Association between neighborhood deprivation and fruits and vegetables consumption and leisure-time physical activity: a cross-sectional multilevel analysis

BMC Public Health

Ana Azevedo¹  Henrique Barros¹  Maria Fátima Pina²  Diogo Costa¹  Milton Severo¹  Susana Silva¹  Luís Alves³ 

[1] Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;Institute of Biomedical Engineering, Rua do Campo Alegre, 823, 4150-180 Porto, Portugal;St. André de Canidelo Family Health Unit, Rua das Fábricas, 282, 4400-230 Vila Nova de Gaia, Portugal

关键词: Leisure-time physical activity;    Fruits and vegetables consumption;    Socioeconomic position;    Neighborhood deprivation;   

Others  :  1161527
DOI  :  10.1186/1471-2458-13-1103

 received in 2013-08-17, accepted in 2013-11-26,  发布年份 2013

【 摘 要 】

Background

Most studies of the association between neighborhood socioeconomic deprivation and individual lifestyles leading to cardiovascular disease focused on a single cardiovascular risk factor. The concomitant assessment of more than one risk factor may provide clues to specific mechanisms linking neighborhood disadvantage to individual lifestyles. We investigated the association of neighborhood deprivation with fruits and vegetables consumption and leisure-time physical activity in adults living in an urban center in Portugal.

Methods

In 1999–2003, we assembled a random sample of 2081 adult residents in the city of Porto. Data on sociodemographic characteristics were collected by trained interviewers using structured questionnaires. Fruits and vegetables consumption was estimated using a validated 82-item semiquantitative food frequency questionnaire covering the previous year and expressed in portions per day. Physical activity was evaluated using a questionnaire exploring leisure-time activities over the previous year and expressed in metabolic equivalents (MET).minute/day. Self-reported address was used to place individuals in neighborhoods. Neighborhoods’ socioeconomic characterization was based on aggregated data at the census block level provided by the 2001 National Census. Latent class analysis models were used to identify three discrete socioeconomic classes of neighborhoods. Random effects models with random intercepts at the neighborhood level were used to explore clustering and contextual effects of neighborhood deprivation on each of the outcomes.

Results

We found evidence of neighborhood clustering of fruits and vegetables consumption and leisure-time physical activity that persisted after adjustment for neighborhood deprivation only among women. Women living in the most deprived neighborhoods presented a consumption increase of 0.43 (95% CI: -0.033 to 0.89) portions of fruits and vegetables per day and a decrease in leisure-time physical activity of 47.8 (95% CI: -91.8 to 1.41) MET.minute/day, when compared to those living in the most affluent neighborhoods. Among men, no contextual neighborhood deprivation effects were observed.

Conclusion

Overall, neighborhood deprivation had a small effect on the consumption of fruits and vegetables and leisure-time physical activity. Neighborhood factors other than socioeconomic deprivation may still impact on the studied outcomes among women. This study provides relevant information for the design of interventions directed to neighborhood characteristics in the prevention of cardiovascular diseases.

【 授权许可】

   
2013 Alves et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kaplan GA, Keil JE: Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 1993, 88:1973-1998.
• [2]Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF: Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil 2008, 15:247-257.
• [3]Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL: Neighborhood of residence and incidence of coronary heart disease. N Engl J Med 2001, 345:99-106.
• [4]Flegal KM, Carroll MD, Kit BK, Ogden CL: Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. Jama 2012, 307:491-497.
• [5]Carreira H, Pereira M, Azevedo A, Lunet N: Trends of BMI and prevalence of overweight and obesity in Portugal (1995–2005): a systematic review. Public Health Nutr 2012, 15:972-981.
• [6]Maes HH, Neale MC, Eaves LJ: Genetic and environmental factors in relative body weight and human adiposity. Behav Genet 1997, 27:325-351.
• [7]Bouchard C: Gene-environment interactions in the etiology of obesity: defining the fundamentals. Obesity (Silver Spring) 2008, 16(Suppl 3):S5-S10.
• [8]Hill JO: Understanding and addressing the epidemic of obesity: an energy balance perspective. Endocr Rev 2006, 27:750-761.
• [9]Di Caro S, Hamad GG, Fernstrom MH, Schauer PR, Bonanomi G: Medical strategies for weight loss in the overweight and obese patient. Minerva Gastroenterol Dietol 2006, 52:415-430.
• [10]Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD: Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011., 12CD001871
• [11]Black JL, Macinko J: Neighborhoods and obesity. Nutr Rev 2008, 66:2-20.
• [12]Janssen I, Boyce WF, Simpson K, Pickett W: Influence of individual- and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr 2006, 83:139-145.
• [13]Mobley LR, Root ED, Finkelstein EA, Khavjou O, Farris RP, Will JC: Environment, obesity, and cardiovascular disease risk in low-income women. Am J Prev Med 2006, 30:327-332.
• [14]van Lenthe FJ, Mackenbach JP: Neighbourhood deprivation and overweight: the GLOBE study. Int J Obes Relat Metab Disord 2002, 26:234-240.
• [15]Leal C, Bean K, Thomas F, Chaix B: Are associations between neighborhood socioeconomic characteristics and body mass index or waist circumference based on model extrapolations? Epidemiology 2011, 22:694-703.
• [16]Dubowitz T, Heron M, Bird CE, Lurie N, Finch BK, Basurto-Davila R, Hale L, Escarce JJ: Neighborhood socioeconomic status and fruit and vegetable intake among whites, blacks, and Mexican Americans in the United States. Am J Clin Nutr 2008, 87:1883-1891.
• [17]Giskes K, Turrell G, van Lenthe FJ, Brug J, Mackenbach JP: A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population: the GLOBE study. Public Health Nutr 2006, 9:75-83.
• [18]van Lenthe FJ, Brug J, Mackenbach JP: Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands. Soc Sci Med 2005, 60:763-775.
• [19]Ecob R, Macintyre S: Small area variations in health related behaviours; do these depend on the behaviour itself, its measurement, or on personal characteristics? Health Place 2000, 6:261-274.
• [20]Alves L, Azevedo A, Silva S, Barros H: Socioeconomic inequalities in the prevalence of nine established cardiovascular risk factors in a Southern European population. PLoS One 2012, 7:e37158.
• [21]Ramos E, Lopes C, Barros H: Investigating the effect of nonparticipation using a population-based case–control study on myocardial infarction. Ann Epidemiol 2004, 14:437-441.
• [22]Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet 2004, 364:937-952.
• [23]Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, et al.: Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006, 114:82-96.
• [24]Lopes C: Reproducibility and validity of a semi-quantitative food-frequency questionnaire. In Diet and acute myocardial infarction: a population-based case–control study. University of Porto Medical School: Department of Hygiene and Epidemiology; 2000.
• [25]Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW Jr, Kris-Etherton P, Goldberg IJ, Kotchen TA, et al.: AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000, 102:2284-2299.
• [26]Camoes M, Severo M, Santos AC, Barros H, Lopes C: Testing an adaptation of the EPIC physical activity questionnaire in Portuguese adults: a validation study that assesses the seasonal bias of self-report. Ann Hum Biol 2010, 37:185-197.
• [27]National Research Council (U.S.). Subcommittee on the Tenth Edition of the RDAs., National Institutes of Health (U.S.), National Research Council (U.S.). Committee on Dietary Allowances: Recommended dietary allowances. 10th edition. Washington, D.C: National Academy Press; 1989.
• [28]Oakes JM: The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology. Soc Sci Med 2004, 58:1929-1952.
• [29]Amâncio L: Género e divisão do trabalho doméstico: o caso português em perspectiva. Lisbon: Instituto de Ciências Sociais; 2007.
• [30]Afonso L: Association between proximity of food retailers to schools and dietary intake and nutritional status of adolescents of Porto. University of Porto, Porto Medical School: Abel Salazar Institute of Biomedical Sciences; 2012. [Master's thesis]
• [31]Beydoun MA, Powell LM, Wang YF: Reduced away-from-home food expenditure and better nutrition knowledge and belief can improve quality of dietary intake among US adults. Public Health Nutr 2009, 12:369-381.
• [32]Shohaimi S, Welch A, Bingham S, Luben R, Day N, Wareham N, Khaw KT: Residential area deprivation predicts fruit and vegetable consumption independently of individual educational level and occupational social class: a cross sectional population study in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). J Epidemiol Community Health 2004, 58:686-691.
• [33]Gordon-Larsen P, Nelson MC, Page P, Popkin BM: Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics 2006, 117:417-424.
• [34]Knoppers A, McDonald M: Scholarship on Gender and Sport in Sex Roles and Beyond. Sex Roles 2010, 63:311-323.
• [35]Klomsten AT, Marsh HW, Skaalvik EM: Adolescents’ perceptions of masculine and feminine values in sport and physical education: a study of gender differences. Sex Roles 2005, 52:625-636.
• [36]Aaron DJ, Storti KL, Robertson RJ, Kriska AM, LaPorte RE: Longitudinal study of the number and choice of leisure time physical activities from mid to late adolescence - Implications for school curricula and community recreation programs. Arch Pediat Adol Med 2002, 156:1075-1080.
• [37]McLaren L, Gauvin L: Neighbourhood level versus individual level correlates of women’s body dissatisfaction: toward a multilevel understanding of the role of affluence. J Epidemiol Community Health 2002, 56:193-199.