Martine Shareck

Reducing social inequities in health through settings-related interventions — a conceptual framework

Introduction: The creation of supportive environments for health is a basic action principle of health promotion, and equity is a core value. A settings approach offers an opportunity to bridge these two, with its focus on the interplay between individual, environmental and social determinants of health. Methods: We conducted a scoping review of the literature on theoretical bases and practical applications of the settings approach. Interventions targeting social inequities in health through action on various settings were analyzed to establish what is done in health equity research and action as it relates to settings. Results: Four elements emerged as central to an equity-focused settings approach: a focus on social determinants of health, addressing the needs of marginalized groups, effecting change in a setting’s structure, and involving stakeholders. Each came with related challenges. To offer potential solutions to these challenges we developed a conceptual framework that integrates theoretical and methodological approaches, along with six core guiding principles, into a ‘settings praxis’. Conclusions: Reducing social inequities in health through the creation of supportive environments requires the application of the settings approach in an innovative way. The proposed conceptual framework can serve as a guide to do so, and help develop, implement and evaluate equity-focused settings-related interventions. (Global Health Promotion, 2013; 20(2): 39–52).

The added value of accounting for activity space when examining the association between tobacco retailer availability and smoking among young adults

Background Despite a declining prevalence in many countries, smoking rates remain consistently high among young adults. Targeting contextual influences on smoking, such as the availability of tobacco retailers, is one promising avenue of intervention. Most studies have focused on residential or school neighbourhoods, without accounting for other settings where individuals spend time, that is, their activity space. We investigated the association between tobacco retailer availability in the residential neighbourhood and in the activity space, and smoking status. Methods Cross-sectional baseline data from 1994 young adults (aged 18–25) participating in the Interdisciplinary Study of Inequalities in Smoking (Montreal, Canada, 2011–2012) were analysed. Residential and activity locations served to derive two measures of tobacco retailer availability: counts within 500 m buffers and proximity to the nearest retailer. Prevalence ratios for the association between each tobacco retailer measure and smoking status were estimated using log-binomial regression. Results Participants encountering high numbers of tobacco retailers in their residential neighbourhood, and both medium and high retailer counts in their activity space, were more likely to smoke compared to those exposed to fewer retailers. While residential proximity was not associated with smoking, we found 36% and 42% higher smoking prevalence among participants conducting activities within medium and high proximity to tobacco retailers compared to those conducting activities further from such outlets. Conclusions This study adds to the sparse literature on contextual correlates of smoking among young adults, and illustrates the added value of considering individuals’ activity space in contextual studies of smoking.

Considering daily mobility for a more comprehensive understanding of contextual effects on social inequalities in health: a conceptual proposal.

Despite growing interest in integrating people׳s daily mobility into contextual studies of social inequalities in health, the links between daily mobility and health inequalities remain inadequately conceptualised. This conceptual proposal anchors the relationship between daily mobility and contextual influences on social inequalities in health into the concept of mobility potential, which encompasses the opportunities and places individuals can choose (or are constrained) to access. Mobility potential is realized as actual mobility through agency. Being shaped by socially-patterned personal and geographic characteristics, mobility potential is unequally distributed across social groups. Social inequalities in realized mobility may thus result. We discuss pathways by which these may contribute to contextual influences on social inequalities in health. One pathway is reflected in disadvantaged groups encountering more fast-food outlets during their daily activities, which may relate to their higher risk of unhealthy eating. This proposal lays the bases for empirical research explicitly testing hypotheses regarding the contribution of daily mobility to social inequalities in health.

Examining the spatial congruence between data obtained with a novel activity location questionnaire, continuous GPS tracking, and prompted recall surveys

BackgroundPlace and health researchers are increasingly interested in integrating individuals’ mobility and the experience they have with multiple settings in their studies. In practice, however, few tools exist which allow for rapid and accurate gathering of detailed information on the geographic location of places where people regularly undertake activities. We describe the development and validation of a new activity location questionnaire which can be useful in accounting for multiple environmental influences in large population health investigations.MethodsTo develop the questionnaire, we relied on a literature review of similar data collection tools and on results of a pilot study wherein we explored content validity, test-retest reliability, and face validity. To estimate convergent validity, we used data from a study of users of a public bicycle share program conducted in Montreal, Canada in 2011. We examined the spatial congruence between questionnaire data and data from three other sources: 1) one-week GPS tracks; 2) activity locations extracted from the GPS tracks; and 3) a prompted recall survey of locations visited during the day. Proximity and convex hull measures were used to compare questionnaire-derived data and GPS and prompted recall survey data.ResultsIn the sample, 75% of questionnaire-reported activity locations were located within 400 meters of an activity location recorded on the GPS track or through the prompted recall survey. Results from convex hull analyses suggested questionnaire activity locations were more concentrated in space than GPS or prompted-recall locations.ConclusionsThe new questionnaire has high convergent validity and can be used to accurately collect data on regular activity spaces in terms of locations regularly visited. The methods, measures, and findings presented provide new material to further study mobility in place and health research.

Improving the measurement of neighbourhood characteristics through systematic observation: Inequalities in smoking as a case study☆

Systematic observation is increasingly used as a method to measure neighbourhood characteristics thought to influence health inequalities. This article reports on the theory-driven development of a new observation tool composed of reflective indicators of neighbourhood characteristics believed to influence inequalities in smoking. We also report the results of generalisability analyses conducted to estimate the reliability (inter-rater reliability and temporal stability) of the observation tool. We use the reliability results to reflect on the quality of the measures and on the theoretical anchors of the tool. We conclude by making recommendations to improve measures collected through systematic observation.

Understanding the role of contrasting urban contexts in healthy aging: an international cohort study using wearable sensor devices (the CURHA study protocol)

BackgroundGiven the challenges of aging populations, calls have been issued for more sustainable urban re-development and implementation of local solutions to address global environmental and healthy aging issues. However, few studies have considered older adults’ daily mobility to better understand how local built and social environments may contribute to healthy aging. Meanwhile, wearable sensors and interactive map-based applications offer novel means for gathering information on people’s mobility, levels of physical activity, or social network structure. Combining such data with classical questionnaires on well-being, physical activity, perceived environments and qualitative assessment of experience of places opens new opportunities to assess the complex interplay between individuals and environments. In line with current gaps and novel analytical capabilities, this research proposes an international research agenda to collect and analyse detailed data on daily mobility, social networks and health outcomes among older adults using interactive web-based questionnaires and wearable sensors.Methods/DesignOur study resorts to a battery of innovative data collection methods including use of a novel multisensor device for collection of location and physical activity, interactive map-based questionnaires on regular destinations and social networks, and qualitative assessment of experience of places. This rich data will allow advanced quantitative and qualitative analyses in the aim to disentangle the complex people-environment interactions linking urban local contexts to healthy aging, with a focus on active living, social networks and participation, and well-being.DiscussionThis project will generate evidence about what characteristics of urban environments relate to active mobility, social participation, and well-being, three important dimensions of healthy aging. It also sets the basis for an international research agenda on built environment and healthy aging based on a shared and comprehensive data collection protocol.

Integrating activity spaces in health research: Comparing the VERITAS activity space questionnaire with 7-day GPS tracking and prompted recall

BACKGROUND Accounting for daily mobility allows assessment of multiple exposure to environments. This study compares spatial data obtained (i) from an interactive map-based questionnaire on regular activity locations (VERITAS) and (ii) from GPS tracking. METHODS 234 participants of the RECORD GPS Study completed the VERITAS questionnaire and wore a GPS tracker for 7 days. Analyses illustrate the spatial match between both datasets. RESULTS For half of the sample, 85.5% of GPS data fell within 500 m of a VERITAS location. The median minimum distance between a VERITAS location and a GPS coordinate ranged from 0.4 m for home to slightly over 100 m for a recreational destination. CONCLUSIONS There is a spatial correspondence between destinations collected through VERITAS and 7-day GPS tracking. Both collection methods offer complementary ways to assess daily mobilities, useful to study environmental determinants of health and health inequities.

Comments on Melis et al. The Effects of the Urban Built Environment on Mental Health: A Cohort Study in a Large Northern Italian City. Int. J. Environ. Res. Public Health, 2015, 12, 14898-14915

In a recent paper by Melis and colleagues [1], exposure to certain built environment characteristics—urban density and accessibility to public transit—is found to be related to mental health, even more so among women, the elderly, and the residentially stable (interactions between built environment and individual characteristics in relation to mental health have unfortunately not been tested statistically, which could have strengthened their demonstration).[...]

Rethinking Exposure in Area Studies on Social Inequities in Smoking in Youth and Young Adults

Smoking is the main modifiable cause of premature death worldwide. It is also increasingly concentrated in younger age groups, lower social classes and deprived geographic areas. These social inequities in smoking are intrinsically unfair and have major implications for public health. As such, they must be addressed, but a better understanding of how social inequities in smoking in youth and young adults come about and could be reduced must first be sought. Part of the answer could lie in characteristics of the areas to which people are exposed. In this chapter, we review the literature on area effects and social inequities in smoking in youth and young adults. We highlight two main limitations of contemporary research and interventions: (1) the narrow focus on single, mainly residential areas, rather than multiple life environments and (2) the lack of research on the differential effect of area-level interventions on smoking across social groups. We conclude by introducing a health promotion perspective which could contribute to furthering the study of area-level influences on social inequities in smoking in youth and young adults. This perspective involves two key principles: the view that health is produced in everyday life environments, where people live, work, study and play, and the explicit focus on equity. This perspective is integrated in an ongoing research project which will be presented for illustrative purposes. As a subcomponent of the Interdisciplinary Study on Inequalities in Smoking (ISIS), the ISIS-Activity Space project explores the influence of area-level exposures measured within multiple life environments, which together form the “activity space”, on social inequities in smoking in a sample of young adults residing in areas of varied deprivation levels in Montreal, Canada.

Challenges to interdisciplinary training for junior space, place and health researchers

The complexity of research questions posed in space, place and health research has led some researchers to suggest that these questions cannot be addressed adequately through a single research discipline. The objective of this article is two-fold. First, we argue that junior researchers face distinct challenges in learning how to conduct interdisciplinary research. Second, we outline how a unique training experience, the Canadian Institutes of Health Research Space, Place and Health Summer Institute addressed some of the challenges to incorporating interdisciplinarity into this unique field. Interdisciplinary training can prepare the next generation of researchers in all health fields to work effectively with colleagues from various disciplines, ask novel questions and address complex issues in innovative ways.