Results from a natural experiment: initial neighbourhood investments do not change objectively-assessed physical activity, psychological distress or perceptions of the neighbourhood

Abstract

Background: Few studies have assessed objectively measured physical activity (PA), active transportation, psychological distress and neighborhood perceptions among residents of a neighborhood before and after substantial improvements in its physical environment. Also, most research-to-date has employed study designs subject to neighborhood selection, which may introduce bias in reported findings. We built upon a previously enrolled cohort of households from two low-income predominantly African American Pittsburgh neighborhoods, matched on socio-demographic composition including race/ethnicity, income and education. One of the two neighborhoods received substantial neighborhood investments over the course of this study including, but not limited to public housing development and greenspace/landscaping. We implemented a natural experiment using matched intervention and control neighborhoods and conducted pre-post assessments among the cohort. Our comprehensive assessments included accelerometry-based PA, active transportation, psychological distress and perceptions of the neighborhood, with assessments conducted both prior to and following the neighborhood changes. In 2013, we collected data from 1003 neighborhood participants and in 2016, we re-interviewed 676 of those participants. We conducted an intent to treat analysis, with a difference-indifference estimator using attrition weighting to account for nonresponse between 2013 and 2016. In addition, we derived an individual-level indicator of exposure to neighbourhood investment and estimated effect of exposure to investment on the same set of outcomes using covariate-adjusted models. Results: We observed no statistically significant differences in activity, psychological distress, satisfaction with one's neighborhood as a place to live or any of the other measures we observed prior to and after the neighborhood investments between the intervention and control neighborhoods or those exposed vs not exposed to investments.

Associations between body mass index, physical activity and the built environment in disadvantaged, minority neighborhoods: Predictive validity of GigaPan® imagery

“…Those studies reported associations between subjective assessments or macro-scale data on distance to a nearby resource, whereas our study used micro-scale audits of environmental features. Dubowitz et al (2019) found no significant difference in BMI between residents in the Hill and Homewood neighborhoods, though unlike our study that analysis did not include micro-scale data on the environment (Dubowitz et al, 2019).…”

“…Several recent natural experiments have examined how changes to the built environment influence health focusing specifically on African American adults and low-income racial and ethnic minorities. A longitudinal assessment of the built environment, physical activity, BMI and neighborhood satisfaction was conducted in two low-income, African American communities in Pittsburgh, PA, USA, which are the primary focus of this study (Dubowitz et al, 2019). A natural experimental design was used to track participants' activity, BMI, and neighborhood satisfaction before and after one of the neighborhoods received investments that improved the built environment, such as new residential buildings, sidewalks, and street crossings.…”

“…This study builds on the Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) study of the Hill District and Homewood neighborhoods in Pittsburgh, which are low-income, predominantly African American communities. The PHRESH study was designed to evaluate the health of residents following planned changes to the built environment, including introduction of a full-service supermarket in the Hill District neighborhood, and renovation of parks and playgrounds and housing construction and developments (Dubowitz et al 2015(Dubowitz et al , 2019. A primary aim of the original PHRESH research was to collect data on food shopping in order to evaluate the influence of access to healthy affordable foods on diet, which may influence obesity and diet-related chronic diseases (Dubowitz et al, 2014).…”

“…Of the 1649 households who were reached at home and eligible to participate, 87% consented to participate in the PHRESH study. Participants were followed over time, with complete interview and accelerometer data obtained from 1003 participants in 2013 and from 676 of the same participants in 2016 (Dubowitz et al 2015(Dubowitz et al , 2019. This study utilizes data collected in 2013 and 2016, when accelerometer data were collected.…”

Methods to Address Self-Selection and Reverse Causation in Studies of Neighborhood Environments and Brain Health

“…For instance, DID has been used to estimate the association between neighborhood condition and weight changes while accounting for potential self-selection due to movers and non-movers [ 54 ]. The method has also been used to estimate the effect of neighborhood investment on physical activity and body mass index adjusting for general changes over time [ 55 ]. In addition, a DID approach has been used to examine self-selection [ 56 ], by estimating how baseline health may relate to changes in NE characteristics after the baseline time period.…”