Do Poorer Children Have Poorer Playgrounds? A Geographically Weighted Analysis of Attractiveness, Cleanliness, and Safety of Playgrounds in Affluent and Deprived Urban Neighborhoods

Background: Playgrounds are a central resource when it comes to physical activity among minors. This study assesses the association between area deprivation and the quality of playgrounds. Methods: All playgrounds in the city of Mannheim, Germany (145 km², 311,000 inhabitants) were visited between July 2016 and January 2017 as part of a systematic audit. Each playground's amenities, attractiveness, cleanliness, and safety were operationalized using well-established, validated instruments. Global and geographically weighted regression models were fitted to investigate the association of the amenities, attractively, cleanliness, and safety of playgrounds with sociodemographic indicators on the social area level. Results: A total of 271 playgrounds were identified. Overall, population density showed the strongest association with all quality variables in the global models, followed by the central official poverty indicator. Significant spatial variation in parameter estimates was found for most of the deprivation indicators with regard to attractiveness, cleanliness, and safety of playgrounds indicating locally negative associations between area-level deprivation and quality. Conclusion: Our findings illustrate the importance of a qualitative approach by analyzing physical activity resources. Concerning the quality of playgrounds, the data from this study support the deprivation amplification hypothesis, meaning that children who are already socially disadvantaged might experience a further contextual disadvantage.

Does neighborhood fast-food outlet exposure amplify inequalities in diet and obesity? A cross-sectional study

BACKGROUND

Greater exposures to fast-food outlets and lower levels of education are independently associated with less healthy diets and obesity. Little is known about the interplay between these environmental and individual factors.

OBJECTIVE

The purpose of this study was to test whether observed differences in fast-food consumption and obesity by fast-food outlet exposure are moderated by educational attainment.

DESIGN

In a population-based cohort of 5958 adults aged 29-62 y in Cambridgeshire, United Kingdom, we used educational attainment-stratified regression models to estimate the food-frequency questionnaire-derived consumption of energy-dense "fast foods" (g/d) typically sold in fast-food restaurants and measured body mass index (BMI; in kg/m(2)) across geographic information system-derived home and work fast-food exposure quartiles. We used logistic regression to estimate the odds of obesity (BMI ≥30) and calculated relative excess risk due to interaction (RERI) on an additive scale. Participant data were collected during 2005-2013 and analyzed in 2015.

RESULTS

Greater fast-food consumption, BMI, and odds of obesity were associated with greater fast-food outlet exposure and a lower educational level. Fast-food consumption and BMI were significantly different across education groups at all levels of fast-food outlet exposure (P < 0.05). High fast-food outlet exposure amplified differences in fast-food consumption across levels of education. The relation between fast-food outlet exposure and obesity was only significant among those who were least educated (OR: 2.05; 95% CI: 1.08, 3.87; RERI = 0.88), which suggested a positive additive interaction between education and fast-food outlet exposure.

CONCLUSION

These findings suggest that efforts to improve diets and health through neighborhood-level fast-food outlet regulation might be effective across socioeconomic groups and may serve to reduce observed socioeconomic inequalities in diet and obesity.

Gender and the double burden of economic and social disadvantages on healthy eating: cross-sectional study of older adults in the EPIC-Norfolk cohort

BACKGROUND

Multiple economic factors and social relationships determine dietary behaviours, but the inter-relations between determinants is unknown. Whether women and men differ in the vulnerability to, and impact of, combined disadvantages is also unclear. We examined associations between diverse combinations of economic resources and social relationships, and healthy eating in British older women and men.

METHODS

Our sample comprised 9,580 over-50s (47 % of over-50 respondents) in the EPIC-Norfolk cohort study. We examined six economic factors (education, social class, home-ownership, money for needs, frequency of insufficient money for food/clothing, paying bills) and three social relationships (marital status, living arrangement and friend contact), independently and in combination, in relation to fruit variety and vegetable variety. We analysed gender-specific associations using multivariable linear regression with interaction terms.

RESULTS

Lower social class, lower education, and difficulty paying bills were associated with lower fruit and vegetable variety in both genders, independent of social relationships. All social relationships were independently associated with fruit variety in men and with vegetable variety in both genders. Substantially lower variety was found for all combinations of low economic resources and lack of social relationship than for either measure alone, with men faring worse in the majority of combined disadvantages. For example, the difference in vegetable variety for men reporting low social class and non-married was much greater (β -4.1, [-4.8, -3.4]), than the independent association of low social class (β -1.5, [-1.8,-1.2]), or non-married (β -1.8, [-2.3,-1.3]). Variety was also lower among men with high economic resources but non-married or lone-living.

CONCLUSION

A double burden of low economic resources and lack of social relationships suggested they are unique joint determinants, particularly in older men, and that public health efforts to improve healthy eating would offer most benefit to older adults with intersecting economic and social disadvantages.

Environmental Audits of Friendliness toward Physical Activity in Three Income Levels

An important research area is the relationship among income status, health, and the environment. This study examined the relationships among income levels, features of the environment and friendliness toward physical activity. We investigated whether low-, middle-, and high-income neighborhoods differ in terms of four environmental characteristics that affect the degree to which an area is conducive to physical activity: population density, land use diversity, street design, and physical disorder in the environment. In a large, urban southwestern county, 30 block groups were randomly selected to represent low-, middle-, and high-income neighborhoods. Using the St. Louis Environmental Checklist Audit, walking audits were conducted and analyzed. The low-income neighborhoods had significantly greater density and land use diversity than the high-income neighborhoods. High- and middle-income neighborhoods had significantly fewer manifestations of physical disorder and incivility than low-income neighborhoods. Features of physical activity-promoting environments were found in each income level neighborhood.