-old and old-old adults in Australia. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The physical and societal characteristics of home have been established as important in influencing the health and wellbeing of older adults, yet these have rarely been explored together. There is also limited research into variation across age groups, with older adults often examined as a homogenous group of those 65 years and over. This study advances the knowledge base by using the concept of person–environment (P-E) fit to analyse differences in personal and home environment (physical and societal) characteristics between young-old (65–74 years) and old-old (75 and above) age groups, and to assess how these characteristics influence their self-perceived health. This cross-sectional study draws upon survey data from 1,999 older adult participants from the Australian Housing Conditions Dataset. Descriptive statistics and inferential analysis were used to assess for significant differences between age groups and a binomial logistic regression was utilised to examine influences on health. The analysis found that the factors which influence health varies appreciably between age groups. For the young-old financial strain, being on the fixed-income pension and hypertension were important contributing factors, in contrast for the old-old gender (being male), having depression and the home being modified for disability were key influences. For both age groups heart disease was a contributing factor to perceived health. The results indicate the important contribution to knowledge of incorporating a wide range of person and environment characteristics when exploring P-E fit for older adults. The inclusion of societal aspects, such as financial strain, fixed-income pension, tenure and access to community aged care services when exploring influences on health, arises as a key conclusion of the study. In terms of impact, this research is significant given rising inequalities globally and specifically in the Australian context, the need for policy measures to address income inequality, and its health and social implications for older households.
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8
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Chung S, Kim M. Age-friendly environment, social support, sense of community, and loneliness among middle-aged and older adults in Korea. Aging Ment Health 2022:1-8. [PMID: 36036282 DOI: 10.1080/13607863.2022.2116395] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES The purpose of this research is to explore the relationship between age-friendly environment, social support, sense of community, and loneliness of Korean adults aged 45 and above. METHODS A total of 590 participants from a cross-sectional and secondary data from an age integration survey conducted in 2018 was used for analysis. Structural equation modelling and bootstrapping method were applied to examine the mediating role of social support and sense of community on the relationship between age-friendly environment and loneliness. RESULTS Age-friendly environment was positively associated with social support (β=.310, p<.001) and sense of community (β=.479, p<.001). Social support was negatively associated with loneliness (β=-.190, p<.001). Full mediation effect of social support was observed in the pathway from age-friendly environment to loneliness (95% CI: -0.135 to -0.036). CONCLUSION Social support was fundamental in lowering loneliness in an age-friendly environment. There was no significant association linking age-friendly environment, sense of community, and loneliness. The results support the adoption of AFE to protect people at risk of loneliness with social support mediating this relationship.
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Affiliation(s)
- Soondool Chung
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
| | - Miri Kim
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea
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9
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Held ML, First JM, Huslage M, Holzer M. Policy stress and social support: Mental health impacts for Latinx Adults in the Southeast United States. Soc Sci Med 2022; 307:115172. [DOI: 10.1016/j.socscimed.2022.115172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/02/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
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10
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Held ML, First JM, Huslage M. Effects of COVID-19, Discrimination, and Social Support on Latinx Adult Mental Health. J Immigr Minor Health 2022; 24:1446-1458. [PMID: 35841445 PMCID: PMC9288212 DOI: 10.1007/s10903-022-01382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
We investigated the role of COVID-19 exposure and discrimination on depressive and posttraumatic stress symptoms among Latinx adults residing in the southeastern United States. Survey data were collected from 264 Latinx adults. Using structural equation modeling (SEM) procedures, we estimated a structural model for hypothesized direct and indirect relationships between the risk factors of COVID-19 exposure and discrimination, social support, and two mental health conditions: depression and posttraumatic stress. COVID-19 exposure and discrimination each had a significant and positive relationship with both depression and posttraumatic stress. Social support was found to have a significant and inverse relationship with depression and posttraumatic stress, as well as to mediate the relationship between discrimination and both mental health symptoms. Implications for service provision and program design are presented. Future studies should examine variation between southeastern states and consider the influence of documentation status among an immigrant-only sample.
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Affiliation(s)
- Mary Lehman Held
- College of Social Work, University of Tennessee, TN, Knoxville, USA.
| | - Jennifer M First
- College of Social Work, University of Tennessee, TN, Knoxville, USA
| | - Melody Huslage
- College of Social Work, University of Tennessee, TN, Knoxville, USA
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11
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Spaces Eliciting Negative and Positive Emotions in Shrinking Neighbourhoods: a Study in Seoul, South Korea, Using EEG (Electroencephalography). J Urban Health 2022; 99:245-259. [PMID: 35312914 PMCID: PMC9033910 DOI: 10.1007/s11524-022-00608-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/18/2022]
Abstract
Although shrinking neighbourhoods are places where urban citizens experience negative emotions, some evidence suggests that people in some shrinking neighbourhoods feel less negative emotions than in other areas. Nevertheless, empirical studies that analyse environmental and personal elements that affect people's emotions in a shrinking neighbourhood remain insufficient. This is rather surprising, considering an increasing interest in the effects of negative emotions on individuals' health. Thus, this study used electroencephalography (EEG) to examine the impacts of environmental and personal characteristics on people's emotional levels in a shrinking area of Seoul, South Korea. A multilinear regression model was used to analyse emotional valence levels between sites with different urban designs and management levels. The results revealed that people felt positive emotions at sites where both urban design factors and their management were both satisfactory at appropriate levels. The results also found that people who had lived or worked in the neighbourhood for a long time and were women experienced more positive emotions than visitors and men. This finding implies that a shrinking neighbourhood can maintain a sense of satisfaction as long as the area is carefully managed. Revealing the emotional effects of environmental and personal characteristics in a shrinking neighbourhood can be used for planning practices and policy-making to create healthy and liveable urban neighbourhoods.
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12
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Tan TH. Perceived Environmental Attributes: Their Impact on Older Adults' Mental Health in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3595. [PMID: 35329282 PMCID: PMC8949010 DOI: 10.3390/ijerph19063595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/17/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023]
Abstract
In Malaysia, the population of older adults will increase in the coming years. In this context, there is a requirement to build an age-friendly environment to enable the elderly to age healthily. Many studies have shown that a built environment that allows older adults to age in place improves their mental health. However, person-environment analysis that considers mental well-being has remained rare for older adults living in Malaysia. This study examines the relationship between Malaysian seniors' perceptions of their surroundings at home and in the neighborhood and their mental health. Using stratified sampling, 510 seniors aged 60 and over were interviewed. The results showed that accessibility (p-value 0.033, 95% CI for coefficients 0.006, 0.146), environmental qualities (0.015, 0.014, 0.129) and neighborhood problems (0.000, -0.299, -0.146) were significant determinants of elderly people's mental health. With respect to respondents' socio-demographic characteristics, female elderly (0.000, 0.616, 0.782), older adults with an elementary education (0.000, 0.263, 0.685) or a college degree (0.026, 0.019, 0.294), being married (0.005, 0.047, 0.259), the ability to drive (0.000, 0.993, 1.315), the number of dependents in the family (0.003, -0.060, -0.012), and homeownership (0.000, -0.602, -0.271) were significantly related to mental well-being.
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Affiliation(s)
- Teck Hong Tan
- School of Economics and Management, Xiamen University Malaysia, Sepang 43900, Selangor, Malaysia
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13
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Ta M, Shankardass K. Piloting the Use of Concept Mapping to Engage Geographic Communities for Stress and Resilience Planning in Toronto, Ontario, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010977. [PMID: 34682722 PMCID: PMC8535682 DOI: 10.3390/ijerph182010977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 11/20/2022]
Abstract
The physical and social characteristics of urban neighborhoods engender unique stressors and assets, contributing to community-level variation in health over the lifecourse. Actors such as city planners and community organizations can help strengthen resilience in places where chronic stress is endemic, by learning about perceived stressors and assets from neighborhood users themselves (residents, workers, business owners). This study piloted a methodology to identify Toronto neighborhoods experiencing chronic stress and to engage them to identify neighborhood stressors, assets, and solutions. Crescent Town was identified as one neighborhood of interest based on relatively high levels of emotional stress in Twitter Tweets produced over two one-year periods (2013–2014 and 2017–2018) and triangulation using other neighborhood-level data. Using concept mapping, community members (n = 23) created a ten-cluster concept map describing neighborhood stressors and assets, and identified two potential strategies, a Crescent Town Residents’ Association and a community fair to promote neighborhood resources and build social networks. We discuss how this knowledge has circulated through the City of Toronto and community-level organizations to date, and lessons for improving this methodology.
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Affiliation(s)
- Martha Ta
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada;
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
- Correspondence:
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14
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Zhang R, Liu S, Li M, He X, Zhou C. The Effect of High-Density Built Environments on Elderly Individuals' Physical Health: A Cross-Sectional Study in Guangzhou, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910250. [PMID: 34639550 PMCID: PMC8508494 DOI: 10.3390/ijerph181910250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 12/28/2022]
Abstract
The built environment refers to the objective material environment built by humans in cities for living and production activities. Existing studies have proven that the built environment plays a significant role in human health, but little attention is paid to the elderly in this regard. At the same time, existing studies are mainly concentrated in Western developed countries, and there are few empirical studies in developing countries such as China. Based on POI (point of interest) data and 882 questionnaires collected from 20 neighborhoods in Guangzhou, we employ multilevel linear regression modeling, mediating effect modeling, to explore the path and mechanism of the impact of the built environment on elderly individuals' physical health, especially the mediating effects of physical and social interaction activity. The results show that the number of POIs, the distance to the nearest park and square, and the number of parks and squares are significantly positively correlated with the physical health of the elderly, while the number of bus and subway stations and the distance to the nearest station are significantly negatively correlated. Secondly, physical activity and social networks play a separate role in mediating the effect of the built environment on elderly individuals' physical health. The results enrich the research on the built environment and elderly individuals' health in the context of high-density cities in China and provide some reference basis for actively promoting spatial intervention and cultivating a healthy aging society.
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Plasencia MZ. Age-friendly as Tranquilo Ambiente: How Socio-Cultural Perspectives Shape the Lived Environment of Latinx Older Adults. THE GERONTOLOGIST 2021; 62:110-118. [PMID: 34543415 DOI: 10.1093/geront/gnab137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Researchers have increasingly considered the importance of age-friendly communities to improve the health and well-being of older adults. Studies have primarily focused on the built environment, such as community infrastructure, older adult behavior, and environmental expectations. Less is known about the role of cultural characteristics in shaping perceptions of age-friendly environments, especially among racial and ethnic minorities. RESEARCH DESIGN AND METHODS Using an ethnographic methodological approach, including participant observation in a Latinx community near New York City and 72 semi-structured interviews, this study examines how older Latinxs characterize age-friendly communities. RESULTS Latinx older adults described their community as age-friendly by way of the concept Tranquilo Ambiente, translated as calm or peaceful environment. More specifically, TA includes: 1) a sense of perceived personal safety, 2) ethnic and social connectedness, and 3) spatial and cultural accessibility. DISCUSSION AND IMPLICATIONS This study extends prior research that has largely considered structural or economic components to show how culture may also influence the well-being of older Latinxs, even if living in an under-resourced area. The concept of Tranquilo Ambiente demonstrates that both structural and cultural environmental factors influence older Latinxs understandings of age-friendly communities. By utilizing a socio-cultural lens, this research highlights how Latinx older adults benefit from an environment that supports their physical (e.g., well-lit and newly paved streets), social (e.g., city hall senior center), and cultural (e.g., events and programs that promote cultural heritage) needs.
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Affiliation(s)
- Melanie Z Plasencia
- Department of Ethnic Studies, University of California, Berkeley, Berkeley, California, USA
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Tabatabaei-Jafari H, Zulfiqar T, Welsh J, Bagheri N. The association between living in socially fragmented neighbourhoods and psychological distress among immigrant and non-immigrant people aged 45 and over in NSW, Australia. Aust N Z J Psychiatry 2021; 55:883-891. [PMID: 33334136 DOI: 10.1177/0004867420981414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Immigrants' mental health is a growing public health concern. Neighbourhood characteristics in the host society may contribute to the poor mental health observed among immigrants. In this study, we aimed to investigate the association between neighbourhood-level social fragmentation and socioeconomic characteristics with psychological distress among immigrants and non-immigrants living in Australia. METHODOLOGY We conducted cross-sectional secondary data analysis of 228,039 participants from the Sax Institute's 45 and Up Study, with psychological distress measured with the Kessler 10 (K10) and area-level social fragmentation and economic advantage/disadvantage measured at the statistical area level 1 (areas containing approximately 400 people). Multilevel logistic models were used to examine the extent to which differences across the least and most fragmented and economic advantage/disadvantage neighbourhoods contributed to the prevalence of high psychological distress (K10 score ⩾ 22). RESULTS Immigrants accounted for about 23% of the sample. Slightly more immigrants (34.8%) compared to non-immigrants (32.9%) lived in fragmented areas. Although immigrants were over represented in areas with socioeconomic advantage (40% vs 33.9%), the prevalence of high psychological distress in neighbourhoods with higher social fragmentation and socioeconomic disadvantage was higher in immigrants than non-immigrants. Immigrants had 17% (95% confidence interval = [12%, 22%]) higher odds of having high psychological distress compared to non-immigrants. There was no evidence of an interaction between social fragmentation or socioeconomic disadvantage and immigrant status. Living in fragmented or socioeconomically disadvantaged areas was associated with higher psychological distress among immigrants and non-immigrants. English as a second language and low annual income were significant predictors of psychological distress in immigrants over and above area-level characteristics. CONCLUSION Immigrants are vulnerable to mental health issues, but the characteristics of the area they live in are also important. Helping immigrants settle into well-integrated and economically advantaged areas may decrease the possibility of mental health issues.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Tehzeeb Zulfiqar
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Nasser Bagheri
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
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Schmidt T, Pawlowski CS, Kerr J, Schipperijn J. Investigating the WHAT and WHY on older adults' use of neighborhood open spaces following an environmental intervention. Transl Behav Med 2021; 11:582-596. [PMID: 32044982 DOI: 10.1093/tbm/ibaa004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Using neighborhood open spaces (NOS) may be an easy way for older adults to maintain healthy aging through physical activity and social interaction. Little is known about older adults' use of NOS, their preferences, and barriers to using them. This paper presents older adults' use of NOS in a deprived neighborhood before and after an intervention and factors promoting or inhibiting their use using convergent mixed methods design. Participatory research was employed involving older adults in the intervention. The System for Observing Play and Recreation in Communities was used to observe older adults' use of 13 NOS in spring 2017 (baseline) and spring 2018 (follow-up). Ten interviews were conducted in 2018 to identify barriers and facilitators for using NOS. Two NOS had a pavilion built and, in one NOS, benches were renovated, including building raised flower beds and small tables. At baseline, 209 older adults were observed, whereas 329 were observed at follow-up. More (44%) older adults were observed at follow-up in the NOS with the renovated benches. No use of the two pavilions was observed. The interviews identified six factors important for older adults' use of NOS: weather, support for social caretakers, support for resourceful volunteers, organized activities, social interaction, and sense of ownership. Organizational resources, such as social caretakers and volunteers, are important to promote older adults' use of NOS. Social interaction is a key factor for older adults' use of NOS and should be prioritized by health promoters.
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Affiliation(s)
- Tanja Schmidt
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Charlotte Skau Pawlowski
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Jasper Schipperijn
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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Anderson CE, Broyles ST, Wallace ME, Bazzano LA, Gustat J. Association of the Neighborhood Built Environment With Incident and Prevalent Depression in the Rural South. Prev Chronic Dis 2021; 18:E67. [PMID: 34237245 PMCID: PMC8269752 DOI: 10.5888/pcd18.200605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION A neighborhood's built environment is associated with physical activity among its residents, and physical activity is associated with depression. Our study aimed to determine whether the built environment was associated with depression among residents of the rural South and whether observed associations were mediated by physical activity. METHODS We selected 2,000 participants from the Bogalusa Heart Study who had a valid residential address, self-reported physical activity (minutes/week), and a complete Center for Epidemiologic Study-Depression (CES-D) scale assessment from 1 or more study visits between 1998 and 2013. We assessed the built environment with the Rural Active Living Assessment street segment audit tool and developed built environment scores. The association between built environment scores and depression (CES-D ≥16) in geographic buffers of various radii were evaluated by using modified Poisson regression, and mediation by physical activity was evaluated with mixed-effects models. RESULTS Depression was observed in 37% of study participants at the first study visit. One-point higher physical security and aesthetic scores for the street segment of residence were associated with 1.07 times higher (95% CI, 1.02-1.11) and 0.96 times lower (95% CI, 0.92-1.00) baseline depression prevalence. One-point higher destination scores (ie, more commercial and civic facilities) in radius buffers of 0.25 miles or more were associated with 1.06 times (95% CI, 1.00-1.13) the risk of depression during follow-up. Neighborhood poverty (defined as percentage of residents with incomes below the federal poverty level and dichotomized at 28.3%) modified cross-sectional and longitudinal associations. Associations were not mediated by physical activity. CONCLUSION The built environment was associated with prevalence and risk of depression, and associations were stronger in high-poverty neighborhoods. Built environment improvements to promote physical activity should take neighborhood context into consideration to minimize negative side effects on mental health in high-poverty communities.
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Affiliation(s)
- Christopher E Anderson
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste 2000, New Orleans, LA 70112.
| | - Stephanie T Broyles
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Maeve E Wallace
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Lydia A Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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Namin S, Zhou Y, Neuner J, Beyer K. Neighborhood Characteristics and Cancer Survivorship: An Overview of the Current Literature on Neighborhood Landscapes and Cancer Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7192. [PMID: 34281129 PMCID: PMC8297243 DOI: 10.3390/ijerph18137192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/21/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022]
Abstract
There is a growing literature on the association between neighborhood contexts and cancer survivorship. To understand the current trends and the gaps in the literature, we aimed to answer the following questions: To what degree, and how, has cancer survivorship research accounted for neighborhood-level effects? What neighborhood metrics have been used to operationalize neighborhood factors? To what degree do the neighborhood level metrics considered in cancer research reflect neighborhood development as identified in the Leadership for Energy and Environmental Design for Neighborhood Development (LEED-ND) guidelines? We first conducted a review guided by PRISMA extension for scoping review of the extant literature on neighborhood effects and cancer survivorship outcomes from January 2000 to January 2021. Second, we categorized the studied neighborhood metrics under six main themes. Third, we assessed the findings based on the LEED-ND guidelines to identify the most relevant neighborhood metrics in association with areas of focus in cancer survivorship care and research. The search results were scoped to 291 relevant peer-reviewed journal articles. Results show that survivorship disparities, primary care, and weight management are the main themes in the literature. Additionally, most articles rely on neighborhood SES as the primary (or only) examined neighborhood level metric. We argue that the expansion of interdisciplinary research to include neighborhood metrics endorsed by current paradigms in salutogenic urban design can enhance the understanding of the role of socioecological context in survivorship care and outcomes.
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Affiliation(s)
- Sima Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
| | - Yuhong Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
| | - Joan Neuner
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Kirsten Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (Y.Z.); (K.B.)
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Gullon P, Bilal U, Hirsch JA, Rundle AG, Judd S, Safford MM, Lovasi GS. Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease? J Epidemiol Community Health 2021; 75:637-642. [PMID: 33318134 PMCID: PMC8200362 DOI: 10.1136/jech-2020-215239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/30/2020] [Accepted: 11/29/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA). METHODS We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000-US$74 000, (3) US$20 000-US$34 000 and (4) RESULTS We found a 25% (95% CI 1.17% to 1.34%) increased hazard of CHD per 1-category decrease in household income category. Adjusting for PA-supportive environments slightly reduced this association (HR=1.24). The income-CHD association was strongest in areas without walking destinations (HR=1.57), an interaction which reached statistical significance in analyses among men. In contrast, the income-CHD association showed a trend towards being strongest in areas with the highest percentage of green land cover. CONCLUSIONS Indicators of a PA supportive environment show divergent trends to modify socioeconomic inequities in CHD . Built environment interventions should measure the effect on socioeconomic inequities.
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Affiliation(s)
- Pedro Gullon
- Public Health and Epidemiology Research Group, Universidad de Alcala de Henares Facultad de Medicina y Ciencias de la Salud, Alcala de Henares, Spain
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Jana A Hirsch
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Andrew G Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, USA
| | - Monika M Safford
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, New York, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
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Lai ETC, Yu R, Woo J. Social gradient of self-rated health in older people-the moderating/mediating role of sense of community. Age Ageing 2021; 50:1283-1289. [PMID: 33454753 DOI: 10.1093/ageing/afaa277] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Social gradients of self-rated health (SRH) of older people are evident in various settings. However, it is not clear whether improving older people's sense of community (SoC) could mitigate the social gradient. METHODS People aged above 60 in five residential districts of Hong Kong were sampled using multistage sampling (n = 1,793). SoC was measured using the validated eight-item Brief Sense of Community Scale, with each item on a five-point Likert scale, forming a score from 8 to 40. SRH was considered as dichotomous (poor/not poor). Socioeconomic status (SES) was operationalised as monthly income, highest education attainment and self-rated disposable income (defined as whether the older person feel he/she has sufficient income). Causal mediation analysis using four-way decomposition was used to assess whether SoC mediates/moderates the association of SES and poor SRH. RESULTS A social gradient of poor SRH by all measures of SES was observed [adjusted relative risk (RR) per standard deviation income increase = 0.92; 95% confidence interval (95% CI) 0.88-0.97; RR comparing lowest to highest education= 1.77; 95% CI: 1.48-2.11; RR comparing very insufficient to very sufficient disposable income = 1.74; 95% CI: 1.48-2.05]. Causal mediation analysis showed that SoC interacts with the association of education and SRH, with higher the SoC, stronger the education gradient. CONCLUSIONS Our findings showed a social gradient of SRH in the older population in Hong Kong. This relationship was moderated by SoC, for which higher SoC is related to stronger SES-SRH gradient.
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Affiliation(s)
- Eric T C Lai
- Jockey Club Institute of Ageing, Chinese University of Hong Kong, Hong Kong SAR
- Institute of Health Equity, Chinese University of Hong Kong, Hong Kong SAR
| | - Ruby Yu
- Jockey Club Institute of Ageing, Chinese University of Hong Kong, Hong Kong SAR
| | - Jean Woo
- Jockey Club Institute of Ageing, Chinese University of Hong Kong, Hong Kong SAR
- Institute of Health Equity, Chinese University of Hong Kong, Hong Kong SAR
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Mental Well-Being and the Influence of Place: Conceptual Approaches for the Built Environment for Planning Healthy and Walkable Cities. SUSTAINABILITY 2021. [DOI: 10.3390/su13116395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Promotion of healthy cities has prompted urban planners and designers to build new conceptual frameworks to improve the design of public spaces, in which mental well-being emerges as a fundamental concept. Mental well-being is related to spatial design, with increasing attention being paid to the built environment as an important predictor of mental well-being. The objective of this article is to advance and contribute new knowledge about the characteristics of the built environment and its potential benefits for mental well-being. A meta-analysis is carried out on various empirical and theoretical approaches from the literature. Using a WOS database as a case study, a methodology based on a bibliometric analysis is proposed to examine which elements of the built environment impact mental well-being in research between 1975 and 2020, using the HistCites and VOSviewer tools. The results show that there are six thematic axes related to the built environment that would favor greater mental well-being in public spaces: walkability, density, spatial design, environmental noise, green areas and social interaction. The six thematic axes are critically analyzed and integrated into a conceptual framework to address the impacts of the built environment on mental well-being in the planning of cities. It concludes with a discussion on the implications of these concepts for urban public policy and the promotion of healthier and more sustainable and walkable environments in Latin American cities.
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Kumari D, Yadav J, Kamal VK, Verma RK. Role of Social Network on Life Satisfaction among Older Persons in Delhi, India: a Structural Equation Modelling. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kowitt SD, Aiello AE, Callahan LF, Fisher EB, Gottfredson NC, Jordan JM, Muessig KE. How Are Neighborhood Characteristics Associated With Mental and Physical Functioning Among Older Adults With Radiographic Knee Osteoarthritis? Arthritis Care Res (Hoboken) 2021; 73:308-317. [PMID: 31841258 DOI: 10.1002/acr.24125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 12/10/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine how neighborhood characteristics are associated with health outcomes among older adults with osteoarthritis. METHODS In multilevel, cross-sectional, and longitudinal analyses we examined whether 4 neighborhood characteristics were associated with depressive symptoms and reported knee impact scores, and whether the neighborhood characteristics interacted with race/ethnicity among older adults with radiographic knee osteoarthritis (n = 656 for cross-sectional analyses and n = 434 for longitudinal analyses). The data came from the Johnston County Osteoarthritis Project, a prospective cohort study in North Carolina designed to examine risk factors for osteoarthritis. RESULTS Although few longitudinal associations were found, cross-sectional results suggested that greater perceived neighborhood social cohesion (B = -0.04, P < 0.001) and perceived neighborhood resources for physical activity and walking (B = -0.03, P < 0.001) were associated with fewer depressive symptoms, and that greater perceived neighborhood resources for physical activity and walking were associated with higher (better) knee impact scores (B = 0.48, P = 0.008). We also observed 2 significant interactions among neighborhood characteristics and race/ethnicity related to depressive symptoms (P < 0.01); for African American adults, greater perceived neighborhood resources for physical activity and walking were associated with fewer depressive symptoms (B = -0.03, P < 0.001), but for White adults, greater perceived neighborhood safety was associated with fewer depressive symptoms (B = -0.04, P = 0.003). CONCLUSION In a sample of older adults with radiographic knee osteoarthritis, neighborhood context mattered, but in nuanced ways. Interventions aiming to improve mental and physical functioning of older adults with knee osteoarthritis can look to this study as evidence for the importance of neighborhood characteristics.
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Affiliation(s)
- Sarah D Kowitt
- Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill
| | - Allison E Aiello
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Leigh F Callahan
- Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill
| | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Nisha C Gottfredson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Joanne M Jordan
- Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill
| | - Kathryn E Muessig
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
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Budd EL, Giuliani NR, Kelly NR. Perceived Neighborhood Crime Safety Moderates the Association Between Racial Discrimination Stress and Chronic Health Conditions Among Hispanic/Latino Adults. Front Public Health 2021; 9:585157. [PMID: 33659230 PMCID: PMC7917115 DOI: 10.3389/fpubh.2021.585157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about the link between perceived neighborhood walkability and prevalence of chronic disease. Even less is known regarding this association among Hispanic/Latino adults, despite exhibiting high rates of chronic diseases. Stress due to racial discrimination is a harmful social determinant of health in Hispanics/Latinos. Having both low perceived neighborhood walkability and high racial discrimination stress may exacerbate the chronic disease status of Hispanics/Latinos. Among a U.S. national sample of Hispanic/Latino adults, this cross-sectional study aims to examine (1) the associations among overall perceived neighborhood walkability, racial discrimination stress, and having a chronic health condition; and (2) whether overall perceived neighborhood walkability moderates the hypothesized association between racial discrimination stress and having a chronic health condition. Methods: In January 2018, 798 Hispanic/Latino adults (M age = 39.7 years, SD = 15.1; 58.6% female; 70.0% U.S. born; 52.0% Mexican/Mexican American) responded to a survey via Qualtrics Panels. Surveys included the Neighborhood Environment Walkability Scale-Abbreviated, Hispanic Stress Inventory-2, and self-reported presence/absence of chronic health conditions (e.g., hypertension, heart disease). A logistic regression was conducted testing for the moderation of the main effect of racial discrimination stress on the presence of a chronic health condition by overall perceived neighborhood walkability. Results: After controlling for age, body mass index, and income, racial discrimination stress was inversely associated with overall perceived neighborhood walkability (b = -0.18, p < 0.001) and positively associated with having a chronic health condition (OR = 1.02; 95% CI [1.00, 1.03]). While overall perceived neighborhood walkability was not associated with having a chronic health condition, perceived crime safety was inversely associated with having a chronic health condition (OR = 0.94; 95% CI [0.89, 0.99]). Perceived crime safety moderated the positive association between discrimination stress and having a chronic health condition, such that the association was only significant among those who perceived their neighborhood to be less safe (β = -0.004, 95% CI [-0.01, -0.00]). Conclusions: Overall perceived neighborhood walkability was inversely associated with racial discrimination stress, but not associated with having a chronic health condition. Perceived neighborhood crime safety, but not infrastructure or aesthetics, matters when it comes to the link between racial discrimination stress and having a chronic health condition among Hispanics/Latinos.
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Affiliation(s)
- Elizabeth L. Budd
- Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR, United States
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
| | - Nicole R. Giuliani
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
- Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, OR, United States
| | - Nichole R. Kelly
- Counseling Psychology and Human Services, College of Education, University of Oregon, Eugene, OR, United States
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
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Buttazzoni A, Doherty S, Minaker L. How Do Urban Environments Affect Young People's Mental Health? A Novel Conceptual Framework to Bridge Public Health, Planning, and Neurourbanism. Public Health Rep 2021; 137:48-61. [PMID: 33563094 PMCID: PMC8721758 DOI: 10.1177/0033354920982088] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Childhood and adolescence are crucial periods for mental and social development. Currently, mental illness among young people is a global epidemic, and rates of disorders such as depression and anxiety are rising. Urban living, compared with rural living, is linked with a higher risk of serious mental illness, which is important because the world is urbanizing faster than ever before. Urban environments and their landscapes, designs, and features influence mental health and well-being. However, no conceptual frameworks to date have detailed the effect of urban environments on young people's mental health, and few studies have considered the growing role of digital and social media in this relationship, leading to calls for the development of holistic approaches to describe this relationship. This article synthesizes existing knowledge on urban places (both built and natural environments) and mental health in the public health and urban planning literature and examines the emerging field of neurourbanism (a multidisciplinary study of the effect of urban environments on mental health and brain activity) to enhance current practice and research. We developed 2 novel conceptual frameworks (1 research-oriented, 1 practice-oriented), adapted from Bronfenbrenner's socioecological model, that focus on the relationship between urban environments and young people's mental health. We added a digital and social media contextual level to the socioecological model, and we applied a multilayer concept to highlight potential cross-field interactions and collaborations. The proposed frameworks can help to guide future practice and research in this area.
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Affiliation(s)
- Adrian Buttazzoni
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada,Geographies of Health in Place, Planning, and Public Health Lab, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada,Adrian Buttazzoni, MSc, University of Waterloo, School of Planning, Faculty of Environment, 200 University Ave W, Environment Building 3, Waterloo, Ontario N2L 3G1, Canada.
| | - Sean Doherty
- Department of Geography and Environmental Studies, Faculty of Arts, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Leia Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada,Geographies of Health in Place, Planning, and Public Health Lab, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada,School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Park SY. Intergenerational Differences in Age-friendly Environments and Health Outcomes: Social Support as a Mediator. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2021. [DOI: 10.1080/15350770.2021.1868240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tong CE, McKay HA, Martin-Matthews A, Mahmood A, Sims-Gould J. "These Few Blocks, These Are My Village": The Physical Activity and Mobility of Foreign-Born Older Adults. THE GERONTOLOGIST 2020; 60:638-650. [PMID: 30794287 DOI: 10.1093/geront/gnz005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The self-reported health of foreign-born older adults (FBOAs) is lower than that of nonimmigrant peers. Physical activity (PA) and mobility enhance health in older age, yet we know very little about the PA and mobility of FBOAs. In this analysis we sought to determine: (a) What factors facilitate PA amongst FBOAs? and (b) How do gender, culture, and personal biography affect participants' PA and mobility? RESEARCH DESIGN AND METHODS We worked closely with community partners to conduct a mixed-method study in Vancouver, Canada. Eighteen visible minority FBOAs completed an in-depth interview in English, Cantonese, Mandarin, Punjabi, or Hindi. RESULTS Three dominant factors promote participants' PA and mobility: (a) participants walk for well-being and socialization; (b) participants have access to a supportive social environment, which includes culturally familiar and linguistically accessible shops and services; and (c) gender and personal biography, including work history and a desire for independence, affect their PA and mobility behaviors. DISCUSSION AND IMPLICATIONS We extend the Webber et al. mobility framework, with examples that further articulate the role of gender (e.g., domestic work), culture (cultural familiarity) and personal biography (work history and a desire for familial independence) (Webber, S. C., Porter, M. M., & Menec, V. H. (2010). Mobility in older adults: A comprehensive framework. The Gerontologist, 50, 443-450. doi:10.1093/geront/gnq013). Future programming to support the PA of FBOAs should be culturally familiar and linguistically accessible.
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Affiliation(s)
- Catherine E Tong
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, Canada
| | - Heather A McKay
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, Canada.,Department of Family Practice, Faculty of Medicine
| | | | - Atiya Mahmood
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, Canada.,Department of Family Practice, Faculty of Medicine
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Pedestrian Walkways for Health in Shiraz, Iran, the Contribution of Attitudes, and Perceived Environmental Attributes. SUSTAINABILITY 2020. [DOI: 10.3390/su12187263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Walking is important for improving physical activity and public health. The pedestrian walkways called Walkways for Health in Shiraz, Iran, present a high standard of aesthetic and design features which attract many people for the purpose of recreation. In addition, a significant percentage of Iranians suffer from mental disorders. The contribution of aesthetic and design features toward walking for recreation as well as mental health has been demonstrated in previous studies, which have focused on either one or the other of these aspects. This interdisciplinary research study aims to evaluate both of these aspects simultaneously. A quantitative approach including a survey questionnaire and multiple regression analysis was used to examine the objectives. The contributions of walking attitudes and several perceived environmental attributes to the attractiveness for walking and to general/mental health were determined, which suggested the need for new arrangements of the visual sequences and social setting along these walkways. In addition, the observation that younger people suffer are more affected by mental health disorders was one of the most challenging findings. The policy makers of this city could apply the findings of this study to these pedestrian walkways in order to improve the attractiveness for walking as well as general and mental health.
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Kowitt SD, Aiello AE, Callahan LF, Fisher EB, Gottfredson NC, Jordan JM, Muessig KE. Associations among neighborhood poverty, perceived neighborhood environment, and depressed mood are mediated by physical activity, perceived individual control, and loneliness. Health Place 2020; 62:102278. [DOI: 10.1016/j.healthplace.2019.102278] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 11/27/2019] [Accepted: 12/16/2019] [Indexed: 11/25/2022]
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Abstract
An ageing population raises the question of providing adequate housing that enables older people to age in place without losing autonomy and independence. Except for the issue of accessibility, no framework exists that specifically outlines a standard to achieve and, as a result, interventions on existing or on new buildings may be inconsistent without leading to a desired rise in living standards. This research addresses this issue by presenting a framework for the assessment of the age-appropriateness of housing through a number of metrics that detect and identify physical and non-physical features of a home environment to enable ageing in place. The study combines data from a qualitative systematic literature review of 93 papers and qualitative data from structured interviews with four experts in the field. As a result, 71 metrics were identified, divided into eight main domains, to describe the framework. This paper provides an improved understanding of the housing features that enable ageing in place. The tool categorizes and rates qualitative and quantitative aspects that contribute to the age-friendliness of housing, resulting in an easy to adopt assessment framework. This is a valuable means for stakeholders engaged in improving the current housing stock or in constructing new buildings for older people.
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Duncan DT, Sutton MY, Park SH, Callander D, Kim B, Jeffries WL, Henny KD, Harry-Hernández S, Barber S, Hickson DA. Associations Between Neighborhood Problems and Sexual Behaviors Among Black Men Who Have Sex with Men in the Deep South: The MARI Study. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:185-193. [PMID: 31950381 PMCID: PMC7410008 DOI: 10.1007/s10508-019-01619-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/05/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
There is a disproportionately high HIV incidence among Black men who have sex with men (MSM) despite equal or lower levels of HIV risk behaviors compared to White MSM. Due to high levels of racial segregation in the U.S., Black MSM have an elevated likelihood of living in neighborhoods that contain psychosocial stressors, which, in turn, may increase behaviors promoting HIV infection. We examined associations between perceived neighborhood problems and sexual behaviors among Black MSM in the Deep South, a population at highest risk of HIV. Data came from the MARI Study, which included Black MSM ages 18-66 years recruited from the Jackson, MS, and Atlanta, GA, metropolitan areas (n = 377). Participants completed questions about neighborhood problems (e.g., excessive noise, heavy traffic/speeding cars and trash/litter) and sexual behaviors (e.g., condomless sex and drug use before or during sex). We used Poisson's regression model with robust standard errors to estimate the adjusted prevalence ratio (aPR; 95% confidence intervals [CI]) of neighborhood problems (coded as tertiles [tertile 1 = low neighborhood problems, tertile 2 = medium neighborhood problems, tertile 3 = high neighborhood problems] as well as continuously) with sexual behaviors, after adjustment for sociodemographic characteristics and other variables. About one-fourth of the sample reported at least one neighborhood problem, with the most common (31.6%) being no/poorly maintained sidewalks, which indicates an infrastructural problem. In multivariable models, compared to those in the lowest tertile, those reporting more neighborhood problems (tertile 2: aPR = 1.49, 95% CI = 1.04, 2.14 and tertile 3: aPR = 1.53, 95% CI = 1.05, 2.24) reported more drug use before or during sex (p for trend = .027). Neighborhood problems may promote behaviors (e.g., drug use before or during sex) conducive to HIV infection. Structural interventions could improve community infrastructure to reduce neighborhood problems (e.g., no/poorly maintained sidewalks and litter). These interventions may help to reduce HIV incidence among Black MSM in the Deep South.
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Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA.
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Su Hyun Park
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Denton Callander
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Byoungjun Kim
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - William L Jeffries
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kirk D Henny
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salem Harry-Hernández
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 715, New York, NY, 10032, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - DeMarc A Hickson
- Center for Research, Evaluation and Environmental and Policy Change, My Brother's Keeper, Inc, Jackson, MS, USA
- Us Helping Us, People Into Living, Inc, Washington, DC, USA
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Tao Y, Yang J, Chai Y. The Anatomy of Health-Supportive Neighborhoods: A Multilevel Analysis of Built Environment, Perceived Disorder, Social Interaction and Mental Health in Beijing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010013. [PMID: 31861358 PMCID: PMC6981470 DOI: 10.3390/ijerph17010013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 12/23/2022]
Abstract
Mental health is an exceedingly prevalent concern for the urban population. Mounting evidence has confirmed the plausibility of high incidences of mental disorders in socioeconomically disadvantaged neighborhoods. However, the association between the neighborhood built environment and individual mental health is understudied and far from conclusive, especially in developing countries such as China. The underlying mechanism requires in-depth analysis combining potential intermediates such as perceived environmental disorder and supportive social relationships. Using a health survey conducted in Beijing in 2017, this study investigates for the first time a socio-environmental pathway through which perceived disorder and social interaction account for the relationship between the built environment and mental health under the very notion of the neighborhood effect. The results from multilevel structural equation models indicate that individual mental health is influenced by the neighborhood-scale built environment through three pathways, independent of neighborhood socioeconomic disadvantages: (1) proximity to parks is the sole indicator directly linked to mental health; (2) population density, road connectivity and proximity to parks are indirectly associated with mental health through interactions with neighbors; and (3) population density, road connectivity and facility diversity are partially associated with perceived neighborhood disorder, which is indirectly correlated with mental health through interactions with neighbors. This study is a preliminary attempt to disentangle the complex relationships among the neighborhood environment, social interaction and mental health in the context of developing megacities. The relevant findings provide an important reference for urban planners and administrators regarding how to build health-supportive neighborhoods and healthy cities.
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Cao Q, Dabelko-Schoeny HI, White KM, Choi MS. Age-friendly communities and perceived disconnectedness: the role of built environment and social engagement. J Aging Health 2019; 32:937-948. [PMID: 31347451 DOI: 10.1177/0898264319865421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: To examine the effect of access to outdoor space and buildings and social or community events on elders' perceived disconnectedness. Method: Data were from a representative survey conducted as part of an age-friendly community initiative in a large midwestern city in the United States. Hierarchical logistic regression was employed to examine the relationships between environment, engagement, and connection. Results: Having access to ramps to enter buildings reduced the odds of perceived disconnectedness by 79%, participation in social or community events reduced the odds of perceived disconnectedness by 83%. The odds of perceived disconnectedness for elders "not sure" of their access to public buildings were around 6 times that of those without access, holding all else constant. Discussion: Ensuring access to ramps to enter buildings, disseminating information about the accessibility of parks and buildings, and social or community events may reduce elders' perceived disconnectedness.
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Affiliation(s)
| | | | - Katie M White
- Blackburn Community Recreation Center, Columbus, OH, USA
| | - Mi-Sun Choi
- The Ohio State University, Columbus, OH, USA
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35
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Associations between Neighborhood Open Space Features and Walking and Social Interaction in Older Adults-A Mixed Methods Study. Geriatrics (Basel) 2019; 4:geriatrics4030041. [PMID: 31284590 PMCID: PMC6787595 DOI: 10.3390/geriatrics4030041] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 12/01/2022] Open
Abstract
Neighborhood Open Spaces (NOS) such as public spaces around people’s homes, parks and village greens, may support activity and socializing for older adults. These spaces might be especially important for older adults as they typically are less mobile and have smaller activity spaces and social networks than other age groups. The present exploratory sequential mixed methods study investigates the association between built environment features, social interaction, and walking within NOS, among older adults living in a low socio-economic neighborhood in Copenhagen. Interviews, the Community Park Audit Tool, and the System for Observing Play and Recreation in Communities (SOPARC) were used to capture quantitative and qualitative data on 353 older adults (59–90 years old) within 11 NOS. Walking was predicted by the condition and shade along paths, seating and landscaping. Social interaction was negatively associated with walking, suggesting that older adults tend to sit down when engaging in social activities. Interviews highlighted the importance of social interaction within NOS. Future designs of NOS should acknowledge the importance of social meeting places, but at the same time provide walkable spaces for older adults to promote healthy aging.
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Environmental Interventions for Physical and Mental Health: Challenges and Opportunities for Greater Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122180. [PMID: 31226746 PMCID: PMC6617017 DOI: 10.3390/ijerph16122180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022]
Abstract
The fields of urban planning and public health were conceived under the same pressures and goals at their inception in the 17th and 18th centuries and continue to address the health concerns of an ever-increasing urban population. While the mutual need that both philosophies have for each other becomes more tangible through research and practice, the application of their interrelatedness continues to benefit residents and visitors of mindfully-built environments. In health-conscious Los Angeles, there lacks a comprehensive assessment of health-centered considerations being implemented by those entrusted with the responsibility of shaping our cities. As a greater majority of the world’s population moves into urban settings, built environment interventions play a progressively vital role in addressing physical and mental health concerns. This piece hopes to bring to attention the need for focused and dynamic approaches in addressing health concerns by means of design, planning, and policy, by focusing on the challenges and opportunities faced by the geographic and human resources of the Greater Los Angeles area.
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37
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Local Environment, Human Functions and the Elderly Depression and Anxiety. AGEING INTERNATIONAL 2019. [DOI: 10.1007/s12126-017-9312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Yu R, Wong M, Woo J. Perceptions of Neighborhood Environment, Sense of Community, and Self-Rated Health: an Age-Friendly City Project in Hong Kong. J Urban Health 2019; 96:276-288. [PMID: 30511137 PMCID: PMC6458199 DOI: 10.1007/s11524-018-00331-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To examine the relationships between perceptions of neighborhood environment, sense of community, and self-rated heath, we recruited 1798 people aged 60 years and older living in Hong Kong. With reference to the checklist of the essential features of age-friendly cities developed by the World Health Organization, perceptions of neighborhood environment were assessed using a questionnaire covering physical and social environmental domains, which mapped onto "outdoor spaces and buildings," "transportation," "housing," "social participation," "respect and social inclusion," "civic participation and employment," "communication and information," and "community support and health services." Sense of community was measured by the Brief Sense of Community Scale. Self-rated health was assessed by a single question. The relationships between these measures were analyzed using partial correlations, multivariate regression models, and path analyses. The mean age of the participants was 71.7 years; of which 54.3% were women. In multivariate regression models, perceived neighborhood environments were positively associated with sense of community and self-rated health. Among the domains of perceived neighborhood environment, "transportation" and "respect and social inclusion" were the physical and the social environmental domains most strongly associated with sense of community, respectively. In addition, sense of community accounted for part of the relationship between perceived neighborhood environments and self-rated health. The results of this study support the importance of perceived neighborhood environments for the sense that older person has of one's community, and self-rated health of older people which may be enhanced through the improvement of neighborhood environments.
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Affiliation(s)
- Ruby Yu
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, SAR, China. .,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Moses Wong
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jean Woo
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Kowitt SD, Donahue KE, Fisher EB, Mitchell M, Young LA. How is neighborhood social disorganization associated with diabetes outcomes? A multilevel investigation of glycemic control and self-reported use of acute or emergency health care services. Clin Diabetes Endocrinol 2018; 4:19. [PMID: 30377539 PMCID: PMC6194713 DOI: 10.1186/s40842-018-0069-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/08/2018] [Indexed: 01/02/2023] Open
Abstract
Background Diabetes management is influenced by a number of factors beyond the individual-level. This study examined how neighborhood social disorganization (i.e., neighborhoods characterized by high economic disadvantage, residential instability, and ethnic heterogeneity), is associated with diabetes-related outcomes. Methods We used a multilevel modeling approach to investigate the associations between census-tract neighborhood social disorganization, A1c, and self-reported use of acute or emergency health care services for a sample of 424 adults with type 2 diabetes. Results Individuals living in neighborhoods with high social disorganization had higher A1c values than individuals living in neighborhoods with medium social disorganization (B = 0.39, p = 0.01). Individuals living in neighborhoods with high economic disadvantage had higher self-reported use of acute or emergency health care services than individuals living in neighborhoods with medium economic disadvantage (B = 0.60, p = 0.02). Conclusions High neighborhood social disorganization was associated with higher A1c values and high neighborhood economic disadvantage was associated with greater self-reported use of acute or emergency health care services. Controlling for individual level variables diminished this effect for A1c, but not acute or emergency health care use. Comprehensive approaches to diabetes management should include attention to neighborhood context. Failure to do so may help explain the continuing disproportionate diabetes burden in many neighborhoods despite decades of attention to individual-level clinical care and education. Trial registration For this study, we used baseline data from a larger study investigating the impacts on patient-centered outcomes of three different approaches to self-monitoring of blood glucose among 450 adults with non-insulin dependent type 2 diabetes living in North Carolina. This study was registered as a clinical trial on 1/7/2014 (https://clinicaltrials.gov/ct2/show/NCT02033499).
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Affiliation(s)
- Sarah D Kowitt
- 1Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440 USA.,2Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Katrina E Donahue
- 2Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA.,3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Edwin B Fisher
- 1Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440 USA
| | - Madeline Mitchell
- 3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Laura A Young
- 4Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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Trecartin SM, Cummings SM. Systematic review of the physical home environment and the relationship to psychological well-being among community-dwelling older adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:567-582. [PMID: 29668403 DOI: 10.1080/01634372.2018.1463339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Older adults with functional impairments are at risk of being excluded from participation in day-to-day life. This exclusion can have detrimental effects on psychological well-being. The physical home environment is a potential force for both enhancing and limiting participation for this population. This systematic review of literature examined relationships between the physical home environment, functional impairment, and psychological well-being among older adults who live in community settings. The Ecological Model of Aging served as the guiding framework for this review. Results suggest that knowledge of the relationships between these constructs is still in the early stages. While associational relationships are established, the nature of these relationships is clouded by the inconsistency of measurement across studies, as well as design challenges. Objective and subjective features of the physical home environment are linked to psychological well-being throughout the literature. A growing body of evidence demonstrates that personal competence serves as a moderator of those relationships.
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Affiliation(s)
- Shannon M Trecartin
- a Department of Social Work, Andrews University , Berrien Springs , MI , USA
| | - Sherry M Cummings
- b College of Social Work, University of Tennessee Knoxville , Nashville , TN , USA
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A Conceptual Framework for Examining Healthcare Access and Navigation: A Behavioral-Ecological Perspective. SOCIAL THEORY & HEALTH 2017; 16:224-240. [PMID: 31007612 DOI: 10.1057/s41285-017-0053-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This paper introduces a conceptual framework for investigating individual ability to navigate healthcare in the contexts of the built environment, social environment, and healthcare infrastructure in which a person is embedded. Given the complexity of healthcare delivery in the United States, consumers are expected to have an increasingly sophisticated set of skills in order to effectively navigate and benefit from the healthcare resources available to them. Addressing barriers to navigation in vulnerable populations may be essential to reducing health disparities. This paper builds on previous conceptual developments in the areas of healthcare use, navigation, and ecological perspectives on health in order to present a behavioral-ecological framework for examining healthcare navigation and access. The model posits that healthcare navigation is an ecologically informed process not only because of the spatial distribution of health services, but because of the spatial distribution of individual and environmental factors that influence decision-making and behavior with respect to service use. The paper discusses areas for further research on healthcare navigation, challenges for research, and implications for reducing health disparities.
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Liu P, Zhao F, Zhang B, Dang Q. Small Change Makes a Big Splash: The Role of Working Self-Concept in the Effects of Stereotype Threat on Memory. THE JOURNAL OF PSYCHOLOGY 2017; 151:613-631. [PMID: 29116908 DOI: 10.1080/00223980.2017.1372340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Assuming that the principle of an active-self account holds true in real life, priming certain constructs could selectively activate a working self-concept, which in turn guides behavior. The current study involved two experiments that examined the relationships between stereotypic identity, working self-concept, and memory performance in older adults. Specifically, Study 1 tested whether a stereotype threat can affect older adults' working self-concept and memory performance. A modified Stroop color naming task and a separate recognition task showed that a stereotype threat prime altered the activation of the working self-concept and deteriorated the older adults' memory performance. Additionally, the working self-concept mediated the effect of stereotype threat on memory performance. Accordingly, we designed Study 2 to assess whether priming different identities can alter the working self-concept of the elderly and buffer the stereotype threat effect on memory performance. The results not only were the same as Study 1 but also revealed that activating multiple identities could mitigate the stereotype threat. These results support an active-self account and the efficacy of stereotype threat intervention. This intervention strategy may be able to be used in real situations to help the elderly alleviate stereotype threats and memory impairment.
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Stroope S, Cohen IFA, Tom JC, Franzen AB, Valasik MA, Markides KS. Neighborhood perception and self-rated health among Mexican American older adults. Geriatr Gerontol Int 2017; 17:2559-2564. [PMID: 28656690 DOI: 10.1111/ggi.13089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/14/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
AIM The aim of the present study was to assess the relationship between neighborhood perception and poor self-rated health among older Mexican Americans, adjusting for important background characteristics, such as neighborhood ethnic composition and other health conditions. METHODS Drawing on the 2004-2005 Hispanic Established Populations for the Epidemiologic Study of the Elderly data (n = 1780), the present study used logistic regression to examine the effects of neighborhood perception on poor self-rated health of older Mexican Americans. RESULTS The results show that participants with a greater positive perception of their neighborhood were less likely to report poor self-rated health, controlling for both socioeconomic status and health status covariates. CONCLUSIONS The findings suggest that positive neighborhood perception serves as an important protective factor in overall health. Geriatr Gerontol Int 2017; 17: 2559-2564.
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Affiliation(s)
- Samuel Stroope
- Department of Sociology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Isaiah F A Cohen
- Department of Sociology, Seattle Pacific University, Seattle, USA
| | - Joshua C Tom
- Department of Sociology, Seattle Pacific University, Seattle, USA.,Institute for Advanced Studies in Culture, University of Virginia, Charlottesville, Virginia, USA
| | - Aaron B Franzen
- Department of Sociology and Social Work, Hope College, Holland, Michigan, USA
| | - Matthew A Valasik
- Department of Sociology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Kyriakos S Markides
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas, USA
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Tong C, Sims-Gould J, McKay H. InterACTIVE Interpreted Interviews (I3): A multi-lingual, mobile method to examine the neighbourhood environment with older adults. Soc Sci Med 2016; 168:207-213. [DOI: 10.1016/j.socscimed.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/24/2016] [Accepted: 08/06/2016] [Indexed: 11/25/2022]
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Gong Y, Palmer S, Gallacher J, Marsden T, Fone D. A systematic review of the relationship between objective measurements of the urban environment and psychological distress. ENVIRONMENT INTERNATIONAL 2016; 96:48-57. [PMID: 27599349 DOI: 10.1016/j.envint.2016.08.019] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 07/15/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
The urban environment has become the main place that people live and work. As a result it can have profound impacts on our health. While much of the literature has focused on physical health, less attention has been paid to the possible psychological impacts of the urban environment. In order to understand the potential relevance and importance of the urban environment to population mental health, we carried out a systematic review to examine the associations between objective measurements of the urban environment and psychological distress, independently of the individual's subjective perceptions of the urban environment. 11 peer-reviewed papers published in English between January 2000 and February 2012 were identified. All studies were cross-sectional. Despite heterogeneity in study design, the overall findings suggested that the urban environment has measurable associations with psychological distress, including housing with deck access, neighbourhood quality, the amount of green space, land-use mix, industry activity and traffic volume. The evidence supports the need for development of interventions to improve mental health through changing the urban environment. We also conclude that new methods for measuring the urban environment objectively are needed which are meaningful to planners. In particular, future work should look at the spatial-temporal dynamic of the urban environment measured in Geographical Information System (GIS) in relation to psychological distress.
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Affiliation(s)
- Yi Gong
- Sustainable Places Research Institute, Cardiff University, United Kingdom; Division of Population Medicine, School of Medicine, Cardiff University, United Kingdom.
| | - Stephen Palmer
- Sustainable Places Research Institute, Cardiff University, United Kingdom.
| | - John Gallacher
- Department of Psychiatry, Medical Sciences Division, University of Oxford, United Kingdom.
| | - Terry Marsden
- Sustainable Places Research Institute, Cardiff University, United Kingdom.
| | - David Fone
- Division of Population Medicine, School of Medicine, Cardiff University, United Kingdom.
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Does disorder get "into the head" and "under the skin"? Layered contexts and bi-directional associations. Health Place 2016; 39:131-41. [PMID: 27086267 DOI: 10.1016/j.healthplace.2016.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 11/21/2022]
Abstract
This paper utilizes a layered context approach to examine how neighborhood and household conditions are associated with the objective and subjective well-being of older adults. Using two waves of data from the National Social Life, Health, and Aging Project (n=2261), we assess subjective mental health through self-reported measures of perceived stress and distress and objective physical health through C-reactive protein (CRP). Environmental disorder was measured by independent, trained interviewers. Cross-sectional results indicate that household disorder is positively associated with perceived stress and distress, overwhelming the association between neighborhood disorder and mental health outcomes. Yet longitudinal findings point to a reverse process, whereby highly stressed women experience deterioration in their home environment across the two waves. Few significant findings surfaced for CRP. Taken together, our findings illustrate the complex interplay between health and proximal environments and underscore how feedback cycles operate between "health" and "place" across multiple outcomes.
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Hill TD, Uchino BN, Eckhardt JL, Angel JL. Perceived Social Support Trajectories and the All-Cause Mortality Risk of Older Mexican American Women and Men. Res Aging 2016; 38:374-98. [PMID: 26966256 PMCID: PMC4908821 DOI: 10.1177/0164027515620239] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Although numerous studies of non-Hispanic Whites and Blacks show that social integration and social support tend to favor longevity, it is unclear whether this general pattern extends to the Mexican American population. Building on previous research, we employed seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the association between perceived social support trajectories and the all-cause mortality risk of older Mexican Americans. Growth mixture estimates revealed three latent classes of support trajectories: high, moderate, and low. Cox regression estimates indicated that older Mexican American men in the low support trajectory tend to exhibit a higher mortality risk than their counterparts in the high support trajectory. Social support trajectories were unrelated to the mortality risk of older Mexican American women. A statistically significant interaction term confirmed that social support was more strongly associated with the mortality risk of men.
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Ivey SL, Kealey M, Kurtovich E, Hunter RH, Prohaska TR, Bayles CM, Satariano WA. Neighborhood characteristics and depressive symptoms in an older population. Aging Ment Health 2016; 19:713-22. [PMID: 25316114 DOI: 10.1080/13607863.2014.962006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We explored relationships between depressive symptoms and neighborhood environment measures including traffic safety, crime, social capital, and density of businesses in community-dwelling older adults from four different regions of the United States. METHOD The Healthy Aging Research Network walking study is a cross-sectional study of 884 adults aged 65+, which included a 10-item Center for Epidemiologic Studies Depression scale of depressive symptoms, demographics, self-reported neighborhood perceptions, and objective neighborhood data. RESULTS After adjusting for individual covariates, reports of neighborhood crime, unsafe traffic, and unwillingness of neighbors to help each other were significantly positively associated with depressive symptoms among participants. CONCLUSION This research suggests an association between self-reported depressive symptoms and the social and built environment; examining causal association requires additional longitudinal research in diverse populations of older adults.
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Affiliation(s)
- Susan L Ivey
- a Community Health and Human Development, School of Public Health , University of California , Berkeley , CA , USA
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Ferraro KF. Life Course Lens on Aging and Health. HANDBOOKS OF SOCIOLOGY AND SOCIAL RESEARCH 2016. [DOI: 10.1007/978-3-319-20880-0_18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Blay SL, Schulz AJ, Mentz G. The Relationship of Built Environment to Health-Related Behaviors and Health Outcomes in Elderly Community Residents in a Middle Income Country. J Public Health Res 2015; 4:548. [PMID: 26425497 PMCID: PMC4568426 DOI: 10.4081/jphr.2015.548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 06/03/2015] [Indexed: 11/23/2022] Open
Abstract
Background Few studies have examined the impact of the built environment (BE) on health behaviours and health outcomes in middle income countries. This study examines associations between self-assessed characteristics of the home and neighbourhood environment and health-related behaviours and health outcomes in an elderly population in Brazil Design and methods In a community sample of 6963 community dwellers 60 years old and older living in the state of Rio Grande do Sul, Brazil, associations between self-reported BE conditions and health behaviours and health outcomes were assessed using a structured questionnaire. Multivariate analysis was conducted to investigate these associations while accounting for other relevant characteristics. Results We found significant positive associations between adverse BE conditions and pulmonary, urinary conditions, gastrointestinal, problems, headache and depression. There were mixed associations between adverse BE conditions and musculoskeletal and sensory conditions, inverse associations with metabolic disorders. and no associations with dermatologic problems and cancer. After accounting for health related behaviours, results suggest a modest association between adverse BE conditions and hypertension, with no significant associations with other indicators of cardiovascular conditions (heart problems, stroke, varicose veins). Conclusions The findings in this study suggest links between adverse conditions in the BE and health related behaviours in the hypothesized direction. Associations with the health conditions examined here are mixed. We find the strongest evidence for effects of adverse BE conditions for pulmonary and infectious conditions. Significant associations between the adverse BE indicators and health outcomes persist after accounting for health related behaviours, suggesting that BE conditions are linked to health pathways above and beyond the health related behaviours assessed in this study. Significance for public health The health outcomes for which we found most consistent evidence of associations with the built environment index (BEI) included respiratory conditions (bronchitis, pneumonia), urinary and renal conditions, gastrointestinal problems, headache, visual impairment and stroke. These health outcomes in the elderly may reflect exposures in the household environment associated with inadequate housing, such as mold, dust and damp. They may also be influenced by poor sanitary conditions, reflected in the absence of indoor plumbing and inadequate waste disposal facilities. Poor vision, headache and depression may all be associated with chronic exposure to poverty and stress, for which the measures of the household and neighborhood environmental conditions used in the BEI may be indicators. Assuring that the elderly in Brazil have access to adequate housing located in neighborhoods with access to basic sanitary conditions, water and lighting, will be increasingly important as the average age of Brazilians continues to increase, and increasing proportions of the population experience the adverse health effects associated with these conditions.
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Affiliation(s)
- Sergio L Blay
- Department of Psychiatry, Federal University of São Paulo , Brazi, MI, USA
| | - Amy J Schulz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor, MI, USA
| | - Graciela Mentz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor, MI, USA
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