Introduction:
Several features of the residential environment have been related to cardiovascular risk. This pilot study tested the feasibility of measuring four specific domains of the urban environment (food, tobacco, alcohol and physical activity) in 12 census sections within the Heart Healthy Hoods Study in Madrid, Spain.
Methods:
12 census sections within the city limits of Madrid were selected using the Median Neighborhood Index (MNI). The MNI selects median clusters (in terms of aging, education, segregation and urban form) of contiguous areas within a city using the SaTSCAN statistic.
Well-trained data collectors conducted the fieldwork during 3 weeks. To assess the food environment they collected data on the number and type of stores as well as the healthy food availability within stores, using an abbreviated and adapted version of the NEMS-S inventory. For the tobacco and alcohol environment they collected data on the type and number of points of sale. For the physical activity environment they directly measured the attributes of 169 street segments associated with walking and cycling within the 12 census sections using the SPACES inventory. The same tool was used to virtually assess the 169 segments using Google Street View. All data collected were geolocated to produce relevant maps. The cardiovascular health profile of the residents over 40 was assessed using the Primary Care Electronic Health Records from two Health Care Center in the area.
Results:
The food environment included 2 public markets, 41 food stores and 61 food places. In terms of healthy food availability (score ranges from 0-27), the assessed stores had a mean score of 12.03, higher for supermarkets compared to other types of stores. The tobacco and alcohol environment included 64 and 94 points of sale respectively. The physical activity environment score includes function, safety, aesthetics and destinations for walking and cycling. For walking, the total score has a mean of 4.27 (ranges from 0-6.96); and 3.50 (ranges from 0-5.97) for cycling. Of the 15715 residents living in the study area, 23,4% were above 65 years of age, 49,6% did not complete secondary education, and 25,9% were foreign-born. The cardiovascular health profile of 8357 residents over 40 showed the following prevalence estimates: Obesity 9.3%, Diabetes 10.4%, Hypertension 29.8%, Hypercholesterolemia 28.7%.
Conclusions:
This pilot study showed a feasible way to measure four important features of the Urban Environment (food, tobacco, alcohol and physical activity) in direct relation to Cardiovascular Health. We aim to use these assessment tools for the future Heart Healthy Hoods Study that will be conducted in 90 neighborhoods of Madrid in order to study the effect of residential environments on the cardiovascular health of its residents.
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