Area-level and individual correlates of active transportation among adults in Germany: A population-based multilevel study.
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SUBMITTER: Finger JD
PROVIDER: S-EPMC6841943 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The objectives were (1) to define physical activity (PA) and sedentary behaviors (SB) patterns in daily life contexts (work, leisure, and transportation) in French working women from NutriNet-Santé web-cohort and (2) to identify pattern(s) of active transportation and their individual, social, and environmental correlates. 23,432 participants completed two questionnaires to evaluate PA and SB in daily life contexts and individual representations of residential neighborhood and transportation modes. Hierarchical cluster analysis was performed which identified 6 distinct movement behavior patterns: (i) active occupation, high sedentary leisure, (ii) sedentary occupation, low leisure, (iii) sedentary transportation, (iv) sedentary occupation and leisure, (v) active transportation, and (vi) active leisure. Multinomial logistic regressions were performed to identify correlates of the "active transportation" cluster. The perceived environmental characteristics positively associated with "active transportation" included "high availability of destinations around home," "presence of bicycle paths," and "low traffic." A "positive image of walking/cycling," the "individual feeling of being physically active," and a "high use of active transport modes by relatives/friends" were positively related to "active transportation," identified as a unique pattern regarding individual and environmental correlates. Identification of PA and SB context-specific patterns will help to understand movement behaviors' complexity and to design interventions to promote active transportation in specific subgroups.
| S-EPMC5498903 | biostudies-literature
Project description:A lack of evidence exists on the association between area-level income inequality and oral health within Australia. This study examined associations between area-level income inequality and oral health outcomes (inadequate dentition (<21 teeth) and poor self-rated oral health) among Australian adults. Variations in the association between area-level income inequality and oral health outcomes according to area-level mean income were also assessed. Finally, household-income gradients in oral health outcomes according to area-level income inequality were compared.For the analyses, data on Australian dentate adults (n = 5,165 nested in 435 Local Government Areas (LGAs)) was obtained from the National Dental Telephone Interview Survey-2013. Multilevel multivariable logistic regression models with random intercept and fixed slopes were fitted to test associations between area-level income inequality and oral health outcomes, examine variations in associations according to area-level mean income, and examine variations in household-income gradients in outcomes according to area-level income inequality. Covariates included age, sex, LGA-level mean weekly household income, geographic remoteness and household income.LGA-level income inequality was not associated with poor self-rated oral health and inversely associated with inadequate dentition (OR: 0.64; 95% CI: 0.48, 0.87) after adjusting for covariates. Inverse association between income inequality and inadequate dentition at the individual level was limited to LGAs within the highest tertile of mean weekly household income. Household income gradients in both outcomes showed poorer oral health at lower levels of household income. The household income gradients for inadequate dentition varied according to the LGA-level income inequality.Findings suggest that income inequality at the LGA-level in Australia is not positively associated with poorer oral health outcomes. Inverse association between income inequality and inadequate dentition is likely due to the contextual differences between Australia and other high-income countries.
| S-EPMC5783384 | biostudies-literature
Project description:Few studies of walkability include both perceived and audited walkability measures. We examined perceived walkability (Neighborhood Environment Walkability Scale-Abbreviated, NEWS-A) and audited walkability (Irvine-Minnesota Inventory, IMI) measures for residents living within 2 km of a "complete street"-one renovated with light rail, bike lanes, and sidewalks. For perceived walkability, we found some differences but substantial similarity between our final scales and those in a prior published confirmatory factor analysis. Perceived walkability, in interaction with distance, was related to complete street active transportation. Residents were likely to have active transportation on the street when they lived nearby and perceived good aesthetics, crime safety, and traffic safety. Audited walkability, analyzed with decision trees, showed three general clusters of walkability areas, with 12 specific subtypes. A subset of walkability items (n = 11), including sidewalks, zebra-striped crosswalks, decorative sidewalks, pedestrian signals, and blank walls combined to cluster street segments. The 12 subtypes yielded 81% correct classification of residents' active transportation. Both perceived and audited walkability were important predictors of active transportation. For audited walkability, we recommend more exploration of decision tree approaches, given their predictive utility and ease of translation into walkability interventions.
| S-EPMC5615551 | biostudies-literature
Project description:BackgroundActive transportation (AT), independent mobility (IM), and outdoor time are promising ways to increase children's physical activity. However, in order to create interventions to increase those forms of physical activity, it is important to understand the relationships between area-level socioeconomic status (SES) and type of urbanization with AT, IM, outdoor time, and physical activity, and this was the aim of the study.MethodsOne thousand six hundred ninety-nine children in grades 4 to 6 (mean age: 10.2 ± 1.0 years) from three Canadian regions participated. AT, IM, and outdoor time were assessed using questionnaires and physical activity was measured using the SC-StepRX pedometer. Area-level SES was assessed using the median household income of the census tract in which the school was located and type of urbanization was determined for each school using standardized procedures. Generalized linear and general linear mixed models were used to examine the relationships.ResultsArea-level SES and the type of urbanization were generally not related to AT, IM, or physical activity for either gender. However, we observed that both boys and girls living in lower SES areas had decreased odds of spending > 2 h outdoors on weekend days compared to their peers from higher SES areas. Girls living in suburban or rural areas were more likely to spend > 2 h outdoors on weekdays compared to their urban counterparts.ConclusionsAT, IM, and physical activity are generally not associated with area-level SES or the type of urbanization in this sample of Canadian children. The finding regarding outdoor time showing that both boys and girls of lower SES areas had decreased odds of spending > 2 h outdoors on weekends compared to their peers from higher SES areas suggest that additional efforts should be implemented to offer outdoor play opportunities in lower SES areas.
| S-EPMC6688238 | biostudies-literature
Project description:Rationale, aims and objectivesEnsuring equitable access to primary care (PC) contributes to reducing differences in health related to people's socioeconomic circumstances. However, there is limited data on system-level factors associated with equitable access to high-quality PC. We examine whether individual-level socioeconomic variation in general practitioner (GP) quality-of-care varies by area-level organisation of PC services.MethodsBaseline data (2006-2009) from the Sax Institute's 45 and Up Study, involving 267,153 adults in New South Wales, Australia, were linked to Medicare Benefits Schedule claims and death data (to December 2012). Small area-level measures of PC service organisation were GPs per capita, bulk-billing (i.e., no copayment) rates, out-of-pocket costs (OPCs), rates of after-hours and chronic disease care planning/coordination services. Using multilevel logistic regression with cross-level interaction terms we quantified the relationship between area-level PC service characteristics and individual-level socioeconomic variation in need-adjusted quality-of-care (continuity-of-care, long-consultations, and care planning), separately by remoteness.ResultsIn major cities, more bulk-billing and chronic disease services and fewer OPCs within areas were associated with an increased odds of continuity-of-care-more so among people of high- than low education (e.g., bulk-billing interaction with university vs. no school certificate 1.006 [1.000, 1.011]). While more bulk-billing, after-hours services and fewer OPCs were associated with long consultations and care planning across all education levels, in regional locations alone, more after-hours services were associated with larger increases in the odds of long consultations among people with low- than high education (0.970 [0.951, 0.989]). Area GP availability was not associated with outcomes.ConclusionsIn major cities, PC initiatives at the local level, such as bulk-billing and after-hours access, were not associated with a relative benefit for low- compared with high-education individuals. In regional locations, policies supporting after-hours access may improve access to long consultations, more so for people with low- compared with high-education.
| S-EPMC10946916 | biostudies-literature
Project description:INTRODUCTION:Self-rated health is strongly associated with morbidity and mortality. It is largely influenced by individual factors but also by individuals' social surroundings and environment. OBJECTIVE:To investigate individual, household, and locality factors associated with self-rated ealth in Colombian adults. MATERIALS AND METHODS:We conducted a cross-sectional multilevel study using data from national databases on 19 urban localities and 37,352 individuals nested within 15,788 households using a population-based survey. Given the natural hierarchical structure of the data, the estimates of self-rated health related to individual, household, and locality characteristics were obtained by fitting a three-level logistic regression. RESULTS:The adjusted multilevel logistic models showed that at individual level, higher odds of poor self-rated health were found among older adults, persons from low socio-economic status, those living without a partner, with no regular physical activity, and reporting morbidities. At the household level, poor self-rated health was associated with households of low socioeconomic status located near noise sources and factories and in polluted and insecure areas. At the locality level, only poverty was associated with poor self-rated health after adjusting for individual and household variables. CONCLUSIONS:These results highlight the need for a more integrated framework when designing and implementing strategies and programs that aim to improve health conditions in urban populations in Latin America.
| S-EPMC7505506 | biostudies-literature
Project description:Socioeconomic status is an important determinant of health, the measurement of which is of great significance to population health research. However, individual-level socioeconomic factors are absent from much health administrative data, resulting in widespread use of area-level measures in their place. This study aims to clarify the role of individual- and area-level socioeconomic status in Ontario, Canada, through comparison of income measures. Using data from four cycles (2005-2012) of the Canadian Community Health Survey, we assessed concordance between individual- and area-level income quintiles using percent agreement and Kappa statistics. Individual-level characteristics were compared at baseline. Cumulative adult premature mortality was calculated for 5-years following interview. Rates were calculated separately for area-level and individual-level income, and jointly for each combination of income groups. Multivariable negative binomial models were fit to estimate associations between area- and individual-level income quintile and premature mortality after adjustment for basic demographics (age, sex, interview cycle) and key risk factors (alcohol, smoking, physical activity, and body mass index). Agreement between individual- and area-level income measures was low. Kappa statistics for same and similar (i.e. ±1 quintile) measures were 0.11 and 0.48, indicating low and moderate agreement, respectively. Socioeconomic disparities in premature mortality were greater for individual-level income than area-level income. When rates were stratified by both area- and individual-level income quintiles simultaneously, individual-level income gradients persisted within each area-level income group. The association between income and premature mortality was significant for both measures, including after full adjustment. Area-level socioeconomic status is an inappropriate proxy for missing individual-level data. The low agreement between area- and individual-level income measures and differences in demographic profile indicate that the two socioeconomic status measures do not capture the same population groups. However, our findings demonstrate that both individual- and area-level income measures are associated with premature mortality, and describe unique socioeconomic inequities.
| S-EPMC7013127 | biostudies-literature
Project description:ObjectivesTo investigate the association between area deprivation at municipality level with low perceived social support, independent of individual socioeconomic position and demographic characteristics. To assess whether there are gender inequalities in this association.DesignCross-sectional multilevel analysis of survey data.SettingGermany.Participants3350 men and 3665 women living in 167 municipalities throughout Germany participating in the 'German Health Interview and Examination Survey for Adults' (DEGS1 2008-2011) as part of the national health monitoring.OutcomePerceived social support as measured by Oslo-3 Social Support Scale.ResultsPrevalence of low perceived social support was 11.4% in men and 11.1% in women. Low social support was associated in men and women with sociodemographic characteristics that indicate more disadvantaged living situations. Taking these individual-level characteristics into account, municipal-level deprivation was independently associated with low perceived social support in men (OR for the most deprived quintile: 1.80 (95% CI 1.14 to 2.84)), but not in women (OR 1.22 (95% CI 0.78 to 1.90)).ConclusionThe results of our multilevel analysis suggest that there are gender inequalities in the association of municipal-level deprivation with the prevalence of low perceived social support in Germany independent of individual socioeconomic position. Community health interventions aiming at promotion of social support among residents might profit from a further understanding of the observed gender differences.
| S-EPMC5898354 | biostudies-literature
Project description:OBJECTIVES:Health disparities in schizophrenia are well established. However, it is less understood whether area-level socioeconomic status (SES) is differentially associated with schizophrenia depending on individual-level SES. Therefore, using a nationally large representative data, this study investigated the association between individual-level SES, area-level SES and their interaction with schizophrenia in Chinese adults from a multilevel perspective. SETTING:Household interviews in 734 counties (districts), 2980 towns (streets) and 5964 communities (villages) from 31 provinces, People's Republic of China, as part of the cross-sectional survey of Second China National Sample Survey on Disability. PARTICIPANTS:1 909 205 men and women aged 18 years old and above. PRIMARY AND SECONDARY OUTCOME MEASURES:A screen followed by clinical diagnosis was used to identify schizophrenia, and schizophrenia was ascertained according to the International Statistical Classification of Diseases, 10th Revision (code F20). RESULTS:1-SD increase in individual SES was associated with decreased risk of schizophrenia (OR=0.45, 95% CI 0.43 to 0.46). 1-SD increase in area-level SES was associated with increased risk of schizophrenia (OR=1.30, 95% CI 1.24 to 1.37). The interaction of individual SES and area-level SES was statistically significant (OR=1.05, 95% CI 1.02 to 1.08); as the level of area SES increased, schizophrenia risk of lower SES people grew faster than the risk of higher SES people. CONCLUSIONS:Area-level SES is particularly important to mental health of low SES individuals, with low SES people in high SES counties having the highest risk of schizophrenia than other groups. Action to reduce SES disparities in schizophrenia will require attention to the area-level context of low SES adults.
| S-EPMC6731895 | biostudies-other
Project description:Although excessive alcohol-related mortality in the post-Soviet countries remains the major public health threat, determinants of this phenomenon are still poorly understood.We assess simultaneously individual- and area-level factors associated with an elevated risk of alcohol-related mortality among Lithuanian males aged 30-64.Our analysis is based on a census-linked dataset containing information on individual- and area-level characteristics and death events which occurred between March 1st, 2011 and December 31st, 2013. We limit the analysis to a few causes of death which are directly linked to excessive alcohol consumption: accidental poisonings by alcohol (X45) and liver cirrhosis (K70 and K74). Multilevel Poisson regression models with random intercepts are applied to estimate mortality rate ratios (MRR).The selected individual-level characteristics are important predictors of alcohol-related mortality, whereas area-level variables show much less pronounced or insignificant effects. Compared to married men, never married (MRR = 1.9, CI:1.6-2.2), divorced (MRR = 2.6, CI:2.3-2.9), and widowed (MRR = 2.4, CI: 1.8-3.1) men are disadvantaged groups. Men who have the lowest level of educational attainment have the highest mortality risk (MRR = 1.7 CI:1.4-2.1). Being unemployed is associated with a five-fold risk of alcohol-related death (MRR = 5.1, CI: 4.4-5.9), even after adjusting for all other individual variables. Lithuanian males have an advantage over Russian (MRR = 1.3, CI:1.1-1.6) and Polish (MRR = 1.8, CI: 1.5-2.2) males. After adjusting for all individual characteristics, only two out of seven area-level variables-i.e., the share of ethnic minorities in the population and the election turnout-have statistically significant direct associations. These variables contribute to a higher risk of alcohol-related mortality at the individual level.The huge and increasing socio-economic disparities in alcohol-related mortality indicate that recently implemented anti-alcohol measures in Lithuania should be reinforced by specific measures targeting the most disadvantaged population groups and geographical areas.
| S-EPMC5521820 | biostudies-literature