Do communities differ in health behaviors?

doi:10.1016/0895-4356(93)90113-F

Journal of Clinical Epidemiology

Volume 46, Issue 10, October 1993, Pages 1141-1149

https://doi.org/10.1016/0895-4356(93)90113-F Get rights and content

Abstract

Communities differ in the prevalence of various health behaviors, but it is not known to what extent these differences are due to “different types” of people living in them. We used data from the evaluation of the Henry J Kaiser Family Foundation Community Health Promotion Grant Program to study individual-level and community-level variation in health behaviors for 15 communities. Our results show (1) there was significant variation among these communities in prevalences of smoking, consumption of alcohol and dietary fat, and use of seatbelts; (2) these differences persisted after control for demographic, health status, and other health behavioral characteristics of the people in the communities; (3) the community effect on a particular person's behavior, as represented by R², was very small (less than I%); and (4) the adjusted differences in prevalences among communities were potentially large (for example, a 7 percentage point difference in the probability of smoking). Unique features of communities may influence health behaviors. These findings affirm the potential importance of contextual effects on individual health behavior and thus support the theory that changing the community environment may offer effective ways to change individual health behavior.

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Measuring the food and built environments in urban centres: Reliability and validity of the EURO-PREVOB Community Questionnaire
2012, Public Health
Citation Excerpt :
A rapidly growing body of research seeks to measure various aspects of the environment, particularly as they relate to diet and physical activity.1–9 Earlier studies have shown associations between area of residence and health behaviour,10–13 and between deprivation and opportunities to take physical activity or consume healthy food,14–19 contributing to the now well-established concept of ‘obesogenic environments’.20–24 An environmental approach is a potentially effective element of strategies encouraging healthy living for all.22–24
The authors designed an instrument to measure objectively aspects of the built and food environments in urban areas, the EURO-PREVOB Community Questionnaire, within the EU-funded project ‘Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe’ (EURO-PREVOB). This paper describes its development, reliability, validity, feasibility and relevance to public health and obesity research.
The Community Questionnaire is designed to measure key aspects of the food and built environments in urban areas of varying levels of affluence or deprivation, within different countries. The questionnaire assesses (1) the food environment and (2) the built environment.
Pilot tests of the EURO-PREVOB Community Questionnaire were conducted in five to 10 purposively sampled urban areas of different socio-economic status in each of Ankara, Brno, Marseille, Riga, and Sarajevo. Inter-rater reliability was compared between two pairs of fieldworkers in each city centre using three methods: inter-observer agreement (IOA), kappa statistics, and intraclass correlation coefficients (ICCs).
Data were collected successfully in all five cities. Overall reliability of the EURO-PREVOB Community Questionnaire was excellent (inter-observer agreement (IOA) > 0.87; intraclass correlation coefficients (ICC)s > 0.91 and kappa statistics > 0.7. However, assessment of certain aspects of the quality of the built environment yielded slightly lower IOA coefficients than the quantitative aspects.
The EURO-PREVOB Community Questionnaire was found to be a reliable and practical observational tool for measuring differences in community-level data on environmental factors that can impact on dietary intake and physical activity. The next step is to evaluate its predictive power by collecting behavioural and anthropometric data relevant to obesity and its determinants.
Associations of neighborhood problems and neighborhood social cohesion with mental health and health behaviors: The Multi-Ethnic Study of Atherosclerosis
2008, Health and Place
Few studies have investigated the specific features implicated in neighborhood–health associations. We examined associations between measures of neighborhood problems and neighborhood social cohesion with depression, smoking, drinking, and walking for exercise in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Neighborhoods were characterized according to participant self-report and aggregated measures based on other MESA participants. Individuals living in the least problematic neighborhoods were significantly less likely to be depressed, to smoke, or to drink. Less socially cohesive neighborhoods were associated with increased depression, smoking, and not walking for exercise. Results persisted after adjusting for individual-level variables. Each measure appeared to capture distinct features of the neighborhood and associations did not differ by race/ethnicity. Results for neighborhood problems were robust to the use of aggregate measures but results for social cohesion generally were not. Future work should determine the health effect of modifying specific features of the neighborhood context.
The built environment and alcohol consumption in urban neighborhoods
2007, Drug and Alcohol Dependence
To examine the relations between characteristics of the neighborhood built environment and recent alcohol use.
We recruited participants through a random digit dial telephone survey of New York City (NYC) residents. Alcohol consumption was assessed using a structured interview. All respondents were assigned to neighborhood of residence. Data on the internal and external built environment in 59 NYC neighborhoods were collected from archival sources. Multilevel models were used to assess the adjusted relations between features of the built environment and alcohol use.
Of the 1355 respondents, 40% reported any alcohol consumption in the past 30 days, and 3% reported more than five drinks in one sitting (heavy drinking) in the past 30 days. Few characteristics of the built environment were associated with any alcohol use in the past 30 days. However, several features of the internal and external built environment were associated with recent heavy drinking. After adjustment, persons living in neighborhoods characterized by poorer features of the built environment were up to 150% more likely to report heavy drinking in the last 30 days compared to persons living in neighborhoods characterized by a better built environment.
Quality of the neighborhood built environment may be associated with heavy alcohol consumption in urban populations, independent of individual characteristics. The role of the residential environment as a determinant of alcohol abuse warrants further examination.
Neighborhood Deprivation Is Associated with Lower Levels of Serum Carotenoids among Adults Participating in the Third National Health and Nutrition Examination Survey
2007, Journal of the American Dietetic Association
Citation Excerpt :
This study was the first we know of to analyze the neighborhood distribution of an objective marker for fruit and vegetable intake. Previous studies that used self-reported data on food intake found mixed evidence for an association between low-income areas and poor nutrition (4,23,24). Other reports have produced impressive findings regarding the distribution of food stores and restaurants, leading to the conclusion that low-income areas may have disproportionately more fast-food restaurants and be extremely disadvantaged with respect to access to supermarkets, which generally have a wider variety of quality foods at lower prices (17-22).
This study tested the hypothesis that neighborhood deprivation will be associated with lower levels of serum carotenoids in comparison with wealthy residential areas.
Cross-sectional, nationally representative survey data were used to assess the relationship between neighborhood level socioeconomic status and serum carotenoids.
Seventeen thousand two participants aged 17 years and older from the Third National Health and Nutrition Examination Survey were linked with 1990 census data.
Serum levels of lycopene, β-carotene, α-carotene, lutein/zeaxanthin, and β-cryptoxanthin.
Multivariate linear regression was used to model the association of serum carotenoids and neighborhood deprivation, which is a summary index of 11 indicators for tract level socioeconomic status. Adjustments are made for individual level age, sex, years of education, household income, employment, race/ethnicity, body mass index, serum cotinine, alcohol use, physical activity, and serum cholesterol.
Multivariate analysis revealed a negative and statistically significant association between high levels of neighborhood deprivation and β-carotene (β=−2.98 μg/dL [−0.06 μmol/L], P=0.00), α-carotene (β=−1.28 μg/dL [−0.02 μmol/L], P=<0.0001), lutein/zeaxanthin (−1.69 μg/dL [−0.03 μmol/L], P=0.00, β-cryptoxanthin (β=−1.34 μg/dL [−0.02 μmol/L], P<0.0001), and total carotenoids (β=−8.20 μg/dL, P=<0.0001). Lycopene was not related to neighborhood deprivation. Adjusted mean levels of carotenoids for high deprivation neighborhoods were lower than neighborhoods with low deprivation: β-carotene=8.72 μg/dL [0.16 μmol/L] vs 20.64 μg/dL [0.38 μmol/L], α-carotene=0.44 μg/dL [0.008 μmol/L] vs 5.56 μg/dL [0.10 μmol/L], lutein/zeaxanthin=13.79 μg/dL [0.24 μmol/L] vs 20.55 μg/dL [0.36 μmol/L], β-cryptoxanthin=4.57 μg/dL [0.08 μmol/L] vs 9.93 μg/dL [0.18 μmol/L], lycopene=22.07 μg/dL [0.41 μmol/L] vs 25.63 μg/dL [0.48 μmol/L], and total=49.56 μg/dL vs 82.36 μg/dL.
Neighborhood deprivation was associated with lower serum levels of carotenoids. There was a substantial disparity between low deprivation and high deprivation residential areas with respect to fruit and vegetable intake.
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Original articleDo communities differ in health behaviors?

Abstract

Lancet

J Clin Epidemiol

Prev Med

Prev Med

Reducing the risk of cardiovascular disease: effects of a community-based campaign on knowledge and behavior

J Commun Health

Effects of communitywide education on cardiovascular disease risk factors: the Stanford five-city project

JAMA

Changes in morbidity and mortality during comprehensive community programme to control cardiovascular diseases during 1972–1977 in North Karelia

Br Med J

Theory and action for health promotion: illustrations from the North Karelia Project

Am J Public Health

Change in risk factors for coronary heart disease during 10 years of a community intervention programme (North Karelia project)

Br Med J

The Minnesota Heart Health Program: a research and demonstration project in cardiovascular disease prevention

Lay volunteer delivery of a community-based cardiovascular risk change program: the Pawtucket experiment

Original article
Do communities differ in health behaviors?