Project update …

I n s i d e

t h i s I s s u e :

Residential perceptions of

local area features

2

Physiotherapy Honours

Student: Thomas Orschulok

2

Area-level relationships of

Metabolic Syndrome

3

ISBNPA Conference Report 3

Social Epidemiology and

Evaluation Research Group

4

International Collaborations 4

Project Chief Investigators 4

Contact Details 4

Public open space and cardiometabolic risk

Place and Metabolic Syndrome Project A u g u s t 2 0 1 1 V o l u m e 1 , I s s u e 2

Linking research

to better health.

The Place and Metabolic

Syndrome (PAMS) project has

been underway for just over

12 months. There has been

excellent progress since the

initiation of this research within

the Social Epidemiology and

Evaluation Research Group,

University of South Australia.

Activities since our last

newsletter have included:

Advisory Group meeting held

in November 2010;

Individual and group

meetings with key research

partners;

Establishment of core

environmental and health

outcome data sources on

over 4000 study participants;

Preliminary analyses initiated

to explore key questions

about the social or built

environment and metabolic

syndrome;

Development of two PhD

projects and one Honours

project;

Presentations at several

international and national

conferences ;

In this edition of the PAMS

newsletter our reports focus

on current research being

undertaken by our team

specifically on public open

space and cardiometabolic risk.

We express appreciation to our

many partners for their

support of this important

research project. We look

forward to working with many

of you in the coming months as

we undertake another phase of

consultation and engagement

with partners.

PAMS undertakes research across

the metropolitan region of Adelaide

The availability of public open space (POS) as well as

its greenness, type (sporting facilities present or

not) and size have been associated with physical

activity. Whilst the attributes of POS are similarly

assumed to extend a beneficial impact to

cardio-metabolic health, few studies have reported

on associations between POS characteristics and

cardiometabolic risk markers.

Dr Catherine Paquet recently presented a poster at

the 2011 annual meeting of the International Society

of Behavioural Nutrition and Physical Activity

(ISBNPA) in Melbourne. Analysis undertaken within

the north-west region of metropolitan Adelaide

indicated a high availability of POS. For residents of

this area greater availability of POS was not related

to cardiometabolic risk. Locally available POS classi-

fied as greener, larger and designed for undertaking

physical activity was, however, associated with

lower cardiometabolic risk. These findings suggest

that the characteristics, not the number, of locally

available POS may be relevant to cardiometabolic

health. Our team is currently investigating the

mechanisms that may explain these associations.

Experience. The Difference.

Public Open Space promotes physical activity and well-being

Professor Mark Daniel

Research Chair: Social Epidemiology

For the full publication, visit:

unisa.edu.au/sansominstitute/pams

“We shape our buildings,

and afterwards, our

buildings shape us ”

- Winston Churchill

Urban landscapes

promote well-being as

well as physical activity

Residential perceptions of local area features Katherine Baldock commenced her PhD in 2009

researching “The mediating role of environmental

perceptions linking residential areas to

cardiometabolic outcomes”.

Associations between where people live and health

are well documented. What remains unclear is how

environments influence health. Katherine’s doctoral

research being undertaken as part of the PAMS

project will endeavour to further explore the

mechanisms of these place and health

relationships. This cross-sectional research aims to

identify whether residents’ perceptions of specific

features within their local area are a possible

mechanism linking objectively measured attributes

and cardiometabolic outcomes. Environmental data

extracted from a geographic information system are

being analysed in relation to environmental

perceptions and the cardiometabolic health

outcomes of participants in the North West

Adelaide Health Study (NWAHS) in metropolitan

Adelaide.

Preliminary results from Katherine’s research

suggest that people who perceive their local area to

be aesthetically pleasing have a lower risk of

having metabolic syndrome. A subset of NWAHS

participants (n=1337) completed a questionnaire

assessing six items relating to their perceptions

of neighbourhood aesthetics, including: greenery

(e.g., trees, bushes, gardens); tree cover or

canopy along footpaths; interesting environmental

features; attractive buildings/homes; pleasant

natural features; and speed of traffic on street of

residence (40km/h or less). The analysis showed

that for every one point increase in the

neighbourhood aesthetics score, there was a 12%

reduction in risk for metabolic syndrome. This

research has also tested whether this relationship

could be explained by residents’ walking behaviour.

The results indicated that walking behaviour

acts as a link between resident perceptions of

their neighbourhood and metabolic syndrome.

This information is important in developing

environmental interventions that can lead to

improvements in health. The results from this

analysis suggest that residential areas that are more

aesthetically pleasing can lead to residents walking

more, which in turn, can lead to improvements

in cardiometabolic health and reduced risk for

metabolic syndrome.

Katherine is co-supervised by Prof Mark Daniel &

Dr Catherine Paquet. Her Associate Supervisor is

Prof Graeme Hugo (Adelaide Uni).

Physiotherapy Honours Student

Thomas Orschulok

Tom commenced his Bachelor of

Physiotherapy Honours in 2010

researching “Are cardiometabolic

disease risk factors related

to availability of neighbourhood

public open spaces and their

characteristics?”

Tom’s research project has been

evaluating associations between

certain aspects of neighbourhood

public open space (size, greenness,

type and availability) and

overall cardiometabolic risk.

Cardiometabolic risk is expressed

as the total count of a number of

cardiometabolic risk factors that

apply to any given individual.

Tom’s hypothesis is that people

who live closer to or have more

parks located close to them that

are larger, greener, more attractive

and which provide facilities

for sporting activities will have

a lower number of cardiometabolic

risk factors and thus a reduced

risk of developing cardiometabolic

diseases.

Tom is supervised by Dr Catherine

Paquet, Prof Mark Daniel, and Mr

Neil Coffee.

P l a c e a n d M e t a b o l i c S y n d r o m e P r o j e c t

More aesthetically

pleasing perception

of residential area

Increased walking

time per week

Decreased risk for

metabolic syndrome

Professor Mark Daniel presented within an ISBNPA Symposium, led by the National Cancer Institute (US), “Understanding and overcoming

key barriers to assessing the relevance of the food environment to diet and health”. Mark presented within this symposium on the

“Challenges in use and results of analyses of secondary data on food environments”. The presentation framed challenges and emerging

tensions in research on food environments using geographic information systems (GIS)-based secondary data, including linking constructs to

measures, validity of indirect measures, and coherence of relationships between food-source availability, composition and context, eating

behaviour, and cardiometabolic outcomes .

Mrs Katherine Baldock, PhD Candidate, presented results of preliminary analyses testing associations between the perceived environment,

sense of community, and metabolic syndrome. Findings indicated that a greater number of locally available services and resources was

associated with a greater sense of community. In addition, a greater sense of community was associated with a lower risk of having metabolic

syndrome. Knowledge of the specific features of residential environments that may potentially improve residents’ sense of community and

cardiometabolic health could inform environmental interventions to improve population health.

Mr Peter Lekkas, PhD Candidate, attended a satellite meeting “Advancing research on the built environment and active living: working with

policy makers and designing natural experiments”, hosted by the Centre for Built Environment and Health, University of Western Australia.

The aim of this satellite meeting was to advance knowledge of natural experiments. Using real case studies of urban regeneration programs

awaiting formal development approval, participants were challenged to formulate robust evaluations to capture the prospective

influence of changes to the built environment on ‘active living’, health and wellbeing. The meeting was convened by Professors Billie

Giles-Corti and Fiona Bull with expert guidance on the conduct of natural experiments for public health provided by Professor David Ogilvie

(MRC Epidemiology Unit & the UKCRC Centre for Diet and Activity Research (CEDAR) Cambridge, UK). Central to the learning process was the

involvement of industry stakeholders from local government and urban developers.

www.isbnpa2011.org

2011 Annual Meeting of the International Society for

Behavioral Nutrition and Physical Activity, Melbourne

Residents living within disadvantaged areas have

worse health than those living in advantaged

areas. Figure 1 outlines an example of variation in the

prevalence of metabolic syndrome across a social

gradient. North West Adelaide Health Study

(NWAHS) participants living within the most

disadvantaged local communities display the highest

prevalence of metabolic syndrome. Metabolic

syndrome was calculated for NWAHS participants at

Wave 1 (2000-03) using the International Diabetes

Federation (IDF) definition:

Waist Girth:

≥80cm females or ≥94cm males

Plus any two of the following:

Blood Pressure:

Systolic ≥ 130 mmHg or Diastolic ≥85 mmHg

Raised triglycerides:

≥1.7 mmol/L or treatment for lipid abnormality

Reduced HDL-Cholesterol:

≤1.03 mmol/L females or ≤1.29 mmol/L males

Fasting Plasma Glucose :

≥ 5.6 mmol/L or diagnosed Diabetes

The work of the PAMS project will investigate the

basis of these social relationships with metabolic

syndrome. Specifically, the PAMS project will analyse

how behavioural and psycho-social factors influence

the development of metabolic syndrome over time

for the NWAHS population.

Area-level relationships

of Metabolic Syndrome

Socioeconomic Indexes for Areas, Index of Relative Socioeconomic Disadvantage (SEIFA IRSD)

Pre

vale

nce

of

Me

tab

olic

Syn

dro

me

(%

)

Most Disadvantaged Local Communities Least Disadvantaged Local Communities

50.0

45.0

40.0

35.0

30.0

25.0

20.0

15.0

10.0

5.0

0.0

Figure 1: Prevalence of Metabolic Syndrome by area-level disadvantage

North West Adelaide Health Study, Wave 1 (2000-03)

The Socio Economic Indexes for Areas

(SEIFA) is commonly used to describe area-

level disadvantage within the Australian

context and is derived from Australian

Bureau of Statistics (ABS) area-level Census

information. The SEIFA Index of Relative

Socio-economic Disadvantage (IRSD)

comprises indicators on both advantage

and disadvantage. A low score of SEIFA

IRSD represents ‘disadvantage’ and a high

score ‘advantage’. In this analysis the

distribution within the population has been

categorised according to quintiles, as

defined by the following cut-off values:

Quintile 1 & 2 = Most Disadvantaged

Local Communities

Quintile 3 = Middle Quintile

Quintile 4 & 5 = Least Disadvantaged

Local Communities

Defining Area-level Disadvantage?

Research Team National Health and Medical Research Council (NHMRC) Partnership Project (#570150), 2010-2012

“Linking Place to Metabolic Syndrome via Behavioural and Psychosocial Antecedents: Levers for Public Health Intervention”

unisa.edu.au/sansominstitute/pams

Miss Kristy Scherer, Project Co-ordinator e. kristy.scherer@unisa.edu.au t. +61 8 8302 2629 f: +61 8 8302 2603

Prof Mark Daniel, Chair: Social Epidemiology e. mark.daniel@unisa.edu.au t. +61 8 8302 2518

Dr Catherine Paquet, NHMRC Research Fellow e. catherine.paquet@unisa.edu.au t. +61 8 8302 2615

Dr Margaret Cargo, ARC Future Fellow e. margaret.cargo@unisa.edu.au t. +61 8 8302 2141

Mr Neil Coffee, Senior Research Fellow e. neil.coffee@unisa.edu.au t. +61 8 8302 2632

Dr Natasha Howard, Research Fellow e. natasha.howard@unisa.edu.au t. +61 8 8302 2776

Chief Investigators Prof Mark Daniel (UniSA)

Prof Graeme Hugo (Adelaide)

Dr Catherine Paquet (UniSA)

A/Prof Anne Taylor (Adelaide)

Dr Margaret Cargo (UniSA)

A/Prof Robert Adams (Adelaide)

P l a c e a n d M e t a b o l i c S y n d r o m e P r o j e c t

The PAMS project is one of several research projects currently being undertaken within

the Social Epidemiology and Evaluation Research Group (SEERG). Another project

funded by the SA Health Strategic Health Research Program is investigating smoking

reduction strategies and interventions among Aboriginal health workers.

Smoking is prevalent among Aboriginal Health Workers. This affects their health

directly. It also affects their professional practice influencing the delivery of smoking

cessation programs to clients. Addressing this issue requires deep understanding. To do

so we have partnered with the Aboriginal Health Council of South Australia. Critical also

is the use of a participatory mixed-methods approach. By this approach we aim to

contextualise smoking to better understand its basis in individuals and opportunities for

prevention, reduction and cessation. This will enable the development of culturally

sensitive cessation strategies for Aboriginal Health Workers and their communities.

Our website provides further information on the Research Team and current research

activities: unisa.edu.au/sansominstitute/epidemiology

Staff and friends of the Social Epidemiology and

Evaluation Research Group undertaking the

2011 Mutual Community Tour Down Under Challenge

Social Epidemiology and

Evaluation Research Group

Montreal, Quebec, Canada

Utilising MEGAPHONE® within SEERG...

Torbjorn Van Heeswijck commenced his

PhD in 2009 researching “Active transport

environments, active transport behaviour

and cardiovascular mortality”. This research

investigates how Individuals are exposed

to multiple environments as part of their

daily movements. Using Montréal data, the

project is investigating whether the built

and social environment to which individuals

are exposed during their daily commute

is related to active transport behaviour

as well as population-level cardiovascular

disease (CVD) mortality.

The SEERG has many international

collaborations, several of which

involve the l’Université de

Montréal, Quebec, Canada. Much

of this research involves the

application of data derived from a

geographic information system

(GIS) MEGAPHONE® - Montreal

Epidemiological & Geographic Anal-

ysis of Population Health Outcomes

& Neighbourhood Effects. MEGA-

PHONE® was co-developed with

Research Fellow Dr Yan Kestens

during Prof Mark Daniel’s time as

Canada Research Chair at the

Centre de recherche du Centre

hospitalier de l’Université de

Montréal (CR-CHUM).

MEGAPHONE® was developed to

support exposure surveillance and

population health research on

social, built, and physical

environmental features affecting

health across the Montréal

metropolitan region of 3.4 million

residents. It combines a diverse

array of geospatial databases and

analysis tools, a graphical user

interface, and a unique relational

infrastructure to facilitate the

storage, management and use of

health-related geographic data.

International

Collaborations