Considering daily mobility for a more comprehensive understanding of contextual effects on social inequalities in health: A conceptual proposal

Understanding patients' mobility for treatment seeking in India

Healthcare systems worldwide are grappling with the challenge of providing high-quality healthcare in the face of evolving disease patterns. India, like many other countries, faces a significant treatment gap for various curable impairments, non-communicable diseases (NCDs), and cardiovascular diseases (CVDs). To address their healthcare needs, individuals often relocate in search of better treatment options. However, no studies were conducted to understand the spatial mobility. This paper explores the determinants of spatial mobility for treatment in India using data from NSS 75th round (2017-2018). A total of 64,779 individual medical cases of different diseases were taken into consideration for our analysis. Fixed effect and multinomial regression models were used to understand diseases specific mobility for treatment. It was found that those with CVDs, NCDs, and disabilities are more prone to travel outside their district for medical care. Rural and economically disadvantaged individuals also tend to travel further for treatment. The key factors impacting treatment-seeking mobility include insurance coverage, hospital quality, cost of medicine, and cost of X-rays/surgeries. The study highlights the need for improved policies to address the gap between healthcare needs and infrastructure in India, with a focus on prioritizing the development of local healthcare facilities for disabilities, NCDs, and CVDs.

Neighborhood Physical and Social Environments and Social Inequalities in Health in Older Adolescents and Young Adults: A Scoping Review

Poor health and well-being are prevalent among young people. Neighborhoods may play a role in promoting good health. Little is known on if and how neighborhood characteristics affect health, and social inequalities therein, among young people. In this scoping review, we asked: (1) what features of the neighborhood physical and social environments have been studied in association with the physical and mental health and well-being of young people 15 to 30 years old; and (2) to what extent have social differentials in these associations been studied, and how? We identified peer-reviewed articles (2000 to 2023) through database and snowball searches. We summarized study characteristics, exposure(s), outcome(s) and main findings, with an eye on social inequalities in health. Out of the 69 articles reviewed, most were quantitative, cross-sectional, conducted among 18-year-olds and younger, and focused on the residential neighborhood. Neighborhood social capital and mental health were the most common exposure and outcome studied, respectively. Almost half of the studies examined social inequalities in health, mostly across sex/gender, socioeconomic status, and ethnicity. Evidence gaps remain, which include exploring settings other than residential neighborhoods, studying the older age stratum of young adulthood, and assessing a broader range of social inequalities. Addressing these gaps can support research and action on designing healthy and equitable neighborhoods for young people.

Neighborhood social organization exposures and racial/ethnic disparities in hypertension risk in Los Angeles

Despite a growing evidence base documenting associations between neighborhood characteristics and the risk of developing high blood pressure, little work has established the role played by neighborhood social organization exposures in racial/ethnic disparities in hypertension risk. There is also ambiguity around prior estimates of neighborhood effects on hypertension prevalence, given the lack of attention paid to individuals' exposures to both residential and nonresidential spaces. This study contributes to the neighborhoods and hypertension literature by using novel longitudinal data from the Los Angeles Family and Neighborhood Survey to construct exposure-weighted measures of neighborhood social organization characteristics-organizational participation and collective efficacy-and examine their associations with hypertension risk, as well as their relative contributions to racial/ethnic differences in hypertension. We also assess whether the hypertension effects of neighborhood social organization vary across our sample of Black, Latino, and White adults. Results from random effects logistic regression models indicate that adults living in neighborhoods where people are highly active in informal and formal organizations have a lower probability of being hypertensive. This protective effect of exposure to neighborhood organizational participation is also significantly stronger for Black adults than Latino and White adults, such that, at high levels of neighborhood organizational participation, the observed Black-White and Black-Latino hypertension differences are substantially reduced to nonsignificance. Nonlinear decomposition results also indicate that almost one-fifth of the Black-White hypertension gap can be explained by differential exposures to neighborhood social organization.

Air pollution and metabolic disorders: Dynamic versus static measures of exposure among Hispanics/Latinos and non-Hispanics

INTRODUCTION

Exposure to air pollution disproportionately affects racial/ethnic minorities that could contribute to health inequalities including metabolic disorders. However, most existing studies used a static assessment of air pollution exposure (mostly using the residential address) and do not account for activity space when modelling exposure to air pollution. The aim of this study is to understand how exposure to air pollution impacts metabolic disorders biomarkers, how this effect differs according to ethnicity, and for the first time compare these findings with two methods of exposure assessment: dynamic and static measures.

METHODS

Among the Community of Mine study, a cross-sectional study conducted in San Diego County, insulin resistance, diabetes, hypertension, obesity, dyslipidemia, and metabolic syndrome (MetS) were assessed. Exposure to air pollution (PM_2.5, NO₂, traffic) was calculated using static measures around the home, and dynamic measures of mobility derived from Global Positioning Systems (GPS) traces using kernel density estimators to account for exposure variability across space and time. Associations of air pollution with metabolic disorders were quantified using generalized estimating equation models to account for the clustered nature of the data.

RESULTS

Among 552 participants (mean age 58.7 years, 42% Hispanic/Latino), Hispanics/Latinos had a higher exposure to PM_2.5 compared to non-Hispanics using static measures. In contrast, Hispanics/Latinos had less exposure to PM_2.5 using dynamic measures. For all participants, higher dynamic exposure to PM_2.5 and NO₂ was associated with increased insulin resistance and cholesterol levels, and increased risk of obesity, dyslipidemia and MetS (RR 1.17, 95% CI: 1.07-1.28; RR 1.21, 95% CI: 1.12-1.30, respectively). The association between dynamic PM_2.5 exposure and MetS differed by Hispanic/Latino ethnicity.

CONCLUSION

These results highlight the importance of considering people's daily mobility in assessing the impact of air pollution on health.

Impact of Land Use Diversity on Daytime Social Segregation Patterns in Santiago de Chile

Latin American cities are known for their high levels of marginality, segregation and inequality. As such, these issues have been the subject of substantial discussions in academia, with the predominant approach being the study of residential segregation, or what we call “nighttime segregation”. Another dimension of urban sociability, related to labor, is what we call “daytime segregation”, which has been far less studied. This article makes an original methodological contribution to the measurement of non-residential or daytime segregation based on data from mobility surveys. It seeks to explain this segregation measurement according to the diversity and distribution of land uses, as well as other characteristics of the built stock, such as land price and built-up density. We measured daytime social mix in urban spaces, and we show how it highly relates to land use diversity in a Latin American megacity, such as Santiago, Chile. We found that land use diversity plays a key role in enhancing the daytime social diversity of urban spaces, contributing to generate a more heterogeneous city and social gatherings during working days. This research is not only a contribution to the understanding of sociability patterns in cities but is also a contribution to public policy and the work of urban planners, as it informs the development of more diverse and integrated cities, which is a key tool for strengthening democracy, the exchange of ideas, the economy and social welfare.

Change in GPS-assessed walking locations following a cluster-randomized controlled physical activity trial in older adults, results from the MIPARC trial

This study employed novel GPS methods to assess the effect of a multilevel physical activity (PA) intervention on device-measured walking locations in 305 community dwelling older adults, ages 65+ (mean age = 83, 73% women). Retirement communities were randomized to a 1-year PA intervention that encouraged neighborhood walking, or to a healthy aging control condition. Total time and time spent walking in four life-space domains were assessed using GPS and accelerometer devices. The intervention increased the time spent walking as a proportion of total time spent in the Campus, Neighborhood and Beyond Neighborhood domains. Intervention effects on walking location were observed in both genders and across physical and cognitive functioning groups. Results demonstrate that an intervention providing individual, social and environmental support for walking can increase PA in larger life-space domains for a broad spectrum of older adults.

Assessment of sociodemographic disparities in environmental exposure might be erroneous due to neighborhood effect averaging: Implications for environmental inequality research

The neighborhood effect averaging problem (NEAP) is a major methodological problem that might affect the accuracy of assessments of individual exposure to mobility-dependent environmental factors (e.g., air/noise pollution, green/blue spaces, or healthy food environments). Focusing on outdoor ground-level ozone as a major air pollutant, this paper examines the NEAP in the evaluation of sociodemographic disparities in people's air pollution exposures in Los Angeles using one-day activity-travel diary data of 3790 individuals. It addresses two questions: (1) How does the NEAP affect the evaluation of sociodemographic disparities in people's air pollution exposures? (2) Which social groups with high residence-based exposures do not experience neighborhood effect averaging? The results of our spatial regression models indicate that assessments of sociodemographic disparities in people's outdoor ground-level ozone exposures might be erroneous when people's daily mobility is ignored because of the different manifestations of neighborhood effect averaging for different social/racial groups. The results of our spatial autologistic regression model reveal that non-workers (e.g., the unemployed, homemakers, the retired, and students) do not experience downward averaging: they have significantly lower odds of experiencing downward averaging that could have attenuated their high exposures experienced in their residential neighborhoods while traveling to other neighborhoods (thus, being doubly disadvantaged). Therefore, to avoid erroneous conclusions in environmental inequality research and ineffective public policies, it would be critical to take the NEAP into account in future studies of sociodemographic disparities related to mobility-dependent environmental factors.

Is Smoking Cessation in Young Adults Associated With Tobacco Retailer Availability in Their Activity Space?

INTRODUCTION

The presence of tobacco retailers in residential neighborhoods has been inversely associated with residents' likelihood of quitting smoking. Few studies have yet explored whether this association holds when accounting for tobacco retailers found in the multiple environments where people conduct their daily activities, that is, their activity space.

METHODS

We analyzed cross-sectional data from 921 young adults (18- to 25-years old) participating in the Interdisciplinary Study of Inequalities in Smoking (Montreal, Canada). Respondents self-reported sociodemographic, smoking, and activity location data. Log-binomial regression was used to estimate prevalence ratios (PRs) for the association between smoking cessation and (1) the number of tobacco retailers (counts), and (2) the distance to the closest retailer (proximity) in participants' residential neighborhood and activity space.

RESULTS

Smoking cessation was positively associated with low and intermediate tertile levels of tobacco retailer counts in both the residential neighborhood and activity space, and with the furthest distance level in the activity space [PR (95% CI) = 1.21 (1.02 to 1.43)].

CONCLUSIONS

Individuals encounter resources in the course of their regular daily activities that may hamper smoking cessation. This study highlights the relevance of considering the tobacco retail environment of both individuals' residential neighborhood and activity space to understand its association with smoking cessation.

IMPLICATIONS

This article contributes to the literature on the association between the tobacco retail environment and smoking cessation in young adults by moving beyond the residential neighborhood to also assess individuals' access to tobacco retailers in the multiple areas where they regularly spend time, that is, their activity space. Findings suggest that lower numbers of tobacco retailers in both the residential neighborhood and activity space, and further distance to tobacco retailers in the activity space are associated with increased smoking cessation.

Using the concept of activity space to understand the social health of older adults living with memory problems and dementia at home

Globally as the population ages, the prevalence of dementia will increase. Simultaneously, there is a trend toward people ageing at home. Therefore, more people will be ageing at home with dementia, as opposed to institutional environments. In this context, there has been a recent shift in research exploring ways that people can live well with the consequences of the disease. As a part of this emerging research, the social and spatial aspects of the lives of people living with memory problems are becoming increasingly of interest. The aim of this article is to use the concept of activity space to examine the social health of older adults with memory problems and dementia who live at home. Activity space data were collected from seven older adults experiencing memory problems and living at home in the Netherlands. Using a mixed-methods approach, insight into their activity spaces were gained through walking interviews, 14 days of global positioning system (GPS) movement data, travel diary entries and in-depth interviews. The GPS data, travel diary data and interview transcripts were analyzed using a grounded visualization approach. Our findings show that participants interact independently in routine activity spaces but depend on others to participate in occasional activity spaces. Interactions within both these spaces contribute to the social health of older adults with memory problems and dementia who live at home. Additionally, participants used coping strategies and decision-making to maintain autonomy in daily life. The findings can inform dementia-friendly initiatives and social health care planning.

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

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

Assessing Older Adults' Daily Mobility: A Comparison of GPS-Derived and Self-Reported Mobility Indicators

Interest in global positioning system (GPS)-based mobility assessment for health and aging research is growing, and with it the demand for validated GPS-based mobility indicators. Time out of home (TOH) and number of activity locations (#ALs) are two indicators that are often derived from GPS data, despite lacking consensus regarding thresholds to be used to extract those as well as limited knowledge about their validity. Using 7 days of GPS and diary data of 35 older adults, we make the following three main contributions. First, we perform a sensitivity analysis to investigate how using spatial and temporal thresholds to compute TOH and #ALs affects the agreement between self-reported and GPS-based indicators. Second, we show how daily self-reported and GPS-derived mobility indicators are compared. Third, we explore whether the type and duration of self-reported activity events are related to the degree of correspondence between reported and GPS event. Highest indicator agreement was found for temporal interpolation (Tmax) of up to 5 h for both indicators, a radius (Dmax) to delineate home between 100 and 200 m for TOH, and for #ALs a spatial extent (Dmax) between 125 and 200 m, and temporal extent (Tmin) between 5 and 6 min to define an activity location. High agreement between self-reported and GPS-based indicators is obtained for TOH and moderate agreement for #ALs. While reported event type and duration impact on whether a reported event has a matching GPS event, indoor and outdoor events are detected at equal proportions. This work will help future studies to choose optimal threshold settings and will provide knowledge about the validity of mobility indicators.

Integrating activity spaces in health research: Comparing the VERITAS activity space questionnaire with 7-day GPS tracking and prompted recall

BACKGROUND

Accounting for daily mobility allows assessment of multiple exposure to environments. This study compares spatial data obtained (i) from an interactive map-based questionnaire on regular activity locations (VERITAS) and (ii) from GPS tracking.

METHODS

234 participants of the RECORD GPS Study completed the VERITAS questionnaire and wore a GPS tracker for 7 days. Analyses illustrate the spatial match between both datasets.

RESULTS

For half of the sample, 85.5% of GPS data fell within 500 m of a VERITAS location. The median minimum distance between a VERITAS location and a GPS coordinate ranged from 0.4 m for home to slightly over 100 m for a recreational destination.

CONCLUSIONS

There is a spatial correspondence between destinations collected through VERITAS and 7-day GPS tracking. Both collection methods offer complementary ways to assess daily mobilities, useful to study environmental determinants of health and health inequities.

Multi-Contextual Segregation and Environmental Justice Research: Toward Fine-Scale Spatiotemporal Approaches

Many environmental justice studies have sought to examine the effect of residential segregation on unequal exposure to environmental factors among different social groups, but little is known about how segregation in non-residential contexts affects such disparity. Based on a review of the relevant literature, this paper discusses the limitations of traditional residence-based approaches in examining the association between socioeconomic or racial/ethnic segregation and unequal environmental exposure in environmental justice research. It emphasizes that future research needs to go beyond residential segregation by considering the full spectrum of segregation experienced by people in various geographic and temporal contexts of everyday life. Along with this comprehensive understanding of segregation, the paper also highlights the importance of assessing environmental exposure at a high spatiotemporal resolution in environmental justice research. The successful integration of a comprehensive concept of segregation, high-resolution data and fine-grained spatiotemporal approaches to assessing segregation and environmental exposure would provide more nuanced and robust findings on the associations between segregation and disparities in environmental exposure and their health impacts. Moreover, it would also contribute to significantly expanding the scope of environmental justice research.

The daycourse of place

The present paper aims to contribute to the debate about the temporal relationships between place and health. It explores the notion of 'daycourse of place' echoing the discussion which recently occurred in this journal about the 'lifecourse of place' (Andrews, 2017; Lekkas et al., 2017a, b). When highlighting the importance of time in shaping health within places, most of studies focus either on the trajectories of places over a matter of years or the daily trajectories of people in link with their activity space. However, daily trajectories of places remain a poor cousin in place and health literature. This paper is intended to overcome 'jetlag', which places suffer when they are labelled with frozen attributes over a 24-h period. It explores the values and feasibility of exploring daily trajectories of places to investigate place effects on health or to design area-based interventions for public health action. More than just a metaphor, the 'daycourse of place' appears to be an inspiring framework to elaborate the importance of daily temporal relationalities for research and action in place-based health inequalities.

Annatto carotenoids attenuate oxidative stress and inflammatory response after high-calorie meal in healthy subjects

The aim of this study was to evaluate the effect of annatto carotenoids intake associated to a single high-calorie meal (high fat and high carbohydrate) in postprandial biochemical, inflammatory and oxidative stress markers. Twelve healthy subjects (6 men, 6 women) were included in this randomised, controlled crossover study. Baseline blood samples were collected from fasting subjects that immediately received high-calorie meal without carotenoid (placebo) or containing 1.2mg/kg bixin (BIX) or 0.06mg/kg norbixin (NBIX). Blood samples were taken 60, 120 and 240min after meal intake. NBIX intake did not affect biochemical blood markers but reduced the postprandial levels of inflammatory cytokines (IL-1, IL-6 and TNF-α) and lipid oxidation 60-120min after meal. BIX only partially prevented postprandial-induced lipid oxidation. Results indicate that the intake of NBIX may be an alternative to reduce the postprandial inflammatory and oxidative stress responses to high-calorie meals.

The Local Food Environment and Fruit and Vegetable Intake: A Geographically Weighted Regression Approach in the ORiEL Study

Studies that explore associations between the local food environment and diet routinely use global regression models, which assume that relationships are invariant across space, yet such stationarity assumptions have been little tested. We used global and geographically weighted regression models to explore associations between the residential food environment and fruit and vegetable intake. Analyses were performed in 4 boroughs of London, United Kingdom, using data collected between April 2012 and July 2012 from 969 adults in the Olympic Regeneration in East London Study. Exposures were assessed both as absolute densities of healthy and unhealthy outlets, taken separately, and as a relative measure (proportion of total outlets classified as healthy). Overall, local models performed better than global models (lower Akaike information criterion). Locally estimated coefficients varied across space, regardless of the type of exposure measure, although changes of sign were observed only when absolute measures were used. Despite findings from global models showing significant associations between the relative measure and fruit and vegetable intake (β = 0.022; P < 0.01) only, geographically weighted regression models using absolute measures outperformed models using relative measures. This study suggests that greater attention should be given to nonstationary relationships between the food environment and diet. It further challenges the idea that a single measure of exposure, whether relative or absolute, can reflect the many ways the food environment may shape health behaviors.

Re-creating daily mobility histories for health research from raw GPS tracks: Validation of a kernel-based algorithm using real-life data

BACKGROUND

GPS tracking is increasingly used to document daily mobility, allowing refined analysis of daily exposures and health behaviour. Validation of algorithms processing raw GPS data to identify activity locations and trips are lacking.

OBJECTIVE

Propose novel ways to evaluate GPS processing algorithms data while validating an existing kernel-based algorithm with real-life GPS tracks.

METHODS

Seven-day GPS tracking and GPS-prompted recall interviews were conducted among 234 adult participants of the RECORD GPS Study. Raw GPS data was transformed using a kernel-based algorithm. Two match and nine mismatch configurations are analysed. Algorithm detection of activity locations and trips were validated.

RESULTS

Some 95.8% of available GPS time was correctly classified as an activity location or a trip. The algorithm falsely identified a trip for 2.2% of the tracking time, and falsely identified an activity location 0.7% of time. Missed trips and missed activity locations counted for less than .4% of the time.

CONCLUSION

The tested kernel-based algorithm provides histories of activity locations and trips that are highly concordant with GPS-prompted follow-up interviews.