Cross-sectional associations between residential environmental exposures and cardiovascular diseases.

BACKGROUND: Prior research examining neighbourhood effects on cardiovascular diseases (CVDs) has focused on the impact of neighbourhood socio-economic status or a few selected environmental variables. No studies of cardiovascular disease outcomes have investigated a broad range of urban planning related environmental factors. This is the first study to combine multiple neighbourhood influences in an integrated approach to understanding the association between the built and social environment and CVDs. By modeling multiple neighbourhood level social and environmental variables simultaneously, the study improved the estimation of effects by accounting for potential contextual confounders. METHODS: Data were collected using a cross-sectional survey (n = 2411) across 87 census tracts (CT) in Toronto, Canada, and commercial and census data were accessed to characterize the residential environment. Multilevel regressions were used to estimate the associations of neighbourhood factors on the risk of CVD. RESULTS: Exposure to violent crimes, environmental noise, and proximity to a major road were independently associated with increased odds of CVDs (p < 0.05) in the fully adjusted model. While reduced access to food stores, parks/recreation, and increased access to fast food restaurants were associated with increased odds of CVDs in partially adjusted models (p < 0.05), these associations were fully attenuated after adjusting for BMI and physical activity. Housing disrepair was not associated with CVD risk. CONCLUSIONS: These findings illustrate the importance of measuring and modeling a broad range of neighborhood factors--exposure to violent crimes, environmental noise, and traffic, and access to food stores, fast food, parks/recreation areas--to identify specific stressors in relation to adverse health outcomes. Further research to investigate the temporal order of events is needed to better understand the direction of causation for the observed associations

Did the UK COVID-19 Lockdown Modify the Influence of Neighbourhood Disorder on Psychological Distress? Evidence From a Prospective Cohort Study

National lockdown in the UK during the COVID-19 pandemic severely restricted the mobility of residents and increased time spent in their residential neighbourhoods. This is a unique opportunity to understand how an exogenous factor that reduces mobility may influence the association between neighbourhood social environment and mental health. This study investigates whether the COVID-19 lockdown may modify the effect of neighbourhood disorder on psychological distress. Methods: We tracked changes in psychological distress, using the UK household longitudinal survey across the pre-COVID and lockdown periods in 16,535 adults. Neighbourhood disorder was measured along two subscales: social stressors and property crime. Fixed-effects regression was used to evaluate whether the widespread reduction in mobility modifies the association between the subscales of neighbourhood disorder and psychological distress. Results: The effect of neighbourhood social stressors on psychological distress was stronger in the lockdown period compared to the pre-COVID period. Compared to the pre-COVID period, the effect of being in neighbourhoods with the highest social stressors (compared to the lowest) on psychological distress increased by 20% during the lockdown. Meanwhile, the effect of neighbourhood property crime on mental health did not change during the lockdown. Conclusion: The sudden loss of mobility as a result of COVID-19 lockdown is a unique opportunity to address the endogeneity problem as it relates to mobility and locational preferences in the study of neighbourhood effects on health. Vulnerable groups who have limited mobility are likely more sensitive to neighbourhood social stressors compared to the general population

Sleep problems among sexual minorities: a longitudinal study on the influence of the family of origin and chosen family

Background: There is growing evidence that lesbian, gay, and bisexual (LGB) adults experience more sleep problems than the general population. As LGB individuals experience a signifcantly greater risk of family rejection and low family support, our study investigates the role of family support as a potential determinant of LGB sleep problems over a prolonged period, and whether friend support (i.e. chosen family) can mitigate the efect of low family support. Given the importance of sleep on mental and physical health, study results may help shed light on persistent health disparities across sexual orientations. Methods: Our sample included 1703 LGB individuals from the UK Household Longitudinal Study (UKHLS). Mixed-efect logistic regressions were used to estimate the efect of family and friend support on the development of sleep problems after 24months while controlling for potential confounders. A modifed Pittsburgh Sleep Quality Index was used to measure 1) presence of any sleep problems, 2) short sleep duration, and 3) poor sleep quality. Results: Family support at baseline was independently associated with all sleep problems in our study after 24-months: 1 SD increase in family support was associated with a 0.94 times lower risk of sleep problems (95% C.I=0.90-0.98), a 0.88 times lower risk of short sleep duration (95% C.I=0.81-0.95), and a 0.92 times lower risk of sleep quality (95% C.I=0.93-0.98). Support from one’s chosen family (proxied by friend support) did not mitigate the efects of low family support on sleep problems. Conclusions: Our study found a consistent efect of family support across all sleep outcomes along with evidence of a persistent efect after 24months. Our fndings point to the importance of targeting family support in designing interventions aimed at reducing LGB sleep problems.Brock Library Open Access Publishing Fun

The effect of food environments on fruit and vegetable intake as modified by time spent at home: a cross-sectional study.

OBJECTIVE: There is a growing body of research that investigates how the residential neighbourhood context relates to individual diet. However, previous studies ignore participants' time spent in the residential environment and this may be a problem because time-use studies show that adults' time-use pattern can significantly vary. To better understand the role of exposure duration, we designed a study to examine 'time spent at home' as a moderator to the residential food environment-diet association. DESIGN: Cross-sectional observational study. SETTINGS: City of Toronto, Ontario, Canada. PARTICIPANTS: 2411 adults aged 25-65. PRIMARY OUTCOME MEASURE: Frequency of vegetable and fruit intake (VFI) per day. RESULTS: To examine how time spent at home may moderate the relationship between residential food environment and VFI, the full sample was split into three equal subgroups--short, medium and long duration spent at home. We detected significant associations between density of food stores in the residential food environment and VFI for subgroups that spend medium and long durations at home (ie, spending a mean of 8.0 and 12.3 h at home, respectively--not including sleep time), but no associations exist for people who spend the lowest amount of time at home (mean=4.7 h). Also, no associations were detected in analyses using the full sample. CONCLUSIONS: Our study is the first to demonstrate that time spent at home may be an important variable to identify hidden population patterns regarding VFI. Time spent at home can impact the association between the residential food environment and individual VFI

How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial.

OBJECTIVES: We studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness. METHODS: Participants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU). Participants (N=197) had in-person interviews every 3 months for 2 years. RESULTS: The HF+ACT group spent more time stably housed compared to the TAU group with the mean difference between the groups of 45.8% (95% CI 37.1% to 54.4%, p<0.0001). Accounting for baseline differences, HF+ACT group showed significant improvements over TAU group for community functioning, selected quality-of-life subscales and arrests at some time points during follow-up. No differences between HF+ACT and TAU groups over the follow-up were observed for health service usage, community integration and substance use. CONCLUSIONS: HF for individuals with high levels of need increased housing stability and selected health and justice outcomes over 2 years in a city with many social and health services. TRIAL REGISTRATION NUMBER: ISRCTN42520374

Socio-environmental Determinants of Cardiovascular Diseases

Cardiovascular diseases (CVDs) are the leading cause of death and disability around the world. The purpose of this thesis is to investigate the impact of socio-environmental determinants of CVDs at the neighbourhood scale in order to inform actionable interventions, which may lead to large-scale reductions in preventable CVDs. Drawing on 2411 surveys carried out in Toronto, Canada, this thesis employs multilevel models to estimate the magnitude of socio-environmental influences on the risk of CVD while adjusting for individual-level risk factors. To advance current research methodology, strategies and innovations were developed to 1) improve the characterization of neighbourhoods by empirically testing a full range of socio-environmental influences; 2) account for non-residential exposures by including a combined analysis of work and home contexts; 3) account for variations in the duration of exposure through the use of time-weighted models; 4) deal with problem of spatial data aggregation by developing and testing a novel method of neighbourhood zone design, and 5) account for the spatial scales of different socio-environmental determinants by modeling at multiple scales. The thesis demonstrated that land use decisions are inextricably public health decisions. It found that living in neighbourhoods with inadequate access to food stores and areas for physical activity, burdened by violent crimes and fast food restaurants, and over-dependent on automobiles (leading to air pollution), with a high level of noise may significantly increase the risk of CVDs, over and above individual-level risks. The thesis also found that working in neighbourhoods that are socio-economically disadvantaged or have high-traffic may significantly increase CVD risk. The thesis developed and demonstrated novel methods to reduce the measurement error of neighbourhood exposures through 1) the use of “amoeba buffers” to improve neighbourhood zone design to better reflect participants’ local neighbourhoods and 2) the use of duration of exposure weights to adjust for individual differences in the time spent across different contexts. Finally, it found that the significance of socio-environmental factors depends on the scale of data aggregation; thus, investigation of multiple scales may be required to identify the relevant scale that matches the specific contextual factor in future research.Ph

The impact of gentrification on residential evictions

Gentrification, a process of transforming working-class areas into middle-class use, is a pervasive process in many cities around the world. Although researchers recognize the dangers of displacement in this process, the magnitude of dislocation is highly contested. Literature on gentrification offers little guidance with regard to understanding the timing of displacement in a gentrifying neighborhood. Moreover, evictions have been neglected as a form of gentrification-led displacement, which may have led to underestimating displacement effects. This study sheds light on the geography of displacement through an analysis of 59,415 eviction applications in the City of Toronto from 1999 to 2001, which are compared with the timing of gentrification at the census tract level (n=502). The study finds that evictions are positively associated with (1) neighborhoods in early stages of gentrification, and (2) pre-gentrified neighborhoods that are beginning to be marked by changes in social composition, that is, an increasing number of artists and people with higher education, but no significant increase yet in aggregate income or the number of owner-occupied dwellings. By illuminating the timing and magnitude of displacement in gentrifying neighborhoods, this study fosters a better understanding of gentrification outcomes that may inform policies to ameliorate its negative impacts

Family support modifies the effect of changes to same-sex marriage legislation on LGB mental health: evidence from a UK cohort study

Many lesbian, gay and bisexual (LGB) individuals continue to experience unique challenges, such as the lack of family support and access to same-sex marriage. This study examines the effect of the introduction of same-sex marriage in the UK (2013-14) on mental health functioning among sexual minorities, and investigates whether low family support may hamper the positive effects of marriage equality legislation among LGB individuals. This analysis included LGB participants (n = 2172) from the UK household longitudinal study waves 3-7, comprising two waves before and two waves after marriage equality legislation passed in England, Wales and Scotland. Individual-level mental health functioning was measured using the mental component score (MCS-12) of the Short Form-12 survey. Fixed-effect panel linear models examined the effect of marriage equality on MCS-12 across varying family support levels. Analyses included adjustment for covariates and survey weights. Legalization of same-sex marriage was independently associated with an increase of 1.17 [95% confidence interval (CI): 0.28-2.05] MCS-12 in men and 1.13 (95% CI: 0.47-2.27) MCS-12 in women. For men, each additional standard deviation of family support modified the effect of legalization on mental health functioning by +0.70 (95% CI: 0.22-1.18) MCS-12 score. No interaction was found in women. Our findings provide evidence that same-sex marriage will likely improve LGB mental health functioning, and these effects may be generalizable to other European countries. Since male sexual minorities with low family support benefited the least, additional interventions aimed at improving family support and acceptance of this group is required to help reduce mental health disparities

Built Environmental Correlates of Cycling Accidents Involving Fatalities and Serious Injuries in London, UK

Introduction: Approximately 2,552 individuals were killed or seriously injured through cycling accidents in the Greater London Area between 2010 and 2015. The purpose of this study is to investigate a wide range of built environmental correlates of cycling accidents resulting in KSI so that we can identify potential areas for targeted interventions.Methods: We performed a cross-sectional analysis to examine the association between serious cycling injuries (2010-15), using road segment as the unit of analysis, and a wide range of built environmental characteristics. Multilevel models were used to account for potential spatial clustering.Results: Serious cycling injuries were independently associated with higher commercial and residential densities, higher distance to speed camera, higher bus, car, and 2-wheeled (motorcycle and moped) traffic, and higher density of alcohol outlets. Greenspace was associated with decreased odds of injuries up to the 3rd quartile, but roads adjacent to the highest levels of green space (4th quartile) had increased odds of injuries. Findings from our study point to the potential of urban planning interventions to reduce serious cycling injuries (e.g., speed cameras, improving safety near alcohol outlets and in parks, and recreational areas, etc.). Further research using quasi-experimental approaches is required to evaluate whether the implementation of interventions leads to injury reductions.Urban Data Scienc

Construct Validity of the SF-12v2 for the Homeless Population with Mental Illness: An Instrument to Measure Self-Reported Mental and Physical Health.

BACKGROUND:Self-reported health measures are important indicators used by clinicians and researchers for the evaluation of health interventions, outcome assessment of clinical studies, and identification of health needs to improve resource allocation. However, the application of self-reported health measures relies on developing reliable and valid instruments that are suitable across diverse populations. The main objective of this study is to evaluate the construct validity of the SF-12v.2, an instrument for measuring self-rated physical and mental health, for homeless adults with mental illness. Various interventions have been aimed at improving the health of homeless people with mental illness, and the development of valid instruments to evaluate these interventions is imperative. STUDY DESIGN:We measured self-rated mental and physical health from a quota sample of 575 homeless people with mental illness using the SF-12v2, EQ-5D, Colorado Symptoms Index, and physical/mental health visual analogue scales. We examined the construct validity of the SF-12v2 through confirmatory factor analyses (CFA), and using ANOVA/correlation analyses to compare the SF-12v2 to the other instruments to ascertain discriminant/convergent validity. RESULTS:Our CFA showed that the measurement properties of the original SF-12v2 model had a mediocre fit with our empirical data (χ2 = 193.6, df = 43, p < .0001, CFI = 0.85, NFI = 0.83, RMSEA = 0.08). We demonstrate that changes based on theoretical rationale and previous studies can significantly improve the model, achieving an excellent fit in our final model (χ2 = 160.6, df = 48, p < .0001, CFI = 0.95, NFI = 0.95, RMSEA = 0.06). Our CFA results suggest that an alternative scoring method based on the new model may optimize health status measurement of a homeless population. Despite these issues, convergent and discriminant validity of the SF-12v2 (scored based on the original model) was supported through multiple comparisons with other instruments. CONCLUSION:Our study demonstrates for the first time that the SF-12v2 is generally appropriate as a measure of physical and mental health status for a homeless population with mental illness