Associations of perceived neighbourhood safety from traffic and crime with overweight/obesity among South African adults of low-socioeconomic status

Does a sprawling neighborhood affect obesity? Evidence from Indonesia

While the causes of obesity have been widely discussed from various perspectives, studies that examine how the physical form of a neighborhood could causally affect obesity remain limited. This study combined individual-level longitudinal data from the Indonesian Family Life Survey and subdistrict-level land cover data to investigate whether a neighborhood's physical form affects individuals' obesity status. We controlled for individual and location fixed-effect to account for individuals' sorting preferences and unobserved heterogeneity at the subdistrict level. Our results suggest that a sprawling neighborhood corresponds to a lower body mass index, particularly among males. We also show that consumption behavior can explain this mechanism.

Association between Young People's Neighbourhoods' Characteristics and Health Risk Factors in Saudi Arabia

INTRODUCTION

A neighbourhood's environmental characteristics can positively or negatively influence health and well-being. To date, no studies have examined this concept in the context of Saudi Arabian youth. Therefore, this study aimed to evaluate the association between a neighbourhood's environmental characteristics and health risk factors among Saudi Arabian youth.

METHODS

A total of 335 secondary-school students (175 males, 160 females), aged 15-19 years old, participated. Body mass index (BMI) and waist circumference measurements were taken, and physical activity (steps) was measured via pedometer. The perceived neighbourhood environment was assessed using the International Physical Activity Questionnaire Environment Module (IPAQ-E).

RESULTS

Significant differences were found between the youths from urban, rural farm, and rural desert locations in terms of BMI, waist circumference, daily steps, accessibility, infrastructure, social environment, household vehicles, safety, and access to facilities (p < 0.001). Rural desert youths were less active, and males (26.43 + 8.13) and females (24.68 + 5.03) had higher BMIs compared to the youths from other areas. Chi-square analysis revealed a significant difference (χ21 = 12.664, p < 0.001) between the genders as to social-environment perceptions. Males perceived their neighbourhood as a social environment more than was reported by females (68.39% and 50.28%, respectively). Pearson's correlation revealed negative significant relationships between steps and both safety of neighbourhood (r = -0.235, p < 0.001) and crime rate (r = -0.281, p < 0.001).

DISCUSSION

Geographical location, cultural attitudes, lack of facilities, and accessibility impact youth physical-activity engagement and weight status; this includes environmental variables such as residential density, neighbourhood safety, household motor vehicles, and social environment.

CONCLUSIONS

This is the first study examining associations with neighbourhood environments in the youths of the Kingdom of Saudi Arabia. Significant associations and geographical differences were found. More research and policy interventions to address neighbourhoods' environmental characteristics and health risk factors relative to Saudi Arabian youth are warranted.

Obesity, beverage consumption and sleep patterns in rural African women in relation to advertising of these beverages

BACKGROUND

The burden of obesity-related, non-communicable diseases in South Africa is persistent, with poor and black South African women particularly vulnerable. The purpose of the present study was to determine relationships between obesity, physical activity, sleep patterns and beverage consumption among black South African women in a rural village in the Limpopo province.

METHODS

A cross-sectional study was conducted among 200 rural-dwelling African women. Data were collected on beverage consumption, sociodemographic information, sleep patterns and anthropometry using self-reported questionnaires.

RESULTS

The mean body mass index (BMI) was 28.5±7.3 kg/m2, with 40% being classified as obese (BMI ≥30 kg/m2) and the mean sleep score was 4.68±2.51. Participants with very bad habitual sleeping patterns consumed significantly more sugar-sweetened beverages and alcohol than those with very good sleeping patterns. We also observed that when total coffee with sugar, fruit juice, total sugar-sweetened beverages and weight decreased the number of hours participants slept increased.

CONCLUSIONS

The study identified significant associations between body weight, sleep duration and sugar-sweetened beverage consumption among rural black South African women. This underscores a need to address unhealthy lifestyle behaviours to lower incidences of non-communicable diseases in rural-dwelling women.

Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study

BACKGROUND

Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China).

METHODS

The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes.

RESULTS

Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants.

CONCLUSION

Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.

Is city-level travel time by car associated with individual obesity or diabetes in Latin American cities? Evidence from 178 cities in the SALURBAL project

There is growing evidence that longer travel time by private car poses physical and mental risks. Individual-level obesity and diabetes, two of the main public health challenges in low- and middle-income contexts, could be associated to city-level travel times by car. We used individual obesity and diabetes data from national health surveys from individuals in 178 Latin American cities, compiled and harmonized by the SALURBAL project. We calculated city-level travel times by car using the Google Maps Distance Matrix API. We estimated associations between peak hour city-level travel time by car and obesity and diabetes using multilevel logistic regression models, while adjusting for individual characteristics and other city-level covariates. In our study we did not observe a relationship between city-level peak-hour travel time by car and individual obesity and diabetes, as reported in previous research for individual time spent in vehicles in high-income settings. Our results suggest that this relationship may be more complex in Latin America compared to other settings, especially considering that cities in the region are characterized by high degrees of population density and compactness and by a higher prevalence of walking and public transportation use.

Association of social capital with obesity among older adults in China: a cross-sectional analysis

Background

Under the global aging trend, health issues of the elderly have received more and more attention. Among them, older adults’ obesity is one of the common health problems of the elderly. The association between social capital and obesity in the older adults has been analysed and discussed in previous studies but remains controversial. There are few studies on the association between social capital and obesity in the older adults in China. We examined whether social capital was associated with obesity in Chinese older adults.

Methods

The data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) —wave 8 (2017–2018) was used in this study. Totally, 10,164 respondents were included in the final analysis. Generalized trust, social participation (informal social interaction and participation of organized social activities), and social support was used as measures of social capital. Obesity status was defined by body mass index (BMI). Logistic regression analyses were used to assess associations between the social capital and obesity, adjusting for confounders.

Results

We found that the older adults who did not trust people around had greater odds of being overweighted/obese compared to those who trust [Adjusted Odds Ratio (AOR) 1.155, 95% CI 1.045 to 1.265]. The older adults having formal participation (participating in organized social activities) registered considerably higher BMI (AOR 1.155, 95% CI 1.041 to 1.269). The older adults who did not trust people around them had greater odds of being overweighted/obese both in males (AOR 1.172, 95% CI 1.012–1.333) and in females (AOR 1.155, 95% CI 1.004–1.306). Males having formal social participation were more likely to be overweighted/obese (AOR 1.181, 95% CI 1.024 to 1.337), but not in females.

Conclusions

Generalized trust and formal social participation was associated with overweight/obesity among older adults in China. Targeted obesity interventions for older adults are needed by developing public health policies for social capital optimization.

Estimating the changing burden of disease attributable to low levels of physical activity in South Africa for 2000, 2006 and 2012

Background. Physical activity is associated with a lower risk of cardiovascular outcomes, certain cancers and diabetes. The previous South African Comparative Risk Assessment (SACRA1) study assessed the attributable burden of low physical activity for 2000, but updated estimates are required, as well as an assessment of trends over time.Objective. To estimate the national prevalence of physical activity by age, year and sex and to quantify the burden of disease attributable to low physical activity in South Africa (SA) for 2000, 2006 and 2012.Methods. Comparative risk assessment methodology was used. Physical activity was treated as a categorical variable with four categories, i.e. inactive, active, very active and highly active. Prevalence estimates of physical activity levels, representing the three different years, were derived from two national surveys. Physical activity estimates together with the relative risks from the Global Burden of Disease, Injuries, and Risk Factors (GBD) 2016 study were used to calculate population attributable fractions due to inactive, active and very active levels of physical activity relative to highly active levels considered to be the theoretical minimum risk exposure (>8 000 metabolic equivalent of time (MET)-min/wk), in accordance with the GBD 2016 study. These were applied to relevant disease outcomes sourced from the Second National Burden of Disease Study to calculate attributable deaths, years of life lost, years lived with disability and disability adjusted life years (DALYs). Uncertainty analysis was performed using Monte Carlo simulation.Results. The prevalence of physical inactivity (<600 METS) decreased by 16% and 8% between 2000 and 2012 for females and males, respectively. Attributable DALYs due to low physical activity increased between 2000 (n=194 284) and 2006 (n=238 475), but decreased thereafter in 2012 (n=219 851). The attributable death age-standardised rates (ASRs) declined between 2000 and 2012 from 60/100 000 population in 2000 to 54/100 000 population in 2012. Diabetes mellitus type 2 displaced ischaemic heart disease as the largest contributor to attributable deaths, increasing from 31% in 2000 to 42% in 2012.Conclusions. Low physical activity is responsible for a large portion of disease burden in SA. While the decreased attributable death ASR due to low physical activity is encouraging, this burden may be lowered further with an additional reduction in the overall prevalence of physical inactivity, in particular. It is concerning that the attributable burden for diabetes mellitus is growing, which suggests that existing non-communicable disease policies need better implementation, with ongoing surveillance of physical activity, and population- and community-based interventions are required in order to reach set targets.

Estimating the changing burden of disease attributable to low levels of physical activity in South Africa for 2000, 2006 and 2012

Background. Physical activity is associated with a lower risk of cardiovascular outcomes, certain cancers and diabetes. The previous South African Comparative Risk Assessment (SACRA1) study assessed the attributable burden of low physical activity for 2000, but updated estimates are required, as well as an assessment of trends over time.Objective. To estimate the national prevalence of physical activity by age, year and sex and to quantify the burden of disease attributable to low physical activity in South Africa (SA) for 2000, 2006 and 2012.Methods. Comparative risk assessment methodology was used. Physical activity was treated as a categorical variable with four categories, i.e. inactive, active, very active and highly active. Prevalence estimates of physical activity levels, representing the three different years, were derived from two national surveys. Physical activity estimates together with the relative risks from the Global Burden of Disease, Injuries, and Risk Factors (GBD) 2016 study were used to calculate population attributable fractions due to inactive, active and very active levels of physical activity relative to highly active levels considered to be the theoretical minimum risk exposure (>8 000 metabolic equivalent of time (MET)-min/wk), in accordance with the GBD 2016 study. These were applied to relevant disease outcomes sourced from the Second National Burden of Disease Study to calculate attributable deaths, years of life lost, years lived with disability and disability adjusted life years (DALYs). Uncertainty analysis was performed using Monte Carlo simulation.Results. The prevalence of physical inactivity (<600 METS) decreased by 16% and 8% between 2000 and 2012 for females and males, respectively. Attributable DALYs due to low physical activity increased between 2000 (n=194 284) and 2006 (n=238 475), but decreased thereafter in 2012 (n=219 851). The attributable death age-standardised rates (ASRs) declined between 2000 and 2012 from 60/100 000 population in 2000 to 54/100 000 population in 2012. Diabetes mellitus type 2 displaced ischaemic heart disease as the largest contributor to attributable deaths, increasing from 31% in 2000 to 42% in 2012.Conclusions. Low physical activity is responsible for a large portion of disease burden in SA. While the decreased attributable death ASR due to low physical activity is encouraging, this burden may be lowered further with an additional reduction in the overall prevalence of physical inactivity, in particular. It is concerning that the attributable burden for diabetes mellitus is growing, which suggests that existing non-communicable disease policies need better implementation, with ongoing surveillance of physical activity, and population- and community-based interventions are required in order to reach set targets.

The Healthy Aging Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women

Due to the increasing non-communicable disease burden in Africa, several strategies that target the major lifestyle and physiological risk factors have been implemented to combat such diseases. The Healthy Aging Adult South Africa report card systematically reviews national and regional prevalence data of middle-aged South African adults (45-65 years) published between 2013 and 2020 on diet, physical activity, tobacco use and alcohol consumption, obesity, hypertension, dyslipidaemia and diabetes mellitus. Each indicator was assigned two grades, (1) based on the availability of prevalence data, and (2) based on whether policies have been proposed and implemented for the respective indicators. Alcohol consumption, obesity, hypertension and diabetes received an A grade for the availability of prevalence data. Tobacco use and diet received an A grade for policy and implementation. Gaps have been identified that need to be filled by future research focusing on continued surveillance of all indicators in order to inform and implement effective policies.

Prevalence of stressful life events and associations with symptoms of depression, anxiety, and post-traumatic stress disorder among people entering care for HIV in Cameroon

BACKGROUND

Exposure to stressors increases the risk of mental health disorders. People living with HIV (PLWH) are particularly affected by poor mental health which can contribute to adverse HIV treatment outcomes.

METHODS

We estimated the prevalence of recent stressful life events (modified Life Events Survey) among a cohort of PLWH entering HIV care at three public health care facilities in Cameroon and quantified the association of seven types of stressful life events with symptoms of depression (Patient Health Questionnaire-9 scores>9), anxiety (General Anxiety Disorder-7 scores>9), and PTSD (PTSD Checklist for DSM-5 scores>30) using separate log-binomial regression models.

RESULTS

Of 426 PLWH enrolling in care, a majority were women (59%), in relationships (58%), and aged 21 to 39 years (58%). Recent death of a family member (39%) and severe illness of a family member (34%) were the most commonly reported stressful life events. In multivariable analyses, more stressful life event types, a negative relationship change, death or illness of a friend/family member, experience of violence, work-related difficulties, and feeling unsafe in one's neighborhood were independently associated with at least one of the mental health outcomes assessed. The greatest magnitude of association was observed between work-related difficulties and PTSD (adjusted prevalence ratio: 3.1; 95% confidence interval: 2.0-4.8).

LIMITATIONS

Given the design of our study, findings are subject to recall and social desirability bias.

CONCLUSIONS

Stressful life events were common among this population of PLWH entering care in Cameroon. Evidence-based interventions that improve coping, stress management, and mental health are needed.

Perceived neighborhood safety and exercise behavior among community dwellers in Gauteng, South Africa

ABSTRACT

Maintaining a physically active life is an important determinant of overall health and psychosocial wellbeing among adults. Physical exercise behavior can be influenced by various social and environmental circumstances including neighborhood safety. Using data from South Africa Quality of life Survey 2015/16, this study aimed to assess the hypothesis that lack of perceived neighborhood safety (PNS) can reduce the likelihood of engaging in physical exercise (PE). The participants were 30,002 men and women aged 18 years and above. The association between self-reported PE behavior and neighborhood safety were assessed by multivariable regression method while adjusting for potentially confounding factors. Less than a quarter (23.41%) of the participants reported taking exercise on daily basis whereas 27.90% reported never taking any. Respectively 6.0% and 38.1% of the participants reported feeling very unsafe walking in the neighborhood during day and night. In regression analysis, both the pooled and stratified models indicated that lack of PNS was inversely associated with regular PE. Lack of PNS (bit unsafe) during day was associated with lower odds of PE both among men (OR = 0.776, P < .001) and women (OR = 0.874, P < .001). The negative association between lack of PNS and PE during day was significant among those living with disability (OR = 0.758, P < .001). Further analysis showed that the negative association between lack of PNS with regular PE during day was significant in Johannesburg (OR = 0.800, P < .001), Tshwane (OR = 0.735, P < .001) and Emfuleni (OR = 0.619, P < .001) only, while that during night was significant in Johannesburg (OR = 0.737, P < .001), Ekurhuleni (OR = 0.673, P < .001), Emfuleni (OR = 0.418, P < .001), Lesedi (OR = 0.385, P < .001), Mogale City (OR = 0.693, P < .001), and Randfontein (OR = 0.565, P < .001). Overall, the findings highlight a significantly inverse association between lack of PNS and PE behavior. In light of the current findings, it is recommended that PE promotion programs pay special attention on population living in the neighborhoods fraught with crime concerns.

Prostate Cancer Screening in Middle-Aged and Older American Men: Combined Effects of Ethnicity and Years of Schooling

BACKGROUND

Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown.

OBJECTIVES

The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association.

METHODS

This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African-American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one's lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis.

RESULTS

A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test.

CONCLUSION

Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.

Combined Effects of Race and Educational Attainment on Physician Visits Over 24 Years in a National Sample of Middle-Aged and Older Americans

Background

The literature on Minorities' Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities.

Objectives

The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US.

Methods

This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10 880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis.

Results

Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. A similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults.

Conclusion

Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people's pro-health behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.

Educational Attainment Better Increases the Chance of Breast Physical Exam for Non-Hispanic Than Hispanic American Women: National Health Interview Survey

Background

The Minorities' Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites.

Objective

The current study explored the racial and ethnic differences in the association between educational attainment and breast physical exam (BPE) among women in the U.S.

Methods

The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis.

Results

Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR] = 1.11, 95% CI = 1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR = 0.96, 95% CI = 0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02).

Conclusion

In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.

Educational Attainment and Exercise Frequency in American Women; Blacks' Diminished Returns

BACKGROUND

Minorities' Diminished Returns (MDRs) refer to smaller protects health effects of socioeconomic status (SES) indicators for Blacks and other minority groups than Whites.

OBJECTIVES

The current study aimed to explore Black- White differences in the association between educational attainment and exercise frequency among women in the US.

METHODS

For the current study, we used the National Survey of American Life's (NSAL) data which included 3,175 women who were either White (n = 876) or Black (n = 2,299). The independent variable was educational attainment. The dependent variable was exercise frequency. Age, region, household income, financial distress, marital status, unemployment, and depression were the covariates. Race was the focal moderator. Linear regression was applied for data analysis.

RESULTS

In the overall sample of women, high educational attainment was associated with higher exercise frequency (b = 0.07, 95% CI = 0.02-0.12). Race and educational attainment showed a significant interaction (b = -0.09, 95% CI = -0.19-0.00), suggestive of a smaller effect of education attainment on exercise frequency for Black women than White women. In race specific models, high educational attainment was associated with higher exercise frequency for White (b = 0.12, 95% CI =0.04-0.20) but not Black (b = 0.03, 95% CI = -0.03-0.08) women.

CONCLUSION

In line with the past research on MDRs, White women gain more health from their educational attainment than Black women. It is not race or class but race and class that shape the health behaviors of American women.