Andrea Nathan

Using GPS technology to (re)-examine operational definitions of ‘neighbourhood’ in place-based health research

BackgroundInconsistencies in research findings on the impact of the built environment on walking across the life course may be methodologically driven. Commonly used methods to define ‘neighbourhood’, from which built environment variables are measured, may not accurately represent the spatial extent to which the behaviour in question occurs. This paper aims to provide new methods for spatially defining ‘neighbourhood’ based on how people use their surrounding environment.ResultsInformed by Global Positioning Systems (GPS) tracking data, several alternative neighbourhood delineation techniques were examined (i.e., variable width, convex hull and standard deviation buffers). Compared with traditionally used buffers (i.e., circular and polygon network), differences were found in built environment characteristics within the newly created ‘neighbourhoods’. Model fit statistics indicated that exposure measures derived from alternative buffering techniques provided a better fit when examining the relationship between land-use and walking for transport or leisure.ConclusionsThis research identifies how changes in the spatial extent from which built environment measures are derived may influence walking behaviour. Buffer size and orientation influences the relationship between built environment measures and walking for leisure in older adults. The use of GPS data proved suitable for re-examining operational definitions of neighbourhood.

The impact of the built environment on health across the life course: design of a cross-sectional data linkage study

Introduction The built environment is increasingly recognised as being associated with health outcomes. Relationships between the built environment and health differ among age groups, especially between children and adults, but also between younger, mid-age and older adults. Yet few address differences across life stage groups within a single population study. Moreover, existing research mostly focuses on physical activity behaviours, with few studying objective clinical and mental health outcomes. The Life Course Built Environment and Health (LCBEH) project explores the impact of the built environment on self-reported and objectively measured health outcomes in a random sample of people across the life course. Methods and analysis This cross-sectional data linkage study involves 15 954 children (0–15 years), young adults (16–24 years), adults (25–64 years) and older adults (65+years) from the Perth metropolitan region who completed the Health and Wellbeing Surveillance System survey administered by the Department of Health of Western Australia from 2003 to 2009. Survey data were linked to Western Australias (WA) Hospital Morbidity Database System (hospital admission) and Mental Health Information System (mental health system outpatient) data. Participants’ residential address was geocoded and features of their ‘neighbourhood’ were measured using Geographic Information Systems software. Associations between the built environment and self-reported and clinical health outcomes will be explored across varying geographic scales and life stages. Ethics and dissemination The University of Western Australias Human Research Ethics Committee and the Department of Health of Western Australia approved the study protocol (#2010/1). Findings will be published in peer-reviewed journals and presented at local, national and international conferences, thus contributing to the evidence base informing the design of healthy neighbourhoods for all residents.

The Pet Factor - Companion Animals as a Conduit for Getting to Know People, Friendship Formation and Social Support

Background While companion animals have been previously identified as a direct source of companionship and support to their owners, their role as a catalyst for friendship formation or social support networks among humans has received little attention. This study investigated the indirect role of pets as facilitators for three dimensions of social relatedness; getting to know people, friendship formation and social support networks. Methods A telephone survey of randomly selected residents in four cities, one in Australia (Perth; n = 704) and three in the U.S. (San Diego, n = 690; Portland, n = 634; Nashville, n = 664) was conducted. All participants were asked about getting to know people within their neighborhood. Pet owners were asked additional questions about the type/s of pet/s they owned, whether they had formed friendships as a result of their pet, and if they had received any of four different types of social support from the people they met through their pet. Results Pet owners were significantly more likely to get to know people in their neighborhood than non-pet owners (OR 1.61; 95%CI: 1.30, 1.99). When analyzed by site, this relationship was significant for Perth, San Diego and Nashville. Among pet owners, dog owners in the three U.S. cities (but not Perth) were significantly more likely than owners of other types of pets to regard people whom they met through their pet as a friend (OR 2.59; 95%CI: 1.94, 3.46). Around 40% of pet owners reported receiving one or more types of social support (i.e. emotional, informational, appraisal, instrumental) via people they met through their pet. Conclusion This research suggests companion animals can be a catalyst for several dimensions of human social relationships in neighborhood settings, ranging from incidental social interaction and getting to know people, through to formation of new friendships. For many pet owners, their pets also facilitated relationships from which they derived tangible forms of social support, both of a practical and emotionally supportive nature. Given growing evidence for social isolation as a risk factor for mental health, and, conversely, friendships and social support as protective factors for individual and community well-being, pets may be an important factor in developing healthy neighborhoods.

Perceptions of the Built Environment and Associations with Walking Among Retirement Village Residents

Housing options, such as retirement villages, that promote and encourage healthy behaviors are needed to accommodate the growing older adult population. To examine how environmental perceptions relate to walking, residents of retirement villages in Perth, Australia, were sampled, and associations between a wide range of village and neighborhood environmental attributes and walking leisurely, briskly, and for transport were examined. Perceived village features associated with walking included aesthetics (odds ratio [OR] = 1.72), personal safety (OR = 0.43), and services and facilities (OR = 0.80), whereas neighborhood attributes included fewer physical barriers (OR = 1.37) and proximate destinations (OR = 1.93). Findings suggest that locating retirement villages in neighborhoods with many local destinations may encourage more walking than providing many services and facilities within villages. Indeed, safe villages rich with amenities were shown to be related to less walking in residents. These findings have implications for the location, design, and layout of retirement villages.

Applying the ecological model of behavior change to a physical activity trial in retirement communities: Description of the study protocol

OBJECTIVES To describe the intervention protocol for the first multilevel ecological intervention for physical activity in retirement communities that addresses individual, interpersonal and community influences on behavior change. DESIGN A cluster randomized controlled trial design was employed with two study arms: a physical activity intervention and an attention control successful aging condition. SETTING Sixteen continuing care retirement communities in San Diego County. PARTICIPANTS Three hundred twenty older adults, aged 65 years and older, are being recruited to participate in the trial. In addition, peer leaders are being recruited to lead some study activities, especially to sustain the intervention after study activities ceased. INTERVENTION Participants in the physical activity trial receive individual, interpersonal and community intervention components. The individual level components include pedometers, goal setting and individual phone counseling. The interpersonal level components include group education sessions and peer-led activities. The community level components include resource audits and enumeration, tailored walking maps, and community improvement projects. The successful aging group receives individual and group attention about successful aging topics. MEASUREMENTS The main outcome is light to moderate physical activity, measured objectively by accelerometry. Other objective outcomes included physical functioning, blood pressure, physical fitness, and cognitive functioning. Self report measures include depressive symptoms and health related quality of life. RESULTS The intervention is being delivered successfully in the communities and compliance rates are high. CONCLUSION Ecological Models call for interventions that address multiple levels of the model. Previous studies have not included components at each level and retirement communities provide a model environment to demonstrate how to implement such an intervention.

Environmental factors associated with active living in retirement village residents: Findings from an exploratory qualitative enquiry

This exploratory enquiry employs qualitative methods to advance knowledge and understanding of physical environmental attributes related to active living among residents of Australian retirement villages. Six focus groups (n = 51 residents) were held and participants described how their current, and subsequently ideal, retirement village and neighborhood supported active lifestyles. Thematic analysis revealed three key environmental factors associated with active living: a positive social environment within the village; services and facilities provided in the village and wider neighborhood; and the presence of suitable pedestrian infrastructure. The unique discovery that environmental factors of both the retirement village and the surrounding neighborhood were associated with residents’ active living raises many questions for study. Findings informed the development of a survey instrument, and further understanding in this area has the potential to contribute to the design and siting practices of senior housing complexes within neighborhoods.

Exploring Socioecological Correlates of Active Living in Retirement Village Residents

This study explored individual, social, and built environmental attributes in and outside of the retirement village setting and associations with various active living outcomes including objectively measured physical activity, specific walking behaviors, and social participation. Residents in Perth, Australia (N = 323), were surveyed on environmental perceptions of the village and surrounding neighborhood, self-reported physical activity, and demographic characteristics and wore accelerometers. Managers (N = 32) were surveyed on village characteristics, and objective neighborhood measures were generated in a Geographic Information System (GIS). Results indicated that built- and social-environmental attributes within and outside of retirement villages were associated with active living among residents; however, salient attributes varied depending on the specific outcome considered. Findings suggest that locating villages close to destinations is important for walking and that locating them close to previous and familiar neighborhoods is important for social participation. Further understanding and consideration into retirement village designs that promote both walking and social participation are needed.

Nowhere to Go and Nothing to Do but Sit? Youth Screen Time and the Association With Access to Neighborhood Destinations

With not much to do in their neighborhood, youth may spend more time in the home engaged in screen-based activities. Screen time data from 2,790 youth in the Western Australian Health and Wellbeing Survey were linked to objectively measured count of types of neighborhood “services,” “convenience goods,” “public open space,” and “youth-related” destinations. On average, youth accrued 801 mean min/week screen time and had access to seven different types of neighborhood destinations. A larger number of different types of neighborhood “youth-related,” “service,” and “total” destinations were associated with less screen time (all p ≤ .05). A significant gender interaction was observed. Girls with access to ≥12 youth-related destinations had 109 fewer mean min/week screen time, compared with girls with 0 to 3 youth-related destinations. Providing alternatives to screen use by ensuring access to a variety of neighborhood places for structured and unstructured activities may be an important strategy for decreasing youth screen time.

Physical Environments That Promote Physical Activity Among Older People

Characteristics of neighbourhoods, streets, and public open spaces can hinder or facilitate physical activity (PA) among older adults. This chapter aims to critically review key conceptual and theoretical frameworks and the empirical evidence about the relationships between aspects of the physical environment and older adults’ PA. Access to local shops, services, public transport, public open spaces (e.g., parks), and recreational facilities within walking distance along well-maintained and aesthetically pleasing streets with high-quality pedestrian infrastructure appeared to be key determinants of PA among older adults. Therefore, policies underpinning the implementation of such environments should be evaluated to further strengthen the evidence base.

Neighbourhood disadvantage, geographic remoteness and body mass index among immigrants to Australia: A national cohort study 2006-2014

Obesity is socioeconomically, geographically and ethnically patterned. Understanding these elements of disadvantage is vital in understanding population obesity trends and the development of effective and equitable interventions. This study examined the relationship between neighbourhood socioeconomic disadvantage and geographic remoteness with prospective trends in mean body mass index (BMI) among immigrants to Australia. Longitudinal data (2006–2014) from a national panel survey of Australian adults was divided into an immigrant-only sample (n = 4,293, 52.6% women and 19,404 person-year observations). The data were analysed using multi-level random effects linear regression modelling that controlled for individual socioeconomic and demographic factors. Male immigrants living in the most disadvantaged neighbourhoods had significantly higher mean BMI compared with those living in the least disadvantaged. Over time, mean BMI increased for all groups except for men living in the least disadvantaged neighbourhoods, for whom mean BMI remained almost static (0.1 kg/m2 increase from 2006 to 2014), effectively widening neighbourhood inequalities. Among women, mean BMI was also significantly higher in the most compared with the least, disadvantaged neighbourhoods (β = 2.08 kg/m2; 95%CI: 1.48, 2.68). Neighbourhood inequalities were maintained over time as mean BMI increased for all groups at a similar rate. Male and female immigrants residing in outer regional areas had significantly higher mean BMI compared with those living in major cities; however, differences were attenuated and no longer significant following adjustment for ethnicity, individual socioeconomic position and neighbourhood disadvantage. Over time, mean BMI increased in all male and female groups with no differences based on geographic remoteness. Obesity prevention policy targeted at immigrant cohorts needs to include area-level interventions that address inequalities in BMI arising from neighbourhood disadvantage, and be inclusive of immigrants living outside Australia’s major cities.