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1.
Acad Pediatr ; 2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33933683

RESUMO

OBJECTIVE: Children from socioeconomically disadvantaged backgrounds have poorer learning outcomes. These inequities are a significant public health issue, tracking forward to adverse health outcomes in adulthood. We examined the potential to reduce socioeconomic gaps in children's reading skills through increasing home reading and preschool attendance amongst disadvantaged children. METHODS: We drew on data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (N=5107) to examine the impact of socioeconomic disadvantage (0-1 year) on children's reading skills (8-9 years). An interventional effects approach was applied to estimate the extent to which improving the levels of home reading (2-5 years) and preschool attendance (4-5 years) of socioeconomically disadvantaged children to be commensurate with their advantaged peers, could potentially reduce socioeconomic gaps in children's reading skills. RESULTS: Socioeconomically disadvantaged children had a higher risk of poor reading outcomes compared to more advantaged peers: absolute risk difference=20% (95% CI: 16.0% to 24.2%). Results suggest that improving disadvantaged children's home reading and preschool attendance to the level of their advantaged peers could eliminate 6.5% and 2.1% of socioeconomic gaps in reading skills, respectively. However, large socioeconomic gaps would remain, with disadvantaged children maintaining an 18.3% (95% CI: 14.0% to 22.7%) higher risk of poor reading outcomes in absolute terms. CONCLUSIONS: There are clear socioeconomic disparities in children's reading skills by late childhood. Findings suggest that interventions that improve home reading and preschool attendance may contribute to reducing these inequities, but alone are unlikely to be sufficient to close the equity gap.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33114716

RESUMO

The importance of health-promoting neighborhoods has long been recognized, and characteristics of local built environments are among the social determinants of health. People with disability are more likely than other population groups to experience geographic mobility and cost restrictions, and to be reliant on 'opportunity structures' available locally. We conducted an ecological analysis to explore associations between area-level disability prevalence for people aged 15-64 years and area-level built environment characteristics in Australia's 21 largest cities. Overall, disability was more prevalent in areas with lower walkability and lower local availability of various neighborhood amenities such as public transport, healthier food options, public open space, physical activity and recreation destinations and health and mental health services. These patterns of lower liveability in areas of higher disability prevalence were observed in major cities but not in regional cities. Our findings suggest that geographically targeted interventions to improve access to health-enhancing neighborhood infrastructure could reduce disability-related inequalities in the social determinants of health.

3.
Health Place ; 64: 102365, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32838891

RESUMO

Gender-based violence can include, but is not limited to, domestic violence, intimate partner violence, rape, and intimate partner homicide. It is well-established that gender inequality is the main driver of gender-based violence. However, little work has attempted to unpack how gender-based violence perpetuates within the neighbourhood context, and whether 'liveability' attributes might intersect with gender inequality and violence. We systematically reviewed quantitative evidence examining associations between gender-based violence and several liveability neighbourhood-level factors. MEDLINE (Ovid) and Scopus databases yielded 1822 potentially relevant articles. 50 articles met inclusion criteria. Neighbourhood social capital was most consistently associated with reduced gender-based violence. Few studies examined built environment attributes (e.g. gambling venue densities, access to services). Future research is needed to more deeply examine how combinations of salutogenic or pathogenic neighbourhood attributes may reinforce or prevent violence.

4.
Aust N Z J Public Health ; 44(3): 227-232, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32311191

RESUMO

OBJECTIVE: To develop a framework and indicators to monitor inequalities in health and the social determinants of health for Australians with disability. METHODS: The development drew on existing frameworks and input from people with lived experience of disability. RESULTS: The Disability and Wellbeing Monitoring Framework has 19 domains. Australian national data are available for 73% of the 128 indicators in these domains. Data gaps and limitations include the absence of national data and the absence of disability identifiers in some data sources. CONCLUSIONS: The framework will be used to report baseline data for people with and without disability and to monitor inequalities over time in Australia. It will also be used to locate policy priorities and focus efforts to address data gaps. Implications for public health: Inequality between people with and without disability in relation to health and the social determinants of health is a public health issue that warrants greater attention than it has received to date. The framework provides a robust, evidence-informed tool to address the health inequalities of people with disability, inform the development of effective policy and practice responses, and monitor change over time.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Equidade em Saúde , Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Determinantes Sociais da Saúde , Adolescente , Adulto , Austrália , Feminino , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Características de Residência , Fatores Socioeconômicos , Adulto Jovem
5.
Children (Basel) ; 7(4)2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32268507

RESUMO

Good public transport accessibility is associated with active travel, but this is under-researched among adolescents. We tested associations between public transport accessibility and active travel among school-going adolescents (12-18 years; n = 1329) from Melbourne, Australia analysing Victorian Integrated Survey of Travel and Activity data. Outcomes included main mode of transport to school and accumulating ≥20 min of active travel over the day. Low and high compared to no public transport accessibility around homes were associated with higher odds of public transport use (low (odds ratio (OR): 1.94 95% confidence interval (CI): 1.28, 2.94) high (OR: 2.86 95% CI: 1.80, 4.53)). Low and high public transport accessibility around homes were also associated with higher prevalence of achieving ≥20 min of active travel (low (prevalence ratio (PR): 1.14 95% CI: 0.97, 1.34) high (PR: 1.31 95% CI: 1.11, 1.54)) compared to none. Public transport accessibility around schools was associated with public transport use (low (OR: 2.13 95% CI: 1.40, 3.24) high (OR: 5.07 95% CI: 3.35, 7.67)) and achieving ≥20 min of active travel (low (PR: 1.18 95% CI: 1.00, 1.38) high (PR: 1.64 95% CI: 1.41, 1.90)). Positive associations were confirmed between public transport accessibility and both outcomes of active travel.

6.
J Epidemiol Community Health ; 74(6): 495-501, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32169955

RESUMO

AIM: The inverse care law suggests that those with the greatest need for services are least likely to receive them. Our aim of this study was to test the inverse care law in relation to the use of health services by children aged 4-5 years in Australia who were developmentally vulnerable and socioeconomically disadvantaged. METHOD: Cross-sectional data were collected from the Longitudinal Study of Australian Children birth cohort when the children were aged 4-5 years. Children were grouped according to the combination of developmental vulnerability (yes, no) and socioeconomic disadvantage (lower, higher), resulting in four groups (reference group: developmentally vulnerable and disadvantaged). Multivariate regression was used to examine the impact of the combination of developmental vulnerability and disadvantage on health service use, adjusting for other sociodemographic characteristics. RESULTS: 3967 (90%) of children had data on developmental vulnerability at 4-5 years. A third of children (32.6%) were classified as developmentally vulnerable, and 10%-25% of these children had used health services. Non-disadvantaged children who were developmentally vulnerable (middle need) had 1.4-2.0 times greater odds of using primary healthcare, specialist and hospital services; and non-disadvantaged children who were not developmentally vulnerable (lowest need) had 1.6-1.8 times greater odds of using primary healthcare services, compared with children who were developmentally vulnerable and disadvantaged (highest need). CONCLUSION: We found some evidence of the inverse care law. Equity in service delivery remains a challenge that is critically important to tackle in ensuring a healthy start for children.

7.
SSM Popul Health ; 10: 100538, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32072006

RESUMO

Background: The RESIDential Environments (RESIDE) project is a unique longitudinal natural experiment designed to evaluate the health impacts of the "Liveable Neighbourhoods" planning policy, which was introduced by the Western Australian government to create more walkable suburbs. Objectives: To summarize the RESIDE evidence of the impact of the planning policy on a range of health-supportive behaviours and wellbeing outcomes and to assess the consistency and direction of the estimates of associations. Methods: An audit of 26 RESIDE research papers (from 2003 to 2012) identified the number of positive associations (statistically significant and consistent with policy expectations), negative associations (statistically significant and inconsistent with policy expectations), and null findings from multiple-exposure models between objective and perceived measures of 20 policy design requirements and 13 health-supportive behaviors and wellbeing outcomes. Results: In total 332 eligible estimates of associations (n = 257 objective measures and n = 75 perceived measures) were identified. Positively significant findings were detected for: 57% of walking estimates with objectively measured policy design features (negative = 3%; null = 40%) (n = 115) and 54% perceived measures (negative = 0%; null = 33%) (n = 27); 42% of sense of community estimates with objectively measured of policy design features (negative = 8%; null = 50%) (n = 12) and 61% perceived measures (negative = 8%; null = 31%) (n = 13); 39% of safety or crime-related estimates with objectively measured of policy design features (negative = 22%; null = 39%) (n = 28) and 100% perceived measures (n = 7). All (n = 4) estimates for mental health outcomes with objectively measured policy-related design features were positively significant. Conclusions: The synthesis of findings suggests that new suburban communities built in accordance with the "Liveable Neighbourhoods" policy have the potential to encourage health supportive behaviors and wellbeing outcomes including transport and recreation walking, and to create neighborhoods with a stronger sense of community where residents may feel safer.

8.
Environ Health Perspect ; 127(9): 97004, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31532240

RESUMO

BACKGROUND: Most research on walking for transport has focused on the walkability of residential neighborhoods, overlooking the contribution of places of work/study and the ease with which destinations outside the immediate neighborhood can be accessed, referred to as regional accessibility. OBJECTIVES: We aimed to examine if local accessibility/walkability around place of work/study and regional accessibility are independently and interactively associated with walking. METHODS: A sample of 4,913 adult commuters was derived from a household travel survey in Melbourne, Australia (2012-2014). Local accessibility was measured as the availability of destinations within an 800-m pedestrian network from homes and places of work/education using a local living index [LLI; 0-3 (low), 4-6, 7-9, and 10-12 (high) destinations]. Regional accessibility was estimated using employment opportunity, commute travel time by mode, and public transport accessibility. Every individual's potential minutes of walking for each level of exposure (observed and counter to fact) were predicted using multivariable regression models including confounders and interaction terms. For each contrast of exposure levels of interest, the corresponding within-individual differences in predicted walking were averaged across individuals to estimate marginal effects. RESULTS: High LLI at home and work/education was associated with more minutes walking than low LLI by 3.9 [95% confidence interval (CI): 2.3, 5.5] and 8.3 (95% CI: 7.3, 9.3) min, respectively, in mutually adjusted models. Across regional accessibility measures, an independent association with walking and an interactive association with LLI at work/education was observed. To take one example, the regional accessibility measure of "Jobs within 30 min by public transport" was associated with 4.3 (95% CI: 2.9, 5.7) more mins walking for high (≥30,000 jobs) compared with low (<4,000 jobs) accessibility in adjusted models. The estimated difference for high vs. low LLI (work/education) (among those with low regional accessibility) was 3.6 min (95% CI: 2.3, 4.8), while the difference for high vs. low regional accessibility (among those with low LLI) was negligible (-0.01; 95% CI: -1.2, 1.2). However, the combined effect estimate for high LLI and high regional accessibility, compared with low on both, was 12.8 min (95% CI: 11.1, 14.5), or 9.3 (95% CI: 6.7, 11.8) min/d walking more than expected based on the separate effect estimates. CONCLUSIONS: High local living (work/education) and regional accessibility, regardless of the regional accessibility measure used, are positively associated with physical activity. High exposure to both is associated with greater benefit than exposure to one or the other alone. https://doi.org/10.1289/EHP3395.


Assuntos
Pedestres , Transportes , Caminhada , Austrália , Planejamento Ambiental , Humanos , Características de Residência , Fatores Socioeconômicos
9.
Global Health ; 15(1): 51, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362751

RESUMO

BACKGROUND: Creating 'liveable' cities has become a priority for various sectors, including those tasked with improving population health and reducing inequities. Two-thirds of the world's population will live in cities by 2050, with the most rapid urbanisation in low- and middle-income countries (LMIC). However, there is limited guidance about what constitutes a liveable city from a LMIC perspective, with most of the evidence relating to high-income countries, such as Australia. Existing liveability frameworks include features such as public transport, affordable housing, and public open space; however, these frameworks may not capture all of the liveability considerations for cities in LMIC contexts. OBJECTIVES: This case study formed a multi-sectoral partnership between academics, policymakers (Bangkok Metropolitan Administration, Victorian (Australia) Department of Health and Human Services), and a non-government organisation (UN Global Compact - Cities Programme). This study aimed to: 1) conceptualise and prioritise components of urban liveability within the Bangkok, Thailand context; 2) identify alignment to or divergence from other existing liveability tools; and 3) identify potential indicators and data sources for use within a Pilot Bangkok Liveability Framework. METHODS: The Urban Liveability Workshop involving technical leaders from the Bangkok Metropolitan Administration and a rapid review of liveability literature informed the conceptualisation of liveability for Bangkok. The Bangkok Metropolitan Administration Working Group and key informants in Bangkok provided input into the liveability framework. Indicators identified for Bangkok were mapped onto existing liveability tools, including the UN Global Compact CityScan. RESULTS: Findings revealed commonalities with the Australian liveability definition, as well as new potential indicators for Bangkok. The resulting Pilot Bangkok Liveability Framework provides a structure for measuring liveability in Bangkok that can be implemented by the Bangkok Metropolitan Administration immediately, pending appropriate data acquisition and licensing. The Bangkok Metropolitan Administration Working Group and key informants identified core issues for implementation, including limited spatial data available at the district-level or lower. CONCLUSIONS: This study conceptualised urban liveability for Bangkok, a city in a LMIC context, with potential for adjustment to other cities. Future work should leverage opportunities for using open source data, building local capacity in spatial data expertise, and knowledge sharing between cities.


Assuntos
Planejamento de Cidades , Saúde da População Urbana , Cidades , Países em Desenvolvimento , Humanos , Tailândia
10.
Int J Health Geogr ; 18(1): 15, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266518

RESUMO

BACKGROUND: Identifying socioeconomic determinants that are associated with access to and availability of exercise facilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reduce health inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to, and availability of, exercise facilities in Madrid, Spain. METHODS: Area-level SES was measured using a composite index based on seven sociodemographic indicators. Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional. Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the 125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilities in a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflated Poisson regression analyses to assess the association between area-level SES and exercise facility accessibility and availability. RESULTS: Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities. Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities. CONCLUSION: Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number of facilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lower SES areas may be an intervention to improve health equity.


Assuntos
Exercício Físico , Características de Residência , Classe Social , Instalações Esportivas e Recreacionais/economia , População Urbana , Exercício Físico/fisiologia , Humanos , Espanha/epidemiologia
11.
Int J Health Geogr ; 18(1): 14, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185987

RESUMO

BACKGROUND: Designing healthy, liveable cities is a global priority. Current liveability indices are aggregated at the city-level, do not reflect spatial variation within cities, and are often not aligned to policy or health. OBJECTIVES: To combine policy-relevant liveability indicators associated with health into a spatial Urban Liveability Index (ULI) and examine its association with adult travel behaviours. METHODS: We developed methods to calculate spatial liveability indicators and the ULI for all residential addresses in Melbourne, Australia. Associations between the address-level ULI and adult travel behaviours from the 2012-2014 Victorian Integrated Survey of Travel and Activity (VISTA) (n = 12,323) were analysed using multilevel logistic regression. Sensitivity analyses to evaluate impact of methodological choices on distribution of liveability as assessed by the ULI and associations with travel mode choice were also conducted. RESULTS: Liveability estimates were calculated for 1,550,641 residential addresses. ULI scores were positively associated with active transport behaviour: for each unit increase in the ULI score the estimated adjusted odds ratio (OR) for: walking increased by 12% (95% Credible Interval: 9%, 15%); cycling increased by 10% (4%, 17%); public transport increased by 15% (11%, 19%); and private vehicle transport decreased by 12% (- 9%, - 15%). CONCLUSIONS: The ULI provides an evidence-informed and policy-relevant measure of urban liveability, that is significantly and approximately linearly associated with adult travel behaviours in the Melbourne context. The ULI can be used to evaluate progress towards implementing policies designed to achieve more liveable cities, identify spatial inequities, and examine relationships with health and wellbeing.


Assuntos
Planejamento de Cidades/métodos , Planejamento Ambiental , Política de Saúde , Transportes/métodos , Saúde da População Urbana , Cidades/epidemiologia , Planejamento de Cidades/tendências , Planejamento Ambiental/tendências , Política de Saúde/tendências , Humanos , Saúde da População Urbana/tendências , Vitória/epidemiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-31035699

RESUMO

BACKGROUND: Optimal mental health in early childhood is key to later mental health, physical health, education, and social outcomes; yet, children facing disadvantage tend to have worse mental health and fewer opportunities to develop this foundation. An emerging body of research shows that neighborhoods provide important opportunities for the development of children's mental health. Synthesizing this evidence can advance understandings of the features of the neighborhood built environment (e.g., housing, parks) that (1) promote optimal mental health in childhood and (2) reduce mental health inequities. METHODS: We systematically searched and critically reviewed the international quantitative literature investigating associations between the neighborhood built environment and young children's mental health. RESULTS: 14 articles met inclusion criteria; most examined nature or public open space. Studies tended to find greater access to or quantity of neighborhood nature or public open space were associated with better mental health. Significant gaps included a lack of studies investigating social infrastructure, and few studies examined how the built environment related to positive mental health (i.e., functioning, rather than problems). CONCLUSIONS: Current evidence suggests there is some relationship, but additional research is needed that addresses these gaps and examines differences in associations between child subgroups (e.g., diverse socioeconomic backgrounds).


Assuntos
Ambiente Construído , Saúde Mental , Características de Residência , Meio Ambiente , Habitação , Humanos
13.
Soc Sci Med ; 232: 94-105, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31075753

RESUMO

The aspiration of liveable cities, underpinned by the New Urban Agenda, is gaining popularity as a mechanism to enhance population health and wellbeing. However, less attention has been given to understanding how urban liveability may provide an opportunity to redress health inequities. Using an environmental justice lens, this paper investigates whether urban liveability poses an opportunity or threat to reducing health inequities and outlines a future research agenda. Selected urban liveability attributes, being: education; employment; food, alcohol, and tobacco; green space; housing; transport; and walkability, were investigated to understand how they can serve to widen or narrow inequities. Some domains showed consistent evidence, others suggested context-specific associations that made it difficult to draw general conclusions, and some showed a reverse patterning with the social gradient, but with poorer outcomes. This suggests urban liveability attributes have equigenic potential, but operate within a complex system. We conclude more disadvantaged neighbourhoods and their residents likely have additional policy and design considerations for optimising outcomes, especially as changes to the contextual environment may impact neighbourhood composition through displacement and/or pulling up effects. Future research needs to continue to explore downstream associations using longitudinal and natural experiments, and also seek to gain a deeper understanding of the urban liveability system, including interactions, feedback loops, and non-linear and linear responses. There is a need to monitor neighbourhood population changes over time to understand how liveability impacts the most vulnerable. Other areas worthy of further investigation include applying a life course approach and understanding liveability within the context of other adversities and contextual settings.


Assuntos
Planejamento de Cidades/tendências , Disparidades nos Níveis de Saúde , População Urbana/estatística & dados numéricos , Cidades , Planejamento de Cidades/métodos , Emprego/normas , Emprego/estatística & dados numéricos , Humanos
14.
Artigo em Inglês | MEDLINE | ID: mdl-31100794

RESUMO

Disadvantaged communities tend to have poorer early childhood development outcomes. Access to safe, secure, and stable housing is a well-known social determinant of health but there is a need to examine key features of neighbourhood housing that reduce early childhood development inequities. The 2012 Australian Early Development Census (AEDC), a population-wide measure of early childhood development, and the Australian Bureau of Statistics Socio-economic Index for Areas Index of Relative Socio-economic Disadvantage were used to select fourteen disadvantaged local communities in five Australian states and territories based on those performing better (off-diagonal), or as expected (on-diagonal) on the AEDC relative to their socio-economic profile. Between 2015-2017, qualitative and quantitative housing data were collected in the local communities. In total, 87 interviews with stakeholders, 30 focus groups with local service providers and parents, and Australian Census dwelling information were analysed. A comparative case study approach was used to examine differences in housing characteristics (e.g., public housing, density, affordability, and tenure) between disadvantaged local communities performing 'better than expected' and 'as expected' on early childhood development. Perceived better housing affordability, objectively measured housing tenure (ownership) and perceived and objectively measured lower-density public housing were housing characteristics that emerged as points of difference for disadvantaged local communities where children had relatively better early childhood development outcomes. These characteristics are potential modifiable and policy sensitive housing levers for reducing early childhood development inequities.


Assuntos
Desenvolvimento Infantil , Características de Residência , Populações Vulneráveis , Austrália , Criança , Pré-Escolar , Grupos Focais , Humanos , Lactente , Recém-Nascido
15.
Artigo em Inglês | MEDLINE | ID: mdl-30832269

RESUMO

A current challenge in physical activity research is engaging citizens with co-creating policies that support physical activity participation. Using Photovoice, a participatory action research method, the objectives of this study were to: 1) Identify community perceptions of urban built, social, and political/economic environment factors associated with physical activity; and 2) generate community-driven policy recommendations to increase physical activity. Two districts in Madrid of varying socio-economic status (SES) were selected. Overall, 24 residents participated in 4 groups stratified by sex and district (6 participants per group). Groups met weekly for 4 weeks to discuss and analyze their photographs. Participants coded photographs into categories, which were then regrouped into broader themes. The categories were transformed into policy recommendations using an adaptation of the logical framework approach. Participants took 161 photos, which were classified into 61 categories and 14 broader themes (e.g., active transportation, sport in the city). After this, participants generated a set of 34 policy recommendations to improve the urban environment to support physical activity (e.g., to redistribute sports facilities). Collaboration between citizens and researchers led to a deeper understanding of the community perceptions of urban built, social, and political/economic environment factors associated with physical activity in two districts of Madrid, while engaging citizens in recommending public policies.


Assuntos
Planejamento Ambiental , Exercício Físico , Pesquisa sobre Serviços de Saúde/métodos , Fotografação , Adulto , Idoso , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção
17.
Artigo em Inglês | MEDLINE | ID: mdl-30423874

RESUMO

The etiology of motor neuron disease (MND) is still unknown. The aims of this study were to: (1) analyze MND mortality at a fine-grained level; and (2) explore associations of MND and heavy metals released into Spanish river basins. MND deaths were extracted from the Spanish nationwide mortality registry (2007⁻2016). Standardized mortality ratios (SMRs) for MND were estimated at a municipal level. Sites that emitted quantities of heavy metals above the regulatory thresholds were obtained from the European Pollutant Release and Transfer Register database (2007⁻2015). The relative risks for non-exposed and exposed municipalities (considering a downstream 20 km river section) by type of heavy metal were analyzed using a log-linear model. SMRs were significantly higher in central and northern municipalities. SMRs were 1.14 (1.10⁻1.17) higher in areas exposed to heavy metals than in non-exposed areas: 0.95 (0.92⁻0.96). Considering the different metals, we found the following increased MND death risks in exposed areas: 20.9% higher risk for lead, 20.0% for zinc, 16.7% for arsenic, 15.7% for chromium, 15.4% for cadmium, 12.7% for copper, and 12.4% for mercury. This study provides associations between MND death risk and heavy metals in exposed municipalities. Further studies investigating heavy metal exposure are needed to progress in MND understanding.


Assuntos
Exposição Ambiental/efeitos adversos , Metais Pesados/toxicidade , Doença dos Neurônios Motores/induzido quimicamente , Doença dos Neurônios Motores/mortalidade , Rios/química , Poluentes Químicos da Água/toxicidade , Poluição Química da Água/efeitos adversos , Exposição Ambiental/análise , Exposição Ambiental/estatística & dados numéricos , Humanos , Metais Pesados/análise , Fatores de Risco , Espanha/epidemiologia , Poluentes Químicos da Água/análise , Poluição Química da Água/análise , Poluição Química da Água/estatística & dados numéricos
18.
Artigo em Inglês | MEDLINE | ID: mdl-30004462

RESUMO

More than half the world's population now live in urban settlements. Worldwide, cities are expanding at their fringe to accommodate population growth. Low-density residential development, urban sprawl, and car dependency are common, contributing to physical inactivity and obesity. However, urban design and planning can modify urban form and enhance health by improving access to healthy food, public transport, and services. This study used a sequential mixed methods approach to investigate associations between food outlet access and body mass index (BMI) across urban-growth and established areas of Melbourne, Australia, and identify factors that influence local food environments. Population survey data for 3141 adults were analyzed to examine associations, and 27 interviews with government, non-government, and private sector stakeholders were conducted to contextualize results. Fast food density was positively associated with BMI in established areas and negatively associated in urban-growth areas. Interrelated challenges of car dependency, poor public transport, and low-density development hampered healthy food access. This study showed how patterns of suburban development influence local food environments and health outcomes in an urbanized city context and provides insights for other rapidly growing cities. More nuanced understandings of the differential effect of food environments within cities have potential to guide intra-city planning for improving health and reducing inequities.


Assuntos
Índice de Massa Corporal , Abastecimento de Alimentos/estatística & dados numéricos , Obesidade/epidemiologia , População Suburbana/estatística & dados numéricos , Urbanização , Adulto , Austrália/epidemiologia , Fast Foods/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Int J Epidemiol ; 47(5): 1485-1496, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29850874

RESUMO

Background: Understanding the relationship between different aspects of disadvantage over time and domains of child development will facilitate the formulation of more precise policy responses. We examined the association between exposure to aspects of disadvantage over the childhood period (from 0-9 years) and child development at 10-11 years. Methods: We used data from the nationally representative birth cohort of the Longitudinal Study of Australian Children (n = 4979). Generalized linear models with log-Poisson link were used to estimate the association between previously derived disadvantage trajectories (in each of four lenses of sociodemographic, geographic environments, health conditions and risk factors, and a composite of these) and risk of poor child developmental outcomes. Population-attributable fractions were calculated to quantify the potential benefit of providing all children with optimal conditions for each developmental outcome. Results: Trajectories of disadvantage were associated with developmental outcomes: children in the most disadvantaged composite trajectory had seven times higher risk of poor outcomes on two or more developmental domains, compared with those most advantaged. Trajectories of disadvantage in different lenses were varyingly associated with the child development domains of socio-emotional adjustment, physical functioning and learning competencies. Exposure to the most advantaged trajectory across all lenses could reduce poor developmental outcomes by as much as 70%. Conclusions: Exposure to disadvantage over time is associated with adverse child development outcomes. Developmental outcomes varied with the aspects of disadvantage experienced, highlighting potential targets for more precise policy responses. The findings provide evidence to stimulate advocacy and action to reduce child inequities.


Assuntos
Desenvolvimento Infantil , Fatores Socioeconômicos , Populações Vulneráveis/estatística & dados numéricos , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Fatores de Risco
20.
Int J Epidemiol ; 47(4): 1307-1316, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29878228

RESUMO

Background: Disadvantage rarely manifests as a single event, but rather is the enduring context in which a child's development unfolds. We aimed to characterize patterns of stability and change in multiple aspects of disadvantage over the childhood period, in order to inform more precise and nuanced policy development. Methods: Participants were from the Longitudinal Study of Australian Children birth cohort (n = 5107). Four lenses of disadvantage (sociodemographic, geographic environment, health conditions and risk factors), and a composite of these representing average exposure across all lenses, were assessed longitudinally from 0 to 9 years of age. Trajectory models identified groups of children with similar patterns of disadvantage over time for each of these lenses and for composite disadvantage. Concurrent validity of these trajectory groups was examined through associations with academic performance at 10-11 years. Results: We found four distinct trajectories of children's exposure to composite disadvantage, which showed high levels of stability over time. In regard to the individual lenses of disadvantage, three exhibited notable change over time (the sociodemographic lens was the exception). Over a third of children (36.3%) were exposed to the 'most disadvantaged' trajectory in at least one lens. Trajectories of disadvantage were associated with academic performance, providing evidence of concurrent validity. Conclusions: Children's overall level of composite disadvantage was stable over time, whereas geographic environments, health conditions and risk factors changed over time for some children. Measuring disadvantage as uni-dimensional, at a single time point, is likely to understate the true extent and persistence of disadvantage.


Assuntos
Desenvolvimento Infantil , Meio Ambiente , Disparidades em Assistência à Saúde , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Populações Vulneráveis
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