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Heilenbach N, Ogunsola T, Elgin C, Fry D, Iskander M, Abazah Y, Aboseria A, Alshamah R, Alshamah J, Mooney SJ, Maestre G, Lovasi GS, Patel V, Al-Aswad LA. Novel Methods of Identifying Individual and Neighborhood Risk Factors for Loss to Follow-Up After Ophthalmic Screening. J Glaucoma 2024; 33:288-296. [PMID: 37974319 PMCID: PMC10954411 DOI: 10.1097/ijg.0000000000002328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
PRCIS Residence in a middle-class neighborhood correlated with lower follow-up compared with residence in more affluent neighborhoods. The most common explanations for not following up were the process of making an appointment and lack of symptoms. PURPOSE To explore which individual-level and neighborhood-level factors influence follow-up as recommended after positive ophthalmic and primary care screening in a vulnerable population using novel methodologies. PARTICIPANTS AND METHODS From 2017 to 2018, 957 participants were screened for ophthalmic disease and cardiovascular risk factors as part of the Real-Time Mobile Teleophthalmology study. Individuals who screened positive for either ophthalmic or cardiovascular risk factors were contacted to determine whether or not they followed up with a health care provider. Data from the Social Vulnerability Index, a novel virtual auditing system, and personal demographics were collected for each participant. A multivariate logistic regression was performed to determine which factors significantly differed between participants who followed up and those who did not. RESULTS As a whole, the study population was more socioeconomically vulnerable than the national average (mean summary Social Vulnerability Index score=0.81). Participants whose neighborhoods fell in the middle of the national per capita income distribution had a lower likelihood of follow-up compared with those who resided in the most affluent neighborhoods (relative risk ratio=0.21, P -value<0.01). Participants cited the complicated process of making an eye care appointment and lack of symptoms as the most common reasons for not following up as instructed within 4 months. CONCLUSIONS Residence in a middle-class neighborhood, difficulty accessing eye care appointments, and low health literacy may influence follow-up among vulnerable populations.
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Affiliation(s)
- Noah Heilenbach
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | | | | | - Dustin Fry
- Drexel University, Dornsife School of Public Health, Urban Health Collaborative
| | - Mina Iskander
- University of Miami, Miller School of Medicine, Department of Medicine
| | - Yara Abazah
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | - Ahmed Aboseria
- State University of New York, Downstate Health Sciences University College of Medicine
| | - Rahm Alshamah
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | - Jad Alshamah
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | | | - Gladys Maestre
- University of Texas, Rio Grande Valley School of Medicine
| | - Gina S. Lovasi
- Drexel University, Dornsife School of Public Health, Urban Health Collaborative
| | - Vipul Patel
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | - Lama A. Al-Aswad
- University of Pennsylvania, Scheie Eye Institute, Department of Ophthalmology
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Brown J, Hirsch JA, Tabb LP, Judd SE, Bennett A, Rundle A, Lovasi GS. A Segmented Regression Analysis of Household Income and Recurrent Falls Among Adults in a National Cohort Study. Am J Epidemiol 2024; 193:516-526. [PMID: 37939143 DOI: 10.1093/aje/kwad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/22/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Falls can have life-altering consequences for older adults, including extended recovery periods and compromised independence. Higher household income may mitigate the risk of falls by providing financial resources for mobility tools, remediation of environmental hazards, and needed supports, or it may buffer the impact of an initial fall on subsequent risk through improved assistance and care. Household income has not had a consistently observed association with falls in older adults; however, a segmented association may exist such that associations are attenuated above a certain income threshold. In this study, we utilized segmented negative binomial regression analysis to examine the association between household income and recurrent falls among 2,302 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study recruited between 2003 and 2007. Income-fall association segments separated by changes in slope were considered. Model results indicated a 2-segment association between household income and recurrent falls in the past year. In the range below the breakpoint, household income was negatively associated with the rate of recurrent falls across all age groups examined; in a higher income range (from $20,000-$49,999 to ≥$150,000), the association was attenuated (weaker negative trend) or reversed (positive trend). These findings point to potential benefits of ensuring that incomes for lower-income adults exceed the threshold needed to confer a reduced risk of recurrent falls.
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Medozile M, Lovasi GS, Kolokotronis SO, Hoepner LA. Excess mortality in northern Haiti during the 2010 cholera epidemic. PLoS Negl Trop Dis 2023; 17:e0011750. [PMID: 38055681 PMCID: PMC10699631 DOI: 10.1371/journal.pntd.0011750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/26/2023] [Indexed: 12/08/2023] Open
Abstract
In the course of infectious disease outbreaks, barriers to accessing health care can contribute to preventable mortality. According to the Ministry of Health of Haiti (Ministère de la Santé Publique et de la Population [MSPP]), the 2010 cholera epidemic caused 7,936 deaths from October 2010 to December 2012 in Haiti alone. We seek to quantify the excess mortality attributable to patients not seeking care during the cholera outbreak in the Nord Department in 2010-2012. Using data from a community-based retrospective survey conducted by Doctors Without Borders (Médecins Sans Frontières [MSF]) in Northern Haiti, we used logistic regression to examine the association between healthcare utilization and fatality among household members with watery diarrhea in the Communes of Borgne, Pilate, Plaisance, and Port-Margot in the Nord Department. We found that failing to seek care resulted in a 5-fold increase in the case fatality ratio among infected individuals (26%) versus those who sought care (5%). Common concerns noted for why care was not sought included travel distance to treatment centers, not attributing watery diarrhea episodes to cholera, and being unsure where to seek health care for their watery diarrhea episodes within their Communes. In conclusion, addressing transportation and information needs could increase healthcare utilization and reduce lives lost during an outbreak.
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Affiliation(s)
- Macceau Medozile
- Department of Environmental and Occupational Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Gina S. Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Sergios-Orestis Kolokotronis
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
- Institute for Genomics in Health, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
- Division of Infectious Diseases, Department of Medicine, College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Lori A. Hoepner
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
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Uddin J, Zhu S, Adhikari S, Nordberg CM, Howell CR, Malla G, Judd SE, Cherrington AL, Rummo PE, Lopez P, Kanchi R, Siegel K, De Silva SA, Algur Y, Lovasi GS, Lee NL, Carson AP, Hirsch AG, Thorpe LE, Long DL. Age and sex differences in the association between neighborhood socioeconomic environment and incident diabetes: Results from the diabetes location, environmental attributes and disparities (LEAD) network. SSM Popul Health 2023; 24:101541. [PMID: 38021462 PMCID: PMC10665656 DOI: 10.1016/j.ssmph.2023.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Worse neighborhood socioeconomic environment (NSEE) may contribute to an increased risk of type 2 diabetes (T2D). We examined whether the relationship between NSEE and T2D differs by sex and age in three study populations. Research design and methods We conducted a harmonized analysis using data from three independent longitudinal study samples in the US: 1) the Veteran Administration Diabetes Risk (VADR) cohort, 2) the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, and 3) a case-control study of Geisinger electronic health records in Pennsylvania. We measured NSEE with a z-score sum of six census tract indicators within strata of community type (higher density urban, lower density urban, suburban/small town, and rural). Community type-stratified models evaluated the likelihood of new diagnoses of T2D in each study sample using restricted cubic splines and quartiles of NSEE. Results Across study samples, worse NSEE was associated with higher risk of T2D. We observed significant effect modification by sex and age, though evidence of effect modification varied by site and community type. Largely, stronger associations between worse NSEE and diabetes risk were found among women relative to men and among those less than age 45 in the VADR cohort. Similar modification by age group results were observed in the Geisinger sample in small town/suburban communities only and similar modification by sex was observed in REGARDS in lower density urban communities. Conclusions The impact of NSEE on T2D risk may differ for males and females and by age group within different community types.
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Affiliation(s)
- Jalal Uddin
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
- Department of Community Health and Epidemiology, Dalhousie University, Faculty of Medicine, Halifax, Canada
| | - Sha Zhu
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Samrachana Adhikari
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Cara M. Nordberg
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Carrie R. Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Gargya Malla
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Suzanne E. Judd
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Andrea L. Cherrington
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Pasquale E. Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Priscilla Lopez
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rania Kanchi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Karen Siegel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Shanika A. De Silva
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Yasemin Algur
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Nora L. Lee
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Lorna E. Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - D. Leann Long
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
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Rundle AG, Neckerman KM, Judd SE, Colabianchi N, Moore KA, Quinn JW, Hirsch JA, Lovasi GS. Cumulative Experience of Neighborhood Walkability and Change in Weight and Waist Circumference in REGARDS. Am J Epidemiol 2023; 192:1960-1970. [PMID: 37312569 PMCID: PMC10691194 DOI: 10.1093/aje/kwad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/24/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
Neighborhood walkability-features of the built environment that promote pedestrian activity-has been associated with greater physical activity and lower body mass index (BMI; calculated as weight (kg)/height (m)2) among neighborhood residents. However, much of the literature has been cross-sectional and only a few cohort studies have assessed neighborhood features throughout follow-up. Using data from the Reasons for Geographic and Racial Differences in Stroke Study (2003-2016) and a neighborhood walkability index (NWI) measured annually during follow-up, we assessed whether the cumulative experience of neighborhood walkability (NWI-years) predicted BMI and waist circumference after approximately 10 years of follow-up, controlling for these anthropometric measures at enrollment. Analyses were adjusted for individual-level sociodemographic covariates and the cumulative experience of neighborhood poverty rate and neighborhood greenspace coverage. Almost a third (29%) of participants changed address at least once during follow-up. The first change of residence, on average, brought the participants to neighborhoods with higher home values and lower NWI scores than their originating neighborhoods. Compared with those having experienced the lowest quartile of cumulative NWI-years, those who experienced the highest quartile had 0.83 lower BMI (95% confidence interval, -1.5, -0.16) and 1.07-cm smaller waist circumference (95% confidence interval, -1.96, -0.19) at follow-up. These analyses provide additional longitudinal evidence that residential neighborhood features that support pedestrian activity are associated with lower adiposity.
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Affiliation(s)
- Andrew G Rundle
- Correspondence to Dr. Andrew Rundle, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 (e-mail: )
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Feathers A, Lovasi GS, Grigoryan Z, Beem K, Datta SK, Faleck DM, Socci T, Maggi R, Swaminath A. Crohn's Disease Mortality and Ambient Air Pollution in New York City. Inflamm Bowel Dis 2023:izad243. [PMID: 37934758 DOI: 10.1093/ibd/izad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The worldwide increase in Crohn's disease (CD) has accelerated alongside rising urbanization and accompanying decline in air quality. Air pollution affects epithelial cell function, modulates immune responses, and changes the gut microbiome composition. In epidemiologic studies, ambient air pollution has a demonstrated relationship with incident CD and hospitalizations. However, no data exist on the association of CD-related death and air pollution. METHODS We conducted an ecologic study comparing the number of CD-related deaths of individuals residing in given zip codes, with the level of air pollution from nitric oxide, nitrogen dioxide, sulfur dioxide (SO2), and fine particulate matter. Air pollution was measured by the New York Community Air Survey. We conducted Pearson correlations and a Poisson regression with robust standard errors. Each pollution component was modeled separately. RESULTS There was a higher risk of CD-related death in zip codes with higher levels of SO2 (incidence rate ratio [IRR], 1.16; 95% confidence interval [CI], 1.06-1.27). Zip codes with higher percentage of Black or Latinx residents were associated with lower CD-related death rates in the SO2 model (IRR, 0.58; 95% CI, 0.35-0.98; and IRR, 0.13; 95% CI, 0.05-0.30, respectively). There was no significant association of either population density or area-based income with the CD-related death rate. CONCLUSIONS In New York City from 1993 to 2010, CD-related death rates were higher among individuals from neighborhoods with higher levels of SO2 but were not associated with levels of nitric oxide, nitrogen dioxide, and fine particulate matter. These findings raise an important and timely public health issue regarding exposure of CD patients to environmental SO2, warranting further exploration.
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Affiliation(s)
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Zoya Grigoryan
- Department of Internal Medicine, Lenox Hill Hospital, New York, NY, USA
| | | | - Samit K Datta
- Gastroenterology, Department at Skagit Regional Health in Mt. Vernon, WA
| | - David M Faleck
- Gastroenterology, Hepatology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas Socci
- Division of Gastroenterology, Lenox Hill Hospital, New York, NY, USA
| | - Rachel Maggi
- Division of Gastroenterology, Lenox Hill Hospital, New York, NY, USA
| | - Arun Swaminath
- Division of Gastroenterology, Lenox Hill Hospital, New York, NY, USA
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Boise S, Crossa A, Etheredge AJ, McCulley EM, Lovasi GS. Concepts, Characterizations, and Cautions: A Public Health Guide and Glossary for Planning Food Environment Measurement. Open Public Health J 2023; 16:e187494452308210. [PMID: 38179222 PMCID: PMC10766432 DOI: 10.2174/18749445-v16-230821-2023-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 01/06/2024]
Abstract
Background There is no singular approach to measuring the food environment suitable for all studies. Understanding terminology, methodology, and common issues is crucial to choosing the best approach. Objective This review is designed to support a shared understanding so diverse multi-institutional teams engaged in food environment measurement can justify their measurement choices and have informed discussions about reasons for measurement strategies to vary across projects. Methods This guide defines key terms and provides annotated resources identified as a useful starting point for exploring the food environment literature. The writing team was an academic-practice collaboration, reflecting on the experience of a multi-institutional team focused on retail environments across the US relevant to cardiovascular disease. Results Terms and annotated resources are divided into three sections: food environment constructs, classification and measures, and errors and strategies to reduce error. Two examples of methods and challenges encountered while measuring the food environment in the context of a US health department are provided. Researchers and practice professionals are directed to the Food Environment Electronic Database Directory (https://www.foodenvironmentdirectory.com/) for comparing available data resources for food environment measurement, focused on the US; this resource incorporates updates informed by user input and literature reviews. Discussion Measuring the food environment is complex and risks oversimplification. This guide serves as a starting point but only partially captures some aspects of neighborhood food environment measurement. Conclusions No single food environment measure or data source meets all research and practice objectives. This shared starting point can facilitate theoretically grounded food environment measurement.
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Affiliation(s)
- Sarah Boise
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia PA
- Penn Medicine Medical Group, University of Pennsylvania Health System, Penn Medicine
| | - Aldo Crossa
- Department of Health and Mental Hygiene, New York, NY
| | | | - Edwin M. McCulley
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia PA
| | - Gina S. Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia PA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia PA
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Besser LM, Lovasi GS, Zambrano JJ, Camacho S, Dhanekula D, Michael YL, Garg P, Hirsch JA, Siscovick D, Hurvitz PM, Biggs ML, Galvin JE, Bartz TM, Longstreth WT. Neighborhood greenspace and neighborhood income associated with white matter grade worsening: Cardiovascular Health Study. Alzheimers Dement (Amst) 2023; 15:e12484. [PMID: 37885920 PMCID: PMC10598801 DOI: 10.1002/dad2.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION We examined whether a combined measure of neighborhood greenspace and neighborhood median income was associated with white matter hyperintensity (WMH) and ventricle size changes. METHODS The sample included 1260 cognitively normal ≥ 65-year-olds with two magnetic resonance images (MRI; ≈ 5 years apart). WMH and ventricular size were graded from 0 (least) to 9 (most) abnormal (worsening = increase of ≥1 grade from initial to follow-up MRI scans). The four-category neighborhood greenspace-income measure was based on median neighborhood greenspace and income values at initial MRI. Multivariable logistic regression tested associations between neighborhood greenspace-income and MRI measures (worsening vs. not). RESULTS White matter grade worsening was more likely for those in lower greenspace-lower income neighborhoods than higher greenspace-higher income neighborhoods (odds ratio = 1.73; 95% confidence interval = 1.19-2.51). DISCUSSION The combination of lower neighborhood income and lower greenspace may be a risk factor for worsening white matter grade on MRI. However, findings need to be replicated in more diverse cohorts. HIGHLIGHTS Population-based cohort of older adults (≥ 65 years) with greenspace and MRI dataCombined measure of neighborhood greenspace and neighborhood income at initial MRIMRI outcomes included white matter hyperintensities (WMH) and ventricular sizeLongitudinal change in MRI outcomes measured approximately 5 years apartWorsening WMH over time more likely for lower greenspace-lower income neighborhoods.
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Affiliation(s)
- Lilah M. Besser
- Comprehensive Center for Brain HealthDepartment of NeurologyUniversity of Miami Miller School of MedicineBoca RatonFloridaUSA
| | - Gina S. Lovasi
- Urban Health Collaborative and Department of Epidemiology and BiostatisticsDornslife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Joyce Jimenez Zambrano
- Comprehensive Center for Brain HealthDepartment of NeurologyUniversity of Miami Miller School of MedicineBoca RatonFloridaUSA
| | - Simone Camacho
- Comprehensive Center for Brain HealthDepartment of NeurologyUniversity of Miami Miller School of MedicineBoca RatonFloridaUSA
| | | | - Yvonne L. Michael
- Urban Health Collaborative and Department of Epidemiology and BiostatisticsDornslife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Parveen Garg
- Division of CardiologyKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jana A. Hirsch
- Urban Health Collaborative and Department of Epidemiology and BiostatisticsDornslife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - David Siscovick
- Division of ResearchEvaluation, and PolicyThe New York Academy of MedicineNew YorkNew YorkUSA
| | - Philip M. Hurvitz
- Center for Studies in Demography and Ecology and Urban Form LabUniversity of WashingtonSeattleWashingtonUSA
| | - Mary L. Biggs
- Department of BiostatisticsSchool of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - James E. Galvin
- Comprehensive Center for Brain HealthDepartment of NeurologyMiller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Traci M. Bartz
- Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - W. T. Longstreth
- Departments of Neurology and EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
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Algur Y, Rummo PE, McAlexander TP, De Silva SSA, Lovasi GS, Judd SE, Ryan V, Malla G, Koyama AK, Lee DC, Thorpe LE, McClure LA. Assessing the association between food environment and dietary inflammation by community type: a cross-sectional REGARDS study. Int J Health Geogr 2023; 22:24. [PMID: 37730612 PMCID: PMC10510199 DOI: 10.1186/s12942-023-00345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Communities in the United States (US) exist on a continuum of urbanicity, which may inform how individuals interact with their food environment, and thus modify the relationship between food access and dietary behaviors. OBJECTIVE This cross-sectional study aims to examine the modifying effect of community type in the association between the relative availability of food outlets and dietary inflammation across the US. METHODS Using baseline data from the REasons for Geographic and Racial Differences in Stroke study (2003-2007), we calculated participants' dietary inflammation score (DIS). Higher DIS indicates greater pro-inflammatory exposure. We defined our exposures as the relative availability of supermarkets and fast-food restaurants (percentage of food outlet type out of all food stores or restaurants, respectively) using street-network buffers around the population-weighted centroid of each participant's census tract. We used 1-, 2-, 6-, and 10-mile (~ 2-, 3-, 10-, and 16 km) buffer sizes for higher density urban, lower density urban, suburban/small town, and rural community types, respectively. Using generalized estimating equations, we estimated the association between relative food outlet availability and DIS, controlling for individual and neighborhood socio-demographics and total food outlets. The percentage of supermarkets and fast-food restaurants were modeled together. RESULTS Participants (n = 20,322) were distributed across all community types: higher density urban (16.7%), lower density urban (39.8%), suburban/small town (19.3%), and rural (24.2%). Across all community types, mean DIS was - 0.004 (SD = 2.5; min = - 14.2, max = 9.9). DIS was associated with relative availability of fast-food restaurants, but not supermarkets. Association between fast-food restaurants and DIS varied by community type (P for interaction = 0.02). Increases in the relative availability of fast-food restaurants were associated with higher DIS in suburban/small towns and lower density urban areas (p-values < 0.01); no significant associations were present in higher density urban or rural areas. CONCLUSIONS The relative availability of fast-food restaurants was associated with higher DIS among participants residing in suburban/small town and lower density urban community types, suggesting that these communities might benefit most from interventions and policies that either promote restaurant diversity or expand healthier food options.
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Affiliation(s)
- Yasemin Algur
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA.
| | - Pasquale E Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Tara P McAlexander
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - S Shanika A De Silva
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Suzanne E Judd
- Department of Biostatistics, The University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Victoria Ryan
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Gargya Malla
- Department of Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Alain K Koyama
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David C Lee
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, USA
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Kinsey EW, Widen EM, Quinn JW, Huynh M, Van Wye G, Lovasi GS, Neckerman KM, Caniglia EC, Rundle AG. Neighborhood Food Environment and Birth Weight Outcomes in New York City. JAMA Netw Open 2023; 6:e2317952. [PMID: 37306998 DOI: 10.1001/jamanetworkopen.2023.17952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Importance Infants born with unhealthy birth weight are at greater risk for long-term health complications, but little is known about how neighborhood characteristics (eg, walkability, food environment) may affect birth weight outcomes. Objective To assess whether neighborhood-level characteristics (poverty rate, food environment, and walkability) are associated with risk of unhealthy birth weight outcomes and to evaluate whether gestational weight gain mediated these associations. Design, Setting, and Participants The population-based cross-sectional study included births in the 2015 vital statistics records from the New York City Department of Health and Mental Hygiene. Only singleton births and observations with complete birth weight and covariate data were included. Analyses were performed from November 2021 to March 2022. Exposures Residential neighborhood-level characteristics, including poverty, food environment (healthy and unhealthy food retail establishments), and walkability (measured by both walkable destinations and a neighborhood walkability index combining walkability measures like street intersection and transit stop density). Neighborhood-level variables categorized into quartiles. Main Outcomes and Measures The main outcomes were birth certificate birth weight measures including small for gestational age (SGA), large for gestational age (LGA), and sex-specific birth weight for gestational age z-score. Generalized linear mixed-effects models and hierarchical linear models estimated risk ratios for associations between density of neighborhood-level characteristics within a 1-km buffer of residential census block centroid and birth weight outcomes. Results The study included 106 194 births in New York City. The mean (SD) age of pregnant individuals in the sample was 29.9 (6.1) years. Prevalence of SGA and LGA were 12.9% and 8.4%, respectively. Residence in the highest density quartile of healthy food retail establishments compared with the lowest quartile was associated with lower adjusted risk of SGA (with adjustment for individual covariates including gestational weight gain z-score: risk ratio [RR], 0.89; 95% CI 0.83-0.97). Higher neighborhood density of unhealthy food retail establishments was associated with higher adjusted risk of delivering an infant classified as SGA (fourth vs first quartile: RR, 1.12; 95% CI, 1.01-1.24). The RR for the association between density of unhealthy food retail establishments and risk of LGA was higher after adjustment for all covariates in each quartile compared with quartile 1 (second: RR, 1.12 [95% CI, 1.04-1.20]; third: RR, 1.18 [95% CI, 1.08-1.29]; fourth: RR, 1.16; [95% CI, 1.04-1.29]). There were no associations between neighborhood walkability and birth weight outcomes (SGA for fourth vs first quartile: RR, 1.01 [95% CI, 0.94-1.08]; LGA for fourth vs first quartile: RR, 1.06 [95% CI, 0.98-1.14]). Conclusions and Relevance In this population-based cross-sectional study, healthfulness of neighborhood food environments was associated with risk of SGA and LGA. The findings support use of urban design and planning guidelines to improve food environments to support healthy pregnancies and birth weight.
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Affiliation(s)
- Eliza W Kinsey
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Elizabeth M Widen
- Department of Nutritional Sciences and Population Research Center, University of Texas at Austin
| | - James W Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mary Huynh
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York
| | - Gretchen Van Wye
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York
| | - Gina S Lovasi
- Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Kathryn M Neckerman
- Columbia Population Research Center, Columbia University, New York, New York
| | - Ellen C Caniglia
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Hyun J, Katz MJ, Derby CA, Roque N, Muñoz E, Sliwinski MJ, Lovasi GS, Lipton RB. Availability of healthy foods, fruit and vegetable consumption, and cognition among urban older adults. BMC Geriatr 2023; 23:302. [PMID: 37198552 PMCID: PMC10189949 DOI: 10.1186/s12877-023-04003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND . Although prior studies have examined the associations between neighborhood characteristics and cognitive health, little is known about whether local food environments, which are critical for individuals' daily living, are associated with late-life cognition. Further, little is known about how local environments may shape individuals' health-related behaviors and impact cognitive health. The aim of this study is to examine whether objective and subjective measures of healthy food availability are associated with ambulatory cognitive performance and whether behavioral and cardiovascular factors mediate these associations among urban older adults. METHODS . The sample consisted of systematically recruited, community-dwelling older adults (N = 315, mean age = 77.5, range = 70-91) from the Einstein Aging Study. Objective availability of healthy foods was defined as density of healthy food stores. Subjective availability of healthy foods and fruit/vegetable consumption were assessed using self-reported questionnaires. Cognitive performance was assessed using smartphone-administered cognitive tasks that measured processing speed, short-term memory binding, and spatial working memory performance 6 times a day for 14 days. RESULTS . Results from multilevel models showed that subjective availability of healthy foods, but not objective food environments, was associated with better processing speed (estimate= -0.176, p = .003) and more accurate memory binding performance (estimate = 0.042, p = .012). Further, 14~16% of the effects of subjective availability of healthy foods on cognition were mediated through fruit and vegetable consumption. CONCLUSIONS . Local food environments seem to be important for individuals' dietary behavior and cognitive health. Specifically, subjective measures of food environments may better reflect individuals' experiences regarding their local food environments not captured by objective measures. Future policy and intervention strategies will need to include both objective and subjective food environment measures in identifying impactful target for intervention and evaluating effectiveness of policy changes.
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Affiliation(s)
- Jinshil Hyun
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Mindy J Katz
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Carol A Derby
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Nelson Roque
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Elizabeth Muñoz
- Department of Human Development and Family Sciences, University of Texas Austin, Austin, TX, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Richard B Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Headache Center, Montefiore Medical Center, Bronx, NY, USA
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12
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Gullón P, Fry D, Plascak JJ, Mooney SJ, Lovasi GS. Measuring changes in neighborhood disorder using Google Street View longitudinal imagery: a feasibility study. Cities Health 2023; 7:823-829. [PMID: 37850028 PMCID: PMC10578651 DOI: 10.1080/23748834.2023.2207931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/24/2023] [Indexed: 10/19/2023]
Abstract
Few studies have used longitudinal imagery of Google Street View (GSV) despite its potential for measuring changes in urban streetscapes characteristics relevant to health, such as neighborhood disorder. Neighborhood disorder has been previously associated with health outcomes. We conducted a feasibility study exploring image availability over time in the Philadelphia metropolitan region and describing changes in neighborhood disorder in this region between 2009, 2014, and 2019. Our team audited Street View images from 192 street segments in the Philadelphia Metropolitan Region. On each segment, we measured the number of images available through time, and for locations where imagery from more than one time point was available, we collected 8 neighborhood disorder indicators at 3 different times (up to 2009, up to 2014, and up to 2019). More than 70% of streets segments had at least one image. Neighborhood disorder increased between 2009 and 2019. Future studies should study the determinants of change of neighborhood disorder using longitudinal GSV imagery.
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Affiliation(s)
- Pedro Gullón
- Public Health and Epidemiology Research Group. Department of Surgery, Social and Medical Sciences. School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, Madrid, Spain
- Centre for Urban Research, RMIT University, Melbourne, Australia
| | - Dustin Fry
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health Drexel University, Philadelphia, PA, USA
| | - Jesse J. Plascak
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Stephen J. Mooney
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Gina S. Lovasi
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health Drexel University, Philadelphia, PA, USA
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13
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Lovasi GS, Treat CA, Fry D, Shah I, Clougherty JE, Berberian A, Perera FP, Kioumourtzoglou MA. Clean fleets, different streets: evaluating the effect of New York City's clean bus program on changes to estimated ambient air pollution. J Expo Sci Environ Epidemiol 2023; 33:332-338. [PMID: 35906405 PMCID: PMC10234802 DOI: 10.1038/s41370-022-00454-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Motor vehicles, including public transit buses, are a major source of air pollution in New York City (NYC) and worldwide. To address this problem, governments and transit agencies have implemented policies to introduce cleaner vehicles into transit fleets. Beginning in 2000, the Metropolitan Transit Agency began deploying compressed natural gas, hybrid electric, and low-sulfur diesel buses to reduce urban air pollution. OBJECTIVE We hypothesized that bus fleet changes incorporating cleaner vehicles would have detectable effects on air pollution concentrations between 2009 and 2014, as measured by the New York City Community Air Survey (NYCCAS). METHODS Depot- and route-specific information allowed identification of areas with larger or smaller changes in the proportion of distance traveled by clean buses. Data were assembled for 9670 300 m × 300 m grid cell areas with annual concentration estimates for nitrogen oxide (NO), nitrogen dioxide (NO2), and black carbon (BC) from NYCCAS. Spatial error models adjusted for truck route presence and total traffic volume. RESULTS While concentrations of all three pollutants declined between 2009 and 2014 even in the 39.7% of cells without bus service, the decline in concentrations of NO and NO2 was greater in areas with more bus service and with higher proportional shifts toward clean buses. Conversely, the decline in BC concentration was slower in areas with more bus service and higher proportional clean bus shifts. SIGNIFICANCE These results provide evidence that the NYC clean bus program impacted concentrations of air pollution, particularly in reductions of NO2. Further work can investigate the potential impact of these changes on health outcomes in NYC residents. IMPACT STATEMENT Urban air pollution from diesel-burning buses is an important health exposure. The New York Metropolitan Transit Agency has worked to deploy cleaner buses into their fleet, but the impact of this policy has not been evaluated. Successful reductions in air pollution are critical for public health.
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Affiliation(s)
- Gina S Lovasi
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Christian A Treat
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Dustin Fry
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Isha Shah
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Jane E Clougherty
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Alique Berberian
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Frederica P Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Marianthi-Anna Kioumourtzoglou
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA
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Hirsch JA, Zhao Y, Melly S, Moore KA, Berger N, Quinn J, Rundle A, Lovasi GS. National trends and disparities in retail food environments in the USA between 1990 and 2014. Public Health Nutr 2023; 26:1052-1062. [PMID: 36644895 PMCID: PMC10191888 DOI: 10.1017/s1368980023000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 09/29/2022] [Accepted: 11/25/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe national disparities in retail food environments by neighbourhood composition (race/ethnicity and socio-economic status) across time and space. DESIGN We examined built food environments (retail outlets) between 1990 and 2014 for census tracts in the contiguous USA (n 71 547). We measured retail food environment as counts of all food stores, all unhealthy food sources (including fast food, convenience stores, bakeries and ice cream) and healthy food stores (including supermarkets, fruit and vegetable markets) from National Establishment Time Series business data. Changes in food environment were mapped to display spatial patterns. Multi-level Poisson models, clustered by tract, estimated time trends in counts of food stores with a land area offset and independent variables population density, racial composition (categorised as predominantly one race/ethnicity (>60 %) or mixed), and inflation-adjusted income tertile. SETTING The contiguous USA between 1990 and 2014. PARTICIPANTS All census tracts (n 71 547). RESULTS All food stores and unhealthy food sources increased, while the subcategory healthy food remained relatively stable. In models adjusting for population density, predominantly non-Hispanic Black, Hispanic, Asian and mixed tracts had significantly more destinations of all food categories than predominantly non-Hispanic White tracts. This disparity increased over time, predominantly driven by larger increases in unhealthy food sources for tracts which were not predominantly non-Hispanic White. Income and food store access were inversely related, although disparities narrowed over time. CONCLUSIONS Our findings illustrate a national food landscape with both persistent and shifting spatial patterns in the availability of establishments across neighbourhoods with different racial/ethnic and socio-economic compositions.
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Affiliation(s)
- Jana A Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA19104, USA
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
| | - Steven Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
| | - Kari A Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
| | - Nicolas Berger
- Department of Epidemiology and Public Health, Sciensano (Belgian Scientific Institute of Public Health), Ixelles, Belgium
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - James Quinn
- Built Environment and Health Research Group, Mailman School of Public Health, Columbia University, New York, USA
| | - Andrew Rundle
- Built Environment and Health Research Group, Mailman School of Public Health, Columbia University, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA19104, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA19104, USA
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Zafra-Tanaka JH, Braverman A, Anza-Ramirez C, Ortigoza A, Lazo M, Doberti T, Rodriguez-Osiac L, Lovasi GS, Mazariegos M, Sarmiento O, Pérez Ferrer C, Miranda JJ. City features related to obesity in preschool children: a cross-sectional analysis of 159 cities in six Latin American countries. Lancet Reg Health Am 2023; 20:100458. [PMID: 36942152 PMCID: PMC10023940 DOI: 10.1016/j.lana.2023.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/12/2023]
Abstract
Background Childhood obesity is a rising global health problem. The rapid urbanization experienced in Latin America might impact childhood obesity through different pathways involving urban built and social features of cities. We aimed to evaluate the association between built and social environment features of cities and childhood obesity across countries and cities in Latin America. Methods Cross-sectional analysis of data from 20,040 children aged 1-5 years living in 159 large cities in six Latin American countries. We used individual-level anthropometric data for excess weight (overweight or obesity) from health surveys that could be linked to city-level data. City and sub-city level exposures included the social environment (living conditions, service provision and educational attainment) and the built environment (fragmentation, isolation, presence of mass transit, population density, intersection density and percent greenness). Multi-level logistic models were used to explore associations between city features and excess weight, adjusting for age, sex, and head of household education. Findings The overall prevalence of excess weight among preschool children was 8% but varied substantially between and within countries, ranging from 4% to 25%. Our analysis showed that 97% of the variability was between individuals within sub-city units and around 3% of the variance in z-scores of weight for height was explained by the city and sub-city levels. At the city-level, a higher distance between urban patches (isolation, per 1 SD increase) was associated with lower odds of excess weight (OR 0.90, 95% CI 0.82-0.99). Higher sub-city education was also associated with lower odds of excess weight, but better sub-city living conditions were associated with higher odds of excess weight. Interpretation Built and social environment features are related to excess weight in preschool children. Our evidence from a wide range of large Latin American cities suggests that urban health interventions may be suitable alternatives towards attaining the goal of reducing excess weight early in the life course. Funding The SALURBAL project (Salud Urbana en América Latina, Urban Health in Latin America) is funded by Wellcome [205177/Z/16/Z].
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Affiliation(s)
- Jessica Hanae Zafra-Tanaka
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
- Corresponding author. CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Lima 15074, Peru.
| | - Ariela Braverman
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Cecilia Anza-Ramirez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mariana Lazo
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tamara Doberti
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | | | - Gina S. Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Olga Sarmiento
- School of Medicine, Universidad de Los Andes, Bogota, Colombia
| | | | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Lovasi GS, Boise S, Jogi S, Hurvitz PM, Rundle AG, Diez J, Hirsch JA, Fitzpatrick A, Biggs ML, Siscovick DS. Time-Varying Food Retail and Incident Disease in the Cardiovascular Health Study. Am J Prev Med 2023; 64:877-887. [PMID: 36882344 DOI: 10.1016/j.amepre.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Natural experiments can strengthen evidence linking neighborhood food retail presence to dietary intake patterns and cardiometabolic health outcomes, yet sample size and follow-up duration are typically not extensive. To complement natural experiment evidence, longitudinal data were used to estimate the impacts of neighborhood food retail presence on incident disease. METHODS The Cardiovascular Health Study recruited adults aged 65+ years in 1989-1993. Analyses conducted in 2021-2022 included those in good baseline health, with addresses updated annually through the year of death (restricted to 91% who died during >2 decades of cohort follow-up). Baseline and annually updated presence of 2 combined food retail categories (supermarkets/produce markets and convenience/snack focused) was characterized using establishment-level data for 1-km and 5-km Euclidean buffers. Cox proportional hazards models estimated associations with time to each incident outcome (cardiovascular disease, diabetes), adjusting for individual and area-based confounders. RESULTS Among 2,939 participants, 36% with baseline supermarket/produce market presence within 1 km had excess incident cardiovascular disease (hazard ratio=1.12; 95% CI=1.01, 1.24); the association was attenuated and no longer statistically significant after adjustment for sociodemographic characteristics. Adjusted associations were robustly null for time-varying supermarket/produce market or convenience/fast food retail presence across analyses with outcomes of cardiovascular disease or diabetes incidence. CONCLUSIONS Food environment changes continue to be studied to provide an evidence base for policy decisions, and null findings in this longitudinal analysis add literature that casts doubt on the sufficiency of strategies targeting food retail presence alone of an elderly cohort for curtailing incident events of clinical importance.
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Affiliation(s)
- Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
| | - Sarah Boise
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Siddharth Jogi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Philip M Hurvitz
- Center for Studies in Demography & Ecology, University of Washington, Seattle, Washington; Department of Urban Design and Planning, College of Built Environments, University of Washington, Seattle, Washington
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Julia Diez
- Department of Surgery, Medical and Social Sciences, Universidad de Alcalá, Madrid, Spain
| | - Jana A Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Annette Fitzpatrick
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington; Department of Global Health, School of Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Mary L Biggs
- Department of Biostatistics, School Public Health, University of Washington, Seattle, Washington
| | - David S Siscovick
- Research, evaluation and policy, New York Academy of Medicine, New York, New York
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Rundle AG, Kinsey EW, Widen EM, Quinn JW, Huynh M, Lovasi GS, Neckerman KM, Van Wye G. Neighbourhood walkability is associated with risk of gestational diabetes: A cross-sectional study in New York City. Paediatr Perinat Epidemiol 2023; 37:212-217. [PMID: 36633306 PMCID: PMC10404343 DOI: 10.1111/ppe.12952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/14/2022] [Accepted: 12/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite the links between neighbourhood walkability and physical activity, body size and risk of diabetes, there are few studies of neighbourhood walkability and risk of gestational diabetes (GD). OBJECTIVES Assess whether higher neighbourhood walkability is associated with lower risk of GD in New York City (NYC). METHODS Cross-sectional analyses of a neighbourhood walkability index (NWI) score and density of walkable destinations (DWD) and risk of GD in 109,863 births recorded in NYC in 2015. NWI and DWD were measured for the land area of 1 km radius circles around the geographic centroid of each Census block of residence. Mixed generalised linear models, with robust standard error estimation and random intercepts for NYC Community Districts, were used to estimate risk ratios for GD for increasing quartiles of each of the neighbourhood walkability measures after adjustment for the pregnant individual's age, race and ethnicity, parity, education, nativity, and marital status and the neighbourhood poverty rate. RESULTS Overall, 7.5% of pregnant individuals experienced GD. Risk of GD decreased across increasing quartiles of NWI, with an adjusted risk ratio of 0.81 (95% Confidence Interval (CI) 0.75, 0.87) comparing those living in areas in the 4th quartile of NWI to those in the first quartile. Similarly, for comparisons of the 4th to 1st quartile of DWD, the adjusted risk ratio for GD was 0.77 (95% CI 0.71, 0.84). CONCLUSIONS These analyses find support for the hypothesis that higher neighbourhood walkability is associated with a lower risk of GD. The analyses provide further health related support for urban design policies to increase walkability.
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Affiliation(s)
- Andrew G Rundle
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Eliza W Kinsey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth M Widen
- College of Natural Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - James W Quinn
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Mary Huynh
- School of Health Sciences, Human Services, & Nursing, Lehman College, New York, New York, USA
| | - Gina S Lovasi
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kathryn M Neckerman
- Columbia Population Research Center, Columbia University, New York, New York, USA
| | - Gretchen Van Wye
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York, USA
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Moon KA, Nordberg CM, Orstad SL, Zhu A, Uddin J, Lopez P, Schwartz MD, Ryan V, Hirsch AG, Schwartz BS, Carson AP, Long DL, Meeker M, Brown J, Lovasi GS, Adhikari S, Kanchi R, Avramovic S, Imperatore G, Poulsen MN. Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples. BMJ Open Diabetes Res Care 2023; 11:11/2/e003120. [PMID: 36858436 PMCID: PMC9980357 DOI: 10.1136/bmjdrc-2022-003120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Inequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment. RESEARCH DESIGN AND METHODS We conducted analyses in three study samples: the national Veterans Administration Diabetes Risk (VADR) cohort comprising electronic health records (EHR) of 4.1 million T2D-free veterans, the national prospective cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) (11 208 T2D free), and a case-control study of Geisinger EHR in Pennsylvania (15 888 T2D cases). New-onset T2D was defined using diagnoses, laboratory and medication data. We harmonized neighborhood-level variables, including exposure, confounders, and effect modifiers. We measured NSEE with a summary index of six census tract indicators. The LTPA environment was measured by physical activity (PA) facility (gyms and other commercial facilities) density within street network buffers and population-weighted distance to parks. We estimated natural direct and indirect effects for each mediator stratified by community type. RESULTS The magnitudes of the indirect effects were generally small, and the direction of the indirect effects differed by community type and study sample. The most consistent findings were for mediation via PA facility density in rural communities, where we observed positive indirect effects (differences in T2D incidence rates (95% CI) comparing the highest versus lowest quartiles of NSEE, multiplied by 100) of 1.53 (0.25, 3.05) in REGARDS and 0.0066 (0.0038, 0.0099) in VADR. No mediation was evident in Geisinger. CONCLUSIONS PA facility density and distance to parks did not substantially mediate the relation between NSEE and T2D. Our heterogeneous results suggest that approaches to reduce T2D through changes to the LTPA environment require local tailoring.
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Affiliation(s)
- Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cara M Nordberg
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Stephanie L Orstad
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Aowen Zhu
- Department of Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Jalal Uddin
- Department of Epidemiology, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Priscilla Lopez
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Mark D Schwartz
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
- The Department of Veterans Affairs, New York Harbor Healthcare System, New York, NY, USA
| | - Victoria Ryan
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Annemarie G Hirsch
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
| | - April P Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - D Leann Long
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Melissa Meeker
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Janene Brown
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- The Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Samranchana Adhikari
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Rania Kanchi
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Sanja Avramovic
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, USA
| | - Giuseppina Imperatore
- Surveillance, Epidemiology, Economics, and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Melissa N Poulsen
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania, USA
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Godina SL, Rosso AL, Hirsch JA, Besser LM, Lovasi GS, Donovan GH, Garg PK, Platt JM, Fitzpatrick AL, Lopez OL, Carlson MC, Michael YL. Neighborhood greenspace and cognition: The cardiovascular health study. Health Place 2023; 79:102960. [PMID: 36603455 PMCID: PMC9928891 DOI: 10.1016/j.healthplace.2022.102960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/04/2022] [Accepted: 12/14/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES We examined whether greenspace measures (overall percent greenspace and forest, and number of greenspace types) were associated with clinically adjudicated dementia status. METHODS In a sample of non-demented older adults (n = 2141, average age = 75.3 years) from the Cardiovascular Health and Cognition Study, Cox proportional hazard and logistic regression analyses were used to estimate associations of baseline greenspace with risks of incident dementia and MCI, respectively, while adjusting for demographics, co-morbidities, and other neighborhood factors. We derived quartiles of percent greenness (greenspace), forest (percent tree canopy cover), and tertiles of greenspace diversity (number of greenspace types) for 5-km radial buffers around participant's residences at study entry (1989-1990) from the 1992 National Land Cover Dataset. Dementia status and mild cognitive impairment (MCI) over 10 years was clinically adjudicated. RESULTS We observed no significant association between overall percent greenspace and risk of mild cognitive impairment or dementia and mostly null results for forest and greenspace diversity. Forest greenspace was associated with lower odds of MCI (OR quartile 4 versus 1: 0.54, 95% CI: 0.29-0.98) and greenspace diversity was associated with lower hazard of incident dementia (HR tertile 2 versus 1: 0.70, 95% CI = 0.50-0.99). DISCUSSION We found divergent results for different types of greenspace and mild cognitive impairment or dementia. Improved greenspace type and diversity measurement could better characterize the association between greenspace and cognition.
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Affiliation(s)
- Sara L Godina
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, 130 DeSoto Street, Pittsburgh, PA, 15261, USA.
| | - Andrea L Rosso
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, 130 DeSoto Street, Pittsburgh, PA, 15261, USA
| | - Jana A Hirsch
- Drexel University Dornsife School of Public Health, Urban Health Collaborative, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA
| | - Lilah M Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, 7700 W Camino Real, Suite 200, Boca Raton, FL, 33433, USA
| | - Gina S Lovasi
- Drexel University Dornsife School of Public Health, Urban Health Collaborative, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA
| | - Geoffrey H Donovan
- U.S. Department of Agriculture Forest Service, PNW Research Station, 620 SW Main, Suite 502, Portland, OR, 97205, USA
| | - Parveen K Garg
- University of Southern California Keck School of Medicine, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Jonathan M Platt
- The University of Iowa, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA
| | - Annette L Fitzpatrick
- University of Washington School of Public Health, Department of Epidemiology, 3980 15th Avenue NE, Seattle, WA, 98195, USA
| | - Oscar L Lopez
- University of Pittsburgh School of Medicine, Department of Neurology, Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Michelle C Carlson
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Yvonne L Michael
- Drexel University Dornsife School of Public Health, Urban Health Collaborative, 3600 Market Street, 7th Floor, Philadelphia, PA, 19104, USA
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Ghanbari R, Lovasi GS, Bader MDM. Exploring potential for selection bias in using survey data to estimate the association between institutional trust and depression. Ann Epidemiol 2023; 77:61-66. [PMID: 36519721 DOI: 10.1016/j.annepidem.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/21/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We tested the hypothesis that low institutional trust would be associated with depressive symptom elevation, with attention to potential selection bias. METHODS The District of Columbia Area Survey (DCAS) was conducted by mail in 2018. Invitations sent to 8800 households resulted in a sample of 1061 adults. Institutional trust questions referenced nonprofit organizations, businesses, and government. Depressive symptom elevation was assessed using PHQ-9. Logistic regression model estimates were compared with and without adjustment for sociodemographic characteristics and neighborhood satisfaction; among complete cases and following multiple imputation of missing covariate data; and with and without survey weights or correction for collider selection bias. RESULTS Of 968 participants without missing depressive symptom or trust data, 24% reported low institutional trust. Low institutional trust was associated with elevated depressive symptoms (adjusted OR following multiple imputation: 2.0; 95% CI: 1.1, 3.4), although the association was attenuated with use of survey weights (adjusted OR incorporating multiple imputation and survey weights: 1.6; 95% CI: 0.7, 3.2). CONCLUSIONS Under contrasting scenarios where low institutional trust and depressive symptoms jointly increase nonresponse, selection bias could lead to under- or overestimation of this association. Future research could explore posited selection bias scenarios that differ in direction of bias.
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Affiliation(s)
- Rozhan Ghanbari
- Drexel University Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Philadelphia, PA
| | - Gina S Lovasi
- Drexel University Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Philadelphia, PA; Drexel University Dornsife School of Public Health, Urban Health Collaborative, Philadelphia, PA.
| | - Michael D M Bader
- Johns Hopkins University, Department of Sociology and 21st Century Cities Initiative, Baltimore, MD
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Rundle AG, Bader MDM, Branas CC, Lovasi GS, Mooney SJ, Morrison CN, Neckerman KM. Causal Inference with Case-Only Studies in Injury Epidemiology Research. CURR EPIDEMIOL REP 2022; 9:223-232. [PMID: 37152190 PMCID: PMC10161782 DOI: 10.1007/s40471-022-00306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/03/2022]
Abstract
Purpose of Review We review the application and limitations of two implementations of the "case-only design" in injury epidemiology with example analyses of Fatality Analysis Reporting System data. Recent Findings The term "case-only design" covers a variety of epidemiologic designs; here, two implementations of the design are reviewed: (1) studies to uncover etiological heterogeneity and (2) studies to measure exposure effect modification. These two designs produce results that require different interpretations and rely upon different assumptions. The key assumption of case-only designs for exposure effect modification, the more commonly used of the two designs, does not commonly hold for injuries and so results from studies using this design cannot be interpreted. Case-only designs to identify etiological heterogeneity in injury risk are interpretable but only when the case-series is conceptualized as arising from an underlying cohort. Summary The results of studies using case-only designs are commonly misinterpreted in the injury literature.
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Affiliation(s)
- Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 727, New York, NY 10032, USA
| | | | - Charles C. Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 727, New York, NY 10032, USA
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
| | - Stephen J. Mooney
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Christopher N. Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 727, New York, NY 10032, USA
| | - Kathryn M. Neckerman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 727, New York, NY 10032, USA
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22
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Le VT, Rhew IC, Kosterman R, Lovasi GS, Frank LD. Associations of Cumulative and Point-in-Time Neighborhood Poverty and Walkability with Body Mass from Age 30 to 39. J Urban Health 2022; 99:1080-1090. [PMID: 36222973 PMCID: PMC9727000 DOI: 10.1007/s11524-022-00688-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
Few studies examining the effects of neighborhood exposures have accounted for longitudinal residential history. This study examined associations of body mass index (BMI, kg/m2) with neighborhood-level walkability and poverty, both assessed concurrently and cumulatively in the years leading up to BMI assessment. Participants (N = 808) were from a cohort study of individuals originally recruited from public schools in Seattle, Washington, in fifth grade in 1985. Height and weight for BMI were obtained at four assessments at ages: 30 (in 2005), 33, 35, and 39. Participants also completed residential timelines listing each address where they lived from ages 28 to 39, creating a continuous record of addresses and moves. Neighborhood-level walkability and poverty were based on census block groups of each address. Generalized estimating equation models estimated associations of standardized neighborhood variables, both at point-in-time concurrently with assessment of BMI and cumulatively up to the time of BMI assessment. Mean BMI across observations was 28.8 (SD = 7.1). After adjusting for covariates, cumulative walkability was associated with lower BMI (b = - 0.28; 95% CI: - 0.55, - 0.02), and cumulative neighborhood poverty was associated with higher BMI (b = 0.35; 95% CI: 0.09, 0.60). When examining point-in-time concurrent walkability and poverty with BMI, adjusted associations were close to the null and non-significant. This study provides evidence for a significant role of cumulative exposure to neighborhood built and socioeconomic environments predicting BMI. It underscores the relative strength and importance of cumulative assessments to capture neighborhood exposure not captured through point-in-time assessments.
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Affiliation(s)
- Vi T Le
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave NE, Suite 401, Seattle, WA, 98115, USA.
| | - Isaac C Rhew
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health and Risk Behaviors, University of Washington, Seattle, WA, USA
| | - Rick Kosterman
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave NE, Suite 401, Seattle, WA, 98115, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Lawrence D Frank
- Department of Urban Studies and Planning, University of California San Diego, San Diego, CA, USA
- Urban Design 4 Health, Seattle, WA, USA
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23
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Salbach NM, MacKay-Lyons M, Howe JA, McDonald A, Solomon P, Bayley MT, McEwen S, Nelson M, Bulmer B, Lovasi GS. Assessment of Walking Speed and Distance Post-Stroke Increases After Providing a Theory-Based Toolkit. J Neurol Phys Ther 2022; 46:251-259. [PMID: 35671402 PMCID: PMC9462135 DOI: 10.1097/npt.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE While underutilized, poststroke administration of the 10-m walk test (10mWT) and 6-minute walk test (6MWT) can improve care and is considered best practice. We aimed to evaluate provision of a toolkit designed to increase use of these tests by physical therapists (PTs). METHODS In a before-and-after study, 54 PTs and professional leaders in 9 hospitals were provided a toolkit and access to a clinical expert over a 5-month period. The toolkit comprised a guide, smartphone app, and video, and described how to set up walkways, implement learning sessions, administer walk tests, and interpret and apply test results clinically. The proportion of hospital visits for which each walk test score was documented at least once (based on abstracted health records of ambulatory patients) were compared over 8-month periods pre- and post-intervention using generalized mixed models. RESULTS Data from 347 and 375 pre- and postintervention hospital visits, respectively, were analyzed. Compared with preintervention, the odds of implementing the 10mWT were 12 times greater (odds ratio [OR] = 12.4, 95% confidence interval [CI] 5.8, 26.3), and of implementing the 6MWT were approximately 4 times greater (OR = 3.9, 95% CI 2.3, 6.7), post-intervention, after adjusting for hospital setting, ambulation ability, presence of aphasia and cognitive impairment, and provider-level clustering. Unadjusted change in the percentage of visits for which the 10mWT/6MWT was documented at least once was smallest in acute care settings (2.0/3.8%), and largest in inpatient and outpatient rehabilitation settings (28.0/19.9% and 29.4/23.4%, respectively). DISCUSSION AND CONCLUSIONS Providing a comprehensive toolkit to hospitals with professional leaders likely contributed to increasing 10mWT and 6MWT administration during inpatient and outpatient stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A390 ).
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Affiliation(s)
- Nancy M. Salbach
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Marilyn MacKay-Lyons
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Jo-Anne Howe
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Alison McDonald
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Patricia Solomon
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Mark T. Bayley
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Sara McEwen
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Michelle Nelson
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Beverly Bulmer
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
| | - Gina S. Lovasi
- Departments of Physical Therapy (N.M.S., J.A.H., B.B.) and Medicine (M.T.B.), University of Toronto, Toronto, Canada; The KITE Research Institute, University Health Network, Toronto, Canada (N.M.S., J.A.H., M.T.B.); School of Physiotherapy, Dalhousie University, Halifax, Canada (M.M.L.); Nova Scotia Health Authority, Halifax, Canada (A.M.); School of Rehabilitation Science, McMaster University, Hamilton, Canada (P.S.); Selkirk College, Castlegar, Canada (S.M.); Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada (M.N.); Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (M.N.); Unity Health Toronto, Toronto, Canada (B.B.); and Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania (G.S.L.)
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India-Aldana S, Kanchi R, Adhikari S, Lopez P, Schwartz MD, Elbel BD, Rummo PE, Meeker MA, Lovasi GS, Siegel KR, Chen Y, Thorpe LE. Impact of land use and food environment on risk of type 2 diabetes: A national study of veterans, 2008-2018. Environ Res 2022; 212:113146. [PMID: 35337829 PMCID: PMC10424702 DOI: 10.1016/j.envres.2022.113146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Large-scale longitudinal studies evaluating influences of the built environment on risk for type 2 diabetes (T2D) are scarce, and findings have been inconsistent. OBJECTIVE To evaluate whether land use environment (LUE), a proxy of neighborhood walkability, is associated with T2D risk across different US community types, and to assess whether the association is modified by food environment. METHODS The Veteran's Administration Diabetes Risk (VADR) study is a retrospective cohort of diabetes-free US veteran patients enrolled in VA primary care facilities nationwide from January 1, 2008, to December 31, 2016, and followed longitudinally through December 31, 2018. A total of 4,096,629 patients had baseline addresses available in electronic health records that were geocoded and assigned a census tract-level LUE score. LUE scores were divided into quartiles, where a higher score indicated higher neighborhood walkability levels. New diagnoses for T2D were identified using a published computable phenotype. Adjusted time-to-event analyses using piecewise exponential models were fit within four strata of community types (higher-density urban, lower-density urban, suburban/small town, and rural). We also evaluated effect modification by tract-level food environment measures within each stratum. RESULTS In adjusted analyses, higher LUE had a protective effect on T2D risk in rural and suburban/small town communities (linear quartile trend test p-value <0.001). However, in lower density urban communities, higher LUE increased T2D risk (linear quartile trend test p-value <0.001) and no association was found in higher density urban communities (linear quartile trend test p-value = 0.317). Particularly strong protective effects were observed for veterans living in suburban/small towns with more supermarkets and more walkable spaces (p-interaction = 0.001). CONCLUSION Among veterans, LUE may influence T2D risk, particularly in rural and suburban communities. Food environment may modify the association between LUE and T2D.
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Affiliation(s)
- Sandra India-Aldana
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Rania Kanchi
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Samrachana Adhikari
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Priscilla Lopez
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Mark D Schwartz
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 9th Fl., New York, NY, 10016, USA; VA New York Harbor Healthcare System, 423 E 23rd, New York, NY, 10010, USA
| | - Brian D Elbel
- Division of Health and Behavior, Section on Health Choice, Policy and Evaluation, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 3rd Fl., New York, NY, 10016, USA; NYU Wagner Graduate School of Public Service, 295 Lafayette Street, New York, NY, 10012, USA
| | - Pasquale E Rummo
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Melissa A Meeker
- Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104, USA
| | - Gina S Lovasi
- Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104, USA
| | - Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorna E Thorpe
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA.
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25
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Qin B, Kim K, Goldman N, Rundle AG, Chanumolu D, Zeinomar N, Xu B, Pawlish KS, Ambrosone CB, Demissie K, Hong CC, Lovasi GS, Bandera EV. Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors. J Clin Oncol 2022; 40:2213-2223. [PMID: 35333586 PMCID: PMC9273374 DOI: 10.1200/jco.21.02973] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Unfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group. METHODS Adiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models. RESULTS Adiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss. CONCLUSION Both individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.
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Affiliation(s)
- Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kate Kim
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Noreen Goldman
- Office of Population Research, Princeton University, Princeton, NJ
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Dhanya Chanumolu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Nur Zeinomar
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Baichen Xu
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Karen S. Pawlish
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Kitaw Demissie
- Department of Epidemiology and Biostatistics, SUNY Downstate Health Sciences University School of Public Health, Brooklyn, NY
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Gina S. Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Armstrong HF, Lederer D, Lovasi GS, Hiura G, Ventetuolo CE, Barr RG. Selective serotonin reuptake inhibitors and lung function in the multi-ethnic study of atherosclerosis lung study. Respir Med 2022; 196:106805. [PMID: 35306387 PMCID: PMC9453638 DOI: 10.1016/j.rmed.2022.106805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Depression in patients with Chronic Obstructive Pulmonary Disease (COPD) has been shown to be chronic and potentially increase the burden of symptoms. Selective serotonin reuptake inhibitors (SSRIs) have anti-inflammatory and serotonergic effects that may improve lung function. We hypothesized that participants taking SSRIs have better lung function than those not taking SSRIs. The dataset was the Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study. Use of SSRIs was assessed by medication inventory; spirometry was conducted following standard guidelines; dyspnea ratings were self-reported. RESULTS Contrary to our hypothesis, FEV1 was lower, and odds of dyspnea were higher among participants taking SSRIs as compared with those not taking an antidepressant; these differences persisted even with control for potential confounders including depressive symptoms. We found no evidence of a beneficial association between SSRI use and lung function or dyspnea in a large US-based cohort.
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Affiliation(s)
| | | | - Gina S Lovasi
- Drexel Dornsife School of Public Health, Philadelphia, USA.
| | - Grant Hiura
- Columbia University Medical Center, New York, USA.
| | | | - RGraham Barr
- Columbia University Medical Center, New York, USA.
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27
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Gilman SE, Aiello A, Galea S, Howe CJ, Kawachi I, Lovasi GS, Dean LT, Oakes JM, Siddiqi A, Glymour MM. Advancing the Social Epidemiology Mission of the American Journal of Epidemiology. Am J Epidemiol 2022; 191:557-560. [PMID: 34791025 DOI: 10.1093/aje/kwab277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field.
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28
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Park Y, Quinn JW, Hurvitz PM, Hirsch JA, Goldsmith J, Neckerman KM, Lovasi GS, Rundle AG. Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study. BMC Health Serv Res 2022; 22:367. [PMID: 35305617 PMCID: PMC8934473 DOI: 10.1186/s12913-022-07749-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background To address patient’s unmet social needs and improve health outcomes, health systems have developed programs to refer patients in need to social service agencies. However, the capacity to respond to patient referrals varies tremendously across communities. This study assesses the emergence of disparities in spatial access to social services from 1990 to 2014. Methods Social service providers in the lower 48 continental U.S. states were identified annually from 1990 to 2014 from the National Establishment Times Series (NETS) database. The addresses of providers were linked in each year to 2010 US Census tract geometries. Time series analyses of annual counts of services per Km2 were conducted using Generalized Estimating Equations with tracts stratified into tertiles of 1990 population density, quartiles of 1990 poverty rate and quartiles of 1990 to 2010 change in median household income. Results Throughout the period, social service agencies/Km2 increased across tracts. For high population density tracts, in the top quartile of 1990 poverty rate, compared to tracts that experienced the steepest declines in median household income from 1990 to 2010, tracts that experienced the largest increases in income had more services (+ 1.53/Km2, 95% CI 1.23, 1.83) in 1990 and also experienced the steepest increases in services from 1990 to 2010: a 0.09 services/Km2/year greater increase (95% CI 0.07, 0.11). Similar results were observed for high poverty tracts in the middle third of population density, but not in tracts in the lowest third of population density, where there were very few providers. Conclusion From 1990 to 2014 a spatial mismatch emerged between the availability of social services and the expected need for social services as the population characteristics of neighborhoods changed. High poverty tracts that experienced further economic decline from 1990 to 2010, began the period with the lowest access to services and experienced the smallest increases in access to services. Access was highest and grew the fastest in high poverty tracts that experienced the largest increases in median household income. We theorize that agglomeration benefits and the marketization of welfare may explain the emergence of this spatial mismatch.
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29
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Kinsey EW, Widen E, Quinn JW, Huynh M, Van Wye G, Lovasi GS, Neckerman K, Rundle A. Neighborhood walkability and poverty predict excessive gestational weight gain: A cross-sectional study in New York City. Obesity (Silver Spring) 2022; 30:503-514. [PMID: 35068077 PMCID: PMC8830702 DOI: 10.1002/oby.23339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study evaluated associations between neighborhood-level characteristics and gestational weight gain (GWG) in a population-level study of 2015 New York City births. METHODS Generalized linear mixed-effects models were used to estimate odds ratios (ORs) for associations between neighborhood-level characteristics (poverty, food environment, walkability) within 1 km of a residential Census block centroid and excessive or inadequate GWG compared with recommended GWG. All models were adjusted for individual-level sociodemographic characteristics. RESULTS Among the sample of 106,285 births, 41.8% had excessive GWG, and 26.3% had inadequate GWG. Residence in the highest versus lowest quartile of neighborhood poverty was associated with greater odds of excessive GWG (OR: 1.17, 95% CI: 1.08-1.26). Residence in neighborhoods in the quartile of highest walkability compared with the quartile of lowest walkability was associated with lower odds of excessive GWG (OR: 0.87, 95% CI: 0.81-0.93). Adjustment for prepregnancy BMI attenuated the associations for neighborhood poverty, but not for walkability. Neighborhood variables were not associated with inadequate GWG. CONCLUSIONS These analyses indicate that greater neighborhood walkability is associated with lower odds of excessive GWG, potentially from differences in pedestrian activity during pregnancy. This research provides further evidence for using urban design to support healthy weight status during pregnancy.
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Affiliation(s)
- Eliza W. Kinsey
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Elizabeth Widen
- Department of Nutritional Sciences and Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - James W. Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mary Huynh
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Gretchen Van Wye
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Gina S. Lovasi
- Epidemiology and Biostatistics, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kathryn Neckerman
- Columbia Population Research Center, Columbia University, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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30
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Zhang L, He MZ, Gibson EA, Perera F, Lovasi GS, Clougherty JE, Carrión D, Burke K, Fry D, Kioumourtzoglou MA. Evaluating the Impact of the Clean Heat Program on Air Pollution Levels in New York City. Environ Health Perspect 2021; 129:127701. [PMID: 34878319 PMCID: PMC8653771 DOI: 10.1289/ehp9976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Lyuou Zhang
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Mike Z. He
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth A. Gibson
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Frederica Perera
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Jane E. Clougherty
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Daniel Carrión
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kimberly Burke
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Dustin Fry
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Marianthi-Anna Kioumourtzoglou
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
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31
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Zhang K, Lovasi GS, Odden MC, Michael YL, Newman AB, Arnold AM, Kim DH, Wu C. Association of Retail Environment and Neighborhood Socioeconomic Status with Mortality among Community-dwelling Older Adults in the US: Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2021; 77:2240-2247. [PMID: 34669918 DOI: 10.1093/gerona/glab319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Few studies have examined the association of neighborhood environment and mortality among community-dwelling older populations. Geographic Information Systems (GIS)-based measures of neighborhood physical environment may provide new insights on the health effects of the social and built environment. METHODS We studied 4,379 community-dwelling older adults in the US aged ≥65 years from the Cardiovascular Health Study. Principal component analysis was used to identify neighborhood components from 48 variables assessing facilities and establishments, demographic composition, socio-economic status, and economic prosperity. We used a Cox model to evaluate the association of neighborhood components with five-year mortality. Age, sex, race, education, income, marital status, body mass index, smoking status, disability, coronary heart disease, and diabetes were included as covariates. We also examined the interactions between neighborhood components and sex and race (Black vs. white or other). RESULTS We identified five neighborhood components, representing facilities and resources, immigrant communities, community-level economic deprivation, resident-level socio-economic status and residents' age. Communities' economic deprivation and residents' socio-economic status were significantly associated with five-year mortality. We did not find interactions between sex or race and any of the five neighborhood components. The results were similar in a sensitivity analysis where we used ten-year mortality as the outcome. CONCLUSIONS We found that communities' economic status but not facilities in communities was associated with mortality among older adults. These findings revealed the importance and benefits living in a socio-economically advantaged neighborhood could have on health among older residents with different demographic backgrounds.
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Affiliation(s)
- Kehan Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Gina S Lovasi
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
| | - Yvonne L Michael
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Anne B Newman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Alice M Arnold
- School of Public Health, University of Washington, Seattle, WA
| | - Dae Hyun Kim
- Hebrew Rehabilitation Center, Harvard University, Cambridge, MA
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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Hanna DB, Hua S, Gonzalez F, Kershaw KN, Rundle AG, Van Horn LV, Wylie-Rosett J, Gellman MD, Lovasi GS, Kaplan RC, Mossavar-Rahmani Y, Shaw PA. Higher Neighborhood Population Density Is Associated with Lower Potassium Intake in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Int J Environ Res Public Health 2021; 18:ijerph182010716. [PMID: 34682466 PMCID: PMC8535329 DOI: 10.3390/ijerph182010716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 11/26/2022]
Abstract
Current U.S. dietary guidelines recommend a daily potassium intake of 3400 mg/day for men and 2600 mg/day for women. Sub-optimal access to nutrient-rich foods may limit potassium intake and increase cardiometabolic risk. We examined the association of neighborhood characteristics related to food availability with potassium intake in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). 13,835 participants completed a 24-h dietary recall assessment and had complete covariates. Self-reported potassium intake was calibrated with an objective 24-h urinary potassium biomarker, using equations developed in the SOL Nutrition & Physical Activity Assessment Study (SOLNAS, N = 440). Neighborhood population density, median household income, Hispanic/Latino diversity, and a retail food environment index by census tract were obtained. Linear regression assessed associations with 24-h potassium intake, adjusting for individual-level and neighborhood confounders. Mean 24-h potassium was 2629 mg/day based on the SOLNAS biomarker and 2702 mg/day using multiple imputation and HCHS/SOL biomarker calibration. Compared with the lowest quartile of neighborhood population density, living in the highest quartile was associated with a 26% lower potassium intake in SOLNAS (adjusted fold-change 0.74, 95% CI 0.59–0.94) and a 39% lower intake in HCHS/SOL (adjusted fold-change 0.61 95% CI 0.45–0.84). Results were only partially explained by the retail food environment. The mechanisms by which population density affects potassium intake should be further studied.
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Affiliation(s)
- David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
- Correspondence:
| | - Simin Hua
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Franklyn Gonzalez
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.N.K.); (L.V.V.H.)
| | - Andrew G. Rundle
- Department of Epidemiology, Columbia University, New York, NY 10032, USA;
| | - Linda V. Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA; (K.N.K.); (L.V.V.H.)
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Marc D. Gellman
- Department of Psychology, University of Miami, Coral Gables, FL 33124, USA;
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics and Urban Health Collective, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (S.H.); (J.W.-R.); (R.C.K.); (Y.M.-R.)
| | - Pamela A. Shaw
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA;
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Gullon P, Bilal U, Hirsch JA, Rundle A, Judd S, Safford M, Lovasi GS. 261Can a physical activity supportive environment reduce socioeconomic inequities in incident coronary heart disease? Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This research aims to: (1) explore the contribution of physical activity supportive environments to income inequities in coronary heart disease (CHD) incidence, and (2) investigate whether income inequities in CHD incidence are modified by physical activity supportive environments.
Methods
We used data from the REGARDS study, which recruited US-residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n = 20808), followed until December 31st 2014. We categorized household income and treated it as ordinal: (1) $75,000+, (2) $35,000-$74,000, (3) $20,000-$34,000, and (4) <$20,000. We operationalized physical activity supportive environments within a 1-km residential buffer as density of walkable destinations and physical activity facilities, and proportion green land cover. Cox models were estimated the adjusted association of income with incident CHD, and tested effect modification by environment variables.
Results
We found a 17% (95% CI 8% to 25%) increased hazard of CHD per decrease in household income category. After adjusting for physical activity environments, the HR was attenuated by 3% (HR = 1.15), and the income-CHD association was stronger in areas lacking walking destinations (HR = 1.54 vs 1.16).
Conclusions
Physical activity supportive environments, especially those with walking destinations, may moderate associations between household income and CHD.
Key messages
Low-income individuals have greater risk of developing CHD, however, the built environment has a small moderating effect on this association. Income inequities in CHD were also noted to be higher in areas with no walking destinations
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Affiliation(s)
| | - Usama Bilal
- Drexel University School of Public Health, Philadelphia, United States of America
| | - Jana A. Hirsch
- Drexel University School of Public Health, Philadelphia, United States of America
| | - Andrew Rundle
- Columbia University Mailman School of Public Health, New York, United States of America
| | - Suzanne Judd
- School of Public Health, University of Alabama at Birmingham, Birmingham, United States of America
| | - Monika Safford
- Cornell School of Medicine, New York, United States of America
| | - Gina S. Lovasi
- Drexel University School of Public Health, Philadelphia, United States of America
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Besser LM, Lovasi GS, Michael YL, Garg P, Hirsch JA, Siscovick D, Hurvitz P, Biggs ML, Galvin JE, Bartz TM, Longstreth WT. Associations between neighborhood greenspace and brain imaging measures in non-demented older adults: the Cardiovascular Health Study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1575-1585. [PMID: 33388800 PMCID: PMC8253869 DOI: 10.1007/s00127-020-02000-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Greater neighborhood greenspace has been associated with brain health, including better cognition and lower odds of Alzheimer's disease in older adults. We investigated associations between neighborhood greenspace and brain-based magnetic resonance imaging (MRI) measures and potential effect modification by sex or apolipoprotein E genotype (APOE), a risk factor for Alzheimer's disease. METHODS We obtained a sample of non-demented participants 65 years or older (n = 1125) from the longitudinal, population-based Cardiovascular Health Study (CHS). Greenspace data were derived from the National Land Cover Dataset. Adjusted multivariable linear regression estimated associations between neighborhood greenspace five years prior to the MRI and left and right hippocampal volume and 10-point grades of ventricular size and burden of white matter hyperintensity. Interaction terms tested effect modification by APOE genotype and sex. CHS data (1989-1999) were obtained/analyzed in 2020. RESULTS Participants were on average 79 years old [standard deviation (SD) = 4], 58% were female, and 11% were non-white race. Mean neighborhood greenspace was 38% (SD = 28%). Greater proportion of greenspace in the neighborhood five years before MRI was borderline associated with lower ventricle grade (estimate: - 0.30; 95% confidence interval: - 0.61, 0.00). We observed no associations between greenspace and the other MRI outcome measures and no evidence of effect modification by APOE genotype and sex. CONCLUSION This study suggests a possible association between greater greenspace and less ventricular enlargement, a measure reflecting global brain atrophy. If confirmed in other longitudinal cohort studies, interventions and policies to improve community greenspaces may help to maintain brain health in older age.
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Affiliation(s)
- Lilah M Besser
- Institute for Human Health and Disease Intervention, Department of Urban and Regional Planning, Florida Atlantic University, 777 Glades Rd, SO-44, Room 284H, Boca Raton, FL, 33431, USA.
| | - Gina S Lovasi
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Yvonne L Michael
- Department of Epidemiology and Biostatistics, Dornslife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Parveen Garg
- Division of Cardiology, Keck School of Medicine, University of Southern California, 1510 San Pablo Street Suite #322, Los Angeles, CA, 90033, USA
| | - Jana A Hirsch
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - David Siscovick
- Division of Research, Evaluation, and Policy, The New York Academy of Medicine, New York, NY, 10029, USA
| | - Phil Hurvitz
- Center for Studies in Demography and Ecology and Urban Form Lab, University of Washington, Seattle, WA, 98195, USA
| | - Mary L Biggs
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, 98195-9775, USA
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Brooks MS, Bennett A, Lovasi GS, Hurvitz PM, Colabianchi N, Howard VJ, Manly J, Judd SE. Matching participant address with public records database in a US national longitudinal cohort study. SSM Popul Health 2021; 15:100887. [PMID: 34401464 PMCID: PMC8358447 DOI: 10.1016/j.ssmph.2021.100887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Epidemiological studies utilize residential histories to assess environmental exposure risk. The validity from using commercially-sourced residential histories within national longitudinal studies remains unclear. Our study assessed predictors of non-agreement between baseline addresses from the commercially-sourced LexisNexis database and participants in the national longitudinal study, REasons for Geographic and Racial Differences in Stroke (REGARDS). Additionally, we assessed differences in stroke risk by neighborhood socioeconomic score (nSES) based on participant reported address compared to nSES from LexisNexis/REGARDS matched baseline address. Methods From January 2003–October 2007, REGARDS enrolled 30,239 black and white adults aged 45 and older within the continental United States and collected their baseline address. ArcGIS Desktop 10.5.1 with ESRI 2016 Business Analyst Data was used to geocode baseline addresses from LexisNexis and REGARDS. Logistic regression was used to estimate the likelihood that LexisNexis address matched REGARDS baseline address for each participant. Survival analysis was used to estimate association between nSES and incident stroke. Results Approximately 91% of REGARDS participants had a LexisNexis address. Of these geocoded addresses, 93% of REGARDS baseline addresses matched LexisNexis addresses. Odds of agreement between LexisNexis and REGARDS was higher for older-aged participants (OR = 1.02 per year, 95% CI: 1.01, 1.02), blacks compared to whites (OR = 1.16, 95% CI: 1.05, 1.29), females compared to males (OR = 1.15, 95% CI: 1.04, 1.26), participants with an income of $34k-74k compared to an income less than $20k (OR = 1.62, 95% CI: 1.39, 1.89). Odds of agreement were lower for residents in Midwest compared to residents in the south (OR = 0.82, 95% CI: 0.73, 0.94). No significant differences in nSES-stroke associations were observed between REGARDS only and LexisNexis/REGARDS matched addresses; however, differences in interactions were observed. Conclusion Agreement between LexisNexis and REGARDS addresses varied by sociodemographic groups, potentially introducing bias in studies reliant on LexisNexis alone for residential address data. Approximately 9% of REGARDS participants did not have a LexisNexis address history available. Of participants with both REGARDS and LexisNexis addresses available, 93% of these addresses matched. Agreement between REGARDS and LexisNexis address varied by socio-demographics—potentially biasing environmental exposures. Compared to LexisNexis, REGARDS addresses may be valuable in detecting interactions contributing to stroke disparities.
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Affiliation(s)
- Marquita S Brooks
- Department of Biostatistics, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Aleena Bennett
- Department of Biostatistics, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Philip M Hurvitz
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Natalie Colabianchi
- Environment and Policy Lab, University of Michigan School of Kinesiology, Ann Arbor, MI, USA
| | | | - Jennifer Manly
- Neurology at Gertrude H. Sergievsky Center and the Taub Institute for Research in Aging and Alzheimer's Disease, Columbia University, New York, NY, USA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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Lovasi GS, Johnson NJ, Altekruse SF, Hirsch JA, Moore KA, Brown JR, Rundle AG, Quinn JW, Neckerman K, Siscovick DS. Healthy food retail availability and cardiovascular mortality in the United States: a cohort study. BMJ Open 2021; 11:e048390. [PMID: 34244272 PMCID: PMC8273445 DOI: 10.1136/bmjopen-2020-048390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/26/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We investigated the association of healthy food retail presence and cardiovascular mortality, controlling for sociodemographic characteristics. This association could inform efforts to preserve or increase local supermarkets or produce market availability. DESIGN Cohort study, combining Mortality Disparities in American Communities (individual-level data from 2008 American Community Survey linked to National Death Index records from 2008 to 2015) and retail establishment data. SETTING Across the continental US area-based sociodemographic and retail characteristics were linked to residential location by ZIP code tabulation area (ZCTA). Sensitivity analyses used census tracts instead, restricted to urbanicity or county-based strata, or accounted for non-independence using frailty models. PARTICIPANTS 2 753 000 individuals age 25+ living in households with full kitchen facilities, excluding group quarters. PRIMARY AND SECONDARY OUTCOME MEASURES Cardiovascular mortality (primary) and all-cause mortality (secondary). RESULTS 82% had healthy food retail (supermarket, produce market) within their ZCTA. Density of such retail was correlated with density of unhealthy food sources (eg, fast food, convenience store). Healthy food retail presence was not associated with reduced cardiovascular (HR: 1.03; 95% CI 1.00 to 1.07) or all-cause mortality (HR: 1.05; 95% CI 1.04 to 1.06) in fully adjusted models (with adjustment for gender, age, marital status, nativity, Black race, Hispanic ethnicity, educational attainment, income, median household income, population density, walkable destination density). The null finding for cardiovascular mortality was consistent across adjustment strategies including minimally adjusted models (individual demographics only), sensitivity analyses related to setting, and across gender or household type strata. However, unhealthy food retail presence was associated with elevated all-cause mortality (HR: 1.15; 95% CI 1.11 to 1.20). CONCLUSIONS In this study using food establishment locations within administrative areas across the USA, the hypothesised association of healthy food retail availability with reduced cardiovascular mortality was not supported; an association of unhealthy food retail presence with higher mortality was not specific to cardiovascular causes.
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Affiliation(s)
- Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Norman J Johnson
- Center for Administrative Records and Research Applications, Census Bureau, Washington, District of Columbia, USA
| | - Sean F Altekruse
- National Heart Lung and Blood institute, Division of Cardiovascular Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Jana A Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kari A Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Janene R Brown
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Andrew G Rundle
- Built Environment and Health Research Group, Columbia University, New York, New York, USA
| | - James W Quinn
- Built Environment and Health Research Group, Columbia University, New York, New York, USA
| | - Kathryn Neckerman
- Built Environment and Health Research Group, Columbia University, New York, New York, USA
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Gullon P, Bilal U, Hirsch JA, Rundle AG, Judd S, Safford MM, Lovasi GS. Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease? J Epidemiol Community Health 2021; 75:637-642. [PMID: 33318134 PMCID: PMC8200362 DOI: 10.1136/jech-2020-215239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/30/2020] [Accepted: 11/29/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA). METHODS We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000-US$74 000, (3) US$20 000-US$34 000 and (4) RESULTS We found a 25% (95% CI 1.17% to 1.34%) increased hazard of CHD per 1-category decrease in household income category. Adjusting for PA-supportive environments slightly reduced this association (HR=1.24). The income-CHD association was strongest in areas without walking destinations (HR=1.57), an interaction which reached statistical significance in analyses among men. In contrast, the income-CHD association showed a trend towards being strongest in areas with the highest percentage of green land cover. CONCLUSIONS Indicators of a PA supportive environment show divergent trends to modify socioeconomic inequities in CHD . Built environment interventions should measure the effect on socioeconomic inequities.
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Affiliation(s)
- Pedro Gullon
- Public Health and Epidemiology Research Group, Universidad de Alcala de Henares Facultad de Medicina y Ciencias de la Salud, Alcala de Henares, Spain
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Usama Bilal
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Jana A Hirsch
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Andrew G Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, USA
| | - Monika M Safford
- Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, New York, USA
| | - Gina S Lovasi
- Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
- Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
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Garg PK, Platt JM, Hirsch JA, Hurvitz P, Rundle A, Biggs ML, Psaty BM, Moore K, Lovasi GS. Association of neighborhood physical activity opportunities with incident cardiovascular disease in the Cardiovascular Health Study. Health Place 2021; 70:102596. [PMID: 34091144 DOI: 10.1016/j.healthplace.2021.102596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
We determined associations of cumulative exposures to neighborhood physical activity opportunities with risk of incident cardiovascular disease (CVD). We included 3595 participants from the Cardiovascular Health Study recruited between 1989 and 1993 (mean age = 73; 60% women; 11% black). Neighborhood environment measures were calculated using Geographic Information Systems (GIS) and annual information from the National Establishment Time Series database, including the density of (1) walking destinations and (2) physical activity/recreational facilities in a 1- and 5-km radius around the respondent's home. Incident CVD was defined as the development of myocardial infarction, stroke, or cardiovascular death and associations with time to incident CVD were estimated using Cox proportional hazards models. A total of 1986 incident CVD cases occurred over a median follow-up of 11.2 years. After adjusting for baseline and time-varying individual and neighborhood-level confounding, a one standard deviation increase in walking destinations and physical activity/recreational facilities within 5 km of home was associated with a respective 7% (95% confidence interval (CI) = 0.87-0.99) and 12% (95% CI = 0.73-1.0) decreased risk of incident CVD. No significant associations were noted within a 1-km radius. Efforts to improve the availability of physical activity resources in neighborhoods may be an important strategy for lowering CVD.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Jonathan M Platt
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Jana A Hirsch
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Philip Hurvitz
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA; Urban Form Lab, Department of Urban Design and Planning, University of Washington, Seattle, WA, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mary Lou Biggs
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, USA
| | - Kari Moore
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Gina S Lovasi
- Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Pineo H, Audia C, Black D, French M, Gemmell E, Lovasi GS, Milner J, Montes F, Niu Y, Pérez-Ferrer C, Siri J, Taruc RR. Building a Methodological Foundation for Impactful Urban Planetary Health Science. J Urban Health 2021; 98:442-452. [PMID: 32572677 PMCID: PMC8190224 DOI: 10.1007/s11524-020-00463-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Anthropogenic environmental change will heavily impact cities, yet associated health risks will depend significantly on decisions made by urban leaders across a wide range of non-health sectors, including transport, energy, housing, basic urban services, and others. A subset of planetary health researchers focus on understanding the urban health impacts of global environmental change, and how these vary globally and within cities. Such researchers increasingly adopt collaborative transdisciplinary approaches to engage policy-makers, private citizens, and other actors in identifying and evaluating potential policy solutions that will reduce environmental impacts in ways that simultaneously promote health, equity, and/or local economies-in other words, maximising 'co-benefits'. This report presents observations from a participatory workshop focused on challenges and opportunities for urban planetary health research. The workshop, held at the 16th International Conference on Urban Health (ICUH) in Xiamen, China, in November 2019, brought together 49 participants and covered topics related to collaboration, data, and research impact. It featured research projects funded by the Wellcome Trust's Our Planet Our Health (OPOH) programme. This report aims to concisely summarise and disseminate participants' collective contributions to current methodological practice in urban planetary health research.
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Affiliation(s)
- Helen Pineo
- Institute for Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, Central House, 14 Upper Woburn Place, London, WC1H 0NN, UK.
| | - Camilla Audia
- Department of Geography, School of Global Affairs, Faculty of Social Science and Public Policy, King's College London, Strand, London, WC2R 2LS, UK
| | - Daniel Black
- Population Health Sciences, Bristol Medical School, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, UK
| | - Matthew French
- Monash Sustainable Development Institute, Monash University, 8 Scenic Blvd, Clayton, VIC, Australia
| | - Emily Gemmell
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St 7th Floor, Philadelphia, PA, 19104, USA
| | - James Milner
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Felipe Montes
- Department of Industrial Engineering, Universidad de los Andes, Cra 1E#19A-40, Bogota, Colombia
| | - Yanlin Niu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing, 102206, China
| | - Carolina Pérez-Ferrer
- CONACYT ─ National Institute of Public Health, Avenida Universidad 655, Cuernavaca, Morelos, Mexico
| | - José Siri
- Our Planet Our Health, Wellcome Trust, 215 Euston Road, London, NW1 2BE, UK
| | - Ruzka R Taruc
- Public Health Faculty, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Makassar, Indonesia
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Fry D, Aaron Hipp J, Alberico C, Huang JH, Lovasi GS, Floyd MF. Land use diversity and park use in New York City. Prev Med Rep 2021; 22:101321. [PMID: 35966049 PMCID: PMC9366970 DOI: 10.1016/j.pmedr.2021.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/07/2021] [Accepted: 01/20/2021] [Indexed: 11/25/2022] Open
Abstract
Neighborhood parks and mixed-use land development are both understood to be important independent contributors to physical activity levels. It has been hypothesized that mixed-use land development could increase park use as a result of mixed-use neighborhoods being consistently activated throughout the day, but the results of previous research on this question have been inconsistent and the mediational role of neighborhood activation has not been tested. This study leverages data from Google Places Popular Times and the National Establishment Time Series to directly test the mediational role of the daily temporal distribution of neighborhood activation, to construct a novel measure of commercial activity diversity, and to help disentangle built-environment density from commercial diversity. Park use data was measured from 10,004 systematic observations of 20 neighborhood parks in New York City in the spring and summer of 2017. The hypothesis that commercial activity diversity is positively associated with park use was not supported in any models. However, a positive relationship between built-environment density and park use was found, which may help to explain prior inconsistent findings.
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Abstract
Background:
A growing body of evidence demonstrates that diets high in ultra-processed food products (UPF)—ready-to-eat formulations of processed substances that have been extracted or refined from whole foods and that typically contain added flavors, colors, and other cosmetic additives -- lack nutrient quality and contribute to energy imbalance. However, few studies have examined the impact on hypertension, a diet-sensitive condition characterized by racial disparities across the disease spectrum. We sought to determine black-white differences in UPF consumption and associations with incident hypertension.
Methods:
Data from the Reasons for Geographic and Racial Disparities in Stroke (REGARDS) Cohort Study was used. Participants free of hypertension at baseline (2003-2007) who had complete food intake data and completed visit 2 (2013-2017) were included. The NOVA classification system was used to categorize participants food and drink into categories according to their level of processing, from 1 (minimally processed) to 4 (ultra-processed). The percent gram contribution of UPF to total grams consumed was calculated and used to create quartiles of UPF intake. The outcome, incident hypertension, was defined as systolic blood pressure of =>140 mm Hg or diastolic pressure =>90 mm Hg or taking antihypertensive medication at visit 2. Summary statistics were used to examine participant demographics by UPF consumption. Multivariable logistic regression was used to assess the hypothesis that UPF consumption is associated with incident hypertension and that the association varies by race.
Results:
A total of 5,957 participants were included in analyses, 23 percent were Black and 77 White. Black participants had higher UPF intake compared to White participants. Thirty-eight percent of Black participants were in the top quartile of UPF consumption compared to 21 percent among White participants. Women, those with lower educational attainment, lower physical activity, and income below 35K were more likely to be in the top quartile of UPF consumption. Regression model results showed individuals in the top quartile of UPF consumption had 38 percent greater odds of incident hypertension (CI=1.11-1.53) after adjustment for sociodemographic characteristics. Race-stratified model results showed that Blacks in the top quartile had 47 percent greater odds (CI=1.06-2.03) of incident hypertension. UPF consumption was not significantly associated with incident hypertension among Whites (OR=1.19, CI=0.99-1.43).
Conclusions:
Findings demonstrate racial disparities in consumption of UPF and that disparities contribute to higher incident hypertension among Black persons. Results contribute to the growing evidence base needed to inform equitable food system policies, support healthier dietary consumption, and address hypertension disparities.
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Affiliation(s)
| | | | | | - Ya Yuan
- UNIVERSITY ALABAMA BIRMINGHAM, Vestavia, AL
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Kim K, Bandera EV, Xu B, Chanumolu D, Rundle AG, Hurvitz PM, Ambrosone CB, Demissie K, Hong CC, Lovasi GS, Qin B. Multilevel Risk Factors for Weight Change after Breast Cancer Diagnosis Among Black Women. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1055-9965.epi-21-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Weight gain after breast cancer diagnosis increases the risk of mortality. African American/Black breast cancer survivors are more likely to have excess body weight than their White counterparts, which may contribute to their higher mortality rate. Emerging evidence suggests that post-diagnosis weight gain may result from multilevel determinants. However, no study has investigated the multilevel characteristics among Black breast cancer survivors. Objective: To evaluate associations between individual-level factors and neighborhood social and built environment factors with weight change after breast cancer diagnosis among Black women. Methods: We evaluated associations of interest among 785 women enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), a longitudinal study of Black breast cancer survivors in New Jersey. Weight change was primarily based on measurements at baseline and follow-up visits (Median: 10.3 and 23.2 mo. since diagnosis, respectively). Participants were grouped into categories of stable weight (52.4%), ≥3% weight loss (20.0%), and ≥3% weight gain (27.6%). Using multivariate- adjusted multinomial logistic regression and multilevel multinomial logistic regression, we evaluated relative risk ratios (RRRs) for associations between multilevel factors and post-diagnosis weight change category. Results: Black breast cancer survivors who were older at diagnosis, had higher household income, post-menopausal status, and higher baseline BMI were less likely to gain weight compared to women with stable weight. Former smoking, higher tumor stage, and chemotherapy were associated with increased relative risk of weight gain (e.g. RRR-chemo: 1.45, 95% CI: 1.01, 2.08). Black women residing in neighborhoods in the highest tertile for density of walkable destinations had a decreased relative risk of post- diagnosis weight gain (e.g. RRR-T3 highest density vs. T1 lowest: 0.39, 95% CI: 0.20, 0.75), while those residing in neighborhoods with higher density of fast food restaurants had increased relative risk of weight gain (RRR-T3 highest density vs. T1 lowest: 1.94, 95% CI: 1.23, 3.05). Conclusion: Both individual and neighborhood factors may influence the risk of weight gain among Black women after breast cancer diagnosis.
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Hirsch JA, Moore KA, Cahill J, Quinn J, Zhao Y, Bayer FJ, Rundle A, Lovasi GS. Business Data Categorization and Refinement for Application in Longitudinal Neighborhood Health Research: a Methodology. J Urban Health 2021; 98:271-284. [PMID: 33005987 PMCID: PMC8079597 DOI: 10.1007/s11524-020-00482-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/31/2022]
Abstract
Retail environments, such as healthcare locations, food stores, and recreation facilities, may be relevant to many health behaviors and outcomes. However, minimal guidance on how to collect, process, aggregate, and link these data results in inconsistent or incomplete measurement that can introduce misclassification bias and limit replication of existing research. We describe the following steps to leverage business data for longitudinal neighborhood health research: re-geolocating establishment addresses, preliminary classification using standard industrial codes, systematic checks to refine classifications, incorporation and integration of complementary data sources, documentation of a flexible hierarchical classification system and variable naming conventions, and linking to neighborhoods and participant residences. We show results of this classification from a dataset of locations (over 77 million establishment locations) across the contiguous U.S. from 1990 to 2014. By incorporating complementary data sources, through manual spot checks in Google StreetView and word and name searches, we enhanced a basic classification using only standard industrial codes. Ultimately, providing these enhanced longitudinal data and supplying detailed methods for researchers to replicate our work promotes consistency, replicability, and new opportunities in neighborhood health research.
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Affiliation(s)
- Jana A. Hirsch
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, PA Philadelphia, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Kari A. Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Jesse Cahill
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY USA
| | - James Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY USA
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Felicia J. Bayer
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY USA
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, PA Philadelphia, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
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44
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Schinasi LH, Cole HVS, Hirsch JA, Hamra GB, Gullon P, Bayer F, Melly SJ, Neckerman KM, Clougherty JE, Lovasi GS. Associations between Greenspace and Gentrification-Related Sociodemographic and Housing Cost Changes in Major Metropolitan Areas across the United States. Int J Environ Res Public Health 2021; 18:ijerph18063315. [PMID: 33806987 PMCID: PMC8005168 DOI: 10.3390/ijerph18063315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022]
Abstract
Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and Brown University Longitudinal Tracts databases, as well as spatial lag models, to estimate census tract-level associations between percentage greenspace (years 1990, 2000) and subsequent changes (1990–2000, 2000–2010) in percentage college-educated, percentage working professional jobs, race/ethnic composition, household income, percentage living in poverty, household rent, and home value. We also investigated effect modification by racial/ethnic composition. We ran models for each MSA and time period and used random-effects meta-analyses to derive summary estimates for each period. Estimates were modest in magnitude and heterogeneous across MSAs. After adjusting for census-tract level population density in 1990, compared to tracts with low percentage greenspace in 1992 (defined as ≤50th percentile of the MSA-specific distribution in 1992), those with high percentage greenspace (defined as >75th percentile of the MSA-specific distribution) experienced higher 1990–2000 increases in percentage of the employed civilian aged 16+ population working professional jobs (β: 0.18, 95% confidence interval (CI): 0.11, 0.26) and in median household income (β: 0.23, 95% CI: 0.15, 0.31). Adjusted estimates for the 2000–2010 period were near the null. We did not observe evidence of effect modification by race/ethnic composition. We observed evidence of modest associations between greenspace and gentrification trends. Further research is needed to explore reasons for heterogeneity and to quantify health implications.
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Affiliation(s)
- Leah H. Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (J.A.H.); (F.B.); (S.J.M.); (G.S.L.)
- Correspondence:
| | - Helen V. S. Cole
- Medical Research Institute of the Hospital del Mar (IMIM), 08003 Barcelona, Spain;
- Institute for Environmental Science and Technology, Universidad Autónoma de Barcelona, 08193 Bellaterra, Spain
| | - Jana A. Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (J.A.H.); (F.B.); (S.J.M.); (G.S.L.)
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Ghassan B. Hamra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (G.B.H.); (P.G.)
| | - Pedro Gullon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (G.B.H.); (P.G.)
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, 28801 Madrid, Spain
| | - Felicia Bayer
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (J.A.H.); (F.B.); (S.J.M.); (G.S.L.)
| | - Steven J. Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (J.A.H.); (F.B.); (S.J.M.); (G.S.L.)
| | - Kathryn M. Neckerman
- Columbia Population Research Center, Columbia University, New York, NY 10027, USA;
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (J.A.H.); (F.B.); (S.J.M.); (G.S.L.)
| | - Gina S. Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA; (J.A.H.); (F.B.); (S.J.M.); (G.S.L.)
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
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Brown JR, Hirsch JA, Judd SE, Hurvitz PM, Howard VJ, Safford M, Moore J, Lovasi GS. The Association of Neighborhood Medical Facilities with Aging in Place and Risk of Incident Myocardial Infarction. J Aging Health 2020; 33:227-236. [PMID: 33251918 PMCID: PMC8592305 DOI: 10.1177/0898264320975228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Aging in place (residential stability) is a desirable means of aging where adults remain in their homes, even when facing challenges that impair their capacity for self-care. Residential stability, especially following acute health challenges, depends on individual and community factors, possibly including proximity to medical facilities. Methods: We explored the association between the density of medical facilities around homes with risk of incident myocardial infarction (MI) and with aging in place following incident MI. Results: Densities of neighborhood pharmacies were not associated with aging in place or time to MI. High densities of neighborhood clinical care facilities were significantly associated with decreased residential stability. Discussion: The lack of significant associations between medical facility exposures and MI-related outcomes, coupled with prior findings, casts doubt on their salience and may indicate that other neighborhood features are more strongly associated with these outcomes.
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Affiliation(s)
- Janene R Brown
- Urban Health Collaborative, 6527Drexel University, PA, USA
| | - Jana A Hirsch
- Urban Health Collaborative, 6527Drexel University, PA, USA
| | | | | | | | - Monika Safford
- Weill Cornell Medical College, Cornell University, NY, USA
| | - Jeffrey Moore
- Urban Health Collaborative, 6527Drexel University, PA, USA
| | - Gina S Lovasi
- Urban Health Collaborative, 6527Drexel University, PA, USA
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46
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Mooney SJ, Bader MD, Lovasi GS, Neckerman KM, Rundle AG, Teitler JO. Using universal kriging to improve neighborhood physical disorder measurement. Sociol Methods Res 2020; 49:1163-1185. [PMID: 34354317 PMCID: PMC8330519 DOI: 10.1177/0049124118769103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Ordinary kriging, a spatial interpolation technique, is commonly used in social sciences to estimate neighborhood attributes such as physical disorder. Universal kriging, developed and used in physical sciences, extends ordinary kriging by supplementing the spatial model with additional covariates. We measured physical disorder on 1,826 sampled block faces across 4 US cities (New York, Philadelphia, Detroit, and San Jose) using Google Street View imagery. We then compared leave-one-out cross-validation accuracy between universal and ordinary kriging and used random subsamples of our observed data to explore whether universal kriging could provide equal measurement accuracy with less spatially dense samples. Universal kriging did not always improve accuracy. However, a measure of housing vacancy did improve estimation accuracy in Philadelphia and Detroit (7.9 and 6.8% lower root mean square error, respectively) and allowed for equivalent estimation accuracy with half the sampled points in Philadelphia. Universal kriging may improve neighborhood measurement.
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Affiliation(s)
- Stephen J Mooney
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Michael Dm Bader
- Center on Health, Risk, and Society, American University, Washington, DC
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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47
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Abstract
Virtual audits using Google Street View are an increasingly popular method of assessing neighborhood environments for health and urban planning research. However, the validity of these studies may be threatened by issues of image availability, image age, and variance of image age, particularly in the Global South. This study identifies patterns of Street View image availability, image age, and image age variance across cities in Latin America and assesses relationships between these measures and measures of resident socioeconomic conditions. Image availability was assessed at 530,308 near-road points within the boundaries of 371 Latin American cities described by the SALURBAL (Salud Urbana en America Latina) project. At the subcity level, mixed-effect linear and logistic models were used to assess relationships between measures of socioeconomic conditions and image availability, average image age, and the standard deviation of image age. Street View imagery was available at 239,394 points (45.1%) of the total sampled, and rates of image availability varied widely between cities and countries. Subcity units with higher scores on measures of socioeconomic conditions had higher rates of image availability (OR = 1.11 per point increase of combined index, p < 0.001) and the imagery was newer on average (- 1.15 months per point increase of combined index, p < 0.001), but image capture date within these areas varied more (0.59-month increase in standard deviation of image age per point increase of combined index, p < 0.001). All three assessed threats to the validity of Street View virtual audit studies spatially covary with measures of socioeconomic conditions in Latin American cities. Researchers should be attentive to these issues when using Street View imagery.
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Affiliation(s)
- Dustin Fry
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3600 Market Street 7th Floor, Philadelphia, PA 19104 USA
| | - Stephen J. Mooney
- Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Seattle, WA 98195 USA
| | - Daniel A. Rodríguez
- Department of City & Regional Planning, University of California–Berkeley College of Environmental Design, 230 Wurster Hall, Berkeley, CA 94720 USA
| | - Waleska T. Caiaffa
- Department of Preventive and Social Medicine, Federal University of Minas Gerais Observatory for Urban Health in Belo Horizonte, Av. Alfredo Balena, 190, Belo Horizonte, CEP: 30130-100 Brazil
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3600 Market Street 7th Floor, Philadelphia, PA 19104 USA
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48
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Fry D, Kioumourtzoglou MA, Treat CA, Burke KR, Evans D, Tabb LP, Carrion D, Perera FP, Lovasi GS. Development and validation of a method to quantify benefits of clean-air taxi legislation. J Expo Sci Environ Epidemiol 2020; 30:629-640. [PMID: 31142812 PMCID: PMC7398736 DOI: 10.1038/s41370-019-0141-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/23/2019] [Accepted: 04/07/2019] [Indexed: 06/09/2023]
Abstract
Air pollution from motor vehicle traffic remains a significant threat to public health. Using taxi inspection and trip data, we assessed changes in New York City's taxi fleet following Clean Air Taxi legislation enacted in 2005-2006. Inspection and trip data between 2004 and 2015 were used to assess changes in New York's taxi fleet and to estimate and spatially apportion annual taxi-related exhaust emissions of nitric oxide (NO) and total particulate matter (PMT). These emissions changes were used to predict reductions in NO and fine particulate matter (PM2.5) concentrations estimates using data from the New York City Community Air Survey (NYCCAS) in 2009-2015. Efficiency trends among other for-hire vehicles and spatial variation in traffic intensity were also considered. The city fuel efficiency of the medallion taxi fleet increased from 15.7 MPG to 33.1 MPG, and corresponding NO and PMT exhaust emissions estimates declined by 82 and 49%, respectively. These emissions reductions were associated with changes in NYCCAS-modeled NO and PM2.5 concentrations (p < 0.001). New York's clean air taxi legislation was effective at increasing fuel efficiency of the medallion taxi fleet, and reductions in estimated taxi emissions were associated with decreases in NO and PM2.5 concentrations.
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Affiliation(s)
- Dustin Fry
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA.
| | | | - Christian A Treat
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Kimberly R Burke
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - David Evans
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, USA
| | - Loni P Tabb
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Daniel Carrion
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Frederica P Perera
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA
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49
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Tsui J, Hirsch JA, Bayer FJ, Quinn JW, Cahill J, Siscovick D, Lovasi GS. Patterns in Geographic Access to Health Care Facilities Across Neighborhoods in the United States Based on Data From the National Establishment Time-Series Between 2000 and 2014. JAMA Netw Open 2020; 3:e205105. [PMID: 32412637 PMCID: PMC7229525 DOI: 10.1001/jamanetworkopen.2020.5105] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE The association between proximity to health care facilities and improved disease management and population health has been documented, but little is known about small-area health care environments and how the presence of health care facilities has changed over time during recent health system and policy change. OBJECTIVE To examine geographic access to health care facilities across neighborhoods in the United States over a 15-year period. DESIGN, SETTING, AND PARTICIPANTS Using longitudinal business data from the National Establishment Time-Series, this cross-sectional study examined the presence of and change in ambulatory care facilities and pharmacies and drugstores in census tracts (CTs) throughout the continental United States between 2000 and 2014. Between January and April 2019, multinomial logistic regression was used to estimate associations between health care facility presence and neighborhood sociodemographic characteristics over time. MAIN OUTCOMES AND MEASURES Change in health care facility presence was measured as never present, lost, gained, or always present between 2000 and 2014. Neighborhood sociodemographic characteristics (ie, CTs) and their change over time were measured from US Census reports (2000 and 2010) and the American Community Survey (2008-2012). RESULTS Among 72 246 included CTs, the percentage of non-US-born residents, residents 75 years or older, poverty status, and population density increased, and 8.1% of CTs showed a change in the racial/ethnic composition of an area from predominantly non-Hispanic (NH) white to other racial/ethnic composition categories between 2000 and 2010. The presence of ambulatory care facilities increased from a mean (SD) of 7.7 (15.9) per CT in 2000 to 13.0 (22.9) per CT in 2014, and the presence of pharmacies and drugstores increased from a mean (SD) of 0.6 (1.0) per CT in 2000 to 0.9 (1.4) per CT in 2014. Census tracts with predominantly NH black individuals (adjusted odds ratio [aOR], 2.37; 95% CI, 2.03-2.77), Hispanic/Latino individuals (aOR 1.30; 95% CI, 1.00-1.69), and racially/ethnically mixed individuals (aOR, 1.53; 95% CI, 1.33-1.77) in 2000 had higher odds of losing health care facilities between 2000 and 2014 compared with CTs with predominantly NH white individuals, after controlling for other neighborhood characteristics. Census tracts of geographic areas with higher levels of poverty in 2000 also had higher odds of losing health care facilities between 2000 and 2014 (aOR, 1.12; 95% CI, 1.05-1.19). CONCLUSIONS AND RELEVANCE Differential change was found in the presence of health care facilities across neighborhoods over time, indicating the need to monitor and address the spatial distribution of health care resources within the context of population health disparities.
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Affiliation(s)
- Jennifer Tsui
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, New Brunswick
- Rutgers Center for State Health Policy, Rutgers, The State University of New Jersey, New Brunswick
| | - Jana A. Hirsch
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Felicia J. Bayer
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - James W. Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Jesse Cahill
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - David Siscovick
- Research, Evaluation & Policy, New York Academy of Medicine, New York, New York
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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50
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Eisenman TS, Jariwala SP, Lovasi GS. Urban trees and asthma: a call for epidemiological research. Lancet Respir Med 2020; 7:e19-e20. [PMID: 31253377 DOI: 10.1016/s2213-2600(19)30193-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Theodore S Eisenman
- Department of Landscape Architecture and Regional Planning, University of Massachusetts, Amherst, MA, USA.
| | - Sunit P Jariwala
- Division of Allergy/Immunology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Gina S Lovasi
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
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