Social environment characteristics are related to self-rated health in four Latin America countries: Evidence from the SALURBAL Project.

We investigated the associations of social and built environment and demographic features of urban areas with self-rated health among adults living in four Latin American countries. We estimated multilevel models with harmonized data from 69,840 adults, nested in 262 sub-cities and 112 cities, obtained from the Salud Urbana en América Latina project. Poor self-rated health was inversely associated with services provision score at the sub-city-level and with social environment index at the city-level. We did not identify associations of built environment and demographic features with self-rated health. Approaches and policies to improve health in Latin American should be urban context-sensitive.

Physical Disorders and Poor Self-Rated Health in Adults Living in Four Latin American Cities: A Multilevel Approach.

Considering that urban environments may affect self-rated health through behavioral and psychosocial mechanisms, the aim of this study was to investigate the association between self-rated health and perceived urban environment characteristics among adults living in four Latin American cities. Data is from a population-based survey by Development Bank of Latin America, encompassing adults between 20 and 60 years old in Buenos Aires, Lima, Mexico City, and Panama City. Self-rated health was measured using a single question and the response options were categorized as poor and good. The explanatory variables were empirical Bayes estimates of self-reported area physical disorder, social disorder, access to services, and access to leisure spaces derived from the survey. The covariates were: individual age, sex, education, wealth index, and length of residency in the neighborhood; and an area social environment index. Multilevel logistic regressions with two levels (individual and sub-city areas) were fitted. Poor self-rated health was reported by 34.73% (95% CI: 33.17 to 36.29) of the participants and was associated with physical disorder (OR = 1.16 per SD; 95% CI: 1.02 to 1.32). Our findings suggest that public policies to promote population health should consider area urban environment factors, especially those associated with disorder.

Individual and food environmental factors: association with diet.

OBJECTIVE: To examine the associations of individual and food environmental factors with fruit and vegetable (F&V) intake in a city in a low-to-middle-income country (LMIC). DESIGN: Cross-sectional. SETTING: Representative sample of the Brazilian Primary Care service known as the Health Academy Program (HAP) in Belo Horizonte, a Brazilian city. SUBJECTS: Using a conceptual model as a guide, individual and food environment data were obtained through: (i) face-to-face interviews with participants aged 20 years or older; and (ii) F&V food store audits. A broad set of individual, household, and community and consumer nutrition environment variables was investigated. Multilevel linear regression was used to quantify area-level variations in F&V intake and to estimate associations with the factors. RESULTS: Eighteen HAP centres were selected and 2944 participants and 336 food stores were included. F&V intake varied between contexts, being higher in areas with better socio-economic conditions and food store quality, such as specialised F&V markets. Individual-level factors, including age, income, food insecurity, stage of change, self-efficacy and decisional balance, were significantly associated with F&V intake. After controlling for individual-level characteristics, greater F&V intake was also associated with higher quality of food stores. CONCLUSIONS: In one of the first studies to comprehensively assess the food environment in an LMIC, individual-level factors accounted for the largest variation in F&V intake; however, the food environment was also important, because area-level variables explained 10·5 % of the F&V intake variation. The consumer nutrition environment was more predictive of healthy eating than was the community nutrition environment. The findings suggest new possibilities for interventions.

Fruit and vegetable intake: Influence of perceived food environment and self-efficacy.

OBJECTIVE: Identify the effects of food environment and self-efficacy perceptions on fruit and vegetable (FV) consumption. METHODS: A cross-sectional study with a representative sample population from a public health service in a Brazilian city. Participants (3414) aged ≥20 years were recruited from 18 Health Academy Program centres via stratified cluster sampling. Perceptions of the food environment were measured by survey; participants indicated how confident they were about FV availability in their food environment. Statements about self-efficacy assessed three domains regarding perceived affordability, time, and cooking skills. In order to assess the combined effects of both perceptions of food environment and self-efficacy on FV consumption, a combined variable was created. RESULTS: Both perceptions of food environment and self-efficacy in addition to FV consumption were higher in older participants and those with higher incomes and educational levels. Analyses of the combined variables showed that the highest FV intake was found among individuals with better food environment perceptions and greater self-efficacy. After adjustments, the association of food environment perceptions with FV consumption was marginally significant (p = 0.062), while self-efficacy was more strongly associated (p < 0.001); a one standard deviation higher confidence score was associated with a 35.10 g higher FV intake. CONCLUSIONS: Among participants of low socioeconomic position, individuals' self-efficacy for promoting FV intake were more important to greater consumption than perceptions of food environments. In addition to public policies for tackling socioeconomic inequalities in restricted environments, it is possible that building capabilities among vulnerable individuals are fruitful pathways for enabling them to partially overcome the challenges of poor food environments.

Homicidios por armas de fuego en Argentina, 1991-2006: un análisis de niveles múltiples / Homicides involving firearms in Argentina between 1991 and 2006: a multilevel analysis

Se analizó la influencia de variables de distintos niveles de agregación y el efecto del tiempo sobre la ocurrencia de homicidios por arma de fuego (HAF) en Argentina durante el periodo 1991-2006, con la técnica de niveles múltiples. Se utilizó un modelo de regresión de Poisson de tres niveles. El primer nivel correspondió a la distribución del número de HAF según sexo y grupo de edad para cada departamento y período; el segundo nivel a la variabilidad a lo largo del tiempo (cuatrienios) de los HAF al interior de cada departamento; y el tercero a la variabilidad entre departamentos según Nivel de Urbanización, Porcentaje de hogares con Necesidades Básicas Insatisfechas y Porcentaje de Población Ocupada. Se trabajó con 15.067 HAF en mayores de 14 años, ocurridos en los 493 departamentos en 1991-2006. El riesgo de morir por HAF fue superior en varones y en personas de 15 a 29 años de edad; el aumento de la edad se asoció con un menor riesgo. El efecto de la edad fue mayor en las zonas centro-urbanas. Se registró un mayor riesgo en 1999-2002. El Nivel de Urbanización fue la variable socioeconómica de mayor importancia. El riesgo de morir por HAF en las zonas centro-urbanas fue 1,6 veces mayor que en las zonas no centrales. En ambas zonas el riesgo fue superior en 1999-2002.

The influence of variables at different levels of organization and the effect of time on the occurrence of firearm-related homicides (FRH) in Argentina between 1991 and 2006 was analyzed using multilevel analysis. A three-level Poisson regression model was used. The first level corresponded to the distribution of the number of FRH by sex and age group for each administrative region and (four-year) period; the second corresponded to the variation over time in the interior of each administrative region; the third modeled the variation between administrative regions in accordance with the Level of Urbanization, Percentage of Homes with Unsatisfied Basic Needs and the Percentage of Working Adults. There were 15,067 FRH in persons aged 14 and over between 1991 and 2006 in the 493 administrative regions. The risk of death was higher in males and persons of 15 to 29 years of age; ages above that were associated with a lower risk. The influence of age was greater in central-urban zones and between 1999 and 2002 than during other periods. The level of urbanization was the socioeconomic variable most strongly associated with FRH risk. The risk of death from FRH was 1.6 times higher in central-urban zones compared with non-central zones. In both zones, the risk was highest between 1999 and 2002.

[Homicides involving firearms in Argentina between 1991 and 2006: a multilevel analysis]. / Homicidios por armas de fuego en Argentina, 1991-2006: un análisis de niveles múltiples.

The influence of variables at different levels of organization and the effect of time on the occurrence of firearm-related homicides (FRH) in Argentina between 1991 and 2006 was analyzed using multilevel analysis. A three-level Poisson regression model was used. The first level corresponded to the distribution of the number of FRH by sex and age group for each administrative region and (four-year) period; the second corresponded to the variation over time in the interior of each administrative region; the third modeled the variation between administrative regions in accordance with the Level of Urbanization, Percentage of Homes with Unsatisfied Basic Needs and the Percentage of Working Adults. There were 15,067 FRH in persons aged 14 and over between 1991 and 2006 in the 493 administrative regions. The risk of death was higher in males and persons of 15 to 29 years of age; ages above that were associated with a lower risk. The influence of age was greater in central-urban zones and between 1999 and 2002 than during other periods. The level of urbanization was the socioeconomic variable most strongly associated with FRH risk. The risk of death from FRH was 1.6 times higher in central-urban zones compared with non-central zones. In both zones, the risk was highest between 1999 and 2002.