What is new?
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This is the first national survey in the Caribbean to examine neighborhood determinants of physical activity (PA), measures of adiposity, and diabetes mellitus (DM) within a multilevel framework.
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There was significant clustering in PA, overweight/obesity, and DM across Jamaican neighborhoods with neighborhood characteristics having a greater effect in women.
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Greater levels of neighborhood disorder, home disorder, and counterintuitively recreational space availability were associated with higher levels of low/no PA among women.
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Better levels of neighborhood infrastructure were associated with overweight/obesity in men.
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The implications of these findings include the need to further understand the upstream factors leading to clustering and associations observed.
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Public health efforts to increase PA and reduce both overweight/obesity and DM should include targeted neighborhood-level interventions.
The increasing prevalence of diabetes mellitus (DM) worldwide is thought to be a result of rising obesity and physical inactivity [1]. DM, obesity, and associated comorbidities are a major threat to public health and pose a significant economic burden in both developing and developed countries [2], [3], [4], [5]. Considerable success in decreasing morbidity from chronic noncommunicable diseases such as DM can be attributed to better treatment of these conditions—primarily through pharmacological agents. However, health promotion activities that address underlying causes of these conditions, such as obesity and reduced physical activity (PA), have been effective and are necessary. Social factors are thought to be important determinants of risk, and efforts to understand and address them must also be intensified to stem the worsening epidemic of DM and obesity [6], [7]. The 2007–08 Jamaica Health and Lifestyle Survey II (JHLS II) found the following prevalences among 15–74-year-old Jamaicans: DM was 8% (standard error [S.E.], 0.6%) (females, 9.3% [S.E., 0.6%]; males, 6.4% [S.E., 1.0%]) and obesity 25% (S.E., 1.2%) (females, 37% [S.E., 1.5%]; males, 12% [S.E., 1.7%]), respectively [8]. The prevalence of low/no levels of PA was 45% (S.E., 1.5%) (females, 62% [S.E., 1.6%]; males, 28% [S.E., 2.0%]) [8].
The Jamaican data reported prevalence of these outcomes at both the national and parish level and whether survey participants resided in urban vs. rural areas. No significant differences were detected at these geographical levels [8]. However, very little is known about the variability of these health outcomes in Jamaica at the levels of smaller geopolitical units, such as constituencies or enumeration districts (EDs). Researchers have recognized that the neighborhood may contribute negatively or positively to an individual's health and health-related behaviors.
Studies in the United States [9], [10], Canada [11], [12], [13], Australia [14], [15], and Europe [16], [17] have documented geographic variability in PA, obesity, and DM. There are also studies that have explored whether associations exist between the built environment and PA [12], [18], [19], [20], [21]. Greater neighborhood disorder has been significantly associated with less PA [22], [23]. However, the findings are less consistent regarding an association of the availability of recreational spaces/other spaces or play areas with PA [12], [18], [24], [25]. Multilevel conceptual models and statistical techniques have facilitated social scientists and epidemiologists studying the effects of neighborhoods on an individual's health. We are unaware of research from nationally representative samples from developing countries, which have examined clustering of PA, obesity, and DM at neighborhood level. We hypothesize that within Jamaica, there is significant variability in these outcomes at the smaller geopolitical levels.
The purpose of our analysis was to examine the variability in PA, obesity, and DM across small geopolitical units known as EDs in Jamaica using data from the JHLS II. Among other things, these outcomes may be influenced by neighborhood characteristics, such as access to open spaces and neighborhood disorder [22], [26], [27]. We also sought to explore whether home disorder, perceived safety, and neighborhood measures, such as neighborhood infrastructure and disorder, availability of recreational areas/spaces/playing fields (including whether they were within walking distance), were associated with these behavioral and health outcomes within a multilevel framework.