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.

Could strength of exposure to the residential neighbourhood modify associations between walkability and physical activity?

UNLABELLED: The importance of neighbourhoods for health and wellbeing may vary according to an individual's reliance on their local resources, but this assertion is rarely tested. We investigate whether greater neighbourhood 'exposure' through reliance on or engagement with the residential setting magnifies neighbourhood-health associations. METHODS: Three built environment characteristics (destination density, streetscape (attractiveness of built environment) and street connectivity) and two physical activity components (weekday and weekend accelerometer counts) were measured for 2033 residents living in 48 neighbourhoods within four New Zealand cities in 2009-2010, giving six different built environment-physical activity associations. Interactions for each built environment-physical activity association with four individual-level characteristics (acting as proxies for exposure: gender, working status, car access, and income) were assessed with multi-level regression models; a total of 24 'tests'. RESULTS: Of the 12 weekday built environment-physical activity tests, 5 interaction terms were significant (p < 0.05) in the expected direction (e.g. stronger streetscape-physical activity among those with restricted car access). For weekend tests, one association was statistically significant. No significant tests were contradictory. Pooled across the 12 weekday physical activity 'tests', a 1 standard deviation increase in the walkability of the built environment was associated with an overall 3.8% (95% CI: 3.6%-4.1%) greater increase in weekday physical activity across all the types of people we hypothesised to spend more time in their residential neighbourhood, and for weekend physical activity it was 4.2% (95% CI 3.9%-4.5%). CONCLUSIONS: Using multiple evaluation methods, interactions were in line with our hypothesis, with a stronger association seen for proxy exposure indicators (for example, restricted car access). Added to the wider evidence base, our study strengthens causal evidence of an effect of the built environment on physical activity, and highlights that health gains from improvements of the residential neighbourhood may be greater for some people.

Neighbourhood built environment associations with body size in adults: mediating effects of activity and sedentariness in a cross-sectional study of New Zealand adults.

BACKGROUND: The aim of this study was to determine the associations between body size and built environment walkability variables, as well as the mediating role of physical activity and sedentary behaviours with body size. METHODS: Objective environment, body size (body mass index (BMI), waist circumference (WC)), and sedentary time and physical activity data were collected from a random selection of 2033 adults aged 20-65 years living in 48 neighbourhoods across four New Zealand cities. Multilevel regression models were calculated for each comparison between body size outcome and built environment exposure. RESULTS AND DISCUSSION: Street connectivity and neighborhood destination accessibility were significant predictors of body size (1 SDchange predicted a 1.27 to 1.41 % reduction in BMI and a 1.76 to 2.29 % reduction in WC). Significantrelationships were also observed for streetscape (1 SD change predicted a 1.33 % reduction in BMI) anddwelling density (1 SD change predicted a 1.97 % reduction in BMI). Mediation analyses revealed asignificant mediating effect of physical activity on the relationships between body size and street connectivity and neighbourhood destination accessibility (explaining between 10.4 and 14.6 % of the total effect). No significant mediating effect of sedentary behaviour was found. Findings from this cross-sectional study of a random selection of New Zealand adults are consistent with international research. Findings are limited to individual environment features only; conclusions cannot be drawn about the cumulative and combined effect of individual features on outcomes. CONCLUSIONS: Built environment features were associated with body size in the expected directions. Objectively-assessed physical activity mediated observed built environment-body size relationships.

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 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.

"Dinner's ready!" A qualitative exploration of the food domain across the lifecourse.

The influence of the childhood food domain on adult food-related practices is only partially understood. Through an interpretive study using in-depth life-story interviewing and narrative analysis, we aimed to discover how preferences and perceptions relating to the food domain become embodied during childhood, and once embodied, how these influence practices in adulthood. We observed distinct 'food mood' pathways seemingly anchored in childhood memories about dinnertime. One pathway led to food philosophies participants perceived to be beneficial for their health and wellbeing, whilst another led to perceptions of food as a chore and bore they would rather ignore. Parental attitudes were very important to the food domain of childhood, as this is now recalled through life-story narratives. Our findings suggest a positive relationship with the food domain needs to be fostered during childhood for the long-term protection and promotion of health and wellbeing in adulthood.

Childhood neighbourhoods as third places: Developing durable skills and preferences that enhance wellbeing in adulthood.

UNLABELLED: Study purpose The social environment is an important new area in neighbourhoods and health research that complements existing research on the built environment and household characteristics. Through a narrative analysis of the life-stories of 16 women we explored the influence of the neighbourhood social environment on social wellbeing. PRINCIPAL RESULTS: In order for adults to capitalise on local health-enhancing social opportunities they require particular social skills and preferences. We found one way the attainment of those skills and preferences comes about is through the experience of the childhood neighbourhood as a third place, with preferences and practices being carried forward to adulthood, influencing wellbeing through different modes of neighbourly engagement. MAJOR CONCLUSIONS: The experience of the childhood neighbourhood as a third place provided the opportunity for establishing a durable, taken-for-granted template of how to do 'neighbourhood'. Without such a template, the benefits to well-being associated with local social connections are difficult to access in adulthood.

What shape is your neighbourhood? Investigating the micro geographies of physical activity.

Being physically active has demonstrated health benefits, and more walkable neighbourhoods can potentially increase physical activity. Yet not all neighbourhoods provide opportunities for active lifestyles. This paper examines the social context of being active in local and non-local places. We use a social practice theoretical framework to examine how residents talk about and make sense of physical activity and places, contrasting individual and neighbourhood factors. In 2010, fourteen focus groups were held in four neighbourhoods varying by walkability and area-level deprivation (two Auckland and two Wellington, New Zealand), and with participants grouped by gender, ethnicity, and employment. Focus groups elicited discussion on where local residents go for physical activity, and the opportunities and barriers to physical activity in their local area and beyond. Thematic analyses compared across all groups for contrasts and similarities in the issues discussed. Neighbourhood walkability factors appeared to shape where residents engage with public places, with residents seeking out good places. Individual factors (e.g. employment status) also influenced how residents engage with their local neighbourhoods. All groups referred to being active in places both close by and further afield, but residents in less walkable neighbourhoods with fewer local destinations drew attention to the need to go elsewhere, notably for exercise, being social, and to be in pleasant, restorative environments. Being physically active in public settings was valued for social connection and mental restoration, over and above specifically 'health' reasons. Residents talk about being active in local and non-local places revealed agency in how they managed the limitations and opportunities within their immediate residential setting. That is, factors of place and people contributed to the 'shape' of everyday residential environments, at least with regard to physical activity.

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 Zealand's 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.

Built environment and physical activity in New Zealand adolescents: a protocol for a cross-sectional study.

INTRODUCTION: Built-environment interventions have the potential to provide population-wide effects and the means for a sustained effect on behaviour change. Population-wide effects for adult physical activity have been shown with selected built environment attributes; however, the association between the built environment and adolescent health behaviours is less clear. This New Zealand study is part of an international project across 10 countries (International Physical Activity and the Environment Network-adolescents) that aims to characterise the links between built environment and adolescent health outcomes. METHODS AND ANALYSES: An observational, cross-sectional study of the associations between measures of the built environment with physical activity, sedentary behaviour, body size and social connectedness in 1600 New Zealand adolescents aged 12-18 years will be conducted in 2013-2014. Walkability and neighbourhood destination accessibility indices will be objectively measured using Geographic Information Systems (GIS). Physical activity and sedentary behaviours will be objectively measured using accelerometers over seven consecutive days. Body mass index will be calculated as weight divided by squared height. Demographics, socioeconomic status, active commuting behaviours and perceived neighbourhood walkability will be assessed using the Neighbourhood Environment Walkability Scale for Youth and psychosocial indicators. A web-based computer-assisted personal interview tool Visualisation and Evaluation of Route Itineraries, Travel Destinations, and Activity Spaces (VERITAS) and Global Positioning System (GPS) receivers will be used in a subsample of 300 participants. A qualitative research component will explore barriers and facilitators for physical activity in adolescents with respect to the built and social environment in a subsample of 80 participants. ETHICS AND DISSEMINATION: The study received ethical approval from the Auckland University of Technology Ethics Committee (12/161). Data will be entered and stored into a secure (password protected) database. Only the named researchers will have access to the data. Data will be stored for 10 years and permanently destroyed thereafter. The results papers will be submitted for publication in peer-reviewed journals.

Are feelings of peace or depression the drivers of the relationship between neighbourhood social fragmentation and mental health in Aotearoa/New Zealand?

Exploration of the influence of neighbourhood social context on supportive relationships and social cohesion is on the rise. Positive social contexts may be less stressful for residents, resulting in mental wellbeing and calmness; whereas negative contexts may increase stress and deleterious mental health. To examine this, we measured the relationship between an Index of Neighbourhood Social Fragmentation and overall mental well-being in New Zealand. Then we examined the influence of fragmentation on two components of mental health: depression and calmness. Increased fragmentation was significantly associated with lower mental health scores for the entire population and for females, with similar but insignificant trends for males. Increased fragmentation was associated with increased depression in both sexes, but not calmness. Depression rather than calmness may contribute to the observed association between fragmentation and overall mental health. Groups vulnerable to stressful social contexts may be prone to depression in fragmented neighbourhoods. Further examination of the specific aspects of living in fragmented neighbourhoods which increase depressive feelings is warranted.

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.

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?

BACKGROUND: Adult 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. METHODS: Data 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. RESULTS: Respondents 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. CONCLUSIONS: This 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.

No association of neighbourhood volunteerism with mortality in New Zealand: a national multilevel cohort study.

BACKGROUND: The association of social capital with health and mortality is contentious, and empirical findings are inconsistent. This study tests the association of neighbourhood-level volunteerism with mortality. METHODS: Cohort study of 1996 New Zealand census respondents aged 25-74 years (4.75 million person years) using multilevel Poisson regression analyses. Neighbourhood (average population 2,034) measures included indices of social capital (volunteering activities for all census respondents) and deprivation. RESULTS: Adjusting for just age and marital status, the mortality rate ratios for people living in the quintile of neighbourhoods with the lowest compared with highest volunteerism were 1.16 (95% confidence interval 1.08-1.24) and 1.09 (1.01-1.18), for males and females, respectively. Adjusting for potential individual-level and neighbourhood-level socioeconomic confounders reduced the rate ratios to 0.94 (0.88-1.01) and 0.92 (0.85-1.01), respectively. There was no significant association with any cause of death, including suicide [rate ratios 0.89 (0.64-1.22) and 0.57 (0.31-1.05), respectively]. Restricting the analyses to only those census respondents living at their census night address for five or more years, and therefore 'exposed' to that level of volunteerism for a longer period, did not substantially alter findings. CONCLUSIONS: This study, one of the largest multilevel studies yet, found no statistically significant independent association of a structural measure of neighbourhood social capital with mortality-including suicide. Assuming social features of neighbourhoods are important determinants of health, future research should examine other features (e.g. social fragmentation) and other outcomes (e.g. behaviour).