Publications by authors named "Gina S Lovasi"

89 Publications

Associations between Greenspace and Gentrification-Related Sociodemographic and Housing Cost Changes in Major Metropolitan Areas across the United States.

Int J Environ Res Public Health 2021 03 23;18(6). Epub 2021 Mar 23.

Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA.

Neighborhood greenspace may attract new residents and lead to sociodemographic or housing cost changes. We estimated relationships between greenspace and gentrification-related changes in the 43 largest metropolitan statistical areas (MSAs) of the United States (US). We used the US National Land Cover and Brown University Longitudinal Tracts databases, as well as spatial lag models, to estimate census tract-level associations between percentage greenspace (years 1990, 2000) and subsequent changes (1990-2000, 2000-2010) in percentage college-educated, percentage working professional jobs, race/ethnic composition, household income, percentage living in poverty, household rent, and home value. We also investigated effect modification by racial/ethnic composition. We ran models for each MSA and time period and used random-effects meta-analyses to derive summary estimates for each period. Estimates were modest in magnitude and heterogeneous across MSAs. After adjusting for census-tract level population density in 1990, compared to tracts with low percentage greenspace in 1992 (defined as ≤50th percentile of the MSA-specific distribution in 1992), those with high percentage greenspace (defined as >75th percentile of the MSA-specific distribution) experienced higher 1990-2000 increases in percentage of the employed civilian aged 16+ population working professional jobs (β: 0.18, 95% confidence interval (CI): 0.11, 0.26) and in median household income (β: 0.23, 95% CI: 0.15, 0.31). Adjusted estimates for the 2000-2010 period were near the null. We did not observe evidence of effect modification by race/ethnic composition. We observed evidence of modest associations between greenspace and gentrification trends. Further research is needed to explore reasons for heterogeneity and to quantify health implications.
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http://dx.doi.org/10.3390/ijerph18063315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005168PMC
March 2021

Associations between neighborhood greenspace and brain imaging measures in non-demented older adults: the Cardiovascular Health Study.

Soc Psychiatry Psychiatr Epidemiol 2021 Jan 3. Epub 2021 Jan 3.

Departments of Neurology and Epidemiology, University of Washington, Seattle, WA, 98195-9775, USA.

Purpose: Greater neighborhood greenspace has been associated with brain health, including better cognition and lower odds of Alzheimer's disease in older adults. We investigated associations between neighborhood greenspace and brain-based magnetic resonance imaging (MRI) measures and potential effect modification by sex or apolipoprotein E genotype (APOE), a risk factor for Alzheimer's disease.

Methods: We obtained a sample of non-demented participants 65 years or older (n = 1125) from the longitudinal, population-based Cardiovascular Health Study (CHS). Greenspace data were derived from the National Land Cover Dataset. Adjusted multivariable linear regression estimated associations between neighborhood greenspace five years prior to the MRI and left and right hippocampal volume and 10-point grades of ventricular size and burden of white matter hyperintensity. Interaction terms tested effect modification by APOE genotype and sex. CHS data (1989-1999) were obtained/analyzed in 2020.

Results: Participants were on average 79 years old [standard deviation (SD) = 4], 58% were female, and 11% were non-white race. Mean neighborhood greenspace was 38% (SD = 28%). Greater proportion of greenspace in the neighborhood five years before MRI was borderline associated with lower ventricle grade (estimate: - 0.30; 95% confidence interval: - 0.61, 0.00). We observed no associations between greenspace and the other MRI outcome measures and no evidence of effect modification by APOE genotype and sex.

Conclusion: This study suggests a possible association between greater greenspace and less ventricular enlargement, a measure reflecting global brain atrophy. If confirmed in other longitudinal cohort studies, interventions and policies to improve community greenspaces may help to maintain brain health in older age.
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http://dx.doi.org/10.1007/s00127-020-02000-wDOI Listing
January 2021

Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease?

J Epidemiol Community Health 2020 Dec 14. Epub 2020 Dec 14.

Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA.

Background: Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA).

Methods: We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000-US$74 000, (3) US$20 000-US$34 000 and (4)
Results: We found a 25% (95% CI 1.17% to 1.34%) increased hazard of CHD per 1-category decrease in household income category. Adjusting for PA-supportive environments slightly reduced this association (HR=1.24). The income-CHD association was strongest in areas without walking destinations (HR=1.57), an interaction which reached statistical significance in analyses among men. In contrast, the income-CHD association showed a trend towards being strongest in areas with the highest percentage of green land cover.

Conclusions: Indicators of a PA supportive environment show divergent trends to modify socioeconomic inequities in CHD . Built environment interventions should measure the effect on socioeconomic inequities.
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http://dx.doi.org/10.1136/jech-2020-215239DOI Listing
December 2020

The Association of Neighborhood Medical Facilities with Aging in Place and Risk of Incident Myocardial Infarction.

J Aging Health 2021 Mar 30;33(3-4):227-236. Epub 2020 Nov 30.

Urban Health Collaborative, 6527Drexel University, PA, USA.

Aging in place (residential stability) is a desirable means of aging where adults remain in their homes, even when facing challenges that impair their capacity for self-care. Residential stability, especially following acute health challenges, depends on individual and community factors, possibly including proximity to medical facilities. We explored the association between the density of medical facilities around homes with risk of incident myocardial infarction (MI) and with aging in place following incident MI. Densities of neighborhood pharmacies were not associated with aging in place or time to MI. High densities of neighborhood clinical care facilities were significantly associated with decreased residential stability. The lack of significant associations between medical facility exposures and MI-related outcomes, coupled with prior findings, casts doubt on their salience and may indicate that other neighborhood features are more strongly associated with these outcomes.
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http://dx.doi.org/10.1177/0898264320975228DOI Listing
March 2021

Business Data Categorization and Refinement for Application in Longitudinal Neighborhood Health Research: a Methodology.

J Urban Health 2021 Apr 1;98(2):271-284. Epub 2020 Oct 1.

Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, PA, Philadelphia, USA.

Retail environments, such as healthcare locations, food stores, and recreation facilities, may be relevant to many health behaviors and outcomes. However, minimal guidance on how to collect, process, aggregate, and link these data results in inconsistent or incomplete measurement that can introduce misclassification bias and limit replication of existing research. We describe the following steps to leverage business data for longitudinal neighborhood health research: re-geolocating establishment addresses, preliminary classification using standard industrial codes, systematic checks to refine classifications, incorporation and integration of complementary data sources, documentation of a flexible hierarchical classification system and variable naming conventions, and linking to neighborhoods and participant residences. We show results of this classification from a dataset of locations (over 77 million establishment locations) across the contiguous U.S. from 1990 to 2014. By incorporating complementary data sources, through manual spot checks in Google StreetView and word and name searches, we enhanced a basic classification using only standard industrial codes. Ultimately, providing these enhanced longitudinal data and supplying detailed methods for researchers to replicate our work promotes consistency, replicability, and new opportunities in neighborhood health research.
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http://dx.doi.org/10.1007/s11524-020-00482-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079597PMC
April 2021

Building a Methodological Foundation for Impactful Urban Planetary Health Science.

J Urban Health 2020 Jun 22. Epub 2020 Jun 22.

Public Health Faculty, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Makassar, Indonesia.

Anthropogenic environmental change will heavily impact cities, yet associated health risks will depend significantly on decisions made by urban leaders across a wide range of non-health sectors, including transport, energy, housing, basic urban services, and others. A subset of planetary health researchers focus on understanding the urban health impacts of global environmental change, and how these vary globally and within cities. Such researchers increasingly adopt collaborative transdisciplinary approaches to engage policy-makers, private citizens, and other actors in identifying and evaluating potential policy solutions that will reduce environmental impacts in ways that simultaneously promote health, equity, and/or local economies-in other words, maximising 'co-benefits'. This report presents observations from a participatory workshop focused on challenges and opportunities for urban planetary health research. The workshop, held at the 16th International Conference on Urban Health (ICUH) in Xiamen, China, in November 2019, brought together 49 participants and covered topics related to collaboration, data, and research impact. It featured research projects funded by the Wellcome Trust's Our Planet Our Health (OPOH) programme. This report aims to concisely summarise and disseminate participants' collective contributions to current methodological practice in urban planetary health research.
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http://dx.doi.org/10.1007/s11524-020-00463-5DOI Listing
June 2020

Patterns in Geographic Access to Health Care Facilities Across Neighborhoods in the United States Based on Data From the National Establishment Time-Series Between 2000 and 2014.

JAMA Netw Open 2020 05 1;3(5):e205105. Epub 2020 May 1.

Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.

Importance: The association between proximity to health care facilities and improved disease management and population health has been documented, but little is known about small-area health care environments and how the presence of health care facilities has changed over time during recent health system and policy change.

Objective: To examine geographic access to health care facilities across neighborhoods in the United States over a 15-year period.

Design, Setting, And Participants: Using longitudinal business data from the National Establishment Time-Series, this cross-sectional study examined the presence of and change in ambulatory care facilities and pharmacies and drugstores in census tracts (CTs) throughout the continental United States between 2000 and 2014. Between January and April 2019, multinomial logistic regression was used to estimate associations between health care facility presence and neighborhood sociodemographic characteristics over time.

Main Outcomes And Measures: Change in health care facility presence was measured as never present, lost, gained, or always present between 2000 and 2014. Neighborhood sociodemographic characteristics (ie, CTs) and their change over time were measured from US Census reports (2000 and 2010) and the American Community Survey (2008-2012).

Results: Among 72 246 included CTs, the percentage of non-US-born residents, residents 75 years or older, poverty status, and population density increased, and 8.1% of CTs showed a change in the racial/ethnic composition of an area from predominantly non-Hispanic (NH) white to other racial/ethnic composition categories between 2000 and 2010. The presence of ambulatory care facilities increased from a mean (SD) of 7.7 (15.9) per CT in 2000 to 13.0 (22.9) per CT in 2014, and the presence of pharmacies and drugstores increased from a mean (SD) of 0.6 (1.0) per CT in 2000 to 0.9 (1.4) per CT in 2014. Census tracts with predominantly NH black individuals (adjusted odds ratio [aOR], 2.37; 95% CI, 2.03-2.77), Hispanic/Latino individuals (aOR 1.30; 95% CI, 1.00-1.69), and racially/ethnically mixed individuals (aOR, 1.53; 95% CI, 1.33-1.77) in 2000 had higher odds of losing health care facilities between 2000 and 2014 compared with CTs with predominantly NH white individuals, after controlling for other neighborhood characteristics. Census tracts of geographic areas with higher levels of poverty in 2000 also had higher odds of losing health care facilities between 2000 and 2014 (aOR, 1.12; 95% CI, 1.05-1.19).

Conclusions And Relevance: Differential change was found in the presence of health care facilities across neighborhoods over time, indicating the need to monitor and address the spatial distribution of health care resources within the context of population health disparities.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.5105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229525PMC
May 2020

Tracking of Obesity in Childhood into Adulthood: Effects on Body Mass Index and Fat Mass Index at Age 50.

Child Obes 2020 04;16(3):226-233

Department of Sociology, University of California. Riverside, Riverside, CA.

Obesity is present in 17% of US youth, age 2-19 years, but the extent to which obesity in childhood is associated with higher BMI and fat mass in middle age is unclear. In this study, links between childhood body size and BMI and body composition at age ∼50 were assessed. Child Health and Development Studies participants, born between 1960 and 1963 in Alameda County, and still living in California, from whom anthropometric data were collected at age 5, 9-11, and/or 15-17 years were followed-up at age ∼50 for anthropometric outcomes (251 women; 249 men). Linear regression analyses assessed whether overweight (85th to <95th BMI percentile) or obesity (≥95th BMI percentile) at age 5 were associated with BMI, fat mass index (FMI), and lean mass index (LMI) at age ∼50. At age 50, participants with obesity at age 5 had BMI scores that were 6.51 units higher [95% confidence interval (CI) = 3.67-9.35] than participants who were normal weight at age 5; FMI and LMI scores were 4.15 (95% CI = 1.98-6.32) and 2.36 (95% CI = 1.45-3.26) units higher, respectively. However, obesity experienced at age 5 had only a modest positive predictive value for predicting the presence of obesity at age 50 (67%), whereas obesity present at age 15-17 had a higher positive predictive value (86%). The experience of obesity at age 5 for members of this birth cohort was associated with significantly higher BMI, FMI, and LMI at age ∼50.
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http://dx.doi.org/10.1089/chi.2019.0185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099417PMC
April 2020

Assessing Google Street View Image Availability in Latin American Cities.

J Urban Health 2020 08;97(4):552-560

Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3600 Market Street 7th Floor, Philadelphia, PA, 19104, USA.

Virtual audits using Google Street View are an increasingly popular method of assessing neighborhood environments for health and urban planning research. However, the validity of these studies may be threatened by issues of image availability, image age, and variance of image age, particularly in the Global South. This study identifies patterns of Street View image availability, image age, and image age variance across cities in Latin America and assesses relationships between these measures and measures of resident socioeconomic conditions. Image availability was assessed at 530,308 near-road points within the boundaries of 371 Latin American cities described by the SALURBAL (Salud Urbana en America Latina) project. At the subcity level, mixed-effect linear and logistic models were used to assess relationships between measures of socioeconomic conditions and image availability, average image age, and the standard deviation of image age. Street View imagery was available at 239,394 points (45.1%) of the total sampled, and rates of image availability varied widely between cities and countries. Subcity units with higher scores on measures of socioeconomic conditions had higher rates of image availability (OR = 1.11 per point increase of combined index, p < 0.001) and the imagery was newer on average (- 1.15 months per point increase of combined index, p < 0.001), but image capture date within these areas varied more (0.59-month increase in standard deviation of image age per point increase of combined index, p < 0.001). All three assessed threats to the validity of Street View virtual audit studies spatially covary with measures of socioeconomic conditions in Latin American cities. Researchers should be attentive to these issues when using Street View imagery.
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http://dx.doi.org/10.1007/s11524-019-00408-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392983PMC
August 2020

A COMPARATIVE CASE STUDY OF WALKING ENVIRONMENT IN MADRID AND PHILADELPHIA USING MULTIPLE SAMPLING METHODS AND STREET VIRTUAL AUDITS.

Cities Health 2020 27;4(3):336-344. Epub 2020 Jan 27.

Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcala, Alcala de Henares, 28871 Madrid, Spain.

The objective of this study is to quantify, using virtual audits in Madrid and Philadelphia, cross-city differences in the walking environment and to test whether differences vary by sampling method. We used two sampling methods; first, a contiguous area combining census units (~15.000 population area for each setting) was selected using the Median Neighborhood Index (MNI). MNI is a summary index that averages Euclidean distances of sociodemographic and urban form features, used to select the median neighborhood for a given city. Second, we selected a population-density stratified sampling of the same number of census units as above. M-SPACES audit tool was deployed, using street virtual audits to measure function, safety, aesthetics, and destinations along each street segment. Madrid streets had lower scores for function (=-0.29 CI95% -0.55;-0.31) and safety (=-0.38 CI95% -0.61;-0.14). Madrid had a greater proportion of streets having at least one walking destination in the street segment (PR=1.92 95% CI 1.55; 2.39). We did not find a significant difference between Madrid and Philadelphia in aesthetics. We found an interaction between safety and sampling methods. This approach can reveal which elements of the built environment account for between-city differences, key to mass influences that operate at the city level.
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http://dx.doi.org/10.1080/23748834.2020.1715117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954042PMC
January 2020

Use of SOPARC to assess physical activity in parks: do race/ethnicity, contextual conditions, and settings of the target area, affect reliability?

BMC Public Health 2019 Dec 23;19(1):1730. Epub 2019 Dec 23.

Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA.

Background: Since its introduction in 2006, SOPARC (Systematic Observation of Play and Recreation in Communities) has become a fundamental tool to quantify park visitor behaviors and characteristics. We tested SOPARC reliability when assessing race/ethnicity, physical activity, contextual conditions at the time of observation, and settings of target areas to understand its utility when trying to account for individual characteristics of users.

Methods: We used 4725 SOPARC observations completed simultaneously by two independent observers to evaluate intraclass correlation and agreement rate between the two observers when trying to assess sex, age group, race/ethnicity, and level of physical activity of urban park users in different park settings. Observations were in 20 New York City parks during Spring and Summer 2017 within the PARC project.

Results: Observers counted 25,765 park users with high interobserver reliability (ICC = .94; %Agreement.75). Reliability scores were negatively affected by the population being observed, the intensity of physical activity, and the contextual conditions and settings of the target area at the time of observation. Specific challenges emerged when assessing the combination of physical activity and race/ethnicity.

Conclusions: SOPARC training should aim to improve reliability when assessing concurrent measures such as physical activity, race/ethnicity, age, and sex. Similarly, observing crowded park areas with many active users areas may require more observation practice hours.
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http://dx.doi.org/10.1186/s12889-019-8107-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929368PMC
December 2019

Neighborhood characteristics associated with park use and park-based physical activity among children in low-income diverse neighborhoods in New York City.

Prev Med 2020 02 10;131:105948. Epub 2019 Dec 10.

Department of Parks, Recreation, and Tourism Management, NC State University, NC, USA.

Urban parks provide spaces and facilities for children's physical activity (PA) and can be a free resource in low-income communities. This study examined whether neighborhood characteristics were associated with children's park use and park-based moderate-to-vigorous PA (MVPA) in low-income diverse communities and how associations differed between ethnic groups. Data on park visits and MVPA came from 16,402 children 5-10-years old directly observed using the System for Observing Play and Recreation in Communities in 20 parks in low-income neighborhoods with majority Latino or Asian populations in New York City. Neighborhood characteristics included land use mix (LUM), street audits, crime rates, and an area deprivation index. We employed Poisson and negative binomial models to estimate effects of neighborhood-level variables on the number of children observed in parks and engaging in MVPA, overall and by ethnicity. Results for Asian, Latino, and African American children indicated that higher levels of LUM and pedestrian-friendly streets were associated with greater numbers of children in parks and higher MVPA across all three groups. For Asian and Latino children only, quality of environment was positively associated with MVPA, whereas level of deprivation and crime rates in the surrounding neighborhood were negatively associated with children's park-based MVPA. In contrast, a park's access to public transportation was negatively associated with number of all children observed and engaging in MVPA. Study findings suggest that park-based MVPA interventions can be informed by understanding how neighborhood characteristics facilitate and constrain park use and park-based MVPA.
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http://dx.doi.org/10.1016/j.ypmed.2019.105948DOI Listing
February 2020

Measuring Neighborhood Order and Disorder: a Rapid Literature Review.

Curr Environ Health Rep 2019 12;6(4):316-326

Belo Horizonte Observatory for Urban Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Purpose Of Review: Neighborhood disorder has received attention as a determinant of health in urban contexts, through pathways that include psychosocial stress, perceived safety, and physical activity. This review provides a summary of data collection methods, descriptive terms, and specific items employed to assess neighborhood disorder/order.

Recent Findings: The proliferation of methods and terminology employed in measuring neighborhood disorder (or neighborhood order) noted over the past two decades has made related studies increasingly difficult to compare. Following a search of peer-reviewed articles published from January 1998 to May 2018, this rapid literature review identified 18 studies that described neighborhood environments, yielding 23 broad terms related to neighborhood disorder/order, and a total of 74 distinct measurable items. A majority of neighborhood disorder/order measurements were assessed using primary data collection, often relying on resident self-report or investigatory observations conducted in person or using stored images for virtual audits. Items were balanced across signs of order or disorder, and further classification was proposed based on whether items were physically observable and relatively stable over time.
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http://dx.doi.org/10.1007/s40572-019-00259-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920232PMC
December 2019

How Does Park Use and Physical Activity Differ between Childhood and Adolescence? A Focus on Gender and Race-Ethnicity.

J Urban Health 2019 10;96(5):692-702

Department of Parks, Recreation, and Tourism Management, NC State University, Raleigh, NC, USA.

Physical activity typically declines between childhood and adolescence. Despite urban parks being a great venue for physical activity, children change both the frequency of park use and their park use habits as they age into adolescence. However, little is known about how these differences vary by gender and how distinct race/ethnicity groups differentially change their park habits. This study analyzed the differences in park use and per capita energy expenditure between children and teenagers of different gender and race/ethnicity backgrounds. Using the System for Observing Play and Recreation in Communities (SOPARC), systematic observations were conducted in 20 New York City parks in 2017, located in low-income areas with high presence of Latino or Asian residents. A total of 9963 scans in 167 distinct target areas counted 16,602 children (5-10 years old) and 11,269 teenagers (11 or older). Using adjusted marginal means, we estimated the number of park users of each age range, gender, and race/ethnicity expected to be found in each park activity setting. Teenagers of both genders and most race/ethnicity groups were less likely to be in a park and had lower per capita energy expenditure, compared with children. The difference in park attendance was greater than the difference in per capita energy expenditure. Dissimilarities were clearly gendered and race/ethnicity dependent. Asian and Latino females showed the greatest divergence between childhood and adolescence. African American boys were the only group to show a positive age contrast in park attendance and per capita energy expenditure.
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http://dx.doi.org/10.1007/s11524-019-00388-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814698PMC
October 2019

Urban trees and asthma: a call for epidemiological research.

Lancet Respir Med 2019 07;7(7):e19-e20

Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA.

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http://dx.doi.org/10.1016/S2213-2600(19)30193-6DOI Listing
July 2019

Disparities in trajectories of changes in the unhealthy food environment in New York City: A latent class growth analysis, 1990-2010.

Soc Sci Med 2019 08 11;234:112362. Epub 2019 Jun 11.

Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States. Electronic address:

Disparities in availability of food retailers in the residential environment may help explain racial/ethnic and socio-economic differences in obesity risk. Research is needed that describes whether food environment dynamics may contribute to equalizing conditions across neighborhoods or to amplifying existing inequalities over time. This study improves the understanding of how the BMI-unhealthy food environment has evolved over time in New York City. We use longitudinal census tract-level data from the National Establishment Time-Series (NETS) for New York City in the period 1990-2010 and implement latent class growth analysis (LCGA) to (1) examine trajectories of change in the number of unhealthy food outlets (characterized as selling calorie-dense foods such as pizza and pastries) at the census tract-level, and (2) examine how trajectories are related to socio-demographic characteristics of the census tract. Overall, the number of BMI-unhealthy food outlets increased between 1990 and 2010. We summarized trajectories of evolutions with a 5-class model that indicates a pattern of fanning out, such that census tracts with a higher initial number of BMI-unhealthy food outlets in 1990 experienced a more rapid increase over time. Finally, fully adjusted logistic regression models reveal a greater increase in BMI-unhealthy food outlets in census tracts with: higher baseline population size, lower baseline income, and lower proportion of Black residents. Greater BMI-unhealthy food outlet increases were also noted in the context of census tracts change suggestive of urbanization (increasing population density) or increasing purchasing power (increasing income).
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http://dx.doi.org/10.1016/j.socscimed.2019.112362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689383PMC
August 2019

Development of a Neighborhood Walkability Index for Studying Neighborhood Physical Activity Contexts in Communities across the U.S. over the Past Three Decades.

J Urban Health 2019 08;96(4):583-590

Columbia Population Research Center, Columbia University, New York, NY, USA.

To examine how urban form shapes physical activity and health over time, a measure of neighborhood walkability is needed that can be linked to cohort studies with participants living across the United States (U.S.) that have been followed over the past decades. The Built Environment and Health-Neighborhood Walkability Index (BEH-NWI), a measure of neighborhood walkability that can be calculated for communities across the United States between 1990 and 2015, was conceptualized, developed, and tested using data from the New York City Tri-State Area. BEH-NWI measures were created for 1990 and 2010 using historical data on population density, street intersection density, density of rail stops, and density of pedestrian trip generating/supporting establishments. BEH-NWI scores were calculated for 1-km buffers around the 1990 residences of NYU Women's Health Study (NYUWHS) participants and NYC Department of Health and Mental Hygiene's Physical Activity and Transit (PAT) survey participants enrolled in 2011. Higher neighborhood BEH-NWI scores were significantly associated with greater self-reported walking per week (+ 0.31 MET-hours/week per unit BEH-NWI, 95% CI 0.23, 0.36) and lower body mass index (- 0.17 BMI units per unit BEH-NWI, 95% - 0.23, - 0.12) among NYUWHS participants. Higher neighborhood BEH-NWI scores were associated with significantly higher accelerometer-measured physical activity among PAT survey participants (39% more minutes of moderate-intensity equivalent activity/week across the interquartile range of BEH-NWI, 95% CI 21%, 60%). The BEH-NWI can be calculated using historical data going back to 1990, and BEH-NWI scores predict BMI, weekly walking, and physical activity in two NYC area datasets.
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http://dx.doi.org/10.1007/s11524-019-00370-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677835PMC
August 2019

Short-term associations between objective crime, park-use, and park-based physical activity in low-income neighborhoods.

Prev Med 2019 09 29;126:105735. Epub 2019 May 29.

Department of Parks, Recreation and Tourism Management, NC State University, NC, USA.

Crime and safety perceptions are commonly cited barriers to park use and physical activity (PA). Given the importance of parks as settings for outdoor recreation and physical activity, the presence of crime may have a detrimental effect on public health. This study uses objective police crime reports and observational park use data to assess type of crime and the time when the crime was committed effects on park user behaviors in 20 parks located in low-income neighborhoods in New York City. The System for Observing Play and Recreation in Communities (SOPARC) was used to assess the number of park users and their physical activity during 78 park visits in Spring 2017. The association between crime rates and park use was assessed using two types of crimes (violent and property crimes). The timing of the crime was assessed using the crimes committed within periods of one week, one month, and three months prior to the visit to the park. By including objective measures of crime together with the exact time on which they were committed, we were able to analyze the short and long term effects of crime on park behavior. Overall, there was a consistent negative association between crime and park use. This relationship was stronger at the 1 month and 3 months' period and weaker at the 1-week period. Violent crimes were strongly associated with lower park use, and crimes proved to be associated with child park use to a greater degree. Girls were more affected by crime than boys.
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http://dx.doi.org/10.1016/j.ypmed.2019.05.023DOI Listing
September 2019

Development and validation of a method to quantify benefits of clean-air taxi legislation.

J Expo Sci Environ Epidemiol 2020 07 29;30(4):629-640. Epub 2019 May 29.

Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA.

Air pollution from motor vehicle traffic remains a significant threat to public health. Using taxi inspection and trip data, we assessed changes in New York City's taxi fleet following Clean Air Taxi legislation enacted in 2005-2006. Inspection and trip data between 2004 and 2015 were used to assess changes in New York's taxi fleet and to estimate and spatially apportion annual taxi-related exhaust emissions of nitric oxide (NO) and total particulate matter (PM). These emissions changes were used to predict reductions in NO and fine particulate matter (PM) concentrations estimates using data from the New York City Community Air Survey (NYCCAS) in 2009-2015. Efficiency trends among other for-hire vehicles and spatial variation in traffic intensity were also considered. The city fuel efficiency of the medallion taxi fleet increased from 15.7 MPG to 33.1 MPG, and corresponding NO and PM exhaust emissions estimates declined by 82 and 49%, respectively. These emissions reductions were associated with changes in NYCCAS-modeled NO and PM concentrations (p < 0.001). New York's clean air taxi legislation was effective at increasing fuel efficiency of the medallion taxi fleet, and reductions in estimated taxi emissions were associated with decreases in NO and PM concentrations.
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http://dx.doi.org/10.1038/s41370-019-0141-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398736PMC
July 2020

Safer sex intentions modify the relationship between substance use and sexual risk behavior among black South African men who have sex with men.

Int J STD AIDS 2019 07 29;30(8):786-794. Epub 2019 May 29.

5 HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Columbia University, New York, NY, USA.

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http://dx.doi.org/10.1177/0956462418825333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765215PMC
July 2019

Neighborhood Recreation Facilities and Facility Membership Are Jointly Associated with Objectively Measured Physical Activity.

J Urban Health 2019 08;96(4):570-582

Urban Health Collaborative, Drexel University, 3600 Market Street 7th Floor Suite, Philadelphia, PA, 19104, USA.

Efforts to increase physical activity have traditionally included either individual-level interventions (e.g., educational campaigns) or neighborhood-level interventions (e.g., additional recreational facilities). Little work has addressed the interaction between spatial proximity and individual characteristics related to facility use. We aimed to better understand the synergistic impact of both physical activity environments and recreational facility membership on objectively measured physical activity. Using the New York City Physical Activity and Transit (PAT) survey (n = 644), we evaluated associations between counts of commercial physical activity facilities within 1 km of participants' home addresses with both facility membership and accelerometry-measured physical activity. Individuals living near more facilities were more likely to report membership (adjusted odds ratio for top versus bottom quartile of facility count: 3.77 (95% CI 1.54-9.20). Additionally, while amount of facilities within a neighborhood was associated with more physical activity, this association was stronger for individuals reporting gym membership. Interventions aiming to increase physical activity should consider both neighborhood amenities and potential barriers, including the financial and social barriers of membership. Evaluation of neighborhood opportunities must expand beyond physical presence to consider multiple dimensions of accessibility.
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http://dx.doi.org/10.1007/s11524-019-00357-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677841PMC
August 2019

Body mass index across the life course: emergence of race-by-sex disparities in early childhood.

Ann Epidemiol 2019 05 28;33:44-48. Epub 2019 Mar 28.

Department of Sociology, University of California, Riverside, Riverside, CA.

Purpose: The purpose of this study was to assess when in the life-course race-by-sex disparities in body mass index (BMI) emerge.

Methods: Child Health and Development Studies participants, from whom height and weight data were collected at ages 5, 9-11, and 15-17 years, were followed up at the age of 50 years for anthropometric outcomes. Follow-up was completed for 605 subjects, 460 of whom were assessed for height and weight at the age of 50 years, had at least one available childhood BMI measure, and self-identified as either non-Hispanic black or non-Hispanic white. Linear regression analyses were conducted to determine whether interactions existed between race (black vs. white) and sex for predicting BMI at ages 5, 9-11, 15-17, and 50 years.

Results: At age 5 years, BMI was independent of sex for both blacks and whites, but by the age of 9-11 years, BMI was sex-dependent in blacks, with higher BMI observed among black females. This sex dependence for BMI among blacks persisted at ages 15-17 years and age 50 years. The race-by-sex interaction was significant at ages 9-11, 15-17, and 50 years (P for interaction = 0.001, 0.002, and 0.01, respectively).

Conclusions: Race-by-sex disparities in body size were observed by the age of 9-11 years and persisted until the age of 50 years.
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http://dx.doi.org/10.1016/j.annepidem.2019.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501836PMC
May 2019

A Local View of Informal Urban Environments: a Mobile Phone-Based Neighborhood Audit of Street-Level Factors in a Brazilian Informal Community.

J Urban Health 2019 08;96(4):537-548

Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.

Street-level environment characteristics influence the health behaviors and safety of urban residents, and may particularly threaten health within informal communities. However, available data on how such characteristics vary within and among informal communities is limited. We sought to adapt street audit strategies designed to characterize the physical environment for use in a large informal community, Rio das Pedras (RdP) located in Rio de Janeiro, Brazil. A smartphone-based systematic observation protocol was used to gather street-level information for a high-density convenience sample of street segments (N = 630, estimated as 86% of all street segments in the community). We adapted items related to physical disorder and physical deterioration. Measures selected to illustrate the approach include the presence of the following: (1) low-hanging or tangled wires, (2) litter, (3) structural evidence of sinking, and (4) an unpleasant odor. Intercept-only spatial generalized additive models (GAM) were used to evaluate and visualize spatial variation within the RdP community. We also examined how our estimates and conclusions about spatial variation might have been affected by lower-density sampling from random subsets street observations. Random subsets were selected to determine the robustness of study results in scenarios with sparser street sampling. Selected characteristics were estimated to be present for between 18% (unpleasant odor) to 59% (low-hanging or tangled wires) of the street segments in RdP; estimates remain similar (± 6%) when relying on a random subset created to simulate lower-density spatial sampling. Spatial patterns of variation based on predicted probabilities across RdP differed by indicator. Structural sinking and low-hanging or tangled wires demonstrated relatively consistent spatial distribution patterns across full and random subset sample sizes. Smartphone-based systematic observations represent an efficient and potentially feasible approach to systematically studying neighborhood environments within informal communities. Future deployment of such tools will benefit from incorporating data collection across multiple time points to explore reliability and quantify neighborhood change. These tools can prove useful means to assess street-level exposures that can be modifiable health determinants across a wide range of informal urban settings. Findings can contribute to improved urban planning and provide useful information for identifying potential locations for neighborhood-scaled interventions that can improve living conditions for residents in Rio das Pedras.
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http://dx.doi.org/10.1007/s11524-019-00351-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890882PMC
August 2019

Association of secondhand tobacco smoke exposure during childhood on adult cardiovascular disease risk among never-smokers.

Ann Epidemiol 2019 04 5;32:28-34.e1. Epub 2019 Feb 5.

Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Electronic address:

Purpose: Adult secondhand tobacco smoke (SHS) exposure is related to stroke and coronary heart disease (CHD) risk, but long-term effects are less clear. We evaluated whether childhood SHS exposure affects subsequent stroke or CHD risk among adult black and white never-smokers followed for stroke and CHD.

Methods: In this prospective cohort study, inverse probability weights were calculated to correct for bias due to attrition and survey nonresponse. Cox proportional hazards models were used to assess hazard ratios and 95% confidence intervals for stroke or CHD, separately, by number of childhood household smokers.

Results: Of 13,142 eligible participants, 6136 had childhood SHS exposure assessed. Baseline mean (SD) age was 63.5 (9.0), 65% were female, 30% black, 46% reported 0 childhood household smokers, 36% reported 1, and 18% reported 2+. In 60,649 person-years, 174 strokes were observed (2.9% of participants), and in 45,195 person-years, 114 CHD events were observed (2.1% of participants). The weighted and adjusted hazard ratios (95% confidence intervals) of stroke for 2+ versus 0 childhood household smokers was 1.66 (1.29-2.13) and was 1.15 (0.82-1.59) for CHD.

Conclusions: We observed a significant association between childhood SHS exposure and stroke, but not CHD, after age 45 years and adjusting for missing information.
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http://dx.doi.org/10.1016/j.annepidem.2019.01.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441374PMC
April 2019

Associations of Neighborhood-Level Social Determinants of Health with Bacterial Infections in Young, Febrile Infants.

J Pediatr 2018 12 21;203:336-344.e1. Epub 2018 Sep 21.

Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA.

Objective: To examine the sociodemographic characteristics of one population of young, febrile infants and identify associations between neighborhood-level social determinants of health (SDHs) with bacterial infections.

Study Design: This was a retrospective cross sectional study of all infants ≤90 days old with a temperature of ≥38°C who presented in 2014 to the emergency department of an urban children's hospital in a large east coast city. The primary outcome was the presence of a bacterial infection, defined as a positive urine, blood, or cerebrospinal fluid culture that was treated clinically as a pathogen. The home address of each infant was geocoded and linked to neighborhood data based on census tract. Neighborhood-level SDHs included deprivation index, median household income, poverty, childhood poverty, social capital, and crowded housing. Associations were estimated using generalized estimating equations and negative binomial regression analysis. Models were adjusted for age, prematurity, and race/ethnicity.

Results: Of 232 febrile infants, the median age was 54 days, 58% were male, 49% were Hispanic, and 88% had public health insurance; 31 infants (13.4%) had a bacterial infection. In the adjusted analyses, the risk of bacterial infection among infants from neighborhoods with high rates of childhood poverty was >3 times higher (relative risk, 3.16; 95% CI, 1.04-9.6) compared with infants from neighborhoods with low rates of childhood poverty.

Conclusions: Our findings suggest that SDHs may be associated with bacterial infections in young, febrile infants. If confirmed in subsequent studies, the inclusion of SDHs in predictive tools may improve accuracy in detecting bacterial infections among young, febrile infants.
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http://dx.doi.org/10.1016/j.jpeds.2018.08.020DOI Listing
December 2018

Neighborhood food environment, dietary fatty acid biomarkers, and cardiac arrest risk.

Health Place 2018 09 16;53:128-134. Epub 2018 Aug 16.

Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.

We explored links between food environments, dietary intake biomarkers, and sudden cardiac arrest in a population-based longitudinal study using cases and controls accruing between 1990 and 2010 in King County, WA. Surprisingly, presence of more unhealthy food sources near home was associated with a lower 18:1 trans-fatty acid concentration (-0.05% per standard deviation higher count of unhealthy food sources, 95% Confidence Interval [CI]: 0.01, 0.09). However, presence of more unhealthy food sources was associated with higher odds of cardiac arrest (Odds Ratio [OR]: 2.29, 95% CI: 1.19, 4.41 per standard deviation in unhealthy food outlets). While unhealthy food outlets were associated with higher cardiac arrest risk, circulating 18:1 trans fats did not explain the association.
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http://dx.doi.org/10.1016/j.healthplace.2018.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245544PMC
September 2018

Medical facilities in the neighborhood and incidence of sudden cardiac arrest.

Resuscitation 2018 09 6;130:118-123. Epub 2018 Jul 6.

Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States.

Background: Medical establishments in the neighborhood, such as pharmacies and primary care clinics, may play a role in improving access to preventive care and treatment and could explain previously reported neighborhood variations in sudden cardiac arrest (SCA) incidence and survival.

Methods: The Cardiac Arrest Blood Study Repository is a population-based repository of data from adult cardiac arrest patients and population-based controls residing in King County, Washington. We examined the association between the availability of medical facilities near home with SCA risk, using adult (age 18-80) Seattle residents experiencing cardiac arrest (n = 446) and matched controls (n = 208) without a history of heart disease. We also analyzed the association of major medical centers near the event location with emergency medical service (EMS) response time and survival among adult cases (age 18+) presenting with ventricular fibrillation from throughout King County (n = 1537). The number of medical facilities per census tract was determined by geocoding business locations from the National Establishment Time-Series longitudinal database 1990-2010.

Results: More pharmacies in the home census tract was unexpectedly associated with higher odds of SCA (OR:1.28, 95% CI: 1.03, 1.59), and similar associations were observed for other medical facility types. The presence of a major medical center in the event census tract was associated with a faster EMS response time (-53 s, 95% CI: -84, -22), but not with short-term survival.

Conclusions: We did not observe a protective association between medical facilities in the home census tract and SCA risk, orbetween major medical centers in the event census tract and survival.
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http://dx.doi.org/10.1016/j.resuscitation.2018.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467836PMC
September 2018

The relationship between childhood obesity and neighborhood food ecology explored through the context of gentrification in New York City.

Int Public Health J 2018 ;10(4):481-496

Department of Environmental Health Sciences, Columbia University, Mailman School of Public Health, New York City, New York, United States of America.

Inequity and health disparities can be exacerbated as a result of gentrification when long-term residents are displaced, or remain but are not able to take advantage of new opportunities. The disappearance of old and emergence of new food establishments may increase the proximity to and density of healthy food options, however, affordability and consumption of healthy food, nor a decrease in risk of adverse health outcomes are not guaranteed. Our study aims to understand the relationship between gentrification, neighborhood food environment, and childhood obesity. We describe food opportunities changes in New York City using National Establishments Time Series Database stratified by gentrification status. Using data from the Columbia Center for Children's Environmental Health birth cohort study, we evaluate the impact of the area-level changing food chances on the body mass index z-scores of children at age five. Overall, gentrifying neighborhoods have the highest number of food chances and experience the most substantial increase in both healthy (p < 0.001) and unhealthy (p < 0.001) food chances between 1990-2010. After adjusting for covariates, higher access to healthy food chances was associated with both lower BMI z-score (p < 0.01) and less likelihood of being overweight or obese (p < 0.001) for five-year-old children. Our results suggest gentrification was associated with contemporaneous changes in the neighborhood food chances in NYC and children exposed to greater healthy foods experienced a lower probability of excess body weight by five years old. Further research is needed to understand other potential pathways connecting gentrification to childhood BMI.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377337PMC
January 2018

The association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs.

Drug Alcohol Depend 2018 02 8;183:184-191. Epub 2017 Dec 8.

Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W 168th St, New York, NY, 10032, USA.

Background: Although much research has been conducted on the determinants of HIV risk behavior among people who inject drugs (PWID), the influence of the neighborhood context on high-risk injection behavior remains understudied. To address this gap in the literature, we measured associations between neighborhood socioeconomic disadvantage and high-risk injection behavior, and determined whether these associations were modified by drug-related police activity and syringe exchange program (SEP) accessibility.

Methods: Our sample was comprised of 484 pharmacy-recruited PWID in New York City. Measures of neighborhood socioeconomic disadvantage were created using data from the 2006-2010 American Community Survey. Associations with high-risk injection behavior were estimated using multivariable Poisson regression. Effect modification by drug-related police activity and SEP accessibility was assessed by entering cross-product terms into adjusted models of high-risk injection behavior.

Results: Neighborhood socioeconomic disadvantage was associated with decreased receptive syringe sharing and unsterile syringe use. In neighborhoods with high drug-related police activity, associations between neighborhood disadvantage and unsterile syringe use were attenuated to the null. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased acquisition of syringes from an unsafe source.

Conclusions: PWID in disadvantaged neighborhoods reported safer injection behaviors than their counterparts in neighborhoods that were relatively better off. The contrasting patterns of effect modification by SEP accessibility and drug-related police activity support the use of harm reduction approaches over law enforcement-based strategies for the control of blood borne virus transmission among PWID in disadvantaged urban areas.
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http://dx.doi.org/10.1016/j.drugalcdep.2017.10.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927611PMC
February 2018

Model-based and design-based inference goals frame how to account for neighborhood clustering in studies of health in overlapping context types.

SSM Popul Health 2017 Dec 19;3:600-608. Epub 2017 Jul 19.

University of California Riverside, U4649 9 Street, Riverside, CA, 92501, United States.

Accounting for non-independence in health research often warrants attention. Particularly, the availability of geographic information systems data has increased the ease with which studies can add measures of the local "neighborhood" even if participant recruitment was through other contexts, such as schools or clinics. We highlight a tension between two perspectives that is often present, but particularly salient when more than one type of potentially health-relevant context is indexed (e.g., both neighborhood and school). On the one hand, a model-based perspective emphasizes the processes producing outcome variation, and observed data are used to make inference about that process. On the other hand, a design-based perspective emphasizes inference to a well-defined finite population, and is commonly invoked by those using complex survey samples or those with responsibility for the health of local residents. These two perspectives have divergent implications when deciding whether clustering must be accounted for analytically and how to select among candidate cluster definitions, though the perspectives are by no means monolithic. There are tensions within each perspective as well as between perspectives. We aim to provide insight into these perspectives and their implications for population health researchers. We focus on the crucial step of deciding which cluster definition or definitions to use at the analysis stage, as this has consequences for all subsequent analytic and interpretational challenges with potentially clustered data.
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http://dx.doi.org/10.1016/j.ssmph.2017.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737714PMC
December 2017