Placing individuals in a multileveled context

Table of Contents

Placing individuals in a multileveled context
Initial notes from PT
Annotations on common readings
Annotated additions by students
Idea: Different or even contradictory associations can be detected at different levels of aggregation (e.g., individual, region, nation), but not all influences can be assigned to properties of the individual—Membership in a larger aggregation can influence outcomes even after conditioning on the attributes of the individuals.

Guidelines for annotations
Notes and annotations from 2007 course

Initial notes from PT

Prepare for class as follows:
Ecological & atomistic fallacies:
Neighborhood effects:
Income inequality, stature, and obesity:


Annotations on common readings


Annotated additions by students


Balfour and Kaplan
These researchers examined the effect of environment and risk factors on the health of senior citizens in Alameda Co. CA. In particular, they were interested in how the presence and severity of heavy traffic, loud noise, high crime, excess litter and trash, poor lighting and limited public transportation impacted the mobility, engagement, functionality and independence of senior citizens in poor and non-poor neighborhoods. Comprising a longitudinal cohort study, this research looked at neighborhood effects on physical functionality over time. This data was supplemented by census tract level data that established the neighborhood contextual effects. The authors found that poorer census tracts had a higher level of environmental risk factors and a higher proportion of senior citizens with multiple health problems. Neighborhood income was also closely associated with degree of urban characteristics, with poorer neighborhoods being more densely populated with residents and environmental risks. A number of statistical models were employed to conduct a multi-level analysis of individual and neighborhood characteristics.
Marcelli, Jencks and Kawachi
This article on the relationship between parental income, and therefore family SES, and height of children was quite interesting. The researchers had to control for parental height (i.e. genetics), diet/nutrition, illness and access to medical care. Their primary argument is that apart from these potential confounders, and material resources, contextual effects also influence height in children. They also address the issue of Vitamin D, and the relationship of sunlight as a protective factor concerning chronic disease and height, which has leapt to the forefront of public health and popular interest in the past month. It was interesting to read about their use of NHANES as a dataset, as I am currently working on a project with the Boston Public Health Commission, which entails learning more about NHANES. The researchers find that height is related to family income, and as real wages have declines, so has height among youth.
posted by AHelburn 11.02.09

Balfour
This reading focuses on the health of older adults. Presently, it is predicted that people will enjoy a longer life, and that this trend is expected to continue. A focus of gerontologists is to help these individuals live longer, healthier lives – with that, there is focus on how one’s social and physical environment impacts a persons health and well-being. Past studies have focused on the entire population. And, studies have been limited to middle-aged and young persons. There is now a push to understand whether the local environment effects health and functional ability in older adults.

As studies regarding neighborhood conditions continue, some have come to different determinations. Some studies did not “link characteristics of the neighborhood environment with health or functional status.” However, ecologic and cross-sectional studies have implied a connection that is dependent on characteristics of areas, such as neighborhood socioeconomic status and neighborhood characteristics. Balfour suggests that it is indeed neighborhood socioeconomic factors, rather than individual socioeconomic factors, that influence older individuals’ health.

Lower extremity and functional loss have been associated with negative neighborhood environments with noxious features, which might impact older adults’ life and health “through a number of direct and indirect pathways.” In a longitudinal, population-based cohort study of individuals 55 years and older, conducted by the Alameda County, 6,928 adults were enrolled using a stratified, random household sample. Subsequent surveys were conducted in 1974, 1983, 1994, and 1995. Rates for these surveys were 86, 85, 87, 93, and 97 percent of eligible respondents. Balfour and Kaplan focus on participants in the 1994 and 1995 “survey waves” who were 55 years and over in 1994 and Alameda County residents (N=1,135). People who did not complete the survey in 1995 (N=76) had “moved within a year prior to 1994” (N=11), or were “missing information on important variables” (N=37); they were excluded.

In 1994, San Francisco Bay residents were asked to look at their neighborhood and rate the seriousness of six potential problems: “crime, lighting at night, traffic, excessive noise, trash, litter, and access to public transportation.” Problems reported were grouped according to response. MapInfo Professional was used to assign people to census tracks. “Census tracks were classified by measures of socioeconomic status, quality of housing stock, and household tenure.” In 1994 and 1995, respondents were asked to rate nine physical tasks which represented functional limitations. The level of difficulty is used to assess “overall” functional limitation, with a focus on lower-extremity strength. Participants rated the level of difficulty of these tasks and their responses were summed.

Reported most frequently as problems were traffic, crime, and excessive noise, “while difficulty accessing public transportation, inadequate lighting at night, and trash and litter, were reported less frequently.” Seventeen percent of respondents reported at least one neighborhood problem, and equally, 17 percent reported multiple neighborhood problems. “The number of neighborhood problems reported was strongly associated with sociodemographic and housing characteristics of the census trace (table 2). A correlation was found: “The proportion of people residing in census tracts with lower overall socioeconomic status, poorer housing stock, and greater residential instability increased with increasing number of reported neighborhood problems.” People who reported multiple problems were older unmarried Black low-income females. Interestingly, respondents who indicated serious neighborhood problems were not more likely to be smokers or socially isolated.

These studies do have limitations and it is clear that problematic neighborhood environments impact the functional health of older adults. Loss of physical function and lower extremity function is of great concern for older individuals. Barriers and the lack of resources in a community may “trigger a pattern of disuse and subsequent decrements in functional health, in essence speeding up the aging process.” In the future, community developers and other like minded entities could possibly assist in alleviating this growing problem (of age related functionality) through intervention. (CH '09)