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Le Touquet – Paris-Plage, France

Karusisi N.,French Institute of Health and Medical Research | Karusisi N.,University Pierre and Marie Curie | Thomas F.,Center dInvestigations Preventives et Cliniques | Meline J.,French Institute of Health and Medical Research | And 2 more authors.
International Journal of Behavioral Nutrition and Physical Activity | Year: 2013

Background: Physical activity is considered as a major component of a healthy lifestyle. However, few studies have examined the relationships between the spatial accessibility to sport facilities and sport practice with a sufficient degree of specificity. The aim of this study was to investigate the associations between the spatial accessibility to specific types of sports facilities and the practice of the corresponding sports after carefully controlling for various individual socio-demographic characteristics and neighborhood socioeconomic variables.Methods: Data from the RECORD Study involving 7290 participants recruited in 2007-2008, aged 30-79 years, and residing in the Paris metropolitan area were analyzed. Four categories of sports were studied: team sports, racket sports, swimming and related activities, and fitness. Spatial accessibility to sport facilities was measured with two complementary approaches that both take into account the street network (distance to the nearest facility and count of facilities around the dwelling). Associations between the spatial accessibility to sport facilities and the practice of the corresponding sports were assessed using multilevel logistic regression after adjusting for individual and contextual characteristics.Results: High individual education and high household income were associated with the practice of racket sports, swimming or related activities, and fitness over the previous 7 days. The spatial accessibility to swimming pools was associated with swimming and related sports, even after adjustment for individual/contextual factors. The spatial accessibility to facilities was not related to the practice of other sports. High neighborhood income was associated with the practice of a racket sport and fitness.Conclusions: Accessibility is a multi-dimensional concept that integrates educational, financial, and geographical aspects. Our work supports the evidence that strategies to increase participation in sport activities should improve the spatial and financial access to specific facilities, but also address educational disparities in sport practice. © 2013 Karusisi et al.; licensee BioMed Central Ltd.


Havard S.,French Institute of Health and Medical Research | Havard S.,University Pierre and Marie Curie | Reich B.J.,North Carolina State University | Bean K.,Center dInvestigations Preventives et Cliniques | And 2 more authors.
Occupational and Environmental Medicine | Year: 2011

Objectives To explore social inequalities in residential exposure to road traffic noise in an urban area. Methods Environmental injustice in road traffic noise exposure was investigated in Paris, France, using the RECORD Cohort Study (n=2130) and modelled noise data. Associations were assessed by estimating noise exposure within the local area around participants' residence, considering various socioeconomic variables defined at both individual and neighbourhood level, and comparing different regression models attempting or not to control for spatial autocorrelation in noise levels. Results After individual-level adjustment, participants' noise exposure increased with neighbourhood educational level and dwelling value but also with proportion of non-French citizens, suggesting seemingly contradictory findings. However, when country of citizenship was defined according to its human development level, noise exposure in fact increased and decreased with the proportions of citizens from advantaged and disadvantaged countries, respectively. These findings were consistent with those reported for the other socioeconomic characteristics, suggesting higher road traffic noise exposure in advantaged neighbourhoods. Substantial collinearity between neighbourhood explanatory variables and spatial random effects caused identifiability problems that prevented successful control for spatial autocorrelation. Conclusions Contrary to previous literature, this study shows that people living in advantaged neighbourhoods were more exposed to road traffic noise in their residential environment than their deprived counterparts. This case study demonstrates the need to systematically perform sensitivity analyses with multiple socioeconomic characteristics to avoid incorrect inferences about an environmental injustice situation and the complexity of effectively controlling for spatial autocorrelation when fixed and random components of the model are correlated.


Ben-Shlomo Y.,University of Bristol | Spears M.,University of Bristol | Boustred C.,University of Bristol | May M.,University of Bristol | And 28 more authors.
Journal of the American College of Cardiology | Year: 2014

Objectives The goal of this study was to determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular disease (CVD) events beyond conventional risk factors. Background Several studies have shown that aPWV may be a useful risk factor for predicting CVD, but they have been underpowered to examine whether this is true for different subgroups. Methods We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with CVD outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects. Results Of 17,635 participants, a total of 1,785 (10%) had a CVD event. The pooled age- and sex-adjusted hazard ratios (HRs) per 1-SD change in loge aPWV were 1.35 (95% confidence interval [CI]: 1.22 to 1.50; p < 0.001) for coronary heart disease, 1.54 (95% CI: 1.34 to 1.78; p < 0.001) for stroke, and 1.45 (95% CI: 1.30 to 1.61; p < 0.001) for CVD. Associations stratified according to sex, diabetes, and hypertension were similar but decreased with age (1.89, 1.77, 1.36, and 1.23 for age ≤50, 51 to 60, 61 to 70, and >70 years, respectively; pinteraction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor of coronary heart disease (HR: 1.23 [95% CI: 1.11 to 1.35]; p < 0.001), stroke (HR: 1.28 [95% CI: 1.16 to 1.42]; p < 0.001), and CVD events (HR: 1.30 [95% CI: 1.18 to 1.43]; p < 0.001). Reclassification indices showed that the addition of aPWV improved risk prediction (13% for 10-year CVD risk for intermediate risk) for some subgroups. Conclusions Consideration of aPWV improves model fit and reclassifies risk for future CVD events in models that include standard risk factors. aPWV may enable better identification of high-risk populations that might benefit from more aggressive CVD risk factor management.


Leal C.,French Institute of Health and Medical Research | Leal C.,University Pierre and Marie Curie | Leal C.,EHESP School of Public Health | Bean K.,Center dInvestigations Preventives et Cliniques | And 3 more authors.
Epidemiology | Year: 2011

Background: We investigated whether neighborhood socioeconomic characteristics, measured within person-centered areas (ie, centered on individuals' residences) are associated with body mass index (BMI [kg/m 2]) and waist circumference. We used propensityscore matching as a diagnostic and validation tool to examine whether socio-spatial segregation (and related structural confounding) allowed us to estimate neighborhood socioeconomic effects adjusted for individual socioeconomic characteristics without excessive model extrapolations. Methods: Using the RECORD (Residential Environment and CORonary heart Disease) Cohort Study, we conducted cross-sectional analyses of 7230 adults from the Paris region. We first estimated the relationships of 3 neighborhood socioeconomic indicators (education, income, real estate prices) with BMI and waist circumference using traditional multilevel regression models adjusted for individual covariates. Second, we examined whether these associations persisted when estimated among participants exchangeable based on their probability of living in low-socioeconomic-status neighborhoods (propensity-score matched samples). Copyright © 2011 by Lippincott Williams & Wilkins.


Leal C.,French Institute of Health and Medical Research | Leal C.,University Pierre and Marie Curie | Leal C.,EHESP School of Public Health | Bean K.,Center dInvestigations Preventives et Cliniques | And 3 more authors.
American Journal of Epidemiology | Year: 2012

Because of the strong correlations among neighborhoods' characteristics, it is not clear whether the associations of specific environmental exposures (e.g., densities of physical features and services) with obesity can be disentangled. Using data from the RECORD (Residential Environment and Coronary Heart Disease) Cohort Study (Paris, France, 20072008), the authors investigated whether neighborhood characteristics related to the sociodemographic, physical, service-related, and social-interactional environments were associated with body mass index and waist circumference. The authors developed an original neighborhood characteristic-matching technique (analyses within pairs of participants similarly exposed to an environmental variable) to assess whether or not these associations could be disentangled. After adjustment for individual/neighborhood socioeconomic variables, body mass index/waist circumference was negatively associated with characteristics of the physical/service environments reflecting higher densities (e.g., proportion of built surface, densities of shops selling fruits/vegetables, and restaurants). Multiple adjustment models and the neighborhood characteristic-matching technique were unable to identify which of these neighborhood variables were driving the associations because of high correlations between the environmental variables. Overall, beyond the socioeconomic environment, the physical and service environments may be associated with weight status, but it is difficult to disentangle the effects of strongly correlated environmental dimensions, even if they imply different causal mechanisms and interventions. © 2012 The Author.

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