Investigating the effects of medical density on health-seeking behaviours using a multiscale approach to residential and activity spaces: results from a prospective cohort study in the Paris metropolitan area, France

[Time and space in the care pathways of women suffering from breast cancer]

Facing breast cancer, women in precarious situations are more likely to be diagnosed at an advanced stage, and when detected at the same stage, they are more to die as well as faster. In this paper, we analyze a corpus of 40 semi-structured interviews conducted in six cancer services in hospitals of the Paris area on the care pathways of women with breast cancer. The analysis focuses on the beginning of the pathways (until the first treatments) and concentrates on their spatial and temporal dimension in the light of precariousness. Depending on the women's situations with regard to precariousness, the spatial and temporal organization of the pathways differs. There are socially differentiated latency periods that delay diagnosis (prior to meeting a medical professional) or the beginning of treatment (in relation to rights, the responsiveness of the health care system, and the interactions between women and the system). Spatially, the geometry of the pathways is variable and reflects different expectations of health institutions and medical staff according to the social profiles of the women. However, a detailed analysis of the pathways allows us to nuance these differences in terms of precariousness. The women's capacity to be autonomous, their network of contacts, the accessibility and responsiveness of the health care system, as well as the sensitive and emotional dimension of this stressful event affect the pathways both in terms of time and space.

Cervical cancer screening pathways in France in 2015-2021, a nationwide study based on medico-administrative data

To better document cervical cancer screening (CCS) pathways, the purpose of our study was to examine CCS pathways among women who had undergone a screening test (opportunistic or organised programme), based on real-life data over a 7-year period. This study used data from the French national health care database (SNDS), which covers almost 100 % of the French population of around 66 million inhabitants. Data from 2015 to 2021 were extracted. More than one quarter (27 %) of women who were at least 25 years old in 2015 and up to 65 years old in 2021 were not screened over the 2015-2021 period. Compared to women who had undergone screening at least once, women who were not screened were older (36 % vs. 23 % in the 50-59 years age group in 2015) and lived in the most deprived urban areas (21 % vs 16 % for less and most deprived respectively). 57 % of women underwent screening within recommended intervals, 13 % of women were under-screened, and 30 % were overscreened. Overall, our study identified that, in 2021, women who participated in the French organised screening programme were less likely to be screened within the recommended interval over the 7-year period. These analyses need to be continued over time in order to assess whether the programme helps reintegrate women into the screening process.

Factors associated with participation in the organized cervical cancer screening program in the greater Paris area (France): An analysis among more than 200,000 women

We aimed to identify the contextual factors associated with participation in the organized Cervical Cancer Screening (CCS) pilot program, which includes specific interventions to reach vulnerable women, in the Greater Paris region. Study population consisted of 231,712 women aged 25-65 years, who were not up to date to their smear test and had been invited to take part in the program from July 2014 to September 2017. Using a multilevel mixed logistic regression with random effects, we investigated the effect of grassroots interventions targeting vulnerable women, healthcare provider accessibility, social environment and municipal policy-related factors. The CCS rate was two times higher in women who had received their first invitation to the program during the study period (32·9%) compared to those who were already invited before the study period (15·3%). In both populations, there were no significant trends in participation with regards to the type of grassroots interventions, level of accessibility of healthcare services or municipal commitment to healthcare. Among women invited previously and aged above 35 increased participation was seen in neighborhoods with low proportion of single women or in less deprived neighborhoods. Our results identified groups of women who participated less in the organized CCS program and suggested that additional interventions targeting the barriers faced by vulnerable women, especially those aged 35-45 years old, are needed.

Risk of late cervical cancer screening in the Paris region according to social deprivation and medical densities in daily visited neighborhoods

Background

Social and physical characteristics of the daily visited neighborhoods have gained an extensive interest in analyzing socio-territorial inequalities in health and healthcare. The objective of the present paper is to estimate and discuss the role of individual and contextual factors on participation in preventive health-care activities (smear screening) in the Greater Paris area focusing on the characteristics of daily visited neighborhoods in terms of medical densities and social deprivation.

Methods

The study included 1817 women involved in the SIRS survey carried out in 2010. Participants could report three neighborhoods they regularly visit (residence, work/study, and the next most regularly visited). Two “cumulative exposure scores” have been computed from household income and medical densities (general practitioners and gynecologists) in these neighborhoods. Multilevel logistic regression models were used to measure association between late cervical screening (> 3 years) and characteristics of daily visited neighborhoods (residential, work or study, visit).

Results

One-quarter of the women reported that they had not had a smear test in the previous 3 years. Late smear test was found to be more frequent among younger and older women, among women being single, foreigners and among women having a low-level of education and a limited activity space. After adjustment on individual characteristics, a significant association between the cumulative exposure scores and the risk of a delayed smear test was found: women who were exposed to low social deprivation and to low medical densities in the neighborhoods they daily visit had a significantly higher risk of late cervical cancer screening than their counterparts.

Conclusions

For a better understanding of social and territorial inequalities in healthcare, there is a need for considering multiple daily visited neighborhoods. Cumulative exposure scores may be an innovative approach for analyzing contextual effects of daily visited neighborhoods rather than focusing on the sole residential neighborhood.

Influence of Individual and Contextual Perceptions and of Multiple Neighborhoods on Depression

The risk of depression is related to multiple various determinants. The consideration of multiple neighborhoods daily frequented by individuals has led to increased interest in analyzing socio-territorial inequalities in health. In this context, the main objective of this study was (i) to describe and analyze the spatial distribution of depression and (ii) to investigate the role of the perception of the different frequented spaces in the risk of depression in the overall population and in the population stratified by gender. Data were extracted from the 2010 SIRS (a French acronym for "health, inequalities and social ruptures") cohort survey. In addition to the classic individual characteristics, the participants reported their residential neighborhoods, their workplace neighborhoods and a third one: a daily frequented neighborhood. A new approach was developed to simultaneously consider the three reported neighborhoods to better quantify the level of neighborhood socioeconomic deprivation. Multiple simple and cross-classified multilevel logistic regression models were used to analyze the data. Depression was reported more frequently in low-income (OR = 1.89; CI = [1.07-3.35]) or middle-income (OR = 1.91; CI = [1.09-3.36]) neighborhoods and those with cumulative poverty (OR = 1.64; CI = [1.10-2.45]). In conclusion, a cumulative exposure score, such as the one presented here, may be an appropriate innovative approach to analyzing their effects in the investigation of socio-territorial inequalities in health.

Is accessibility in the eye of the beholder? Social inequalities in spatial accessibility to health-related resources in Montréal, Canada

Neighbourhood resources are often considered to be spatially accessible to people when they are located close to their place of residence, a perspective which overlooks individuals' unique lived experience of their neighbourhood and how they define it. Drawing on the relational approach to place and on Sen's capability approach, we explore spatial accessibility to health-related resources, and the social gradient therein, in light of people's place experiences. Using data from 1101 young adults from Montreal (Canada) who participated in the Interdisciplinary Study of Inequalities in Smoking (ISIS), we compare the social gradients in the presence of health-related resources located (i) within uniform areas (defined as circular buffers and road-network buffers) around participants' place of residence; and (ii) within participants' self-defined neighbourhoods. Social inequalities in accessibility to a diversity of health-related resources (grocery stores, fruit and vegetable stores, eating and drinking places, recreational sports centres, civic, social, and fraternal organizations, bike paths, parks, social services, libraries, dental offices, physician offices) were more pronounced in self-defined neighbourhoods than in uniform buffer areas. Neglecting the variability in people's place experiences may distort the assessment of social inequalities in accessibility, and ultimately, of neighbourhood effects on health inequalities.

Influence of activity space on the association between neighborhood characteristics and dementia risk: results from the 3-City study cohort

Background

Socioeconomic level of residential environment was found to influence cognitive performance. However, individuals from the same place of residence may be affected differently. We aim to investigate for the first time the influence of individual activity space on the association between neighborhood socioeconomic status (NSES) and the risk of dementia.

Methods

In the frame of the Three-City cohort, a French population-based study, we followed longitudinally (12 years) 7009 participants aged over 65. The activity space (i.e., the spatial area through which a person moves daily) was defined using two questions from Lawton’s Instrumental Activities of Daily Living scale (“Goes shopping independently”,“Travels alone”), and one question about mobility restriction. The survival analysis was performed using a Cox marginal model that takes into account intra-neighborhood correlations and includes a large number of potential confounders.

Results

Among people with a limited activity space (n = 772, 11%), risk of dementia is increased in subjects living in a deprived area (characterized by high GINI index or low median income) compared to those living in more favored.

Conclusion

This study shows that the individual activity space modifies the association between NSES and the risk of dementia providing a more complete picture of residential inequalities. If confirmed in different populations, these findings suggest that people with limited activity space and living in a deprived neighborhood are particularly at risk and should be targeted for prevention.

Comparing the Data Quality of Global Positioning System Devices and Mobile Phones for Assessing Relationships Between Place, Mobility, and Health: Field Study

Background

Mobile devices are increasingly used to collect location-based information from individuals about their physical activities, dietary intake, environmental exposures, and mental well-being. Such research, which typically uses wearable devices or mobile phones to track location, benefits from the growing availability of fine-grained data regarding human mobility. However, little is known about the comparative geospatial accuracy of such devices.

Objective

In this study, we compared the data quality of location information collected from two mobile devices that determine location in different ways—a global positioning system (GPS) watch and a mobile phone with Google’s Location History feature enabled.

Methods

A total of 21 chronically ill participants carried both devices, which generated digital traces of locations, for 28 days. A mobile phone–based brief ecological momentary assessment (EMA) survey asked participants to manually report their location at 4 random times throughout each day. Participants also took part in qualitative interviews and completed surveys twice during the study period in which they reviewed recent mobile phone and watch trace data to compare the devices’ trace data with their memory of their activities on those days. Trace data from the devices were compared on the basis of (1) missing data days, (2) reasons for missing data, (3) distance between the route data collected for matching day and the associated EMA survey locations, and (4) activity space total area and density surfaces.

Results

The watch resulted in a much higher proportion of missing data days (P<.001), with missing data explained by technical differences between the devices as well as participant behaviors. The mobile phone was significantly more accurate in detecting home locations (P=.004) and marginally more accurate (P=.07) for all types of locations combined. The watch data resulted in a smaller activity space area and more accurately recorded outdoor travel and recreation.

Conclusions

The most suitable mobile device for location-based health research depends on the particular study objectives. Furthermore, data generated from mobile devices, such as GPS phones and smartwatches, require careful analysis to ensure quality and completeness. Studies that seek precise measurement of outdoor activity and travel, such as measuring outdoor physical activity or exposure to localized environmental hazards, would benefit from the use of GPS devices. Conversely, studies that aim to account for time within buildings at home or work, or those that document visits to particular places (such as supermarkets, medical facilities, or fast food restaurants), would benefit from the greater precision demonstrated by the mobile phone in recording indoor activities.

Impact of car transport availability and drive time on eye examination uptake among adults aged ≥60 years: a record linkage study

AIM

To examine associations between uptake of free primary eye care, service availability (density of optometric practices) and service accessibility (household car access and drive time to nearest provider) after accounting for socioeconomic status and other individual, household and area factors.

METHODS

We constructed a cohort of 294 870 community-dwelling adults aged 60 years, drawing contextual information from the 2011 Northern Ireland Census. Minimum drive times to the nearest optometry practice (1-19 min) and number of practices were derived for 890 geographical areas. The primary outcome was attendance at one or more publicly funded eye examinations to which all cohort members were entitled between 2009 and 2014. We used multiple log-binomial regression to estimate associations between eye care uptake, car ownership and drive time.

RESULTS

Eye examination uptake was 60.0%. 23.7% of the cohort had no car access, and these individuals had lower uptake than car owners (unadjusted risk ratio (RR) of uptake=0.86 (0.86, 0.87)). Among non-car owners, uptake decreased with drive time (longest vs shortest: RR=0.92 (0.88, 0.97)) with the largest decrease at 4 min drive time (approximately 1.5 miles). This pattern was weaker among car owners. These associations were independent of service availability, which was not associated with uptake.

CONCLUSION

Both drive time and household car access were associated with eye care use, adjusting for individual, household and area factors. Policies to improve uptake should target those with no car access, especially those beyond walking distance from the nearest eye care provider.

User acceptance of location-tracking technologies in health research: Implications for study design and data quality

Research regarding place and health has undergone a revolution due to the availability of consumer-focused location-tracking devices that reveal fine-grained details of human mobility. Such research requires that participants accept such devices enough to use them in their daily lives. There is a need for a theoretically grounded understanding of acceptance of different location-tracking technology options, and its research implications. Guided by an extended Unified Theory of Acceptance and Use of Technology (UTAUT), we conducted a 28-day field study comparing 21 chronically ill people's acceptance of two leading, consumer-focused location-tracking technologies deployed for research purposes: (1) a location-enabled smartphone, and (2) a GPS watch/activity tracker. Participants used both, and completed two surveys and qualitative interviews. Findings revealed that all participants exerted effort to facilitate data capture, such as by incorporating devices into daily routines and developing workarounds to keep devices functioning. Nevertheless, the smartphone was perceived to be significantly easier and posed fewer usability challenges for participants than the watch. Older participants found the watch significantly more difficult to use. For both devices, effort expectancy was significantly associated with future willingness to participate in research although prosocial motivations overcame some concerns. Social influence, performance expectancy and use behavior were significantly associated with intentions to use the devices in participants' personal lives. Data gathered via the smartphone was significantly more complete than data gathered via the watch, primarily due to usability challenges. To make longer-term participation in location tracking research a reality, and to achieve complete data capture, researchers must minimize the effort involved in participation; this requires usable devices. For long-term location-tracking studies using similar devices, findings indicate that only smartphone-based tracking is up to the challenge.

[Schizotypal Personality Questionnaire-Brief - Likert format: Factor structure analysis in general population in France]

INTRODUCTION

The main objective of the study was to explore the factorial structure of the French version of the Schizotypal Personality Questionnaire-Brief (SPQ-B) in a Likert format, in a representative sample of the general population. In addition, differences in the dimensional scores of schizotypy according to gender and age were analyzed. As the study in the general population of schizotypal traits and its determinants has been recently proposed as a way toward the understanding of aetiology and pathophysiology of schizophrenia, consistent self-report tools are crucial to measure psychometric schizotypy. A shorter version of the widely used Schizotypal Personality Questionnaire (SPQ-Brief) has been extensively investigated in different countries, particularly in samples of students or clinical adolescents, and more recently, a few studies used a Likert-type scale format which allows partial endorsement of items and reduces the risk of defensive answers.

METHOD

A sample of 233 subjects representative of the adult population from an urban area near Paris (Créteil) was recruited using the "itinerary method". They completed the French version of the SPQ-B with a 5-point Likert-type response format (1=completely disagree; 5=completely agree). We examined the dimensional structure of the French version of the SPQ-B with a Principal Components Analysis (PCA) followed by a promax rotation. Factor selection was based on Eigenvalues over 1.0 (Kaiser's criterion), Cattell's Scree-plot test, and interpretability of the factors. Items with loadings greater than 0.4 were retained for each dimension. The internal consistency estimate of the dimensions was calculated with Cronbach's α. In order to study the influence of age and gender, we carried out a simple linear regression with the subscales as dependent variables.

RESULTS

Our sample was composed of 131 women (mean age=52.5±18.2 years) and 102 men (mean age=53±18.1 years). SPQ-B Likert total scores ranged from 22 to 84 points (mean=43.6±13). Factor analysis resulted in a 3-factor solution that explained 47.7% of the variance. Factor 1 (disorganized; 10 items) included items related to "odd behavior", "odd speech", as well as "social anxiety", one item of "constricted affect" and one item of "ideas of reference". Factor 2 (interpersonal; 7 items) included items related to "no close friends", "constricted affect", and three of the items of "suspiciousness". Factor 3 (cognitive-perceptual; 5 items) included items related to "ideas of reference", "magical thinking", "unusual perceptual experiences" and one item of "suspiciousness". Coefficient α for the three subscales and total scale were respectively 0.81, 0.81, 0.77 and 0.88. We found no differences in total schizotypy and the three dimensions scores according to age and sex.

CONCLUSION

Factor analysis of the French version of the SPQ-B in a Likert format confirmed the three-factor structure of schizotypy. We found a pure cognitive perceptual dimension including the most representative positive features. As expected, "Suspiciousness" subscale is included in both positive and negative dimensions, but mainly in the negative dimension. Surprisingly, "social anxiety" subscale is included in the disorganized dimension in our analysis. The SPQ-B in a Likert format demonstrated good internal reliability for both total and subscales scores. Unlike previous published results, we did not find any influence of age or gender on schizotypal dimensions.

Socio-Economic Determinants of the Need for Dental Care in Adults

BACKGROUND

Oral health has improved in France. However, there are still inequalities related to the socio-economic status.

OBJECTIVES

The aim of this study was to measure the prevalence of dental care needs in an adult population and to identify the demographic, socio-economic and behavioral variables that may explain variations in this parameter.

METHODS

A cross-sectional analysis of the French SIRS cohort (n = 2,997 adults from the Paris region; 2010 data) was carried out to determine the prevalence of self-reported dental care needs relative to demographic, socio-economic and behavioral variables. A logistic regression model was used to identify the variables that were most strongly associated with the level of need.

RESULTS

In 2010, the prevalence of the need for dental care in the SIRS cohort was 35.0% (95% CI [32.3-37.8]). It was lower in people with higher education levels (31.3% [27.9-34.6]), without immigrant background (31.3% [28.0-34.6]) and with comprehensive health insurance (social security + complementary health cover; 32.8% [30.2-35.4]). It decreased as the socio-economic status increased, but without following a strict linear change. It was also lower among individuals who had a dental check-up visit in the previous two years. In multivariate analyses, the socioeconomic variables most strongly associated with the need for dental care were: educational attainment (OR = 1.21 [1.02-1.44]), income level (OR = 1.66 [1.92-2.12]) and national origin (OR = 1.53 [1.26-1.86]).

CONCLUSION

These results confirm that the prevalence of dental care needs is higher among adults with low socio-economic status. Education level, income level and also national origin were more strongly associated with the need for dental care than insurance cover level.

Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore- a mixed methods study

Background

In Singapore, subsidized primary care is provided by centralized polyclinics; since 2000, policies have allowed lower-income Singaporeans to utilize subsidies at private general-practitioner (GP) clinics. We sought to determine whether proximity to primary care, subsidised primary care, or having regular primary care associated with health screening participation in a low socioeconomic-status public rental-flat community in Singapore.

Methods

From 2009–2014, residents in five public rental-flat enclaves (N = 936) and neighboring owner-occupied precincts (N = 1060) were assessed for participation in cardiovascular and cancer screening. We then evaluated whether proximity to primary care, subsidised primary care, or having regular primary care associated with improved adherence to health screening. We also investigated attitudes to health screening using qualitative methodology.

Results

In the rental flat population, for cardiovascular screening, regular primary care was independently associated with regular diabetes screening (adjusted odds ratio, aOR = 1.59, CI = 1.12–2.26, p = 0.009) and hyperlipidemia screening (aOR = 1.82, CI = 1.10–3.04, p = 0.023). In the owner-occupied flats, regular primary care was independently associated with regular hypertension screening (aOR = 9.34 (1.82–47.85, p = 0.007), while subsidized primary care was associated with regular diabetes screening (aOR = 2.94, CI = 1.04–8.31, p = 0.042). For cancer screening, in the rental flat population, proximity to primary care was associated with less participation in regular colorectal cancer screening (aOR = 0.42, CI = 0.17–0.99, p = 0.049) and breast cancer screening (aOR = 0.29, CI = 0.10–0.84, p = 0.023). In the owner-occupied flat population, for gynecological cancer screening, usage of subsidized primary care and proximity to primary care was associated with higher rates of breast cancer and cervical cancer screening; however, being on regular primary care followup was associated with lower rates of mammography (aOR = 0.10, CI = 0.01–0.75, p = 0.025). On qualitative analysis, patients were discouraged from screening by distrust in the doctor-patient relationship; for cancer screening in particular, patients were discouraged by potential embarrassment.

Conclusions

Regular primary care was independently associated with regular participation in cardiovascular screening in both low-SES and higher-SES communities. However, for cancer screening, in the low-SES community, proximity to primary care was associated with less participation in regular screening, while in the higher-SES community, regular primary care was associated with lower screening participation; possibly due to embarrassment regarding screening modalities.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0411-5) contains supplementary material, which is available to authorized users.

Self-defined residential neighbourhoods: size variations and correlates across five European urban regions

The neighbourhood is recognized as an important unit of analysis in research on the relation between obesogenic environments and development of obesity. One important challenge is to define the limits of the residential neighbourhood, as perceived by study participants themselves, in order to improve our understanding of the interaction between contextual features and patterns of obesity. An innovative tool was developed in the framework of the SPOTLIGHT project to identify the boundaries of neighbourhoods as defined by participants in five European urban regions. The aims of this study were (i) to describe self-defined neighbourhood (size and overlap with predefined residential area) according to the characteristics of the sampling administrative neighbourhoods (residential density and socioeconomic status) within the five study regions and (ii) to determine which individual or/and environmental factors are associated with variations in size of self-defined neighbourhoods. Self-defined neighbourhood size varies according to both individual factors (age, educational level, length of residence and attachment to neighbourhood) and contextual factors. These findings have consequences for how residential neighbourhoods are defined and operationalized and can inform how self-defined neighbourhoods may be used in research on associations between contextual characteristics and health outcomes such as obesity.

Which adults in the Paris metropolitan area have never been tested for HIV? A 2010 multilevel, cross-sectional, population-based study

BACKGROUND

Despite the widespread offer of free HIV testing in France, the proportion of people who have never been tested remains high. The objective of this study was to identify, in men and women separately, the various factors independently associated with no lifetime HIV testing.

METHODS

We used multilevel logistic regression models on data from the SIRS cohort, which included 3006 French-speaking adults as a representative sample of the adult population in the Paris metropolitan area in 2010. The lifetime absence of any HIV testing was studied in relation to individual demographic and socioeconomic factors, psychosocial characteristics, sexual biographies, HIV prevention behaviors, attitudes towards people living with HIV/AIDS (PLWHA), and certain neighborhood characteristics.

RESULTS

In 2010, in the Paris area, men were less likely to have been tested for HIV at least once during their lifetime than women. In multivariate analysis, in both sexes, never having been tested was significantly associated with an age younger or older than the middle-age group (30-44 years), a low education level, a low self-perception of HIV risk, not knowing any PLWHA, a low lifetime number of couple relationships, and the absence of any history of STIs. In women, other associated factors were not having a child < 20 years of age, not having additional health insurance, having had no or only one sexual partner in the previous 5 years, living in a cohabiting couple or having no relationship at the time of the survey, and a feeling of belonging to a community. Men with specific health insurance for low-income individuals were less likely to have never been tested, and those with a high stigma score towards PLWHA were more likely to be never-testers. Our study also found neighborhood differences in the likelihood of men never having been tested, which was, at least partially, explained by the neighborhood proportion of immigrants. In contrast, in women, no contextual variable was significantly associated with never-testing for HIV after adjustment for individual characteristics.

CONCLUSIONS

Studies such as this one can help target people who have never been tested in the context of recommendations for universal HIV screening in primary care.

Catchments of general practice in different countries--a literature review

The purpose of this paper is to review the current research on catchment areas of private general practices in different developed countries because healthcare reform, including primary health care, has featured prominently as an important political issue in a number of developed countries. The debates around health reform have had a significant health geographic focus.

Conceptually, GP catchments describe the distribution, composition and profile of patients who access a general practitioner or a general practice (i.e. a site or facility comprising one or more general practitioners). Therefore, GP catchments provide important information into the geographic variation of access rates, utilisation of services and health outcomes by all of the population or different population groups in a defined area or aggregated area.

This review highlights a wide range of diversity in the literature as to how GP catchments can be described, the indicators and measures used to frame the scale of catchments. Patient access to general practice health care services should be considered from a range of locational concepts, and not necessarily constrained by their place of residence. An analysis of catchment patterns of general practitioners should be considered as dynamic and multi-perspective. Geographic information systems provide opportunities to contribute valuable methodologies to study these relationships. However, researchers acknowledge that a conceptual framework for the analysis of GP catchments requires access to real world data. Recent studies have shown promising developments in the use of real world data, especially from studies in the UK.

Understanding the catchment profiles of individual GP surgeries is important if governments are serious about patient choice being a key part of proposed primary health reforms. Future health planning should incorporate models of GP catchments as planning tools, at the micro level as well as the macro level, to assist policies on the allocation of resources so that opportunities for good health outcomes for all groups within society, especially those who have been systematically denied equitable access, are maximised.

Assessing patterns of spatial behavior in health studies: their socio-demographic determinants and associations with transportation modes (the RECORD Cohort Study)

Prior epidemiological studies have mainly focused on local residential neighborhoods to assess environmental exposures. However, individual spatial behavior may modify residential neighborhood influences, with weaker health effects expected for mobile populations. By examining individual patterns of daily mobility and associated socio-demographic profiles and transportation modes, this article seeks to develop innovative methods to account for daily mobility in health studies. We used data from the RECORD Cohort Study collected in 2011-2012 in the Paris metropolitan area, France. A sample of 2062 individuals was investigated. Participants' perceived residential neighborhood boundaries and regular activity locations were geocoded using the VERITAS application. Twenty-four indicators were created to qualify individual space-time patterns, using spatial analysis methods and a geographic information system. Three domains of indicators were considered: lifestyle indicators, indicators related to the geometry of the activity space, and indicators related to the importance of the residential neighborhood in the overall activity space. Principal component analysis was used to identify main dimensions of spatial behavior. Multilevel linear regression was used to determine which individual characteristics were associated with each spatial behavior dimension. The factor analysis generated five dimensions of spatial behavior: importance of the residential neighborhood in the activity space, volume of activities, and size, eccentricity, and specialization of the activity space. Age, socioeconomic status, and location of the household in the region were the main predictors of daily mobility patterns. Activity spaces of small sizes centered on the residential neighborhood and implying a large volume of activities were associated with walking and/or biking as a transportation mode. Examination of patterns of spatial behavior by individual socio-demographic characteristics and in relation to transportation modes is useful to identify populations with specific mobility/accessibility needs and has implications for investigating transportation-related physical activity and assessing environmental exposures and their effects on health.

Moving beyond the residential neighborhood to explore social inequalities in exposure to area-level disadvantage: Results from the Interdisciplinary Study on Inequalities in Smoking

The focus, in place and health research, on a single, residential, context overlooks the fact that individuals are mobile and experience other settings in the course of their daily activities. Socio-economic characteristics are associated with activity patterns, as well as with the quality of places where certain groups conduct activities, i.e. their non-residential activity space. Examining how measures of exposure to resources, and inequalities thereof, compare between residential and non-residential contexts is required. Baseline data from 1890 young adults (18-25 years-old) participating in the Interdisciplinary Study of Inequalities in Smoking, Montreal, Canada (2011-2012), were analyzed. Socio-demographic and activity location data were collected using a validated, self-administered questionnaire. Area-level material deprivation was measured within 500-m road-network buffer zones around participants' residential and activity locations. Deprivation scores in the residential area and non-residential activity space were compared between social groups. Multivariate linear regression was used to estimate associations between individual- and area-level characteristics and non-residential activity space deprivation, and to explore whether these characteristics attenuated the education-deprivation association. Participants in low educational categories lived and conducted activities in more disadvantaged areas than university students/graduates. Educational inequalities in exposure to area-level deprivation were larger in the non-residential activity space than in the residential area for the least educated, but smaller for the intermediate group. Adjusting for selected covariates such as transportation resources and residential deprivation did not significantly attenuate the education-deprivation associations. Results support the existence of social isolation in residential areas and activity locations, whereby less educated individuals tend to be confined to more disadvantaged areas than their more educated counterparts. They also highlight the relevance of investigating both residential and non-residential contexts when studying inequalities in health-relevant exposures.