Drewnowski, Adam; Rehm, Colin D.; Moudon, Anne V.; Arterburn, David. (2014). The Geography of Diabetes by Census Tract in a Large Sample of Insured Adults in King County, Washington, 2005-2006. Preventing Chronic Disease, 11.
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Abstract
Introduction Identifying areas of high diabetes prevalence can have an impact on public health prevention and intervention programs. Local health practitioners and public health agencies lack small-area data on obesity and diabetes. Methods Clinical data from the Group Health Cooperative health care system were used to estimate diabetes prevalence among 59,767 adults by census tract. Area-based measures of socioeconomic status and the Modified Retail Food Environment Index were obtained at the census-tract level in King County, Washington. Spatial analyses and regression models were used to assess the relationship between census tract level diabetes and area-based socioeconomic status and food environment variables. The mediating effect of obesity on the geographic distribution of diabetes was also examined. Results In this population of insured adults, diabetes was concentrated in south and southeast King County, with smoothed diabetes prevalence ranging from 6.9% to 21.2%. In spatial regression models, home value and college education were more strongly associated with diabetes than was household income. For each 50% increase in median home value, diabetes prevalence was 1.2 percentage points lower. The Modified Retail Food Environment Index was not related to diabetes at the census-tract level. The observed associations between area-based socioeconomic status and diabetes were largely mediated by obesity (home value, 58%; education, 47%). Conclusion The observed geographic disparities in diabetes among insured adults by census tract point to the importance of area socioeconomic status. Small-area studies can help health professionals design community-based programs for diabetes prevention and control.
Keywords
Prevalence; Obesity; Us; Disease
Drewnowski, Adam; Aggarwal, Anju; Tang, Wesley; Hurvitz, Philip M.; Scully, Jason; Stewart, Orion; Moudon, Anne Vernez. (2016). Obesity, Diet Quality, Physical Activity, and the Built Environment: The Need for Behavioral Pathways. BMC Public Health, 16.
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Abstract
Background: The built environment ( BE) is said to influence local obesity rates. Few studies have explored causal pathways between home-neighborhood BE variables and health outcomes such as obesity. Such pathways are likely to involve both physical activity and diet. Methods: The Seattle Obesity Study ( SOS II) was a longitudinal cohort of 440 adult residents of King Co, WA. Home addresses were geocoded. Home-neighborhood BE measures were framed as counts and densities of food sources and physical activity locations. Tax parcel property values were obtained from County tax assessor. Healthy Eating Index ( HEI 2010) scores were constructed using data from food frequency questionnaires. Physical activity ( PA) was obtained by self-report. Weights and heights were measured at baseline and following 12 months' exposure. Multivariable regressions examined the associations among BE measures at baseline, health behaviors ( HEI-2010 and physical activity) at baseline, and health outcome both cross-sectionally and longitudinally. Results: None of the conventional neighborhood BE metrics were associated either with diet quality, or with meeting PA guidelines. Only higher property values did predict better diets and more physical activity. Better diets and more physical activity were associated with lower obesity prevalence at baseline and 12 mo, but did not predict weight change. Conclusion: Any links between the BE and health outcomes critically depend on establishing appropriate behavioral pathways. In this study, home-centric BE measures, were not related to physical activity or to diet. Further studies will need to consider a broader range of BE attributes that may be related to diets and health.
Keywords
Body-mass Index; Local Food Environment; Residential Property-values; Supermarket Accessibility; Park Proximity; Neighborhood Walkability; Vegetable Consumption; Atherosclerosis Risk; Restaurant Food; Associations; Built Environment; Physical Activity; Obesity; Diet Quality
Goh, Charlene E.; Mooney, Stephen J.; Siscovick, David S.; Lemaitre, Rozenn N.; Hurvitz, Philip; Sotoodehnia, Nona; Kaufman, Tanya K.; Zulaika, Garazi; Lovasi, Gina S. (2018). Medical Facilities in the Neighborhood and Incidence of Sudden Cardiac Arrest. Resuscitation, 130, 118 – 123.
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Abstract
Background: Medical establishments in the neighborhood, such as pharmacies and primary care clinics, may play a role in improving access to preventive care and treatment and could explain previously reported neighborhood variations in sudden cardiac arrest (SCA) incidence and survival. Methods: The Cardiac Arrest Blood Study Repository is a population-based repository of data from adult cardiac arrest patients and population-based controls residing in King County, Washington. We examined the association between the availability of medical facilities near home with SCA risk, using adult (age 18-80) Seattle residents experiencing cardiac arrest (n = 446) and matched controls (n = 208) without a history of heart disease. We also analyzed the association of major medical centers near the event location with emergency medical service (EMS) response time and survival among adult cases (age 18+) presenting with ventricular fibrillation from throughout King County (n = 1537). The number of medical facilities per census tract was determined by geocoding business locations from the National Establishment Time-Series longitudinal database 1990-2010. Results: More pharmacies in the home census tract was unexpectedly associated with higher odds of SCA (OR: 1.28, 95% CI: 1.03, 1.59), and similar associations were observed for other medical facility types. The presence of a major medical center in the event census tract was associated with a faster EMS response time (-53 s, 95% CI: -84, -22), but not with short-term survival. Conclusions: We did not observe a protective association between medical facilities in the home census tract and SCA risk, orbetween major medical centers in the event census tract and survival.
Keywords
Cardiac Arrest; Medical Care; Emergency Medical Services; Ventricular Fibrillation; Heart Diseases; Patients; Medical Facilities; Neighborhood; Observational Study; Sudden Cardiac Arrest; Survival; Ambulance Response-times; Socioeconomic-status; Association; Care; Resuscitation; Disparities; Population; Provision; Disease
Muni, Kennedy; Kobusingye, Olive; Mock, Charlie; Hughes, James P.; Hurvitz, Philip M.; Guthrie, Brandon. (2019). Motorcycle Taxi Programme is Associated with Reduced Risk of Road Traffic Crash among Motorcycle Taxi Drivers in Kampala, Uganda. International Journal Of Injury Control & Safety Promotion, 26(3), 294 – 301.
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Abstract
SafeBoda is a transportation company that provides road safety training and helmets to its motorcycle taxi drivers in Kampala. We sought to determine whether risk of road traffic crash (RTC) was lower in SafeBoda compared to regular (non-SafeBoda) motorcycle taxi drivers during a 6-month follow-up period. We collected participant demographic and behavioural data at baseline using computer-assisted personal interview, and occurrence of RTC every 2 months using text messaging and telephone interview from a cohort of 342 drivers. There were 85 crashes (31 in SafeBoda and 54 in regular drivers) during follow-up. Over the 6-month follow-up period, SafeBoda drivers were 39% less likely to be involved in a RTC than regular drivers after adjusting for age, possession of a driver's license, and education (RR: 0.61, 95% CI: 0.39-0.97, p = .04). These findings suggest that the SafeBoda programme results in safer driving and fewer RTCs among motorcycle taxi drivers in Kampala.
Keywords
Motorcyclists; Motorcycle Helmets; Text Messages; Telephone Interviewing; Motorcycles; Kampala (uganda); Uganda; Boda-boda; Crash; Injury; Road Safety; Injuries; Burden; Riders; Kenya; Traffic Accidents; Transportation; Risk Management; Crashes; Demographics; Transportation Safety; Short Message Service; Traffic; Traffic Accidents & Safety; Roads; Risk Reduction; Taxicabs; Protective Equipment; Drivers Licenses; Kampala Uganda
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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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
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
Duncan, Glen E.; Mills, Brianna; Strachan, Eric; Hurvitz, Philip; Huang, Ruizhu; Moudon, Anne Vernez; Turkheimer, Eric. (2014). Stepping Towards Causation in Studies of Neighborhood and Environmental Effects: How Twin Research Can Overcome Problems of Selection and Reverse Causation. Health & Place, 27, 106 – 111.
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Abstract
No causal evidence is available to translate associations between neighborhood characteristics and health outcomes into beneficial changes to built environments. Observed associations may be causal or result from uncontrolled confounds related to family upbringing. Twin designs can help neighborhood effects studies overcome selection and reverse causation problems in specifying causal mechanisms. Beyond quantifying genetic effects (i.e., heritability coefficients), we provide examples of innovative measures and analytic methods that use twins as quasi-experimental controls for confounding by environmental effects. We conclude that collaboration among investigators from multiple fields can move the field forward by designing studies that step toward causation. (C) 2014 Elsevier Ltd. All rights reserved,
Keywords
Residential Location; Methylation; Gene; Interplay; Obesity; Causality; Environment Design; Lifestyle Risk Reduction; Social And Built Environments; Twin Studies
Hwang, Liang-dar; Hurvitz, Philip M.; Duncan, Glen E. (2016). Cross Sectional Association between Spatially Measured Walking Bouts and Neighborhood Walkability. International Journal Of Environmental Research And Public Health, 13(4).
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Abstract
Walking is the most popular choice of aerobic physical activity to improve health among U.S. adults. Physical characteristics of the home neighborhood can facilitate or hinder walking. The purpose of this study was to quantify neighborhood walking, using objective methods and to examine the association between counts of walking bouts in the home neighborhood and neighborhood walkability. This was a cross-sectional study of 106 adults who wore accelerometers and GPS devices for two weeks. Walking was quantified within 1, 2, and 3 km Euclidean (straight-line) and network buffers around the geocoded home location. Walkability was estimated using a commercially available index. Walking bout counts increased with buffer size and were associated with walkability, regardless of buffer type or size (p < 0.001). Quantification of walking bouts within (and outside) of pre-defined neighborhood buffers of different sizes and types allowed for the specification of walking locations to better describe and elucidate walking behaviors. These data support the concept that neighborhood characteristics can influence walking among adults.
Keywords
Physical-activity; Accelerometer Data; United-states; Urban Form; Land-use; Validation; Health; Transportation; Environments; Intensity; Geographic Information Systems; Residence Characteristics; Twins; Walking
Kang, Bumjoon; Moudon, Anne V.; Hurvitz, Philip M.; Saelens, Brian E. (2018). Increased Walking’s Additive and No Substitution Effect on Total Physical Activity. Medicine & Science In Sports & Exercise, 50(3), 468 – 475.
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Abstract
Purpose We assessed the associations between a change in time spent walking and a change in total physical activity (PA) time within an urban living adult sample to test for additive or substitution effects. Methods Participants living in the greater Seattle area were assessed in 2008-2009 and again 1-2 yr later (2010-2011). At each time point, they wore accelerometers and GPS units and recorded trips and locations in a travel diary for seven consecutive days. These data streams were combined to derive a more objective estimate of walking and total PA. Participants also completed the International Physical Activity Questionnaire to provide self-reported estimates of walking and total PA. Regression analyses assessed the associations between within-participant changes in objective and self-reported walking and total PA. Results Data came from 437 participants. On average, a 1-min increase in total walking was associated with an increase in total PA of 1 min, measured by objective data, and 1.2-min, measured by self-reported data. A similar additive effect was consistently found with utilitarian, transportation, or job-related walking, measured by both objective and self-reported data. For recreational walking, the effect of change was mixed between objective and self-reported results. Conclusion Both objective and self-reported data confirmed an additive effect of utilitarian and total walking on PA.
Keywords
Accelerometers; Global Positioning System; Metropolitan Areas; Questionnaires; Recreation; Self-evaluation; Time; Walking; Physical Activity; Accelerometer; Gps; Ipaq; Longitudinal Study; Self-reported Measures; Light-rail Construction; Built Environment; Accelerometer Data; Older-adults; Urban Form; Transit Use; Travel; Neighborhood; Interventions; Calibration
Scully, Jason Y.; Moudon, Anne Vernez; Hurvitz, Philip M.; Aggarwal, Anju; Drewnowski, Adam. (2019). A Time-Based Objective Measure of Exposure to the Food Environment. International Journal Of Environmental Research And Public Health, 16(7).
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Abstract
Exposure to food environments has mainly been limited to counting food outlets near participants' homes. This study considers food environment exposures in time and space using global positioning systems (GPS) records and fast food restaurants (FFRs) as the environment of interest. Data came from 412 participants (median participant age of 45) in the Seattle Obesity Study II who completed a survey, wore GPS receivers, and filled out travel logs for seven days. FFR locations were obtained from Public Health Seattle King County and geocoded. Exposure was conceptualized as contact between stressors (FFRs) and receptors (participants' mobility records from GPS data) using four proximities: 21 m, 100 m, 500 m, and 1/2 mile. Measures included count of proximal FFRs, time duration in proximity to 1 FFR, and time duration in proximity to FFRs weighted by FFR counts. Self-reported exposures (FFR visits) were excluded from these measures. Logistic regressions tested associations between one or more reported FFR visits and the three exposure measures at the four proximities. Time spent in proximity to an FFR was associated with significantly higher odds of FFR visits at all proximities. Weighted duration also showed positive associations with FFR visits at 21-m and 100-m proximities. FFR counts were not associated with FFR visits. Duration of exposure helps measure the relationship between the food environment, mobility patterns, and health behaviors. The stronger associations between exposure and outcome found at closer proximities (<100 m) need further research.
Keywords
Global Positioning Systems; Physical-activity; Health Research; Land-use; Neighborhood; Gps; Obesity; Tracking; Validity; Mobility; Fast Food; Spatio-temporal Exposure; Mobility Patterns; Selective Mobility Bias