Main findings

Food environment and socioeconomic status influence obesity rates in Seattle and in Paris

Study objectives : Link to the corresponding study

Diffusion date : 08/2013

The objective was to compare the associations between food environment at the individual level, socioeconomic status and obesity rates in two cities: Seattle and Paris. Analyses of the Seattle Obesity Study (SOS) were based on a representative sample of 1340 adults in metropolitan Seattle and King County. The RECORD (Residential Environment and Coronary Heart Disease) cohort analyses were based on 7131 adults in central Paris and suburbs. Physical distance to supermarkets was unrelated to obesity risk. By contrast, lower education and incomes, lower surrounding property values and shopping at lower-cost stores were consistently associated with higher obesity risk in the two samples.

http://www.record-study.org/images/record/upload/publications/IJO_RECORD-SOS.pdf

Spatial accessibility to sport facilities and sport practice

Study objectives : Link to the corresponding study

Diffusion date : 03/2013

The aim of this study was to investigate the associations between the spatial accessibility to specific types of sports facilities and the practice of the corresponding sports after carefully controlling for various individual socio-demographic characteristics and neighborhood socioeconomic variables. High individual education and high household income were associated with the practice of racket sports, swimming or related activities, and fitness over the previous 7 days. The spatial accessibility to swimming pools was associated with swimming and related sports, even after adjustment for individual/contextual factors. The spatial accessibility to facilities was not related to the practice of other sports. High neighborhood income was associated with the practice of a racket sport and fitness.

http://www.record-study.org/images/record/upload/publications/IJBNPA_equisport.pdf

Relationships between a typology of neighborhoods and blood pressure

Study objectives : Link to the corresponding study

Diffusion date : 03/2013

Studies of associations between neighborhood environments and blood pressure have relied on imprecise characterizations of neighborhoods. This study examined associations between a neighborhood typology based on numerous residential environment characteristics and systolic and diastolic blood pressure. Six contrasting neighborhood types were identified and examined in relation to systolic and diastolic blood pressure. The neighborhood typology included suburban to central urban neighborhood types with varying levels of adverse social conditions. An association was documented between residing in urban low social standing neighborhoods and systolic blood pressure. This association was still apparent after adjusting for individual/neighborhood socioeconomic status and individual risk factors for hypertension. An inverse association between the level of urbanicity of the neighborhood and diastolic blood pressure was observed, even after adjustment for individual risk factors for hypertension.

Multiple dimensions of residential environments and jogging behavior

Study objectives : Link to the corresponding study

Diffusion date : 04/2012

The study was published in Preventive Medicine. The purpose of this study was to examine the associations between a broad range of environmental characteristics and jogging behavior while taking into account different complementary outcomes to describe the behavior. The presence and quality of green and open spaces was associated both with a greater probability of jogging and with the practice of jogging within rather than outside the neighborhood. Moreover, a high social cohesion and the presence of enjoyable places were associated with a higher probability of jogging while the presence of parks or a lake increased the probability of jogging inside rather than outside the neighborhood.

http://www.record-study.org/images/record/upload/publications/Prev_Med_Jogging.pdf

Supermarket brands and characteristics and excess weight and abdominal fat

Study objectives : Link to the corresponding study

Diffusion date : 06/2011

Over the last years, many studies have investigated the effects that the food environment may have on weight status. However, these studies have generally defined the food environment for the residential neighborhood, without information on whether people effectively use or not food outlets located in their own neighborhood. On the opposite, in the RECORD Study, in order to derive individualized measures of the food environment, we have asked to the participants to report their primary supermarket for food shopping. Overall, 7131 participants did their food shopping in 1097 different supermarkets. Only 11% of the participants did most of their food shopping in their residential neighborhood. A so-called “multilevel” analysis indicated that after accounting for the residential neighborhood, two persons who were shopping in the same supermarket had a more comparable body mass index and waist circumference than persons who were shopping in different supermarkets. Beyond effects of individual socioeconomic characteristics, we found that participants who were shopping in specific supermarket brands had a greater body mass index and waist circumference. Considering groups of supermarket brands, we found that, compared to people who were shopping in citymarkets, those who were shopping in small or large supermarkets or in hypermarkets had a greater body mass index and waist circumference. Excess weight and abdominal fat was still more important for people who were shopping in hard discount supermarkets. Interestingly, shopping in a hard discount supermarket was not associated with anthropometric indices among people having a high personal education level. However, shopping in a hard discount was associated with an excess in body weight and abdominal fat that regularly increased with decreasing personal education. Regarding interpretation of the findings, the associations identified perhaps do not reflect or do not entirely reflect a causal effect related to the fact of shopping in a supermarket or another. However, whatever the origin of the associations, these results suggest that supermarkets, as places where dietary preferences are translated in a series of specific purchased foods, may be relevant places to develop nutritional interventions to encourage people to modify their dietary behavior. This work also allows one to identify supermarkets in which such nutritional interventions may be particularly beneficial.

The physical, service, and social environments: associations with weight status and abdominal fat?

Study objectives : Link to the corresponding study

Diffusion date : 06/2011

The aim of research conducted in a number of countries on the relationships between geographic environments and weight status is to propose intervention strategies to tackle the obesity epidemic. In this perspective, it is important to identify the particular characteristics of the environment, especially of the physical and service environments, that are associated with weight status and abdominal fat. To investigate such mechanisms, we examined whether different characteristics of the physical environment, service environment, and social interactional environment were associated with the body mass index and waist circumference of participants, after accounting for the socioeconomic characteristics of the participants and of their residential neighborhood. Beyond individual and neighborhood social characteristics, we found that waist circumference was larger among participants who were living in neighborhoods with a low building density, and in neighborhoods where densities of fruit and vegetable shops, restaurants (full-service and fast-food together), and destinations in general were weak. Overall, situations of excess abdominal fat were therefore more prevalent in areas with weaker densities. However, the different variables of the physical environment and service environment are strongly correlated with each other. Accordingly, it is important to examine whether we are really able to disentangle the effects related to the different environmental factors based on the data available to us. Different analyses based on complementary methodologies were conducted to address this question. In these analyses, none of the environmental variables remained systematically associated with waist circumference when examined simultaneously with other environmental factors. Nonetheless, specific characteristics such as the proportion of the area covered with buildings or the number of fruit and vegetable shops in the vicinity were perhaps more particularly associated with excess abdominal fat in certain analyses. However, even the effect of these variables tended to disappear when analyzed together with other correlated environmental factors. These analyses suggest that it is difficult to disentangle the effects of the different facets of the physical and service environment on excess weight and abdominal fat, especially when the corresponding environmental variables are related to densities strongly correlated with each other. On the basis of these findings, it seems more relevant to only conclude to an overall protective effect of high densities. We are currently exploring alternative analytical strategies that should allow us to understand how the multiple facets of geographic environments combine their effects to influence weight status and fat distribution.

Social inequalities in residential exposure to road traffic noise: An environmental justice study

Study objectives : Link to the corresponding study

Diffusion date : 11/2010

Road traffic-related noise is nowadays a major environmental risk to which urban populations are exposed. Noise exposure is likely to affect the health and the well-being through physiological (hearing loss, cardiovascular diseases, sleep disturbances, etc.) and psychological effects (noise annoyance, psychiatric and behavioral disorders, etc.). This environmental risk may also contribute to social health inequalities through an uneven distribution of exposure among socioeconomic groups. If the issue of environmental injustice has been widely investigated in relation to air pollution exposure, few studies have, however, focused on the social inequalities in exposure to community noise, especially road traffic noise. Using noise data from the noise monitoring agency of the City of Paris matched to the RECORD Cohort, the aim of the study was to explore whether socially disadvantaged populations experience in their residential neighborhood higher noise exposure levels than socially advantaged populations. In coherence with the concept of environmental injustice, we demonstrated social disparities in residential exposure to road traffic noise in the City of Paris. However, contrary to most previous studies, we showed that people living in socially advantaged neighborhoods (defined in terms of education level, dwelling value, and country of citizenship of residents) were likely to be exposed in their residential neighborhood to higher noise levels than their deprived counterparts. These findings are consistent with the spatial distribution of road traffic noise levels in the City of Paris where noisier high-traffic arteries are mainly located in the vicinity of better-off business and tourist neighborhoods, considered as socially advantaged (see figure). Moreover, we also highlighted the sensitivity of our results to the definition of socioeconomic characteristics, especially for the citizenship status of residents. When considering the proportion of non-French citizens in the neighborhood, we observed an association seemingly contrary to those identified with the education level and dwelling values, namely a higher residential exposure to road traffic noise for people living in neighborhoods with a large proportion of non-French citizens. However, when redefining the citizenship status according to the countries’ human development level, we concluded to an increasing noise exposure when the proportion of citizens from developed countries increased in the neighborhood and the proportion of citizens from underdeveloped countries decreased; a finding now consistent with those observed for the other socioeconomic variables. These findings suggest that it is important 1) to remain cautious as to the interpretation of preliminary results; and 2) to systematically perform sensitivity analyses using multiple socioeconomic characteristics so as to avoid drawing wrong conclusions regarding the presence or absence of an environmental injustice situation.

http://www.record-study.org/images/record/upload/OEM_published.pdf

Individual and neighborhood determinants of participation in the RECORD Cohort Study: identification and correction of related biases

Study objectives : Link to the corresponding study

Diffusion date : 11/2010

In the literature on neighborhood effects on health, cohort studies used to investigate associations between neighborhood characteristics and health suffer from a number of biases, including those related to selective participation in cohort studies, which may distort the estimated associations between environmental exposures and health. In this study, our first aim was to develop a comprehensive, theory-based model of neighborhood determinants of participation in the RECORD Cohort Study. Our second aim was to examine whether neighborhood effects on study participation biased the associations between neighborhood socioeconomic variables and type 2 diabetes. Overall, a markedly-higher rate of study participation was observed for populations with a high education attainment. Rate of participation was lower for people residing far from the study centers. Study participation was higher in both high median income and high mean property value neighborhoods after taking into account other individual and neighborhood characteristics. Regarding physical environmental variables, we observed higher rates of study participation in neighborhoods with a low proportion of the area covered by buildings and a low mean building height. Complementary analyses confirmed that distance to the centers and area indicators of socioeconomic position and density were associated with going to the centers for health checkups, but were not associated (or associated only very weakly) with study participation among persons who were at the examination centers for the health checkup. Investigating associations between neighborhood socioeconomic variables and type 2 diabetes, we found that geographic variations in the rate of study participation were associated with diabetes. We corrected the resulting bias in the association between neighborhood education and diabetes that was observed through the joint modeling of the neighborhood determinants of study participation and the neighborhood determinants of diabetes.

http://www.record-study.org/images/record/upload/publications/Epidemiology_bias_article.pdf

Associations entre niveau socio-économique du quartier de résidence et pression artérielle : rôle du poids et de la fréquence cardiaque comme mécanismes explicatifs ?

Study objectives : Link to the corresponding study

Diffusion date : 10/2009

Un objectif de ce travail était d’étudier les disparités de pression artérielle qui existent entre quartier d’Île-de-France. En cohérence avec des résultats connus, nous observons des différences de pression artérielle importantes en fonction du niveau d’instruction des individus, une pression artérielle systolique supérieure de 4 mmHg étant observée pour les personnes ayant un niveau d’instruction égal ou inférieur au BEPC par rapport à celle ayant un niveau d’instruction équivalent ou supérieur à BAC + 2. Par ailleurs, au-delà des effets associés aux caractéristiques socio-économiques individuelles, nous observons que la pression artérielle systolique tend à augmenter à mesure que le niveau socio-économique du quartier de résidence diminue. Comme au niveau individuel, des disparités de pression artérielle plus importantes sont observées entre quartiers lorsque l’on tient compte du niveau d’instruction moyen plutôt que du niveau de revenus moyen des habitants du quartier ou d’autres variables socio-économique. Au-delà des effets associés aux caractéristiques socio-économiques individuelles, si l’on divise les quartiers franciliens de l’étude en quatre classes en fonction de leur niveau d’instruction, on observe que la pression artérielle est supérieure de 0,5 mmHg, 1,3 mmHg et 2,4 mmHg dans les trois groupes de quartiers de plus en plus défavorisés par rapport aux quartiers les plus favorisés. Au-delà, l’objectif était de s’intéresser aux mécanismes qui pourraient contribuer à ces disparités, en tenant compte d’un certain nombre de facteurs de risque comportementaux, cliniques et biologique d’hypertension artérielle. Ces analyses suggèrent que 28% de la relation entre niveau d’instruction individuel et pression artérielle et près de 52% de la relation entre niveau d’instruction du quartier et pression artérielle étaient dus au poids et au tour de taille plus importants des personnes moins favorisées. Autrement dit, les disparités sociales d’obésité qui existent en Île-de-France entre quartiers sont assez importantes pour donner lieu à des disparités de pression artérielle entre quartiers favorisés et défavorisés, se répercutant ainsi de façon observable sur ce paramètre biologique intime. Par ailleurs, au-delà de l’obésité, nous trouvons qu’une partie non négligeable des différences de pression artérielle entre quartiers semble liée aux écarts de fréquence cardiaque au repos que l’on observe entre quartiers, phénomène que certains auteurs dans la littérature interpréteraient en termes d’exposition plus importante à des facteurs de stress dans les quartiers défavorisés. Ce travail s’appuyant sur des données transversales (recueillies à un moment unique dans le temps), il convient bien sûr de rester prudent sur les conclusions qu’on en tire.

http://www.record-study.org/images/record/upload/publications/Hypertension_article.pdf

Les disparités d’obésité en Île-de-France : une influence massive du niveau socio-économique du quartier de résidence

Study objectives : Link to the corresponding study

Diffusion date : 06/2009

Dans la Cohorte RECORD, 12,4% des participants étaient en situation d’obésité au moment de l’examen. Au-delà de cette valeur moyenne, des différences importantes existent en fonction de la catégorie sociale des individus. Ainsi, le taux d’obésité est tout particulièrement lié au niveau d’instruction des individus (plus encore qu’au revenu), le pourcentage d’obèses étant respectivement de 8%, 12%, 17% et 23% chez les personnes avec un diplôme supérieur à BAC+2, un diplôme entre BAC et BAC+2, un diplôme inférieur au BAC et chez les personnes sans diplôme. Tout l’objet des travaux de l’équipe est de tenir compte, au-delà des caractéristiques des individus, des caractéristiques de leur quartier de résidence. De même qu’au niveau individuel, le niveau d’instruction des habitants du quartier (proportion des résidents ayant un niveau d’instruction supérieur) semble plus fortement lié au risque d’obésité que le revenu moyen du quartier. Ainsi, le graphique ci-contre suggère que le pourcentage d’individus obèses augmente à la fois lorsque diminue le niveau d’instruction des individus et lorsque diminue le niveau d’instruction moyen de leur quartier de résidence. De façon particulièrement remarquable, des analyses plus précises suggèrent que le niveau d’instruction des individus et le niveau d’instruction moyen de leur quartier de résidence contribuent dans des proportions comparables aux disparités sociales massives d’obésité d’obésité que l’on observe en Île-de-France.

http://www.record-study.org/images/record/upload/Epidemiology_obesity.pdf

Les conditions de vie contrastées des quartiers d’Île-de-France : le quartier comme source de stress ?

Diffusion date : 06/2009

Il semble important, si l’on veut comprendre comment les quartiers de vie et leurs caractéristiques objectives influent sur la santé, de tenir compte des expériences vécues par les résidents au sein de leur quartier. Nous avons donc cherché à voir si les résidents de certains quartiers sont soumis à un cumul d’expériences plus ou moins négatives au sein de leur environnement de résidence. L’étude réalisée montre que le pourcentage de participants qui déclarent vivre dans un environnement physique dégradé diminue très nettement à mesure qu’augmentent les revenus du quartier. Ainsi, les habitants des quartiers moins favorisés rapportent beaucoup plus souvent un manque d’entretien des équipements collectifs, la présence de détritus dans la rue, des problèmes de vandalisme et des façades d’immeubles du quartier en mauvais état. Au-delà, il est important de tenir compte, à côté des aspects de l’environnement physique, des relations sociales au sein du quartier. Sur ce plan, les habitants des quartiers défavorisés sont nettement plus nombreux à rapporter des incivilités ou comportements agressifs de personnes de leur quartier, déclarent plus fréquemment avoir été personnellement victime d’une agression physique ou verbale, rapportent beaucoup plus souvent se sentir en insécurité dans leur quartier, et sont également plus nombreux à faire état de conflits de voisinage. A la fois les situations socio-économiques et ces conditions de vie sont susceptibles de jouer sur le bien-être des personnes. Au total, 12% des participants indiquent que le fait de vivre dans leur quartier est une source de stress pour eux. Toutefois, ainsi que l’indique la figure ci-contre, du groupe des quartiers favorisés aux quartiers les moins favorisés, ce sont 4%, 6%, 11% et 27% des enquêtés qui sont dans cette situation. De même, le pourcentage des participants qui estiment que le fait de vivre dans leur quartier les rend parfois « cafardeux ou déprimés » augmentent très fortement des quartiers les plus favorisés aux quartiers les plus défavorisés. Dans nos prochains travaux, il s’agira de voir si des différences entre quartiers sont également observées lorsque l’on tient compte de véritables indicateurs de mauvaise santé psychologique (par exemple de dépression).