Anne Ellaway

Graffiti, greenery, and obesity in adults: secondary analysis of European cross sectional survey

Obesity levels are high and increasing worldwide. Being overweight is linked with increased death rates and contributes to a wide range of conditions, including ischaemic heart disease, hypertension, stroke, diabetes, certain cancers, and diseases of the gall bladder.1 The principal cause of obesity is an imbalance between energy intake and energy expenditure. And there is growing recognition that, independently of individual characteristics, place of residence may be associated with health outcomes, including body size2 and health related behaviours, such as level of physical exercise.3 Few studies have explored which features of the local neighbourhood might be related to these outcomes or behaviours, although perceived attractiveness has been found to be related to levels of physical activity.4 Levels of incivilities, such as litter and graffiti, are associated with poorer health outcomes such as general wellbeing but not, to our knowledge, with levels of physical activity. Few studies use …

Perceptions of Place and Health in Socially Contrasting Neighbourhoods

This paper describes an analysis of perceptions of the local residential environment and self-reported health in four socially contrasting neighbourhoods in Glasgow in the late 1990s. After adjusting for individual characteristics such as age, sex and social class, neighbourhood of residence predicted perceptions of problems and neighbourhood cohesion in the area: and self-assessed health, mental health and recent symptoms were associated with perceived local problems and neighbourhood cohesion. Housing tenure and employment status also predicted perceptions of the neighbourhood. These results support the importance of tackling anti-social problems in worst-off areas and of neighbourhood management across a range of areas.

Does area of residence affect body size and shape

OBJECTIVE: To examine whether neighbourhood or residence is associated with body size and shape (height, weight, BMI, waist circumference and waist-hip ratio). DESIGN: Analysis of data collected in fact to face interviews at the second wave of longitudinal health survey of two adult age cohorts in the West of Scotland. SETTING: Four socially contrasting urban neighbourhoods in Glasgow City, Scotland. SUBJECTS: A total of 691 subjects: 142 males and 176 females aged 40 at interview; and 167 males and 206 females aged 60 at interview. All had been resident in their current neighbourhood for at least four years. MEASUREMENTS: height, weight, BMI, waist circumference and waist-hip ratio. RESULTS: Neighbourhood of residence was significantly associated with height, BMI, waist circumference and waist-hip ratio after controlling for individual characteristics such as gender, age, social class, smoking behaviour and material deprivation (an index comprising income, housing tenure and car ownership). Individuals living in the most deprived neighbourhood were significantly shorter, and had bigger waist circumferences, waist-hip ratios and BMIs. CONCLUSIONS: If Health of the Nation targets on reducing the proportion of overweight individuals in the population are to be met, public health policy should focus on places as well as people.

Neighbourhood environment and its association with self rated health: evidence from Scotland and England

Objectives: To investigate associations between measures of neighbourhood social and material environment and self rated health. Design: New contextual measures added to cross sectional study of a sample of people from the Health Survey for England and the Scottish Health Survey to provide multilevel data. Participants: 13 899 men and women aged 16 or over for whom data on self rated health were available from the Health Survey for England (years 1994–99) and the Scottish Health Survey (years 1995 and 1998). Results: Fair to very bad self rated health was significantly associated with six neighbourhood attributes: poor physical quality residential environment, left wing political climate, low political engagement, high unemployment, lower access to private transport, and lower transport wealth. Associations were independent of sex, age, social class, and economic activity. Odds ratios were larger for non-employed residents than for employed residents. Self rated health was not significantly associated with five other neighbourhood measures: public recreation facilities, crime, health service provision, access to food shops, or access to banks and buildings societies. Conclusions: Some, but not all, features of the neighbourhood environment are associated with self rated health and may be indicators of important causal pathways that could provide a focus for public health intervention strategies. Associations were more pronounced for non-employed residents, perhaps because of greater exposure to the local environment compared with employed people. Operationalising specific measures of the characteristics of local areas hypothesised to be important for living a healthy life provides a more focused approach than general measures of deprivation in the search for area effects.

Do housing tenure and car access predict health because they are simply markers of income or self esteem? A Scottish study.

OBJECTIVE: To investigate relations between health (using a range of measures) and housing tenure or car access; and to test the hypothesis that observed relations between these asset based measures and health are simply because they are markers for income or self esteem. DESIGN: Analysis of data from second wave of data collection of West of Scotland Twenty-07 study, collected in 1991 by face to face interviews conducted by nurse interviewers. SETTING: The Central Clydeside Conurbation, in the West of Scotland. SUBJECTS: 785 people (354 men, 431 women) in their late 30s, and 718 people (358 men, 359 women) in their late 50s, participants in a longitudinal study. MEASURES: General Health Questionnaire scores, respiratory function, waist/hip ratio, number of longstanding illnesses, number of symptoms in the last month, and systolic blood pressure; household income adjusted for household size and composition; Rosenberg self esteem score; housing tenure and care access. RESULTS: On bivariate analysis, all the health measures were significantly associated with housing tenure, and all except waist/hip ratio with car access; all except waist/hip ratio were related to income, and all except systolic blood pressure were related to self esteem. In models controlling for age, sex, and their interaction, neither waist/hip ratio nor systolic blood pressure remained significantly associated with tenure or care access. Significant relations with all the remaining health measures persisted after further controlling for income or self esteem. CONCLUSIONS: Housing tenure and car access may not only be related to health because they are markers for income or psychological traits; they may also have some directly health promoting or damaging effects. More research is needed to establish mechanisms by which they may influence health, and to determine the policy implications of their association with health.

Do poorer people have poorer access to local resources and facilities? The distribution of local resources by area deprivation in Glasgow, Scotland

It has commonly been suggested that in modern cities individual or household deprivation (for example, low income or education) is amplified by area level deprivation (for example, lack of jobs or good schools), in ways which damage the health of the poorest and increase health inequalities. The aim of this study was to determine the location of a range of resources and exposures by deprivation in a UK city. We examined the location of 42 resources in Glasgow City, Scotland, in 2005–2006, by quintile of small area deprivation. Measures included number per 1000 population, network distance to nearest resource, and percentage of data zones containing at least one of each type of resource. Twelve resources had higher density in, and/or were closer to or more common in, more deprived neighbourhoods: public nurseries, public primary schools, police stations, pharmacies, credit unions, post offices, bus stops, bingo halls, public swimming pools, public sports centres, outdoor play areas, and vacant and derelict land/buildings. Sixteen had higher density in, and/or were closer to, or more common in, more affluent neighbourhoods: public secondary schools, private schools, banks, building societies, museums/art galleries, railway stations, subway stations, tennis courts, bowling greens, private health clubs, private swimming pools, colleges, A & E hospitals, parks, waste disposal sites, and tourist attractions. Private nurseries, Universities, fire stations, general, dental and ophthalmic practices, pawn brokers, ATMs, supermarkets, fast food chains, cafes, public libraries, golf courses, and cinemas showed no clear pattern by deprivation. Thus it appears that in the early 21st century access to resources does not always disadvantage poorer neighbourhoods in the UK. We conclude that we need to ensure that theories and policies are based on up-to-date and context-specific empirical evidence on the distribution of neighbourhood resources, and to engage in further research on interactions between individual and environmental factors in shaping health and health inequalities.

In the driving seat: psychosocial benefits from private motor vehicle transport compared to public transport

The aim of current transport policy in the UK and many other developed countries is to reduce reliance on private motor vehicle transport in order to promote public health and reduce environmental degradation. Despite the emphasis in these policies on the unhealthiness of private motor car use, epidemiological studies have consistently shown that car access is associated with longevity and better health. We examine this paradox using a postal survey of adults in the West of Scotland (n=2043, m=896, f=1147) to investigate the psychosocial benefits associated with private and public motor vehicle transport. Those with access to a car appear to gain more psychosocial benefits (mastery, self esteem, and feelings of autonomy, protection, and prestige) than public transport users from their habitual mode of transport. Being a car driver conferred more benefits than being a passenger, except for self esteem which was only associated with driving among men. Self-esteem was also associated with type of car among men but not women. This study suggests that if people are to be encouraged to reduce private motor vehicle use, policies need to take into account some of the psychosocial benefits people might derive from such use.

Does housing tenure predict health in the UK because it exposes people to different levels of housing related hazards in the home or its surroundings

In the UK housing tenure (whether the dwelling is owner occupied or rented) has consistently been found to be associated with longevity and with a number of measures of health. It has been argued that it is a good measure of material circumstances, and it is often incorporated into area based measures of social or material deprivation. However there is little published research on whether housing tenure predicts mortality and morbidity simply because it is an indicator of material well being, or whether, in addition, different categories of housing tenure expose people to different levels of health hazards in the dwelling itself or in the immediate environment. In this paper we examine, using data on adults aged 40 and 60 from socially contrasting neighbourhoods in Glasgow, Scotland, whether housing tenure is associated with housing stressors (e.g. overcrowding, dampness, hazards, difficulty with heating the home) and with assessment of the local environment (e.g. amenities, problems, crime, neighbourliness, area reputation and satisfaction), and whether this might help to explain tenure differences in long-standing illness, limiting long-standing illness, anxiety and depression. Controlling for income, age and sex, housing stressors independently predicted limiting long-standing illness; assessment of the area and housing type independently contributed to anxiety; and housing stressors, housing type and assessment of the area independently contributed to depression. This suggests that housing tenure may expose people to different levels of health hazards, and has implications for urban housing policies.

Beyond four walls - the psycho-social benefits of home: evidence from West Central Scotland

This paper reviews the literatures on housing and ontological security and the meaning of the home in order to derive specific examples of the psycho-social benefits of the home which can be assessed through empirical research. A postal survey measuring these psycho-social benefits was distributed to a random sample of adults in eight local authority districts in West Central Scotland. From the responses to the survey, three factors were constructed relating to the home as a haven, as a locus of autonomy and as a source of status for the occupants. Multivariate analysis showed that housing tenure is less important as an influence upon the attainment of psycho-social benefits from the home than the neighbourhood context and the incidence of problems with the home. Further, those factors negatively associated with psycho-social benefits appear to be more important than those factors positively associated with such benefits. This suggests that future research should focus on the fact that what detracts from psycho-social benefits may be more important than what contributes to them. A further important finding is that, after controlling for other influences, people living alone derive more benefits from the home as a haven and as a locus of autonomy than people in multi-person households.

MEANS OF TRANSPORT AND ONTOLOGICAL SECURITY: DO CARS PROVIDE PSYCHO-SOCIAL BENEFITS TO THEIR USERS?

This paper presents some empirical evidence on the psycho-social benefits people seem to derive from their cars based on in-depth interviews with a sample of car owners and non-car owners in the West of Scotland. We suggest that psycho-social benefits of protection, autonomy and prestige may help to explain peoples attachment to cars and also why studies have found consistently that car owners are healthier than non-car owners. In our study cars were seen to provide protection from undesirable people events, and a comfortable cocoon (but not as providing protection against accidents). Cars provided autonomy because car use was seen as being more convenient, reliable and providing access to more destinations than public transport. Cars were seen to confer prestige and other socially desirable attributes such as competence, skill and masculinity. We think that it is important for policy makers to consider how to make public transport more attractive by increasing its potential to provide similar sorts of benefits, and to do so by targetting the different needs of various population groups.