To compare 2 frequently used area-level socioeconomic deprivation indices: the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI).
Index agreement was assessed via pairwise ...correlations, decile score distribution and mean comparisons, and mapping. The 2019 ADI and 2018 SVI indices at the U.S. census tract-level were analyzed.
Index correlation was modest (R = 0.51). Less than half (44.4%) of all tracts had good index agreement (0-1 decile difference). Among the 6.3% of tracts with poor index agreement (≥6 decile difference), nearly 1 in 5 were classified by high SVI and low ADI scores. Index items driving poor agreement, such as high rents, mortgages, and home values in urban areas with characteristics indicative of socioeconomic deprivation, were also identified.
Differences in index dimensions and agreement indicated that ADI and SVI are not interchangeable measures of socioeconomic deprivation at the tract level. Careful consideration is necessary when selecting an area-level socioeconomic deprivation measure that appropriately defines deprivation relative to the context in which it will be used. How deprivation is operationalized affects interpretation by researchers as well as public health practitioners and policymakers making decisions about resource allocation and working to address health equity.
Strategies to reduce childhood obesity and improve nutrition include creating school food environments that promote healthy eating. Despite well-documented health benefits of fruit and vegetable (FV) ...consumption, many U.S. school-aged children, especially low-income youth, fail to meet national dietary guidelines for FV intake. The Cafeteria Assessment for Elementary Schools (CAFES) was developed to quantify physical attributes of elementary school cafeteria environments associated with students' selection and consumption of FV. CAFES procedures require observation of the cafeteria environment where preparation, serving, and eating occur; staff interviews; photography; and scoring.
CAFES development included three phases. First, assessment items were identified via a literature review, expert panel review, and pilot testing. Second, reliability testing included calculating inter-item correlations, internal consistency (Kuder-Richardson-21 coefficients), and inter-rater reliability (percent agreement) based on data collected from 50 elementary schools in low-income communities and 3187 National School Lunch Program participants in four U.S. states. At least 43% of each participating school's students qualified for free- or reduced-price meals. Third, FV servings and consumption data, obtained from lunch tray photography, and multi-level modeling were used to assess the predictive validity of CAFES.
CAFES' 198 items (grouped into 108 questions) capture four environmental scales: room (50 points), table/display (133 points), plate (4 points), and food (11 points). Internal consistency (KR-21) was 0.88 (overall), 0.80 (room), 0.72 (table), 0.83 (plate), and 0.58 (food). Room subscales include ambient environment, appearance, windows, layout/visibility, healthy signage, and kitchen/serving area. Table subscales include furniture, availability, display layout/presentation, serving method, and variety. Inter-rater reliability (percent agreement) of the final CAFES tool was 90%. Predictive validity analyses indicated that the total CAFES and four measurement scale scores were significantly associated with percentage consumed of FV served (p < .05).
CAFES offers a practical and low-cost measurement tool for school staff, design and public health practitioners, and researchers to identify critical areas for intervention; suggest low- and no-cost intervention strategies; and contribute to guidelines for cafeteria design, food presentation and layout, and operations aimed at promoting healthy eating among elementary school students.
Clubhouses are non-clinical, community-based centers for adult members with serious mental illness. The evidence-based model assists adults with identifying employment, housing, education, and social ...opportunities; wellness and health-promoting activities; reducing hospitalizations and criminal justice system involvement; and improving social relationships, satisfaction, and quality of life. The model enables member participation in all Clubhouse operations, yet offers little guidance concerning facility design and member engagement in the design process. This case study explored the use of participatory design research exercises to (1) document member needs, preferences, and priorities to inform the design of a new midwestern U.S. Clubhouse facility and (2) meaningfully engage members (
= 16) in the design process. Four participatory design research exercises were developed, administered, and analyzed. Results revealed aesthetics and ambience; safety and security; ease of use and maintenance; adaptability, flexibility, and accessibility; and transportation as future priorities. Space and furnishing needs and priorities were also identified. Informal observations and participant feedback suggested that the participatory exercises meaningfully engaged members in a manner aligned with Clubhouse Model principles by centering member dignity, strengths, and work-oriented expectations. Future directions for research on Clubhouse design and member engagement in the design process are also discussed.
Pain catastrophizing is among the strongest predictors of pain intensity. This study examined the role of the nearby natural environment in the experience of pain among community-dwelling adults with ...chronic pain (
=81) living in New York City and explored the notion that attention may underlie nature's effect. Nearby nature was objectively measured using satellite data. Daily diary data across 14 days was employed to operationalize pain catastrophizing (and subscales: rumination, helplessness, and magnification) and pain intensity. Results indicated that nearby nature buffered the relation between catastrophizing and pain intensity. Moreover, nearby nature moderated the association between pain-related rumination (the most attention-based subscale of pain catastrophizing) and pain intensity, but did not moderate the helplessness-pain intensity or the magnification-pain intensity associations. These results suggest that the mechanism underlying nearby nature's moderating influence involves attention. Practitioners in search of strategies to reduce pain intensity experienced by community-dwelling chronic pain sufferers might look to a community resource: nearby nature.
Early BEH research addressed influences of toxic environmental exposures, zoning laws, building codes, and healthy housing and communities on asthma, injury, violence, healthy and unhealthy food ...consumption, mental health, social capital, and health inequities.1 Awareness increased regarding the benefits of denser, more walkable, and less automobile-dependent settings, as well as the accessibility, mobility, and livability needs ofthe growing aging population. Work on automobile dependence, traffic safety, walking and biking, commuting, and sedentary time was primarily driven by the Robert Wood Johnson Foundation's Active Living Research initiative to promote active living via environment, policy, and practice improvements3,4 Research linked specific building and community features to health outcomes, enabling more effective interventions such as appealing stairways, ample sidewalks, and vibrant activity centers.5 The business case for healthpromoting, walkable places was documented.6 Unintended consequences, including gentrification and displacement, of interventions aimed at improving health among people from racial and ethnic minority groups and of lower incomes were increasingly recognized, resulting in more research focused on how to mitigate these risks.7 The history of structural racism, segregation, redlining, neighborhood disinvestment, health inequities, and disparities in walkability, housing, and greenspace access was only recently widely acknowledged.8 Numerous books (Table E, available as a supplement to the online version of this article at http://www.ajph.org) and dozens of BEH measures (e.g., walkability https://www.wal kscore. com, access to parks https://www.tpl. org/ParkScore, livability http://www. livabilitylndex.AARP.org, and brain health https://cognability.isr.umich. edu) were also published, reflecting the growth and maturation ofthe field. The effects of these evolving technologies on land use, housing, economic and community development, traffic patterns, transportation planning and infrastructure, air quality, and associated health outcomes require further research and evaluation (Table G, reference 3).10 PRACTICE Professional organizations across disciplines established BEH committees and working groups (Table F, available as a supplement to the online version of this article at http://www.ajph.org), promoting healthy building and community design through conferences, reports, training, and advocacy (e.g., https://www. Health impact assessments (HIAs) were used to consider potential health impacts of proposed projects and programs and identify disproportionately affected populations as well as howto mitigate adverse effects9,11,12 HIAs improved collaboration, amplified community member voices, increased awareness of health issues, and informed decision makers, but the time and resources required to complete HIAs limited their success.12 Cross-disciplinary public health, planning, policy, real estate, architecture, engineering, transportation, and public-private partnership efforts, along with Complete Streets approaches (https://highways.dot.gov/ complete-streets), improved pedestrian infrastructure and safety.
The built environment directly and indirectly affects mental health, especially for people transitioning from long-term homelessness to permanent supportive housing (PSH) who often experience ...co-occurring behavioral health challenges. Despite a rapid increase in PSH availability, little research examines influences of architecture and design within this context. This integrative review synthesized limited research on PSH design in the U.S. and Canada to identify built environment characteristics associated with PSH residents’ mental health, highlight gaps in the literature, and prioritize future research directions. A systematic search for peer-reviewed articles was conducted using nine databases drawing from multiple disciplines including architecture, environmental psychology, interior design, psychology, psychiatry, medicine, and nursing. Seventeen articles met inclusion criteria. Study design, methodology, built environment properties, place attributes, and relevant findings were extracted and iteratively analyzed. Three domains relevant to architecture and design were identified related to home, ontological security, and trauma sensitivity; dwelling unit type, privacy, control, safety, housing quality and location, and access to amenities; and shared common space. Integrative review results emphasize the potential of architecture and design to contribute to improved built environment quality and mental health outcomes among PSH residents. Methodological limitations and directions for future research are also discussed.
Although sociodemographic factors are one aspect of understanding the effects of neighborhood environments on health, equating neighborhood quality with socioeconomic status ignores the important ...role of physical neighborhood attributes. Prior work on neighborhood environments and health has relied primarily on level of socioeconomic disadvantage as the indicator of neighborhood quality without attention to physical neighborhood quality. A small but increasing number of studies have assessed neighborhood physical characteristics. Findings generally indicate that there is an association between living in deprived neighborhoods and poor health outcomes, but rigorous evidence linking specific physical neighborhood attributes to particular health outcomes is lacking. This paper discusses the methodological challenges and limitations of measuring physical neighborhood environments relevant to health and concludes with proposed directions for future work.
Summary Female singers often wear high heels for auditions and performances. Heel height research in non-singing contexts indicates that wearing heels can affect body alignment and head position. ...Studies in orthodontics, sleep apnea, and voice science suggest that head and neck positioning can alter the vocal tract. The purpose of this study was to assess the effects, if any, of heel height (barefoot, 10.16-cm stilettos) on three angles of singer head position (calculated from C7–tragus–nasion), long-term average spectra data, and perceptual data (questionnaire) acquired from female ( N = 30) soloists during alternating periods of silence and singing. Results indicated that all participants (100%) significantly decreased head position angle measurements (inferior and posterior head and neck movement) when singing in high heels compared with singing barefoot. Participants, on average, significantly increased head position angle measurements (superior and anterior head and neck movement) when singing compared with standing silently, and did so to a greater degree when transitioning from silent heels to singing heels compared with transitioning from silent barefoot to singing barefoot. Long-term average spectra data indicated significant spectral energy differences between barefoot and high heel singing conditions across participants. Most participants ( n = 21, 70.00%) indicated they felt comfortable and sang their best while barefoot. Results of this study, the second in a series of experiments addressing the effects of shoe heel height on female singers' vocal production, were discussed in terms of application to vocal pedagogy and directions for future research.
Chronic crowding within housing adversely affects psychological well-being, yet little is known about how design attributes contribute to these effects, especially among children. This ...cross-sectional study first examined associations between residential interior density and children’s (M = 9 years of age) perceived bedroom and home crowding. Second, analyses investigated whether interior design attributes (residential floor plan arrangement measured by space syntax depth and permeability; bedroom ceiling height, volume, and window area) buffer negative effects of perceived crowding on multimethodological indices of child development, including psychological distress, learned helplessness, and physiological stress. After adjusting for home type, clutter, income, gender, and age, interior density was significantly associated with perceived home and bedroom crowding. Regression results suggested that bedroom ceiling height was associated with reduced negative effects of home, but not bedroom, perceived crowding on blood pressure, epinephrine, norepinephrine, and allostatic load among participants who reported higher levels of perceived crowding.
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