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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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India-Aldana S, Rundle AG, Quinn JW, Clendenen TV, Afanasyeva Y, Koenig KL, Liu M, Neckerman KM, Thorpe LE, Zeleniuch-Jacquotte A, Chen Y. Long-Term Exposure to Walkable Residential Neighborhoods and Risk of Obesity-Related Cancer in the New York University Women's Health Study (NYUWHS). Environ Health Perspect 2023; 131:107001. [PMID: 37791759 PMCID: PMC10548871 DOI: 10.1289/ehp11538] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Living in neighborhoods with higher levels of walkability has been associated with a reduced risk of obesity and higher levels of physical activity. Obesity has been linked to increased risk of 13 cancers in women. However, long-term prospective studies of neighborhood walkability and risk for obesity-related cancer are scarce. OBJECTIVES We evaluated the association between long-term average neighborhood walkability and obesity-related cancer risk in women. METHODS The New York University Women's Health Study (NYUWHS) is a prospective cohort with 14,274 women recruited between 1985 and 1991 in New York City and followed over nearly three decades. We geocoded residential addresses for each participant throughout follow-up and calculated an average annual measure of neighborhood walkability across years of follow-up using data on population density and accessibility to destinations associated with geocoded residential addresses. We used ICD-9 codes to characterize first primary obesity-related cancers and employed Cox proportional hazards models to assess the association between average neighborhood walkability and risk of overall and site-specific obesity-related cancers. RESULTS Residing in neighborhoods with a higher walkability level was associated with a reduced risk of overall and site-specific obesity-related cancers. The hazards ratios associated with a 1-standard deviation increase in average annual neighborhood walkability were 0.88 (95% CI: 0.85, 0.93) for overall obesity-related cancer, 0.89 (95% CI: 0.84, 0.95) for postmenopausal breast cancer, 0.82 (95% CI: 0.68, 0.99) for ovarian cancer, 0.87 (95% CI: 0.76, 0.99) for endometrial cancer, and 0.68 (95% CI: 0.49, 0.94) for multiple myeloma, adjusting for potential confounders at both the individual and neighborhood level. The association between neighborhood walkability and risk of overall obesity-related cancer was stronger among women living in neighborhoods with higher levels of poverty compared with women living in areas with lower poverty levels (p Interaction = 0.006 ). DISCUSSION Our study highlights a potential protective role of neighborhood walkability in preventing obesity-related cancers in women. https://doi.org/10.1289/EHP11538.
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Affiliation(s)
- Sandra India-Aldana
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - James W. Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tess V. Clendenen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Yelena Afanasyeva
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Karen L. Koenig
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Mengling Liu
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, New York, USA
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Kathryn M. Neckerman
- Columbia Population Research Center, Columbia University, New York, New York, USA
| | - Lorna E. Thorpe
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, New York, 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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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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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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India-Aldana S, Rundle AG, Clendenen TV, Quinn JW, Arslan AA, Afanasyeva Y, Koenig KL, Liu M, Neckerman KM, Thorpe LE, Zeleniuch-Jacquotte A, Chen Y. Neighborhood walkability and sex steroid hormone levels in women. Environ Res 2022; 215:114285. [PMID: 36088991 PMCID: PMC10039647 DOI: 10.1016/j.envres.2022.114285] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Neighborhood walkability (NW) has been linked to increased physical activity, which in turn is associated with lower concentrations of sex hormones and higher concentration of SHBG in women. However, no study has directly examined the association of NW with female sex hormone levels. OBJECTIVE We conducted a cross-sectional study to evaluate the association between NW and circulating levels of sex hormones and SHBG in pre- and post-menopausal women. METHODS We included 797 premenopausal and 618 postmenopausal women from the New York University Women's Health Study (NYUWHS) who were healthy controls in previous nested case-control studies in which sex hormones (androstenedione, testosterone, DHEAS, estradiol and estrone) and SHBG had been measured in serum at enrollment. Baseline residential addresses were geo-coded and the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) was calculated. Generalized Estimating Equations were used to assess the association between BEH-NWI and sex hormone and SHBG concentrations adjusting for individual- and neighborhood-level factors. RESULTS In premenopausal women, a one standard deviation (SD) increment in BEH-NWI was associated with a 3.5% (95% CI 0.9%-6.1%) lower DHEAS concentration. In postmenopausal women, a one SD increment in BEH-NWI was related to an 8.5% (95% CI 5.4%-11.5%) lower level of DHEAS, a 3.7% (95% CI 0.5%-6.8%) lower level of testosterone, a 1.8% (95% CI 0.5%-3.0%) lower level of estrone, and a 4.2% (95% CI 2.7%-5.7%) higher level of SHBG. However, the associations with respect to DHEAS and estrone became apparent only after adjusting for neighborhood-level variables. Sensitivity analyses using fixed effects meta-analysis and inverse probability weighting accounting for potential selection bias yielded similar results. CONCLUSION Our findings suggest that NW is associated with lower concentrations of androgens and estrone, and increased SHBG, in postmenopausal women, and lower levels of DHEAS in premenopausal women.
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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
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Tess V Clendenen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - James W Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Alan A Arslan
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA; Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, New York, NY, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Yelena Afanasyeva
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Karen L Koenig
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Mengling Liu
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA; Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Kathryn M Neckerman
- Columbia Population Research Center, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, 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
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, 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.
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Albanese NNY, Lin I, Friedberg JP, Lipsitz SR, Rundle A, Quinn JW, Neckerman KM, Nicholson A, Allegrante JP, Wylie-Rosett J, Natarajan S. Association of the built environment and neighborhood resources with obesity-related health behaviors in older veterans with hypertension. Health Psychol 2022; 41:701-709. [PMID: 35389690 PMCID: PMC10110294 DOI: 10.1037/hea0001161] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the association of the built environment and neighborhood resources with exercise, diet, and body mass index (BMI). METHOD Person-level data were collected from 533 veterans with uncontrolled hypertension. Neighborhood measures were: (a) census-tract level walkability; and (b) healthy food proximity (HFP). Robust or logistic regression (adjusting for age, race, education, comorbidity, and clustered by provider) was used to evaluate associations between neighborhood and exercise duration (hours/week), exercise adherence (% adherent), saturated fat index (0-10), Healthy Eating Index (HEI; 0-100), HEI adherence (≥ 74 score), stage of change (SOC) for exercise and diet (% in action/maintenance), BMI (kg/m²), and obesity (BMI ≥ 30 kg/m²). RESULTS The adjusted difference in HEI score (standard error [SE]) between the highest and lowest walkability tertiles was 3.67 (1.35), p = .006; the corresponding comparison for the saturated fat index was 1.03 (.50), p = .041 and BMI was -1.12 (.45), p = .013. The adjusted odds ratio (OR; 95% confidence intervals [CI]) between the highest and lowest walkability tertiles for HEI adherence was 2.16 [1.22, 3.82], p = .009 and for action/maintenance for exercise SOC was 1.78 [1.15, 2.76], p = .011. The adjusted difference (SE) between the highest and lowest HFP tertiles for exercise duration was .65 (.31), p = .03. The adjusted OR [95% CI] between the highest and lowest HFP tertiles for exercise adherence was 1.74 [1.08, 2.79], p = .023 and for action/maintenance for exercise SOC was 1.75 [1.10, 2.79], p = .034. CONCLUSIONS Geographical location is associated with exercise and diet. Environment-tailored health recommendations could promote healthier lifestyles and decrease obesity-related cardiovascular disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Iris Lin
- Research and Development Service
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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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India-Aldana S, Rundle AG, Zeleniuch-Jacquotte A, Quinn JW, Kim B, Afanasyeva Y, Clendenen TV, Koenig KL, Liu M, Neckerman KM, Thorpe LE, Chen Y. Neighborhood Walkability and Mortality in a Prospective Cohort of Women. Epidemiology 2021; 32:763-772. [PMID: 34347687 PMCID: PMC8969891 DOI: 10.1097/ede.0000000000001406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of prospective cohort studies evaluating neighborhood walkability in relation to the risk of death. METHODS We geocoded baseline residential addresses of 13,832 women in the New York University Women's Health Study (NYUWHS) and estimated the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) for each participant circa 1990. The participants were recruited from 1985 to 1991 in New York City and followed for an average of 27 years. We conducted survival analyses using Cox proportional hazards models to assess the association between neighborhood walkability and risk of death from any cause, obesity-related diseases, cardiometabolic diseases, and obesity-related cancers. RESULTS Residing in a neighborhood with a higher neighborhood walkability score was associated with a lower mortality rate. Comparing women in the top versus the lowest walkability tertile, the hazards ratios (and 95% CIs) were 0.96 (0.93, 0.99) for all-cause, 0.91 (0.86, 0.97) for obesity-related disease, and 0.72 (0.62, 0.85) for obesity-related cancer mortality, respectively, adjusting for potential confounders at both the individual and neighborhood level. We found no association between neighborhood walkability and risk of death from cardiometabolic diseases. Results were similar in analyses censoring participants who moved during follow-up, using multiple imputation for missing covariates, and using propensity scores matching women with high and low neighborhood walkability on potential confounders. Exploratory analyses indicate that outdoor walking and average BMI mediated the association between neighborhood walkability and mortality. CONCLUSION Our findings are consistent with a protective role of neighborhood walkability in obesity-related mortality in women, particularly obesity-related cancer mortality.
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Affiliation(s)
- Sandra India-Aldana
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - James W. Quinn
- Columbia Population Research Center, Columbia University
| | - Byoungjun Kim
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Yelena Afanasyeva
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Tess V. Clendenen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Karen L. Koenig
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 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, 5 Fl., New York, NY, 10016, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
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10
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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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11
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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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12
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Hirsch JA, Zhao Y, Bilal U, Neckerman KM, Michael YL. Health and Health-Related Resources in Newly Designated Federally Qualified Opportunity Zones: United States, 2012-2016. Am J Public Health 2020; 110:407-415. [PMID: 31944851 DOI: 10.2105/ajph.2019.305489] [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: 11/04/2022]
Abstract
Objectives. To characterize health and health-related resources in the new qualified opportunity zones (QOZs) relative to tracts not selected or not eligible for this federal investment incentive.Methods. We used tract-level data from the 498 largest cities in the contiguous United States (n = 24 409), categorized using designations from the Department of Treasury. We compiled data on population characteristics, health-related resources, and health from the American Community Survey, the National Establishment Time Series, the National Land Cover Dataset, and the US Small-Area Life Expectancy Estimates Project and the 500 Cities projects. We calculated means and SDs for ineligible, eligible (but not designated), and designated QOZ tracts.Results. In general, designated QOZ tracts had lower access to health care facilities, physical activity resources, and healthy food. They had a higher prevalence of unhealthy behaviors and worse health outcomes across most measures.Conclusions. By benchmarking conditions, we facilitate tracking and assessment of QOZ impacts.Public Health Implications. QOZ could spur unprecedented neighborhood change with substantial influence on health resources and outcomes. Public health collaboration and strategic local governance of QOZ will be crucial for yielding health benefits for existing residents.
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Affiliation(s)
- Jana A Hirsch
- Jana A. Hirsch, Yuzhe Zhao, Usama Bilal, and Yvonne L. Michael are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Jana A. Hirsch, Usama Bilal, and Yvonne L. Michael are also with Department of Epidemiology and Biostatistics, Dornsife School of Public Health. Kathryn M. Neckerman is with the Columbia Population Research Center, Columbia University, New York, NY
| | - Yuzhe Zhao
- Jana A. Hirsch, Yuzhe Zhao, Usama Bilal, and Yvonne L. Michael are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Jana A. Hirsch, Usama Bilal, and Yvonne L. Michael are also with Department of Epidemiology and Biostatistics, Dornsife School of Public Health. Kathryn M. Neckerman is with the Columbia Population Research Center, Columbia University, New York, NY
| | - Usama Bilal
- Jana A. Hirsch, Yuzhe Zhao, Usama Bilal, and Yvonne L. Michael are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Jana A. Hirsch, Usama Bilal, and Yvonne L. Michael are also with Department of Epidemiology and Biostatistics, Dornsife School of Public Health. Kathryn M. Neckerman is with the Columbia Population Research Center, Columbia University, New York, NY
| | - Kathryn M Neckerman
- Jana A. Hirsch, Yuzhe Zhao, Usama Bilal, and Yvonne L. Michael are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Jana A. Hirsch, Usama Bilal, and Yvonne L. Michael are also with Department of Epidemiology and Biostatistics, Dornsife School of Public Health. Kathryn M. Neckerman is with the Columbia Population Research Center, Columbia University, New York, NY
| | - Yvonne L Michael
- Jana A. Hirsch, Yuzhe Zhao, Usama Bilal, and Yvonne L. Michael are with the Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Jana A. Hirsch, Usama Bilal, and Yvonne L. Michael are also with Department of Epidemiology and Biostatistics, Dornsife School of Public Health. Kathryn M. Neckerman is with the Columbia Population Research Center, Columbia University, New York, NY
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13
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Kaufman TK, Rundle A, Neckerman KM, Sheehan DM, Lovasi GS, Hirsch JA. Neighborhood Recreation Facilities and Facility Membership Are Jointly Associated with Objectively Measured Physical Activity. J Urban Health 2019; 96:570-582. [PMID: 31037481 PMCID: PMC6677841 DOI: 10.1007/s11524-019-00357-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Indexed: 10/26/2022]
Abstract
Efforts to increase physical activity have traditionally included either individual-level interventions (e.g., educational campaigns) or neighborhood-level interventions (e.g., additional recreational facilities). Little work has addressed the interaction between spatial proximity and individual characteristics related to facility use. We aimed to better understand the synergistic impact of both physical activity environments and recreational facility membership on objectively measured physical activity. Using the New York City Physical Activity and Transit (PAT) survey (n = 644), we evaluated associations between counts of commercial physical activity facilities within 1 km of participants' home addresses with both facility membership and accelerometry-measured physical activity. Individuals living near more facilities were more likely to report membership (adjusted odds ratio for top versus bottom quartile of facility count: 3.77 (95% CI 1.54-9.20). Additionally, while amount of facilities within a neighborhood was associated with more physical activity, this association was stronger for individuals reporting gym membership. Interventions aiming to increase physical activity should consider both neighborhood amenities and potential barriers, including the financial and social barriers of membership. Evaluation of neighborhood opportunities must expand beyond physical presence to consider multiple dimensions of accessibility.
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Affiliation(s)
| | | | | | | | - Gina S Lovasi
- Urban Health Collaborative, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA, 19104, USA
| | - Jana A Hirsch
- Urban Health Collaborative, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA, 19104, USA.
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14
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Rundle AG, Chen Y, Quinn JW, Rahai N, Bartley K, Mooney SJ, Bader MD, Zeleniuch-Jacquotte A, Lovasi GS, Neckerman KM. Development of a Neighborhood Walkability Index for Studying Neighborhood Physical Activity Contexts in Communities across the U.S. over the Past Three Decades. J Urban Health 2019; 96:583-590. [PMID: 31214976 PMCID: PMC6677835 DOI: 10.1007/s11524-019-00370-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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] [Indexed: 10/26/2022]
Abstract
To examine how urban form shapes physical activity and health over time, a measure of neighborhood walkability is needed that can be linked to cohort studies with participants living across the United States (U.S.) that have been followed over the past decades. The Built Environment and Health-Neighborhood Walkability Index (BEH-NWI), a measure of neighborhood walkability that can be calculated for communities across the United States between 1990 and 2015, was conceptualized, developed, and tested using data from the New York City Tri-State Area. BEH-NWI measures were created for 1990 and 2010 using historical data on population density, street intersection density, density of rail stops, and density of pedestrian trip generating/supporting establishments. BEH-NWI scores were calculated for 1-km buffers around the 1990 residences of NYU Women's Health Study (NYUWHS) participants and NYC Department of Health and Mental Hygiene's Physical Activity and Transit (PAT) survey participants enrolled in 2011. Higher neighborhood BEH-NWI scores were significantly associated with greater self-reported walking per week (+ 0.31 MET-hours/week per unit BEH-NWI, 95% CI 0.23, 0.36) and lower body mass index (- 0.17 BMI units per unit BEH-NWI, 95% - 0.23, - 0.12) among NYUWHS participants. Higher neighborhood BEH-NWI scores were associated with significantly higher accelerometer-measured physical activity among PAT survey participants (39% more minutes of moderate-intensity equivalent activity/week across the interquartile range of BEH-NWI, 95% CI 21%, 60%). The BEH-NWI can be calculated using historical data going back to 1990, and BEH-NWI scores predict BMI, weekly walking, and physical activity in two NYC area datasets.
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Affiliation(s)
- Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.
| | - Yu Chen
- Division of Epidemiology, Department of Population Health and Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - James W Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Neloufar Rahai
- Division of Epidemiology, Department of Population Health and Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Katherine Bartley
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, USA
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Michael D Bader
- Department of Sociology, American University, Washington, DC, USA
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health and Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Gina S Lovasi
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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15
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Berger N, Kaufman TK, Bader MDM, Rundle AG, Mooney SJ, Neckerman KM, Lovasi GS. Disparities in trajectories of changes in the unhealthy food environment in New York City: A latent class growth analysis, 1990-2010. Soc Sci Med 2019; 234:112362. [PMID: 31247345 DOI: 10.1016/j.socscimed.2019.112362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/06/2019] [Revised: 04/08/2019] [Accepted: 06/10/2019] [Indexed: 11/27/2022]
Abstract
Disparities in availability of food retailers in the residential environment may help explain racial/ethnic and socio-economic differences in obesity risk. Research is needed that describes whether food environment dynamics may contribute to equalizing conditions across neighborhoods or to amplifying existing inequalities over time. This study improves the understanding of how the BMI-unhealthy food environment has evolved over time in New York City. We use longitudinal census tract-level data from the National Establishment Time-Series (NETS) for New York City in the period 1990-2010 and implement latent class growth analysis (LCGA) to (1) examine trajectories of change in the number of unhealthy food outlets (characterized as selling calorie-dense foods such as pizza and pastries) at the census tract-level, and (2) examine how trajectories are related to socio-demographic characteristics of the census tract. Overall, the number of BMI-unhealthy food outlets increased between 1990 and 2010. We summarized trajectories of evolutions with a 5-class model that indicates a pattern of fanning out, such that census tracts with a higher initial number of BMI-unhealthy food outlets in 1990 experienced a more rapid increase over time. Finally, fully adjusted logistic regression models reveal a greater increase in BMI-unhealthy food outlets in census tracts with: higher baseline population size, lower baseline income, and lower proportion of Black residents. Greater BMI-unhealthy food outlet increases were also noted in the context of census tracts change suggestive of urbanization (increasing population density) or increasing purchasing power (increasing income).
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Affiliation(s)
- Nicolas Berger
- Population Health Innovation Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Tanya K Kaufman
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - Michael D M Bader
- Center on Health, Risk, and Society, American University, Washington, DC, United States.
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
| | - Stephen J Mooney
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, United States.
| | - Kathryn M Neckerman
- Columbia Population Research Center, Columbia University, New York, NY, United States.
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States.
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16
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Abstract
Purpose. To examine whether urban form is associated with body size within a densely-settled city. Design. Cross-sectional analysis using multilevel modeling to relate body mass index (BMI) to built environment resources. Setting. Census tracts (n = 1989) within the five boroughs of New York City. Subjects. Adult volunteers (n = 13,102) from the five boroughs of New York City recruited between January 2000 and December 2002. Measures. The dependent variable was objectively-measured BMI. Independent variables included land use mix; bus and subway stop density; population density; and intersection density. Covariates included age, gender, race, education, and census tract–level poverty and race/ethnicity. Analysis. Cross-sectional multilevel analyses. Results. Mixed land use (Beta = 2.55, p < .01), density of bus stops (Beta = −.01, p < .01) and subway stops (Beta = −.06, p < .01), and population density (Beta = −.25, p < .001), but not intersection density (Beta = −.002) were significantly inversely associated with BMI after adjustment for individual- and neighborhood-level sociodemographic characteristics. Comparing the 90th to the 10th percentile of each built environment variable, the predicted adjusted difference in BMI with increased mixed land use was −.41 units, with bus stop density was −.33 units, with subway stop density was −.34 units, and with population density was −.86 units. Conclusion. BMI is associated with built environment characteristics in New York City.
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Affiliation(s)
- Andrew Rundle
- Mailman School of Public Health, 722 West 168th Street, Room 730, New York, NY 10032, USA.
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17
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Mooney SJ, DiMaggio CJ, Lovasi GS, Neckerman KM, Bader MDM, Teitler JO, Sheehan DM, Jack DW, Rundle AG. Use of Google Street View to Assess Environmental Contributions to Pedestrian Injury. Am J Public Health 2016; 106:462-9. [PMID: 26794155 DOI: 10.2105/ajph.2015.302978] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To demonstrate an information technology-based approach to assess characteristics of streets and intersections associated with injuries that is less costly and time-consuming than location-based studies of pedestrian injury. METHODS We used imagery captured by Google Street View from 2007 to 2011 to assess 9 characteristics of 532 intersections within New York City. We controlled for estimated pedestrian count and estimated the relation between intersections' characteristics and frequency of injurious collisions. RESULTS The count of pedestrian injuries at intersections was associated with the presence of marked crosswalks (80% increase; 95% confidence interval [CI] = 2%, 218%), pedestrian signals (156% increase; 95% CI = 69%, 259%), nearby billboards (42% increase; 95% CI = 7%, 90%), and bus stops (120% increase; 95% CI = 51%, 220%). Injury incidence per pedestrian was lower at intersections with higher estimated pedestrian volumes. CONCLUSIONS Consistent with in-person study observations, the information-technology approach found traffic islands, visual advertising, bus stops, and crosswalk infrastructures to be associated with elevated counts of pedestrian injury in New York City. Virtual site visits for pedestrian injury control studies are a viable and informative methodology.
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Affiliation(s)
- Stephen J Mooney
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
| | - Charles J DiMaggio
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
| | - Gina S Lovasi
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
| | - Kathryn M Neckerman
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
| | - Michael D M Bader
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
| | - Julien O Teitler
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
| | - Daniel M Sheehan
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
| | - Darby W Jack
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
| | - Andrew G Rundle
- Stephen J. Mooney, Charles J. DiMaggio, Gina S. Lovasi, Daniel M. Sheehan, and Andrew G. Rundle are with Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Kathryn M. Neckerman is with Columbia Population Research Center, Columbia University. Michael D. M. Bader is with Department of Sociology, American University, Washington, DC. Julien O. Teitler is with School of Social Work, Columbia University. Darby W. Jack is with Department of Environmental Health Sciences, Mailman School of Public Health
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18
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Quinn JW, Mooney SJ, Sheehan DM, Teitler JO, Neckerman KM, Kaufman TK, Lovasi GS, Bader MDM, Rundle AG. Neighborhood Physical Disorder in New York City. J Maps 2016; 12:53-60. [PMID: 27482283 PMCID: PMC4963033 DOI: 10.1080/17445647.2014.978910] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 05/22/2023]
Abstract
Neighborhood physical disorder, or the deterioration of urban environments, is associated with negative mental and physical health outcomes. Eleven trained raters used CANVAS, a web-based system for conducting reliable virtual street audits, to collect data on nine indicators of physical disorder using Google Street View imagery of 532 block faces in New York City, New York, USA. We combined the block face indicator data into a disorder scale using item response theory; indicators ranged in severity from presence of litter, a weak indicator of disorder, to abandoned cars, a strong indicator. Using this scale, we estimated disorder at the center point of each sampled block. We then used ordinary kriging to interpolate estimates of disorder levels throughout the city. The resulting map condenses a complex estimation process into an interpretable visualization of the spatial distribution of physical disorder in New York City.
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Affiliation(s)
- James W Quinn
- Department of Epidemiology, Mailman School of Public Health, 722 W 168 St 7 Floor, New York NY 10032,
| | - Stephen J Mooney
- Department of Epidemiology, Mailman School of Public Health, 722 W 168 St 7 Floor, New York NY 10032,
| | - Daniel M Sheehan
- Department of Epidemiology, Mailman School of Public Health, 722 W 168 St 7 Floor, New York NY 10032,
| | - Julien O Teitler
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York NY 10027, New York NY 10027,
| | - Kathryn M Neckerman
- Columbia Population Research Center, 1255 Amsterdam Avenue, Room 715, New York NY 10027,
| | - Tanya K Kaufman
- Department of Epidemiology, Mailman School of Public Health, 722 W 168 St 8 Floor, New York NY 10032,
| | - Gina S Lovasi
- Department of Epidemiology, Mailman School of Public Health, 722 W 168 St 8 Floor, New York NY 10032,
| | - Michael D M Bader
- Department of Sociology and Center on Health, Risk and Society, American University, 4400 Massachusetts Ave., NW, Washington, DC 20016,
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, 722 West 168th Street, New York NY 10032,
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Kaufman TK, Sheehan DM, Rundle A, Neckerman KM, Bader MDM, Jack D, Lovasi GS. Measuring health-relevant businesses over 21 years: refining the National Establishment Time-Series (NETS), a dynamic longitudinal data set. BMC Res Notes 2015; 8:507. [PMID: 26420471 PMCID: PMC4588464 DOI: 10.1186/s13104-015-1482-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 09/21/2015] [Indexed: 11/30/2022] Open
Abstract
Background The densities of food retailers, alcohol outlets, physical activity facilities, and medical facilities have been associated with diet, physical activity, and management of medical conditions. Most of the research, however, has relied on cross-sectional studies. In this paper, we assess methodological issues raised by a data source that is increasingly used to characterize change in the local business environment: the National Establishment Time Series (NETS) dataset. Discussion Longitudinal data, such as NETS, offer opportunities to assess how differential access to resources impacts population health, to consider correlations among multiple environmental influences across the life course, and to gain a better understanding of their interactions and cumulative health effects. Longitudinal data also introduce new data management, geoprocessing, and business categorization challenges. Examining geocoding accuracy and categorization over 21 years of data in 23 counties surrounding New York City (NY, USA), we find that health-related business environments change considerably over time. We note that re-geocoding data may improve spatial precision, particularly in early years. Our intent with this paper is to make future public health applications of NETS data more efficient, since the size and complexity of the data can be difficult to exploit fully within its 2-year data-licensing period. Further, standardized approaches to NETS and other “big data” will facilitate the veracity and comparability of results across studies. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1482-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tanya K Kaufman
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, 8th Floor, New York, NY, 10032, USA. .,NYC Department of Health and Mental Hygiene, Brooklyn District Public Health Office, 485 Throop Avenue, Brooklyn, New York, NY, 11221, USA.
| | - Daniel M Sheehan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, 8th Floor, New York, NY, 10032, USA.
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, 8th Floor, New York, NY, 10032, USA.
| | - Kathryn M Neckerman
- Columbia Population Research Center, 1255 Amsterdam Avenue, Room 715, New York, NY, 10027, USA.
| | - Michael D M Bader
- Department of Sociology, Center on Health, Risk and Society, American University, Battelle-Thompkins T-15, 4400 Massachusetts Ave., N.W., Washington DC, 20016, USA.
| | - Darby Jack
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, 11th Floor, New York, NY, 10032, USA.
| | - Gina S Lovasi
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, 8th Floor, New York, NY, 10032, USA.
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Bader MDM, Mooney SJ, Lee YJ, Sheehan D, Neckerman KM, Rundle AG, Teitler JO. Development and deployment of the Computer Assisted Neighborhood Visual Assessment System (CANVAS) to measure health-related neighborhood conditions. Health Place 2014; 31:163-72. [PMID: 25545769 DOI: 10.1016/j.healthplace.2014.10.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [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: 08/23/2013] [Revised: 09/23/2014] [Accepted: 10/28/2014] [Indexed: 11/15/2022]
Abstract
Public health research has shown that neighborhood conditions are associated with health behaviors and outcomes. Systematic neighborhood audits have helped researchers measure neighborhood conditions that they deem theoretically relevant but not available in existing administrative data. Systematic audits, however, are expensive to conduct and rarely comparable across geographic regions. We describe the development of an online application, the Computer Assisted Neighborhood Visual Assessment System (CANVAS), that uses Google Street View to conduct virtual audits of neighborhood environments. We use this system to assess the inter-rater reliability of 187 items related to walkability and physical disorder on a national sample of 150 street segments in the United States. We find that many items are reliably measured across auditors using CANVAS and that agreement between auditors appears to be uncorrelated with neighborhood demographic characteristics. Based on our results we conclude that Google Street View and CANVAS offer opportunities to develop greater comparability across neighborhood audit studies.
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Affiliation(s)
- Michael D M Bader
- Department of Sociology and Center on Health, Risk and Society, American University, Washington, DC, United States.
| | - Stephen J Mooney
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Yeon Jin Lee
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Sheehan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Kathryn M Neckerman
- Columbia Population Research Center, Columbia University, New York, NY, United States
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Julien O Teitler
- School of Social Work, Columbia University, New York, NY, United States
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Mooney SJ, Bader MDM, Lovasi GS, Neckerman KM, Teitler JO, Rundle AG. Validity of an ecometric neighborhood physical disorder measure constructed by virtual street audit. Am J Epidemiol 2014; 180:626-35. [PMID: 25122584 DOI: 10.1093/aje/kwu180] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [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] [Indexed: 12/31/2022] Open
Abstract
Neighborhood physical disorder is thought to affect mental and physical health, but it has been difficult to measure objectively and reliably across large geographical areas or multiple locales. Virtual street audits are a novel method for assessing neighborhood characteristics. We evaluated the ecometric properties of a neighborhood physical disorder measure constructed from virtual street audit data. Eleven trained auditors assessed 9 previously validated items developed to capture physical disorder (e.g., litter, graffiti, and abandoned buildings) on 1,826 block faces using Google Street View imagery (Google, Inc., Mountain View, California) dating from 2007-2011 in 4 US cities (San Jose, California; Detroit, Michigan; New York, New York; and Philadelphia, Pennsylvania). We constructed a 2-parameter item response theory scale to estimate latent levels of disorder on each block face and defined a function using kriging to estimate physical disorder levels, with confidence estimates, for any point in each city. The internal consistency reliability of the resulting scale was 0.93. The final measure of disorder was positively correlated with US Census data on unemployment and housing vacancy and negatively correlated with data on owner-occupied housing. These results suggest that neighborhood physical disorder can be measured reliably and validly using virtual audits, facilitating research on possible associations between physical disorder and health.
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Affiliation(s)
- Kathryn M Neckerman
- Columbia Population Research Center, Columbia University, New York, NY 10027, USA
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Lovasi GS, Schwartz-Soicher O, Neckerman KM, Konty K, Kerker B, Quinn J, Rundle A. Aesthetic amenities and safety hazards associated with walking and bicycling for transportation in New York City. Ann Behav Med 2014; 45 Suppl 1:S76-85. [PMID: 23011913 DOI: 10.1007/s12160-012-9416-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND One strategy to address health problems related to insufficient physical activity is to examine modifiable neighborhood characteristics associated with active transportation. PURPOSE The aim of this study is to evaluate whether neighborhoods with more aesthetic amenities (sidewalk cafés, street trees, and clean sidewalks) and fewer safety hazards (pedestrian-auto fatalities and homicides) are associated with active transportation. METHODS The 2003 Community Health Survey in New York City, which asked about active transportation (walking or bicycling >10 blocks) in the past 30 days, was linked to ZIP-code population census and built environment characteristics. Adjusted associations were estimated for dichotomous (any active transportation versus none) and continuous (trip frequency) active transportation outcomes. RESULTS Among 8,034 adults, those living near sidewalk cafés were 10 % more likely to report active transportation (p = 0.01). Homicide rate was associated with less frequent active transportation among those reporting any active transportation (p = 0.002). CONCLUSIONS Investments in aesthetic amenities or homicide prevention may help to promote active transportation.
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Affiliation(s)
- Gina S Lovasi
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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Neckerman KM, Lovasi L, Yousefzadeh P, Sheehan D, Milinkovic K, Baecker A, Bader MDM, Weiss C, Lovasi GS, Rundle A. Comparing nutrition environments in bodegas and fast-food restaurants. J Acad Nutr Diet 2013; 114:595-602. [PMID: 24035459 DOI: 10.1016/j.jand.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 06/26/2013] [Indexed: 11/24/2022]
Abstract
Many small grocery stores or "bodegas" sell prepared or ready-to-eat items, filling a niche in the food environment similar to fast-food restaurants. However, little comparative information is available about the nutrition environments of bodegas and fast-food outlets. This study compared the nutrition environments of bodegas and national chain fast-food restaurants using a common audit instrument, the Nutrition Environment Measures Study in Restaurants (NEMS-R) protocol. The analytic sample included 109 bodegas and 107 fast-food restaurants located in New York City neighborhoods in the upper third and lower third of the census tract poverty rate distribution. Inter-rater reliability was evaluated in 102 food outlets, including 31 from the analytic sample and 71 from a supplementary convenience sample. The analysis compared scores on individual NEMS-R items, a total summary score, and subscores indicating healthy food availability, nutrition information, promotions of healthy or unhealthy eating, and price incentives for healthy eating, using t tests and χ(2) statistics to evaluate differences by outlet type and neighborhood poverty. Fast-food restaurants were more likely to provide nutrition information, and bodegas scored higher on healthy food availability, promotions, and pricing. Bodegas and fast-food restaurants had similar NEMS-R total scores (bodegas 13.09, fast food 14.31; P=0.22). NEMS-R total scores were higher (indicating healthier environments) in low- than high-poverty neighborhoods among both bodegas (14.79 vs 11.54; P=0.01) and fast-food restaurants (16.27 vs 11.60; P<0.01). Results imply different policy measures to improve nutrition environments in the two types of food outlets.
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Lovasi GS, Schwartz-Soicher O, Quinn JW, Berger DK, Neckerman KM, Jaslow R, Lee KK, Rundle A. Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York City. Prev Med 2013; 57:189-93. [PMID: 23732240 PMCID: PMC3748212 DOI: 10.1016/j.ypmed.2013.05.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [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: 12/27/2012] [Revised: 05/15/2013] [Accepted: 05/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Neighborhood safety, green space, walkability, and sociodemographics may influence physical activity and childhood obesity. METHODS Data on measured height and weight, demographic characteristics, and home ZIP code were collected from year 2004 enrollees in a means-tested preschool program in New York City. Each ZIP code was surrounded by a 400-m buffer and characterized using data from the US census, local government departments, New York Times website, and Transportation Alternatives. Linear and Poisson models were constructed using cluster robust standard errors and adjusting for child's sex, race, ethnicity, age, and neighborhood characteristics. RESULTS Analyses included 11,562 children ages 3-5 years living in 160 residential ZIP codes. A higher homicide rate (at the 75th vs 25th percentile) was associated with a 22% higher prevalence of obesity (95% CI for the prevalence ratio (PR): 1.05 to 1.41). A higher density of street trees (at the 75th vs 25th percentile) was associated with 12% lower prevalence of obesity (95% CI for the PR: 0.79 to 0.99). Other neighborhood characteristics did not have significant associations with childhood obesity. CONCLUSIONS Among preschool children from low-income families, neighborhood homicide rate was associated with more obesity and street tree density was associated with less obesity.
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Affiliation(s)
- Gina S Lovasi
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, USA.
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Bader MDM, Schwartz-Soicher O, Jack D, Weiss CC, Richards CA, Quinn JW, Lovasi GS, Neckerman KM, Rundle AG. More neighborhood retail associated with lower obesity among New York City public high school students. Health Place 2013; 23:104-10. [PMID: 23827943 DOI: 10.1016/j.healthplace.2013.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 05/22/2012] [Revised: 05/20/2013] [Accepted: 05/23/2013] [Indexed: 11/28/2022]
Abstract
Policies target fast food outlets to curb adolescent obesity. We argue that researchers should examine the entire retail ecology of neighborhoods, not just fast food outlets. We examine the association between the neighborhood retail environment and obesity using Fitnessgram data collected from 94,348 New York City public high school students. In generalized hierarchical linear models, the number of fast food restaurants predicted lower odds of obesity for adolescents (OR:0.972 per establishment; CI:0.957-0.988). In a "placebo test" we found that banks--a measure of neighborhood retail ecology--also predicted lower obesity (OR:0.979 per bank; CI:0.962-0.994). Retail disinvestment might be associated with greater obesity; accordingly, public health research should study the influence of general retail disinvestment not just food-specific investment.
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Affiliation(s)
- Michael D M Bader
- Department of Sociology and Center on Health, Risk and Society, American University Washington, DC 20016-8072, USA.
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Lovasi GS, Jacobson JS, Quinn JW, Neckerman KM, Ashby-Thompson MN, Rundle A. Is the environment near home and school associated with physical activity and adiposity of urban preschool children? J Urban Health 2011; 88:1143-57. [PMID: 21826583 PMCID: PMC3232416 DOI: 10.1007/s11524-011-9604-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [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: 01/22/2023]
Abstract
Preventing sedentary behavior and adiposity in childhood has become a public health priority. We examined urban social and built environment characteristics as correlates of physical activity and anthropometry among 428 preschool children from low-income families in New York City. We measured the children's height, weight, skinfold thicknesses, physical activity by accelerometer, and covariates. We geocoded home and Head Start center addresses and estimated the following for an area within 0.5 km of those two locations using a detailed geographic database: neighborhood composition, walkability, crime and traffic safety, and aesthetic characteristics. Generalized estimating equations were used to examine the associations of area characteristics with physical activity or adiposity, adjusted for characteristics of the child, mother, and home. Participants were 2-5 years old, 53% female, 83% Hispanic, and 43% either overweight or obese. Of the walkability indicators, land use mix was associated with physical activity (26 more activity counts/minute per standard deviation increase in mixed land use, p = 0.015) and subway stop density was associated with adiposity (1.2 mm smaller sums of skinfold thicknesses sum per standard deviation increase in subway stop density, p = 0.001). The pedestrian-auto injury rate, an indicator of traffic safety problems, was associated with physical activity and adiposity (16 fewer activity counts/minute, p = 0.033, and 1.0 mm greater skinfold thickness per standard deviation increase in pedestrian-auto injuries, p = 0.018). Children living in areas with more street trees were more physically active and those living in areas with more park access had smaller skinfolds. However, many of the tested associations were not statistically significant and some trends were not in the hypothesized direction. Efforts to enhance walkability, safety, and green spaces in the local environment may be relevant to physical activity and adiposity, and therefore to the health of preschool-aged children from low-income families.
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Affiliation(s)
- Gina S Lovasi
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Abstract
With increasing concern about rising rates of obesity, public health researchers have begun to examine the availability of parks and other spaces for physical activity, particularly in cities, to assess whether access to parks reduces the risk of obesity. Much of the research in this field has shown that proximity to parks may support increased physical activity in urban environments; however, as yet, there has been limited consideration of environmental impediments or disamenities that might influence individuals' perceptions or usage of public recreation opportunities. Prior research suggests that neighborhood disamenities, for instance crime, pedestrian safety, and noxious land uses, might dissuade people from using parks or recreational facilities and vary by neighborhood composition. Motivated by such research, this study estimates the relationship between neighborhood compositional characteristics and measures of park facilities, controlling for variation in neighborhood disamenities, using geographic information systems (GIS) data for New York City parks and employing both kernel density estimation and distance measures. The central finding is that attention to neighborhood disamenities can appreciably alter the relationship between neighborhood composition and spatial access to parks. Policy efforts to enhance the recreational opportunities in urban areas should expand beyond a focus on availability to consider also the hazards and disincentives that may influence park usage.
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Affiliation(s)
- Christopher C Weiss
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA.
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Neckerman KM, Bader MDM, Richards CA, Purciel M, Quinn JW, Thomas JS, Warbelow C, Weiss CC, Lovasi GS, Rundle A. Disparities in the food environments of New York City public schools. Am J Prev Med 2010; 39:195-202. [PMID: 20709250 DOI: 10.1016/j.amepre.2010.05.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Revised: 02/24/2010] [Accepted: 05/06/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies of the food environment near schools have focused on fast food. Research is needed that describes patterns of exposure to a broader range of food outlet types and that examines the influence of neighborhood built environments. PURPOSE Using data for New York City, this paper describes the prevalence of five different food outlet types near schools, examines disparities by economic status and race/ethnicity in access to these food outlets, and evaluates the extent to which these disparities are explained by the built environment surrounding the school. METHODS National chain and local fast-food restaurants, pizzerias, small grocery stores ("bodegas"), and convenience stores within 400 m of public schools in New York City were identified by matching 2005 Dun & Bradstreet data to 2006-2007 school locations. Associations of student poverty and race/ethnicity with food outlet density, adjusted for school level, population density, commercial zoning, and public transit access, were evaluated in 2009 using negative binomial regression. RESULTS New York City's public school students have high levels of access to unhealthy food near their schools: 92.9% of students had a bodega within 400 m, and pizzerias (70.6%); convenience stores (48.9%); national chain restaurants (43.2%); and local fast-food restaurants (33.9%) were also prevalent within 400 m. Racial/ethnic minority and low-income students were more likely to attend schools with unhealthy food outlets nearby. Bodegas were the most common source of unhealthy food, with an average of nearly ten bodegas within 400 m, and were more prevalent near schools attended by low-income and racial/ethnic minority students; this was the only association that remained significant after adjustment for school and built-environment characteristics. CONCLUSIONS Nearly all New York City public school students have access to inexpensive, energy-dense foods within a 5-minute walk of school. Low-income and Hispanic students had the highest level of exposure to the food outlets studied here.
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Affiliation(s)
- Kathryn M Neckerman
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois 60637, USA.
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Abstract
Public health researchers have begun to map the neighborhood “food environment” and examine its association with the risk of overweight and obesity. Some argue that “food deserts”—areas with little or no provision of fresh produce and other healthy food—may contribute to disparities in obesity, diabetes, and related health problems. While research on neighborhood food environments has taken advantage of more technically sophisticated ways to assess distance and density, in general, it has not considered how individual or neighborhood conditions might modify physical distance and thereby affect patterns of spatial accessibility. This study carried out a series of sensitivity analyses to illustrate the effects on the measurement of disparities in food environments of adjusting for cross-neighborhood variation in vehicle ownership rates, public transit access, and impediments to pedestrian travel, such as crime and poor traffic safety. The analysis used geographic information systems data for New York City supermarkets, fruit and vegetable markets, and farmers' markets and employed both kernel density and distance measures. We found that adjusting for vehicle ownership and crime tended to increase measured disparities in access to supermarkets by neighborhood race/ethnicity and income, while adjusting for public transit and traffic safety tended to narrow these disparities. Further, considering fruit and vegetable markets and farmers' markets, as well as supermarkets, increased the density of healthy food outlets, especially in neighborhoods with high concentrations of Hispanics, Asians, and foreign-born residents and in high-poverty neighborhoods.
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Purciel M, Neckerman KM, Lovasi GS, Quinn JW, Weiss C, Bader MD, Ewing R, Rundle A. Creating and validating GIS measures of urban design for health research. J Environ Psychol 2009; 29:457-466. [PMID: 22956856 PMCID: PMC3433081 DOI: 10.1016/j.jenvp.2009.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Studies relating urban design to health have been impeded by the unfeasibility of conducting field observations across large areas and the lack of validated objective measures of urban design. This study describes measures for five dimensions of urban design - imageability, enclosure, human scale, transparency, and complexity - created using public geographic information systems (GIS) data from the US Census and city and state government. GIS measures were validated for a sample of 588 New York City block faces using a well-documented field observation protocol. Correlations between GIS and observed measures ranged from 0.28 to 0.89. Results show valid urban design measures can be constructed from digital sources.
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Affiliation(s)
- Marnie Purciel
- Institute for Social & Economic Research & Policy, 420 West 118th Street, Mail Code 3355, Columbia University, New York, NY 10027, USA
| | - Kathryn M. Neckerman
- Institute for Social & Economic Research & Policy, 420 West 118th Street, Mail Code 3355, Columbia University, New York, NY 10027, USA
| | - Gina S. Lovasi
- Robert Wood Johnson Foundation Health & Society Scholars program at Columbia University, New York, NY, USA
| | - James W. Quinn
- Institute for Social & Economic Research & Policy, 420 West 118th Street, Mail Code 3355, Columbia University, New York, NY 10027, USA
| | - Christopher Weiss
- Institute for Social & Economic Research & Policy, 420 West 118th Street, Mail Code 3355, Columbia University, New York, NY 10027, USA
| | - Michael D.M. Bader
- Institute for Social & Economic Research & Policy, 420 West 118th Street, Mail Code 3355, Columbia University, New York, NY 10027, USA
| | - Reid Ewing
- College of Architecture & Planning, University of Utah, Salt Lake City, UT, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Abstract
In the United States, health disparities in obesity and obesity-related illnesses have been the subject of growing concern. To better understand how obesity-related health disparities might relate to obesogenic built environments, the authors conducted a systematic review of the published scientific literature, screening for studies with relevance to disadvantaged individuals or areas, identified by low socioeconomic status, black race, or Hispanic ethnicity. A search for related terms in publication databases and topically related resources yielded 45 studies published between January 1995 and January 2009 with at least 100 participants or area residents that provided information on 1) the built environment correlates of obesity or related health behaviors within one or more disadvantaged groups or 2) the relative exposure these groups had to potentially obesogenic built environment characteristics. Upon consideration of the obesity and behavioral correlates of built environment characteristics, research provided the strongest support for food stores (supermarkets instead of smaller grocery/convenience stores), places to exercise, and safety as potentially influential for disadvantaged groups. There is also evidence that disadvantaged groups were living in worse environments with respect to food stores, places to exercise, aesthetic problems, and traffic or crime-related safety. One strategy to reduce obesity would involve changing the built environment to be more supportive of physical activity and a healthy diet. Based on the authors' review, increasing supermarket access, places to exercise, and neighborhood safety may also be promising strategies to reduce obesity-related health disparities.
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Affiliation(s)
- Gina S Lovasi
- Robert Wood Johnson Foundation Health and Society Scholars Program, Institute of Social and Economic Research and Policy, Columbia University, New York, NY 10027, USA.
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Rundle A, Neckerman KM, Freeman L, Lovasi GS, Purciel M, Quinn J, Richards C, Sircar N, Weiss C. Neighborhood food environment and walkability predict obesity in New York City. Environ Health Perspect 2009; 117:442-7. [PMID: 19337520 PMCID: PMC2661915 DOI: 10.1289/ehp.11590] [Citation(s) in RCA: 260] [Impact Index Per Article: 17.3] [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: 04/17/2008] [Accepted: 10/01/2008] [Indexed: 05/18/2023]
Abstract
BACKGROUND Differences in the neighborhood food environment may contribute to disparities in obesity. OBJECTIVES The purpose of this study was to examine the association of neighborhood food environments with body mass index (BMI) and obesity after control for neighborhood walkability. METHODS This study employed a cross-sectional, multilevel analysis of BMI and obesity among 13,102 adult residents of New York City. We constructed measures of the food environment and walkability for the neighborhood, defined as a half-mile buffer around the study subject's home address. RESULTS Density of BMI-healthy food outlets (supermarkets, fruit and vegetable markets, and natural food stores) was inversely associated with BMI. Mean adjusted BMI was similar in the first two quintiles of healthy food density (0 and 1.13 stores/km2, respectively), but declined across the three higher quintiles and was 0.80 units lower [95% confidence interval (CI), 0.27-1.32] in the fifth quintile (10.98 stores/km2) than in the first. The prevalence ratio for obesity comparing the fifth quintile of healthy food density with the lowest two quintiles combined was 0.87 (95% CI, 0.78-0.97). These associations remained after control for two neighborhood walkability measures, population density and land-use mix. The prevalence ratio for obesity for the fourth versus first quartile of population density was 0.84 (95% CI, 0.73-0.96) and for land-use mix was 0.91 (95% CI, 0.86-0.97). Increasing density of food outlets categorized as BMI-unhealthy was not significantly associated with BMI or obesity. CONCLUSIONS Access to BMI-healthy food stores is associated with lower BMI and lower prevalence of obesity.
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Affiliation(s)
- Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Lovasi GS, Neckerman KM, Quinn JW, Weiss CC, Rundle A. Effect of individual or neighborhood disadvantage on the association between neighborhood walkability and body mass index. Am J Public Health 2008; 99:279-84. [PMID: 19059849 DOI: 10.2105/ajph.2008.138230] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to test whether the association between walkable environments and lower body mass index (BMI) was stronger within disadvantaged groups that may be particularly sensitive to environmental constraints. METHODS We measured height and weight in a diverse sample of 13 102 adults living throughout New York City from 2000-2002. Each participant's home address was geocoded and surrounded by a circular buffer with a 1-km radius. The composition and built environment characteristics of these areas were used to predict BMI through the use of generalized estimating equations. Indicators of individual or area disadvantage included low educational attainment, low household income, Black race, and Hispanic ethnicity. RESULTS Higher population density, more mixed land use, and greater transit access were most consistently associated with a lower BMI among those with more education or higher incomes and among non-Hispanic Whites. Significant interactions were observed for education, income, race, and ethnicity. CONCLUSIONS Contrary to expectations, built environment characteristics were less consistently associated with BMI among disadvantaged groups. This pattern may be explained by other barriers to maintaining a healthy weight encountered by disadvantaged groups.
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Affiliation(s)
- Gina S Lovasi
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA.
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Lovasi GS, Quinn JW, Neckerman KM, Perzanowski MS, Rundle A. Children living in areas with more street trees have lower prevalence of asthma. J Epidemiol Community Health 2008; 62:647-9. [PMID: 18450765 DOI: 10.1136/jech.2007.071894] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The prevalence of childhood asthma in the USA increased by 50% from 1980 to 2000, with especially high prevalence in poor urban communities. METHODS Data on the prevalence of asthma among children aged 4-5 years and on hospitalisations for asthma among children less than 15 years old were available for 42 health service catchment areas within New York City. Street tree counts were provided by the New York City Department of Parks and Recreation. The proximity to pollution sources, sociodemographic characteristics and population density for each area were also measured. RESULTS Controlling for potential confounders, an increase in tree density of 1 standard deviation (SD, 343 trees/km(2)) was associated with a lower prevalence of asthma (RR, 0.71 per SD of tree density; 95% CI, 0.64 to 0.79), but not with hospitalisations for asthma (RR, 0.89 per SD of tree density; 95% CI, 0.75 to 1.06). CONCLUSIONS Street trees were associated with a lower prevalence of early childhood asthma. This study does not permit inference that trees are causally related to asthma at the individual level. The PlaNYC sustainability initiative, which includes a commitment to plant one million trees by the year 2017, offers an opportunity for a large prospective evaluation.
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Affiliation(s)
- G S Lovasi
- Institute for Social andEconomic Research and Policy; New York, NY, USA.
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Park Y, Neckerman KM, Quinn J, Weiss C, Rundle A. Place of birth, duration of residence, neighborhood immigrant composition and body mass index in New York City. Int J Behav Nutr Phys Act 2008; 5:19. [PMID: 18394171 PMCID: PMC2373307 DOI: 10.1186/1479-5868-5-19] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 04/06/2008] [Indexed: 11/05/2022] Open
Abstract
Background Past research has suggested that changes in culture explain the substantial weight gain seen in many immigrant groups with length of residence in the U.S. and across generations of residence in the U.S. However, it has been theorized that those settling in immigrant and co-ethnic neighborhoods may be buffered against this acculturative process and will be more likely to maintain home country dietary and physical activity patterns. To investigate this theory we incorporated measures of neighborhood immigrant composition into analyses of individual's body mass index (BMI) and generation of immigration and duration of residence in the U.S. Methods Multilevel analyses were performed using objectively measured height and weight and survey data on diet and physical activity from a sample of 13,011 residents of New York City. Census data were used to calculate the proportion of foreign-born residents and extent of household linguistic isolation in a ½ mile radial buffer around the subject's home. Results Foreign birth was associated with a significantly lower BMI (-1.09 BMI units, P < 0.001). This association was weakest among Asians (-0.66 BMI units, P = 0.08) and strongest among Black-Caribbeans (-1.41 BMI units, P = 0.07). After controlling for individual level variables, neighborhood proportion foreign-born was not associated with BMI, but increasing neighborhood linguistic isolation was inversely associated with BMI among Hispanics (-2.97 BMI units, P = 0.03). Furthermore among Hispanics, the association between foreign birth and BMI was stronger in low linguistic isolation neighborhoods (-1.36 BMI units, P < 0.0001) as compared to in high linguistic isolation levels (-0.42 BMI units, P = 0.79). Increasing duration of residence in the U.S. was significantly associated with higher BMI overall and among Hispanics. Conclusion The analyses suggest that acculturation is associated with weight gain, and that neighborhood characteristics are only associated with BMI among Hispanics. However, we suggest that changes in body size currently interpreted as post-migration effects of acculturation to U.S. norms may in fact reflect changes in norms that are taking place internationally.
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Affiliation(s)
- Yoosun Park
- School for Social Work, Smith College, Northampton MA, USA.
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Rowland D, Perloff JD, Kletke PR, Neckerman KM. Medicaid and Pediatric Primary Care. J Public Health Policy 1988. [DOI: 10.2307/3342583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Many Medicaid policy changes occurred in recent years including those resulting from the Omnibus Budget Reconciliation Act of 1981 and the Tax Equity and Fiscal Responsibility Act of 1982. At the same time, the supply of providers increased and the health care market became more competitive. This paper presents evidence about how these developments are affecting pediatricians' participation in state Medicaid programs. Surveys conducted in 1978 (N = 814) and 1983 (N = 791) indicate that the proportion participating declined only slightly from 85.1% to 82.0%. The average Medicaid case load of participants remained at 15%, although extent of participation of individual pediatricians fluctuated. Previous research demonstrates that physicians' Medicaid participation is affected by reimbursement level, administrative complexity, and generosity of eligibility and benefits. Our data confirm these influences. However, the longitudinal design of the analyses reported here also captures shifts in the relative influence of these factors. The influence of policy factors has diminished over time, while the influence of changes in physician supply has increased. Increased physician supply, however, is associated with decreased Medicaid participation. Thus, diminished access to pediatric care for low-income children may result from recent changes in Medicaid and in the broader health care environment.
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