Actual or potential neighborhood resources and access to them: testing hypotheses of social capital for the health of female caregivers

This study considers three commonly overlooked aspects of neighborhood social capital: actual or potential network resources, access to such resources, and their potentially negative implications, as they bear on the health of adult female caregivers of children. Drawing upon Bourdieu's social capital theory and urban and community sociology research, two sets of related hypotheses are formulated and tested. The first set examines specific resources that inhere within neighborhood social relations by testing hypotheses concerning four forms of social capital (social support, social leverage, informal social control, and neighborhood organization participation) and their respective associations with daily smoking and perceived health. The second set assesses the importance of one's access to the neighborhood networks that possess such resources by testing hypotheses regarding how residents' neighborhood attachment moderates the association between social capital forms and these health outcomes in positive and negative ways. Analyses of the Los Angeles Family and Neighborhood Survey (L.A.FANS) linked with tract level census data indicate that specific social capital forms were directly associated with positive and negative health outcomes. Neighborhood attachment significantly moderated relationships between several social capital forms and health, indicating that a female caregiver's degree of network integration matters in both health promoting and health damaging ways. In addition to illustrating the utility of a Bourdieusian perspective for formulating explicit, testable hypotheses regarding how social capital may matter for health, these findings suggest that future public health studies of neighborhood social capital need to consider (1) the actual or potential resources that inhere within relationships, and (2) the role of access to such resources for promoting or compromising health.     

Neighborhood social and economic change and diabetes incidence: The HeartHealthyHoods study

We studied the association between neighborhood social and economic change and type 2 diabetes incidence in the city of Madrid (Spain). We followed 199,621 individuals living in 393 census tracts for diabetes incidence for 6 years using electronic health records, starting in 2009. We measured neighborhood social and economic change from 2005 to 2009 using a finite mixture model with 16 indicators that resulted in four types of neighborhood change. Adjusted results showed an association between neighborhood change and diabetes incidence: compared to those living in Aging/Stable areas, people living in Declining SES, New Housing and Improving SES areas have an 8% (HR = 0.92, 95% CI 0.87 to 0.99), 9% (HR = 0.91, 95% CI 0.81 to 1.01) and 11% (HR = 0.89, 95% CI 0.81 to 0.98) decrease in diabetes incidence. This evidence can help guide policies for diabetes prevention by focusing efforts on specific urban areas.     

Activity space environment and dietary and physical activity behaviors: a pilot study

This study examined relationships among individual demographics, environmental features (e.g., fast food outlet density, park land use) of residential neighborhoods and activity spaces, and weight-related behaviors (diet, physical activity). Participants’ movement was tracked for 7 days using global positioning systems (GPS). Two activity space measures (one standard deviation ellipse, daily path area) were derived from the GPS data. Activity spaces were generally larger than residential neighborhoods; environmental features of residential neighborhoods and activity spaces were weakly associated; and some activity space environmental features were related to dietary behaviors. Activity spaces may provide new insights into environmental influences on obesity-related behaviors.     

Accounting for space,time, and behavior using GPS derived dynamic measures of environmental exposure

Time-weighted spatial averaging approaches (TWSA) are an increasingly utilized method for calculating exposure using global positioning system (GPS) mobility data for health-related research. They can provide a time-weighted measure of exposure, or dose, to various environments or health hazards. However, little work has been done to compare existing methodologies, nor to assess how sensitive these methods are to mobility data inputs (e.g., walking vs driving), the type of environmental data being assessed as the exposure (e.g., continuous surfaces vs points of interest), and underlying point-pattern clustering of participants (e.g., if a person is highly mobile vs predominantly stationary). Here we contrast three TWSA approaches that have been previously used or recently introduced in the literature: Kernel Density Estimation (KDE), Density Ranking (DR), and Point Overlay (PO). We feed GPS and accelerometer data from 602 participants through each method to derive time-weighted activity spaces, comparing four mobility behaviors: all movement, stationary time, walking time, and in-vehicle time. We then calculate exposure values derived from the various TWSA activity spaces with four environmental layer data types (point, line, area, surface). Similarities and differences across TWSA derived exposures for the sample and between individuals are explored, and we discuss interpretation of TWSA outputs providing recommendations for researchers seeking to apply these methods to health-related studies.     

Activity spaces in place and health research: Novel exposure measures,data collection tools,and designs

Activity space research provides a framework to consider mobility while linking environments to behaviors in the study of neighborhood effects on health. Increased use of wearable location sensors provides new opportunities to observe and analyze fine-grained spatial and temporal information on individuals' mobility patterns, environmental exposures and behaviors; however, these analysis does not easily translate into causal inference. Additional dimensions underlying behavioral decision-making likely influence or even modify environmental effects on behaviors. This commentary discusses how further progresses in exposure measurement, integration of data collection tools, and development of study designs could support future interventions to optimize how environments shape health profiles and inequities.     

Neighborhood social and physical environments and type 2 diabetes mellitus in African Americans: The Jackson Heart Study

Using data from Jackson Heart Study, we investigated the associations of neighborhood social and physical environments with prevalence and incidence of type 2 diabetes mellitus (T2DM) in African Americans (AA). Among non-diabetic participants at baseline (n=3670), 521 (14.2%) developed T2DM during a median follow-up of 7.3 years. Measures of neighborhood social environments, and food and physical activity resources were derived using survey-and GIS-based methods. Prevalence ratios (PR) and Hazard ratios (HR) were estimated using generalized estimating equations and Cox proportional hazards models. Higher neighborhood social cohesion was associated with a 22% lower incidence of T2DM while higher density of unfavorable food stores was associated with a 34% higher incidence of T2DM after adjusting for individual-level risk factors (HR=0.78 [95% CI:0.62, 0.99] and HR=1.34 [1.12, 1.60], respectively). In addition, neighborhood problems was also associated with prevalence of T2DM (PR=1.12 [1.03, 1.21]) independent of individual-level risk factors. Our findings suggest that efforts to strengthen community ties or to attract healthy food retail outlets might be important strategies to consider for prevention of T2DM in AA.     

Neighborhood walkability,deprivation and incidence of type 2 diabetes: A population-based study on 512,061 Swedish adults

Neighborhood walkability has been associated with increased physical activity, but only a few studies have explored the association between walkability and health outcomes related to physical activity, such as type 2 diabetes. The aim of this study was to investigate the association between objectively assessed neighborhood walkability and the 4-year incidence of type 2 diabetes in a sample of 512,061 Swedish adults aged 18 years and older. Neighborhoods were defined by 408 administratively defined geographical areas in the city of Stockholm. We found a negative association between walkability and type 2 diabetes (OR=1.33, 95% CI=1.13–1.55) that remained significant after adjusting for neighborhood deprivation. This association, however, no longer remained statistically significant after adjusting for individual socio-demographic factors. These results were also confirmed using a co-sibling design. Future studies are encouraged to further explore the potential effect of a broader array of the neighborhood built environment on health outcomes related to physical activity.     

Neighborhood green, social support, physical activity, and stress: assessing the cumulative impact

We estimate the cumulative stress mitigating impact of neighborhood greenness by investigating whether neighborhood green mitigates stress directly, and indirectly by encouraging physical activity and/or fostering social support. Using data from a recent community health survey in Chicago and two-stage instrumental variables regression modeling, we find that different components of neighborhood green play distinct roles in influencing stress. Park spaces are found to indirectly mitigate stress by fostering social support. Overall neighborhood vegetation is found to have direct stress mitigation impact, yet the impact is counteracted by its negative effect on social support. When comparing the effect size, park spaces show a more positive impact on health and well-being than the overall neighborhood vegetation level. Policy makers are recommended to focus on creating structured green spaces with public recreation and socialization opportunities rather than simply conserving green spaces in the neighborhood. Previous studies, as they often investigate the direct impact only and rarely use multiple measures of greenness, may have mis-estimated health benefits of neighborhood green.     

The role of daily mobility in mental health inequalities: the interactive influence of activity space and neighbourhood of residence on depression

The literature reports an association between neighbourhood deprivation and individual depression after adjustment for individual factors. The present paper investigates whether vulnerability to neighbourhood features is influenced by individual "activity space" (i.e., the space within which people move about or travel in the course of their daily activities). It can be assumed that a deprived residential environment can exert a stronger influence on the mental health of people whose activity space is limited to their neighbourhood of residence, since their exposure to their neighbourhood would be greater. Moreover, we studied the relationship between activity space size and depression. A limited activity space could indeed reflect spatial and social confinement and thus be associated with a higher risk of being depressed, or, conversely, it could be linked to a deep attachment to the neighbourhood of residence and thus be associated with a lower risk of being depressed. Multilevel logistic regression analyses of a representative sample consisting of 3011 inhabitants surveyed in 2005 in the Paris, France metropolitan area and nested within 50 census blocks showed, after adjusting for individual-level variables, that people living in deprived neighbourhoods were significantly more depressed that those living in more advantaged neighbourhoods. We also observed a statistically significant cross-level interaction between activity space and neighbourhood deprivation, as they relate to depression. Living in a deprived neighbourhood had a stronger and statistically significant effect on depression in people whose activity space was limited to their neighbourhood than in those whose daily travels extended beyond it. In addition, a limited activity space appeared to be a protective factor with regard to depression for people living in advantaged neighbourhoods and a risk factor for those living in deprived neighbourhoods. It could therefore be useful to take activity space into consideration more often when studying the social and spatial determinants of depression.     

Activity spaces in studies of the environment and physical activity: A review and synthesis of implications for causality

Activity spaces are increasingly used to understand how people interact with their environment and engage in activity but their use may raise challenges regarding causal inference. We conducted a systematic review of findings and the methodological, analytical and conceptual issues relevant to causal inference. Studies were included if they comprised a spatial summary of locations visited, assessed any part of the causal pathway between the environment, physical activity and health, and used quantitative or qualitative methods. We searched seven electronic databases in January 2018 and screened 11910 articles for eligibility. Forty-seven studies were included for review. Studies answered research questions about features of or environmental features within activity spaces using a range of spatial and temporal summary techniques. The conceptual challenge of using activity spaces to strengthen causal inference was rarely considered, although some studies discussed circularity, temporality, and plausibility. Future studies should use longitudinal and experimental designs and consider the potential and actual use of spaces for physical activity, and their relationship with total levels of activity.     

Disentangling neighborhood contextual associations with child body mass index,diet, and physical activity: The role of built,socioeconomic, and social environments

Obesity prevalence among US children and adolescents has tripled in the past three decades. Consequently, dramatic increases in chronic disease incidence are expected, particularly among populations already experiencing health disparities. Recent evidence identifies characteristics of “obesogenic” neighborhood environments that affect weight and weight-related behaviors. This study aimed to examine associations between built, socioeconomic, and social characteristics of a child's residential environment on body mass index (BMI), diet, and physical activity. We focused on pre-adolescent children living in New Haven, Connecticut to better understand neighborhood environments' contribution to persistent health disparities. Participants were 1048 fifth and sixth grade students who completed school-based health surveys and physical measures in fall 2009. Student data were linked to US Census, parks, retailer, and crime data. Analyses were conducted using multilevel modeling. Property crimes and living further from a grocery store were associated with higher BMI. Students living within a 5-min walk of a fast food outlet had higher BMI, and those living in a tract with higher density of fast food outlets reported less frequent healthy eating and more frequent unhealthy eating. Students' reported perceptions of access to parks, playgrounds, and gyms were associated with more frequent healthy eating and exercise. Students living in more affluent neighborhoods reported more frequent healthy eating, less unhealthy eating, and less screen time. Neighborhood social ties were positively associated with frequency of exercise. In conclusion, distinct domains of neighborhood environment characteristics were independently related to children's BMI and health behaviors. Findings link healthy behaviors with built, social, and socioeconomic environment assets (access to parks, social ties, affluence), and unhealthy behaviors with built environment inhibitors (access to fast food outlets), suggesting neighborhood environments are an important level at which to intervene to prevent childhood obesity and its adverse consequences.     

浙江省成年人群肥胖及体育锻炼等因素与糖尿病风险分析

目的 探讨肥胖与体育锻炼、静坐休闲时间、职业劳动强度联合对2型糖尿病和糖调节受损(IGR)的关系.方法 利用2010年浙江省代谢综合征患病率调查的17 437名≥18岁人群调查数据,采用logistic回归模型分析比较不同肥胖程度与不同体育锻炼水平、静坐休闲时间、职业劳动强度下各亚组人群糖尿病患病和IGR风险.结果 在同一静坐休闲时间组,按BMI标准的肥胖组糖尿病发生风险是正常及低体重组的2.52～2.75倍,按WC标准的过度肥胖组糖尿病发生风险是正常组的2.09 ～ 3.71倍;在同一职业劳动强度组,按BMI标准的肥胖组糖尿病发生风险是正常及低体重组的2.19 ～ 5.98倍,按WC标准的过度肥胖组糖尿病发生风险是正常组的3.10～6.25倍.肥胖与体育锻炼强度联合分析发现,在按BMI分组分析时,无体育锻炼者中,肥胖组的糖尿病发生风险是正常及低体重组的3.21倍,但在体育锻炼者中未观察到发生糖尿病的风险随BMI增长而增加的规律,也未观察到体育锻炼对糖尿病患病风险影响的规律.在按WC分组分析时,3个锻炼水平下均可见肥胖程度越高,糖尿病患病风险越大,同一锻炼水平下,过度肥胖组的糖尿病发生风险是正常组的1.68 ～ 4.23倍.结论 与增加体育锻炼、减少静坐时间相比,控制BMI和WC对糖尿病的预防更加重要;在考虑体育锻炼水平时,WC是比BMI更好的糖尿病和IGR的预测指标.     

Decentralisation and health services delivery in Tanzania: Analysis of decision space in planning,allocation, and use of financial resources

While decentralisation of health systems has been on the policy agenda in low‐income and middle‐income countries since the 1970s, many studies have focused on understanding who has more decision‐making powers but less attention is paid to understand what those powers encompass. Using the decision space approach, this study aimed to understand the amount of decision‐making space transferred from the central government to institutions at the periphery in the decentralised health system in Tanzania. The findings of this study indicated that the decentralisation process in Tanzania has provided authorities with a range of decision‐making space. In the areas of priority setting and planning, district health authorities had moderate decision space. However, in the financial resource allocation and expenditure of funds from the central government, the districts had narrow decision‐making space. The districts, nevertheless, had wider decision‐making space in mobilising and using locally generated financial resources. However, the ability of the districts to allocate and use locally generated resources was constrained by bureaucratic procedures of the central government. The study concludes that decentralisation by devolution which is being promoted in the policy documents in Tanzania is yet to be realised at the district and local levels. The study recommends that the central government should provide more space to the decentralised district health systems to incorporate locally defined priorities in the district health plans.     

Neighborhood environment,social participation,and physical activity in older adults with lower limb osteoarthritis: A mediation analysis

Older adults with lower limb osteoarthritis (LLOA) are highly dependent on their physical and social environment for being physically active. Longitudinal data from 2286 older adults (M_age = 73.8 years; 50.3% female) in six European countries were analyzed using cross-lagged Structural Equation Modeling (SEM) and multi-group SEM. In cross-sectional analyses, neighborhood resources were associated with physical activity (r = 0.26;p < .001) and social participation (r = 0.13;p = .003). Physical activity at follow-up was associated with neighborhood resources, with this relationship mediated by social participation in people with LLOA (β = 0.018;p = .013). To promote future physical activity, opportunities to socially engage in neighborhoods need to be targeted primarily to people with LLOA.     

Lifetime medical costs for women: cardiovascular disease, diabetes, and stress urinary incontinence

PURPOSE: To estimate the absolute and relative lifetime medical costs of treating women with cardiovascular disease (CVD), diabetes, or stress urinary incontinence (SUI). METHODS: Women under 65 years, treated for CVD, diabetes, or SUI, were identified using administrative medical claims data from a large employer (n >100,000). A case-control methodology was used to estimate the annual medical costs of these women. Based on these estimates and published government statistics, annual costs for women 65 years and older were calculated. An incidence-based methodology with steady-state assumptions was used to project to lifetime medical costs. Cost estimates are incremental, measured as the difference between costs of patients and their demographically similar controls without the condition. They therefore represent the additional costs of treating patients with the condition, beyond the average, baseline costs incurred by controls without the condition. FINDINGS: The incremental lifetime medical cost of treating a woman (in 2002 dollars) with CVD is $423,000, with diabetes is $233,000, and with SUI is $58,000 US dollars. Including the baseline medical costs of the control, the total lifetime medical costs (i.e., sum of incremental and baseline lifetime medical costs) of treating a woman with CVD are 3.4 times greater than the costs of a woman without CVD. Similarly, a woman with diabetes has total costs on average, 2.5 times greater than the costs of her control, whereas a woman with SUI has total lifetime medical costs 1.8 times greater than the costs of a similar woman without SUI. CONCLUSIONS: These substantial cost estimates suggest the need for further gender-specific research and policies addressing the long-term implications of health care financing, treatment, and preventive care.     

Exploring the linkage between greenness exposure and depression among Chinese people: Mediating roles of physical activity,stress and social cohesion and moderating role of urbanicity

Although a plethora of studies have investigated the association between green exposure and mental health in developed countries, it is only recently that academics and policymakers have paid attention to how this association works in rapidly urbanizing and developing countries. This study aims to explore biopsychosocial pathways linking residential greenness exposure to depression in the Chinese context using data from the 2016 wave of China Labour-force Dynamics Survey. Results from multilevel models along with mediation analysis show that exposure to residential greenness is negatively associated with depression, and that physical activity, stress and neighbourhood social cohesion altogether have a complete mediation effect on this association. Results from moderation analysis suggest that urbanicity moderates the relationship between greenness exposure and depression, and that the relationship is strongest at the upper level of urbanicity. Our findings suggest the necessity of increasing the provision of recreational green spaces and improving the quality of green spaces in Chinese less urbanized areas.     

Pesticide exposures in professional turf applicators, job titles, and tasks performed: implications of exposure measurement error for epidemiologic study design and interpretation of results

BACKGROUND: Little information on the validity of job title and task classifications, for the prediction of pesticide use or exposure, is available. METHODS: Job titles and task classifications were evaluated in relation to the absorbed dose of herbicides in 98 professional turf applicators. Self-reported use over a 1-week period and other proxies of pesticide use were compared with employer records. RESULTS: Job titles and tasks performed explained (R(2)) 11% and 16% of the variation in dose, respectively. Individuals who sprayed pesticides only, had the highest average doses in the study followed by those spraying and mixing, and those mixing only. The use of 2,4-D products by individual workers over a work season was not related to standardized measures of the amount purchased or used at the company. CONCLUSIONS: These findings suggest that job titles and tasks performed are poor proxies of pesticide use and exposures in professional turf applicators.     

Important park features for encouraging park visitation,physical activity and social interaction among adolescents: A conjoint analysis

Little is known about what park features adolescents perceive as most important for encouraging them to visit and be active and social in parks. This study examined the relative importance of park features for encouraging these behaviours among adolescents and explored differences according to gender and frequency of visitation. Adolescents were recruited from secondary schools in diverse areas of Melbourne, Australia. In Phase 1 (2018–2019), participants [n = 222; 14.0 years (SD 1.1); 46% female] rated photographs of 40 park features in an online survey, indicating the degree to which each feature encouraged them to visit, and be active and social in the park. In Phase 2 (2019–2020), the top ten-rated features from Phase 1 for each outcome (overall and by gender and frequency of visitation) were presented in Adaptive Choice-Based Conjoint tasks to another sample of participants [n = 244; 14.7 years (SD 1.3); 46% female]. The most important feature for encouraging visitation was large swings; for physical activity was sports courts; and for social interaction was a café. Grassy open space was important for all behaviours, and preferred park features varied among sub-groups. The results highlight which park features park planners and designers should prioritise to support active and social park use among adolescents.     

Studies on chemical modification and biology of a natural product, gambogic acid (III): determination of the essential pharmacophore for biological activity

Caged 4-oxa-tricyclo[4.3.1.0^3,7]dec-2-one structural motifs are found in Garcinia natural products that demonstrate anti-tumor activity. Gambogic acid (GA, 1), the most abundant caged Garcinia xanthones, has been reported to be a promising anti-cancer agent. To identify the essential pharmacophore for its anti-tumor activity, a series of GA analogues that address potential key structural features for biological activity were synthesized, among which compound 11a displayed comparable in vitro anti-tumor activity as GA. Mechanistic studies on 11a determined that the compound induces apoptosis as well as arrests the G2/M phase of the cell cycle in HepG2 cells. The determination of the essential part of the scaffold found in GA to maintain anti-tumor effects, and the SAR based on the caged pharmacophore are reported and will provide key information for future anti-cancer drug development studies.