Robert Pampalon

Using experienced activity spaces to measure foodscape exposure

Researchers are increasingly interested in understanding how food environments influence eating behavior and weight-related health outcomes. Little is known about the dose-response relationship between foodscapes and behavior or weight, with measures of food exposure having mainly focused on fixed anchor points including residential neighborhoods, schools, or workplaces. Recent calls have been made to extend the consideration of environmental influences beyond local neighborhoods and also to shift away from place-based, to people-based, measures of exposure. This report presents analyses of novel activity-space measures of exposure to foodscapes, combining travel survey data with food store locations in Montreal and Quebec City, Canada. The resulting individual activity-space experienced foodscape exposure measures differ from traditional residential-based measures, and show variations by age and income levels. Furthermore, these activity-space exposure measures once modeled, can be used as predictors of health outcomes. Hence, travel surveys can be used to estimate environmental exposure for health survey participants.

Association between Activity Space Exposure to Food Establishments and Individual Risk of Overweight

Objective Environmental exposure to food sources may underpin area level differences in individual risk for overweight. Place of residence is generally used to assess neighbourhood exposure. Yet, because people are mobile, multiple exposures should be accounted for to assess the relation between food environments and overweight. Unfortunately, mobility data is often missing from health surveys. We hereby test the feasibility of linking travel survey data with food listings to derive food store exposure predictors of overweight among health survey participants. Methods Food environment exposure measures accounting for non-residential activity places (activity spaces) were computed and modelled in Montreal and Quebec City, Canada, using travel surveys and food store listings. Models were then used to predict activity space food exposures for 5,578 participants of the Canadian Community Health Survey. These food exposure estimates, accounting for daily mobility, were used to model self-reported overweight in a multilevel framework. Median Odd Ratios were used to assess the proportion of between-neighborhood variance explained by such food exposure predictors. Results Estimates of food environment exposure accounting for both residential and non-residential destinations were significantly and more strongly associated with overweight than residential-only measures of exposure for men. For women, residential exposures were more strongly associated with overweight than non-residential exposures. In Montreal, adjusted models showed men in the highest quartile of exposure to food stores were at lesser risk of being overweight considering exposure to restaurants (OR = 0.36 [0.21–0.62]), fast food outlets (0.48 [0.30–0.79]), or corner stores (0.52 [0.35–0.78]). Conversely, men experiencing the highest proportion of restaurants being fast-food outlets were at higher risk of being overweight (2.07 [1.25–3.42]). Women experiencing higher residential exposures were at lower risk of overweight. Conclusion Using residential neighbourhood food exposure measures may underestimate true exposure and observed associations. Using mobility data offers potential for deriving activity space exposure estimates in epidemiological models.

A multi-perspective approach for defining neighbourhood units in the context of a study on health inequalities in the Quebec City region

BackgroundIdentification of socioeconomic and health inequalities at the local scale is facilitated by using relevant small geographical sectors. Although these places are routinely defined according to administrative boundaries on the basis of statistical criteria, it is important to carefully consider the way they are circumscribed as they can create spatial analysis problems and produce misleading information. This article introduces a new approach to defining neighbourhood units which is based on the integration of elements stemming from the socioeconomic situation of the area, its history, and how it is perceived by local key actors.ResultsUsing this set of geographical units shows important socioeconomic and health disparities at the local scale. These disparities can be seen, for example, in a 16-year difference in disability-free life expectancy at birth, and a

Geographies of health perception in Québec: a multilevel perspective.

10,000-difference in average personal income between close neighbourhoods. The geographical units also facilitate information transfer to local stakeholders.ConclusionThe context of this study has made it possible to explore several relevant methodological issues related to the definition of neighbourhood units. This multi-perspective approach allows the combination of many different elements such as physical structures, historical and administrative boundaries, material and social deprivation of the population, and sense of belonging. Results made sense to local stakeholders and helped them to raise important issues to improve future developments.

Health inequalities in urban and rural Canada: Comparing inequalities in survival according to an individual and area-based deprivation index

Self perceived health is a widely used measure and, in Quebec, it has been shown to vary significantly between geographical areas. In the present study, these geographical variations are examined in a multilevel analysis in order to disentangle compositional (individual characteristics) and contextual (place) effects. The analysis recognizes four levels of variation: individual, household, local and regional. Similar analyses carried out in Britain, have considered only two levels: individual and local. Data come from the 1992-1993 Quebec Health and Social Survey, a general household survey using a stratified two-stage sampling design. Health perception (the response variable) is considered with a set of individual predictor characteristics reflecting gender, lifestyle, socio-economic conditions, marital status and social support. Results show the existence of significant local area variations in health perception after having allowed for individual characteristics and variations at the household level. At the regional level, however, no systematic and significant variations remain although some individual regions are found to have a significant impact on health perception.

Recent changes in the geography of social disparities in premature mortality in Québec

Social health inequalities are smaller in rural than urban areas because, some argue, peoples social conditions are estimated at a small-area level, hiding variability at the individual or household level. This paper compares inequalities in survival according to an individual and area-based version of a deprivation index among a large sample of Canadians living in various urban and rural settings. Results show that survival inequalities in small towns and rural areas are lower than elsewhere when an area-based index is used, except in the remote hinterland, but of equal magnitude when the individual version of this index is considered.

Avoidable mortality in Québec and its regions

Most recent research reveals that social inequalities in premature mortality are widening. Such findings mainly apply to countries as a whole. In this study, we model recent changes in the association between premature mortality and a deprivation index (a small area-based index) in four geographic settings in Québec, namely the Montréal metropolitan area, other Québec metropolitan areas, mid-size cities, and small towns and rural areas. Deaths from all-cause and specific causes of mortality among people under age 75 are considered for the periods 1989-1993 and 1999-2003. Mortality rates are modeled using negative binomial regressions. Models are fitted for the overall population and for men and women, separately, in every geographic setting. Three measures of inequalities are used: mortality rates for different population groups, rate ratios and rate differences. Results show that social inequalities in premature mortality increase everywhere in Québec except in the Montréal metropolitan area. Presently, the highest mortality rates among deprived groups are found in mid-size cities, small towns and rural areas; the highest rate ratios in the Montréal metropolitan area and other metropolitan areas of Québec; and the highest rate differences in the Montréal metropolitan area, other metropolitan areas of Québec and mid-size cities. These results are discussed with reference to possible explanatory factors, namely relative deprivation, smoking, immigration and internal migration. Indications on future research and policy implications are provided.

Health discrepancies in rural areas in Québec

Avoidable mortality has been proposed as an outcome measure of health services and our aim, in this study, is to trace its general features and regional variations in Québec. For that purpose, comparisons are established between two time periods (1969-73 and 1982-90) and with several countries. Furthermore, regional SMRs (for the period 1982-90) are submitted to the Gail heterogeneity test and introduced in a stepwise regression with variables describing health services, socio-economic context and prevalence or incidence of related diseases. An analysis of proportional mortality is carried out in the two northern regions of Kativik and Baie-James. Avoidable mortality has dropped substantially in Québec, except in the case of asthma, and now displays excellent scores at the international level. Only three causes of death show significant regional variations: tuberculosis, hypertensive and cerebrovascular diseases and perinatal mortality. These variations are mainly associated with socio-economic factors but also with health services. Furthermore, the highest rates of avoidable death have been observed in Gaspésie, Saguenay/Lac St-Jean and in the two northern regions. These results are discussed through information already available on health services in Québec.

Weighing the contributions of material and social area deprivation to preterm birth

Little information exists on health discrepancies within rural areas. Our research proposes to analyse the Québec Health Survey--a population health survey carried out in Québec in 1987--using a geographic grid which defines three different rural areas: that area bordering urban centers, a more remote area and the very remote hinterland. The analysis brings to light major, statistically significant, discrepancies between these areas in three sectors: health status determinants (physical activity and social support), the actual state of health (perceived health, a global health index and various pathologies) and the consequences that may be attributed to this state of health (disability and medication). It shows the difficult situation of inhabitants of the very remote hinterland.

Local Context Influence, Activity Space, and Foodscape Exposure in Two Canadian Metropolitan Settings: Is Daily Mobility Exposure Associated with Overweight?

Evidence suggests that individual socioeconomic status is a better predictor of preterm birth (PTB) than other individual social characteristics, but it is not clear if socioeconomic (material) area context is likewise more strongly related to PTB than social area characteristics. We compared material and social area deprivation to determine which was more strongly associated with PTB. Live singleton births from Québec, Canada were obtained for 1999-2006 (N = 581,898). PTB was defined as <37 completed gestational weeks. Two composite indices representing area-level material and social deprivation were used in Cox proportional hazards regression models to compute hazard ratios (HR) and 95% confidence intervals (CI) for PTB, accounting for individual-level characteristics including maternal education. Results indicated that PTB rates were higher for areas with high material (7.1%) and social (6.8%) deprivation than those with low material (5.5%) and social (5.9%) deprivation. Adjusted hazards of PTB were slightly greater for material deprivation than social deprivation. These findings indicate that material area deprivation is marginally more strongly associated with PTB than social deprivation, but it is not clear that interventions to prevent PTB should focus on material deprivation any more than on social area deprivation.