Transcript Neighborhoods and Health

POPULATION RESEARCH SEMINAR SERIES
Sponsored by the Statistics and Survey Methods Core of the U54 Partnership
Neighborhoods and Health
Reginald Tucker-Seeley, ScD
Assistant Professor of Social and Behavioral Sciences
Center for Community Based Research, Dana-Farber Cancer Institute/
Department of Social and Behavioral Sciences, Harvard School of Public Health
Overview
• Background
• Challenges to research on the association
between neighborhoods and health
• Interventions at the neighborhood level
– Intervening on the residents
– Intervening on the place/space
– Intervening on the residents and the place/space
• Summary/Conclusions
Background
• Where we live matters
Background
• Characteristics of places associated with
health/health behavior:
– Safety (Tucker-Seeley, et al. 2009; Bennett, et al.
2007)
– Aesthetics (Hoehner, et al. 2005)
– Physical structure (Brownson, et al. 2009)
– Food stores (Sharkey, et al. 2009)
Background
• Proximity and the density of liquor stores
associated with health behavior and health
status of residents (Cunradi, 2010; Romley, et
al, 2007; LaVeist et al, 2000)
• Association between minority concentration,
alcohol outlet density, and alcohol problems
(Alaniz, 1998)
Source: RWJF Commission to Build a Healthier America, Where we live
matters to our health
What is a neighborhood?
• Block(s)
• Administrative boundary (e.g. census)
• Area between natural/man-made barriers
What is a neighborhood?
What is a neighborhood?
Neighborhood Definition
• The definition of “neighborhoods” is a difficult
one to capture; as “neighborhoods” have
emergent properties that are created and
defined both by larger structural forces AND
by the residents within them.
Neighborhood Definition (Sampson, 2012)
• Neighborhoods are “spatial units with variable
organizational features, and…are nested
within..larger communities. Neighborhoods
vary in size and complexity depending on the
social phenomenon under study and the
ecological structure of the larger community.”
(Sampson, 2012, pg. 54).
What is a “good” neighborhood?
• Safe to walk to destinations
• Aesthetically pleasing (attractive features,
well-maintained buildings)
• Trust fellow neighbors
• Can count on neighborhoods to help keep
neighborhood well-maintained
• Stable/long-term residents
What is a “bad” neighborhood?
•
•
•
•
Not safe (fearful of crime)
Transient residents
Dilapidated buildings
Unfavorable retail
– liquor stores
– alternative financial institutions (check cashers,
pawn shops)
– Empty storefronts
Neighborhood environment
• Where we live matters
– Quality of the neighborhood environment influences health and
health behavior
– Safety
– Aesthetics
– Physical structure
• Neighborhood service environment
– What are the options available to the residents for services?
– Are there specific mixes of services associated with resident
behavior?
– Is the current mix of services what the residents want?
Sampson (2012)
• “What happens in one neighborhood is tightly
connected to adjacent neighborhoods,
creating a “ripplelike” effect that encompasses
the entire city.”
Neighborhood Boundaries
• Perceived “neighborhood” boundaries may vary
between residents in an area (Coulton, et al, 2013)
• Different neighborhood sizes used in research may
work differently across variables and behaviors (Lee
and Moudon, 2006)
• “the effects of area-based attributes could be affected
by how contextual units or neighborhoods are
geographically delineated and the extent to which
these areal units deviate from the true causally
relevant geographic context” (Kwan, 2012)
Neighborhoods and Health Theory
• No widely accepted theory that clearly
outlines constructs, describes mechanisms
and links to health behavior/health
– Ross (2000) hypothesizes that neighborhoods can
affect behavior through a contagion mechanism
where people’s behavior is influenced by those
around them and a structural mechanism where
neighborhood environments organize the
opportunities and resources available to the
residents that can influence health behavior.
Sampson (2012)
• “How do individual choices combine to create social
contexts that then constrain choices?”
– At multiple levels
– How do we capture the individual choices and social
contexts and their influence on constrained choices in our
theories and methods?
Model of the influence of neighborhood and individual
level resources on health
Residential segregation
by race/ethnicity and
socioeconomic position
Neighborhood physical environments
Environmental exposures
Food and recreational resources
Built environment
Aesthetic quality/natural spaces
Services
Quality of housing
Behavioral
mediators
Health
Stress
Inequalities in
resource
distribution
Neighborhood social environments
Safety/violence
Social connections/cohesion
Local institutions
Norms
Personal Characteristics
Material resources
Psychosocial resources
Biological attributes
Source: Diez-Roux and Mair, 2010
Model of the influence of neighborhood and individual
level resources on health
City level policies
•Zoning
Residential segregation
by race/ethnicity and
socioeconomic position
Historical
housing/ mortgage
practices
•“Redlining”
Neighborhood physical environments
Environmental exposures
Food and recreational resources
Built environment
Aesthetic quality/natural spaces
Services
Quality of housing
Behavioral
mediators
Health
Stress
Inequalities in
resource
distribution
Neighborhood social environments
Safety/violence
Social connections/cohesion
Local institutions
Norms
Personal Characteristics
Material resources
Psychosocial resources
Biological attributes
Source: Diez-Roux and Mair, 2010
Model of the influence of neighborhood
environment
Psychological
Well-Being
Neighborhood
Environment
• Land Use
• Public services
• Health care
resources
• Financial
Resources
• Retail/Commercial
Based on Chaix, 2009
Experience of the
Neighborhood
•
•
•
•
•
•
Attachment
Sense of Community
Feeling of relegation
Residential captivity
Internalized Stigma
Perceived Safety
• Stress
• Anxiety
• Depressive
Symptoms
Social Cognitive
Factors
•
•
•
•
•
Life Values
Knowledge/beliefs
Self-esteem
Self-efficacy
Locus of Control
Health Behaviors
• Physical activity
o Recreation
o Transportation
• Diet
• Smoking
• Alcohol
Consumption
• Health care
utilization
Other Risk Factors
• Obesity
What do we really mean by
“neighborhood effects”?
• What are “neighborhood/place effects” really
capturing?
Segregation and Place
“The research literature documents that “places” which
are racially segregated with high concentrations of blacks
or Hispanics tend to be places with limited opportunities
and failing infrastructure, resulting from a lack of
investment in social and economic development. The
result is a community that produces bad health
outcomes. So, racial inequalities in health status and
outcomes are predominantly the result of place. Race
helps to determine place, and in turn, place influences
health.” (Segregated Spaces, Risky Places: The Effects of Racial
Segregation on Health Inequalities by the Joint Center for Political and
Economic Studies)
Methodological challenge
• Selection bias
– “the selection issue (the fact that persons may be selected
into neighborhoods based on individual attributes which
are themselves related to health) is the key problem in
observational studies of neighborhood effects.” (DiezRoux, 2004)
– “the ‘‘selection’’ of people to neighborhoods
induces systematic difference in the background
composition of residents across neighborhoods” (Oakes,
2004)
Selection
• Explicating the sorting process is [should be]
an important aspect of research on
neighborhoods and health
– “Selection bias in neighborhood effects research is
more than a statistical error and…understanding
selection into and out of neighborhoods is at the
heart of understanding neighborhood effects.”
(Hedman and van Ham, 2012)
Interventions
• Focused on moving residents out of
disadvantaged neighborhoods
– Moving to Opportunity (MTO) Demonstration Project:
“Households chosen for the demonstration's
experimental group receive housing counseling and
vouchers for rental housing in areas with less than 10
percent poverty.”
Source:
http://portal.hud.gov/hudportal/HUD?src=/programdes
cription/mto
www.mtoresearch.org
Interventions
• Moving residents out of disadvantaged
neighborhoods
– What about the residents left behind?
– What about the neighborhoods the residents
leave?
Interventions
• Focused on changing the place
– Increased physical activity after walking path and
playground installed (Gustat et al, 2012)
Interventions
• Focused on residents and the place
– RESIDential Environments (RESIDE) Project (Perth,
Australia) (Foster, et al, 2013)
• Residents relocated to new housing developments
across Perth. New areas designed to create safe,
pedestrian friendly neighborhoods.
Summary/Conclusion
• Disparities in health are complex
– With individual level and contextual determinants
• Research on the association between the
neighborhood environment and health and
interventions at the neighborhood level is
complex
References
1. Tucker-Seeley RD, Subramanian SV, Li Y, Sorensen G. Neighborhood
Safety, Socioeconomic Status, and Physical Activity in Older Adults. Am J
Prev Med 2009;37(3):207-213.
2. Bennett GG, McNeill LH, Wolin KY, Duncan DT, Puleo E, Emmons KM.
Safe to walk? Neighborhood safety and physical activity among public
housing residents. PLoS Med 2007;4(10):1599-1606.
3. Brownson RC, Hoehner CM, Day K, Forsyth A, Sallis JF. Measuring the
built environment for physical activity: state of the science. Am J Prev Med
2009;36(4 Suppl):S99-123.
4. Sharkey JR, Horel S, Han D, Huber JC, Jr. Association between
neighborhood need and spatial access to food stores and fast food
restaurants in neighborhoods of colonias. Int J Health Geogr 2009;8:9.
5. Cunradi CB. Neighborhoods, alcohol outlets and intimate partner
violence: addressing research gaps in explanatory mechanisms. Int J
Environ Res Public Health 2010;7(3):799-813.
References
6. Romley JA, Cohen D, Ringel J, Sturm R. Alcohol and
environmental justice: the density of liquor stores and bars in urban
neighborhoods in the United States. J Stud Alcohol Drugs
2007;68(1):48-55.
7. LaVeist TA, Wallace JM, Jr. Health risk and inequitable
distribution of liquor stores in African American neighborhood. Soc
Sci Med 2000;51(4):613-617.
8. Alaniz ML. Alcohol availability and targeted advertising in
racial/ethnic minority communities. Alcohol Health Res World
1998;22(4):286-289.
9. Sampson RJ. Great American City: Chicago and the Enduring
Neighborhood Effect. Chicago, IL: University of Chicago Press; 2012.
10. Coulton CJ, Jennings MZ, Chan T. How big is my neighborhood?
Individual and contextual effects on perceptions of neighborhood
scale. Am J Community Psychol 2013;51(1-2):140-150.
References
11. Lee C, Moudon AV, Courbois JY. Built environment and behavior:
spatial sampling using parcel data. Ann Epidemiol 2006;16(5):387-394.
12. Kwan MP. The uncertain geographic context problem. Annals of the
Association of American Geographers 2012;102(5):958-968.
13. Ross CE. "Walking, exercise, and smoking: Does neighborhood
matter? Social science & medicine 2000;51(2):265-274.
14. Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci
2010;1186:125-145.
15. Chaix B. Geographic life environments and coronary heart disease: a
literature review, theoretical contributions, methodological updates, and a
research agenda. Annu Rev Public Health 2009;30:81-105.
16. LaVeist TA, Gaskin D, Trujillo AJ. Segregated Spaces, Risky Places: The
Effects of Racial Segregation on Health Inequalities. Joint Center for
Political and Economic Studies, 2011
References
17. Diez-Roux AV. Estimating neighborhood health effects: the challenges of
causal inference in a complex world. Soc Sci Med 2004;58(10):1953-1960.
18. Oakes JM. The (mis)estimation of neighborhood effects: causal inference for
a practicable social epidemiology. Social science & medicine 2004;58(10):19291952.
19. Hedman L, van Ham M. Understanding Neighbourhood Effects: Selection
Bias and Residential Mobility. In: van Ham M, Manley D, Bailey N, Simpson L,
Maclennan D, editors. Neighbourhood Effects Research: New Perspectives.
Springer Netherlands; 2012:79-99.
20. Gustat J, Rice J, Parker KM, Becker AB, Farley TA. Effect of changes to the
neighborhood built environment on physical activity in a low-income African
American neighborhood. Prev Chronic Dis 2012;9:E57.
21. Foster S, Wood L, Christian H, Knuiman M, Giles-Corti B. Planning safer
suburbs: Do changes in the built environment influence residents' perceptions of
crime risk? Soc Sci Med 2013;97:87-94.
POPULATION RESEARCH SEMINAR SERIES
Sponsored by the Statistics and Survey Methods Core of the U54 Partnership
Questions? Comments?
[email protected]