Neighbourhood disadvantage and smoking: Examining the role of neighbourhood-level psychosocial characteristics

PurposeThis study aims to determine if neighbourhood psychosocial characteristics contribute to inequalities in smoking among residents from neighbourhoods of differing socioeconomic disadvantage.MethodsThis cross-sectional study includes 11,035 residents from 200 neighbourhoods in Brisbane, Australia in 2007. Self-reported measures were obtained for smoking and neighbourhood psychosocial characteristics (perceptions of incivilities, crime and safety, and social cohesion). Neighbourhood socioeconomic disadvantage was measured using a census-derived index. Data were analysed using multilevel logistic regression random intercept models.ResultsSmoking was associated with neighbourhood disadvantage; this relationship remained after adjustment for individual-level socioeconomic position. Area-level perceptions of crime and safety and social cohesion were not independently associated with smoking, and did not explain the higher prevalence of smoking in disadvantaged areas; however, perceptions of incivilities showed an independent effect.ConclusionsSome neighbourhood psychosocial characteristics seem to contribute to the higher rates of smoking in disadvantaged areas.     

Associations between the built environment and physical activity among adults with low socio-economic status in Canada: a systematic review

ObjectiveTo synthesize literature on the associations between the built environment and physical activity among adults with low socio-economic status (SES) in Canada.MethodsUsing a pre-specified study protocol (PROSPERO ID: CRD42019117894), we searched seven databases from inception to November 2018, for peer-reviewed quantitative studies that (1) included adults with low SES living in Canada and (2) estimated the association between self-reported or objectively measured built characteristics and self-reported or objectively measured physical activity. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Findings were synthesized using a narrative approach.SynthesisOf the 8338 citations identified by our search, seven studies met the inclusion criteria. Most studies included adults living in one province (Alberta, British Columbia, Ontario, or Quebec), with one study including a national sample. All studies were cross-sectional, and none controlled for residential self-selection. Sampling designs and data collection strategies were heterogeneous. Sample sizes ranged between 78 and 37,241 participants. Most studies measured SES using household income. Street connectivity, greenness, destination density, and walkability were positively associated with physical activity. Relative to the objectively measured built environment, associations between the self-reported built environment and physical activity were less consistent. Studies were of fair to good quality.ConclusionFindings suggest that the neighbourhood built environment is associated with physical activity among adults with low SES in Canada. More rigorous study designs are needed to determine whether or not the built environment and physical activity are causally related within this vulnerable population.     

Food safety knowledge and practices in ready-to-eat food establishments

Safe food handling in ready-to-eat food establishments is a basic element in the reduction of foodborne illness. The aim of this research was to investigate (using a questionnaire), knowledge and attitudes about food safety held by management and staff in ready-to-eat food establishments. Fieldwork was conducted in 2002 in Wellington City, New Zealand. Managers rated 'staff with good food safety knowledge' the most important aspect of ensuring safe food. Half of these managers were prepared to pay higher wages to staff holding a current food safety certificate. Although respondents considered that closure of the establishment was the most serious business consequence of a breakdown in safe food handling, less than half (49%) were prepared to pay an additional insurance premium to cover this risk. All food handling workers should be encouraged to obtain and maintain a current food safety certificate. Environmental health officers who inspect ready-to-eat food establishments play an important role in guiding and assisting owners and staff in improving food handling standards.     

Neighbourhood community life and health: A systematic review of reviews

Neighbourhood community life has been widely recognized as an important determinant of population health. This systematic review of reviews provides an overview of the evidence for the ecological correlation between neighbourhood community life and population health. Nine databases were searched from 2008 to 2018 in order to identify systematic reviews of studies examining the association between neighbourhood community life and population health in urban neighbourhoods within the Organisation for Economic Co-operation and Development countries. Two reviewers completed selection and data extraction, then assessed the methodological quality of reviews using the Measurement Tool to Assess Systematic Reviews. We identified three high quality reviews and five of moderate quality. The reviews vary in quality of methodology, concepts, and measures. Most of the reviews examined the influence of social cohesion, social capital, and social interactions on health. Reviews found evidence supporting a consistently favourable correlation between social cohesion and physical activity, as well as a favourable trend in the relationship between social cohesion and healthy weight. They also found evidence of a favourable trend in the correlation between social capital and healthy weight. Reviews identified studies supporting a consistently favourable correlation between social interaction and depression. We identify evidence of a positive association between neighbourhood community life and several population health outcomes. Future research should define and conceptualize neighbourhood community life factors and health indicators to improve the comparison between studies and the process of evidence synthesis. This will also enable policy makers to take appropriate decisions.     

Neighbourhood deprivation and the cost of accessing gyms and fitness centres: National study in Wales

It has been hypothesised that residents of deprived neighbourhoods have poorer economic access to physical activity resources, inhibiting physical activity. Here we explore whether the cost of accessing gyms and fitness centres varies by neighbourhood deprivation in Wales. The location of gyms and fitness suites were obtained, and a telephone survey of all facilities was conducted to collect entry price data. We tested associations between neighbourhood deprivation and mean entry prices for public and private facilities. The cost of accessing private facilities is lower in deprived versus affluent neighbourhoods, whereas costs are similar across all deprivation categories for public facilities.     

The evolution of local food environments within established neighbourhoods and new developments in Perth,Western Australia

Temporal changes in the location of food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study used mixed linear models to investigate how the location of food outlets around the home evolved over time with respect to area-level socio-economic status (SES) and urban design within established neighbourhoods and new residential developments. Food outlet data (supermarket/greengrocers, convenience stores, café restaurants and takeaway/fast food) were sourced from commercial database listings (SENSIS Pty. Ltd.) in 2004, 2006, 2007, and 2011. Using 2468 addresses from the RESIDential Environments Project (RESIDE), in Perth, Western Australia (WA), a count of each food outlet type and percentage of healthy food outlets within a 1.6 km road network buffer around the home, along with the road network distance to nearest food outlet were generated relative to each address at each time point. Proximity to and count of all food outlets increased over time in both new developments and established neighbourhoods. However, unhealthy food outlets were always in greater numbers and proximity to the home. The percentage of healthy food outlets was significantly greater in established neighbourhoods compared to new developments at all four time points. There were significantly more food outlets, and within closer proximity to the home, in established neighbourhoods compared to new developments at each time point. In established neighbourhoods, there were more convenience stores, takeaway/fast food and café restaurants, a lower percentage of healthy food outlets, and closer proximity to convenience stores in lower compared to high SES areas. In new developments there were significantly less supermarket/greengrocers, a lower percentage of healthy food outlets and greater proximity to takeaway/fast food and café restaurants in low compared to high SES areas. New developments designed according to the WA government's “Liveable Neighbourhoods Community Design Guidelines” policy had significantly more of all food outlets compared to other new developments. As such, people living in new developments, and low SES areas of Perth, may be disadvantaged with poorer access to healthy food outlets and greater exposure to unhealthy food outlets. Future urban planning and policy should focus on providing incentives that support the early development of supermarkets and healthy food outlets within new developments and low SES areas of Perth.     

Neighbourhood availability of alcohol outlets and hazardous alcohol consumption in New Zealand

The socio-spatial arrangement of alcohol retailers is potentially important in understanding the relationship between neighbourhood context and ‘excessive’ alcohol consumption. This New Zealand study examines whether the availability of alcohol products is associated with individual-level alcohol consumption. Measures capturing the availability of alcohol retailers were calculated for neighbourhoods across the country and then appended to a national health survey. At the national level there was no evidence for an association between hazardous consumption and alcohol outlet access. However, there was evidence of associations with neighbourhood retailing for younger Māori and Pacific peoples males; younger European females; middle-aged European men; and older men. The findings provide evidence that ‘alcogenic’ environments are associated with excessive drinking in New Zealand, albeit that the associations are restricted to particular vulnerable groups.     

Do perceived neighbourhood cohesion and safety contribute to neighbourhood differences in health?

This paper reports on a survey (N=3344) and in-depth interviews (N=80) from four socio-economically contrasting postcode areas in Adelaide. Logistic regression was used to examine locational differences in self-rated health, controlling for demographic, socio-economic factors, health behaviours, individual social capital (social networks, support, reciprocity, trust) and perceived neighbourhood cohesion and safety. Statistically significant locational differences in health emerged. Perceived neighbourhood cohesion and safety accounted for this difference. Interviews explored perceptions of cohesion and safety and found that they were intricately related and varied between the areas. The implications of the findings for understanding locational differences in health are discussed.     

A farmers’ market in a food desert: Evaluating impacts on the price and availability of healthy food

Several studies have examined supermarket access for low-income residents, but few have explored how access to healthy food changes when a new food retailer such as a farmers’ market opens in a place previously known as a ‘food desert’. This paper uses a ‘before and after’ approach to examine the impact of the introduction of a farmers’ market on the price and availability of healthy food in an underserved urban neighbourhood. The farmers’ market had a major impact on grocery prices in the neighbourhood, which decreased by almost 12% in 3 years.     

Disparities in Access to Healthy Diets: How Food Security and Food Shopping Behaviors Relate to Fruit and Vegetable Intake

BackgroundFood shopping behaviors may help determine how local food environments influence fruit and vegetable (F/V) intake, especially among food insecure households.ObjectiveTo examine whether household food security, food access, and food shopping behaviors are associated with F/V intake among residents of a low-income neighborhood.DesignStudy design is cross-sectional.Participants/settingA simple random sample of 451 adults from a low-income neighborhood in Montreal (Canada) were recruited through telephone interviews in 2014. Final analyses included 417 participants.Main outcome measuresValidated assessment tools were applied to measure F/V intake and to distinguish food secure (FS) from food insecure (FI) participants. Neighborhood food access was calculated according to number of food stores within 0.5 miles of road network buffer of participants’ homes. Self-reported food shopping behaviors included trip frequency, store types, and transport used to reach the 3 most frequented stores. Participants also reported on mobility constraints, use of F/V markets, gardening, and perceived access to healthy food.Statistical analysesF/V intake was modeled using multivariable linear regression.ResultsA sample of adults, of whom 21.3% were living in FI households, reported consuming F/V an average of 4.1 times daily. FI participants had a lower intake of F/V (b = −0.69, P = .04), independent of sociodemographics, food access, resource constraints, perceived access to healthy food, and food shopping behaviors. Participants with mobility constraints had lower F/V intake (b = −0.68, P = .02), while gardening was associated with higher F/V intake (b = 0.59, P = .01). Number of supermarkets (b = −0.06, P = .03) and specialty stores (b = 0.10, P = .04) were associated with F/V intake, although the strength of the association was weak.ConclusionsFor FI households, barriers to food access linked to financial challenges are associated with lower intake of F/V. Studies on food environment should include people’s experience of food access to better understand the numerous barriers to F/V consumption faced by FI households.     

Access to Healthful Foods among an Urban Food Insecure Population: Perceptions versus Reality

The influence of local food environments on the risk for obesity is important overall, but may be particularly important for food insecure populations in urban settings. Access to healthful foods is most limited among racial and ethnic minorities and low-income populations; these same populations experience the highest rates of obesity and food insecurity. Few valid and reliable measures have been developed to assess the quality of local food environments. This research addresses this gap by introducing an inventory for measuring self-reported perceptions of food access and then compares the perceptions measure to objective assessments of local food environments. Data are focused on an urban population experiencing disproportionate rates of food insecurity. The four-item perceptions of food access inventory had high internal consistency (Cronbach’s alpha = 0.80). Participants’ perceptions of access to healthful foods mirrored the reality of their food environment; however, perceptions of access to alcohol and tobacco were less accurate. Findings suggest that people living in low-income, urban, minority, and food insecure communities can validly assess (in)access to healthful foods. Future research is needed to further validate the perceptions of food access measure introduced and, more importantly, to develop strategies for increasing access to healthful foods in food insecure contexts.     

Smoking, smoking cessation, and use of smoking cessation aids and support services in South Derbyshire, England

OBJECTIVES: To describe smoking behaviour, motivation to quit and quit rates, and the effect of advice and support for smoking cessation among smokers from more and less disadvantaged socio-economic groups in South Derbyshire, a mixed urban and rural area of central England. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study with a random, stratified sample of people aged 25-44 years and people aged 65-74 years with over-sampling of populations living in disadvantaged areas. Main outcome measures included the proportion of smokers wishing to quit and quitting in the last year; reported advice to quit from family and friends and health professionals; and awareness and use of NHS smoking-cessation services. RESULTS: Over half of smokers aged 25-44 years, about one-third of women smokers and 40% of male smokers aged 65-74 years wished to quit. This varied little by socio-economic status. Quit rates were generally lower among smokers of lower socio-economic status (SES), especially among people aged 25-44 years. Smokers of lower SES reported slightly less advice to quit from family and friends, and more so from health professionals. Awareness and use of cessation services was about 30% and 5%, respectively, among smokers and recent quitters. Awareness varied little but accessing services was generally higher among smokers of lower SES. CONCLUSIONS: Despite evidence that health professionals and cessation services were targeting smokers with lower SES and of similar motivation to quit, quit rates were lower. Broader tobacco control interventions targeting the social and environmental contexts that create and maintain socio-economic differentials in smoking are required.     

浅谈我国的食品卫生安全监督管理

作者针对目前我国的食品卫生现状 ,分析我国食品卫生安全监督管理工作的缺失 ,建议从加强体制建设、法制建设、准入许可等方面强化卫生监督管理工作。     

北京市老年人慢性病社会决定因素研究

目的：研究北京市老年人慢性病在不同社会阶层人群中的患病差异。方法：利用北京大学公共卫生学院2013年对北京市老年人进行的入户调查数据库,获取1717名具有北京代表性的60岁及以上人口的入户调查信息。以收入、受教育程度、职业和户口等社会经济地位指标对社会阶层进行度量,采用Logistic回归模型,分析北京市老年人慢性病患病在不同社会阶层人群间的分布。结果：非农业户口人群、收入位于中间和最高人群、小学组和大专及以上组慢性病患病风险较低。退休前从事农林牧渔业水利业生产人员慢性病患病风险较高。收入次低20％组同时患3种以上慢性病风险较高。结论：慢性病防控策略的制定应充分考虑社会分层等健康社会决定因素,而不仅仅是针对慢性病的直接病因。北京市老年人的慢性病防控工作应当重点关注农业户口、低收入和受教育程度较低人群。     

Environmental inequity in England: small area associations between socio-economic status and environmental pollution

Recent studies have suggested that more deprived people tend to live in areas characterised by higher levels of environmental pollution. If generally true, these environmental inequities may combine to cause adverse effects on health and also exacerbate problems of confounding in epidemiological studies. Previous studies of environmental inequity have nevertheless indicated considerable complexity in the associations involved, which merit further investigation using more detailed data and more advanced analytical methods. This study investigates the ways in which environmental inequity in England varies in relation to: (a) different environmental pollutants (measured in different ways); (b) different aspects of socio-economic status; and (c) different geographical scales and contexts (urban vs. rural). Associations were analysed between the Index of Multiple Deprivation (IMD2004) and its domains and five sets of environmental pollutants (relating to road traffic, industry, electro-magnetic frequency radiation, disinfection by-products in drinking water and radon), measured in terms of proximity, emission intensity and environmental concentration. Associations were assessed using bivariate and multivariate correlation, and by comparing the highest and lowest quintiles of deprivation using Student's t-test and Hotelling's T2. Associations are generally weak (R(2) < 0.10), and vary depending on the specific measures used. Strongest associations occur with what can be regarded as contingent components of deprivation (e.g. crime, living environment, health) rather than causative factors such as income, employment or education. Associations also become stronger with increasing level of spatial aggregation. Overall, the results suggest that any triple jeopardy for health, and problems of confounding, associated with environmental inequities are likely to be limited.     

Continuing inequalities in COVID-19 mortality in England and Wales,and the changing importance of regional,over local,deprivation

BackgroundObservational studies have highlighted that where individuals live is far more important for risk of dying with COVID-19, than for dying of other causes. Deprivation is commonly proposed as explaining such differences. During the period of localised restrictions in late 2020, areas with higher restrictions tended to be more deprived. We explore how this impacted the relationship between deprivation and mortality and see whether local or regional deprivation matters more for inequalities in COVID-19 mortality.MethodsWe use publicly available population data on deaths due to COVID-19 and all-cause mortality between March 2020 and April 2021 to investigate the scale of spatial inequalities. We use a multiscale approach to simultaneously consider three spatial scales through which processes driving inequalities may act. We go on to explore whether deprivation explains such inequalities.ResultsAdjusting for population age structure and number of care homes, we find highest regional inequality in October 2020, with a COVID-19 mortality rate ratio of 5.86 (95% CI 3.31 to 19.00) for the median between-region comparison. We find spatial context is most important, and spatial inequalities higher, during periods of low mortality. Almost all unexplained spatial inequality in October 2020 is removed by adjusting for deprivation. During October 2020, one standard deviation increase in regional deprivation was associated with 20% higher local mortality (95% CI, 1.10 to 1.30).ConclusionsSpatial inequalities are greatest in periods of lowest overall mortality, implying that as mortality declines it does not do so equally. During the prolonged period of low restrictions and low mortality in summer 2020, spatial inequalities strongly increased. Contrary to previous months, we show that the strong spatial patterning during autumn 2020 is almost entirely explained by deprivation. As overall mortality declines, policymakers must be proactive in detecting areas where this is not happening, or risk worsening already strong health inequalities.     

Do perceptions of the neighbourhood food environment predict fruit and vegetable intake in low-income neighbourhoods?

The aim of this study is to investigate the extent to which perceptions of the quality, variety and affordability of local food retail provision predict fruit and vegetable intake. Secondary analysis of baseline data from the Philadelphia Neighbourhood Food Environment Study was undertaken. This study investigating the role of the neighbourhood food environment on diet and obesity comprised a random sample of households from two low-income Philadelphia neighbourhoods, matched on socio-demographic characteristics and food environment. The analytic sample comprised adult men and women aged 18–92 (n=1263). Perception of the food environment was measured using five related dimensions pertaining to quality, choice and expense of local food outlets and locally available fruits and vegetables. The outcome, portions of fruits and vegetables consumed per day, was measured using the Block Food Frequency Questionnaire. Results from multivariate regression analyses suggest that measured dimensions of perceived neighbourhood food environment did not predict fruit and vegetable consumption. Further investigation of what constitutes an individual′s ‘true’ food retail environment is required.     

Households' Food Insecurity and Its Association with Demographic and Socioeconomic Factors in Gaza Strip,Palestine: A Cross-Sectional Study

BackgroundThis sudy aimed to identify the prevalence of household''s food insecurity and its association with demographic and socioeconomic factors.MethodsA cross-sectional study was conducted in September 2021 among a representative sample of households in the Gaza strip governorates. A total of 1167 households randomly selected from all five governorates and were included in the study. The Radimer/Cornell food security scale was used to determine the prevalence and levels of household food insecurity. The household''s demographic and socioeconomic characteristics were obtained using an interview-based questionnaire. Statistical analysis was performed using SPSS version 25.ResultsThe overall prevalence of household''s food insecurity was 71.5%. The prevalence by governorates was highest in Gaza (30.8%), followed by Khanyounis (23.0%), North-Gaza (18.6%), Middle-Area (15.2%) and Rafah (12.4%). Regarding the food insecurity levels, 333 (28.5%) of the households were food secure, 422 (36.2%) had mild food insecurity, 161 (13.8%) had moderate food insecurity, and 251 (21.5%) had severe food insecurity. Significant associations were found between governorates, monthly income, homeownership, work status with the household''s food insecurity, (Crude OR [COR] = 2.02, 95% CI = [1.02–3.98], P value < 0.05), (COR = 2.00, 95% CI = [1.04–2.75], P value < 0.05), (COR = 2.36, 95% CI = [1.39–3.99], P value < 0.05), and (COR = 1.14, 95% CI = [0.66–1.97], P value < 0.05), respectively.ConclusionsOur study demonstrates that food insecurity is highly prevalent in the Gaza strip and is associated with poor living conditions. Therefore, this high prevalence should be seriously discussed and urgently considered.     

Differences in Food Environment Perceptions and Spatial Attributes of Food Shopping Between Residents of Low and High Food Access Areas

ObjectiveTo explore potential differences in food shopping behaviors and healthy food availability perceptions between residents living in areas with low and high food access.DesignA cross-sectional telephone survey to assess food shopping behaviors and perceptions. Data from an 8-county food environment field census used to define the Centers for Disease Control and Prevention (CDC) healthier food retail tract and US Department of Agriculture Economic Research Service food desert measure.ParticipantsA total of 968 residents in 8 South Carolina counties.Main Outcome MeasuresResidents' food shopping behaviors and healthy food availability perceptions.AnalysisLinear and logistic regression.ResultsCompared with residents in high food access areas, residents in low food access areas traveled farther to their primary food store (US Department of Agriculture Economic Research Service: 8.8 vs 7.1 miles, P = .03; CDC: 9.2 vs 6.1 miles, P < .001), accumulated more total shopping miles per week (CDC: 28.0 vs 15.4 miles; P < .001), and showed differences in perceived healthy food availability (P < .001) and shopping access (P < .001).Conclusions and ImplicationsThese findings lend support to ongoing community and policy interventions aimed at reducing food access disparities.     

Change in an Urban Food Environment: Storefront Sources of Food/Drink Increasing Over Time and Not Limited to Food Stores and Restaurants

Background

Local food environments include food stores (eg, supermarkets, grocery stores, bakeries) and restaurants. However, the extent to which other storefront businesses offer food/drink is not well described, nor is the extent to which food/drink availability through a full range of storefront businesses might change over time.