Mathieu D. Philibert

Conceptual and operational considerations in identifying socioenvironmental factors associated with disability among community-dwelling adults.

Disability is conceived as a person–context interaction. Physical and social environments are identified as intervention targets for improving social participation and independence. In comparison to the body of research on place and health, relatively few reports have been published on residential environments and disability in the health sciences literature. We reviewed studies evaluating the socioenvironmental correlates of disability. Searches were conducted in Medline, Embase and CINAHL databases for peer-reviewed articles published between 1997 and 2014. We found many environmental factors to be associated with disability, particularly area-level socioeconomic status and rurality. However, diversity in conceptual and methodological approaches to such research yields a limited basis for comparing studies. Conceptual inconsistencies in operational measures of disability and conceptual disagreement between studies potentially affect understanding of socioenvironmental influences. Similarly, greater precision in socioenvironmental measures and in study designs are likely to improve inference. Consistent and generalisable support for socioenvironmental influences on disability in the general adult population is scarce.

Interactions between neighborhood characteristics and individual functional status in relation to disability among Québec urbanites.

BACKGROUND Disability is conceived as a person-context interaction. Neighborhoods are among the contexts potentially influencing disability. It is thus expected that neighborhood characteristics will be associated with disability prevalence and that such associations will be moderated by individual-level functional status. Empirical research targeting the influences of features of urban environments is relatively rare. OBJECTIVES To evaluate the presence of contextual differences in disability prevalence and to assess the moderating role of individual functional status on the association between neighborhood characteristics and disability prevalence. METHODS Multi-level analyses of individual-level data obtained from the Canadian Community Health Survey and neighborhood-level data derived from the Canada census. RESULTS A contextual component was observed in the variability of disability prevalence. Significant neighborhood-level differences in disability were found across levels of social deprivation. Evidence of person-place interaction was equivocal. CONCLUSIONS The contextual component of the variability in disability prevalence offers potential for targeting interventions to neighborhoods. The pathway by which social structure is associated with disability prevalence requires further research. Analyses of particular functional limitations may enhance our understanding of the mechanisms by which socioenvironmental factors affect disability. Publicly available survey data on disability in the general Canadian population, while useful, has limitations with respect to estimating socioenvironmental correlates of disability and potential person-place interactions.

Associations between disability prevalence and local-area characteristics in a general community-living population.

BACKGROUND Disability is understood to arise from person-environment interactions. Hence, heterogeneity in local-area characteristics should be associated with local-area variation in disability prevalence. This study evaluated the associations of disability prevalence with local-area socioeconomic status and contextual features. METHODS Disability prevalence was obtained from the Canada census of 2001 for the entire province of Québec at the level of dissemination areas (617 individuals on average) based on responses from 20% of the population. Data on local-area characteristics were urban-rural denomination, social and material deprivation, active and collective commuting, residential stability, and housing quality. Associations between local-area characteristics and disability prevalence were assessed using multilevel logistic regressions. RESULTS Disability was associated with local-area socioeconomic status and contextual characteristics, and heterogeneity in these factors accounted for urban-rural differences in disability prevalence. Associations between contextual features and disability prevalence were confounded by local-area socioeconomic status. Some associations between local-area socioeconomic status and disability prevalence were moderated by contextual characteristics. The importance of this effect modification is greater when expressed in terms of the absolute magnitude of disability than in the relative likelihood of disability. CONCLUSION Explanation of rural-urban differences by the contribution of other local-area characteristics is consistent with the conceptualization of urban-rural categories as the reflection of spatially varying ensembles of compositional and contextual factors. Although local-area socioeconomic status explains most variability in disability prevalence, this study shows that contextual characteristics are relevant to analyses of the spatial patterning of disability as they predict spatial variations of disability, sometimes in interaction with socioeconomic status. This study demonstrates that absolute and relative perspectives on effect modification may lead to differing conclusions.

Neighborhood characteristics associated with the availability of alcohol outlets in quebec, Canada.

Objectives. The objectives of this study were to examine the spatial accessibility to alcohol outlets in Quebec and to assess the association between neighborhood level characteristics and availability of alcohol outlets. Methods. The Tobit Model was used to assess the association between neighborhood level characteristics and the availability of alcohol outlets within 500, 1000, 2000, and 3000 metres, respectively. Results. Alcohol outlets were found to be most available in the two largest metropolitan areas of the province of Quebec (Montréal and Québec City). Within 1000 metres, alcohol outlets are more available in neighbourhoods with the following characteristics: highest concentration of men, least materially deprived highest concentration of persons aged 20 years or more, and location either in a metropolitan area or in a small town. Finally, the number of bars with video lottery terminals increases with the level of social and material deprivation. Conclusion. In Québec, there is no rule governing the location of alcohol outlets. Thus, there is an abundant literature indicating that the regulation of alcohol outlet density could be an effective means of controlling risk attributable to alcohol consumption.