Assessing the psychometric and ecometric properties of neighborhood scales in developing countries: Saúde em Beagá Study, Belo Horizonte, Brazil, 2008-2009

Conceptualisation and Measurement of Social Cohesion within the Sport and Physical Activity Context: A Scoping Review

Sport, physical activity and social cohesion are increasingly linked within the academic literature. Indeed, studies recognise both the importance of social cohesion for promoting physical activity and the potential of sport to support social cohesion. Up until now, however, the ways in which social cohesion has been defined and measured in the context of sport and physical activity have not been the subject of much academic attention. Through a scoping review of studies measuring social cohesion in the sport and physical activity context, we aim to uncover how social cohesion is defined and measured, thus allowing us to better grasp how the concept is understood and operationalised in this field. As such, full-text inclusion occurred when studies quantitatively measured social cohesion through a questionnaire/survey instrument in connection with sport or physical activity participation or within programmes using sport to foster social cohesion. A total of 40 papers were included in the review, showing broad support for the argument that social cohesion is positively related to sport or physical activity participation. However, the retained texts engage on only a surface level with the concept of social cohesion, with around half not defining the term and the associated measurement tools using only a fraction of the dimensions typically associated with social cohesion. To conclude, we propose future directions to enhance conceptual engagement with and measurement of social cohesion.

Physical and social neighborhood disorder in Latin American cities: a scoping review

Neighborhood disorder is an important aspect that may influence the health of residents in urban areas. The aims of this study were to map and systematize methods for measuring physical and social neighborhood disorder in studies conducted in Latin American cities. By means of a scoping review, articles published from 2000 in English, Spanish, and Portuguese with the following descriptors were mapped: neighborhood, physical disorder, and social disorder. Searches were conducted in MEDLINE (PubMed), LILACS (Virtual Health Library), Scopus, Web of Science, and Cochrane Library. Information on authorship, year, study type, locality, data source, target population, outcome, dominion, indicator, method, geographic unit, and unit of analysis was extracted. Variables from the disorder-related studies were extracted and grouped by similarity of content and themes. A total of 22 articles were identified, all published between 2012 and 2022, the majority in Brazil (n = 16). The perception of the individual was the most used method. The most frequent theme addressed in the physical disorder dominion was public streets (n = 20) and security (n = 15), in the social disorder dominion. A lack of consensus in the literature regarding variables used to measure physical and social neighborhood disorder in Latin American cities was detected. In addition to the need for standardization of the theme, studies to verify the sustainability of proposed measurement methods relevant to dynamically classify and compare urban neighborhoods and health impacts based on levels of exposure to physical and social disorder, are recommended.

The challenges of measuring social cohesion in public health research: A systematic review and ecometric meta-analysis

The relationship between social cohesion and health has been studied for decades. Yet, due to the contextual nature of this concept, measuring social cohesion remains challenging. Using a meta-analytical framework, this review's goal was to study the ecometric measurement properties of social cohesion in order to describe dissimilarities in its measurement as well as bring a new perspective on the empirical usefulness of the concept itself. To this end, we analysed if, and to what extent, contextual-level reliability and intersubjective agreement of 78 social cohesion measurements varied under different measurement conditions like measurement instrument, spatial unit, ecometric model specification, or region. We found consistent evidence for the contextual nature of social cohesion, however, most variation existed between individuals, not contexts. While contextual dependence in response behaviour was fairly insensitive to item choices, population size within chosen spatial units of social cohesion measurements mattered. Somewhat counterintuitively, using spatial units with, on average, fewer residents did not yield systematically superior ecometric properties. Instead, our results underline that precise theory about the relevant contextual units of causal relationships between social cohesion and health is vital and cannot be replaced by empirical analysis. Although adjustment for respondent's characteristics had only small effects on ecometric properties, potential pitfalls of this analytic strategy are discussed in this paper. Finally, acknowledging the sensitivity of measuring social cohesion, we derived recommendations for future studies investigating the effects of contextual-level social characteristics on health.

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Social cohesion aims to describe aspects of the social environment we live in but its measurement remains challenging.

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We meta-analysed the ecometric properties of 78 social cohesion measurements.

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There is modest but consistent evidence for the contextual nature of social cohesion.

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Contextual dependence in individual response behaviour is sensitive to the chosen spatial unit.

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Meta-ecometrics studies the empirical usefulness of theoretical concepts aiming to describe social environments.

Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach

Few studies have examined the neighborhood features related to falls in the older population in low-and-middle-income countries, including Brazil. This study aimed to evaluate if perceived neighborhood features are related to falls among older Brazilian adults living in a large urban area. This cross-sectional study was conducted using data from 834 participants (≥60 years) from a multistage household survey in Belo Horizonte, Brazil. The association between fall history in the previous year and perceived neighborhood features (quality of services, physical and social disorder, and safety) was examined using multilevel logistic regression. The fall prevalence was 13.6%. Older adults living in neighborhoods with a higher physical disorder were more likely to report fall in the previous year, even after controlling for demographic, clinical and social variables (OR = 2.59; 95% CI = 1.14-5.87). The other neighborhood features investigated were not associated with a fall history. Our findings suggest that improving the physical environment represents an important strategy to prevent falls in the Brazilian urban older population.

Profiling the variability and inequity in the residential environment in Cyprus according to citizens' ratings: a cross-sectional internet-based "Place Standard" survey

Background

The “Place Standard Tool” (PST) offers a practical framework for structuring conversations about physical and social dimensions of Place which impact on health and well-being. The aim of this study was to survey citizens’ perceptions of Place across diverse settings in Cyprus. While the PST has been extensively used in the context of community engagement, its properties as a measurement tool haven’t been explored.

Methods

An open call was addressed to citizens to rate their neighbourhood environment across the 14 PST items (1: large to 7: little room for improvement). Exploratory factor, cluster and regression analyses were used to explore the dimensionality of the scale, depict neighbourhood profiles and explore differences in ratings according to socio-demographic characteristics, area-level census indicators and residents’ assessment of neighbourhood social position (10-step ladder).

Results

With the exception of safety (M = 4.4, SD = 1.7), 492 participants (mean age 42, 50% residents for > 10 years) from 254 postcodes (21.7% islandwide) did not rate other features favourably, with lowest scores for “influence and sense of control” and “public transport”. A stepwise pattern of dissatisfaction was observed along the social position continuum both for features rated less as well as more favourably (e.g. social contact). For instance, among participants who placed their neighbourhood at the three top steps of the ladder, 48.8% gave a low rating for “influence and sense of control”, while the equivalent figure was 81.0% at the bottom three steps (OR = 4.5, 95% CI 2.3, 8.6). A clear dimensionality of Built (6 items, Cronbach’s α = 0.798), Physical (3 items, α = 0.765), Social (2 items, α = 0.749) and Service (3 items, α = 0.58) environment was identified. A social gradient was evident according to census measures of socio-economic disadvantage (e.g. pre-1980 housing, single-parent households) with larger differences in terms of the built than the social environment.

Conclusions

The study profiled the variability and documented the inequity in the health-related neighbourhood environment across Cypriot communities. The readily interpretable dimensionality of the scale supports its construct validity, allowing calculation of composite scores. The PST can be used as measurement tool in research as well as public health practice to advocate for neighbourhood initiatives which support and enhance citizens’ participation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12706-y.

Associations of the perceived neighborhood environment and screen time in adolescents living in a medium-sized city in Brazil: a cross-sectional study

Individual attributes have been investigated to explain sedentary behavior. However, few studies have evaluated this association at the neighborhood level. This study aimed to determine the association between screen time (ST) among adolescents and perceived neighborhood characteristics. This cross-sectional study was conducted using a multistage household survey in Vespasiano, Brazil, in 2015-2016. Logistic regression analyses were performed to assess the associations between the adolescent self-reported ST (television, computer, and video game > 2 h/day) and neighborhood characteristics (green space, sidewalk maintenance, street lighting, social disorder, safety during the day, and risk of violence) reported by an adult. Four hundred and twenty-three adolescents aged 11-17 participated in the study. ST was reported by 74.0% of the adolescents. After adjustment for confounder variables, neighborhood characteristics did not remain associated with ST. The results evidence no associations between ST among adolescents and perceived neighborhood environment and indicate the need for future studies of this relation.

Social capital and maternal and child health services uptake in low- and middle-income countries: mixed methods systematic review

BACKGROUND

Social capital has become an important concept in the field of public health, and is associated with improved health services uptake. This study aimed to systematically review the available literature on the role of social capital on the utilization of maternal and child health services in low- and middle-income countries (LMICs).

METHODS

Mixed-methods research review and synthesis using three databases PubMed, Scopus, and Science Direct for peer-reviewed literature and Google Scholar and Google search engines for gray literature were performed. Both quantitative and qualitative studies conducted in LMICs, published in English and in grey literature were considered. Prior to inclusion in the review methodological quality was assessed using a standardized critical appraisal instrument.

RESULTS

A total of 1,545 studies were identified, of which 13 records were included after exclusions of studies due to duplicates, reading titles, abstracts, and full-text reviews. Of these eligible studies, six studies were included for quantitative synthesis, and seven were included for qualitative synthesis. Of the six quantitative studies, five of them addressed the association between social capital and health facility delivery. Women who lived in communities with higher membership in groups that helps to form intergroup bridging ties had higher odds of using antenatal care services. Synthesized qualitative findings revealed that women received some form of emotional, informational, and instrumental support from their network members. Receiving health information from trusted people and socio-cultural factors influenced the use of maternal and child health services.

CONCLUSIONS

Social capital has a great contribution to improve maternal and child health services. Countries aiming at improving maternal and child health services can be benefited from adapting existing context-specific social networks in the community. This review identified limited available evidence examining the role of social capital on maternal and child health services uptake and future studies may be required for an in-depth understanding of how social capital could improve maternal and child health services.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021226923.

Physical Disorders and Poor Self-Rated Health in Adults Living in Four Latin American Cities: A Multilevel Approach

Considering that urban environments may affect self-rated health through behavioral and psychosocial mechanisms, the aim of this study was to investigate the association between self-rated health and perceived urban environment characteristics among adults living in four Latin American cities. Data is from a population-based survey by Development Bank of Latin America, encompassing adults between 20 and 60 years old in Buenos Aires, Lima, Mexico City, and Panama City. Self-rated health was measured using a single question and the response options were categorized as poor and good. The explanatory variables were empirical Bayes estimates of self-reported area physical disorder, social disorder, access to services, and access to leisure spaces derived from the survey. The covariates were: individual age, sex, education, wealth index, and length of residency in the neighborhood; and an area social environment index. Multilevel logistic regressions with two levels (individual and sub-city areas) were fitted. Poor self-rated health was reported by 34.73% (95% CI: 33.17 to 36.29) of the participants and was associated with physical disorder (OR = 1.16 per SD; 95% CI: 1.02 to 1.32). Our findings suggest that public policies to promote population health should consider area urban environment factors, especially those associated with disorder.

Assessing Google Street View Image Availability in Latin American Cities

Virtual audits using Google Street View are an increasingly popular method of assessing neighborhood environments for health and urban planning research. However, the validity of these studies may be threatened by issues of image availability, image age, and variance of image age, particularly in the Global South. This study identifies patterns of Street View image availability, image age, and image age variance across cities in Latin America and assesses relationships between these measures and measures of resident socioeconomic conditions. Image availability was assessed at 530,308 near-road points within the boundaries of 371 Latin American cities described by the SALURBAL (Salud Urbana en America Latina) project. At the subcity level, mixed-effect linear and logistic models were used to assess relationships between measures of socioeconomic conditions and image availability, average image age, and the standard deviation of image age. Street View imagery was available at 239,394 points (45.1%) of the total sampled, and rates of image availability varied widely between cities and countries. Subcity units with higher scores on measures of socioeconomic conditions had higher rates of image availability (OR = 1.11 per point increase of combined index, p < 0.001) and the imagery was newer on average (- 1.15 months per point increase of combined index, p < 0.001), but image capture date within these areas varied more (0.59-month increase in standard deviation of image age per point increase of combined index, p < 0.001). All three assessed threats to the validity of Street View virtual audit studies spatially covary with measures of socioeconomic conditions in Latin American cities. Researchers should be attentive to these issues when using Street View imagery.

Densidade de estabelecimentos que comercializam bebidas alcoólicas na área residencial está associada ao consumo de álcool em adolescentes?

RESUMO: Objetivos: Investigar a associação entre a densidade de estabelecimentos de venda de bebidas alcoólicas no entorno da residência dos adolescentes e a prevalência de consumo de álcool na vida e atual, ajustado por fatores individuais e familiares. Métodos: As informações provêm da pesquisa domiciliar por amostragem probabilística estratificada e por conglomerados em três estágios (setor censitário, domicílio, adulto e adolescente), realizada em Belo Horizonte, Brasil (Saúde em Beagá, 2008-9) e de fontes oficiais de estabelecimentos que comercializam bebidas alcoólicas, devidamente georreferenciados. O desfecho foi o autorrelato de consumo de álcool na vida e atual pelos adolescentes. A variável de exposição foi a densidade de estabelecimentos definida como número de locais de venda de bebida dentro do buffer de 200 metros da residência dos adolescentes. A associação foi estimada pela regressão de Poisson ajustada por fatores individuais e familiares. Resultados: Participaram 601 adolescentes de 14-17 anos; 53,3% eram homens e 71% tinham renda familiar até cinco salários mínimos. A prevalência de consumo de álcool na vida foi de 57,0% (intervalo de confiança de 95% - IC95% 51,5 - 62,6) e o atual de 11,9% (IC95% 8,7 - 15,0). Na análise multivariada, verificou-se associação significativa entre o consumo atual de bebidas alcoólicas e a densidade de lanchonetes (razão de prevalência - RP = 1,13; IC95% 1,03 - 1,24), bares (RP = 1,21; IC95% 1,05 - 1,38) e restaurantes (RP = 1,11; IC95% 1,02 - 1,21). Interações significativas entre densidade de estabelecimentos com sexo e idade foram encontradas. Conclusão: O consumo atual de álcool pode ser potencializado pela presença de alguns tipos de estabelecimentos localizados no buffer de 200 metros da residência dos adolescentes.

Perception of neighborhood disorder and blood pressure in adults: a multilevel population-based study

The aim of this study was to verify whether the perception of neighborhood physical and social disorder is associated with increased systolic (SBP) and diastolic blood pressure (DBP), as well as to examine the influence of the residential census tract's socioeconomic status on this association. This was a cross-sectional study that included a representative sample of 1,720 adults 20 to 59 years of age living in Florianópolis, Santa Catarina State, Brazil. Two blood pressure measurements were taken, and information was collected on the perception of neighborhood disorder. The contextual variable was the mean head-of-household's years of schooling in the selected census tracts. Statistical analysis included multilevel models with the first level represented by individuals and the second by census tracts. Interaction terms were examined between schooling tertiles in the census tract and tertiles of perception of neighborhood disorder on blood pressure. No statistically significant overall associations were identified between neighborhood disorder and SBP or DBP. However, the study showed a mean increase in SBP of 7.88mmHg (95%CI: 1.38; 14.40) in subjects that perceived more neighborhood disorder and lived in census tracts with less schooling, when compared to the reference category. Public policies aimed at lowering or that have an impact on SBP and DBP in the population should also address the characteristics of the context where the population lives, specifically in contexts marked by lower levels of schooling.

The Influence of Neighborhood Social Capital on Leisure-Time Physical Activity: a Population-Based Study in Brazil

Environmentally targeted approaches to promote physical activity are emerging in recent years as a complementary strategy to the traditional individual approaches. This study explored the relation between community social capital and leisure-time physical activity in an adult population-based sample in Brazil. We applied a generalized estimating equation approach to analyze a cross-sectional survey of 3667 adults living in 149 neighborhoods. Social capital was assessed by scales that measured collective efficacy and social cohesion in the neighborhood. We find that individuals living in areas with higher level of social cohesion were more likely to be physically active even after controlling for potentially confounding individual and area-level covariates (PR = 1.56; 95% CI = 1.13, 2.16). Collective efficacy was not significantly associated with leisure-time physical activity. Interventions to strengthen social cohesion in the community may be an avenue for promoting physical activity.

Contextual characteristics associated with the perceived neighbourhood scale in a cross-sectional study in a large urban centre in Brazil

INTRODUCTION

Health outcomes have been associated with physical and social characteristics of neighbourhoods, but little is known about the relationship between contextual factors and perceived neighbourhood scale.

OBJECTIVE

To identify the contextual factors associated with self-perceived neighbourhood scale.

METHODS

We analysed data from a cross-sectional population-based study in Belo Horizonte, Brazil, that took place in 2008-2009. The dependent variable was perceived neighbourhood, encoded as an ordinal scale based on a brief description of the concept of the neighbourhood, and two independent scales relating distance, expressed in terms of geography and time. Street connectivity, demographic density and residents' perceptions of the neighbourhoods' physical and social environment were used as contextual predictors. Individual characteristics were used as covariates. Multilevel ordinal logistic regression models estimated the association between perceived neighbourhood scale and contextual characteristics.

RESULTS

Residents that perceive better walkability (OR 2.96; 95% CI 1.29 to 3.82) and high amounts of violence (OR 1.35; 95% CI 1.12 to 1.62) perceived their neighbourhoods to be larger, even after adjusting for individual characteristics.

CONCLUSION

There are contextual factors that are associated with self-perceived neighbourhood scale. Careful definition of neighbourhood scale is a key factor in improving the results of eco-epidemiological studies. Although these findings must be further explored in other studies, these results can contribute to a better understanding of an appropriate choice of neighbourhood scale, especially for cities in Latin America.

Self-rated health and perceived violence in the neighborhood is heterogeneous between young women and men

Background

Self-rated health (SRH) is the general perception of an individual’s own health and a key indicator to measure health in population-based studies. Few studies have examined the association between perceived urban violence and SRH among young adults. There were an estimated 475,000 deaths in 2012 as a result of homicide on the world. Sixty percent of these deaths occurred among males aged 15–44 years, making homicide the third leading cause of death for this population group. This study aimed to determine and quantify the association between sex-specific perception of violence in the neighborhood and SRH among young adults.

Methods

Participants included 955 young adults (18–29 years) residing in Belo Horizonte, Minas Gerais, Brazil between 2008 and 2009. Logistic regression analysis was used to estimate the strength of the associations. The perceived urban violence score was constructed from variables that assessed the respondents’ insecurity and perception of fear and danger of suffering some form of violence in the neighborhood using exploratory factor analysis.

Results

18,3% of respondents rated their health as fair/ poor/very poor. Among women, fair/ poor/very poor SRH was associated with age between 25 and 29 years, low socioeconomic status score, being dissatisfied with weight, not exercising regularly, not having a healthy diet, and having some chronic disease. Men who rated their health as fair/poor/very poor more frequently smoked, were dissatisfied with their weight, did not exercise regularly, consumed fewer fruits and vegetables, and had some chronic disease compared to men who rated their health as very good/good. In the final model, after adjusting for confounding variables, perceived violence in the neighborhood was associated with poor SRH in young women only (OR = 1.52; 95% CI: 1.04–2.21).

Conclusion

The results indicate that public and health policies should implement interventions on the neighborhood physical and social environment to improve the perception of safety and have a positive impact on people’s health, especially women.

[Indicators of physical and social neighborhood attributes measured by the Systematic Social Observation method]

Place of residence is heavily shaped by social position, indicating that neighborhood characteristics can be important contributing factors to health iniquities. The objectives were to construct indicators of the physical and social environment in an urban context based on variables obtained with the Systematic Social Observation method (SSO) and to analyze them according to the Health Vulnerability Index (HVI). The instrument was developed to determine the characteristics of the physical and social neighborhood in two health districts in Belo Horizonte, Minas Gerais State, Brazil. Data were collected from April to June 2011. To develop the simple indicators, ratios were calculated for the number of observed items per residence in each segment. Composite indicators were built using principal components analysis via covariance matrix. The final sample consisted of 1,295 street segments nested in 147 neighborhoods. Indicators referring to street conditions and transit items, mobility, appearance, housing and property, physical disorder, safety/security, and services showed a dose-response behavior in relation to HVI (p < 0.05). Indicators pertaining to place to practice physical activity and leisure did not show significant differences. The indicators displayed coherent behavior towards different HVI strata and proved adequate within each respective domain and subdomain.

Assessing the psychometric and ecometric properties of neighborhood scales using adolescent survey data from urban and rural Scotland

Background

Despite the well-established need for specific measurement instruments to examine the relationship between neighborhood conditions and adolescent well-being outcomes, few studies have developed scales to measure features of the neighborhoods in which adolescents reside. Moreover, measures of neighborhood features may be operationalised differently by adolescents living in different levels of urban/rurality. This has not been addressed in previous studies. The objectives of this study were to: 1) establish instruments to measure adolescent neighborhood features at both the individual and neighborhood level, 2) assess their psychometric and ecometric properties, 3) test for invariance by urban/rurality, and 4) generate neighborhood level scores for use in further analysis.

Methods

Data were from the Scottish 2010 Health Behaviour in School-aged Children Survey, which included an over-sample of rural adolescents. The survey responses of interest came from questions designed to capture different facets of the local area in which each respondent resided. Intermediate data zones were used as proxies for neighborhoods. Internal consistency was evaluated by Cronbach’s alpha. Invariance was examined using confirmatory factor analysis. Multilevel models were used to estimate ecometric properties and generate neighborhood scores.

Results

Two constructs labeled neighborhood social cohesion and neighborhood disorder were identified. Adjustment was made to the originally specified model to improve model fit and measures of invariance. At the individual level, reliability was .760 for social cohesion and .765 for disorder, and between .524 and .571 for both constructs at the neighborhood level. Individuals in rural areas experienced greater neighborhood social cohesion and lower levels of neighborhood disorder compared with those in urban areas.

Conclusion

The scales are appropriate for measuring neighborhood characteristics experienced by adolescents across urban and rural Scotland, and can be used in future studies of neighborhoods and health. However, trade-offs between neighborhood sample size and reliability must be considered.

Prevalência e fatores associados ao autorrelato de deficiência: uma comparação por sexo

RESUMO: Objetivo: Estimar a prevalência de deficiência e sua associação com características sociodemográficas e de saúde, estratificadas por sexo. Métodos: Estudo transversal com amostra probabilística de 4.048 residentes com idade ≥ 18 anos em dois distritos sanitários de Belo Horizonte (MG) durante o período 2008-2009. A variável resposta “deficiência” foi definida com base no autorrelato de problema nas funções ou nas estruturas do corpo. As variáveis explicativas foram sociodemográficas (“sexo”, “idade”, “cor de pele”, “estado civil”, “anos de estudos” e “renda familiar”) e de saúde (“morbidade referida”, “autoavaliação de saúde”, “qualidade de vida” e “satisfação com a vida”). Empregou-se a análise multivariada pela árvore de decisão, utilizando-se o algoritmo Chi-square Automatic Interaction Detector. Resultados: A prevalência global de deficiência foi de 10,4%, maior no sexo feminino (11,9%; intervalo de confiança - IC95% 10,2-13,6) do que no masculino (8,7%; IC95% 6,8-10,5). Na análise multivariada, as variáveis que melhor discriminaram a deficiência foram “idade” e “morbidade” no sexo feminino, “baixa escolaridade” e “pior autoavaliação de saúde” no sexo masculino. O autorrelato de deficiência foi mais frequente entre mulheres em idade produtiva (40 a 59 anos) e de menor renda, e entre homens de menor escolaridade e renda. Com relação às condições de saúde, os maiores percentuais de deficiência foram observados, para ambos os sexos, entre aqueles que relataram três ou mais doenças e pior percepção de saúde. Conclusão: Os resultados reforçam a necessidade de atenção diferenciada, uma vez que mulheres em idade produtiva e homens com menor escolaridade são mais vulneráveis à ocorrência de deficiência.

The place where you live and self-rated health in a large urban area

The aim of this study was to determine and quantify the association between one's perception of the place of residence and self-rated health. 4,048 adult residents of Belo Horizonte, Minas Gerais State, Brazil, participated in the study in 2008 and 2009. Ordinal logistic regression was used to estimate the magnitude of the association. Health was rated as good or very good, fair, or poor or very poor by 65.7%, 27.8%, and 6.5% of the subjects, respectively. Better self-rated health was associated with the following neighborhood characteristics: positive evaluation of aesthetics and mobility, better quality of public services, less physical and social disorder. The perception of violence had a borderline statistically significant association with worse self-rated health. These associations persisted after controlling for potential confounding demographic, socioeconomic, health, and health behavior variables. The results indicate that public and health policies should incorporate interventions that address the physical and social environment in addition to policies focused on individuals.

Social context of neighborhood and socioeconomic status on leisure-time physical activity in a Brazilian urban center: The BH Health Study

This study aimed to estimate the prevalence of leisure-time physical activity and investigate its association with contextual characteristics of the social and physical environment in different socioeconomic statuses, using a household survey in Belo Horizonte, Minas Gerais State, Brazil (2008-2009). Leisure-time physical activity was measured by the International Physical Activity Questionnaire; and the social and physical environment by scales arising from perception of neighborhood attributes. Multilevel logistic regression analysis was performed separately for each socioeconomic status stratum. The overall prevalence of leisure-time physical activity was 30.2%, being 20.2% amongst participants of low socioeconomic status, 25.4% in the medium and 40.6% in the high socioeconomic status group. A greater perception of social cohesion was associated with increased leisure-time physical activity only amongst participants of the lowest socioeconomic status even after adjusting for individual characteristics. The results demonstrate the importance of social cohesion for the promotion of leisure-time physical activity in economically disadvantaged groups, supporting the need to stimulate interventions for enhancing social relationships in this population.

Self-rated health in urban adults, perceptions of the physical and social environment, and reported comorbidities: The BH Health Study

This study assesses the prevalence of poor self-rated health and investigates its association with individual and environmental characteristics in adults with and without reported morbidity. A household survey assessed 4,048 adults in two districts of Belo Horizonte, Minas Gerais State, Brazil. We used Poisson regression with robust variance stratified by the presence of reported morbidity. Prevalence of poor self-rated health was 29.9% (42.6% in those with morbidity and 13.1% in the group without morbidity). All assessed domains were associated with self-rated health in subjects with reported morbidity. In the group without reported morbidity, the following were associated with self-rated health: social environment, socio-demographic factors, lifestyle, and psychological health. Perceived problems in the environment were associated with poor self-rated health in both groups, even after hierarchical adjustment. The results suggest the importance of investigating self-rated health stratified by reported morbidity and reinforce the need to include variables that characterize the physical and social environment.

Association of socioeconomic factors with body mass index, obesity, physical activity, and dietary factors in Belo Horizonte, Minas Gerais State, Brazil: The BH Health Study

Obesity prevalence is rapidly increasing in developing countries. Existing research investigating social patterning of obesity and its risk factors in Latin American urban contexts has inconsistent findings. This study analyzed a multistage household survey in adults in Belo Horizonte, Minas Gerais State, Brazil. Marginal models were used to examine the association of education and household and neighborhood income with body mass index (BMI), obesity, physical inactivity, and low fruit and vegetable intake after adjusting for age and ethnicity and stratifying by sex. BMI and obesity were inversely associated with education in women. BMI was positively associated with household and neighborhood income in men. Additionally, physical inactivity and low fruit and vegetable intake were inversely associated with education and household income in both men and women, and physical inactivity was inversely associated with neighborhood income in men. Understanding the drivers of these patterns will allow for development of appropriate policy and interventions to reduce cardiovascular disease risk in large cities in Latin America.

Neighbourhood social capital: measurement issues and associations with health outcomes

We compared ecometric neighbourhood scores of social capital (contextual variation) to mean neighbourhood scores (individual and contextual variation), using several health-related outcomes (i.e. self-rated health, weight status and obesity-related behaviours). Data were analysed from 5,900 participants in the European SPOTLIGHT survey. Factor analysis of the 13-item social capital scale revealed two social capital constructs: social networks and social cohesion. The associations of ecometric and mean neighbourhood-level scores of these constructs with self-rated health, weight status and obesity-related behaviours were analysed using multilevel regression analyses, adjusted for key covariates. Analyses using ecometric and mean neighbourhood scores, but not mean neighbourhood scores adjusted for individual scores, yielded similar regression coefficients. Higher levels of social network and social cohesion were not only associated with better self-rated health, lower odds of obesity and higher fruit consumption, but also with prolonged sitting and less transport-related physical activity. Only associations with transport-related physical activity and sedentary behaviours were associated with mean neighbourhood scores adjusted for individual scores. As analyses using ecometric scores generated the same results as using mean neighbourhood scores, but different results when using mean neighbourhood scores adjusted for individual scores, this suggests that the theoretical advantage of the ecometric approach (i.e. teasing out individual and contextual variation) may not be achieved in practice. The different operationalisations of social network and social cohesion were associated with several health outcomes, but the constructs that appeared to represent the contextual variation best were only associated with two of the outcomes.

Association of perceived neighborhood problems and census tract income with poor self-rated health in adults: a multilevel approach

Neighborhood problems constitute sources of chronic stress that may increase the risk of poor self-rated health. The associations of census tract level income and perceived neighborhood problems with self-rated health were examined in Florianópolis, Santa Catarina State, Brazil (1,720 adults). Odds ratios (OR) and their 95% confidence intervals (95%CI) of poor self-rated health were estimated through multilevel models. Residents in census tracts in the lower and intermediate tertiles of income reported poorer health than those in the highest tertile. OR of reporting poorer health was 2.44 (95%CI: 2.35- 2.54) in the higher tertile of social disorder (adjusting for mental health). The chances of reporting the poorer health with neighborhood problems ranged from 1.07 (95%CI: 1.03-1.11) to 2.02 (95%CI: 1.95-2.10) for the higher tertile of social disorder (physical health) and physical problem (health-related variables). Perceived neighborhood problems were independently associated with poor health. The perception of a neighborhood among its residents should be considered by health policymakers.

Nutritional status of urban adolescents: individual, household and neighborhood factors based on data from The BH Health Study

Abstract The increasing prevalence of overweight in young people suggests that adolescent nutritional status is influenced by environmental factors. Using hierarchical modelling, this study aimed to analyse the association between individual, household and neighborhood factors and adolescent nutritional status and well-being. The study used data from a population-based household survey conducted in Belo Horizonte, the capital of the State of Minas Gerais, Brazil, between 2008 and 2009. Data was obtained from an adult and adolescent in each household using a confidential questionnaire and anthropometric measurements. Adolescent nutritional status was evaluated using multinomial regression analysis considering distal and proximal influences. The prevalence of overweight and thinness among the sample of 1,030 adolescents was 21.9% and 4.6%, respectively. Although variables from all blocks remained in the final model, head of household education level, family habits and family nutritional status were shown to strongly influence adolescent nutritional status. New approaches to public health are needed which focus on raising awareness and promoting health education targeting teenagers and their social context.

Leisure-time physical activity in the vicinity of Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil: the impact of a health promotion program on the community

Abstract This study analyzed leisure-time physical activity among 1,621 adults who were non-users of the Academias da Cidade Program in Belo Horizonte, Minas Gerais State, Brazil, but who lived in the vicinity of a fitness center in operation (exposed Group I) or in the vicinity of two sites reserved for future installation of centers (control Groups II and III). The dependent variable was leisure-time physical activity, and linear distance from the households to the fitness centers was the exposure variable, categorized in radial buffers: < 500m; 500-1,000m; and 1,000-1,500m. Binary logistic regression was performed with the Generalized Estimation Equations method. Residents living within < 500m of the fitness center gave better ratings to the physical environment when compared to those living in the 1,000 and 1,500m buffers and showed higher odds of leisure-time physical activity (OR = 1.16; 95%CI: 1.03-1.30), independently of socio-demographic factors; the same was not observed in the control groups (II and III). The findings suggests the program’s potential for influencing physical activity in the population living closer to the fitness center and thus provide a strategic alternative for mitigating inequalities in leisure-time physical activity.

Influence of individual and socio-environmental factors on self-rated health in adolescents

OBJECTIVE

This study aimed to determine if individual and socio-environmental characteristics can influence the self-rated health among Brazilian adolescents.

METHODS

It included 1,042 adolescents from 11 to 17 years old who participated in the Beagá Health Study (Estudo Saúde em Beagá), a multistage household survey in an urban setting. Logistic regression analyses were performed to determine the association between the self-rated health and the following explanatory variables: sociodemographic factors, social support, lifestyle, physical and psychological health.

RESULTS

Good/very good and reasonable/poor/very poor self-rated health were reported by 88.5 and 11.5% of adolescents, respectively. The data on sociodemographic factors (SES), social support, lifestyle, psychological and physical health were associated with poor self-rated health (p ≤ 0.05). The associated variables were: age 14 - 17 years (OR =1.71; 95%CI 1.06 - 2.74), low SES (OR =1.68; 95%CI 1.05 - 2.69), few (OR = 2.53; 95%CI 1.44 - 4.46) and many quarrels in family (OR = 9.13; 95%CI 4.53 - 18.39), report of unkind and unhelpful peers (OR = 2.21; 95%CI 1.11 - 4.43), consumption of fruits < 5 times a week (OR = 1.78; 95CI% 1.07 - 2.95), physical inactivity (OR = 2.31; 95%CI 1.15 - 4.69), overweight (OR = 2.42; 95%CI 1.54 - 3.79) and low level of life satisfaction (OR = 2.31; 95%CI 1.34 - 3.98).

CONCLUSIONS

Poor self-rated health among adolescents was associated with individual and socio-environmental characteristics related to family, school and neighborhood issues. Quantifying the self-rated health according to the theoretical framework of the child's well-being should help in arguing that self-rated health might be a strong indicator of social inequities for the studied population.

Bullying among adolescents in a Brazilian urban center - "Health in Beagá" Study

OBJECTIVE

To analyze the prevalence of bullying and its associated factors in Brazilian adolescents.

METHODS

Data were used from a population-based household survey conducted by the Urban Health Observatory (OSUBH) utilizing probability sampling in three stages: census tracts, residences, and individuals. The survey included 598 adolescents (14-17 years old) who responded questions on bullying, sociodemographic characteristics, health-risk behaviors, educational well-being, family structure, physical activity, markers of nutritional habits, and subjective well-being (body image, personal satisfaction, and satisfaction with their present and future life). Univariate and multivariate analysis was done using robust Poisson regression.

RESULTS

The prevalence of bullying was 26.2% (28.0% among males, 24.0% among females). The location of most bullying cases was at or on route to school (70.5%), followed by on the streets (28.5%), at home (9.8%), while practicing sports (7.3%), at parties (4.6%), at work (1.7%), and at other locations (1.6%). Reports of bullying were associated with life dissatisfaction, difficulty relating to parents, involvement in fights with peers and insecurity in the neighborhood.

CONCLUSIONS

A high prevalence of bullying among participating adolescents was found, and the school serves as the main bullying location, although other sites such as home, parties and workplace were also reported. Characteristics regarding self-perception and adolescent perceptions of their environment were also associated with bullying, thus advancing the knowledge of this type of violence, especially in urban centers of developing countries.

Self-Rated Health among Urban Adolescents: The Roles of Age, Gender, and Their Associated Factors

Health status is often analyzed in population surveys. Self-rated health (SRH) is a single-item summary measure of the perception of one’s health. In Brazil, studies on the SRH of adolescents remain scarce, especially those aiming to understand the domains that compose this construct. Therefore, the aim of this study is to determine the prevalence of poor SRH and its associated factors among 11- to 13-year-olds and 14- to 17-year-olds living in a large urban center in Brazil. This cross-sectional study was conducted using a household survey across Belo Horizonte that included 1,042 adolescents. Stratified logistic regression models were used for each age group to assess the associations between worse SRH and the following variables: socio-demographic, social and family support, lifestyles, psychological health, and anthropometry. Approximately 11% (95% CIs = 8.7–13.6) of the studied adolescents rated their health as poor, and SHR decreased with age among males and females. This trend was more pronounced among girls (from 6.9% among 11- to 13-year-old girls to 16.9% among 14- to 17-year-old girls) than boys (from 8.3% among 11- to 13-year-old boys to 11% among 14- to 17-year-old boys). Worse SRH was associated with family support (as assessed by the absence of parent-adolescent conversations; odds ratio [OR] = 3.5 among 11- to 13-year-olds), family structure (OR = 2.8 among 14- to 17-year-olds), and argument reporting (OR = 8.2 among 14- to 17-year-olds). Among older adolescents, the consumption of fruit fewer than five times per week (OR = 2.4), life dissatisfaction (OR = 2.8), underweight status (OR = 6.7), and overweight status (OR = 2.7) were associated with poor SRH. As adolescents age, their universe expands from their relationship with their parents to include more complex issues, such as their lifestyles and life satisfaction. Therefore, these results suggest the importance of evaluating SRH across adolescent age groups and demonstrate the influence of the family environment (in addition to other factors) on negative health assessments, particularly among 14- to 17-year-olds.

[Individual characteristics associated with perception of the local neighborhood's territory]

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual's definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study's results can help produce more significant neighborhood definitions that are more consistent with residents' own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Measurement of social capital in relation to health in low and middle income countries (LMIC): a systematic review

Social capital is a neglected determinant of health in low and middle income countries. To date, majority of evidence syntheses on social capital and health are based upon high income countries. We conducted this systematic review to identify the methods used to measure social capital in low and middle-income countries and to evaluate their relative strengths and weaknesses. An electronic search was conducted using Pubmed, Science citation index expanded, Social science citation index expanded, Web of knowledge, Cochrane, Trip, Google scholar and selected grey literature sources. We aimed to include all studies conducted in low and middle-income countries, published in English that have measured any aspect of social capital in relation to health in the study, from 1980 to January 2013. We extracted data using a data extraction form and performed narrative synthesis as the measures were heterogeneous. Of the 472 articles retrieved, 46 articles were selected for the review. The review included 32 studies from middle income countries and seven studies from low income countries. Seven were cross national studies. Most studies were descriptive cross sectional in design (n = 39). Only two randomized controlled trials were included. Among the studies conducted using primary data (n = 32), we identified18 purposely built tools that measured various dimensions of social capital. Validity (n = 11) and reliability (n = 8) of the tools were assessed only in very few studies. Cognitive constructs of social capital, namely trust, social cohesion and sense of belonging had a positive association towards measured health outcome in majority of the studies. While most studies measured social capital at individual/micro level (n = 32), group level measurements were obtained by aggregation of individual measures. As many tools originate in high income contexts, cultural adaptation, validation and reliability assessment is mandatory in adapting the tool to the study setting. Evidence on causality and assessing predictive validity is a problem due to the scarcity of prospective study designs. We recommend Harpham et al. s' Adapted Social Capital Assessment Tool (A-SCAT), Hurtado et al. s' six item tool and Elgar et al. s' World Value Survey Social Capital Scale for assessment of social capital in low and middle income countries.

Perceived neighborhood problems: multilevel analysis to evaluate psychometric properties in a Southern adult Brazilian population

Background

Physical attributes of the places in which people live, as well as their perceptions of them, may be important health determinants. The perception of place in which people dwell may impact on individual health and may be a more telling indicator for individual health than objective neighborhood characteristics. This paper aims to evaluate psychometric and ecometric properties of a scale on the perceptions of neighborhood problems in adults from Florianopolis, Southern Brazil.

Methods

Individual, census tract level (per capita monthly familiar income) and neighborhood problems perception (physical and social disorders) variables were investigated. Multilevel models (items nested within persons, persons nested within neighborhoods) were run to assess ecometric properties of variables assessing neighborhood problems.

Results

The response rate was 85.3%, (1,720 adults). Participants were distributed in 63 census tracts. Two scales were identified using 16 items: Physical Problems and Social Disorder. The ecometric properties of the scales satisfactory: 0.24 to 0.28 for the intra-class correlation and 0.94 to 0.96 for reliability. Higher values on the scales of problems in the physical and social domains were associated with younger age, more length of time residing in the same neighborhood and lower census tract income level.

Conclusions

The findings support the usefulness of these scales to measure physical and social disorder problems in neighborhoods.

Instrumento para condução de observação social sistemática: métodos e resultados da concordância interobservadores

A observação social sistemática tem sido utilizada para a coleta de informações do entorno físico e social da vizinhança. Os objetivos deste artigo foram descrever a operacionalização da observação social sistemática do entorno físico e social de vizinhanças urbanas e avaliar a concordância do instrumento utilizado. O instrumento foi elaborado para coleta de informações em diferentes domínios. No total, 1.306 segmentos de rua, pertencentes a 149 diferentes vizinhanças de Belo Horizonte, Minas Gerais, Brasil, foram observados. Para o estudo de concordância, 149 segmentos foram reauditados. Para se estabelecer a concordância, foi utilizado o kappa Fleiss interobservador. A concordância média dos itens foi 0,57 (DP = 0,24); 53% tiveram concordância substancial ou quase perfeita; 20,4%, moderada. O instrumento se mostrou adequado para observação de características com maior estabilidade temporal, principalmente quanto a serviços, caracterização dos imóveis, ambiente para pedestres e segurança.