Association between neighbourhood deprivation and hypertension in a US-wide Cohort.

BACKGROUND: Socioeconomic status (SES) at the individual level is associated with hypertension risk. Less is known about neighbourhood level SES or how neighbourhood and individual level SES may jointly affect hypertension risk. METHODS: The Area Deprivation Index (ADI) includes 17 census-based measures reflecting neighbourhood SES. The ADI was linked to enrolment addresses of 47 329 women in the Sister Study cohort and categorised as ≤10% (low deprivation), 11%-20%, 21%-35%, 36%-55% and >55% (high deprivation). Hypertension was defined as either high systolic (≥140 mm Hg) or diastolic (≥90 mm Hg) blood pressure or taking antihypertensive medication. We used log binomial regression to investigate the cross-sectional association between ADI and hypertension and evaluated interactions between ADI and race/ethnicity and between ADI and individual SES. RESULTS: The highest ADI level of >55% was associated with increased prevalence of hypertension, compared with the lowest level of ADI≤10%, in a model adjusted for age, race/ethnicity, educational attainment and annual household income (prevalence ratio=1.26, 95% CI 1.21 to 1.32). We observed interaction between race/ethnicity and ADI (interaction contrast ratio (ICR)=1.9; 95% CI 0.94 to 2.8 comparing non-Hispanic Black women with ADI >55% to non-Hispanic White women with ADI≤10%) and between household income and ADI (ICR 0.38; 95% CI 0.12 to 0.65 comparing participants with household income ≤US$49 999 and ADI>55% to those with household income >US$100 000 and ADI≤10%). CONCLUSIONS: These findings suggest that neighbourhood deprivation measured by ADI may be a risk factor for hypertension and that ADI may act synergistically with race/ethnicity and individual household income to contribute to hypertension.

Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery.

BACKGROUND: Housing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes. METHODS: We used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups. RESULTS: Individuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies. CONCLUSION: Our results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.

Association of census tract-level incarceration rate and life expectancy in New York State.

BACKGROUND: Jail incarceration rates are positively associated with mortality at the county level. However, incarceration rates vary within counties, limiting the generalisability of this finding to neighbourhoods, where incarceration may have the greatest effects. METHODS: We performed a cross-sectional analysis of census tract-level state imprisonment rates in New York State (2010) and life expectancy data from the US Small-area Life Expectancy Estimates Project (2010-2015). We modelled fixed-effects for counties and controlled for tract-level poverty, racial makeup, education, and population density from the American Community Survey (2010-2014), and violent crime data from the New York City Police Department (2010). We also examined interactions between incarceration rate and poverty, racial makeup, and population density on life expectancy. RESULTS: Life expectancy at the highest quintile of incarceration was 5.5 years lower than in the lowest quintile, and over 2 years lower in a fully-adjusted model. Census tract-level poverty and racial makeup both moderated the association between incarceration and life expectancy. CONCLUSION: Census tract-level incarceration is associated with lower life expectancy. Decarceration, including alternatives to incarceration, and release of those currently incarcerated, may help to improve life expectancy at the neighbourhood level.

National movement patterns during the COVID-19 pandemic in New Zealand: the unexplored role of neighbourhood deprivation.

BACKGROUND: The COVID-19 pandemic has asked unprecedented questions of governments around the world. Policy responses have disrupted usual patterns of movement in society, locally and globally, with resultant impacts on national economies and human well-being. These interventions have primarily centred on enforcing lockdowns and introducing social distancing recommendations, leading to questions of trust and competency around the role of institutions and the administrative apparatus of state. This study demonstrates the unequal societal impacts in population movement during a national 'lockdown'. METHODS: We use nationwide mobile phone movement data to quantify the effect of an enforced lockdown on population mobility by neighbourhood deprivation using an ecological study design. We then derive a mobility index using anonymised aggregated population counts for each neighbourhood (2253 Census Statistical Areas; mean population n=2086) of national hourly mobile phone location data (7.45 million records, 1 March 2020-20 July 2020) for New Zealand (NZ). RESULTS: Curtailing movement has highlighted and exacerbated underlying social and spatial inequalities. Our analysis reveals the unequal movements during 'lockdown' by neighbourhood socioeconomic status in NZ. CONCLUSION: In understanding inequalities in neighbourhood movements, we are contributing critical new evidence to the policy debate about the impact(s) and efficacy of national, regional or local lockdowns which have sparked such controversy.

Violent crime, police presence and poor sleep in two low-income urban predominantly Black American neighbourhoods.

OBJECTIVE: To examine violent crime in relation to sleep and explore pathways, including psychological distress, safety perceptions and perceived police presence, that may account for associations. METHODS: In 2018, 515 predominantly Black American (94%) adults (Pittsburgh, Pennsylvania, USA) provided survey data: actigraphy-assessed sleep duration and wakefulness after sleep onset (WASO). We estimated pathways from violent crime (2016-2018) to sleep through psychological distress, perceptions of safety and perceived adequacy of police presence. RESULTS: WASO was most strongly associated with violent crimes that were within 1/10 mile of the participant's home and within the month preceding the interview. Violent crimes were associated with lower perceived safety (ß=-0.13 (0.03), p<0.001) and greater WASO (ß=5.96 (2.80), p=0.03). We observed no indirect associations between crime and either WASO or sleep duration through any of the tested mediators. Crime was not associated with sleep duration. CONCLUSIONS: We demonstrated that more proximal and more recent violent crimes were associated with reduced perceived safety and worse WASO. Differential exposure to violent crime among Black Americans may contribute to health disparities by reducing residents' perceived safety and sleep health.

Temperature and cardiovascular mortality in Rio de Janeiro, Brazil: effect modification by individual-level and neighbourhood-level factors.

BACKGROUND: Many factors related to susceptibility or vulnerability to temperature effects on mortality have been proposed in the literature. However, there is limited evidence of effect modification by some individual-level factors such as occupation, colour/race, education level and community-level factors. We investigated the effect modification of the temperature-cardiovascular mortality relationship by individual-level and neighbourhood-level factors in the city of Rio de Janeiro, Brazil. METHODS: We used a case-crossover study to estimate the total effect of temperature on cardiovascular mortality in Rio de Janeiro between 2001 and 2018, and the effect modification by individual-level and neighbourhood-level factors. Individual-level factors included sex, age, colour/race, education, and place of death. Neighbourhood-level characteristics included social development index (SDI), income, electricity consumption and demographic change. We used conditional Poisson regression models combined with distributed lag non-linear models, adjusted for humidity and public holidays. RESULTS: Our results suggest a higher vulnerability to high temperatures among the elderly, women, non-hospitalised deaths, and people with a lower education level. Vulnerability to low temperatures was higher among the elderly, men, non-white people, and for primary education level. As for neighbourhood-level factors, we identified greater vulnerability to low and high temperatures in places with lower SDI, lower income, lower consumption of electricity, and higher demographic growth. CONCLUSION: The effects of temperature on cardiovascular disease mortality in Rio de Janeiro vary according to individual-level and neighbourhood-level factors. These findings are valuable to inform policymakers about the most vulnerable groups and places, in order to develop more effective and equitable public policies.

Association between neighbourhood characteristics and antidepressant use at older ages: a register-based study of urban areas in three European countries.

BACKGROUND: Research evidence on the association between neighbourhood characteristics and individual mental health at older ages is inconsistent, possibly due to heterogeneity in the measurement of mental-health outcomes, neighbourhood characteristics and confounders. Register-based data enabled us to avoid these problems in this longitudinal study on the associations between socioeconomic and physical neighbourhood characteristics and individual antidepressant use in three national contexts. METHODS: We used register-based longitudinal data on the population aged 50+ from Turin (Italy), Stockholm (Sweden), and the nine largest cities in Finland linked to satellite-based land-cover data. This included individual-level information on sociodemographic factors and antidepressant use, and on neighbourhood socioeconomic characteristics, levels of urbanicity, green space and land-use mix (LUM). We assessed individual-level antidepressant use over 6 years in 2001-2017 using mixed-effects logistic regression. RESULTS: A higher neighbourhood proportion of low-educated individuals predicted lower odds for antidepressant use in Turin and Stockholm when individual-level sociodemographic factors were controlled for. Urbanicity predicted increased antidepressant use in Stockholm (OR=1.02; 95% CI 1.01 to 1.03) together with more LUM (OR=1.03; 1.01-1.05) and population density (OR=1.08; 1.05-1.10). The two latter characteristics also predicted increased antidepressant use in the Finnish cities (OR=1.05; 1.02-1.08 and OR=1.14; 1.02-1.28, respectively). After accounting for all studied neighbourhood and individual characteristics of the residents, the neighbourhoods still varied by odds of antidepressant use. CONCLUSIONS: Overall, the associations of neighbourhood socioeconomic and physical characteristics with older people's antidepressant use were small and inconsistent. However, we found modest evidence that dense physical urban environments predicted higher antidepressant use among older people in Stockholm and the Finnish cities.

Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease?

BACKGROUND: Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA). METHODS: We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000-US$74 000, (3) US$20 000-US$34 000 and (4)

Factors associated with cyber-victimization among immigrants and non-immigrants in Canada: a cross-sectional nationally-representative study.

OBJECTIVES: There is a paucity of research on patterns of cyber-victimization in minority groups, including immigrants. This study aimed to identify individual, interpersonal and contextual characteristics associated with cyber-victimization among immigrants and non-immigrants. METHODS: We drew on nationally representative data from adolescents and adults in the Canadian General Social Survey on victimization (2014). We used multivariable logistic regression to identify potential factors associated with cyber-victimization in the last 12 months, stratified by immigrant status and sex. RESULTS: Among 27,425 survey respondents, the weighted prevalence of cyber-victimization in the last 12 months was 2.1% among immigrants and 2.3% among non-immigrants. Cyber-victimization rates differed significantly by sex among immigrants (2.8% for males vs. 1.4% for females), but not among non-immigrants (2.1% for males vs. 2.4% for females). While most other factors associated with cyber-victimization were similar for immigrants and non-immigrants, there were pronounced associations of past child maltreatment (adjusted prevalence odds ratio [aPOR] 4.85, 95% confidence interval [CI] 2.76, 8.52) and residence in an unwelcoming neighbourhood (aPOR 5.08, 95% CI 2.44, 10.55) with cyber-victimization among immigrants that were diminished or absent among non-immigrants. Additionally, sex-stratified analyses among immigrants showed cyber-victimization to be strongly associated with having a mental health condition (aPOR 3.50, 95% CI 1.36, 8.97) among immigrant males only, and with perceived discrimination (aPOR 4.08, 95% CI 1.65, 10.08), as well as being under 24 years old (aPOR 3.24, 95% CI 1.09, 9.60) among immigrant females. CONCLUSIONS: Immigration status and sex were differentially associated with cyber-victimization. Findings support the salience of a social-ecological perspective and gender-stratified analyses to better elucidate complex pathways linking cyber-victimization to potential gender-based health inequities among immigrants.

Children's neighbourhood physical environment and early development: an individual child level linked data study.

BACKGROUND: Identification of features of the neighbourhood physical environment that have a causal association with positive child development is important for promoting long-term developmental health. Previous research on these associations have been conducted at the neighbourhood level, and do not account for individual variation in exposure to these features. METHODS: This cross-sectional study utilised de-identified linked administrative data. Neighbourhood features were measured with Geographic Information Systems and identified within a 1600 m service area around the child's home address. The study population included a random selection of 5024 Western Australian children who participated in the 2012 Australian Early Development Census (AEDC; median age 5 years, 5 months). Multi-level logistic regressions modelled the odds of children scoring in the bottom 10% on the physical, social or emotional AEDC domains as an outcome of neighbourhood features. RESULTS: After adjustment for individual and neighbourhood sociodemographic factors, lower odds of physical vulnerability were associated with increased neighbourhood residential density, presence of railway station, and higher counts of playgroups and kindergartens. Larger areas of neighbourhood home-yard space were associated with increased odds of physical and social vulnerability. Presence of high-quality green spaces was associated with lower odds of social vulnerability. Increased road traffic exposure was associated with higher odds of social and emotional vulnerability. CONCLUSIONS: The neighbourhood physical environment has a weak but significant association with early childhood development. Future research should consider the interplay between the neighbourhood environment and proximal influences, including parenting attributes and socioeconomic status, and how they influence early child development.

Intersectional community correlates of married women's experiences of male intimate partner physical violence in Bangladesh: a cross-sectional study.

BACKGROUND: In Bangladesh, little is known about community-level factors shaping married women's experiences of male intimate partner physical violence (MIPPV); it is also unknown if these factors interact with each other. We examined the (1) association between four residential community characteristics defined by the attributes of ever married women in those communities-younger age, lower education, higher participation in earning an income and poverty; and (2) two-way interactions between these community-level MIPPV correlates. METHODS: We used a cross-sectional sample comprising 14 557 currently married women who were living with their spouses from 911 Bangladeshi communities. Data were collected during 13-22 August 2015. Conflict Tactics Scale-2 measured the outcome-women's current MIPPV experiences; and multilevel logistic regression models predicted this outcome. RESULTS: Four community characteristics including higher proportions of women's earning an income and achieving higher education were not associated with their increased likelihood of experiencing MIPPV. However, women living in higher earning participation, higher educated communities were significantly more likely to experience MIPPV than those in lower earning participation, higher educated communities (predicted probability, p=0.30, 95% CI 0.26 to 0.34 vs p=0.24, 95% CI 0.22 to 0.25). CONCLUSION: This is the first study to examine interactions between women's community-level MIPPV correlates in Bangladesh. Although we did not find support for the relationship between women's most intersectional community-level locations and MIPPV, we did find a currently invisible vulnerable intersectional location: higher earning participation, higher educated communities. Bangladeshi violence against women prevention policies and programmes, therefore, need to engage with these particular communities to tackle head on male responses to these locations to reduce MIPPV.

Onset of type 1 diabetes mellitus in rural areas of the USA.

BACKGROUND: In the USA, the epidemiologic features of type 1 diabetes are not well-defined across all 50 states. However, the advent of large nationwide insurance databases enables the investigation of where type 1 diabetes cases occur throughout the country. METHODS: An integrated database from a large nationwide health insurer in the USA (Clinformatics Data Mart Database) was used, from 2001 to 2017. The database contained longitudinal information on approximately 77 million people. RESULTS: The incidence of type 1 diabetes was greatest in areas of low population density across the 50 states. Individuals in the lowest population density areas had rates that were 2.28 times (95% CI 2.08 to 2.50) that of persons living in high-density areas. This association was consistent across various measures of rural status (p<0.001 for population density; p<0.001 for per cent rural as defined by the US Census Bureau; p=0.026 for farmland). The association between rural areas and the incidence of type 1 diabetes was evident across all four general regions of the USA. CONCLUSIONS: The predilection of type 1 diabetes in rural areas provides clues to potential factors associated with the onset of this autoimmune disease.

Neighborhood social and economic change and diabetes incidence: The HeartHealthyHoods study.

We studied the association between neighborhood social and economic change and type 2 diabetes incidence in the city of Madrid (Spain). We followed 199,621 individuals living in 393 census tracts for diabetes incidence for 6 years using electronic health records, starting in 2009. We measured neighborhood social and economic change from 2005 to 2009 using a finite mixture model with 16 indicators that resulted in four types of neighborhood change. Adjusted results showed an association between neighborhood change and diabetes incidence: compared to those living in Aging/Stable areas, people living in Declining SES, New Housing and Improving SES areas have an 8% (HR = 0.92, 95% CI 0.87 to 0.99), 9% (HR = 0.91, 95% CI 0.81 to 1.01) and 11% (HR = 0.89, 95% CI 0.81 to 0.98) decrease in diabetes incidence. This evidence can help guide policies for diabetes prevention by focusing efforts on specific urban areas.

Neighbourhood disadvantage and depressive symptoms among adolescents followed into emerging adulthood.

BACKGROUND: Residents of disadvantaged neighbourhoods report higher levels of depressive symptoms; however, few studies have employed prospective designs during adolescence, when depression tends to emerge. We examined associations of neighbourhood social fragmentation, income inequality and median household income with depressive symptoms in a nationally representative survey of adolescents. METHODS: The NEXT Generation Health Study enrolled 10th-grade students from 81 US high schools in the 2009-2010 school year. Depressive symptoms were assessed with the Modified Depression Scale (wave 1) and the paediatric Patient-Reported Outcome Measurement Information System (waves 2-6). Neighbourhood characteristics at waves 1, 3, 4, and 5 were measured at the census tract level using geolinked data from the American Community Survey 5-year estimates. We used linear mixed models to relate neighbourhood disadvantage to depressive symptoms controlling for neighbourhood and individual sociodemographic factors. RESULTS: None of the models demonstrated evidence for associations of social fragmentation, income inequality or median household income with depressive symptoms. CONCLUSION: Despite the prospective design, repeated measures and nationally representative sample, we detected no association between neighbourhood disadvantage and depressive symptoms. This association may not exist or may be too small to detect in a geographically dispersed sample. Given the public health significance of neighbourhood effects, future research should examine the developmental timing of neighbourhood effects across a wider range of ages than in the current sample, consider both objective and subjective measures of neighbourhood conditions, and use spatially informative techniques that account for conditions of nearby neighbourhoods.

Influence of individual life course and neighbourhood socioeconomic position on dietary intake in African Americans: the Jackson Heart Study.

OBJECTIVE: African Americans, especially those in the Southeastern USA, have different dietary behaviours from the general US population, and have the highest prevalence, incidence and mortality of diet-related disease outcomes, such as cardiovascular disease. However, there are scant data regarding factors such as socioeconomic position (SEP) across the life course that influence dietary behaviours in this high-risk population. Our aim was to examine the impact of life course and neighbourhood SEPs on dietary intake among African Americans. PARTICIPANTS AND SETTING: Data for this cross-sectional analysis came from the community-based Jackson Heart Study (JHS). We analysed a total of 3948 JHS participants (mean age: 55.4±12.5; 63.9% women), who had complete dietary intake and covariate information. METHODS: We examined the associations of childhood SEP (CSEP), adulthood SEP (ASEP) and neighbourhood SEP (NSEP) with 10 selected dietary intake measures, using multilevel log-gamma generalised linear regression models. OUTCOME MEASURES: Dietary intake measures include daily saturated fat, sodium, protein, fibre, fruits and vegetables, whole grains, sugar-sweetened beverage, nuts, fish and processed meat. RESULTS: In age, sex and total energy intake adjusted models, most dietary intakes were associated with these three SEP measures. After additional adjustment for other SEP measures, most of the significant associations with CSEP and NSEP were attenuated, except for the associations of fibre with CSEP (relative rate [RR] [95% CI] 1.05 [1.00-1.10]) and whole grains with NSEP (RR [95% CI] 1.28 [1.02-1.61]). The associations (shown as RR [95% CI]) between ASEP and sugar-sweetened beverage: 0.70 (0.59-0.83), processed meat: 0.75 (0.63-0.90), sodium: 0.99 (0.94-1.00), fibre: 1.10 (1.03-1.16), protein: 1.05 (1.01-1.09), fruits and vegetables: 1.21 (1.11-1.32), nuts: 2.13 (1.59-2.87), and fish: 1.57 (1.27-1.95) generally persisted after additional adjustment for both CSEP and NSEP. However, the association between ASEP and whole grains was attenuated. CONCLUSIONS: High ASEP may have a more beneficial influence on dietary practices in African Americans than CSEP or NSEP.

Neighbourhood walkability and the incidence of diabetes: an inverse probability of treatment weighting analysis.

BACKGROUND: People living in highly walkable neighbourhoods tend to be more physically active and less likely to be obese. Whether walkable urban design reduces the future risk of diabetes is less clear. METHODS: We used inverse probability of treatment weighting to compare 10-year diabetes incidence between residents living in high-walkability and low-walkability neighbourhoods within five urban regions in Ontario, Canada. Adults (aged 30-85 years) who were diabetes-free on 1 April 2002 were identified from administrative health databases and followed until 31 March 2012 (n=958 567). Within each region, weights reflecting the propensity to live in each neighbourhood type were created based on sociodemographic characteristics, comorbidities and healthcare utilisation and incorporated into region-specific Cox proportional hazards models. RESULTS: Low-walkability areas were more affluent and had more South Asian residents (6.4%vs3.6%, p<0.001) but fewer residents from other minority groups (16.6%vs21.7%, p<0.001). Baseline characteristics were well balanced between low-walkability and high-walkability neighbourhoods after applying individual weights (standardised differences all <0.1). In each region, high walkability was associated with lower diabetes incidence among adults aged <65 years (overall weighted incidence: 8.2vs9.2 per 1000; HR 0.85, 95% CI 0.78 to 0.93), but not among adults aged ≥65 years (weighted incidence: 20.7vs19.5 per 1000; HR 1.01, 95% CI 0.91 to 1.12). Findings were consistent regardless of income and immigration status. CONCLUSIONS: Younger adults living in high-walkability neighbourhoods had a lower 10-year incidence of diabetes than similarly aged adults living in low-walkability neighbourhoods. Urban designs that support walking may have important benefits for diabetes prevention.

Potentially Avertable Premature Deaths Associated with Jail Incarceration in New York City.

This study assessed neighborhood-level association between jail incarceration and premature mortality and estimated the number of potentially avertable premature deaths associated with jail incarceration in NYC. The study outcome was premature mortality rate and the main predictor of interest was jail incarceration rate. Variables associated with premature mortality in bivariate analysis were considered for inclusion in the multivariable ordinary least squares model and in the multivariable linear mixed effects model accounting for spatial correlation. Numbers of potentially avertable premature deaths were calculated by substituting the citywide incarceration rate for the neighborhoods with incarceration rates higher than the citywide rate in the final regression model. There were large disparities in both jail incarceration and premature mortality rates. Incarceration was strongly associated with premature mortality. The number of potentially avertable premature deaths associated with jail incarceration from 2011 to 2015 was approximately 6000, representing 10% of all predicted premature deaths in NYC. This study indicates that incarceration is closely correlated with premature mortality rates, which may contribute to health inequities among low-income NYC neighborhoods with predominantly black and Latino residents.

Renovations of neighbourhood parks: long-term outcomes on physical activity.

BACKGROUND: Neighbourhood parks are places designed to support physical activity, but are often underutilised. Park renovations are major improvements to the quality of these spaces and usually attract more park users. This study assessed changes in the use of six San Francisco neighbourhood parks and park-based physical activity levels over a 6-year period, during which five of the six parks were renovated. METHODS: We used direct observation to assess park-based physical activity. We used a stepped-wedge study design at three time points in all six parks over 6 years (before all parks were renovated, after two parks were renovated and after an additional three were renovated) to evaluate the short-term and long-term effects of park renovations. RESULTS: Levels of moderate-to-vigorous physical activity (MVPA) and metabolic equivalent hours expended in the parks increased overall, most immediately after renovation. Age groups responded differently with the largest increases in park use and MVPA among adults and children under age 12, with no changes among teens and seniors. CONCLUSIONS: Park renovations attracted more users and increased park-based MVPA than non-renovated parks and sustained increases over time for adults and children, but not teens or seniors. Park renovations that consider and provide facilities that support varied levels of physical activity and cater to all age groups may foster increased park-based physical activity that can be sustained.

Differential vulnerability to neighbourhood disorder: a gene×environment interaction study.

BACKGROUND: Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D. METHOD: We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D. RESULTS: Greater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10, p=0.001). This significant gene×environment interaction was observed after adjusting for years of schooling, age, gender, levels of physical activity and obesity. CONCLUSION: Findings in the present study suggested that minimising people's exposure to vandalism, vacant buildings, trash and circumstances viewed by residents as unsafe may reduce the burden of this prevalent chronic health condition, particularly for subgroups of the population who carry genetic liability for T2D.

Characteristics of the built environment and spatial patterning of type 2 diabetes in the urban core of Durham, North Carolina.

BACKGROUND: Few studies examine relationships between built environment (BE) and type 2 diabetes mellitus (T2DM) using spatial models, investigate BE domains apart from food environment or physical activity resources or conduct sensitivity analysis of methodological choices made in measuring BE. We examine geographic heterogeneity of T2DM, describe how heterogeneity in T2DM relates to BE and estimate associations of T2DM with BE. METHODS: Individual-level electronic health records (n=41 203) from the Duke Medicine Enterprise Data Warehouse (2007-2011) were linked to BE based on census block. Data on housing damage, property disorder, territoriality, vacancy and public nuisances were used to estimate BE based on four different construction methods (CMs). We used race-stratified aspatial and spatial Bayesian models to assess geographic heterogeneity in T2DM and associations of T2DM with BE. RESULTS: Among whites, a 1 SD increase in poor quality BE was associated with a 1.03 (95% credible interval 1.01 to 1.06) and 1.06 (95 % credible interval 1.02 to 1.11) increased risk of T2DM for poor quality BE CM1 and CM2, respectively. Among blacks/African Americans, associations between T2DM and BE overlapped with the null for all CMs. The addition of BE to white models reduced residual geographic heterogeneity in T2DM by 4%-15%, depending on CM. In black/African-American models, BE did not affect residual heterogeneity. CONCLUSION: Associations of T2DM with BE were sensitive to CM and geographic heterogeneity in T2DM differed by race/ethnicity. Findings underscore the need to consider multiple methods of estimating BE and consider differences in relationships by race/ethnicity.