Assessing the Retail Food Environment in Madrid: An Evaluation of Administrative Data against Ground Truthing

Previous studies have suggested that European settings face unique food environment issues; however, retail food environments (RFE) outside Anglo-Saxon contexts remain understudied. We assessed the completeness and accuracy of an administrative dataset against ground truthing, using the example of Madrid (Spain). Further, we tested whether its completeness differed by its area-level socioeconomic status (SES) and population density. First, we collected data on the RFE through the ground truthing of 42 census tracts. Second, we retrieved data on the RFE from an administrative dataset covering the entire city (n = 2412 census tracts), and matched outlets using location matching and location/name matching. Third, we validated the administrative dataset against the gold standard of ground truthing. Using location matching, the administrative dataset had a high sensitivity (0.95; [95% CI = 0.89, 0.98]) and positive predictive values (PPV) (0.79; [95% CI = 0.70, 0.85]), while these values were substantially lower using location/name matching (0.55 and 0.45, respectively). Accuracy was slightly higher using location/name matching (k = 0.71 vs 0.62). We found some evidence for systematic differences in PPV by area-level SES using location matching, and in both sensitivity and PPV by population density using location/name matching. Administrative datasets may offer a reliable and cost-effective source to measure retail food access; however, their accuracy needs to be evaluated before using them for research purposes.This research was funded by the European Research Council under the European Union’ Seventh Framework Programme (FP7/2007–2013/ERC Starting Grant HeartHealthyHoods Agreement no.336893).S

Measuring heart-healthy urban environments: a geospatial approach for studying the contextual determinants of cardiovascular disease

Actualmente las ciudades se presentan como lugares con un importante papel en la salud de las poblaciones. Poseen características físicas y sociales que limitan o promueven comportamientos saludables. El enfoque geoespacial permite tener una apreciación más profunda de las características físicas y sociales de las ciudades al considerar las propiedades geográficas de los datos que impactan sobre los resultados de salud de cualquier estudio ecológico. Este enfoque mejora la comprensión del mecanismo por el cual los determinantes contextuales de las ciudades afectan a la salud. Por lo tanto, el objetivo general de la presente tesis es desarrollar e integrar diferentes medidas de determinantes contextuales urbanos que afectan la salud cardiovascular y analizar espacialmente su relación con la prevalencia de enfermedad cardiovascular. Para ello, se realizaron 3 estudios diferentes. En el primero se diseñó una herramienta basada en Sistemas de Información Geográfica que integra información de los entornos de actividad física y de alimentación para caracterizar el entorno obesogénico de un área urbana. En el segundo se propuso y construyó un índice de privación socioeconómica y se estudió el efecto de la escala espacial en la relación entre la privación y la enfermedad cardiovascular. En el último estudio se desarrolló el índice de entornos cardiosaludables integrando características de cuatro entornos urbanos (alimentos, actividad física, tabaco y alcohol) y se examinó su asociación con la enfermedad cardiovascular. Toda la investigación se desarrolla bajo una perspectiva geoespacial. Se presenta una línea de investigación novedosa basada en Sistemas de la Información Geográfica y centrada en la naturaleza entrelazada de las características multidimensionales del entorno urbano relacionado con la Enfermedad Cardiovascular (ECV). Además, se ha mostrado el impacto que las propiedades geográficas de los datos tienen sobre los resultados de salud. La dependencia espacial, el MAUP, el efecto de escala y la heterogeneidad espacial se han evaluado transversalmente al estudio del contexto urbano y su relación con la ECV. Por lo tanto, se aprecia una doble contribución de esta investigación: 1) considera la conceptualización geográfica necesaria en estudios ecológicos y 2) la aplica a un problema de salud global como la ECV. Este enfoque es crucial para comprender mejor el papel del lugar en la promoción de la salud y la reducción de las desigualdades en salud

Characterizing physical activity and food urban environments: a GIS-based multicomponent proposal

BACKGROUND: Healthier urban environments influence the distribution of cardiovascular risk factors. Our aim was to design and implement a multicomponent method based on Geographic Information Systems to characterize and evaluate environmental correlates of obesity: the food and the physical activity urban environments. METHODS: Study location comprised a socio-demographically average urban area of 12 contiguous census sections (≈16,000 residents), in Madrid, Spain. We conducted on-field audits on all food stores and street segments. We designed a synthetic index integrating continuous measures of both environments, by kernel density analyses. Index ranges from 0 to 100 (least-most healthy). RESULTS: We found a heterogeneous distribution with 75 and 50 % of the area scoring less than 36.8 and 25.5, respectively. Census sections of study area were categorized by Jenks intervals as high, medium-high, medium-low and low. 41.0 % of residents lived in an area with a low score, 23.6 % medium-low and 31.1 % medium-high and 4.2 % in a high. CONCLUSION: The proposed synthetic index may be a relevant tool to inform urban health interventions, providing a feasible way to integrate different measures of barriers and facilitators of healthy urban environments in terms of food and physical activity.This study was supported by the European Research Council under the European Union’s Seventh Framework Programme (FP/2007-2013)/ERC Starting Grant HeartHealthyHoods Agreement n. 336893. Usama Bilal was supported by a fellowship from the Obra Social La Caixa and by a Johns Hopkins Center for a Livable Future-Lerner FellowshipS

Socioeconomic Inequalities in the Retail Food Environment around Schools in a Southern European Context

Across Europe, excess body weight rates are particularly high among children and adolescents living in Southern European contexts. In Spain, current food policies appeal to voluntary self-regulation of the food industry and parents’ responsibility. However, there is no research (within Spain) assessing the food environment surrounding schools. We examined the association between neighborhood-level socioeconomic status (NSES) and the spatial access to an unhealthy food environment around schools using both counts and distance measures, across the city of Madrid. We conducted a cross-sectional study citywide (n = 2443 census tracts). In 2017, we identified all schools (n = 1321) and all food retailers offering unhealthy food and beverages surrounding them (n = 6530) using publicly available data. We examined both the counts of retailers (within 400 m) and the distance (in meters) from the schools to the closest retailer. We used multilevel regressions to model the association of neighborhood-level socioeconomic status (NSES) with both measures, adjusting both models for population density. Almost all schools (95%) were surrounded by unhealthy retailers within 400 m (median = 17 retailers; interquartile range = 8–34). After adjusting for population density, NSES remained inversely associated with unhealthy food availability. Schools located in low-NSES areas (two lowest quintiles) showed, on average, 29% (IRR (Incidence Rate Ratio) = 1.29; 95% CI (Confidence Interval) = 1.12, 1.50) and 62% (IRR = 1.62; 95% CI = 1.35, 1.95) more counts of unhealthy retailers compared with schools in middle-NSES areas (ref.). Schools in high-NSES areas were farther from unhealthy food sources than those schools located in middle-NSES areas (β = 0.35; 95% CI = 0.14, 0.47). Regulating the school food environment (within and beyond school boundaries) may be a promising direction to prevent and reduce childhood obesity

Access to and availability of exercise facilities in Madrid: An equity perspective

Background: Identifying socioeconomic determinants that are associated with access to and availability of exercisefacilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reducehealth 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 the125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilitiesin a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflatedPoisson regression analyses to assess the association between area-level SES and exercise facility accessibility andavailability.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 offacilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lowerSES areas may be an intervention to improve health equity

Access to and availability of exercise facilities in Madrid: An equity perspective

Background: Identifying socioeconomic determinants that are associated with access to and availability of exercisefacilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reducehealth 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 the125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilitiesin a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflatedPoisson regression analyses to assess the association between area-level SES and exercise facility accessibility andavailability.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 offacilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lowerSES areas may be an intervention to improve health equity

Density of green spaces and cardiovascular risk factors in the city of Madrid: the heart healthy hoods study

The aim of this study is to evaluate the relationship between the density of green spaces at different buffer sizes (300, 500, 1000 and 1500 m) and cardiovascular risk factors (obesity, hypertension, high cholesterol, and diabetes) as well as to study if the relationship is different for males and females. We conducted cross-sectional analyses using the baseline measures of the Heart Healthy Hoods study (N = 1625). We obtained data on the outcomes from clinical diagnoses, as well as anthropometric and blood sample measures. Exposure data on green spaces density at different buffer sizes were derived from the land cover distribution map of Madrid. Results showed an association between the density of green spaces within 300 and 500 m buffers with high cholesterol and diabetes, and an association between the density of green spaces within 1500 m buffer with hypertension. However, all of these associations were significant only in women. Study results, along with other evidence, may help policy-makers creating healthier environments that could reduce cardiovascular disease burden and reduce gender health inequities. Further research should investigate the specific mechanisms behind the differences by gender and buffer size of the relationship between green spaces and cardiovascular risk factors.This project was funded by the Instituto de Salud Carlos III, Subdirección General de Evaluación y Fomento de la Investigación, Government of Spain (PI18/00782) and by the European Research Council under the European Union’s Seventh Framework Programme (FP7/2007–2013/ERC Starting Grant Heart Healthy Hoods Agreement no. 623 336893). P.G. was supported by the 2018 Alfonso Martín Escudero Research Grant

MOESM2 of Intersection of neighborhood dynamics and socioeconomic status in small-area walkability: the Heart Healthy Hoods project

Additional file 2. Table S2: Census section sociodemographic and walkability indicators according to socioeconomic status (SES) tertiles (N = 2415)

Development and evaluation of the OHCITIES instrument : assessing alcohol urban environments in the Heart Healthy Hoods project

To describe the development and test-retest reliability of OHCITIES, an instrument characterising alcohol urban environment in terms of availability, promotion and signs of consumption. This study involved: (1) developing the conceptual framework for alcohol urban environment by means of literature reviewing and previous alcohol environment research experience; (2) pilot testing and redesigning the instrument; (3) instrument digitalisation; (4) instrument evaluation using test-retest reliability. Data for testing the reliability of the instrument were collected in seven census sections in Madrid in 2016 by two observers. We computed per cent agreement and Cohen's kappa coefficients to estimate inter-rater and test-retest reliability for alcohol outlet environment measures. We calculated interclass coefficients and their 95% CIs to provide a measure of inter-rater reliability for signs of alcohol consumption measures. We collected information on 92 on-premise and 24 off-premise alcohol outlets identified in the studied areas about availability, accessibility and promotion of alcohol. Most per cent-agreement values for alcohol measures in on-premise and off-premise alcohol outlets were greater than 80%, and inter-rater and test-retest reliability values were generally above 0.80. Observers identified 26 streets and 3 public squares with signs of alcohol consumption. Intraclass correlation coefficient between observers for any type of signs of alcohol consumption was 0.50 (95% CI −0.09 to 0.77). Few items promoting alcohol unrelated to alcohol outlets were found on public spaces. The OHCITIES instrument is a reliable instrument to characterise alcohol urban environment. This instrument might be used to understand how alcohol environment associates with alcohol behaviours and its related health outcomes, and can help in the design and evaluation of policies to reduce the harm caused by alcohol

MOESM1 of Intersection of neighborhood dynamics and socioeconomic status in small-area walkability: the Heart Healthy Hoods project

Additional file 1: Additional information on the operationalization of the variables