NEIGHBORHOOD FACTORS AND HEALTH AMONG RESIDENTS LIVING IN A MICROPOLITAN CITY IN IOWA Erin Foster, BS Amy Schumacher, MS Christine Morris, MA

Transcription

1 NEIGHBORHOOD FACTORS AND HEALTH AMONG RESIDENTS LIVING IN A MICROPOLITAN CITY IN IOWA Erin Foster, BS Amy Schumacher, MS Christine Morris, MA University of Iowa, College of Public Health Iowa Governor s Conference on Public Health April 15 th, 2015

2 Outline Introduction Methods Data Statistical Methods Results Discussion Implications

3 INTRODUCTION

4 Self-rated health Perceptions and realities of the neighborhood environment have been shown to significantly impact health BMI Dietary behaviors Physical activity

5 Self-Rated Health Physical and social disorder Examples: noise; crowding; attachment to the neighborhood Social cohesion and capital Violence Walkability (Diez Roux & Mair, 2010; Franzini, Caughy, Spears, & Esquer, 2005; Rohrer, Pierce, & Denison, 2004; Wen, Hawkley, & Cacioppo, 2006)

6 BMI Access to recreational facilities Walkability Example: quality of sidewalks Physical disorder Density of fast food restaurants Availability of healthy foods (Black, Macinko, Dixon, & Fryer Jr, 2010; Boehmer, Hoehner, Deshpande, Ramirez, & Brownson, 2007; Diez Roux & Mair, 2010; Larson, Story, & Nelson, 2009; Li, Harmer, Cardinal, Bosworth, & Johnson-Shelton, 2009)

7 Dietary Behaviors Access and availability to supermarkets Greater selection of healthy foods increased food and vegetable consumption Social disorder is also important Density of fast-food outlets Aesthetics (Diez Roux & Mair, 2010; Keita, Casazza, Thomas, & Fernandez, 2011; Lopez, 2007; Larson et al., 2009; Litt et al., 2011; Zenk et al., 2009)

8 Physical Activity Environmental settings and resources Examples: gyms; treadmills; sidewalks Walkability Social cohesion Aesthetics Safety (Ball, Bauman, Leslie, & Owen, 2001; Brownson, Baker, Housemann, Brennan, & Bacak, 2001; Centers for Disease Control and Prevention, 1999; Diez Roux & Mair, 2010; Echeverria, Diez-Roux, Shea, Borrell, & Jackson, 2008; Saelens, Sallis, Black, & Chen, 2003; Strong, Reitzel, Wetter, & McNeill, 2013)

9 Gaps in Current Research Studies primarily conducted among neighborhoods in large, urban regions Less is known about neighborhoods in smaller regions, which tend to be more dispersed and experience greater lack of resources More research needed among residents living in neighborhoods in Micropolitan regions Regions with greater than 10,000 but fewer than 50,000 residents Study Aim: To explore the relationships between neighborhood perceptions, dietary behaviors, physical activity, obesity and general health in residents of an Iowa Micropolitan community (Liese, Weis, Pluto, Smith, & Lawson, 2007; Powell, Slater, Mirtcheva, Bao, & Chaloupka, 2007)

10 Proposed Model Main Hypotheses H1: PA, F/V, and Fast Food will have a direct effect on BMI Covariates PA F/V BMI Fast Food

11 Proposed Model Main Hypotheses H1: PA, F/V, and Fast Food will have a direct effect on BMI H2: BMI will have a direct effect on Health H3: PA, F/V, and fast food will have direct and indirect effects on Health Covariates PA F/V Fast Food BMI Health

12 Proposed Model Covariates PA Main Hypotheses H1: PA, F/V, and Fast Food will have a direct effect on BMI H2: BMI will have a direct effect on Health H3: PA, F/V, and fast food will have direct and indirect effects on Health H4: Neighborhood perceptions will have direct effects on PA, F/V, and Fast Food H5: Neighborhood perceptions will have direct and indirect effects on BMI and Health F/V BMI Health NBHD Percept. Fast Food

13 METHODS

14 Data: Ottumwa Community Survey Location: Ottumwa, Iowa Year: 2013 Method: Random digit dial phone survey Sample size: 1087 Topics: Demographics, health behaviors, neighborhood perceptions Data was weighted for age, gender, and ethnicity Data was multiply imputed

15 Weighting Sample 37% Male 63% Female Ottumwa (From 2010 Census) 48% Male 52% Female

16 Weighting Unweighted sample Weighted

17 Weighting Final Sample 48% Male 52% Female

18 Weighting Original Sample 54% Not Employed 46% Employed Weighted Sample 44% Not Employed 56% Employed

19 Statistical Methods Data management in SAS 9.4 Demographics in SAS 9.4 Structural equation modeling (SEM) in Mplus Version 7 Each neighborhood scale tested separately

20 Factor Analysis

21 Structural Equation Modeling Stress Health

22 Structural Equation Modeling Stress Eating Health

23 Structural Equation Modeling Eating Stress Health

24 Structural Equation Modeling Stress1 Eating Stress2 Stress Health Stress3

25 Measures Gender Children Ethnicity Age Education Poverty Social Cohesion Aesthetics Safety Walkability Food Environment Violence Demographics Neighborhood Perceptions PA F/V Fast Food Getting 150 minutes of physical activity through travel and leisure per week Number of fruits and vegetables consumed per day Consumes fast food in a typical week Body Mass Index BMI Rated health as excellent, very good, or good Selfrated Health

26 Neighborhood Measures Social Cohesion People around here are willing to help their neighbors. People in this neighborhood generally get along with each other. People in this neighborhood share the same values. People in this neighborhood can be trusted. Would you say. Strongly agree, Agree, Neither Agree nor Disagree, Disagree, Strongly Disagree

27 Neighborhood Measures Aesthetics There is a lot of trash and litter on the street in my neighborhood. There is a lot of noise in my neighborhood. In my neighborhood, the buildings and homes are well-maintained. The buildings and houses in my neighborhood are interesting. My neighborhood is attractive. There are interesting things to do in my neighborhood. Would you say. Strongly agree, Agree, Neither Agree nor Disagree, Disagree, Strongly Disagree

28 Neighborhood Measures Safety I feel safe walking in my neighborhood, day or night. Violence is not a problem in my neighborhood. My neighborhood is safe from crime. Would you say. Strongly agree, Agree, Neither Agree nor Disagree, Disagree, Strongly Disagree

29 Neighborhood Measures Walkability My neighborhood offers many opportunities to be physically active. Local sports clubs and other facilities in my neighborhood offer many opportunities to get exercise. It is pleasant to walk in my neighborhood. The trees in my neighborhood provide enough shade. In my neighborhood, it is easy to walk places I often see other people walking in my neighborhood. I often see other people exercising, such as jogging, biking, and playing sports, in my neighborhood Would you say. Strongly agree, Agree, Neither Agree nor Disagree, Disagree, Strongly Disagree

30 Neighborhood Measures Food Environment A large selection of fresh fruits and vegetables is available in my neighborhood. The fresh fruits and vegetables in my neighborhood are of high quality. A large selection of low-fat products is available in my neighborhood. Would you say. Strongly agree, Agree, Neither Agree nor Disagree, Disagree, Strongly Disagree

31 Neighborhood Measures Violence A fight in your neighborhood in which a weapon was used. Gang fights in your neighborhood. A sexual assault or rape in your neighborhood. A robbery or mugging in your neighborhood. Hard drug use in your neighborhood. (heroin, meth, coke, crack, etc.) Did this occur. Often, Sometimes, Rarely, Never

32 RESULTS

33 Descriptive Statistics Demographics Female 52.28% Children in household 38.14% Latino 8.52% Average Age Graduated high school 87.22% In poverty 33.04%

34 Descriptive Statistics Variables of Interest > 150 Minutes of PA per week 49.23% Overweight (BMI 25 to 29.9) or Obese (BMI 30 or above) 67.69% Eat fast food in a typical week 77.61% Average # of F/V per day 3.03 Reported excellent, very good, good health 77.49%

35 Health Behaviors Fruit & Veggie Consumption PA BMI Health BMI Demographics: Gender Children Ethnicity Age Education Poverty Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

36 Social Cohesion Fruit & Veggie Consumption Demographics: Gender Children Ethnicity Age Education Poverty BMI Social Cohesion Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

37 Aesthetics Fruit & Veggie Consumption Demographics: Gender Children Ethnicity Age Education Poverty BMI Aesthetics Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

38 Food Environment Fruit & Veggie Consumption Food Environ. PA BMI BMI Demographics: Gender Children Ethnicity Age Education Poverty Food Environ. Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

39 Food Environment Fruit & Veggie Consumption Food Environ. PA Health BMI Demographics: Gender Children Ethnicity Age Education Poverty Food Environ. Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

40 Safety Fruit & Veggie Consumption Demographics: Gender Children Ethnicity Age Education Poverty BMI Safety Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

41 Walkability Fruit & Veggie Consumption Walkability PA BMI Demographics: Gender Children Ethnicity Age Education Poverty BMI Walkability Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

42 Walkability Fruit & Veggie Consumption Walkability PA Health Demographics: Gender Children Ethnicity Age Education Poverty BMI Walkability Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

43 Violence Fruit & Veggie Consumption Demographics: Gender Children Ethnicity Age Education Poverty BMI Violence Eating Fast Food Good Self- Rated Health Getting 150 Minutes of PA RMSEA CFI F/V FF PA BMI Health

44 Model Fit and R 2 Model Fit R 2 Model RMSEA CFI F/V FF PA BMI Health Structural Social Cohesion Aesthetics Food Environ Safety Walkability Violence

45 DISCUSSION & IMPLICATIONS

46 Direct Effects NBHD Item F/V FF PA BMI Health Cohesion X X Aesthetics X Food Environ. X X X X Safety X Walkability X X X Violence X X

47 Indirect Effects Partial Mediation PA Self-Rated Health Full Mediation BMI Food Environ. Physical Activity BMI Food Environ. Self-Rated Health Walkability Physical Activity Self-Rated Health Physical Activity Walkability BMI Physical Activity

48 Implications: Social Cohesion Association between social cohesion and self-rated health consistent with literature Also associated with F/V No association between social cohesion and physical activity found Neighborhood social cohesion is important to consider when developing interventions to: Improve fruit and vegetable consumption Improve self-rated health libraryeuroparl.files.wordpress.com/2013/09/fotolia_ _subscription.jpg?w=350&h=200&crop=1

49 Implications: Aesthetics Association between aesthetics and F/V consistent with other studies No association between aesthetics and PA found Neighborhood aesthetics is important to consider when developing interventions to: Improve fruit and vegetable consumption

50 Implications: Food Environment Consistent with other studies, food environment was associated with dietary behaviors and BMI Also associated with PA and self-rated health Neighborhood food environment is important to consider when developing interventions to: Improve fruit and vegetable consumption Improve self-rated health Increase physical activity levels Reduce fast food consumption Decrease BMI Strong point of intervention y-food_environment.jpg

51 Implications: Safety Association between safety and fruit and vegetable consumption No association between safety and PA found Neighborhood safety may be important to consider when developing interventions to: Improve fruit and vegetable consumption

52 Implications: Walkability Associations between walkability and BMI, PA, self-rated health is mostly consistent with literature Also associated with F/V Neighborhood walkability is important to consider when developing interventions to: Improve fruit and vegetable consumption Increase physical activity Improve self-rated health Reduce BMI Strong point of intervention

53 Implications: Violence Association between violence and self-rated health consistent with literature Also associated with FF Neighborhood violence is important to consider when developing interventions to: Reduce fast food consumption Improve self-rated health t.com/blogs/wonkblog/files/2014/05/ _870bdf4452_z.jpg&w=1484

54 Final Implications Neighborhood perceptions play an important role in health behaviors and outcomes in Micropolitan regions Imperative to assess the physical and social environment of these neighborhoods Food environment in particular a potentially strong point of intervention Future research could explore relationships that warrant further clarification (i.e., walkability and BMI; influence of food environment)

55 Strengths and Limitations Limitations Testing one neighborhood factor at a time Self-report data Cross-sectional Strengths Validated measures Large sample size

56 Acknowledgements This presentation was supported by Cooperative Agreement Number 1-U48DP from the Centers for Disease Control and Prevention. The findings and conclusions in this report presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Department of Community and Behavioral Health Dr. Parker Dr. Baquero Dr. Daniel-Ulloa

57 References Ball, K., Bauman, A., Leslie, E., & Owen, N. (2001). Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults. Preventive medicine, 33(5), Black, J. L., Macinko, J., Dixon, L. B., & Fryer Jr, G. E. (2010). Neighborhoods and obesity in New York City. Health & place, 16(3), Boehmer, T., Hoehner, C., Deshpande, A., Ramirez, L. B., & Brownson, R. C. (2007). Perceived and observed neighborhood indicators of obesity among urban adults. International journal of obesity, 31(6), Brownson, R. C., Baker, E. A., Housemann, R. A., Brennan, L. K., & Bacak, S. J. (2001). Environmental and policy determinants of physical activity in the United States. American journal of public health, 91(12), Centers for Disease Control and Prevention. (1999). Neighborhood safety and the prevalence of physical inactivity--selected states, Morbidity and Mortality Weekly Report, 48(7), 143. Diez Roux, A. V., & Mair, C. (2010). Neighborhoods and health. Ann N Y Acad Sci, 1186, doi: /j x Echeverria, S., Diez-Roux, A. V., Shea, S., Borrell, L. N., & Jackson, S. (2008). Associations of neighborhood problems and neighborhood social cohesion with mental health and health behaviors: the Multi-Ethnic Study of Atherosclerosis. Health Place, 14(4), doi: /j.healthplace Franzini, L., Caughy, M., Spears, W., & Esquer, M. E. F. (2005). Neighborhood economic conditions, social processes, and self-rated health in lowincome neighborhoods in Texas: A multilevel latent variables model. Social science & medicine, 61(6), Keita, A. D., Casazza, K., Thomas, O., & Fernandez, J. R. (2011). Neighborhood perceptions affect dietary behaviors and diet quality. J Nutr Educ Behav, 43(4), doi: /j.jneb

58 References Larson, N. I., Story, M. T., & Nelson, M. C. (2009). Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med, 36(1), doi: /j.amepre Li, F., Harmer, P., Cardinal, B. J., Bosworth, M., & Johnson-Shelton, D. (2009). Obesity and the built environment: does the density of neighborhood fast-food outlets matter? American Journal of Health Promotion, 23(3), Litt, J. S., Soobader, M.-J., Turbin, M. S., Hale, J. W., Buchenau, M., & Marshall, J. A. (2011). The influence of social involvement, neighborhood aesthetics, and community garden participation on fruit and vegetable consumption. American journal of public health, 101(8), Lopez, R. P. (2007). Neighborhood risk factors for obesity. Obesity (Silver Spring), 15(8), Rohrer, J., Pierce, J., & Denison, A. (2004). Walkability and self-rated health in primary care patients. BMC family practice, 5(1), 29. Saelens, B. E., Sallis, J. F., Black, J. B., & Chen, D. (2003). Neighborhood-based differences in physical activity: an environment scale evaluation. American journal of public health, 93(9), Strong, L. L., Reitzel, L. R., Wetter, D. W., & McNeill, L. H. (2013). Associations of perceived neighborhood physical and social environments with physical activity and television viewing in African-American men and women. Am J Health Promot, 27(6), doi: /ajhp QUAN- 127 Wen, M., Hawkley, L. C., & Cacioppo, J. T. (2006). Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: An analysis of older adults in Cook County, Illinois. Social science & medicine, 63(10), Zenk, S. N., Lachance, L. L., Schulz, A. J., Mentz, G., Kannan, S., & Ridella, W. (2009). Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population. Am J Health Promot, 23(4), doi: /ajhp

59 Multiple Imputation ID Gender (1 = Female) Fruits & Veggies/Day HS Grad (1 = Yes)

60 Multiple Imputation ID Gender (1 = Female) Fruits & Veggies/Day HS Grad (1 = Yes)

61 Multiple Imputation Imputation 1 ID Gender (1 = Female) Fruits & Veggies/Day HS Grad (1 = Yes)

62 Multiple Imputation Imputation 2 ID Gender (1 = Female) Fruits & Veggies/Day HS Grad (1 = Yes)

63 Multiple Imputation Imputation 3 ID Gender (1 = Female) Fruits & Veggies/Day HS Grad (1 = Yes)

64 Multiple Imputation- OCS Data Imputation 1 Imputation 2 Imputation 3 Imputation 4 Imputation Final mean using imputed data: fruits per day