Associations between small-area sociodemographic characteristics and intimate partner violence in Montréal, Québec

Background

Intimate partner violence (IPV) affects many individuals and can have a significant impact on their health and well-being. In order to inform prevention strategies, several studies have focused on the determinants of IPV. However, knowledge on the association between neighbourhood characteristics and IPV remains scarce. The social disorganization theory posits that certain neighbourhood characteristics are associated with violent behaviours. This theory has been used to explain spatial variations in IPV, but most studies have been conducted in the United States. Little is known about the effect of neighbourhood factors in urban contexts outside of the United States.

Design and methods

Using police data from 2016 and 2017, this study estimated the association between sociodemographic characteristics of neighbourhoods (socioeconomic status, single-parenthood, residential instability and ethnocultural heterogeneity) and IPV victimization in Montréal, Québec.

Results

Results suggest a neighbourhood-level variation in IPV, and that neighbourhood-level characteristics are associated with IPV victimization. Specifically, the likelihood of IPV is higher in neighbourhoods with the lowest SES level (OR = 2.80, 95%CI: 2.47-3.17, p < 0.001) and the lowest level of residential instability (OR = 0.81, 95%CI: 0.70-0.93, p = 0.003) as well as the highest proportion of single-parent households (OR = 1.88, 95%CI: 1.65-2.15, p < 0.001).

Conclusion

Although neighbourhood-level interventions to reduce IPV are rare, our results highlight the importance of developing such preventive strategies. Prevention programs targeting high-risk neighbourhoods may prove effective in reducing IPV.

Type of Refugee Accommodation and Health of Residents: A Cross-Sectional, Population-Based Cluster Analysis in South-West Germany

Objectives: Few studies have assessed whether refugees' health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on variables on the accommodation and its physical context before assessing its association with health in multivariate analyses. Methods: We performed a cluster analysis based on a hierarchal, agglomerative clustering algorithm using Euclidean Distance and Ward's method. We analysed accommodation clusters based on number of inhabitants, degree of housing deterioration, urbanity of location (urban/rural distinction), and remoteness (walking distance to shops, medical or administrative services). In total, we analysed health and accommodation data of 412 refugees and asylum seekers from 58 different accommodation facilities in the federal state of Baden-Württemberg in the south-west of Germany. Results: Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and generalized anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Conclusion: Our findings inform policymakers on layout and location of refugee collective accommodation centres.

Age Diversity in Neighborhoods-A Mixed-Methods Approach Examining Older Residents and Community Wellbeing

This paper focuses on age diversity in neighbourhoods and its possible impacts on community wellbeing. The aims of this paper are (a) to investigate whether age diversity in neighbourhoods contribute to older residents' wellbeing and (b) to explore older residents' experiences and views on age diversity in their neighbourhood. These questions are addressed using a mixed-method approach combining survey and interview data and analysis. The data is derived from a survey (n = 420) and 19 semistructured interviews addressed to the older residents of a rental house company located in Eastern Finland. The interview data is analysed using qualitative content analysis. The results of qualitative data indicate that older adults see various benefits in an age-diverse living environment. In the quantitative analysis, we apply multilevel models in our statistical analyses to take both community- and individual-level variation into account. The quantitative results show that older adults living in age-diverse neighbourhoods reported higher community wellbeing. Such association was not found among the younger residents. Overall, our study adds to the understanding of the importance of neighbouring relations on community wellbeing in later life. The results can be utilized when developing age-friendly environments and housing policies at local and national levels.

Tell me who's your neighbour and I'll tell you how much time you've got: The spatiotemporal consequences of residential segregation

Relying on data from the United States Census and the American Time Use Survey (2010-2017), we examine how residential segregation influences per capita discretionary time availability in Los Angeles, New York City and Miami. We find a sizable disadvantage of being Latinx for discretionary time availability. Non-Latinx Whites have 182 extra hours of per capita discretionary time per year than do Latinx individuals. Both within-neighbourhood and adjacent-neighbourhood influences matter. In most neighbourhoods, segregation is correlated with having more discretionary time. Individuals in highly segregated areas have approximately 80 more hours of discretionary time per year than those living in diverse areas. This suggests that in addition to socioeconomic, cultural and well-being benefits, ethnic enclaves may also impart temporal advantages. However, we find that there may be diminishing marginal returns with increasing segregation in surrounding areas. Sociodemographic characteristics explain over one-quarter of the variance between segregation and discretionary time availability.

Neighbourhood Income Inequality and General Psychopathology at 3-Years of Age

BACKGROUND

Several studies have linked neighbourhood environment to preschool-aged children's behavioural problems. Income inequality is an identified risk factor for mental health among adolescents, however, little is known as to whether this relationship extends to younger children.

OBJECTIVE

To explore the association between neighbourhood-level income inequality and general psychopathology problems among preschool-aged children.

METHODS

We analyzed data from the All Our Families (AOF) longitudinal cohort located in Calgary, Canada at 3-years postpartum. The analytical sample consisted of 1615 mother-preschooler dyads nested within 184 neighbourhoods. Mothers completed the National Longitudinal Survey of Children and Youth Child Behaviour Checklist (NLSCY-CBCL), which assessed internalizing and externalizing symptoms. Income inequality was assessed via the Gini coefficient, which quantifies the unequal distribution of income in society. Mixed effects linear regression assessed the relationship between neighbourhood income inequality and preschooler's general psychopathology.

RESULTS

The mean Gini coefficient across the 184 neighbourhoods was 0.33 (SD = 0.05; min, max: 0.20-0.56). In the fully adjusted model income inequality was not associated with general psychopathology in children β = 0.07 (95%CI: -0.29, 0.45). Neighbourhood environment accounted for 0.5% of the variance in psychopathology in children.

CONCLUSION

The lack of significant findings may be due to a lack of statistical power in the study. Future studies should investigate this relationship with appropriately powered studies, and over time, to assess if income inequality is a determinant of preschooler psychopathology in Canada.

The effects of neighbourhood social cohesion on preventing depression and anxiety among adolescents and young adults: rapid review

BACKGROUND

Research suggests that increasing neighbourhood social cohesion can prevent mental health problems, including depression and anxiety. However, it is unknown whether this is the case for adolescents and young adults.

AIMS

To investigate whether neighbourhood social cohesion can prevent depression and anxiety, and identify interventions that can increase neighbourhood cohesion in young people.

METHOD

We conducted a rapid review for an overview of the available literature. PubMed, Campbell Collaboration, KSR Ltd and grey literature databases were searched from inception up to 10 July 2020. When synthesising the results, we applied a hierarchy of evidence, prioritising study designs that allowed for the most ability to infer causality. Risk of bias was assessed with the ROBIS tool and Joanna Briggs Institute risk-of-bias assessment. A narrative review and two workshops with young people were conducted to inform what future interventions may look like.

RESULTS

Forty-two peer-reviewed publications, including two systematic reviews, 13 longitudinal studies and 27 cross-sectional studies, were identified. Prospective longitudinal studies found that neighbourhood social cohesion factors (safety, trust, positive social connections, helping others and a lack of crime and violence) were associated with fewer depressive symptoms. Future interventions to increase neighbourhood cohesion should involve creating safe and attractive community centres, accessible and safe outdoor spaces, community activity groups and online communities.

CONCLUSIONS

Neighbourhood social cohesion has the potential to protect mental health. The next step is to conduct intervention studies to evaluate the effects on onset prevention. Clinicians should consider the impact cohesion can have on mental health, and signpost to community initiatives.

The prospective relationship between loneliness, life satisfaction and psychological distress before and during the COVID-19 pandemic in the UK

Aim

Mental wellbeing in the UK seems to have deteriorated significantly during the COVID-19 pandemic, with the rates of loneliness, life satisfaction and psychological distress taking longer to return to the pre-pandemic levels than elsewhere. Nevertheless, there is little knowledge about the interactions between these outcomes, or the factors that played a role in the rates of change. The current study aims to address this gap by simultaneously investigating changes in loneliness, life satisfaction and psychological distress in the UK from pre-pandemic levels to those between April and November 2020, while critically assessing the role of a range of social ecological influencing factors.

Subject and Methods

Longitudinal data from Understanding Society (N=3475) were used to explore the changes in loneliness, life satisfaction and psychological distress from pre-pandemic levels (2017-2019) through November 2020, the interactions between these outcomes, and the role of individual, social, community and geographic factors in the rates of change, using multivariate latent growth curve model.

Results

Loneliness, life satisfaction and psychological distress deteriorated minimally between April and November 2020, compared to the pre-pandemic levels (2017-2019), while the rate of change in each outcome influenced the rates of change in the other two. Key individual (age, gender, physical health), social (number of friends and similarity to them), and environmental (neighbourhood quality) variables influenced baseline scores and the rates of change.

Conclusion

Considering significant dynamic associations between loneliness, life satisfaction and psychological distress, we argue that interventions to tackle any one of the outcomes may have beneficial effects on others, while highlighting malleable factors and individual and community-level interventions to tackle loneliness.

Tracing the potential extra-household contacts of TB patients: findings from a personal social network survey in a high TB burden setting in India

BACKGROUND

Evidence on the extra-household contacts of TB patients who drive disease transmission is scarce.

METHODS

We conducted a cross-sectional personal social network survey among 300 newly diagnosed index pulmonary TB patients to identify their first-degree extra-household contacts.

RESULTS

A significantly higher proportion of neighbourhood (3.5; 95% CI 1.3 to 7.5), occupational (3.2; 95% CI 1.3 to 9.2) and friendship contacts (2.2; 95% CI 0.8 to 4.5) developed TB within 1 y of the index patient's diagnosis than their household contacts (0.7; 95% CI 0.3 to 1.3). Similarly, a higher proportion of extra-household contacts had TB at different time points before the index patient was diagnosed.

CONCLUSION

Extra-household contacts of TB patients could be a potential source of TB or could be at increased risk of TB.

Examining the association between perceived neighbourhood safety and health services utilization: A cross-sectional study among older adults in the United States of America

OBJECTIVE

To assess the association between perceived neighbourhood safety and health services use among older adults.

METHODS

The Health and Retirement Study was used to assess the association of perceived neighbourhood safety with inpatient hospital utilization, contact with a physician, home health use, and any health services utilization in the United States of America (n = 10,844). Logistic regression models were used, while controlling for a large number of potential confounders.

RESULTS

The odds of any contact with a physician were greater among those who perceived their neighbourhood safety to be excellent (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.20, 2.72) or very good (OR: 1.56, 95% CI: 1.04, 2.32) compared with those who perceived their neighbourhood safety as fair or poor, controlling for all model covariates. The odds of any health services utilization were greater among those who perceived their neighbourhood safety to be excellent (OR: 1.95, 95% CI: 1.26, 3.00) or very good (OR: 1.63, 95% CI: 1.06, 2.50) compared with those who perceived their neighbourhood safety as fair or poor controlling for all other model covariates. The odds of inpatient care were higher among those who perceived their neighbourhood to be excellent compared with those who compared their neighbourhood to be fair/poor (OR: 1.22, 95% CI: 1.01, 1.48). Results were not statistically significant for home health utilization.

CONCLUSIONS

These analyses show a relationship between perceived neighbourhood safety and contact with a physician and any health services utilization among older adults and a weaker relationship between perceived neighbourhood safety and inpatient services. Future research should continue to examine this relationship between perceived neighbourhood safety and health services utilization among older adults.

How Can the Lived Environment Support Healthy Ageing? A Spatial Indicators Framework for the Assessment of Age-Friendly Communities

The Age-Friendly Cities and Communities Guide was released by the World Health Organization over a decade ago with the aim of creating environments that support healthy ageing. The comprehensive framework includes the domains of outdoor spaces and buildings, transportation, housing, social participation, respect and inclusion, civic participation and employment, communication and information, and community and health services. A major critique of the age-friendly community movement has argued for a more clearly defined scope of actions, the need to measure or quantify results and increase the connections to policy and funding levers. This paper provides a quantifiable spatial indicators framework to assess local lived environments according to each Age-Friendly Cities and Communities (AFC) domain. The selection of these AFC spatial indicators can be applied within local neighbourhoods, census tracts, suburbs, municipalities, or cities with minimal resource requirements other than applied spatial analysis, which addresses past critiques of the Age-Friendly Community movement. The framework has great potential for applications within local, national, and international policy and planning contexts in the future.

The protective effect of neighbourhood social cohesion on adolescent mental health following stressful life events

BACKGROUND

Exposure to stressful life events is an established risk factor for the development of adolescent mental disorder. Growing evidence also suggests that neighbourhood social environments, including strong social cohesion, could have a protective effect on mental health. However, little is known about how neighbourhood social cohesion may buffer against the effects of stressful life events on adolescent mental health. Our aim was to assess whether neighbourhood social cohesion modifies the association between stressful life events and adolescent mental health outcomes.

METHODS

Data were drawn from a nationally-representative prospective sample of Canadian adolescents, including 5183 adolescents aged 12/13 years at T1 and 14/15 years at T2. Caregivers reported neighbourhood social cohesion at T1, and exposure to stressful life events between T1 and T2. Symptoms of mental health and behaviour problems were self-reported by adolescents at T1 and T2. Multivariable logistic regression was used to determine whether the relationship between stressful life events and outcomes was modified by neighbourhood social cohesion.

RESULTS

Associations between stressful life events and adolescent outcomes were statistically significantly lower in neighbourhoods with greater social cohesion for: depression/anxiety (high cohesion OR = 0.98 v. low cohesion OR = 3.11), suicidal ideation (ORhigh = 1.30 v. ORlow = 5.25), aggression/conduct disorder (ORhigh = 1.09 v. ORlow = 4.27), and property offence (ORhigh = 1.21 v. ORlow = 4.21).

CONCLUSIONS

Greater neighbourhood social cohesion appeared to buffer the effects of stressful life events on several domains of adolescent mental health. This potentially presents a target for public health intervention to improve adolescent mental health and behavioural outcomes.

Hotspots of childhood obesity in a large metropolitan area: does neighbourhood social and built environment play a part?

BACKGROUND

Effective place-based interventions for childhood obesity call for the recognition of the high-risk neighbourhoods and an understanding of the determinants present locally. However, such an approach is uncommon. In this study, we identified neighbourhoods with elevated prevalence of childhood obesity ('hotspots') in the Porto Metropolitan Area and investigated to what extent the socio-economic and built environment characteristics of the neighbourhoods explained such hotspots.

METHODS

We used data on 5203 7-year-old children from a population-based birth cohort, Generation XXI. To identify hotspots, we estimated local obesity odds ratios (OR) and 95% confidence intervals (95%CI) using generalized additive models with a non-parametric smooth for location. Measures of the socio-economic and built environment were determined using a Geographic Information System. Associations between obesity and neighbourhood characteristics were expressed as OR and 95%CI after accounting for individual-level variables.

RESULTS

At 7 years of age, 803 (15.4%) children were obese. The prevalence of obesity varied across neighbourhoods and two hotspots were identified, partially explained by individual-level variables. Adjustment for neighbourhood characteristics attenuated the ORs and further explained the geographic variation. This model revealed an association between neighbourhood socio-economic deprivation score and obesity (OR = 1.014, 95%CI 1.004-1.025), as well as with the presence of fast-food restaurants at a walkable distance from the residence (OR = 1.37, 1.06-1.77).

CONCLUSIONS

In our geographic area it was possible to identify neighbourhoods with elevated prevalence of childhood obesity and to suggest that targeting such high-priority neighbourhoods and their environmental characteristics may help reduce childhood obesity.

Bus Stops Near Schools Advertising Junk Food and Sugary Drinks

Children rarely understand the full extent of the persuasive purpose of advertising on their eating behaviours. Addressing the obesogenic environments in which children live, through a quantification of outdoor advertising, is essential in informing policy changes and enforcing stricter regulations. This research explores the proportion of bus stop advertisements promoting non-core food and beverages within walking distance (500 m) from schools in Auckland, New Zealand while using Google Street View. Information was collected on: school type, decile, address, Walk Score^®, and Transit Score for all 573 schools in the Auckland region. Ground-truthing was conducted on 10% of schools and showed an alignment of 87.8%. The majority of advertisements on bus shelters were for non-food items or services (n = 541, 64.3%). Of the advertisements that were for food and/or beverages, the majority were for non-core foods (n = 108, 50.2%). There was no statistically significant difference between the variables core and non-core food and beverages and School decile (tertiles), Walk Score (quintiles), and Transit Score (quintiles). 12.8% of all bus stop advertisements in this study promoted non-core dietary options; highlighting an opportunity for implementing stricter regulations and policies preventing advertising unhealthy food and drink to children in New Zealand.

Older women's engagement in community occupations: Considerations of lifespan and place

Background: To reach the promise of age-friendly communities, more complete understandings of how participation in community occupations occurs, in place and over time, is needed.Aim: To explore older Canadian women's engagement in community occupations as it occurs over the lifespan and in context.Materials and methods: Data from three selected participants were drawn from an exploration of older adults' social connectedness in neighbourhoods, which involved an ethnographic approach involving narrative interviews, go-along interviews, and activity tracking and follow-up interviews. A transactional lens oriented analysis, considering occupation in place, over time. Analysis involved identifying key storylines and themes and drew on conceptualizations of transition and continuity.Results: The participants' stories revolved around two themes: continuity within leisure over time and social engagement as a work in progress. The participants demonstrated differing patterns of achieving continuity within leisure and worked to maintain social engagement in the face of continually evolving social networks.Conclusions and significance: Findings enhance understandings of transition, continuity and the transactions between person and place that shape leisure and social engagement over time. Occupational therapists can consider community occupations from a transactional lens within services and policy to better support older women's participation and inclusion in neighbourhoods.

Neighbourhood characteristics and cumulative biological risk: evidence from the Jamaica Health and Lifestyle Survey 2008: a cross-sectional study

OBJECTIVE

To examine whether neighbourhood characteristics are associated with cumulative biological risk (CBR) and sex differences in CBR in a nationally representative sample in Jamaica, a small island developing country with increasing prevalence of non-communicable diseases (NCDs).

DESIGN

Cross-sectional study SETTING: A population-based cross-sectional survey, the Jamaica Health and Lifestyle Survey 2008 (JHLS II) recruited persons at their homes over a 4 month period from all 14 parishes and 113 neighbourhoods defined as enumeration districts (EDs).

PARTICIPANTS

2544 persons aged 15-74 years old from the 2008 Jamaica Health and Lifestyle Survey (JHLS II), who completed interviewer-administered questionnaires and had biomarkers assessed, and whose home addresses could be reliably geocoded.

PRIMARY OUTCOME

A summary measure CBR was created using seven markers-systolic and diastolic blood pressure readings, waist circumference, body mass index, total cholesterol, fasting blood glucose levels and self-reported asthma. Weighted multilevel models examined clustering, using the intraclass correlation coefficient (ICC), of CBR across neighbourhoods and the impact of neighbourhood characteristics (recreational space availability and neighbourhood disorder) on CBR.

RESULTS

Women had significantly higher mean CBR scores than men across all age groups. There was significant clustering of CBR by ED, and among women versus men (ICC: F=6.9%, M=0.7%). Women living in more disordered neighbourhoods were 26% more likely to have high CBR as those in less disordered ones (aOR=1.26, 95% CI=1.08 to 1.47; p<0.05). Individuals living in EDs with greater recreational space availability were 25% less likely to have a high CBR (aOR=0.75, 95% CI=0.64 to 0.90; p<0.05).

CONCLUSIONS

Policy-makers in Jamaica should pay greater attention to neighbourhood factors such as recreational space availability and neighbourhood disorder that may contribute to CBR in any effort to curtail the epidemic of NCDs.

An explorative evaluation study of the mechanisms underlying a community-based fitness centre in Denmark - Why do residents participate and keep up the healthy activities?

Health-risk behaviour like physical inactivity is more evident in deprived neighbourhoods than in nondeprived neighbourhoods, and in the former knowledge is lacking as to what causes effects in interventions on physical activity. A possible contribution to physical activity interventions is community engagement, which has been shown to be effective for changing health-risk behaviour, but more knowledge is needed on "the active ingredients" or mechanisms that make interventions work. The aim of this study was to give more insight into the possible mechanisms within an intervention on physical activity using community engagement. The study applied a theory-based evaluation approach using theory of change to uncover the underlying mechanisms of a community-based fitness centre in a deprived Danish neighbourhood. Data were gathered from documents about the intervention, semistructured interviews with three front-line workers on the intervention and ten residents participating in the centre as either volunteer instructors or members. The following mechanisms of the intervention to improve participation and health were anticipated by the front-line workers; the creation of meaningful communities through social interaction, the presence of relatable role models, residents taking responsibility and feeling co-ownership and the experience of being of value as an instructor. Interviews with members and volunteer instructors showed that the anticipated mechanisms did facilitate participation and improved health; however, with some individual variations and with the physical and mental benefits of the particular activities also functioning as mechanisms for participation and engagement. Furthermore, the study found potential unintended consequences related to engagement, such as difficulties in balancing the needs of others with own needs. Findings indicate that both the social aspect and the activities should be prioritised, as should a continued focus on the inclusion of different residents in the area. Furthermore, unintended consequences should be considered and prevented through support for volunteering residents.

Neighbourhood socioeconomic position and risks of major chronic diseases and all-cause mortality: a quasi-experimental study

OBJECTIVES

This study estimated the health impacts of neighbourhood socioeconomic position (SEP) among public housing residents. Because applicants to public housing were assigned to housing projects primarily based on factors other than personal choice, we capitalised on a quasirandom source of variation in neighbourhood of residence to obtain more valid estimates of the health impacts of neighbourhood SEP.

DESIGN

Quasiexperimental study.

SETTING

Greater Metropolitan Toronto area, Canada.

PARTICIPANTS

Residents (24 019-28 858 adults age ≥30 years in 1994 for all outcomes except for asthma, for which the sample was expanded to 66 627 individuals age ≥4 years) of public housing on 1 January 1994.

OUTCOME MEASURES

Incident hypertension, diabetes, asthma, and acute myocardial infarction (MI) and all-cause mortality between 1 January 1994 and 31 December 2006. We used multivariate Cox proportional hazards models to estimate hazard ratios (HRs) for the associations between the quartile of census tract-level SEP and the risk of diagnosis of each health outcome as well as death from any cause.

RESULTS

Living in a public housing project in the second highest neighbourhood SEP quartile (Q3) was associated with lower hazards of acute MI (HR=0.76, 95% CI 0.54 to 1.07; P=0.11), incident asthma (HR=0.80, 95% CI 0.67 to 0.96; P=0.02) and all-cause mortality (HR=0.86, 95% CI 0.73 to 1.01; P=0.06) compared to living in the lowest neighbourhood SEP quartile (Q1), although only the trend for incident asthma reached statistical significance (P for trend=0.04). By contrast, the associations corresponding to living in the highest versus lowest quartile of median household income (Q4 vs Q1) were neither consistent in direction nor significant. The inconsistent associations may partly be attributed to selection and status incongruity.

CONCLUSION

This study provides new evidence compatible with protective influences of higher neighbourhood SEP on health outcomes, particularly asthma.

Children's perceptions of a 'self-explaining road' intervention to improve neighbourhood safety

AIM

Safe neighbourhood environments can provide important spaces for child activity and well-being. Self-explaining roads (SERs), which reduce vehicle speeds by changing neighbourhood street design, are an intervention with known safety benefits. However, little is known about children's experiences of SERs.

METHODS

We engaged schoolchildren in developing a project to articulate children's perspectives of SERs. Students actively researched the experiences of other children at their school, and then participated in a researcher-led focus group.

RESULTS

Children emphasised safer spaces for play as an important benefit of SERs. As well as using new designated play spaces adjoining footpaths, children also felt the roadway became safer, and more fun for cycling. In contrast, children reported that parents held mainly negative views of SERs, considering them annoying and inconvenient.

CONCLUSION

From children's perspective, SERs can provide safe spaces for neighbourhood play, despite limited parental support. Potential benefits for children as well as established safety benefits should inform future implementation of SERs.

Exploring the relationship between local food environments and obesity in UK, Ireland, Australia and New Zealand: a systematic review protocol

INTRODUCTION

Obesity is a global pandemic that affects all socioeconomic strata, however, the highest figures have been observed in the most disadvantaged social groups. Evidence from the USA and Canada showed that specific urban settings encourage obesogenic behaviour in the population living and/or working there. We aim to examine the evidence on the association between local food environments and obesity in the UK, Ireland, Australia and New Zealand.

METHODS

Six databases from 1990 to 2017 will be searched: MEDLINE (Ovid), Embase (Ovid), Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science. Grey literature will also be sought by searching Opengrey Europe, The Grey Literature Report and relevant government websites. Additional studies will be retrieved from the reference lists of the selected articles. It will include cohort, longitudinal, case study and cross-sectional studies that have assessed the relationship between local food environments and obesity in the UK, Ireland, Australia and New Zealand regardless of sex, age and ethnicity of the population. Two researchers will independently select the studies and extract the data. Data items will incorporate: author names, title, study design, year of study, year exposure data collected, country, city, urban/rural, age range, study exclusions, special characteristics of study populations, aims, working definitions of food environments and food outlets, exposure and methods of data collection, outcomes and key findings. A narrative synthesis and a summary of the results will be produced separately for children and adults, according to the type of food exposure-outcome. All the selected studies will be assessed using The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

ETHICS AND DISSEMINATION

This study will be based on published literature, and therefore ethical approval has not been sought. Our findings will be presented at relevant national and international scientific conferences and published in a peer-reviewed journal.

Exploring Children's Perceptions of their Local Environment in Relation to Time Spent Outside

This study aims to understand how children perceive their environment, exploring the affordances children perceive to influence their physical activity (PA) behaviour when outside. Participants included boys and girls aged 10-12 years (n = 15) living in Scotland. Children's visual and verbal representations of their perceived environment were analysed to assess environmental determinants of PA. The findings suggested that physical affordances that offer a sense of risk were important to children's play spaces. Social affordances influenced where the children went in their environment and the features they utilised as part of play behaviour; strangers were considered threatening depending on whether the activity was recognised.

Are Changes in Neighbourhood Perceptions Associated with Changes in Self-Rated Mental Health in Adults? A 13-Year Repeat Cross-Sectional Study, UK

The aim of this study was to examine changes in neighbourhood perceptions on self-rated mental health problems over time, and to explore demographic, geographic and socio-economic factors as determinants of increased or decreased anxiety and depression symptoms. We conducted a repeat cross-sectional study of individuals (N: 4480) living in the same areas of west central Scotland in 1997 and 2010. Individuals were asked to complete a questionnaire at both time-points, containing 14 questions relating to neighbourhood perceptions and the Hospital Anxiety and Depression Scale (HADS). A three-level linear regression model was fitted to HADS scores and changes in neighbourhood perceptions over time; controlling for a number of individual and area-level variables. Overall, area-level mean HADS scores decreased from 1997 to 2010. When adjusted for individual and area-level variables, this decrease did not remain for HADS anxiety. Applying an overall 14-scale neighbourhood perception measure, worsening neighbourhood perceptions were associated with small increases in depression (0.04, 95% confidence interval (CI) 0.01 to 0.07) and anxiety (0.04, 95% CI 0.00 to 0.08) scores over time. This highlights a need for local and national policy to target areas where neighbourhood characteristics are substantially deteriorating in order to ensure the mental health of individuals does not worsen.

Associations between major chain fast-food outlet availability and change in body mass index: a longitudinal observational study of women from Victoria, Australia

OBJECTIVES

The residential neighbourhood fast-food environment has the potential to lead to increased levels of obesity by providing opportunities for residents to consume energy-dense products. This longitudinal study aimed to examine whether change in body mass index (BMI) differed dependent on major chain fast-food outlet availability among women residing in disadvantaged neighbourhoods.

SETTING

Eighty disadvantaged neighbourhoods in Victoria, Australia.

PARTICIPANTS

Sample of 882 women aged 18-46 years at baseline (wave I: 2007/2008) who remained at the same residential location at all three waves (wave II: 2010/2011; wave III: 2012/2013) of the Resilience for Eating and Activity Despite Inequality study.

PRIMARY OUTCOME

BMI based on self-reported height and weight at each wave.

RESULTS

There was no evidence of an interaction between time and the number of major chain fast-food outlets within 2 (p=0.88), 3 (p=0.66) or 5 km (p=0.24) in the multilevel models of BMI. Furthermore, there was no evidence of an interaction between time and change in availability at any distance and BMI.

CONCLUSIONS

Change in BMI was not found to differ by residential major chain fast-food outlet availability among Victorian women residing in disadvantaged neighbourhoods. It may be that exposure to fast-food outlets around other locations regularly visited influence change in BMI. Future research needs to consider what environments are the key sources for accessing and consuming fast food and how these relate to BMI and obesity risk.

Does unmeasured confounding influence associations between the retail food environment and body mass index over time? The Coronary Artery Risk Development in Young Adults (CARDIA) study

Background

Findings in the observational retail food environment and obesity literature are inconsistent, potentially due to a lack of adjustment for residual confounding.

Methods

Using data from the CARDIA study (n = 12 174 person-observations; 6 examinations; 1985-2011) across four US cities (Birmingham, AL; Chicago, IL; Minneapolis, MN; Oakland, CA), we used instrumental-variables (IV) regression to obtain causal estimates of the longitudinal associations between the percentage of neighbourhood food stores or restaurants (per total food outlets within 1 km network distance of respondent residence) with body mass index (BMI), adjusting for individual-level socio-demographics, health behaviours, city, year, total food outlets and market-level prices. To determine the presence and extent of bias, we compared the magnitude and direction of results with ordinary least squares (OLS) and random effects (RE) regression, which do not control for residual confounding, and with fixed effects (FE) regression, which does not control for time-varying residual confounding.

Results

Relative to neighbourhood supermarkets (which tend to be larger and have healthier options than grocery stores), a higher percentage of grocery stores [mean = 53.4%; standard deviation (SD) = 31.8%] was positively associated with BMI [β = 0.05; 95% confidence interval (CI) = 0.01, 0.10] using IV regression. However, associations were negligible or null using OLS (β = -0.001; 95% CI = -0.01, 0.01), RE (β = -0.003; 95% CI = -0.01, 0.0001) and FE (β = -0.003; 95% CI = -0.01, 0.0002) regression. Neighbourhood convenience stores and fast-food restaurants were not associated with BMI in any model.

Conclusions

Longitudinal associations between neighbourhood food outlets and BMI were greater in magnitude using a causal model, suggesting that weak findings in the literature may be due to residual confounding.

'We have different routes for different reasons': Exploring the purpose of walks for carers of people with dementia

This paper explores the purpose of walks for co-residing carers of people with dementia, using a social citizenship lens. The findings are based on the first phase of a study examining the everyday experiences of place, space, and neighbourhood of dementia carers. Using three forms of data collection - social network mapping, walking interviews, and participant-driven photography - the study brings forth information about why carers go on walks either alone or with the person with dementia. Carers explained that walks facilitate their connections with themselves, the person with dementia, their social environment, and their natural and built environment. In sum, walks provide a way of practicing and sustaining social citizenship. Carers' discourse about walks highlights their personal, everyday practices and strategies, as well as the larger tensions and contradictions of dementia care. The findings reinforce the need to bring into dialogue, from a carer perspective, a social citizenship model of dementia with the growing interest in dementia-friendly communities.

The health status and well-being of low-resource, housing-unstable, single-parent families living in violent neighbourhoods in Philadelphia, Pennsylvania

The health and well-being of single-parent families living in violent neighbourhoods in US cities who participate in housing programmes is not well described. This two-phase, mixed-methods study explores the health status of families who were participants in a housing-plus programme in Philadelphia, Pennsylvania between 2011 and 2013 and the relationship between the characteristics of the neighbourhoods in which they lived and their perceptions of well-being and safety. In phase 1, data collected with standardised health status instruments were analysed using descriptive statistics and independent sample t-tests to describe the health of single parents and one randomly selected child from each parent's household in comparison to population norms. In a subset of survey respondents, focus groups were conducted to generate an in-depth understanding of the daily lives and stressors of these families. Focus group data were analysed using content analysis to identify key descriptive themes. In phase 2, daily activity path mapping, surveys and interviews of parent-child dyads were collected to assess how these families perceive their health, neighbourhood and the influence of neighbourhood characteristics on the families' day-to-day experience. Narratives and activity maps were combined with crime data from the Philadelphia Police Department to analyse the relationship between crime and perceptions of fear and safety. Phase 1 data demonstrated that parent participants met or exceeded the national average for self-reported physical health but fell below the national average across all mental health domains. Over 40% reported moderate to severe symptoms of depression. Parents described high levels of stress resulting from competing priorities, financial instability, and concern for their children's well-being and safety. Analysis of phase 2 data demonstrated that neighbourhood characteristics exert influence over parents' perceptions of their environment and how they permit their children to move within it. This research suggests the need for robust research, programmatic and policy interventions to support housing-unstable families who live in neighbourhoods with high levels of violence.

The Influence of Weather Variation, Urban Design and Built Environment on Objectively Measured Sedentary Behaviour in Children

With emerging evidence indicating that independent of physical activity, sedentary behaviour (SB) can be detrimental to health, researchers are increasingly aiming to understand the influence of multiple contexts such as urban design and built environment on SB. However, weather variation, a factor that continuously interacts with all other environmental variables, has been consistently underexplored. This study investigated the influence of diverse environmental exposures (including weather variation, urban design and built environment) on SB in children. This cross-sectional observational study is part of an active living research initiative set in the Canadian prairie city of Saskatoon. Saskatoon's neighbourhoods were classified based on urban street design into grid-pattern, fractured grid-pattern and curvilinear types of neighbourhoods. Diverse environmental exposures were measured including, neighbourhood built environment, and neighbourhood and household socioeconomic environment. Actical accelerometers were deployed between April and June 2010 (spring-summer) to derive SB of 331 10–14 year old children in 25 one week cycles. Each cycle of accelerometry was conducted on a different cohort of children within the total sample. Accelerometer data were matched with localized weather patterns derived from Environment Canada weather data. Multilevel modeling using Hierarchical Linear and Non-linear Modeling software was conducted by factoring in weather variation to depict the influence of diverse environmental exposures on SB. Both weather variation and urban design played a significant role in SB. After factoring in weather variation, it was observed that children living in grid-pattern neighbourhoods closer to the city centre (with higher diversity of destinations) were less likely to be sedentary. This study demonstrates a methodology that could be replicated to integrate geography-specific weather patterns with existing cross-sectional accelerometry data to understand the influence of urban design and built environment on SB in children.

Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study

The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.

Neighbourhood immigrant concentration and hospitalization: a multilevel analysis of cardiovascular-related admissions in Ontario using linked data

OBJECTIVE

To assess the influence of neighbourhood immigrant concentration on cardiovascular-disease-related hospitalizations in Canada (CVDH), while adjusting for individual-level immigrant status and socio-economic indicators at individual and neighbourhood levels.

METHODS

Data were from the 2006 Canadian Census linked to the hospital Discharge Abstract Data (DAD) for the province of Ontario. Adults (n=1,459,950) aged ≥18 years at baseline and grouped by place of birth (Canada, China, South Asia, Europe, and other) were followed between Census Day May 16, 2006 and March 31, 2008. Information on CVDH was obtained from the DAD, while that on immigration and socio-economic indicators was obtained from the Census. The analysis used multilevel logistic regression.

RESULTS

Unadjusted results showed that CVDH was significantly lower among people living in neighbourhoods with medium and high immigrant concentration. Neighbourhood immigrant concentration tended to have no independent effect on CVDH after adjustment for individual-level immigrant status. Immigrants were less likely to experience CVDH irrespective of their country of birth. However, cross-level interaction showed that neighbourhood immigrant concentration provided additional protection to individual-level immigrant status against CVDH for most female immigrant groups, but only for South Asian males.

CONCLUSION

This study resulted from the first-ever linkage of census data to hospitalization data in Canada. It is also the first Canadian study to report on neighbourhood variation and the effect of immigrant concentration on CVDH. The study shows that understanding immigrant health requires both individual and neighbourhood approaches, and a consideration of country of origin.

The role of immigrant enclaves for Latino residential inequalities

We investigate the difference that immigrant enclaves make for the residential contexts of Latino families in the U.S. We argue that enclaves may no longer function simply as temporary way stations, the classic depiction of them, because of the compromised legal status of many Latinos. We examine this role with an innovative method that uses publicly available census tabulations (from the 2000 Census in our case) to develop HLM models, in which race/ethnicity and income are controlled at the family level, along with neighbourhood context and metropolitan characteristics. Comparing Latino residential patterns to those of whites and blacks reveals the large neighbourhood disadvantages of Latinos, which except for greater exposure to whites are on the order of those suffered by African Americans. We find that Hispanic families improve their residential situations as their incomes go up and usually also when they live in suburbs. But residence outside of immigrant enclaves produces the largest positive changes. The enclaves are a fundamentally different kind of residential space, in which the potential for neighbourhood improvement is modest.

Latino youth's internalising behaviours: links to immigrant status and neighbourhood characteristics

OBJECTIVES

Latinos are the fastest-growing immigrant group in the U.S.A. Yet, little is known about the emotional well-being of this population, such as the links among family, neighbourhood context and Latino immigrant youth mental health. Understanding this link will help determine which contexts negatively impact Latino immigrant youth mental health.

DESIGN

Drawing data from the Project on Human Development in Chicago Neighbourhoods collected in 1994-1995 and 1997-1999, this study examined links between Latino youth's internalising behaviours, based on the Child Behavior Checklist (CBCL), and neighbourhood characteristics as a function of immigrant status. The sample included 1040 (aged 9-17) Latino immigrant youth seen twice over three years and identified as first, second or third generation. In this study, neighbourhoods are made up of two to three census tracts that reflect similar racial/ethnic and socioeconomic composition. Using hierarchical linear regression models, the study also explored links between internalising behaviours and neighbourhood characteristics, including concentrated disadvantage, immigrant concentration and residential stability.

RESULTS

First- and second-generation youth had higher internalising behaviour scores (i.e., worse mental health) than third-generation youth after controlling for youth internalising behaviours at Wave 1, maternal depression and family characteristics. First- and second-generation youth were more likely to live in high immigrant-concentrated neighbourhoods and first-generation youth were more likely to live in residentially unstable neighbourhoods. Controlling for neighbourhood clusters eliminated the immigrant-generation internalising association. However, second-generation Latino youth living in neighbourhoods with higher residential stability had higher levels of internalising behaviour problems compared to first- and third-generation youth living in similar neighbourhoods.

CONCLUSIONS

We found that the interaction between immigrant generation and neighbourhood context helps to explain differences observed in the mental health of second-generation immigrant youth, a result that may help other communities in the USA and other countries better understand the factors that contribute to immigrant youth well-being.

Racism, ethnic density and psychological well-being through adolescence: evidence from the Determinants of Adolescent Social Well-Being and Health longitudinal study

OBJECTIVE

To investigate the effect of racism, own-group ethnic density, diversity and deprivation on adolescent trajectories in psychological well-being.

DESIGN

Multilevel models were used in longitudinal analysis of psychological well-being (total difficulties score (TDS) from Goodman's Strengths and Difficulties Questionnaire, higher scores correspond to greater difficulties) for 4782 adolescents aged 11-16 years in 51 London (U.K.) schools. Individual level variables included ethnicity, racism, gender, age, migrant generation, socio-economic circumstances, family type and indicators of family interactions (shared activities, perceived parenting). Contextual variables were per cent eligible for free school-meals, neighbourhood deprivation, per cent own-group ethnic density, and ethnic diversity.

RESULTS

Ethnic minorities were more likely to report racism than whites. Ethnic minority boys (except Indian boys) and Indian girls reported better psychological well-being throughout adolescence compared to their white peers. Notably, lowest mean TDS scores were observed for Nigerian/Ghanaian boys, among whom the reporting of racism increased with age. Adjusted for individual characteristics, psychological well-being improved with age across all ethnic groups. Racism was associated with poorer psychological well-being trajectories for all ethnic groups (p<0.001), reducing with age. For example, mean difference in TDS (95% confidence interval) between boys who experienced racism and those who did not at age 12 years=1.88 (+1.75 to +2.01); at 16 years = +1.19 (+1.07 to +1.31). Less racism was generally reported in schools and neighbourhoods with high than low own-group density. Own ethnic density and diversity were not consistently associated with TDS for any ethnic group. Living in more deprived neighbourhoods was associated with poorer psychological well-being for whites and black Caribbeans (p<0.05).

CONCLUSION

Racism, but not ethnic density and deprivation in schools or neighbourhoods, was an important influence on psychological well-being. However, exposure to racism did not explain the advantage in psychological well-being of ethnic minority groups over whites.

Key stakeholder perspectives on the development of walkable neighbourhoods

Evidence supports the link between the built environment and physical activity. This study investigated factors that influence the decisions made by key stakeholders as they relate to neighbourhood development. Seventeen stakeholders including public health and municipal employees (n=9), city councillors (n=3), and the private sector (e.g., land developers, food retailers) (n=5), participated in interviews. Private sector participants considered healthy lifestyle choices (e.g., PA) to be related more to individual choice than did other groups. All groups agreed that consumer behaviour is essential to invoking change but did not agree on who is responsible for invoking change. Common barriers included financial costs, car dependency, and social norms. Facilitators included growing awareness of health and environmental issues and increasing buy-in from governing bodies for innovative neighbourhood development. More work is needed that acknowledges the differences between while integrating the diverse perspectives of those responsible for the planning of neighbourhoods that are conducive for physical activity.

Factors affecting change over time in self-reported health

BACKGROUND

Self-reported health status has become a conventional measure of health status at the population level. Further, the literature supports its use as a valid indicator of morbidity and mortality. However, relatively little attention has been paid to how self-reported health status changes over time or the factors affecting change. This paper explores the factors affecting health status change over time using data from a neighbourhood health survey.

METHODS

Two rounds (2001; 2003) of health survey data (n=671) were collected across 4 distinct neighbourhoods in Hamilton, Ontario. Logistic regression analysis is used to predict change in self-reported health status between the two time periods as well as determinants of change using a range of compositional, contextual and collective characteristics of individuals as potential explanatory variables.

RESULTS

Results reveal that approximately one third of participants experienced a change in health status between the two survey years. Interestingly, the key factors affecting change in health status are compositional characteristics of individuals (e.g., smoking, health care use) as opposed to contextual (e.g., neighbourhood of residence) or collective (e.g., marital status). Contrary to published literature, the current study does not reveal any significant links between a change in health status and either gender or age.

CONCLUSION

These results inform our understanding of both the stability of health ratings over time and the determinants of health status change. Further research should be undertaken to enhance this understanding; in particular, studies with larger sample sizes, longer time frames and more sensitive indicators of composition, context and collective are needed.