Vivienne Ivory

Neighborhood built environment and transport and leisure physical activity: findings using objective exposure and outcome measures in New Zealand.

Background: Evidence of associations between neighborhood built environments and transport-related physical activity (PA) is accumulating, but few studies have investigated associations with leisure-time PA. Objective: We investigated associations of five objectively measured characteristics of the neighborhood built environment—destination access, street connectivity, dwelling density, land-use mix and streetscape quality—with residents’ self-reported PA (transport, leisure, and walking) and accelerometer-derived measures of PA. Methods: Using a multicity stratified cluster sampling design, we conducted a cross-sectional survey of 2,033 adults who lived in 48 New Zealand neighborhoods. Multilevel regression modeling, which was adjusted for individual-level (sociodemographic and neighborhood preference) and neighborhood-level (deprivation) confounders, was used to estimate associations of built environment with PA. Results: We found that 1-SD increases in destination access, street connectivity, and dwelling density were associated with any versus no self-reported transport, leisure, or walking PA, with increased odds ranging from 21% [street connectivity with leisure PA, 95% confidence interval (CI): 0%, 47%] to 44% (destination accessibility with walking, 95% CI: 17%, 79%). Among participants who self-reported some PA, a 1-SD increase in street connectivity was associated with a 13% increase in leisure PA (95% CI: 0, 28%). SD increases in destination access, street connectivity, and dwelling density were each associated with 7% increases in accelerometer counts. Conclusions: Associations of neighborhood destination access, street connectivity, and dwelling density with self-reported and objectively measured PA were moderately strong, indicating the potential to increase PA through changes in neighborhood characteristics.

Cohort Profile: Growing Up in New Zealand

Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand, Growing Up in New Zealand, University of Auckland, Auckland, New Zealand, School of Medicine, University of Auckland, Auckland, New Zealand, Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand, School of Population Health, University of Auckland, Auckland, New Zealand, Department of Public Health, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand, Office of the Deputy Vice-Chancellor (Māori), Massey University, Wellington, New Zealand, Bioinformatics Institute, University of Auckland, Auckland, New Zealand, Ministry of Pacific Island Affairs, Auckland Office, Auckland, New Zealand, Department of Psychology, University of Auckland, Auckland, New Zealand, Roy McKenzie Centre for the Study of Families, Victoria University, Wellington, New Zealand, Department of Psychology, University of Otago, Dunedin, New Zealand and School of Medical Sciences, University of Auckland, Auckland, New Zealand

When does neighbourhood matter? Multilevel relationships between neighbourhood social fragmentation and mental health

Studies investigating relationships between mental health and residential areas suggest that certain characteristics of neighbourhood environments matter. After developing a conceptual model of neighbourhood social fragmentation and health we examine this relationship (using the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag)) with self-reported mental health (using SF-36). We used the nationally representative 2002/3 New Zealand Health Survey dataset of urban adults, employing multilevel methods. Results suggest that increasing neighbourhood-level social fragmentation is associated with poorer mental health, when simultaneously accounting for individual-level confounding factors and neighbourhood-level deprivation. The association was modified by sex (stronger association seen for women) and labour force status (unemployed women more sensitive to NeighFrag than those employed or not in labour force). There was limited evidence of any association of fragmentation with non-mental health outcomes, suggesting specificity for mental health. Social fragmentation as a property of neighbourhoods appears to have a specific association with mental health among women, and particularly unemployed women, in our study.

Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position?

BackgroundAdult socioeconomic position (SEP) is one of the most frequently hypothesised indirect pathways between childhood SEP and adult health. However, few studies that explore the indirect associations between childhood SEP and adult health systematically investigate the mediating role of multiple individual measures of adult SEP for different health outcomes. We examine the potential mediating role of individual measures of adult SEP in the associations of childhood SEP with self-rated health, self-reported mental health, current smoking status and binge drinking in adulthood.MethodsData came from 10,010 adults aged 25-64 years at Wave 3 of the Survey of Family, Income and Employment in New Zealand. The associations between childhood SEP (assessed using retrospective information on parental occupation) and self-rated health, self-reported psychological distress, current smoking status and binge drinking were determined using logistic regression. Models were adjusted individually for the mediating effects of education, household income, labour market activity and area deprivation.ResultsRespondents from a lower childhood SEP had a greater odds of being a current smoker (OR 1.70 95% CI 1.42-2.03), reporting poorer health (OR 1.82 95% CI 1.39-2.38) or higher psychological distress (OR 1.60 95% CI 1.20-2.14) compared to those from a higher childhood SEP. Two-thirds to three quarters of the association of childhood SEP with current smoking (78%), and psychological distress (66%) and over half the association with poor self-rated health (55%) was explained by educational attainment. Other adult socioeconomic measures had much smaller mediating effects.ConclusionsThis study suggests that the association between childhood SEP and self-rated health, psychological distress and current smoking in adulthood is largely explained through an indirect socioeconomic pathway involving education. However, household income, area deprivation and labour market activity are still likely to be important as they are intermediaries in turn, in the socioeconomic pathway between education and health.

Adherence to nutritional guidelines in pregnancy: evidence from the Growing Up in New Zealand birth cohort study.

OBJECTIVE To determine adherence to nutritional guidelines by pregnant women in New Zealand and maternal characteristics associated with adherence. DESIGN A cohort of the pregnant women enrolled into New Zealands new birth cohort study, Growing Up in New Zealand. SETTING Women residing within a North Island region of New Zealand, where one-third of the national population lives. SUBJECTS Pregnant women (n 5664) were interviewed during 2009-2010. An FFQ was administered during the face-to-face interview. RESULTS The recommended daily number of servings of vegetables and fruit (≥6) were met by 25 % of the women; of breads and cereals (≥6) by 26 %; of milk and milk products (≥3) by 58 %; and of lean meat, meat alternatives and eggs (≥2) by 21 %. One in four women did not meet the recommendations for any food group. Only 3 % met all four food group recommendations. Although adherence to recommendation for the vegetables/fruit group did not vary by ethnicity (P=0·38), it did vary for the breads/cereals, milk/milk products and meat/eggs groups (all P<0·001). Adherence to recommendations for the vegetables/fruit group was higher among older women (P=0·001); for the breads/cereals group was higher for women with previous children (P<0·001) and from lower-income households (P<0·001); and for the meat/eggs group was higher for women with previous children (P=0·003) and from lower-income households (P=0·004). CONCLUSIONS Most pregnant women in New Zealand do not adhere to nutritional guidelines in pregnancy, with only 3 % meeting the recommendations for all four food groups. Adherence varies more so with ethnicity than with other sociodemographic characteristics.

Are neighbourhood social fragmentation and suicide associated in New Zealand? A national multilevel cohort study

Background: Studies of the association between neighbourhood fragmentation and suicide have yielded varied results, and none has simultaneously adjusted for neighbourhood fragmentation, neighbourhood deprivation and individual-level factors. Method: A multilevel analysis of a 3-year cohort study was carried out using probabilistic linkage of census and mortality records, and two measures of neighbourhood fragmentation. A total of 2.8 million respondents to the 1996 New Zealand census were followed up for 3 years for mortality (1101 suicide deaths in the analysis), aged from 20 to 74 years at follow-up. Results: No consistent association was observed between either measure of neighbourhood social fragmentation and suicide, after controlling for individual-level confounders and neighbourhood deprivation. There was some evidence of a U-shaped relationship between neighbourhood fragmentation and suicide, especially for the Congdon(NZ) index. There was no evidence of an association for a nine-variable index that captured family-type variables as well as the usual attachment-type variables. Neighbourhood deprivation remained as an important predictor of suicide rates. Conclusion: This paper highlights the importance of understanding both the measure and the wider national context when considering neighbourhood effects on suicide.

Do Changes in Neighborhood and Household Levels of Smoking and Deprivation Result in Changes in Individual Smoking Behavior? A Large-Scale Longitudinal Study of New Zealand Adults

Health behavior takes place within social contexts. In this study, we investigated whether changes in exposure to neighborhood deprivation and smoking prevalence and to household smoking were associated with change in personal smoking behavior. Three waves of biannual data collection (2004-2009) in a New Zealand longitudinal study, the Survey of Family, Income and Employment (SoFIE)-Health, were used, with 13,815 adults (persons aged ≥15 years) contributing to the analyses. Smoking status was dichotomized as current smoking versus never/ex-smoking. Fixed-effects regression analyses removed time-invariant confounding and adjusted for time-varying covariates (neighborhood smoking prevalence and deprivation, household smoking, labor force status, income, household tenure, and family status). A between-wave decile increase in neighborhood deprivation was significantly associated with increased odds of smoking (odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.02, 1.14), but a between-wave increase in neighborhood smoking prevalence was not (OR = 1.04, 95% CI: 0.98, 1.10). Changing household exposures between waves to live with another smoker (compared with a nonsmoker (referent)) increased the odds of smoking (OR = 2.48, 95% CI: 1.84, 3.34), as did changing to living in a sole-adult household (OR = 1.52, 95% CI: 1.07, 2.14). Tobacco control policies and programs should address the broader household and neighborhood circumstances within which individual smoking takes place.

The New Zealand Index of Neighbourhood Social Fragmentation: Integrating Theory and Data

We report on the development and validation of a neighbourhood measure of social fragmentation. Firstly, we developed a theoretical model of neighbourhood-level social fragmentation, as the structural antecedent to collective social functioning, with three domains (attachment, resources, and means of sharing of norms and values). Secondly, utilising the New Zealand 1996 and 2001 Censuses, variables were constructed to create the New Zealand Index of Neighbourhood Social Fragmentation (NeighFrag) at the small-area level. Nine census variables contributed substantively to a principal components analysis: homeownership, mobility, marital status, nonfamily households, single-person households, children, immigrants, non-English/Māori speakers, and long-term residents. Thirdly, relationships between NeighFrag and other contextual measures were examined, as well as its relationship with individual perceptions of neighbourhood cohesion. The NeighFrag index had a moderate association with deprivation and social capital. It was inversely associated with individual perception of neighbourhood cohesion in multilevel analyses, after adjusting for individual factors and neighbourhood deprivation. Combined, this suggests that NeighFrag provides a meaningful national-level index of neighbourhood social environments for use in analyses.

The Effect of Neighborhood Recorded Crime on Fear: Does Neighborhood Social Context Matter?

A number of individual and neighborhood-level factors may influence the relationship between recorded crime in one’s neighborhood and fear of crime. Understanding these factors may assist in reducing fear, which has been associated with poorer physical and mental health. The aim of this study was to evaluate whether the effect of recorded crime rates on fear differs based on the neighborhood social context (social fragmentation) using hierarchical regression modelling, with separate analyses by crime type. Recorded crimes (2008–2010) and national (New Zealand) survey data were used. Higher crime in a neighborhood was associated with higher fear of crime, with only small effect size differences in feelings of fear by recorded type of crime. However, when stratified, the associations between violent and drug/alcohol crimes and fear of crime were larger for those living in highly fragmented neighborhoods compared with less fragmented neighborhoods. Efforts to alleviate fear of crime should focus on the broader neighborhood social context in which these feelings are espoused.

Living in areas with different levels of earthquake damage and association with risk of cardiovascular disease: a cohort-linkage study

BACKGROUND Cardiovascular disease rates are known to increase immediately after a severe earthquake. However, less is known about the magnitude of this increase over time in relation to the amount of housing damage. We assessed the effect of area housing damage from a major earthquake sequence in Christchurch, Canterbury province, New Zealand, on cardiovascular disease-related hospital admissions and deaths. METHODS For this cohort-linkage study, we used linked administrative datasets from the Statistics New Zealand Integrated Data Infrastructure to identify individuals aged 45 years or older living in Christchurch from the date of the first earthquake on Sept 4, 2010. Individuals were assigned the average damage level for their residential meshblock (small neighbourhood generally comprising 10-50 dwellings) using the insurance-assessed residential building damage costs obtained from the Earthquake Commission as a proportion of property value. We calculated the rates of cardiovascular disease-related hospital admissions (including myocardial infarction) and cardiovascular disease-related mortality and rate ratios (adjusted for age, sex, ethnicity, small-area deprivation index, and personal income) by level of housing damage in the first year and the 4 subsequent years after the earthquake. The rate ratio association between earthquake housing damage and cardiovascular event was examined by Poisson regression, and linear test of trends across damage categories was done by regression modeling. FINDINGS We identified 179 000 residents living in the earthquake-affected region of Christchurch, of whom 148 000 had complete data. For the first 3 months after the Feb 22, 2011 earthquake, the Poisson regression-adjusted rate ratio (RR) for cardiovascular disease-related hospital admissions for residents from areas that were most damaged (compared with residents from the least damaged areas) was 1·12 (95% CI 0·96-1·32; test for linear trend p=0·239). In the first year after the earthquake sequence, for residents from areas that were most damaged (vs the least damaged areas), Poisson regression-adjusted RRs were 1·10 (1·01-1·21; test for linear trend p=0·068) for cardiovascular disease-related hospital admissions, 1·22 (1·00-1·48; p=0·036) for myocardial infarction-related hospital admissions, and 1·25 (1·06-1·47; p=0·105) for cardiovascular disease-related mortality, corresponding to an excess of 66 (95% CI 7-125) cardiovascular disease-related hospital admissions, including 29 (0-53) additional myocardial infarction-related hospital admissions and 46 (13-73) additional deaths from cardiovascular disease. In the 4 subsequent years, we found no evidence of an association of these outcomes with earthquake damage. INTERPRETATION Rates of cardiovascular disease and myocardial infarction were increased in people living in areas with more severely damaged homes in the first year after a major earthquake. Policy responses to reduce the effect of earthquake damage on cardiovascular disease could include pre-earthquake measures to minimise building damage, early wellbeing interventions within the first year to address post-earthquake stress, and enhanced provision of cardiovascular disease prevention and treatment services. FUNDING Healthier Lives National Science Challenge and Natural Hazards Research Platform, Ministry of Business, Innovation and Employment.