Richard M. Carpiano

Subjective and objective neighborhood characteristics and adult health

This study examines both objective and subjective assessments of neighborhood conditions, exploring the overlap between different sources of information on neighborhoods and the relative strength of their association with adult self-rated health. Data on perceived neighborhood quality from Wave IV (2001/2002) of the nationally representative U.S. Americans Changing Lives study are merged with neighborhood-level census tract data to measure subjective and objective neighborhood constructs. Structural equation models indicate that subjective and objective constructs are both related to health. However, the subjective construct (perceived neighborhood quality) is most strongly associated with health and mediates associations between health and the objective constructs (neighborhood disadvantage and affluence). Additionally, individual characteristics play an important role in shaping the contribution of neighborhood conditions through selection and mediation. Our results demonstrate the independent associations between both objective and perceived neighborhood quality and health, and highlight the particularly strong association between perceived neighborhood quality and health.

Participatory photo mapping (PPM): Exploring an integrated method for health and place research with young people

In this manuscript we detail the application and utility of participatory photo mapping (PPM) for studying the implications of place for the health of children. PPM is a transdisciplinary approach that integrates digital tools, narrative interviewing and participatory protocols in order to produce knowledge that can be shared and acted upon by community-based health research partnerships. In discussing the application, strengths, and weaknesses of this method, we relate our own experiences with using PPM for a recent study of neighborhood health and safety that involved young people from a variety of age groups in Madison, Wisconsin. The resultant maps were persuasive presentation tools and provided guidance for community-based interventions.

Community and Drug Use among Gay Men: The Role of Neighborhoods and Networks

Gay neighborhoods serve as vital places for gay men’s socializing, yet few studies have examined their contributions to gay men’s health—either directly or indirectly via residents’ social networks. Drawing from theoretical perspectives on community and networks, we test hypotheses concerning whether gay neighborhoods and social network factors are associated with patterns of recent illicit drug use among a sample of 740 urban gay men from New York City. Higher odds of drug use were observed among individuals who resided in gay neighborhoods, had networks composed predominantly of other gay men, and had increased socialization with gay men. Network factors did not mediate associations between gay neighborhoods and drug use. These findings highlight the need to better contextualize the health risks faced by gay men by accounting for both neighborhood and network structures.

Long-term residential exposure to air pollution and lung cancer risk.

Background: There is accumulating evidence that air pollution causes lung cancer. Still, questions remain about exposure misclassification, the components of air pollution responsible, and the histological subtypes of lung cancer that might be produced. Methods: We investigated lung cancer incidence in relation to long-term exposure to three ambient air pollutants and proximity to major roads, using a Canadian population-based case-control study. We compared 2,390 incident, histologically confirmed lung cancer cases with 3,507 population controls in eight Canadian provinces from 1994 to 1997. We developed spatiotemporal models for the whole country to estimate annual residential exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) over a 20-year exposure period. We carried out a subanalysis in urban centers, using exposures derived from fixed-site air pollution monitors, and also examined traffic proximity measures. Hierarchical logistic regression models incorporated a comprehensive set of individual and geographic covariates. Results: The increase in lung cancer incidence (expressed as fully adjusted odds ratios [ORs]) was 1.29 (95% confidence interval = 0.95–1.76) with a ten-unit increase in PM2.5 (&mgr;g/m3), 1.11 (1.00–1.24) with a ten-unit increase in NO2 (ppb), and 1.09 (0.85–1.39) with a ten-unit increase in O3 (ppb). The urban monitor-based subanalyses generally supported the national results, with larger associations for NO2 (OR = 1.34; 1.07–1.69) per 10 ppb increase. No dose-response trends were observed, and no clear relationships were found for specific histological cancer subtypes. There was the suggestion of increased risk among those living within 100 m of highways, but not among those living near major roads. Conclusions: Lung cancer incidence in this Canadian study was increased most strongly with NO2 and PM2.5 exposure. Further investigation is needed into possible effects of O3 on development of lung cancer.

A guide and glossary on postpositivist theory building for population health

This guide and glossary focuses on the role of theory and conceptual models within population health research. Upon discussing the critical need for theory in conducting interdisciplinary research, it provides strategies for crafting theories that can be empirically tested and a glossary of theory building terms that are useful for guiding research. In addition to general concepts, the glossary includes some terminology commonly found in the social sciences, whose well established traditions and practices of formal theory building may be particularly informative for epidemiologists and other population health researchers who have minimal formal social science training, but study social factors in their research.

Sense of community-belonging and health-behaviour change in Canada

Background Research indicates that primary prevention targeting individual behaviours should incorporate contextual factors. The objectives of this study are to examine the role of community-belonging and contextual factors on health-behaviour change in Canada, and whether the influence of community-belonging on behaviour change varies by specific types of behaviours and contextual factors. Methods Data on individual-level community-belonging, socio-demographics and self-rated health were obtained for 119 693 respondents from the 2007/2008 Canadian Community Health Survey located within 100 health regions across Canada. Contextual factors were based on health-region groupings of socio-economic determinants of health. Multilevel models were used to estimate the influence of community-belonging and health-region contextual factors on general, and specific, health-behaviour changes in the past year. Results After controlling for individual and contextual factors, community-belonging showed a positive dose–response relationship with health-behaviour change. Health-region contextual factors were only slightly associated with behaviour change; however, the influence of community-belonging on behaviour change showed significant variability based on health-region contextual factors. The influence of community-belonging also varied by specific health-behaviour changes, but for most prominent health behaviours (exercise, weight loss and improved diet) the effect was consistent. Conclusions Community-belonging was strongly related to health-behaviour change in Canada and may be an important component of population health prevention strategies. Efforts to increase community-belonging, however, need to be considered along with contextual factors.

Exploring the distribution of food stores in British Columbia: Associations with neighbourhood socio-demographic factors and urban form

Several studies have identified disparities in access to food retailers among urban neighbourhoods with varied socio-demographic characteristics; but few studies have examined whether key zoning and siting mechanisms described in the urban planning literature explain differences in food store access. This study assessed associations between socio-demographic and urban planning variables with the availability of large supermarkets and stores selling fresh food within one kilometre buffers from residential addresses and the proximity to the closest food stores across 630 census tracts in British Columbia, Canada. Multivariate regression results indicated that neighbourhoods with higher median household income had significantly decreased access to food stores. Inclusion of urban planning factors in multivariate models, particularly housing and transportation considerations, explained much of the relation between area income and food store access, and were significant predictors of food store availability and proximity. Public health research and practice addressing food availability would benefit by incorporating theoretical perspectives from urban planning theory.

Representations of Cosmetic Surgery and Emotional Health in Women's Magazines in Canada

OBJECTIVE This research examines how popular womens magazines portray cosmetic surgery and associated emotional health. METHODS Articles regarding cosmetic surgery were coded from the top five most circulated English-language womens magazines in Canada between 2002 and 2006 for type of procedure, patient demographics, risk information, and indicators of emotional health. Content analysis techniques were used to identify patterns of portraying the risks and benefits of cosmetic surgery. RESULTS Content analyses show the articles tend to present readers with detailed physical health risk information. However, 48% of articles discuss the impact that cosmetic surgery has on emotional health, most often linking cosmetic surgery with enhanced emotional well-being regardless of the patients pre-existing state of emotional health. The articles also tend to use accounts given by males to provide defining standards of female attractiveness. CONCLUSION These findings are consistent with arguments in the research literature that womens magazines contribute to the medicalization of the female body. Cosmetic surgery is generally portrayed as a risky--but worthwhile--option for women to enhance both their physical appearance and emotional health. The implications for future research and public education strategies are discussed.

Neighborhood Social Capital, Parenting Strain, and Personal Mastery among Female Primary Caregivers of Children:

Neighborhood social capital—resources inherent within community networks—has been identified as a potential facilitator of personal well-being. We test hypotheses concerning how neighborhood social capital moderates the influence of parenting strain on mastery (individuals’ understanding of their ability to control personal life circumstances) for female primary caregivers of children. First, we test how different forms of neighborhood social capital—social support, social leverage (information exchange), informal social control, and neighborhood organization participation—modify the association between parenting strain and mastery. Second, we test whether such moderation depends on one’s access to these forms via neighbor ties. Analyses of Los Angeles Family and Neighborhood Survey data (N = 765) indicate that the negative relationship between parenting strain and mastery worsens as informal social control increases. Social support and informal social control, however, buffer this parenting strain-mastery relationship when caregivers have stronger ties to neighbors. Our findings implicate mechanisms of “negative social capital” and warrant more nuanced considerations of neighborhood social capital’s health-promoting potential.

Exploring the Gay Community Question: Neighborhood and Network Influences on the Experience of Community among Urban Gay Men

The reported declining significance of gay neighborhoods has raised questions about the role of gay enclaves as a locus for community building. Using Wellman and Leightons community “lost,” “saved,” and “liberated” frameworks, we examine the degree to which gay enclave residence and network socializing are associated with experiences of gay community among men in the New York City area. Multilevel models indicate that enclave residence is neither directly nor indirectly associated with perceived community cohesion or community attachment. Increased socializing with gay men and heterosexuals were, respectively, positively and negatively associated with our community outcomes. Increased socializing with lesbians was associated with greater community attachment, while socializing with bisexuals was associated with greater perceived community cohesion. Our findings lend support for a “gay community liberated” perspective; experiences of gay community are shaped principally by network relations rather than residential proximity to gay institutions.