Changing Health Outcomes of Vulnerable Populations Through Nursing's Influence on Neighborhood Built Environment: A Framework for Nursing Research.
ABSTRACT Purpose: The purpose of this article is to present a framework for nurses to study the impact of built environment on health, particularly in vulnerable populations. Organizing Construct: The framework is adapted from Social Determinants of Health and Environmental Health Promotion, a framework describing how physical and social environments interact to influence individual and population health and health disparities via macro, community-level, and interpersonal factors. Methods: The original framework was modified for public health nursing using nursing research evaluating built environment and health, and supplemented with Nightingale's theory of nursing and health. Findings: The built environment affects health through regional-, neighborhood-, and individual-level factors. Nursing can affect the health of patients by evaluating the neighborhood built environment where patients reside, and by advocating for changes to the built environment. Conclusions: Through development of built environment research, nurses can provide valuable insight into the pathways linking built environment to health of vulnerable populations, providing evidence for public health nurses to advocate for these changes on a neighborhood, state, and federal level. Clinical Relevance: This framework can be used by public health clinicians to understand the pathways by which the built environment may be affecting the health of their patients, and by researchers to investigate the pathways, and to design and test community interventions.
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ABSTRACT: This secondary analysis examined relationships between the environment and adherence to a walking intervention among 252 urban and suburban, midlife African American women. Participants received an enhanced or minimal behavioral intervention. Walking adherence was measured as the percentage of prescribed walks completed. Objective measures of the women's neighborhoods included walkability (land use mix, street intersection density, housing unit density, public transit stop density), aesthetics (physical deterioration, industrial land use), availability of outdoor (recreational open space) and indoor (recreation centers, shopping malls) walking facilities/spaces, and safety (violent crime incidents). Ordinary least squares regression estimated relationships. The presence of one and especially both types of indoor walking facilities were associated with greater adherence. No associations were found between adherence and other environmental variables. The effect of the enhanced intervention on adherence did not differ by environmental characteristics. Aspects of the environment may influence African American women who want to be more active.Health Education & Behavior 08/2008; 36(1):167-81. · 1.54 Impact Factor
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ABSTRACT: : The goal of this study was to investigate cross-sectional associations between features of neighborhoods and hypertension and to examine the sensitivity of results to various methods of estimating neighborhood conditions. : We used data from the Multi-Ethnic Study of Atherosclerosis on 2612 individuals 45-85 years of age. Hypertension was defined as systolic blood pressure above 140 mm Hg, diastolic pressure above 90 mm Hg, or use of antihypertensive medications. Neighborhood (census tract) conditions potentially related to hypertension (walking environment, availability of healthy foods, safety, social cohesion) were measured using information from a separate phone survey conducted in the study neighborhoods. For each neighborhood we estimated scale scores by aggregating residents' responses using simple aggregation (crude means) and empirical Bayes estimation (unconditional, conditional, and spatial). These estimates of neighborhood conditions were linked to each study participant based on the census tract of residence. Two-level binomial regression methods were used to estimate adjusted associations between neighborhood conditions and hypertension. : Residents of neighborhoods with better walkability, availability of healthy foods, greater safety, and more social cohesion were less likely to be hypertensive (relative prevalence [95% confidence interval] for 90th vs. 10th percentile of conditional empirical Bayes estimate = 0.75 [0.64-0.88], 0.72 [0.61-0.85], 0.74 [0.63-0.86], and 0.69 [0.57-0.83]), respectively, after adjusting for site, age, sex, income, and education. Associations were attenuated and often disappeared after additional adjustments for race/ethnicity. : Neighborhood walkability, food availability, safety, and social cohesion may be mechanisms that link neighborhoods to hypertension.Epidemiology (Cambridge, Mass.) 08/2008; 19(4):590-8. · 5.51 Impact Factor
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ABSTRACT: There is growing interest in the relation of built environments to physical activity, obesity, and other health outcomes. The purpose of the present study was to test associations of neighborhood built environment and median income to multiple health outcomes and examine whether associations are similar for low- and high-income groups. This was a cross-sectional study of 32 neighborhoods in Seattle, WA and Baltimore, MD regions, stratified by income and walkability, and conducted between 2001 and 2005. Participants were adults aged 20-65years (n=2199; 26% ethnic minority). The main outcomes were daily minutes of moderate-to-vigorous physical activity (MVPA) from accelerometer monitoring, body mass index (BMI) based on self-report, and mental and physical quality of life (QoL) assessed with the SF-12. We found that MVPA was higher in high- vs. low-walkability neighborhoods but did not differ by neighborhood income. Overweight/obesity (BMI > or = 25) was lower in high-walkability neighborhoods. Physical QoL was higher in high-income neighborhoods but unrelated to walkability. Adjustment for neighborhood self-selection produced minor changes. We concluded that living in walkable neighborhoods was associated with more physical activity and lower overweight/obesity but not with other benefits. Lower- and higher-income groups benefited similarly from living in high-walkability neighborhoods. Adults in higher-income neighborhoods had lower BMI and higher physical QoL.Social Science [?] Medicine 03/2009; 68(7):1285-93. · 2.73 Impact Factor