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Corsi DJ, Marschner S, Lear S, Hystad P, Rosengren A, Ismail R, Yeates K, Swaminathan S, Puoane T, Wang C, Li Y, Rangarajan S, Kruger IM, Chifamba J, Vidhu Kumar K, Mohan I, Davletov K, Artamonov G, Palileo-Villanueva LM, Mat-Nasir N, Zatonska K, Oguz A, Bahonar A, Alhabib KF, Yusufali A, Lopez-Jaramillo P, Lanas F, Galatte A, Avezum Á, Mckee M, Yusuf S, Chow CK. Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study. Lancet Glob Health 2024; 12:e1794-e1806. [PMID: 39348833 PMCID: PMC11483223 DOI: 10.1016/s2214-109x(24)00287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/19/2024] [Accepted: 07/02/2024] [Indexed: 10/02/2024]
Abstract
BACKGROUND The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study. METHODS Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m2) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined. FINDINGS Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (13·3, SD 2·8) compared with other regions (10·1, 2·5) and urban communities (11·2, 3·0). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 0·58, 95% CI 0·35-0·93; p=0·025) for high compared with low scores and for increasing trend (0·85, 0·78-0·91; p<0·0001). The trends were statistically significant in urban (0·85, 0·77-0·93; p=0·0007) and rural (0·87, 0·78-0·97; p=0·015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 0·75 (95% CI 0·61-0·92; p=0·0066); bike lanes RR 0·58 (0·45-0·73; p<0·0001); pedestrian safety RR 0·75 (0·62-0·90; p=0·0018); and traffic signals RR 0·68 (0·52-0·89; p=0·0055). Community disorder was associated with a higher prevalence of obesity (RR 1·48, 95% CI 1·17-1·86; p=0·0010). INTERPRETATION Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban than rural communities. The method presents a novel way of assessing the built environment's potential effect on health. FUNDING Population Health Research Institute, Hamilton Health Sciences Research Institute, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research's Strategy for Patient Oriented Research, Ontario Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, and GlaxoSmithKline.
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Affiliation(s)
- Daniel J Corsi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine & Health, The University of Sydney, Westmead, NSW, Australia
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rosnah Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Bangi, Malaysia
| | - Karen Yeates
- Department of Medicine, Queen's University, Belfast, UK
| | | | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Chuangshi Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Indu Mohan
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - Kairat Davletov
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Galina Artamonov
- Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | | | - Nafiza Mat-Nasir
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia
| | - Katarzyna Zatonska
- Department of Population Health, Wroclaw Medical University, Wroclaw, Poland
| | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Ahmad Bahonar
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Martin Mckee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine & Health, The University of Sydney, Westmead, NSW, Australia.
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Sridhar GR, Gumpeny L. Built environment and childhood obesity. World J Clin Pediatr 2024; 13:93729. [PMID: 39350902 PMCID: PMC11438925 DOI: 10.5409/wjcp.v13.i3.93729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/07/2024] [Accepted: 07/10/2024] [Indexed: 08/30/2024] Open
Abstract
Childhood obesity, an escalating global health challenge, is intricately linked to the built environment in which children live, learn, and play. This review and perspective examined the multifaceted relationship between the built environment and childhood obesity, offering insights into potential interventions for prevention. Factors such as urbanization, access to unhealthy food options, sedentary behaviors, and socioeconomic disparities are critical contributors to this complex epidemic. Built environment encompasses the human-modified spaces such as homes, schools, workplaces, and urban areas. These settings can influence children's physical activity levels, dietary habits, and overall health. The built environment can be modified to prevent childhood obesity by enhancing active transportation through the development of safe walking and cycling routes, creating accessible and inviting green spaces and play areas, and promoting healthy food environments by regulating fast-food outlet density. School design is another area for intervention, with a focus on integrating outdoor spaces and facilities that promote physical activity and healthy eating. Community engagement and education in reinforcing healthy behaviors is necessary, alongside the potential of technology and innovation in encouraging physical activity among children. Policy and legislative support are crucial for sustaining these efforts. In conclusion, addressing the built environment in the fight against childhood obesity requires the need for a comprehensive, multipronged approach that leverages the built environment as a tool for promoting healthier lifestyles among children, ultimately paving the way for a healthier, more active future generation.
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Affiliation(s)
- Gumpeny R Sridhar
- Department of Endocrinology and Diabetes, Endocrine and Diabetes Centre, Visakhapatnam 530002, Andhra Pradesh, India
| | - Lakshmi Gumpeny
- Department of Internal Medicine, Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam 530048, Andhra Pradesh, India
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Pan H, Liu Y, Chen Y. The health effect of perceived built environment on depression of elderly people in rural China: Moderation by income. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:185-193. [PMID: 32627267 DOI: 10.1111/hsc.13081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
This study explored the health effect of perceived built environment on depression of the Chinese elderly people in rural areas. A multifaceted approach in examining perceived built environment was used. A sample of 670 older residents in rural area of China were interviewed, and data were collected mainly for exploratory factor analysis, confirmatory factor analysis and moderation analysis. Results showed a reliable construct of perceived built environment which was developed by this study. A significant moderating role of personal income per month in the significantly negative relationship between perceived built environment and depression was confirmed. That is, the health effect of perceived built environment on depression became weakened among people of higher income levels. This study added evidence for the health effect of perceived built environment on depression among Chinese elderly people. Additionally, individual income was identified as an important influencing factor in such effect. Discussion on the negative relationship between perceived built environment and depression, as well as the moderating effect of personal income in such relationship were presented.
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Affiliation(s)
- Haimin Pan
- Department of Sociology, Zhejiang University, Hangzhou, China
| | - Yixi Liu
- Department of Art Design, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
| | - Yan Chen
- School of Sociology and Anthropology, Xiamen University, Xiamen, China
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Nishimoto M, Tanaka T, Takahashi K, Unyaporn S, Fujisaki-Sueda-Sakai M, Yoshizawa Y, Iijima K. [Oral frailty is associated with food satisfaction in community-dwelling older adults]. Nihon Ronen Igakkai Zasshi 2020; 57:273-281. [PMID: 32893209 DOI: 10.3143/geriatrics.57.273] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The fact that accumulated reductions in the oral function with aging (i.e. oral frailty) lead to physical frailty has recently received considerable attention, and countermeasures are being promoted, mainly in the field of dentistry. We assessed the relationship between oral frailty and subjective food satisfaction under the hypothesis that oral frailty is also related to psychological problems. METHODS Participants were attendees of the fourth wave of the Kashiwa cohort study in 2016. We excluded individuals with cognitive impairment and those who had missing values in the main variables. Regarding food satisfaction, "tastiness," "enjoyment," and "amount of food" were evaluated with self-administered questionnaires. Oral conditions were evaluated based on the number of remaining teeth and oral frailty. RESULTS Of the 940 participants (mean age 76.3±5.1 years; 53% men), 71% responded that their food was "tasty," 96% said it was "enjoyable," 23% said that the amount of food was "large," and 63% said that the amount was "normal." While the number of teeth (20.8±8.5) was not significantly associated with food satisfaction, compared to those without oral frailty, those who had oral frailty were less likely to feel satisfaction with their meals ( "tasty," adjusted odds ratio [95% confidence interval] = 0.49 [0.29-0.83]; "large," 0.36 [0.15-0.84]; "normal," 0.44 [0.22-0.85]). CONCLUSIONS Our results indicated negative associations between oral frailty and food satisfaction. In addition, the absence of a significant association with the number of teeth suggests that it is necessary to maintain not only the number of teeth but also the comprehensive oral function to support older people's enriched diets.
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Affiliation(s)
| | | | | | - Suthutvoravut Unyaporn
- Institute of Gerontology, The University of Tokyo.,Department of Geriatric Medicine, The University of Tokyo
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Leung A, Law J, Cooke M, Leatherdale S. Exploring and visualizing the small-area-level socioeconomic factors, alcohol availability and built environment influences of alcohol expenditure for the City of Toronto: a spatial analysis approach. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2019; 39:15-24. [PMID: 30652839 DOI: 10.24095/hpcdp.39.1.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Many Canadians continue to drink alcohol in excess of the recommended low-risk guidelines. In this study, we visualized the geographic variation of licensed premises alcohol expenditures in Toronto and examined the effects of area-level socioeconomic characteristics, alcohol availability and built environment influences on alcohol expenditures at the Dissemination Area (DA) level. METHODS Dissemination Area average total household expenditures on alcohol from licensed premises, from the 2010 Survey of Household Spending, was the main outcome variable. Moran's I and Local Moran's I were used to quantify geographic variation and determine hot spots and cold spots of expenditure. We used DA-level socioeconomic characteristics from the 2006 Census of Canada, and the density of licensed premises and other built environment characteristics from the 2008 DMTI Spatial and 2010 CanMap datasets to predict alcohol expenditures in multivariate spatial regression models. RESULTS The results indicated that the most significant area-level predictors of alcohol expenditure were the percentage of individuals in management or finance occupations and the percentage with postsecondary education (one-unit increases associated with 78.6% and 35.0% increases in expenditures respectively). Presence of subway lines in the immediate and neighbouring areas was also significant (one-unit increases resulted in 5% and 28% increases respectively). Alcohol outlet density was also positively associated with alcohol expenditures. CONCLUSION The associations identified between licensed premises alcohol expenditures and small-area-level characteristics highlight the potential importance of small-area-level factors in understanding alcohol use. Understanding the small-area-level characteristics of expenditures and geographic variation of alcohol expenditures may provide avenues for alcohol use reduction initiatives and policies.
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Affiliation(s)
- Andrew Leung
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jane Law
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin Cooke
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.,Department of Sociology and Legal Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Scott Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Pineo H, Glonti K, Rutter H, Zimmermann N, Wilkinson P, Davies M. Urban Health Indicator Tools of the Physical Environment: a Systematic Review. J Urban Health 2018; 95:613-646. [PMID: 29663118 PMCID: PMC6181826 DOI: 10.1007/s11524-018-0228-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Urban health indicator (UHI) tools provide evidence about the health impacts of the physical urban environment which can be used in built environment policy and decision-making. Where UHI tools provide data at the neighborhood (and lower) scale they can provide valuable information about health inequalities and environmental deprivation. This review performs a census of UHI tools and explores their nature and characteristics (including how they represent, simplify or address complex systems) to increase understanding of their potential use by municipal built environment policy and decision-makers. We searched seven bibliographic databases, four key journals and six practitioner websites and conducted Google searches between January 27, 2016 and February 24, 2016 for UHI tools. We extracted data from primary studies and online indicator systems. We included 198 documents which identified 145 UHI tools comprising 8006 indicators, from which we developed a taxonomy. Our taxonomy classifies the significant diversity of UHI tools with respect to topic, spatial scale, format, scope and purpose. The proportions of UHI tools which measure data at the neighborhood and lower scale, and present data via interactive maps, have both increased over time. This is particularly relevant to built environment policy and decision-makers, reflects growing analytical capability and offers the potential for improved understanding of the complexity of influences on urban health (an aspect noted as a particular challenge by some indicator producers). The relation between urban health indicators and health impacts attributable to modifiable environmental characteristics is often indirect. Furthermore, the use of UHI tools in policy and decision-making appears to be limited, thus raising questions about the continued development of such tools by multiple organisations duplicating scarce resources. Further research is needed to understand the requirements of built environment policy and decision-makers, public health professionals and local communities regarding the form and presentation of indicators which support their varied objectives.
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Affiliation(s)
- Helen Pineo
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, Central House, 14 Upper Woburn Place, London, WC1H 0NN, UK. .,Building Research Establishment, Bucknalls Lane, Garston, Hertfordshire, WD25 9XX, UK.
| | - Ketevan Glonti
- School of Humanities and Social Sciences, University of Split, Split, Croatia.,Paris Descartes University, 12 Rue de l'École de Médecine, 75006, Paris, France
| | - Harry Rutter
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Nici Zimmermann
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, Central House, 14 Upper Woburn Place, London, WC1H 0NN, UK
| | - Paul Wilkinson
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Michael Davies
- Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, Central House, 14 Upper Woburn Place, London, WC1H 0NN, UK
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Dearfield CT, Horn KA, Jipguep-Akhtar MC. Influence of social and neighborhood contexts on smoking cessation among urban minorities. J Ethn Subst Abuse 2017; 18:445-461. [PMID: 29267142 DOI: 10.1080/15332640.2017.1404956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A range of individual, social, and neighborhood factors influence the smoking-related health inequities of urban minorities. Yet little is known about how these factors interact to influence smoking behaviors, including cessation. Hierarchical linear modeling was used to estimate the variance in cessation service utilization among a sample of primarily African American adults accounted for by individual, social, and neighborhood factors. Findings showed individual and social factors were important predictors of cessation service utilization. Social contexts have significant effects on smoking cessation service use, and social influences were more significant predictors of cessation service use than neighborhood factors.
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Affiliation(s)
- Craig T Dearfield
- a Department of Prevention and Community Health, The Milken Institute School of Public Health , The George Washington University , Washington , DC
| | - Kimberly A Horn
- a Department of Prevention and Community Health, The Milken Institute School of Public Health , The George Washington University , Washington , DC
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Devilee J, Kempen EV, Swart W, Kamp IV, Ameling C. Assessment of spatial and physical neighborhood characteristics that influence sound quality and herewith well-being and health. Noise Health 2017; 19:154-164. [PMID: 28615546 PMCID: PMC5501026 DOI: 10.4103/nah.nah_53_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Environmental noise and health studies seldom address the positive effect of environments with high acoustic quality. Sound quality, in turn, is influenced by a large number of factors, including the spatial–physical characteristics of a neighborhood. In general, these characteristics cannot be retrieved from existing databases. In this article, we describe the design of an audit instrument and demonstrate its value for gathering information about these characteristics of neighborhoods. The audit instrument used was derived from research in other fields than environmental health. The instrument was tested in 33 neighborhoods in the Dutch cities of Amsterdam, Rotterdam, and Arnhem. In these neighborhoods, more or less homogeneous subareas were identified that were subject of the audit. The results show that the audit approach is suitable to gather neighborhood data that are relevant for the sound quality of neighborhoods. Together with survey data, they provide information that could further the field of soundscape and health. Several suggestions for improvement of the audit instrument were made.
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Affiliation(s)
- Jeroen Devilee
- Dutch National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Elise van Kempen
- Dutch National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Wim Swart
- Dutch National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Irene van Kamp
- Dutch National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Caroline Ameling
- Dutch National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands
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Poortinga W, Calve T, Jones N, Lannon S, Rees T, Rodgers SE, Lyons RA, Johnson R. Neighborhood Quality and Attachment: Validation of the Revised Residential Environment Assessment Tool. ENVIRONMENT AND BEHAVIOR 2017; 49:255-282. [PMID: 28260806 PMCID: PMC5316962 DOI: 10.1177/0013916516634403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Various studies have shown that neighborhood quality is linked to neighborhood attachment and satisfaction. However, most have relied upon residents' own perceptions rather than independent observations of the neighborhood environment. This study examines the reliability and validity of the revised Residential Environment Assessment Tool (REAT 2.0), an audit instrument covering both public and private spaces of the neighborhood environment. The research shows that REAT 2.0 is a reliable, easy-to-use instrument and that most underlying constructs can be validated against residents' own neighborhood perceptions. The convergent validity of the instrument, which was tested against digital map data, can be improved for a number of miscellaneous urban form items. The research further found that neighborhood attachment was significantly associated with the overall REAT 2.0 score. This association can mainly be attributed to the property-level neighborhood quality and natural elements components. The research demonstrates the importance of private spaces in the outlook of the neighborhood environment.
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Affiliation(s)
- Wouter Poortinga
- Cardiff University, Wales, UK
- Wouter Poortinga, Welsh School of Architecture, Cardiff University, Bute Building, King Edward VII Avenue, Cardiff CF10 3NB, Wales, UK.
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Built Environment and Health Outcomes: Identification of Contextual Risk Factors for Mental Well-being of Older Adults. AGEING INTERNATIONAL 2016. [DOI: 10.1007/s12126-016-9276-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gong Y, Palmer S, Gallacher J, Marsden T, Fone D. A systematic review of the relationship between objective measurements of the urban environment and psychological distress. ENVIRONMENT INTERNATIONAL 2016; 96:48-57. [PMID: 27599349 DOI: 10.1016/j.envint.2016.08.019] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 07/15/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Abstract
The urban environment has become the main place that people live and work. As a result it can have profound impacts on our health. While much of the literature has focused on physical health, less attention has been paid to the possible psychological impacts of the urban environment. In order to understand the potential relevance and importance of the urban environment to population mental health, we carried out a systematic review to examine the associations between objective measurements of the urban environment and psychological distress, independently of the individual's subjective perceptions of the urban environment. 11 peer-reviewed papers published in English between January 2000 and February 2012 were identified. All studies were cross-sectional. Despite heterogeneity in study design, the overall findings suggested that the urban environment has measurable associations with psychological distress, including housing with deck access, neighbourhood quality, the amount of green space, land-use mix, industry activity and traffic volume. The evidence supports the need for development of interventions to improve mental health through changing the urban environment. We also conclude that new methods for measuring the urban environment objectively are needed which are meaningful to planners. In particular, future work should look at the spatial-temporal dynamic of the urban environment measured in Geographical Information System (GIS) in relation to psychological distress.
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Affiliation(s)
- Yi Gong
- Sustainable Places Research Institute, Cardiff University, United Kingdom; Division of Population Medicine, School of Medicine, Cardiff University, United Kingdom.
| | - Stephen Palmer
- Sustainable Places Research Institute, Cardiff University, United Kingdom.
| | - John Gallacher
- Department of Psychiatry, Medical Sciences Division, University of Oxford, United Kingdom.
| | - Terry Marsden
- Sustainable Places Research Institute, Cardiff University, United Kingdom.
| | - David Fone
- Division of Population Medicine, School of Medicine, Cardiff University, United Kingdom.
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Hansen AY, Umstattd Meyer MR, Lenardson JD, Hartley D. Built Environments and Active Living in Rural and Remote Areas: a Review of the Literature. Curr Obes Rep 2015; 4:484-93. [PMID: 26364307 DOI: 10.1007/s13679-015-0180-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rural children and adults are more likely to have obesity than their urban counterparts even after adjustment for individual-level behaviors, suggesting that rural environments may promote obesity. The rural built environment may be an important area of research that can help us understand rural-urban disparities in obesity. The purpose of this review is to summarize the rural built environment and active living literature, and to address key issues, gaps, and observations in the field. A literature review was conducted in spring 2015 to identify research published from 2000 to 2015. Our review suggests that limited active living built environments in rural communities and unique rural barriers to physical activity may contribute to a higher prevalence of obesity compared to urban populations. More empirical research is needed to build the evidence-base for the association between rural built environments, active living, and obesity. School- and community-based policies that expand active living opportunities in rural areas should also be closely examined.
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Affiliation(s)
- Anush Yousefian Hansen
- Maine Rural Health Research Center, University of Southern Maine, 404G Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - M Renée Umstattd Meyer
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, One Bear Place, #97313, Waco, TX, 76798, USA.
| | - Jennifer D Lenardson
- Maine Rural Health Research Center, University of Southern Maine, 432B Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - David Hartley
- Maine Rural Health Research Center, University of Southern Maine, 418 Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
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Philibert M, Pampalon R, Daniel M. Conceptual and operational considerations in identifying socioenvironmental factors associated with disability among community-dwelling adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3814-34. [PMID: 25854297 PMCID: PMC4410217 DOI: 10.3390/ijerph120403814] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/23/2022]
Abstract
Disability is conceived as a person–context interaction. Physical and social environments are identified as intervention targets for improving social participation and independence. In comparison to the body of research on place and health, relatively few reports have been published on residential environments and disability in the health sciences literature. We reviewed studies evaluating the socioenvironmental correlates of disability. Searches were conducted in Medline, Embase and CINAHL databases for peer-reviewed articles published between 1997 and 2014. We found many environmental factors to be associated with disability, particularly area-level socioeconomic status and rurality. However, diversity in conceptual and methodological approaches to such research yields a limited basis for comparing studies. Conceptual inconsistencies in operational measures of disability and conceptual disagreement between studies potentially affect understanding of socioenvironmental influences. Similarly, greater precision in socioenvironmental measures and in study designs are likely to improve inference. Consistent and generalisable support for socioenvironmental influences on disability in the general adult population is scarce.
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Affiliation(s)
- Mathieu Philibert
- Département de Sexologie, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada.
- Institut National de Santé Publique du Québec, Montréal, QC H2P 1E2, Canada.
- Departement de Medecine Sociale et Preventive, Université de Montréal, Montréal, QC H3N 1X9, Canada.
| | - Robert Pampalon
- Institut National de Santé Publique du Québec, Montréal, QC H2P 1E2, Canada.
- Departement de Medecine Sociale et Preventive, Université Laval, Quebec, QC G1V 0A6, Canada.
| | - Mark Daniel
- Departement de Medecine Sociale et Preventive, Université de Montréal, Montréal, QC H3N 1X9, Canada.
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia.
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Fitzroy, VIC 3065, Australia.
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Bethlehem JR, Mackenbach JD, Ben-Rebah M, Compernolle S, Glonti K, Bárdos H, Rutter HR, Charreire H, Oppert JM, Brug J, Lakerveld J. The SPOTLIGHT virtual audit tool: a valid and reliable tool to assess obesogenic characteristics of the built environment. Int J Health Geogr 2014; 13:52. [PMID: 25515179 PMCID: PMC4279584 DOI: 10.1186/1476-072x-13-52] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/08/2014] [Indexed: 12/05/2022] Open
Abstract
Background A lack of physical activity and overconsumption of energy dense food is associated with overweight and obesity. The neighbourhood environment may stimulate or hinder the development and/or maintenance of a healthy lifestyle. To improve research on the obesogenicity of neighbourhood environments, reliable, valid and convenient assessment methods of potential obesogenic characteristics of neighbourhood environments are needed. This study examines the reliability and validity of the SPOTLIGHT-Virtual Audit Tool (S-VAT), which uses remote sensing techniques (Street View feature in Google Earth) for desk-based assessment of environmental obesogenicity. Methods A total of 128 street segments in four Dutch urban neighbourhoods – heterogeneous in socio-economic status and residential density – were assessed using the S-VAT. Environmental characteristics were categorised as walking related items, cycling related items, public transport, aesthetics, land use-mix, grocery stores, food outlets and physical activity facilities. To assess concordance of inter- and intra-observer reliability of the Street View feature in Google Earth, and validity scores with real life audits, percentage agreement and Cohen's Kappa (k) were calculated. Results Intra-observer reliability was high and ranged from 91.7% agreement (k = 0.654) to 100% agreement (k = 1.000) with an overall agreement of 96.4% (k = 0.848). Inter-observer reliability results ranged from substantial agreement 78.6% (k = 0.440) to high agreement, 99.2% (k = 0.579), with an overall agreement of 91.5% (k = 0.595). Criterion validity was substantial to high for most of the categories ranging from 87.3% agreement (k = 0.539) to 99.9% agreement (k = 0.887) with an overall score of 95.6% agreement (k = 0.747). Conclusion These study results suggest that the S-VAT is a highly reliable and valid remote sensing tool to assess potential obesogenic environmental characteristics. Electronic supplementary material The online version of this article (doi:10.1186/1476-072X-13-52) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John R Bethlehem
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
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Chow CK, Corsi DJ, Lock K, Madhavan M, Mackie P, Li W, Yi S, Wang Y, Swaminathan S, Lopez-Jaramillo P, Gomez-Arbelaez D, Avezum Á, Lear SA, Dagenais G, Teo K, McKee M, Yusuf S. A novel method to evaluate the community built environment using photographs--Environmental Profile of a Community Health (EPOCH) photo neighbourhood evaluation tool. PLoS One 2014; 9:e110042. [PMID: 25369366 PMCID: PMC4219679 DOI: 10.1371/journal.pone.0110042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 09/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background Previous research has shown that environments with features that encourage walking are associated with increased physical activity. Existing methods to assess the built environment using geographical information systems (GIS) data, direct audit or large surveys of the residents face constraints, such as data availability and comparability, when used to study communities in countries in diverse parts of the world. The aim of this study was to develop a method to evaluate features of the built environment of communities using a standard set of photos. In this report we describe the method of photo collection, photo analysis instrument development and inter-rater reliability of the instrument. Methods/Principal Findings A minimum of 5 photos were taken per community in 86 communities in 5 countries according to a standard set of instructions from a designated central point of each community by researchers at each site. A standard pro forma derived from reviewing existing instruments to assess the built environment was developed and used to score the characteristics of each community. Photo sets from each community were assessed independently by three observers in the central research office according to the pro forma and the inter-rater reliability was compared by intra-class correlation (ICC). Overall 87% (53 of 60) items had an ICC of ≥0.70, 7% (4 of 60) had an ICC between 0.60 and 0.70 and 5% (3 of 60) items had an ICC ≤0.50. Conclusions/Significance Analysis of photos using a standardized protocol as described in this study offers a means to obtain reliable and reproducible information on the built environment in communities in very diverse locations around the world. The collection of the photographic data required minimal training and the analysis demonstrated high reliability for the majority of items of interest.
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Affiliation(s)
- Clara K Chow
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; The George Institute for Global Health and Westmead Hospital Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Daniel J Corsi
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Harvard Center for Population & Development Studies, Cambridge, MA, United States of America
| | - Karen Lock
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Manisha Madhavan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pam Mackie
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Wei Li
- Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sun Yi
- Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sumathi Swaminathan
- St. John's Research Institute, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Patricio Lopez-Jaramillo
- Research Direction, Fundacion Oftalmologica de Santander-Clinica Carlos Arila Lulle and Medical School, Universidad de Santander, Bucaramanga, Colombia
| | - Diego Gomez-Arbelaez
- Research Direction, Fundacion Oftalmologica de Santander-Clinica Carlos Arila Lulle and Medical School, Universidad de Santander, Bucaramanga, Colombia
| | - Álvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University and Division of Cardiology, Providence Health Care, Vancouver, B.C., Canada
| | - Gilles Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec (Université Laval), Quebec City, Quebec, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Martin McKee
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Wu YT, Nash P, Barnes LE, Minett T, Matthews FE, Jones A, Brayne C. Assessing environmental features related to mental health: a reliability study of visual streetscape images. BMC Public Health 2014; 14:1094. [PMID: 25335922 PMCID: PMC4219017 DOI: 10.1186/1471-2458-14-1094] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 10/13/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An association between depressive symptoms and features of built environment has been reported in the literature. A remaining research challenge is the development of methods to efficiently capture pertinent environmental features in relevant study settings. Visual streetscape images have been used to replace traditional physical audits and directly observe the built environment of communities. The aim of this work is to examine the inter-method reliability of the two audit methods for assessing community environments with a specific focus on physical features related to mental health. METHODS Forty-eight postcodes in urban and rural areas of Cambridgeshire, England were randomly selected from an alphabetical list of streets hosted on a UK property website. The assessment was conducted in July and August 2012 by both physical and visual image audits based on the items in Residential Environment Assessment Tool (REAT), an observational instrument targeting the micro-scale environmental features related to mental health in UK postcodes. The assessor used the images of Google Street View and virtually "walked through" the streets to conduct the property and street level assessments. Gwet's AC1 coefficients and Bland-Altman plots were used to compare the concordance of two audits. RESULTS The results of conducting the REAT by visual image audits generally correspond to direct observations. More variations were found in property level items regarding physical incivilities, with broad limits of agreement which importantly lead to most of the variation in the overall REAT score. Postcodes in urban areas had lower consistency between the two methods than rural areas. CONCLUSIONS Google Street View has the potential to assess environmental features related to mental health with fair reliability and provide a less resource intense method of assessing community environments than physical audits.
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Affiliation(s)
- Yu-Tzu Wu
- Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
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Himsworth CG, Parsons KL, Feng AYT, Kerr T, Jardine CM, Patrick DM. A mixed methods approach to exploring the relationship between Norway rat (Rattus norvegicus) abundance and features of the urban environment in an inner-city neighborhood of Vancouver, Canada. PLoS One 2014; 9:e97776. [PMID: 24830847 PMCID: PMC4022650 DOI: 10.1371/journal.pone.0097776] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 04/23/2014] [Indexed: 11/19/2022] Open
Abstract
Urban rats (Rattus spp.) are among the most ubiquitous pest species in the world. Previous research has shown that rat abundance is largely determined by features of the environment; however, the specific urban environmental factors that influence rat population density within cities have yet to be clearly identified. Additionally, there are no well described tools or methodologies for conducting an in-depth evaluation of the relationship between urban rat abundance and the environment. In this study, we developed a systematic environmental observation tool using methods borrowed from the field of systematic social observation. This tool, which employed a combination of quantitative and qualitative methodologies, was then used to identify environmental factors associated with the relative abundance of Norway rats (Rattus norvegicus) in an inner-city neighborhood of Vancouver, Canada. Using a multivariate zero-inflated negative binomial model, we found that a variety of factors, including specific land use, building condition, and amount of refuse, were related to rat presence and abundance. Qualitative data largely supported and further clarified observed statistical relationships, but also identified conflicting and unique situations not easily captured through quantitative methods. Overall, the tool helped us to better understand the relationship between features of the urban environment and relative rat abundance within our study area and may useful for studying environmental determinants of zoonotic disease prevalence/distribution among urban rat populations in the future.
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Affiliation(s)
- Chelsea G. Himsworth
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Animal Health Centre, British Columbia Ministry of Agriculture, Abbotsford, British Columbia, Canada
- * E-mail:
| | - Kirbee L. Parsons
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Y. T. Feng
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire M. Jardine
- Department of Pathobiology, University of Guelph, Guelph, Ontario, Canada
| | - David M. Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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BEENACKERS MARIËLLEA, KAMPHUIS CARLIJNBM, PRINS RICHARDG, MACKENBACH JOHANP, BURDORF ALEX, VAN LENTHE FRANKJ. Urban Form and Psychosocial Factors. Med Sci Sports Exerc 2014; 46:293-301. [DOI: 10.1249/mss.0000000000000017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Longitudinal influences of neighbourhood built and social environment on children's weight status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5083-96. [PMID: 24132135 PMCID: PMC3823344 DOI: 10.3390/ijerph10105083] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 12/31/2022]
Abstract
The objective was to examine longitudinal 4-year-relationships between neighbourhood social environment and children’s body mass index-standard deviation score (BMI-SDS) taking into account the built environment. Furthermore, we have analysed the influence of potential interactions between the social environment and family/social data on children’s BMI-SDS. Between 2006–2008 and 2010–2012, anthropometric measurements were conducted among 485 children (age at baseline: 6.1 (5.8–6.4)). Socio-demographic characteristics and perception of residential environment were reported by parents. Geographic Information Systems were used to examine street length, number of food outlets and distance to the nearest playground and park/green space within an 800 m Euclidian buffer of each participant address point. Additional data on neighbourhood characteristics (e.g., traffic density, walkability, crime rates) were obtained from the State Capital of Kiel, Germany. In a multivariate model, walkability, street type, socioeconomic status of the district and perceived frequency of passing trucks/busses were associated with BMI-SDS over 4 years, but only neighbourhood SES had an effect on change in BMI-SDS. However, familial/social factors rather than neighbourhood environment (especially social environment) had an impact on children’s BMI-SDS over 4 years. Thus, social inequalities in childhood overweight are only partially explained by social neighbourhood environment.
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20
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Dunstan F, Fone DL, Glickman M, Palmer S. Objectively measured residential environment and self-reported health: a multilevel analysis of UK census data. PLoS One 2013; 8:e69045. [PMID: 23874861 PMCID: PMC3712953 DOI: 10.1371/journal.pone.0069045] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/05/2013] [Indexed: 11/18/2022] Open
Abstract
Little is known about the association between health and the quality of the residential environment. What is known is often based on subjective assessments of the environment rather than on measurements by independent observers. The aim of this study, therefore, was to determine the association between self-reported general health and an objectively assessed measure of the residential environment. We studied over 30,000 residents aged 18 or over living in 777 neighbourhoods in south Wales. Built environment quality was measured by independent observers using a validated tool, the Residential Environment Assessment Tool (REAT), at unit postcode level. UK Census data on each resident, which included responses to a question which assessed self-reported general health, was linked to the REAT score. The Census data also contained detailed information on socio-economic and demographic characteristics of all respondents and was also linked to the Welsh Index of Multiple Deprivation. After adjusting for both the individual characteristics and area deprivation, respondents in the areas of poorest neighbourhood quality were more likely to report poor health compared to those living in areas of highest quality (OR 1.36, 95% confidence interval 1.22-1.49). The particular neighbourhood characteristics associated with poor health were physical incivilities and measures of how well the residents maintained their properties. Measures of green space were not associated with self-reported health. This is the first full population study to examine such associations and the results demonstrate the importance for health of the quality of the neighbourhood area in which people live and particularly the way in which residents behave towards their own and their neighbours' property. A better understanding of causal pathways that allows the development of interventions to improve neighbourhood quality would offer significant potential health gains.
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Affiliation(s)
- Frank Dunstan
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom.
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21
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Panczak R, Galobardes B, Spoerri A, Zwahlen M, Egger M. High life in the sky? Mortality by floor of residence in Switzerland. Eur J Epidemiol 2013; 28:453-62. [PMID: 23661152 PMCID: PMC3696174 DOI: 10.1007/s10654-013-9809-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
Living in high-rise buildings could influence the health of residents. Previous studies focused on structural features of high-rise buildings or characteristics of their neighbourhoods, ignoring differences within buildings in socio-economic position or health outcomes. We examined mortality by floor of residence in the Swiss National Cohort, a longitudinal study based on the linkage of December 2000 census with mortality and emigration records 2001-2008. Analyses were based on 1.5 million people living in buildings with four or more floors and 142,390 deaths recorded during 11.4 million person-years of follow-up. Cox models were adjusted for age, sex, civil status, nationality, language, religion, education, professional status, type of household and crowding. The rent per m² increased with higher floors and the number of persons per room decreased. Mortality rates decreased with increasing floors: hazard ratios comparing the ground floor with the eighth floor and above were 1.22 [95% confidence interval (CI) 1.15-1.28] for all causes, 1.40 (95% CI 1.11-1.77) for respiratory diseases, 1.35 (95% CI 1.22-1.49) for cardiovascular diseases and 1.22 (95% CI 0.99-1.50) for lung cancer, but 0.41 (95% CI 0.17-0.98) for suicide by jumping from a high place. There was no association with suicide by any means (hazard ratio 0.81; 95% CI 0.57-1.15). We conclude that in Switzerland all-cause and cause-specific mortality varies across floors of residence among people living in high-rise buildings. Gradients in mortality suggest that floor of residence captures residual socioeconomic stratification and is likely to be mediated by behavioural (e.g. physical activity), and environmental exposures, and access to a method of suicide.
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Affiliation(s)
- Radoslaw Panczak
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Bruna Galobardes
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013; 12:18. [PMID: 23496984 PMCID: PMC3610159 DOI: 10.1186/1475-9276-12-18] [Citation(s) in RCA: 1609] [Impact Index Per Article: 134.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/07/2013] [Indexed: 11/17/2022] Open
Abstract
Background Access is central to the performance of health care systems around the world. However, access to health care remains a complex notion as exemplified in the variety of interpretations of the concept across authors. The aim of this paper is to suggest a conceptualisation of access to health care describing broad dimensions and determinants that integrate demand and supply-side-factors and enabling the operationalisation of access to health care all along the process of obtaining care and benefiting from the services. Methods A synthesis of the published literature on the conceptualisation of access has been performed. The most cited frameworks served as a basis to develop a revised conceptual framework. Results Here, we view access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled. We conceptualise five dimensions of accessibility: 1) Approachability; 2) Acceptability; 3) Availability and accommodation; 4) Affordability; 5) Appropriateness. In this framework, five corresponding abilities of populations interact with the dimensions of accessibility to generate access. Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage. Conclusions This paper explains the comprehensiveness and dynamic nature of this conceptualisation of access to care and identifies relevant determinants that can have an impact on access from a multilevel perspective where factors related to health systems, institutions, organisations and providers are considered with factors at the individual, household, community, and population levels.
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Affiliation(s)
- Jean-Frederic Levesque
- Institut national de santé publique du Québec, 190 Crémazie Est, Montréal, QC H2P1E2, Canada.
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Kroeger GL, Messer L, Edwards SE, Miranda ML. A novel tool for assessing and summarizing the built environment. Int J Health Geogr 2012; 11:46. [PMID: 23075269 PMCID: PMC3517394 DOI: 10.1186/1476-072x-11-46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 10/14/2012] [Indexed: 11/18/2022] Open
Abstract
Background A growing corpus of research focuses on assessing the quality of the local built environment and also examining the relationship between the built environment and health outcomes and indicators in communities. However, there is a lack of research presenting a highly resolved, systematic, and comprehensive spatial approach to assessing the built environment over a large geographic extent. In this paper, we contribute to the built environment literature by describing a tool used to assess the residential built environment at the tax parcel-level, as well as a methodology for summarizing the data into meaningful indices for linkages with health data. Methods A database containing residential built environment variables was constructed using the existing body of literature, as well as input from local community partners. During the summer of 2008, a team of trained assessors conducted an on-foot, curb-side assessment of approximately 17,000 tax parcels in Durham, North Carolina, evaluating the built environment on over 80 variables using handheld Global Positioning System (GPS) devices. The exercise was repeated again in the summer of 2011 over a larger geographic area that included roughly 30,700 tax parcels; summary data presented here are from the 2008 assessment. Results Built environment data were combined with Durham crime data and tax assessor data in order to construct seven built environment indices. These indices were aggregated to US Census blocks, as well as to primary adjacency communities (PACs) and secondary adjacency communities (SACs) which better described the larger neighborhood context experienced by local residents. Results were disseminated to community members, public health professionals, and government officials. Conclusions The assessment tool described is both easily-replicable and comprehensive in design. Furthermore, our construction of PACs and SACs introduces a novel concept to approximate varying scales of community and describe the built environment at those scales. Our collaboration with community partners at all stages of the tool development, data collection, and dissemination of results provides a model for engaging the community in an active research program.
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Affiliation(s)
- Gretchen L Kroeger
- Nicholas School of the Environment, Duke University, Box 90328, Durham, NC 27708, USA
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Burns PA, Snow RC. The built environment & the impact of neighborhood characteristics on youth sexual risk behavior in Cape Town, South Africa. Health Place 2012; 18:1088-100. [PMID: 22704913 DOI: 10.1016/j.healthplace.2012.04.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 04/24/2012] [Accepted: 04/30/2012] [Indexed: 11/26/2022]
Abstract
Youth sexual risk behavior is often described in social terms, and there has been limited attention to date on how measures of the built environment, including access to municipal services, impact sexual risk behavior, particularly in resource-limited countries. Using the Cape Area Panel Study, we assessed the impact of neighborhood conditions (six single items and a built environment index (BEI)), net of individual socio-demographic factors. The results suggest that built environment factors are associated with sexual risk behavior. Also, the magnitude of associations between built environment factors and sexual risk behavior was more pronounced for females than for males.
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Affiliation(s)
- Paul A Burns
- Population Studies Center, University of Michigan, USA.
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25
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Shareck M, Dassa C, Frohlich KL. Improving the measurement of neighbourhood characteristics through systematic observation: inequalities in smoking as a case study. Health Place 2012; 18:671-82. [PMID: 22297153 DOI: 10.1016/j.healthplace.2011.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 11/24/2011] [Accepted: 11/27/2011] [Indexed: 11/19/2022]
Abstract
Systematic observation is increasingly used as a method to measure neighbourhood characteristics thought to influence health inequalities. This article reports on the theory-driven development of a new observation tool composed of reflective indicators of neighbourhood characteristics believed to influence inequalities in smoking. We also report the results of generalisability analyses conducted to estimate the reliability (inter-rater reliability and temporal stability) of the observation tool. We use the reliability results to reflect on the quality of the measures and on the theoretical anchors of the tool. We conclude by making recommendations to improve measures collected through systematic observation.
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Affiliation(s)
- Martine Shareck
- Département de médecine sociale et préventive, Université de Montréal, 1420 Boul. Mont-Royal, C.P. 6128, Succ. Centre-Ville, Montréal, Canada.
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Chow CK, Lock K, Madhavan M, Corsi DJ, Gilmore AB, Subramanian SV, Li W, Swaminathan S, Lopez-Jaramillo P, Avezum A, Lear SA, Dagenais G, Teo K, McKee M, Yusuf S. Environmental Profile of a Community's Health (EPOCH): an instrument to measure environmental determinants of cardiovascular health in five countries. PLoS One 2010; 5:e14294. [PMID: 21170320 PMCID: PMC3000812 DOI: 10.1371/journal.pone.0014294] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 11/09/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The environment in which people live is known to be important in influencing diet, physical activity, smoking, psychosocial and other risk factors for cardiovascular (CV) disease. However no instrument exists that evaluates communities for these multiple environmental factors and is suitable for use across different communities, regions and countries. This report describes the design and reliability of an instrument to measure environmental determinants of CV risk factors. METHOD/PRINCIPAL FINDINGS THE ENVIRONMENTAL PROFILE OF COMMUNITY HEALTH (EPOCH) INSTRUMENT COMPRISES TWO PARTS: (I) an assessment of the physical environment, and (II) an interviewer-administered questionnaire to collect residents' perceptions of their community. We examined the inter-rater reliability amongst 3 observers from each region of the direct observation component of the instrument (EPOCH I) in 93 rural and urban communities in 5 countries (Canada, Colombia, Brazil, China and India). Data collection using the EPOCH instrument was feasible in all communities. Reliability of the instrument was excellent (Intraclass Correlation Coefficient--ICC>0.75) for 24 of 38 items and fair to good (ICC 0.4-0.75) for 14 of 38 items. CONCLUSION This report shows data collection with the EPOCH instrument is feasible and direct observation of community measures reliable. The EPOCH instrument will enable further research on environmental determinants of health for population studies from a broad range of settings.
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Affiliation(s)
- Clara K Chow
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Canada.
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Schaefer-McDaniel N, Dunn JR, Minian N, Katz D. Rethinking measurement of neighborhood in the context of health research. Soc Sci Med 2010; 71:651-6. [DOI: 10.1016/j.socscimed.2010.03.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 01/21/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
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Abstract
PURPOSE OF REVIEW Neighborhood factors are increasingly examined for their role in the childhood obesity epidemic. Whereas studies on the impacts of neighborhood factors on adult obesity are relatively common, studies examining these same factors on childhood obesity are far fewer. RECENT FINDINGS Using the Ecological Systems Theory (EST) as a model, we sought to examine the strength of the literature with respect to neighborhood factors as outlined in EST. This includes factors related to the family and the school, which are embedded in larger social contexts of the community and society. These factors are often referred to in the literature as the 'built environment' which encompasses the entire range of structural elements in a residential setting including, for example, housing mix, transportation networks, public resources, and presence of sidewalks or trails. SUMMARY Whereas progress has been made with respect to the body of evidence supporting the role of neighborhood factors on childhood obesity and obesity-related behaviors, much work remains to be done to enhance our understanding of neighborhood level factors. As the body of evidence grows, these studies will inform multilevel interventions which are urgently needed to tackle the growing epidemic of childhood obesity in the US.
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Affiliation(s)
- Maida P Galvez
- Department of Preventive Medicine, University of California, San Francisco, California, USA.
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Kamphuis CBM, Mackenbach JP, Giskes K, Huisman M, Brug J, van Lenthe FJ. Why do poor people perceive poor neighbourhoods? The role of objective neighbourhood features and psychosocial factors. Health Place 2010; 16:744-54. [PMID: 20382555 DOI: 10.1016/j.healthplace.2010.03.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 02/12/2010] [Accepted: 03/17/2010] [Indexed: 11/24/2022]
Abstract
Compared to people with a high socioeconomic status, those with a lower socioeconomic status are more likely to perceive their neighbourhood as unattractive and unsafe, which is associated with their lower levels of physical activity. Agreement between objective and perceived environmental factors is often found to be moderate or low, so it is questionable to what extent 'creating supportive neighbourhoods' would change neighbourhood perceptions. This study among residents (N=814) of fourteen neighbourhoods in the city of Eindhoven (the Netherlands), investigated to what extent socioeconomic differences in perceived neighbourhood safety and perceived neighbourhood attractiveness can be explained by five domains of objective neighbourhood features (i.e. design, traffic safety, social safety, aesthetics, and destinations), and to what extent other factors may play a role. Unfavourable neighbourhood perceptions of low socioeconomic groups partly reflected their actual less aesthetic and less safe neighbourhoods, and partly their perceptions of low social neighbourhood cohesion and adverse psychosocial circumstances.
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Affiliation(s)
- Carlijn B M Kamphuis
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands.
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Parsons JA, Singh G, Scott AN, Nisenbaum R, Balasubramaniam P, Jabbar A, Zaidi Q, Sheppard A, Ramsay J, O'Campo P, Dunn J. Standardized observation of neighbourhood disorder: does it work in Canada? Int J Health Geogr 2010; 9:6. [PMID: 20146821 PMCID: PMC2831024 DOI: 10.1186/1476-072x-9-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 02/10/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a growing body of evidence that where you live is important to your health. Despite numerous previous studies investigating the relationship between neighbourhood deprivation (and structure) and residents' health, the precise nature of this relationship remains unclear. Relatively few investigations have relied on direct observation of neighbourhoods, while those that have were developed primarily in US settings. Evaluation of the transferability of such tools to other contexts is an important first step before applying such instruments to the investigation of health and well-being. This study evaluated the performance of a systematic social observational (SSO) tool (adapted from previous studies of American and British neighbourhoods) in a Canadian urban context. METHODS This was a mixed-methods study. Quantitative SSO ratings and qualitative descriptions of 176 block faces were obtained in six Toronto neighbourhoods (4 low-income, and 2 middle/high-income) by trained raters. Exploratory factor analysis was conducted with the quantitative SSO ratings. Content analysis consisted of independent coding of qualitative data by three members of the research team to yield common themes and categories. RESULTS Factor analysis identified three factors (physical decay/disorder, social accessibility, recreational opportunities), but only 'physical decay/disorder' reflected previous findings in the literature. Qualitative results (based on raters' fieldwork experiences) revealed the tool's shortcomings in capturing important features of the neighbourhoods under study, and informed interpretation of the quantitative findings. CONCLUSIONS This study tested the performance of an SSO tool in a Canadian context, which is an important initial step before applying it to the study of health and disease. The tool demonstrated important shortcomings when applied to six diverse Toronto neighbourhoods. The study's analyses challenge previously held assumptions (e.g. social 'disorder') regarding neighbourhood social and built environments. For example, neighbourhood 'order' has traditionally been assumed to be synonymous with a certain degree of homogeneity, however the neighbourhoods under study were characterized by high degrees of heterogeneity and low levels of disorder. Heterogeneity was seen as an appealing feature of a block face. Employing qualitative techniques with SSO represents a unique contribution, enhancing both our understanding of the quantitative ratings obtained and of neighbourhood characteristics that are not currently captured by such instruments.
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Affiliation(s)
- Janet A Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Gita Singh
- Department of Obstetrics & Gynecology, Markham-Stouffville Hospital, Toronto, Canada
| | - Allison N Scott
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Rosane Nisenbaum
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Amina Jabbar
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Qamar Zaidi
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Amanda Sheppard
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Cancer Care Ontario, Toronto, Canada
| | - Jason Ramsay
- Neurorehabilitation Program, Toronto Rehabilitation Institute, Toronto, Canada
| | - Patricia O'Campo
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - James Dunn
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Chow CK, Lock K, Teo K, Subramanian SV, McKee M, Yusuf S. Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review. Int J Epidemiol 2009; 38:1580-94. [PMID: 19261658 PMCID: PMC2786248 DOI: 10.1093/ije/dyn258] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2008] [Indexed: 11/13/2022] Open
Abstract
It has long been known that cardiovascular disease (CVD) rates vary considerably among populations, across space and through time. It is now apparent that most of the attributable risk for myocardial infarction 'within' populations from across the world can be ascribed to the varying levels of a limited number of risk factors among individuals in a population. Individual risk factors (e.g. blood pressure) can be modified with resulting health gains. Yet, the persistence of large international variations in cardiovascular risk factors and resulting CVD incidence and mortality indicates that there are additional factors that apply to 'populations' that are important to understand as part of a comprehensive approach to CVD control. This article reviews the evidence on why certain populations are more at risk than others.
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Affiliation(s)
- Clara Kayei Chow
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.
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Schaefer-McDaniel N, Caughy MO, O'Campo P, Gearey W. Examining methodological details of neighbourhood observations and the relationship to health: a literature review. Soc Sci Med 2009; 70:277-92. [PMID: 19883966 DOI: 10.1016/j.socscimed.2009.10.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Indexed: 10/20/2022]
Abstract
Neighbourhood research has been growing steadily over the past two decades across the social sciences, and, in particular in the area of public health. Despite this increase, there is currently no consensus on which measure and data source researchers should use to assess neighbourhood attributes. In the past, researchers have relied on census data and household surveys to assess neighbourhood conditions, but in recent years, neighbourhood observations have become a popular alternative method for characterizing neighbourhood environments. Rooted in sociology of crime research, observations are conducted by trained observers who use a checklist to observe and rate neighbourhoods on a number of conditions such as physical (e.g., traffic volume, housing conditions) and social (e.g., presence of people, gang activity) attributes. While this methodology has been gaining momentum in recent years, notably absent from the literature is a review to examine this methodology in detail. The purpose of the present study was to examine research that has used neighbourhood observations as a method. We do so by critically reviewing 51 English language studies published from 1990 onward paying particular attention to the areas of (1) methodological rigor (i.e. how observations are carried out in the field and how data are analyzed), (2) geographical boundaries (i.e. how neighbourhoods and areas of observation are spatially defined), and (3) the relationship between neighbourhood observations and residents' health (i.e. how studies examine and analyze the link between observed neighbourhood attributes and health). We find that little attention is given to details of neighbourhood observations as a method. Further, there is wide variability in how observations are conducted and analyzed making it impossible to confidently compare findings across studies. We see this review as a first step in developing sound observational measures of neighbourhood factors and conclude by providing recommendations for researchers undertaking neighbourhood observations in the future.
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Miranda ML, Maxson P, Edwards S. Environmental contributions to disparities in pregnancy outcomes. Epidemiol Rev 2009; 31:67-83. [PMID: 19846592 DOI: 10.1093/epirev/mxp011] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
One of the most persistent disparities in American health status is the pronounced difference in birth outcomes between non-Hispanic black and non-Hispanic white women. Poor pregnancy outcomes have a substantial impact on mortality, morbidity, and health care costs. Increasing evidence indicates that environmental exposures are associated with poor birth outcomes. This paper reviews the latest research on how environmental exposures affect pregnancy outcomes and then discusses how these exposures may be embedded within a context of significant social and host factor stress. The analysis suggests that environmental, social, and host factors are cumulatively stressing non-Hispanic black women and that this cumulative stress may be a cause of the persistent disparities in pregnancy outcomes.
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Affiliation(s)
- Marie Lynn Miranda
- Nicholas School of the Environment, Duke University, A134-LSRC, Box 90328, Durham, NC 27708, USA.
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Bernstein KT, Galea S, Ahern J, Tracy M, Vlahov D. The built environment and alcohol consumption in urban neighborhoods. Drug Alcohol Depend 2007; 91:244-52. [PMID: 17644274 DOI: 10.1016/j.drugalcdep.2007.06.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 03/13/2007] [Accepted: 06/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine the relations between characteristics of the neighborhood built environment and recent alcohol use. METHODS We recruited participants through a random digit dial telephone survey of New York City (NYC) residents. Alcohol consumption was assessed using a structured interview. All respondents were assigned to neighborhood of residence. Data on the internal and external built environment in 59 NYC neighborhoods were collected from archival sources. Multilevel models were used to assess the adjusted relations between features of the built environment and alcohol use. RESULTS Of the 1355 respondents, 40% reported any alcohol consumption in the past 30 days, and 3% reported more than five drinks in one sitting (heavy drinking) in the past 30 days. Few characteristics of the built environment were associated with any alcohol use in the past 30 days. However, several features of the internal and external built environment were associated with recent heavy drinking. After adjustment, persons living in neighborhoods characterized by poorer features of the built environment were up to 150% more likely to report heavy drinking in the last 30 days compared to persons living in neighborhoods characterized by a better built environment. CONCLUSIONS Quality of the neighborhood built environment may be associated with heavy alcohol consumption in urban populations, independent of individual characteristics. The role of the residential environment as a determinant of alcohol abuse warrants further examination.
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Affiliation(s)
- Kyle T Bernstein
- Department of Emergency Medicine, NYU School of Medicine, New York, NY 10013, USA.
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Splashpads, swings, and shade: parents' preferences for neighbourhood parks. Canadian Journal of Public Health 2007. [PMID: 17626384 DOI: 10.1007/bf03403712] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Physical activity is a modifiable behaviour that can help curtail the increasing worldwide problem of childhood obesity. Appropriate recreational opportunities, including neighbourhood parks, are particularly important for promoting physical activity among children. Because children's use of parks is mainly under the influence of their parents, understanding parents' preferences is essential for creating the most inviting and usable park space to facilitate children's physical activity. METHODS Eighty-two intercept interviews were conducted with a heterogeneous sample of parents/guardians watching their children at neighbourhood parks in London, Ontario. Parents/guardians were asked questions about how often they frequent the park, whether it is the closest to their residence, and their likes/dislikes for the park. Strategies to ensure trustworthiness of the data were employed. RESULTS Interviewees attended their park of choice between 1-7 times per week with the average being 2.5 times per week. Only 49% of respondents frequented the park closest to their starting destination (home or daycare facility), and the majority travelled more than 4 km to get to the park. For those who chose to travel a significant distance to attend their park of choice, park location was not as important as the amenities they desired. Parents' main reasons for choosing parks were: water attractions, shade, swings, and cleanliness. CONCLUSIONS The current study provides useful insights on park use with potentially important implications for increasing physical activity among children. Incorporating parents' preferences into strategies for creating or modifying city parks will help to ensure that limited public resources are being targeted most effectively in support of children's physical activity.
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Lebel A, Pampalon R, Villeneuve PY. A multi-perspective approach for defining neighbourhood units in the context of a study on health inequalities in the Quebec City region. Int J Health Geogr 2007; 6:27. [PMID: 17615065 PMCID: PMC1936419 DOI: 10.1186/1476-072x-6-27] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 07/05/2007] [Indexed: 11/16/2022] Open
Abstract
Background Identification of socioeconomic and health inequalities at the local scale is facilitated by using relevant small geographical sectors. Although these places are routinely defined according to administrative boundaries on the basis of statistical criteria, it is important to carefully consider the way they are circumscribed as they can create spatial analysis problems and produce misleading information. This article introduces a new approach to defining neighbourhood units which is based on the integration of elements stemming from the socioeconomic situation of the area, its history, and how it is perceived by local key actors. Results Using this set of geographical units shows important socioeconomic and health disparities at the local scale. These disparities can be seen, for example, in a 16-year difference in disability-free life expectancy at birth, and a $10,000-difference in average personal income between close neighbourhoods. The geographical units also facilitate information transfer to local stakeholders. Conclusion The context of this study has made it possible to explore several relevant methodological issues related to the definition of neighbourhood units. This multi-perspective approach allows the combination of many different elements such as physical structures, historical and administrative boundaries, material and social deprivation of the population, and sense of belonging. Results made sense to local stakeholders and helped them to raise important issues to improve future developments.
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Affiliation(s)
- Alexandre Lebel
- Centre de recherche en aménagement et développement, Université Laval, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
| | - Robert Pampalon
- Institut national de santé publique du Québec, Québec, Canada
| | - Paul Y Villeneuve
- Centre de recherche en aménagement et développement, Université Laval, Québec, Canada
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Zenk SN, Schulz AJ, Mentz G, House JS, Gravlee CC, Miranda PY, Miller P, Kannan S. Inter-rater and test–retest reliability: Methods and results for the neighborhood observational checklist. Health Place 2007; 13:452-65. [PMID: 16809060 DOI: 10.1016/j.healthplace.2006.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 02/01/2006] [Accepted: 05/02/2006] [Indexed: 11/20/2022]
Abstract
The popularity of direct or systematic social observation as a method to evaluate the mechanisms by which neighborhood environments impact health and contribute to health disparities is growing. The development of measures with adequate inter-rater and test-retest reliability is essential for this research. In this paper, based on our experiences conducting direct observation of neighborhoods in Detroit, MI, we describe strategies to promote high inter-rater and test-retest reliability and methods to evaluate reliability. We then present the results and discuss implications for future research efforts using direct observation in four areas: methods to evaluate reliability, instrument content and design, observer training, and data collection.
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Affiliation(s)
- Shannon N Zenk
- Department of Public Health, Mental Health, and Administrative Nursing, University of Illinois at Chicago College of Nursing, 845 S Damen Ave, M/C 802, Chicago, IL 60608, USA.
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Araya R, Montgomery A, Rojas G, Fritsch R, Solis J, Signorelli A, Lewis G. Common mental disorders and the built environment in Santiago, Chile. Br J Psychiatry 2007; 190:394-401. [PMID: 17470953 DOI: 10.1192/bjp.bp.106.024596] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is growing research interest in the influence of the built environment on mental disorders. AIMS To estimate the variation in the prevalence of common mental disorders attributable to individuals and the built environment of geographical sectors where they live. METHOD A sample of 3870 adults (response rate 90%) clustered in 248 geographical sectors participated in a household cross-sectional survey in Santiago, Chile. Independently rated contextual measures of the built environment were obtained. The Clinical Interview Schedule was used to estimate the prevalence of common mental disorders. RESULTS There was a significant association between the quality of the built environment of small geographical sectors and the presence of common mental disorders among its residents. The better the quality of the built environment, the lower the scores for psychiatric symptoms; however, only a small proportion of the variation in common mental disorder existed at sector level, after adjusting for individual factors. CONCLUSIONS Findings from our study, using a contextual assessment of the quality of the built environment and multilevel modelling in the analysis, suggest these associations may be more marked in non-Western settings with more homogeneous geographical sectors.
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Affiliation(s)
- Ricardo Araya
- Division of Psychiatry, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK.
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Agerbo E, Sterne JAC, Gunnell DJ. Combining individual and ecological data to determine compositional and contextual socio-economic risk factors for suicide. Soc Sci Med 2007; 64:451-61. [PMID: 17050054 DOI: 10.1016/j.socscimed.2006.08.043] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Indexed: 10/23/2022]
Abstract
The social and economic characteristics of geographic areas are associated with their suicide rates. The extent to which these ecological associations are due to the characteristics of the people living in the areas (compositional effects) or the influence of the areas themselves on risk (contextual effects) is uncertain. Denmark's Medical Register on Vital Statistics and its Integrated Database for Longitudinal Labour Market Research were used to identify suicides and 20 matched controls per case in 25-60-year-old men and women between 1982 and 1997. Individual and area (municipality) measures of income, marital and employment status were obtained. There were 9011 suicides and 180,220 controls. Individual-level associations with these risk factors were little changed when controlling for contextual effects. In contrast, ecological associations of increased suicide risk with declining area levels of employment and income and increasing proportions of people living alone were much attenuated after controlling for compositional effects. We found no consistent evidence that associations with individual-level risk factors differed depending on the areas' characteristics (cross-level interactions). This analysis suggests the ecological associations to be attributed to characteristics of the residents rather than area influences on risk.
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Affiliation(s)
- Esben Agerbo
- Faculty of Social Sciences, National Centre for Register-based Research, University of Aarhus, Taasingegade 1, 8000 Aarhus, Denmark.
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Dahly DL, Adair LS. Quantifying the urban environment: a scale measure of urbanicity outperforms the urban-rural dichotomy. Soc Sci Med 2006; 64:1407-19. [PMID: 17196724 PMCID: PMC2001275 DOI: 10.1016/j.socscimed.2006.11.019] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Indexed: 11/23/2022]
Abstract
The rapid urbanization of the developing world has important consequences for human health. Although several authorities have called for better research on the relationships between urbanicity and health, most researchers still use a poor measurement of urbanicity, the urban-rural dichotomy. Our goal was to construct a scale of urbanicity using community level data from the Cebu Longitudinal Health and Nutrition Survey. We used established scale development methods to validate the new measure and tested its performance against the dichotomy. The new scale illustrated misclassification by the urban-rural dichotomy, and was able to detect differences in urbanicity, both between communities and across time, that were not apparent before. Furthermore, using a continuous measure of urbanicity allowed for better illustrations of the relationships between urbanicity and health. The new scale is a better measure of urbanicity than the traditionally used urban-rural dichotomy.
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Coen SE, Ross NA. Exploring the material basis for health: characteristics of parks in Montreal neighborhoods with contrasting health outcomes. Health Place 2006; 12:361-71. [PMID: 16814195 DOI: 10.1016/j.healthplace.2005.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2005] [Indexed: 10/25/2022]
Abstract
The growing evidence of neighborhood influences on health points to the need for investigation of health-relevant features of local environments. This study examines one potentially health-enhancing neighborhood resource, urban parks, to test for systematic differences in material conditions between areas. Twenty-eight parks selected from six urban Montreal neighborhoods along a health status gradient are qualitatively assessed. While neighborhood parks showed a variety of feature quality ratings, those located in poor health areas displayed several pronounced material disadvantages, including concentration of physical incivilities, limited provision of facilities for physical exercise, and adjacency to industrial sites and multi-lane roads. Equalizing park quality between areas may be an important step for public health promotion.
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Affiliation(s)
- Stephanie E Coen
- Department of Geography, McGill University, 805 Sherbrooke St. West, Montréal, QC, Canada H3A 2K6
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Weeks JR, Hill AG, Getis A, Stow D. ETHNIC RESIDENTIAL PATTERNS AS PREDICTORS OF INTRA-URBAN CHILD MORTALITY INEQUALITY IN ACCRA, GHANA. URBAN GEOGRAPHY 2006; 27:526-548. [PMID: 19816546 PMCID: PMC2758568 DOI: 10.2747/0272-3638.27.6.526] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
As cities of developing nations absorb an increasing fraction of the world's population increase, questions have arisen about the potential for emerging inequalities in health within places that are already suffering from inadequate infrastructure. In this paper we explore the pattern of child mortality inequalities (as a proxy for overall health levels) within a large sub-Saharan African city-Accra, Ghana-and then we examine the extent to which existing residential patterns by ethnicity may be predictive of any observed intra-urban inequalities in child mortality. We find that the spatial variability in child mortality in Accra is especially associated with the pattern of residential separation of the Ga from other ethnic groups, with the Ga having higher levels of mortality than other ethnic groups. Being of Ga ethnicity exposes a woman and her children to characteristics of the places in Accra where the Ga live, in which one-room dwellings and poor infrastructure predominate. At the individual level, we find that regardless of where a woman lives, if she is of Ga ethnicity and/or is non-Christian, and if she is not married, her risks of having lost a child are elevated.
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Affiliation(s)
- John R. Weeks
- Correspondence concerning this article should be addressed to John R. Weeks, Department of Geography, San Diego State University, San Diego, CA 92182-4493; telephone: 619-594-8040; fax: 619-594-4938; e-mail:
| | | | - Arthur Getis
- Department of Geography, San Diego State University
| | - Douglas Stow
- Department of Geography, San Diego State University
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Korpela KM, Ylén M. Perceived health is associated with visiting natural favourite places in the vicinity. Health Place 2005; 13:138-51. [PMID: 16386449 DOI: 10.1016/j.healthplace.2005.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 11/09/2005] [Accepted: 11/10/2005] [Indexed: 11/25/2022]
Abstract
Visiting favourite natural settings may serve as a resource for regulating negative feelings and coping with perceived stress. The authors investigated the association between perceived health, the selection and experiential qualities of favourite places in four residential areas; 211 respondents (average age 40 years) responded to the questionnaire. Respondents with a certain amount of health complaints, such as headaches, chest or stomach pains, and faintness or dizziness, were more likely to select natural favourite places than those with few complaints. Respondents with health complaints benefited more in emotional terms from their visits to the favourite place although they did not visit their places more frequently than others. The change toward positive feelings was associated in particular with natural favourite places and relaxing in them. The results give impetus to research on the self-regulation of mood and neighbourhood context in health.
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Affiliation(s)
- Kalevi M Korpela
- Department of Psychology, University of Tampere, 33014 Tampere, Finland.
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Cunningham GO, Michael YL, Farquhar SA, Lapidus J. Developing a reliable Senior Walking Environmental Assessment Tool. Am J Prev Med 2005; 29:215-7. [PMID: 16168871 DOI: 10.1016/j.amepre.2005.05.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 04/25/2005] [Accepted: 05/31/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Research of the effects of the built environment on physical activity often excludes certain segments of the population. The senior population, one segment perhaps most influenced by the physical features of an environment, has been understudied. Developing reliable measures of the environment is important to increase our understanding of the environmental effects on physical activity among seniors. METHODS A review of urban planning and health literature helped identify important concepts and theories that were used to inform the development of the Senior Walking Environmental Assessment Tool (SWEAT). Urban planning and health research professionals were consulted and provided feedback on the tool. A total of 355 neighborhood segments were assessed using SWEAT. Thirty-six neighborhood segments were assessed for inter-rater reliability. RESULTS Overall, raters exhibited good-to-excellent agreement on most items included in SWEAT. Items assessing buildings and destinations were less reliable than other categories. CONCLUSIONS The development of a reliable senior-specific environmental measurement of detailed street level environmental features that may influence walking among seniors is important to advance this research and engage communities to consider simple environmental changes that encourage walking among seniors.
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Affiliation(s)
- Grazia O Cunningham
- Oregon Health and Science University, Department of Public Health and Preventive Medicine, Portland, 97239, USA
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Gauvin L, Richard L, Craig CL, Spivock M, Riva M, Forster M, Laforest S, Laberge S, Fournel MC, Gagnon H, Gagné S, Potvin L. From walkability to active living potential: an "ecometric" validation study. Am J Prev Med 2005; 28:126-33. [PMID: 15694520 DOI: 10.1016/j.amepre.2004.10.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this paper is to establish the reliability and validity of a neighborhood-level measure of active living potential by applying principles of ecometrics. METHODS Following a 3-day training session, observers (n =8) were provided with a map of a predetermined walking route constructed through the joining of ten randomly selected street blocks. Then, using an 18-item observation grid, pairs of observers performed ratings of 112 neighborhoods. Resulting observations produced a hierarchically structured data set including 4032 observations nested within observers, which in turn were nested within neighborhoods. Data from the 2001 Canadian census were linked to the neighborhood data. RESULTS Application of ecometric multilevel modeling analyses showed that once interitem and interobserver variability were statistically controlled, about one third of the variability in observations were at the between-neighborhood level. Reliability estimates were 0.78 for items measuring activity-friendliness, 0.76 for safety, and 0.83 for density of destinations. Assessment of the convergent validity of the instrument identified that safety of the environment was positively associated with neighborhood affluence. Density of destinations was negatively associated with affluence and positively associated with higher proportions of persons in the neighborhood walking to work. CONCLUSIONS The three dimensions of the neighborhood active-living potential measure have good reliability and convergent validity and are able to capture between neighborhood differences. Measurement characteristics would have been difficult to ascertain without the ecometrics methodology.
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Affiliation(s)
- Lise Gauvin
- Groupe de recherche interdisciplinaire en santé (Interdisciplinary Research Group on Health), University of Montreal, Montreal, Quebec, Canada.
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Cunningham GO, Michael YL. Concepts guiding the study of the impact of the built environment on physical activity for older adults: a review of the literature. Am J Health Promot 2004; 18:435-43. [PMID: 15293929 PMCID: PMC3115687 DOI: 10.4278/0890-1171-18.6.435] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify theoretical models and key concepts used to predict the association between built environment and seniors' physical activity on the basis of a comprehensive review of the published literature. DATA SOURCE Computer searches of Medline (1966-2002), PubMed (1966-2002), and Academic Search Elite (1966-2002) were conducted, and 27 English-language articles were found. Search terms included built environment, physical activity, exercise, walking, neighborhood, urban design, seniors, aging, aging in place, and physical environment. STUDY INCLUSION AND EXCLUSION CRITERIA The primary inclusion criterion included the relation between the built environment and the physical activity among seniors living in neighborhoods. Studies assessing physical activity or overall health of a community-based population were included if underlying theoretical models and concepts were applicable to a senior population. Studies solely assessing social or psychosocial characteristics of place were excluded, as were review articles. DATA EXTRACTION Extracted data included theoretical model, aspect of built environment studied, methods, and outcomes. DATA SYNTHESIS Tables present key definitions and summarize information from empirical studies. RESULTS Twenty-seven articles that focused on the environment-behavior relation in neighborhoods, six specific to seniors, were found. This area of research is in its infancy, and inconsistent findings reflect difficulties in measurement of the built environment. CONCLUSIONS The relation between the built environment and the physical activity among seniors has been the subject of a limited number of studies. The choice of theoretical model drives the selection of concepts and variables considered. Safety, microscale urban design elements, aesthetics, and convenience of facilities are consistently studied across models. Few validated instruments have been developed and tested to measure neighborhood built environment.
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Affiliation(s)
- Grazia O Cunningham
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Storr CL, Arria AM, Workman ZRL, Anthony JC. Neighborhood environment and opportunity to try methamphetamine ("ice") and marijuana: evidence from Guam in the Western Pacific region of Micronesia. Subst Use Misuse 2004; 39:253-76. [PMID: 15061561 DOI: 10.1081/ja-120028490] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Although the American popular press and films might generally lead one to think otherwise, illegal drug use and drug trafficking occur outside the boundaries of disadvantaged American inner-city neighborhoods. Nonetheless, the occurrence of youthful drug involvement may be determined by similar community conditions in many parts of the world. In Spring 1998, a probability sample of 776 high school students living in Guam, Micronesia, completed a self-report anonymous survey, one that assessed their village and metropolitan neighborhood environments as well as drug involvement. On Guam, higher levels of neighborhood disadvantage were associated with youths being more likely to have been offered a chance to try drugs. This study adds new evidence on the potential importance of environmental and psychosocial contexts of neighborhood environment that might help account for the nonrandom distribution of youthful drug involvement.
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Affiliation(s)
- Carla L Storr
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Galvez MP, Frieden TR, Landrigan PJ. Obesity in the 21st century. ENVIRONMENTAL HEALTH PERSPECTIVES 2003; 111:A684-5. [PMID: 14527853 PMCID: PMC1241696 DOI: 10.1289/ehp.111-a684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Northridge ME, Stover GN, Rosenthal JE, Sherard D. Environmental equity and health: understanding complexity and moving forward. Am J Public Health 2003; 93:209-14. [PMID: 12554571 PMCID: PMC1447718 DOI: 10.2105/ajph.93.2.209] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The authors invoke a population health perspective to assess the distribution of environmental hazards according to race/ethnicity, social class, age, gender, and sexuality and the implications of these hazards for health. The unequal burden of environmental hazards borne by African American, Native American, Latino, and Asian American/Pacific Islander communities and their relationship to well-documented racial/ethnic disparities in health have not been critically examined across all population groups, regions of the United States, and ages. The determinants of existing environmental inequities also require critical research attention. To ensure inclusiveness and fill important gaps, scientific evidence is needed on the health effects of the built environment as well as the natural environment, cities and suburbs as well as rural areas, and indoor as well as outdoor pollutants.
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Affiliation(s)
- Mary E Northridge
- Harlem Health Promotion Center, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City 10032, USA.
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