The association of current and sustained area-based adverse socioeconomic environment with physical inactivity
Introduction
The relation between physical inactivity and health is well established. Numerous studies have shown that physical inactivity increases the risk of mortality and the risk of the emergence or exacerbation of a large number of non-communicable diseases (Erikssen et al., 1998; Mayer-Davis et al., 1998; Pate et al., 1995; US Department of Health and Human Services, 1996). Consequently, one of the health objectives in developed societies is to reduce physical inactivity in the population by acting on those factors or circumstances associated with this risk behaviour.
The prevalence of physical inactivity is higher in women than in men, increases at older ages and shows an inverse gradient with individual socioeconomic position (Dishman, Sallis, & Orenstein, 1985; Varo et al., 2003). Various studies have shown that, in addition to individual characteristics, different characteristics of the area of residence are also related with physical inactivity (Ball, Bauman, Leslie, & Owen, 2001; Browson, Baker, Houseman, Brennan, & Bacak, 2001; Centers for Disease Control and Prevention, 1999; Diez-Roux, Link, & Northridge, 2000; Ecob & Macintyre, 2000; Giles-Corti & Donovan, 2002; Macintyre & Ellaway, 1998; Parks, Houseman, & Browson, 2003; Takano, Nakamura, & Watanabe, 2002; Van Lenthe, Brug, & Mackenbach, 2005). The demonstration of an independent effect of area-based characteristics on physical inactivity suggests the need for intervention not only at the individual level, but also in the areas where people live.
One characteristic of the area of residence that has been studied is the socioeconomic environment. For example, it has been observed that areas with lower levels of material wellbeing and areas with greater income inequality have higher prevalences of physical inactivity (Diez-Roux et al., 2000; Ecob & Macintyre,2000; Giles-Corti & Donovan, 2002; Macintyre & Ellaway, 1998; Van Lenthe et al., 2005). The authors of most of these studies attribute the results to the fact that these areas have fewer services, such as green spaces or infrastructure for sports and recreational activities. It is assumed that areas with lower material wellbeing and those that are less egalitarian invest fewer resources in the creation of spaces and infrastructure that lead to the development and maintenance of healthy behaviours. However, the few studies that have investigated the relation between socioeconomic context in the area of residence and the availability of services that facilitate physical activity have yielded inconsistent results (Giles-Corti & Donovan, 2002; Sooman & Macintyre, 1995; Van Lenthe et al., 2005). Several studies have examined the association between the availability of facilities and physical activity (Eyler, Brownson, Bacak, & Housemann, 2003; Giles-Corti & Donovan, 2003; Humpel, Owen, Iverson, Leslie, & Bauman 2004; Li, Fisher, Brownson, & Bosworth, 2005; Wendel-Vos, Schuit, Boshuizen, Saris, & Kromhout, 2004), but the only study to explore whether the availability of services is responsible for the association between socioeconomic context and physical activity yielded inconclusive results (Van Lenthe et al., 2005).
It should also be noted that most studies reflect the socioeconomic environment at a given point in time. Although the level of physical activity at a particular time may depend on the availability of green spaces and sports and recreational installations, the provision of these services is influenced by investments made at a previous period of time. In this regard, the availability of services probably reflects the socioeconomic environment of an area over time more than the socioeconomic environment at the current moment.
In this study, we evaluate the association between socioeconomic environment in the province of residence and physical inactivity at the beginning of the 21st century in Spain, using two indicators of socioeconomic environment of the province around that time—per capita income and income inequality—as well as two indicators that reflect the cumulative exposure of each province to an adverse socioeconomic environment in the last two decades of the 20th century. Based on previous investigations, we suggest four hypotheses: (1) The socioeconomic context of the province is associated with the availability of green spaces and sports and recreational installations; (2) The prevalence of physical inactivity will show an inverse relation with per capita income in the province of residence and a direct relation with income inequality; moreover, the magnitude of this relation will increase when provinces are classified in accordance with cumulative exposure to adverse economic environment in the last two decades of the 20th century; (3) The relation between the indicators of socioeconomic context and physical inactivity will decrease after controlling for different variables of individual socioeconomic position; (4) Finally, the relation between indicators of socioeconomic context and physical inactivity will decrease even more when we take into account the availability of green spaces and of sports and recreational facilities in each province.
Section snippets
Measure of physical inactivity
The estimation of physical inactivity was based on the 2001 National Health Survey. Individuals were selected using a multistage procedure in each province: first, the towns were chosen by random selection proportional to the size of the population and then the census areas were chosen by simple random selection. Finally, households were chosen within each census area by means of random routes, and one individual was chosen in each home based on age- and sex-quotas. The non-response rate was
Results
Table 1 shows the distribution of the sample by age, socioeconomic characteristics and the indicators of socioeconomic environment. The Pearson correlation coefficients for the association of GDPpc and the Gini coefficient with the number of sports facilities per 1000 population were 0.49 (p<0.001) and 0.10 (p=0.100), respectively. The Spearman correlation coefficient for the association of the indicators that reflect exposure to adverse socioeconomic environment in the preceding two decades
Discussion
Other studies have explored the effect of exposure to economic conditions in the place of residence on mortality (Curtis, Southall, Congdon, & Dodgeon, 2004) and on self-rated health (Blakely, Kennedy, Glass, & Kawachi, 2000). This is the first study to evaluate the effect of cumulative exposure of areas to adverse socioeconomic circumstances over time on physical inactivity. The results obtained with regard to current GDPpc are similar to the indicator that reflects the number of times each
References (41)
- et al.
Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults
Preventive Medicine
(2001) - et al.
Area effects on health variation over the life-course: Analysis of the longitudinal study sample in England using new data on area of residence in childhood
Social Science & Medicine
(2004) Estimating neighbourhood health effects: The challenges of causal inferences in a complex world
Social Science & Medicine
(2004)- et al.
A multilevel analysis of income inequality and cardiovascular disease risk factors
Social Science & Medicine
(2000) - et al.
Small area variations in health related behaviours; do these depend on the behaviour itself, its measurement, or on personal characteristics?
Health & Place
(2000) - et al.
Changes in physical fitness and changes in mortality
Lancet
(1998) - et al.
Socioeconomic status differences in recreational physical activity levels and real and perceived access to a supportive physical environment
Preventive Medicine
(2002) - et al.
Perceived environment attributes, residential location, and walking for particular purposes
American Journal of Preventive Medicine
(2004) - et al.
Social and local variations in the use of urban neighbourhoods: a case study in Glasgow
Health & Place
(1998) Walking, exercise, and smoking: Does neighborhood matter?
Social Science & Medicine
(2000)
Health and perception of the local environment in socially contrasting neighbourhoods in Glasgow
Health and Place
Neighbourhood inequalities in physical inactivity: The role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands
Social Science & Medicine
What is the lag time between income inequality and health status?
Journal of Epidemiology and Community Health
Environmental and policy determinants of physical activity in the United States
American Journal of Public Health
Equivalence scales, well-being, inequality and poverty: Sensitivity estimates across 10 countries using the LIS database
Review of Income and Wealth
Neighbourhood safety and the prevalence of physical inactivity-selected states
Mortality and Morbidity Weekly Report
Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: A multilevel analysis of individual and area-level determinants
European Journal of Epidemiology
Increasing physical activity: Assessing trends from 1998 to 2003
The determinants of physical activity and exercise
Public Health Reports
Resources for physical activity participation: Does availability and accessibility differ by neighborhood SES?
Annals of Behavioral Medicine
Cited by (19)
Associations between neighborhood socioeconomic environment and physical activity in Cuban immigrants
2016, SSM - Population HealthCitation Excerpt :We suspect that the number of data assessment periods needed to observe statistically significant changes in physical activity behaviors by neighborhood SES level in the current study population is longer than the number of data collection periods included in the current study. As stated before, research studies previously conducted on associations between neighborhood SES environment and physical activity behaviors have not focused on middle-aged Hispanic adults (Alves et al., 2013; Molnar et al., 2004; Pascual et al., 2007; Sallis et al., 2009; Carson et al., 2014; Shishehbor et al., 2008; Boone-Heinonen et al., 2010; Boone-Heinonen et al., 2011; Voorhees et al., 2009). Nevertheless, these studies provide some insight into how neighborhood SES and physical activity may be associated in Hispanics.
Investigating disparities in spatial accessibility to and characteristics of sport facilities: Direction, strength, and spatial scale of associations with area income
2011, Health and PlaceCitation Excerpt :Therefore, describing the spatial distribution of sport facilities is important to public health action, to correct possible situations of environmental injustice in the access to these resources. Previous literature in industrialized countries has provided inconsistent findings (Pascual et al., 2009), documenting a better spatial accessibility to sport facilities in affluent areas in certain studies (Estabrooks et al., 2003; Moore et al., 2008; Pascual et al., 2007; Powell et al., 2006), no association in other studies (van Lenthe et al., 2005), and a poorer accessibility in advantaged neighborhoods in a third group of studies (Giles-Corti and Donovan, 2002b; Lee et al., 2007). A comprehensive assessment of previous studies (see Section 4) suggests that inconsistencies in the association between socioeconomic status and spatial accessibility to facilities may depend on the type of sport facilities (Giles-Corti and Donovan, 2002b), on the country, or even on the region (Moore et al., 2008) examined.