1
|
Brown SC, Aitken WW, Lombard J, Wang K, Rundek T, Byrne MM, Toro M, Nardi MI, Kardys J, Parrish A, Szapocznik J. Precision Greenness and Stroke/Transient Ischemic Attack in 249,405 US Medicare Beneficiaries. J Stroke 2023; 25:173-176. [PMID: 36592966 PMCID: PMC9911840 DOI: 10.5853/jos.2022.02922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/17/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Scott C. Brown
- University of Miami Miller School of Medicine, Miami, FL, USA,University of Miami School of Architecture, Coral Gables, FL, USA
| | - William W. Aitken
- University of Miami Miller School of Medicine, Miami, FL, USA,Correspondence: William W. Aitken Built Environment, Behavior, and Health Research Group, University of Miami, University of Miami Miller School of Medicine, 1120 NW 14th St., Suite. #1129, Miami, FL 33136, USA Tel: +1-305-519-5136 Fax: +1-339-201-5011 E-mail:
| | - Joanna Lombard
- University of Miami Miller School of Medicine, Miami, FL, USA,University of Miami School of Architecture, Coral Gables, FL, USA
| | - Kefeng Wang
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- University of Miami Miller School of Medicine, Miami, FL, USA,Evelyn F. McKnight Brain Institute, University of Miami Department of Neurology, Miami, FL, USA
| | | | - Matthew Toro
- Arizona State University Library, Map and Geospatial Hub, Tempe, AZ, USA
| | - Maria I. Nardi
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Jack Kardys
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | | | - José Szapocznik
- University of Miami Miller School of Medicine, Miami, FL, USA,University of Miami School of Architecture, Coral Gables, FL, USA
| |
Collapse
|
2
|
Brown SC, Aitken W, Lombard J, Wang K, Parrish A, Nardi M, Kardys J, Szapocznik J. Longitudinal impacts of greenness on cardiovascular disease conditions. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2656] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Environmental determinants of health, such as greenness, play an increasing role in our understanding of cardiovascular disease, and can inform how to address geographic cardiovascular disparities. This study assesses the impact of greenness and changes in greenness on cardiovascular disease.
Purpose
The purpose of this study is to investigate the impact of greenness and changes in greenness on cardiovascular disease diagnoses.
Methods
The sample for this prospective, longitudinal study was comprised of 243,558 U.S. Medicare beneficiaries 65 years or older, residing on the same Census Block from 2011 through 2016, and who had a Miami-Dade residential 9-digit zip code. Analyses examined the impact of greenness, measured by mean block-level Normalized Difference Vegetation index (NDVI) from satellite imagery to incidence of new cardiovascular conditions including: acute myocardial infarction, atrial fibrillation, heart failure, ischemic heart disease, hypertension, and stroke/ transient ischemic attack. Zero-inflated poisson regression was used to model the odds of developing any new cardiovascular disease and number of new cardiovascular conditions based on block level greenness while adjusting for individual age, gender, race/ethnicity, number of baseline cardiovascular conditions, and neighborhood characteristics including income and walkability.
Results
Living in a higher greenness Census Block was associated with lower odds of having at least one new cardiovascular condition and having a small number of new conditions, adjusting for individual and neighborhood level characteristics. When compared to individuals living in the lowest tertile of greenness throughout the study, those individuals living in the highest tertile of greenness throughout the study had a 16% lower odds of having any new cardiovascular conditions (OR=0.84, 95% CI: 0.79–0.90, p<0.001) and among individuals developing at least one new cardiovascular disease, 4% fewer new cardiovascular conditions (OR=0.96, 95% CI: 0.92–0.99, p<0.05). When compared to individuals living in the lowest tertile of greenness throughout the study, those individuals living in areas that increased their greenness from the lowest tertile to the highest tertile of greenness had a 15% lower odds of having any new cardiovascular conditions (OR=0.85, 95% CI: 0.75–0.97, p<0.001) and among individuals developing at least one new cardiovascular disease, 9% fewer new cardiovascular conditions (OR=0.91, 95% CI: 0.83–0.99, p<0.05).
Conclusions
High greenness is associated with lower rates of cardiovascular conditions over time, both when greenness increases and when a Census Block maintains high greenness. It is remarkable that these effects appear in five years, a relatively short amount of time for a positive environmental impact; and that even for those who began in the lowest greenness tertile, an increase to the high greenness tertile had a significant effect.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Robert Wood Johnson Evidence for Action Grant
Collapse
Affiliation(s)
- S C Brown
- University of Miami Leonard M. Miller School of Medicine, Department of Public Health, Miami, United States of America
| | - W Aitken
- University of Miami Leonard M. Miller School of Medicine, Department of Medicine, Division of Cardiology, Miami, United States of America
| | - J Lombard
- University of Miami School of Architecture, Coral Gables, United States of America
| | - K Wang
- University of Miami Leonard M. Miller School of Medicine, Department of Public Health, Miami, United States of America
| | - A Parrish
- University of Miami Libraries, Coral Gables, United States of America
| | - M Nardi
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, United States of America
| | - J Kardys
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, United States of America
| | - J Szapocznik
- University of Miami Leonard M. Miller School of Medicine, Department of Public Health, Miami, United States of America
| |
Collapse
|
3
|
Aitken WW, Lombard J, Wang K, Toro M, Byrne M, Nardi MI, Kardys J, Parrish A, Dong C, Szapocznik J, Rundek T, Brown SC. Relationship of Neighborhood Greenness to Alzheimer's Disease and Non-Alzheimer's Dementia Among 249,405 U.S. Medicare Beneficiaries. J Alzheimers Dis 2021; 81:597-606. [PMID: 33814426 DOI: 10.3233/jad-201179] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/15/2022]
Abstract
BACKGROUND Neighborhood greenness (vegetative presence) has been linked to multiple health outcomes, but its relationship to Alzheimer's disease (AD) and non-Alzheimer's (non-AD) dementia has been less studied. OBJECTIVE This study examines the relationship of greenness to both AD and non-AD dementia in a population-based sample of Medicare beneficiaries. METHODS Participants were 249,405 US Medicare beneficiaries aged > 65 years living in Miami-Dade County, FL, from 2010 to 2011. Multi-level analyses examined the relationship of greenness, assessed by mean Census block level Normalized Difference Vegetation Index (NDVI), to odds of each of AD, Alzheimer's disease and related dementias (ADRD), and non-AD dementia, respectively. Covariates included age, gender, race/ethnicity, number of comorbid health conditions, and neighborhood income. RESULTS Higher greenness was associated with reduced risk of AD, ADRD, and non-AD dementia, respectively, adjusting for individual and neighborhood sociodemographics. Compared to the lowest greenness tertile, the highest greenness tertile was associated with reduced odds of AD by 20%(odds ratio, 0.80; 95%CI, 0.75-0.85), ADRD by 18%(odds ratio, 0.82; 95%CI, 0.77-0.86), and non-AD dementia by 11%(odds ratio, 0.89; 95%CI, 0.82-0.96). After further adjusting for number of comorbidities, compared to the lowest greenness tertile, the highest greenness tertile was associated with reduced odds of AD (OR, 0.94; 95%CI, 0.88-1.00) and ADRD (OR, 0.93; 95%CI, 0.88-0.99), but not non-AD dementia (OR, 1.01; 95%CI, 0.93-1.08). CONCLUSION High neighborhood greenness may be associated with lower odds of AD and ADRD. Environmental improvements, such as increasing neighborhood vegetation, may be a strategy to reduce risk for AD and possibly other dementias.
Collapse
Affiliation(s)
- William W Aitken
- Cardiovascular Division, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Joanna Lombard
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.,University of Miami School of Architecture, Coral Gables, FL, USA
| | - Kefeng Wang
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Matthew Toro
- Arizona State University Library, Temple, AZ, USA
| | | | - Maria I Nardi
- Miami-Dade County Department of Parks, Recreation and Open Spaces (MDPROS), Miami, FL, USA
| | - Jack Kardys
- Miami-Dade County Department of Parks, Recreation and Open Spaces (MDPROS), Miami, FL, USA
| | | | - Chuanhui Dong
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - José Szapocznik
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.,University of Miami School of Architecture, Coral Gables, FL, USA
| | - Tatjana Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Scott C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.,University of Miami School of Architecture, Coral Gables, FL, USA
| |
Collapse
|
4
|
Brown SC, Aitken W, Lombard J, Wang K, Rundek T, Dong C, Gutierrez CM, Byrne MM, Toro M, Nardi M, Kardys J, Parrish AK, Szapocznik J. Abstract P631: The Relationship of Neighborhood Greenness to Stroke/ Transient Ischemic Attack in 249,405 US Medicare Beneficiaries. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p631] [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: 11/16/2022]
Abstract
Introduction:
Nature exposures represent a novel environmental protective factor for chronic disease, which is understudied with respect to stroke and transient ischemic attack. The purpose of the present study is to investigate the relationship between objectively measured neighborhood greenness (vegetative presence) and Stroke/Transient Ischemic Attack (Stroke/TIA), in a population-based sample of Medicare beneficiaries.
Methods:
The sample was comprised of 249,405 U.S. Medicare beneficiaries ages
>
65 years with the same location (ZIP+4) in Miami-Dade County, Florida, from 2010-2011. Analyses examined the relationship of greenness, measured by mean block-level Normalized Difference Vegetation Index (NDVI) from satellite imagery, to a diagnosis of Stroke/TIA. Hierarchical regression analyses, in a multi-level framework, assessed the relationship of greenness to Stroke/TIA, adjusting successively for individual age, gender, race/ethnicity, neighborhood income, and biological risk factors (diabetes, hypertension, hyperlipidemia). Secondary analyses then examined the relationship of greenness separately for specific diagnoses of Transient Ischemic Attack (TIA), Ischemic Stroke, and Hemorrhagic Stroke, respectively.
Results:
Higher greenness was associated with reduced risk for Stroke/TIA, adjusting for individual sociodemographics and neighborhood income: When compared to individuals residing in the lowest tertile of greenness, those individuals residing in the highest tertile of greenness had a 20% lower odds of Stroke/TIA (OR=0.80; 95% CI: 0.74, 0.86, p<0.0001), as well as a 26% lower odds of TIA (OR=0.74; 95% CI: 0.66, 0.82; p<0.0001) and a 16% lower odds of Ischemic Stroke (OR=0.84; 95% CI: 0.75, 0.95; p=0.0050), but did not have a statistically significantly reduced odds of Hemorrhagic Stroke (OR=0.84; 95% CI: 0.61, 1.16; p=0.2990). Associations were attenuated after adjusting for biological risk factors, suggesting that cardiometabolic risk factors may partly mediate greenness’ relationship to stroke and TIA.
Conclusions:
Neighborhood greenness may be associated with reduced risk of Stroke/TIA. Policies and strategies to increase greenness may be a future means of reducing Stroke/TIA at the population level.
Collapse
Affiliation(s)
| | | | | | - Kefeng Wang
- Univ of Miami Miller Sch of Medicine, Miami, FL
| | | | | | | | | | | | - Maria Nardi
- Miami-Dade County Dept of Parks, Recreation and Open Spaces, Miami, FL
| | - Jack Kardys
- Miami-Dade County Dept of Parks, Recreation and Open Spaces, Miami, FL
| | | | | |
Collapse
|
5
|
Wang K, Lombard J, Rundek T, Dong C, Gutierrez CM, Byrne MM, Toro M, Nardi MI, Kardys J, Yi L, Szapocznik J, Brown SC. Relationship of Neighborhood Greenness to Heart Disease in 249 405 US Medicare Beneficiaries. J Am Heart Assoc 2020; 8:e010258. [PMID: 30835593 PMCID: PMC6475064 DOI: 10.1161/jaha.118.010258] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Nature exposures may be associated with reduced risk of heart disease. The present study examines the relationship between objective measures of neighborhood greenness (vegetative presence) and 4 heart disease diagnoses (acute myocardial infarction, ischemic heart disease, heart failure, and atrial fibrillation) in a population‐based sample of Medicare beneficiaries. Methods and Results The sample included 249 405 Medicare beneficiaries aged 65 years and older whose location (ZIP+4) in Miami‐Dade County, Florida, did not change from 2010 to 2011. Analyses examined relationships between greenness, measured by mean block‐level normalized difference vegetation index from satellite imagery, and 4 heart disease diagnoses. Hierarchical regression analyses, in a multilevel framework, assessed the relationship of greenness to each heart disease diagnosis, adjusting successively for individual sociodemographics, neighborhood income, and biological risk factors (diabetes mellitus, hypertension, and hyperlipidemia). Higher greenness was associated with reduced heart disease risk, adjusting for individual sociodemographics and neighborhood income. Compared with the lowest tertile of greenness, the highest tertile of greenness was associated with reduced odds of acute myocardial infarction by 25% (odds ratio, 0.75; 95% CI, 0.63–0.90), ischemic heart disease by 20% (odds ratio, 0.80; 95% CI, 0.77–0.83), heart failure by 16% (odds ratio, 0.84; 95% CI, 0.80–0.88), and atrial fibrillation by 6% (odds ratio, 0.94; 95% CI, 0.87–1.00). Associations were attenuated after adjusting for biological risk factors, suggesting that cardiometabolic risk factors may partly mediate the greenness to heart disease relationships. Conclusions Neighborhood greenness may be associated with reduced heart disease risk. Strategies to increase area greenness may be a future means of reducing heart disease at the population level. See Editorial by Balmes
Collapse
Affiliation(s)
- Kefeng Wang
- 1 University of Miami Miller School of Medicine Miami FL
| | - Joanna Lombard
- 1 University of Miami Miller School of Medicine Miami FL.,2 University of Miami School of Architecture Coral Gables FL
| | - Tatjana Rundek
- 1 University of Miami Miller School of Medicine Miami FL
| | - Chuanhui Dong
- 1 University of Miami Miller School of Medicine Miami FL
| | | | | | - Matthew Toro
- 4 ASU Library Map and Geospatial Hub Arizona State University Library Tempe AZ
| | - Maria I Nardi
- 5 Miami-Dade County Department of Parks, Recreation and Open Spaces Miami FL
| | - Jack Kardys
- 5 Miami-Dade County Department of Parks, Recreation and Open Spaces Miami FL
| | - Li Yi
- 2 University of Miami School of Architecture Coral Gables FL
| | - José Szapocznik
- 1 University of Miami Miller School of Medicine Miami FL.,2 University of Miami School of Architecture Coral Gables FL
| | - Scott C Brown
- 1 University of Miami Miller School of Medicine Miami FL.,2 University of Miami School of Architecture Coral Gables FL
| |
Collapse
|
6
|
Perrino T, Lombard J, Rundek T, Wang K, Dong C, Gutierrez CM, Toro M, Byrne MM, Nardi MI, Kardys J, Szapocznik J, Brown SC. Neighbourhood greenness and depression among older adults. Br J Psychiatry 2019; 215:476-480. [PMID: 31190652 DOI: 10.1192/bjp.2019.129] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neighbourhood greenness or vegetative presence has been associated with indicators of health and well-being, but its relationship to depression in older adults has been less studied. Understanding the role of environmental factors in depression may inform and complement traditional depression interventions, including both prevention and treatment.AimsThis study examines the relationship between neighbourhood greenness and depression diagnoses among older adults in Miami-Dade County, Florida, USA. METHOD Analyses examined 249 405 beneficiaries enrolled in Medicare, a USA federal health insurance programme for older adults. Participants were 65 years and older, living in the same Miami location across 2 years (2010-2011). Multilevel analyses assessed the relationship between neighbourhood greenness, assessed by average block-level normalised difference vegetative index via satellite imagery, and depression diagnosis using USA Medicare claims data. Covariates were individual age, gender, race/ethnicity, number of comorbid health conditions and neighbourhood median household income. RESULTS Over 9% of beneficiaries had a depression diagnosis. Higher levels of greenness were associated with lower odds of depression, even after adjusting for demographics and health comorbidities. When compared with individuals residing in the lowest tertile of greenness, individuals from the middle tertile (medium greenness) had 8% lower odds of depression (odds ratio 0.92; 95% CI 0.88, 0.96; P = 0.0004) and those from the high tertile (high greenness) had 16% lower odds of depression (odds ratio 0.84; 95% CI 0.79, 0.88; P < 0.0001). CONCLUSIONS Higher levels of greenness may reduce depression odds among older adults. Increasing greenery - even to moderate levels - may enhance individual-level approaches to promoting wellness.Declaration of interestNone.
Collapse
Affiliation(s)
- Tatiana Perrino
- Associate Professor of Public Health Sciences,Miller School of Medicine,University of Miami,USA
| | - Joanna Lombard
- Professor of Architecture,School of Architecture,University of Miami,USA
| | - Tatjana Rundek
- Professor of Neurology,Miller School of Medicine,University of Miami,USA
| | - Kefeng Wang
- Biostatistician,Miller School of Medicine,University of Miami,USA
| | - Chuanhui Dong
- Research Associate Professor of Neurology,Miller School of Medicine,University of Miami,USA
| | | | - Matthew Toro
- Director of Maps, Imagery, and Geospatial Services,Map and Geospatial Hub,Arizona State University Library,USA
| | - Margaret M Byrne
- Associate Member,Moffitt Cancer Center; andAdjunct Associate Professor,College of Medicine,University of South Florida,USA
| | - Maria I Nardi
- Director,Department of Parks, Recreation and Open Spaces,Miami-Dade County,USA
| | - Jack Kardys
- Department of Parks, Recreation and Open Spaces,Miami-Dade County,USA
| | - José Szapocznik
- Professor of Public Health Sciences,Miller School of Medicine,University of Miami,USA
| | - Scott C Brown
- Research Associate Professor of Public Health Sciences,Miller School of Medicine,University of Miami,USA
| |
Collapse
|
7
|
Affiliation(s)
- Sarah E Messiah
- Departments of Pediatrics (Drs Messiah and Forster) and Public Health Sciences (Dr Messiah), University of Miami Miller School of Medicine, Miami, Florida; and Recreation and Open Spaces Department (Mr Kardys), Miami-Dade County Parks, Miami, Florida
| | | | | |
Collapse
|
8
|
Brown SC, Lombard J, Wang K, Hopwood S, Perrino T, Toro M, Byrne MM, Rundek T, Dong C, Gutierrez CM, Nardi MI, Kardys J, Szapocznik J. P4‐371: NEIGHBORHOOD GREENNESS AND ALZHEIMER'S DISEASE IN 249,405 U.S. MEDICARE BENEFICIARIES. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.07.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Scott C. Brown
- University of Miami Miller School of MedicineMiamiFLUSA
- University of Miami School of ArchitectureCoral GablesFLUSA
| | - Joanna Lombard
- University of Miami Miller School of MedicineMiamiFLUSA
- University of Miami School of ArchitectureCoral GablesFLUSA
| | - Kefeng Wang
- University of Miami Miller School of MedicineMiamiFLUSA
| | | | | | | | | | | | - Chuanhui Dong
- University of Miami Miller School of MedicineMiamiFLUSA
| | | | - Maria I. Nardi
- Miami‐Dade ParksRecreation and Open Spaces DepartmentMiamiFLUSA
| | - Jack Kardys
- Miami‐Dade ParksRecreation and Open Spaces DepartmentMiamiFLUSA
| | - Jose Szapocznik
- University of Miami Miller School of MedicineMiamiFLUSA
- University of Miami School of ArchitectureCoral GablesFLUSA
| |
Collapse
|
9
|
Brown SC, Perrino T, Lombard J, Wang K, Toro M, Rundek T, Gutierrez CM, Dong C, Plater-Zyberk E, Nardi MI, Kardys J, Szapocznik J. Health Disparities in the Relationship of Neighborhood Greenness to Mental Health Outcomes in 249,405 U.S. Medicare Beneficiaries. Int J Environ Res Public Health 2018; 15:E430. [PMID: 29494513 PMCID: PMC5876975 DOI: 10.3390/ijerph15030430] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/12/2018] [Accepted: 02/27/2018] [Indexed: 12/17/2022]
Abstract
Prior studies suggest that exposure to the natural environment may be important for optimal mental health. The present study examines the association between block-level greenness (vegetative presence) and mental health outcomes, in a population-based sample of 249,405 U.S. Medicare beneficiaries aged ≥65 years living in Miami-Dade County, Florida, USA, whose location did not change from 2010 to 2011. Multilevel analyses examined relationships between greenness, as measured by mean Normalized Difference Vegetation Index from satellite imagery at the Census block level, and each of two mental health outcomes; Alzheimer's disease and depression, respectively, after statistically adjusting for age, gender, race/ethnicity, and neighborhood income level of the individuals. Higher block-level greenness was linked to better mental health outcomes: There was a reduced risk of Alzheimer's disease (by 18%) and depression (by 28%) for beneficiaries living in blocks that were 1 SD above the mean for greenness, as compared to blocks that were 1 SD below the mean. Planned post-hoc analyses revealed that higher levels of greenness were associated with even greater mental health benefits in low-income neighborhoods: An increase in greenness from 1 SD below to 1 SD above the mean was associated with 37% lower odds of depression in low-income neighborhoods, compared to 27% and 21% lower odds of depression in medium- and high-income neighborhoods, respectively. Greenness may be effective in promoting mental health in older adults, particularly in low-income neighborhoods, possibly as a result of the increased opportunities for physical activity, social interaction, or stress mitigation.
Collapse
Affiliation(s)
- Scott C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1065, Miami, FL 33136, USA.
- University of Miami School of Architecture, 1223 Dickinson Drive, Building 48 Room 320G, Coral Gables, FL 33146, USA.
| | - Tatiana Perrino
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1065, Miami, FL 33136, USA.
| | - Joanna Lombard
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1065, Miami, FL 33136, USA.
- University of Miami School of Architecture, 1223 Dickinson Drive, Building 48 Room 320G, Coral Gables, FL 33146, USA.
| | - Kefeng Wang
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1065, Miami, FL 33136, USA.
- Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1348, Miami, FL 33136, USA.
| | - Matthew Toro
- ASU Library, Map and Geospatial Hub, Arizona State University, Tempe, AZ 85281, USA.
| | - Tatjana Rundek
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1065, Miami, FL 33136, USA.
- Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1348, Miami, FL 33136, USA.
| | - Carolina Marinovic Gutierrez
- Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1348, Miami, FL 33136, USA.
| | - Chuanhui Dong
- Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1348, Miami, FL 33136, USA.
| | - Elizabeth Plater-Zyberk
- University of Miami School of Architecture, 1223 Dickinson Drive, Building 48 Room 320G, Coral Gables, FL 33146, USA.
| | - Maria I Nardi
- Miami-Dade County Parks, Recreation and Open Spaces Department (MDPROS), 275 NW 2nd Street, Hickman Building, 3rd floor, Miami, FL 33128, USA.
| | - Jack Kardys
- Miami-Dade County Parks, Recreation and Open Spaces Department (MDPROS), 275 NW 2nd Street, Hickman Building, 3rd floor, Miami, FL 33128, USA.
| | - José Szapocznik
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Soffer Clinical Research Center Room 1065, Miami, FL 33136, USA.
- University of Miami School of Architecture, 1223 Dickinson Drive, Building 48 Room 320G, Coral Gables, FL 33146, USA.
| |
Collapse
|
10
|
Messiah SE, D’Agostino EM, Hansen E, Mathew MS, Okeke D, Nardi M, Kardys J, Arheart KL. Longitudinal Impact of a Park-Based Afterschool Healthy Weight Program on Modifiable Cardiovascular Disease Risk Factors in Youth. J Community Health 2017; 43:103-116. [DOI: 10.1007/s10900-017-0393-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
11
|
Messiah SE, Vidot D, Hansen E, Kardys J, Sunil Matthew M, Nardi M, Arheart KL. Impact of a park-based afterschool program replicated over five years on modifiable cardiovascular disease risk factors. Prev Med 2017; 95:66-73. [PMID: 27956224 DOI: 10.1016/j.ypmed.2016.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/17/2016] [Revised: 12/02/2016] [Accepted: 12/07/2016] [Indexed: 11/26/2022]
Abstract
Major challenges to the current childhood obesity epidemic include availability of prevention and/or treatment programs that are affordable and acc5essible. We evaluated the change in several modifiable, obesity-related cardiovascular disease risk factors after participation in Fit2Play™, a structured afterschool program housed in a large urban county parks system. Children ages 6-14 who participated in Fit2Play™ in one of 34 parks for one school year during a five-year period (2010-2015) had height, weight, 4-site skinfold thicknesses, systolic/diastolic blood pressure (SBP/DBP), fitness tests, and a health/wellness behavior/knowledge test collected at the beginning and end of the school year. Comparison of pre/post outcome measures were assessed via general linear mixed models for normal weight, overweight, and obese participants and both aggregate and cohort/year-specific results were generated. Aggregate (N=1546, 51% Hispanic, 44% NHB) results showed after one year of participation (U.S. Department of Health and Human Services, 2016) both the obese and overweight groups significantly decreased their mean body mass index (BMI) percentile (98th to 95th percentile, p<0.001; 91st percentile to 89th percentile, p<0.001, respectively); (Ogden et al. 2015) the normal weight group maintained a healthy BMI percentile (54.6th); (Ogden et al., 2014) mean SBP and DBP significantly decreased (3.6 percentile and 6 percentile points, respectively, p<0.001 for both). Mean number of sit-ups, push-ups, 400meter run time, and nutrition knowledge scores improved in all participants (p<0.001 for all). These findings suggest that parks-based afterschool health/wellness programs can be a low-cost, high value tool in both preventing and treating the current childhood obesity epidemic and among high-risk groups in particular.
Collapse
Affiliation(s)
- Sarah E Messiah
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Denise Vidot
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric Hansen
- Miami Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Jack Kardys
- Miami Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - M Sunil Matthew
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Nardi
- Miami Dade County Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
12
|
Messiah SE, Jiang S, Kardys J, Hansen E, Nardi M, Forster L. Reducing childhood obesity through coordinated care: Development of a park prescription program. World J Clin Pediatr 2016; 5:234-243. [PMID: 27610338 PMCID: PMC4978615 DOI: 10.5409/wjcp.v5.i3.234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/19/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Major hindrances to controlling the current childhood obesity epidemic include access to prevention and/or treatment programs that are affordable, provide minimal barriers for participation, and are available to the general public. Moreover, successful childhood obesity prevention efforts will require coordinated partnerships in multiple sectors such as government, health care, school/afterschool, and the community but very few documented sustainable programs currently exist. Effective, community-based health and wellness programs with a focus on maintaining healthy weight via physical activity and healthy eating have the potential to be a powerful referral resource for pediatricians and other healthcare professionals who have young patients who are overweight/obese. The Miami Dade County Department of Parks, Recreation and Open Spaces in partnership with the University of Miami UHealth Systems have created a “Park Prescription Program (Parks Rx 4HealthTM)” that formally coordinates pediatricians, families, parents, caregivers, and child/adolescents to provide daily obesity-prevention activities. This Parks Rx 4HealthTM program that we describe here allows UHealth pediatricians to seamlessly refer their overweight and obese patients to Fit2PlayTM, an evidence-based, park-based afterschool health and wellness program. Measurable outcomes that include body mass index, blood pressure, fitness, and nutrition knowledge are being collected at baseline and at 3-and 6-mo after referral to document patient progress. Results are then shared with the referring physician so they can follow up with the patient if necessary. Identifying successful models that integrate primary care, public health, and community-based efforts is important to accelerating progress in preventing childhood obesity. Effective, community-based health and wellness programs with a focus on physical activity and nutrition education could be a powerful referral resource for pediatricians who have obese patients.
Collapse
|
13
|
Brown SC, Lombard J, Wang K, Byrne MM, Toro M, Plater-Zyberk E, Feaster DJ, Kardys J, Nardi MI, Perez-Gomez G, Pantin HM, Szapocznik J. Neighborhood Greenness and Chronic Health Conditions in Medicare Beneficiaries. Am J Prev Med 2016; 51:78-89. [PMID: 27061891 DOI: 10.1016/j.amepre.2016.02.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [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: 07/26/2015] [Revised: 01/11/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Prior studies suggest that exposure to the natural environment may impact health. The present study examines the association between objective measures of block-level greenness (vegetative presence) and chronic medical conditions, including cardiometabolic conditions, in a large population-based sample of Medicare beneficiaries in Miami-Dade County, Florida. METHODS The sample included 249,405 Medicare beneficiaries aged ≥65 years whose location (ZIP+4) within Miami-Dade County, Florida, did not change, from 2010 to 2011. Data were obtained in 2013 and multilevel analyses conducted in 2014 to examine relationships between greenness, measured by mean Normalized Difference Vegetation Index from satellite imagery at the Census block level, and chronic health conditions in 2011, adjusting for neighborhood median household income, individual age, gender, race, and ethnicity. RESULTS Higher greenness was significantly associated with better health, adjusting for covariates: An increase in mean block-level Normalized Difference Vegetation Index from 1 SD less to 1 SD more than the mean was associated with 49 fewer chronic conditions per 1,000 individuals, which is approximately similar to a reduction in age of the overall study population by 3 years. This same level of increase in mean Normalized Difference Vegetation Index was associated with a reduced risk of diabetes by 14%, hypertension by 13%, and hyperlipidemia by 10%. Planned post-hoc analyses revealed stronger and more consistently positive relationships between greenness and health in lower- than higher-income neighborhoods. CONCLUSIONS Greenness or vegetative presence may be effective in promoting health in older populations, particularly in poor neighborhoods, possibly due to increased time outdoors, physical activity, or stress mitigation.
Collapse
Affiliation(s)
- Scott C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; University of Miami School of Architecture, Coral Gables, Florida.
| | - Joanna Lombard
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; University of Miami School of Architecture, Coral Gables, Florida
| | - Kefeng Wang
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Margaret M Byrne
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Matthew Toro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth Plater-Zyberk
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; University of Miami School of Architecture, Coral Gables, Florida
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Jack Kardys
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, Florida
| | - Maria I Nardi
- Miami-Dade County Department of Parks, Recreation and Open Spaces, Miami, Florida
| | - Gianna Perez-Gomez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Hilda M Pantin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - José Szapocznik
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; University of Miami School of Architecture, Coral Gables, Florida
| |
Collapse
|
14
|
Haney K, Messiah SE, Arheart KL, Hanson E, Diego A, Kardys J, Kirwin K, Nottage R, Ramirez S, Somarriba G, Binhack L. Park-based afterschool program to improve cardiovascular health and physical fitness in children with disabilities. Disabil Health J 2014; 7:335-42. [PMID: 24947575 DOI: 10.1016/j.dhjo.2014.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 10/10/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Children with disabilities are more likely to be overweight or obese and less likely to engage in physical activities versus their peers without disabilities. OBJECTIVE The effect of a structured afterschool program housed in a large county parks system on several obesity-related health outcomes among children with disabilities was examined. METHODS Children/adolescents with a developmental and/or intellectual disability ages 6-22 (N = 52, mean age 13.7 years) who participated in an afterschool (either 2010-2011 or 2011-2012 school year) health and wellness program called Fit-2-Play™ were assessed. Pre-post comparison of outcome variables (mean height, weight, waist/hip/midarm circumference, fitness tests, and a 9-item health and wellness knowledge assessment) via general linear mixed models analysis was conducted to evaluate the effectiveness of the program for normal and overweight/obese participants. RESULTS Normal weight participants significantly improved pre-post mean number of push-ups (9.69-14.23, p = 0.01) and laps on the PACER test (8.54-11.38, p < 0.01) and the overweight/obese group significantly improved the number of sit ups (7.51-9.84, p < 0.01) and push ups (4.77-9.89, p < 0.001). Pre-post mean health and wellness knowledge composite scores significantly improved for all participants (p < 0.01). CONCLUSIONS Parks-based afterschool programs can be effective community resources for instilling physical health in both normal weight and overweight/obese children with disabilities. More studies are needed to ascertain whether community-based afterschool health and wellness programs can be implemented and sustained across this population.
Collapse
Affiliation(s)
- Kanathy Haney
- Department of Epidemiology and Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Sarah E Messiah
- Department of Epidemiology and Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA; Department of Pediatrics, Division of Pediatric Clinical Research, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
| | - Kristopher L Arheart
- Department of Epidemiology and Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA; Department of Pediatrics, Division of Pediatric Clinical Research, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Eric Hanson
- Miami Dade Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Allison Diego
- Miami Dade Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Jack Kardys
- Miami Dade Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Kevin Kirwin
- Miami Dade Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Renae Nottage
- Miami Dade Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Shawn Ramirez
- Miami Dade Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| | - Gabriel Somarriba
- Department of Pediatrics, Division of Pediatric Clinical Research, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Lucy Binhack
- Miami Dade Department of Parks, Recreation and Open Spaces, Miami, FL, USA
| |
Collapse
|
15
|
Messiah SE, Diego A, Kardys J, Kirwin K, Hanson E, Nottage R, Ramirez S, Arheart KL. Effect of a park-based after-school program on participant obesity-related health outcomes. Am J Health Promot 2014; 29:217-25. [PMID: 24460001 DOI: 10.4278/ajhp.120705-quan-327] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE The objective of this study was to examine the effect of a structured after-school program housed in a large county parks system on participant health and wellness outcomes. DESIGN Longitudinal cohort study over one school year (fall 2011-spring 2012). SETTING A total of 23 county parks in Florida. SUBJECTS Children ages 5 to 16 (N = 349, 55% non-Hispanic black, 40% Hispanic, mean age 8.9 years). INTERVENTION An after-school program called Fit-2-Play that integrates daily standardized physical activity and health and wellness education components. MEASURES Preintervention (August/September 2011) and postintervention (May/June 2012) anthropometric, systolic/diastolic blood pressure, fitness, and health and wellness knowledge measurements were collected. ANALYSIS Comparison of pre-post outcome measure means were assessed via general linear mixed models for normal-weight (body mass index [BMI] <85th percentile for age and sex) and overweight/obese (BMI ≥85th percentile for age and sex) participants. RESULTS The overweight/obese group significantly decreased their mean (1) BMI z score (2.0 to 1.8, p < .01) and (2) subscapular skinfold measurements (19.4 to 17.5 mm, p < .01) and increased (1) mean laps on the Progressive Aerobic Cardiovascular Endurance Run test (10.8 to 12.5, p = .04) and (2) percentage with normal systolic blood pressure (58.1% to 71.0%, p = .03) from pretest to posttest. On average, participants significantly improved their health and wellness knowledge over the school year (p < .01). Normal-weight participants maintained healthy BMI ranges and significantly increased fitness levels. CONCLUSION Findings suggest that the Fit-2-Play after-school programs can be a significant resource for combating childhood obesity and instilling positive physical health in children, particularly among ethnic and socioeconomically diverse communities.
Collapse
|