Garg, Parveen K.; Platt, Jonathan M.; Hirsch, Jana A.; Hurvitz, Philip; Rundle, Andrew; Biggs, Mary Lou; Psaty, Bruce M.; Moore, Kari; Lovasi, Gina S. (2021). Association of Neighborhood Physical Activity Opportunities with Incident Cardiovascular Disease in the Cardiovascular Health Study. Health & Place, 70.
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Abstract
We determined associations of cumulative exposures to neighborhood physical activity opportunities with risk of incident cardiovascular disease (CVD). We included 3595 participants from the Cardiovascular Health Study recruited between 1989 and 1993 (mean age = 73; 60% women; 11% black). Neighborhood environment measures were calculated using Geographic Information Systems (GIS) and annual information from the National Establishment Time Series database, including the density of (1) walking destinations and (2) physical activity/ recreational facilities in a 1- and 5-km radius around the respondent's home. Incident CVD was defined as the development of myocardial infarction, stroke, or cardiovascular death and associations with time to incident CVD were estimated using Cox proportional hazards models. A total of 1986 incident CVD cases occurred over a median follow-up of 11.2 years. After adjusting for baseline and time-varying individual and neighborhood-level confounding, a one standard deviation increase in walking destinations and physical activity/recreational facilities within 5 km of home was associated with a respective 7% (95% confidence interval (CI) = 0.87-0.99) and 12% (95% CI = 0.73-1.0) decreased risk of incident CVD. No significant associations were noted within a 1-km radius. Efforts to improve the availability of physical activity resources in neighborhoods may be an important strategy for lowering CVD.
Keywords
Cardiovascular Diseases; Physical Activity; Proportional Hazards Models; Geographic Information Systems; Recreation Centers; Built Environment; Cardiovascular Disease; Coronary-heart-disease; Census Tract Data; Older-adults; Longitudinal Associations; Risk; Resources; Time; Atherosclerosis; Survival
Moudon, Anne Vernez; Cook, Andrea J.; Ulmer, Jared; Hurvitz, Philip M.; Drewnowski, Adam. (2011). A Neighborhood Wealth Metric for Use in Health Studies. American Journal Of Preventive Medicine, 41(1), 88 – 97.
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Abstract
Background: Measures of neighborhood deprivation used in health research are typically based on conventional area-based SES. Purpose: The aim of this study is to examine new data and measures of SES for use in health research. Specifically, assessed property values are introduced as a new individual-level metric of wealth and tested for their ability to substitute for conventional area-based SES as measures of neighborhood deprivation. Methods: The analysis was conducted in 2010 using data from 1922 participants in the 2008-2009 survey of the Seattle Obesity Study (SOS). It compared the relative strength of the association between the individual-level neighborhood wealth metric (assessed property values) and area-level SES measures (including education, income, and percentage above poverty as single variables, and as the composite Singh index) on the binary outcome fair/poor general health status. Analyses were adjusted for gender, categoric age, race, employment status, home ownership, and household income. Results: The neighborhood wealth measure was more predictive of fair/poor health status than area-level SES measures, calculated either as single variables or as indices (lower DIC measures for all models). The odds of having a fair/poor health status decreased by 0.85 (95% CI=0.77, 0.93) per $50,000 increase in neighborhood property values after adjusting for individual-level SES measures. Conclusions: The proposed individual-level metric of neighborhood wealth, if replicated in other areas, could replace area-based SES measures, thus simplifying analyses of contextual effects on health. (Am J Prev Med 2011; 41(1): 88-97) (C) 2011 American Journal of Preventive Medicine
Keywords
Health -- Social Aspects; Social Status; Public Health Research; Home Ownership; Income; Real Property; Deprivation (psychology); Health Education; Disparities Geocoding Project; Body-mass Index; Socioeconomic-status; Ecological Fallacy; Built Environment; Deprivation Indexes; Multilevel Analysis; Individual-level; Social-class; Inequalities
Quistberg, D. Alex; Howard, Eric J.; Ebel, Beth E.; Moudon, Anne V.; Saelens, Brian E.; Hurvitz, Philip M.; Curtin, James E.; Rivara, Frederick P. (2015). Multilevel Models for Evaluating the Risk of Pedestrian-Motor Vehicle Collisions at Intersections and Mid-Blocks. Accident Analysis & Prevention, 84, 99 – 111.
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Abstract
Walking is a popular form of physical activity associated with clear health benefits. Promoting safe walking for pedestrians requires evaluating the risk of pedestrian motor vehicle collisions at specific roadway locations in order to identify where road improvements and other interventions may be needed. The objective of this analysis was to estimate the risk of pedestrian collisions at intersections and mid-blocks in Seattle, WA. The study used 2007-2013 pedestrian motor vehicle collision data from police reports and detailed characteristics of the microenvironment and macroenvironment at intersection and mid-block locations. The primary outcome was the number of pedestrian motor vehicle collisions over time at each location (incident rate ratio [IRR] and 95% confidence interval [95% CI]). Multilevel mixed effects Poisson models accounted for correlation within and between locations and census blocks over time. Analysis accounted for pedestrian and vehicle activity (e.g., residential density and road classification). In the final multivariable model, intersections with 4 segments or 5 or more segments had higher pedestrian collision rates compared to mid-blocks. Non-residential roads had significantly higher rates than residential roads, with principal arterials having the highest collision rate. The pedestrian collision rate was higher by 9% per 10 feet of street width. Locations with traffic signals had twice the collision rate of locations without a signal and those with marked crosswalks also had a higher rate. Locations with a marked crosswalk also had higher risk of collision. Locations with a one-way road or those with signs encouraging motorists to cede the right-of-way to pedestrians had fewer pedestrian collisions. Collision rates were higher in locations that encourage greater pedestrian activity (more bus use, more fast food restaurants, higher employment, residential, and population densities). Locations with higher intersection density had a lower rate of collisions as did those in areas with higher residential property values. The novel spatiotemporal approach used that integrates road/crossing characteristics with surrounding neighborhood characteristics should help city agencies better identify high-risk locations for further study and analysis. Improving roads and making them safer for pedestrians achieves the public health goals of reducing pedestrian collisions and promoting physical activity. (C) 2015 Elsevier Ltd. All rights reserved.
Keywords
Pedestrian Accidents; Road Interchanges & Intersections; Built Environment; Pedestrian Crosswalks; Correlation (statistics); Collision Risk; Multilevel Model; Pedestrians; Geographic Information-systems; Road-traffic Injuries; Physical-activity; Signalized Intersections; Impact Speed; Urban Form; Land-use; Safety; Walking
Duncan, Glen E.; Avery, Ally; Hurvitz, Philip M.; Moudon, Anne Vernez; Tsang, Siny; Turkheimer, Eric. (2019). Cohort Profile: Twins Study of Environment, Lifestyle Behaviours and Health. International Journal Of Epidemiology, 48(4), 1041.
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Keywords
Twin Studies; Neighborhoods; Native Americans; Normalized Difference Vegetation Index; Life Style; Twins; Body-mass Index; Physical-activity; Neighborhood Walkability; Waist Circumference; Built Environment; Causal Inference; Deprivation; Validation; Registry; Obesity
Kerfeld, Cheryl I.; Hurvitz, Philip M.; Bjornson, Kristie F. (2021). Physical Activity Measurement in Children Who Use Mobility Assistive Devices: Accelerometry and Global Positioning System. Pediatric Physical Therapy, 33(2), 92 – 99.
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Abstract
Purpose: To explore the usefulness of combining accelerometry, global positioning systems, and geographic information systems, to describe the time spent in different locations and physical activity (PA) duration/count levels by location for 4 children with cerebral palsy (CP) who use assistive devices (AD). Methods: A descriptive multiple-case study. Results: Combining the 3 instruments was useful in describing and differentiating duration by location, and amount and location of PA across differing functional levels and AD. For example, the child classified with a Gross Motor Function Classification System (GMFCS) level II exhibited large amounts of PA in community settings. In contrast, the child classified with a GMFCS level V had small amounts of PA and spent most measured time at home. Conclusions: Combined accelerometry, global positioning system, and geographic information system have potential to capture time spent and amount/intensity of PA relative to locations within daily environments for children with CP who use AD.
Keywords
Cerebral-palsy; Objective Measures; Fitness; Youth; Disabilities; Adolescents; Exercise; Adults; Accelerometer; Cerebral Palsy; Environment; Global Positioning System; Mobility Assistive Devices; Physical Activity
Drewnowski, Adam; Aggarwal, Anju; Hurvitz, Philip M.; Monsivais, Pablo; Moudon, Anne V. (2012). Obesity and Supermarket Access: Proximity or Price? American Journal Of Public Health, 102(8), e74 – e80.
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Abstract
Objectives. We examined whether physical proximity to supermarkets or supermarket price was more strongly associated with obesity risk. Methods. The Seattle Obesity Study (SOS) collected and geocoded data on home addresses and food shopping destinations for a representative sample of adult residents of King County, Washington. Supermarkets were stratified into 3 price levels based on average cost of the market basket. Sociodemographic and health data were obtained from a telephone survey. Modified Poisson regression was used to test the associations between obesity and supermarket variables. Results. Only 1 in 7 respondents reported shopping at the nearest supermarket. The risk of obesity was not associated with street network distances between home and the nearest supermarket or the supermarket that SOS participants reported as their primary food source. The type of supermarket, by price, was found to be inversely and significantly associated with obesity rates, even after adjusting for individual-level sociodemographic and lifestyle variables, and proximity measures (adjusted relative risk = 0.34; 95% confidence interval = 0.19, 0.63) Conclusions. Improving physical access to supermarkets may be one strategy to deal with the obesity epidemic; improving economic access to healthy foods is another. [ABSTRACT FROM AUTHOR]; Copyright of American Journal of Public Health is the property of American Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Keywords
Natural Foods; Obesity Risk Factors; Surveys; Cluster Analysis (statistics); Confidence Intervals; Correlation (statistics); Food Service; Geographic Information Systems; Poisson Distribution; Population Geography; Research Funding; User Charges; Residential Patterns; Socioeconomic Factors; Relative Medical Risk; Statistical Models; Descriptive Statistics; Economics; Washington (state)
Baek, So-Ra; Moudon, Anne Vernez; Saelens, Brian E.; Kang, Bumjoon; Hurvitz, Philip M.; Bae, Chang-hee Christine. (2016). Comparisons of Physical Activity and Walking between Korean Immigrant and White Women in King County, WA. Journal Of Immigrant & Minority Health, 18(6), 1541 – 1546.
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Abstract
Immigrant and minority women are less physically active than White women particularly during leisure time. However, prior research demonstrates that reported household physical activity (PA) and non-leisure time walking/biking were higher among the former. Using accelerometers, GPS, and travel logs, transport-related, home-based, and leisure time PA were measured objectively for 7 days from a convenience sample of 60 first-generation Korean immigrant women and 69 matched White women from the Travel Assessment and Community Project in King County, Washington. Time spent in total PA, walking, and home-based PA was higher among Whites than Korean immigrants regardless of PA type or location. 58 % of the White women but only 20 % of the Korean women met CDC's PA recommendations. Socio-economic status, psychosocial factors, and participants' neighborhood built environmental factors failed to account for the observed PA differences between these groups.
Keywords
Accelerometer; Gps; Korean Immigrant Women; Objective Measures; Physical Activity; Walking; White Women; Nonleisure Time; Leisure-time; Environment; Transportation; Adults; Women; Socioeconomic Status; Time Use; Home Based; Environmental Aspects; Economic Status; Immigrants; Leisure; Socioeconomic Factors; Bicycles; Psychosocial Factors; Comparative Analysis; Minority & Ethnic Groups; Physical Fitness; Regression Analysis; Accelerometers; Travel; Traveltime; Environmental Factors; Recreation; Neighborhoods; Hispanic Americans; Global Positioning Systems--gps; Social Support; Noncitizens; Data Collection; Asian Americans; Psychological Aspects; Households; White People; Asian People; King County Washington; United States--us
Eisenberg-Guyot, Jerzy; Moudon, Anne V.; Hurvitz, Philip M.; Mooney, Stephen J.; Whitlock, Kathryn B.; Saelens, Brian E. (2019). Beyond the Bus Stop: Where Transit Users Walk. Journal Of Transport & Health, 14.
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Abstract
Objectives: Extending the health benefits of public-transit investment requires understanding how transit use affects pedestrian activity, including pedestrian activity not directly temporally or spatially related to transit use. In this study, we identified where transit users walked on transit days compared with non-transit days within and beyond 400 m and 800 m buffers surrounding their home and work addresses. Methods: We used data collected from 2008 to 2013 in King County, Washington, from 221 non-physically-disabled adult transit users, who were equipped with an accelerometer, global positioning system (GPS), and travel diary. We assigned walking activity to the following buffer locations: less than and at least 400 m or 800 m from home, work, or home/work (the home and work buffers comprised the latter buffer). We used Poisson generalized estimating equations to estimate differences in minutes per day of total walking and minutes per day of non-transit-related walking on transit days compared with non-transit days in each location. Results: We found that durations of total walking and non-transit-related walking were greater on transit days than on non-transit days in all locations studied. When considering the home neighborhood in isolation, most of the greater duration of walking occurred beyond the home neighborhood at both 400 m and 800 m; results were similar when considering the work neighborhood in isolation. When considering the neighborhoods jointly (i.e., by using the home/work buffer), at 400 m, most of the greater duration of walking occurred beyond the home/work neighborhood. However, at 800 m, most of the greater duration of walking occurred within the home/work neighborhood. Conclusions: Transit days were associated with greater durations of total walking and non-transit related walking within and beyond the home and work neighborhoods. Accordingly, research, design, and policy strategies focused on transit use and pedestrian activity should consider locations outside the home and work neighborhoods, in addition to locations within them.
Keywords
Physical-activity; Public-transit; Accelerometer Data; Combining Gps; United-states; Travel; Transportation; Health; Time; Neighborhood
Robinson, Jamaica R. M.; Phipps, Amanda, I; Barrington, Wendy E.; Hurvitz, Philip M.; Sheppard, Lianne; Malen, Rachel C.; Newcomb, Polly A. (2021). Associations of Household Income with Health-Related Quality of Life Following a Colorectal Cancer Diagnosis Varies with Neighborhood Socioeconomic Status. Cancer Epidemiology Biomarkers & Prevention, 30(7), 1366 – 1374.
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Abstract
Background: Existing evidence indicates household income as a predictor of health-related quality of life (HRQoL) following a colorectal cancer diagnosis. This association likely varies with neighborhood socioeconomic status (nSES), but evidence is limited. Methods: We included data from 1,355 colorectal cancer survivors participating in the population-based Puget Sound Colorectal Cancer Cohort (PSCCC). Survivors reported current annual household income; we measured HRQoL via the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) tool. Using neighborhood data summarized within a 1-km radial buffer of Census block group centroids, we constructed a multidimensional nSES index measure. We employed survivors' geocoded residential addresses to append nSES score for Census block group of residence. With linear generalized estimating equations clustered on survivor location, we evaluated associations of household income with differences in FACT-C mean score, overall and stratified by nSES. We used separate models to explore relationships for wellbeing subscales. Results: We found lower household income to be associated with clinically meaningful differences in overall FACT-C scores [<$30K: -13.6; 95% confidence interval (CI): -16.8 to -10.4] and subscale wellbeing after a recent colorectal cancer diagnosis. Relationships were slightly greater in magnitude for survivors living in lower SES neighborhoods. Conclusions: Our findings suggest that recently diagnosed lower income colorectal cancer survivors are likely to report lower HRQoL, and modestly more so in lower SES neighborhoods. Impact: The findings from this work will aid future investigators' ability to further consider the contexts in which the income of survivors can be leveraged as a means of improving HRQoL
Keywords
Built Environment Factors; Functional Assessment; Fact-c; Population-density; Physical-activity; Survivors; Care; Disparities; Impact; Mortality
Hurvitz, Philip M.; Moudon, Anne Vernez. (2012). Home Versus Nonhome Neighborhood: Quantifying Differences in Exposure to the Built Environment. American Journal Of Preventive Medicine, 42(4), 411 – 417.
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Abstract
Background: Built environment and health research have focused on characteristics of home neighborhoods, whereas overall environmental exposures occur over larger spatial ranges. Purpose: Differences in built environment characteristics were analyzed for home and nonhome locations using GPS data. Methods: GPS data collected in 2007-2008 were analyzed for 41 subjects in the Seattle area in 2010. Environmental characteristics for 3.8 million locations were measured using novel GIS data sets called SmartMaps, representing spatially continuous values of local built environment variables in the domains of neighborhood composition, utilitarian destinations, transportation infrastructure, and traffic conditions. Using bootstrap sampling, CIs were estimated for differences in built environment values for home (1666 m) GPS locations. Results: Home and nonhome built environment values were significantly different for more than 90% of variables across subjects (p < 0.001). Only 51% of subjects had higher counts of supermarkets near than away from home. Different measures of neighborhood parks yielded varying results. Conclusions: SmartMaps helped measure local built environment characteristics for a large set of GPS locations. Most subjects had significantly different home and nonhome built environment exposures. Considering the full range of individuals' environmental exposures may improve understanding of effects of the built environment on behavior and health outcomes. (Am J Prev Med 2012;42(4):411-417) (C) 2012 American Journal of Preventive Medicine
Keywords
Built Environment; Public Health Research; Individual Differences; Neighborhoods; Environmental Exposure; Health Of Homeless People; Global Positioning System; Data Analysis; Quantitative Research; Seattle (wash.); Washington (state); Geographic Information-systems; Global Positioning Systems; Physical-activity; Health Research; Urban Form; Land-use; Associations; Transportation; Availability; Walkability