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Neighbourhood level determinants of Health

A summer research project exploring the use of multi-level analysis on mental health service use in Toronto.

Anita Minh

on 5 December 2011

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Transcript of Neighbourhood level determinants of Health

Exploring neighbourhood effects
on mental health:
Project NEHW Anita Minh, supervised by Dr. Patricia O'Campo 2. Background 1. Project aims 3. Anita's role Do neighbourhood level factors influence mental health beyond the contributions of individual level risk factors? Outcome Measures - composite measure 1. Substance Use (in the past 12 months) Alcohol dependence (physiological and non-physiologial)
Alcohol abuse
Drug dependence (physiological and non-physiological)
Drug abuse 2. Mental health and well-being Depression (CES-DR Scale and CIDI-SF Scale)
Anxiety Acknowledgements Dr. Patricia O'Campo
Catharine Chambers, Antony Chum, and Yu Janice Zhang
The Project NEHW team
The Keenan Research Centre Summer Student Program Thank you to: Neighbourhood Level Stressors Physical disorder
Social Disorder
Built environment
Residential Instability
Insecurity Individual Level Resources Individual Level Stressors Neighbourhood-based sample (88 CTs in Toronto)

Mean no. participants/CT ~ 28 adults (aged 25-64)

Total no. participants = 2400 individuals Life Events
Chronic Stress
Work Stress Personal Resources
Social Resources Neighbourhood Level Resources Neighbourhood wealth (census)
Public services
Institutional Resources
Collective efficacy
Green Space Fig. 2: Parks in Toronto, 2009 Use DMTI-Route Logistics
(updated annually) Mental Health Multi-Level Stress Process Model Study Sample Introduction: Multi-level modelling (assessed using NEHW survey) Primary Study Aims Neighbourhoods "... a unique system of health relevant resources and social relationships embedded within geographical borders" (Curtis & Jones, 1998) Paradigm shift in health research Social determinants of health (e.g. economic deprivation)
Individuals are nested within a larger context
Statistical methodology to simultaneously analyze data at two ore more levels only widely accessible in last 20 years. Concept of neighbourhoods as opportunity structure 1. Physical features (e.g. air quality)
2. Presence of environments that support healthful lifestyle
3. Quality of services for all segments of the population (e.g. schools, libraries, transportation)
4. Sociocultural/socioeconomic features
5. Reputation of area (McIntyre & Ellaway, 2003) Conceptual framework for understanding determinants of mental health "Sickness is poor-spirited, and cannot serve anyone; it must husband its resources to live. But health or fullness answers its own ends, and has to spare, runs over, and inundates the neighborhoods and creeks of other men's necessities." (Ralph Waldo Emerson - The Conduct of Life: 11. Power) The individual-level framework of understanding Chronic or life-event stressors Mental HEalth personal resistance Social buffers social support
social capital personal control
self esteem Mechanisms for translation of nieghbourhood characteristics to individual mental health risk (Ross, 2001): 1. Neighbourhood disorder
persistent threat, disorganization
low personal control

2. Spread of mistrust
linked to unwillingness to reduce neighbourhood stressors
undermines social engagement Joint Influence Possible that the net influence of stress exposures across levels may be modified by either one or a combination of individual and neighbourhood resources.

Hierarchical Multiple Regression
analyze both between and within neighbourhood variations Neighbourhood effects on health and well-being (Project NEHW) Fig. 1. Point map of participants geocoded by address. If you have any questions, please email me at: minha@smh.ca Fig. 3. Point Map of Acute Care Facilities in Toronto, 2010 Use Enhanced Points of Interest (EPOI)

(updated annually) Implications hope to inform the design of neighbourhood level interventions for mental health Fig. 4. Normalized counts of building repair needs in Toronto, 2006 Statistics Canada
Long Form Census, 2006
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