University of Pittsburgh PHDL October 8, 2018 The Role of Place in Mental Health for Urban Adolescents: Adventures in the Exposome with Ecological Momentary Assessment Jeremy Mennis, Ph.D., GISP Department of Geography and Urban Studies Temple University
An Example: Poverty and Smoking Disadvantage (https://www.nytime “Tobacco and poverty s.com/2014/06/26/u pshot/where-are- are inextricably the-hardest-places- linked .” to-live-in-the- us.html) - (WHO, 2017) Smoking (https://www.nyti mes.com/interact ive/2014/03/25/u s/smoking-rate- map.html)
Compositional Mechanisms of Health Behaviors Compositional Individual Poverty Stress Smoking
Contextual Mechanisms of Health Behaviors Compositional Contextual Individual Tobacco Poverty Advertising Attitude Stress Smoking Smoking
Mediated and Moderated Contextual Mechanisms of Health Behaviors Compositional Contextual Individual Tobacco Poverty Advertising Age, Gender, Prior Experience Attitude Stress Family Support, Peer Support Smoking Smoking
How Does Place Influence Health Behavior? Social-Ecological Model • Through the physical, social, and emotional character of the places people encounter in their everyday lives; • As mediated by individuals’ interpretations of those places; • And where interpretations are molded by individual and social characteristics and prior experiences. (Bronfrenbrenner, 1979)
Place from a Humanistic Perspective Place may be said to have “spirit” or “personality” but only human beings can have a sense of place. – Yi Fu Tuan, 1977, Space and Place
The Collective Subjective Experience Matters Too If you think something's real, its consequences are real…shared perceptions of disorder lead to future rates of poverty. What this suggests is that perceptions, not just the reality of how many broken windows or broken beer bottles there are in the street really matter. – Robert Sampson, 2012, Governing
The Exposome “…every exposure to which an individual is subjected from conception to death” (Wild, 2010) (Wild, 2010)
Measuring the Exposome Measuring the exposome requires sampling at key periods of development (e.g. adolescence).
Activity Space (after Hagerstrand, 1970)
Activity Space (Torrens, http://www.geosimulation.org/space-time-analysis/) (after Hagerstrand, 1970)
How Do We Measure Place and Health Behavior? E cological Interviews/ M omentary Surveys A ssessment EMA ‘..allows subjects … to report repeatedly on their experiences in real-time, in real-world settings, over time and across contexts.’ (Shiffman et al., 2009)
How Do We Measure Place and Health Behavior? E cological Interviews/ M omentary Surveys A ssessment EMA ‘..allows subjects … to report repeatedly on their experiences in real-time, G eographic in real-world settings, over time and across I nformation contexts.’ (Shiffman et al., 2009) S ystems G lobal P ositioning S ystems
Geographic Ecological Momentary Assessment (GEMA) The integration of EMA with GPS and GIS to investigate contextual effects on mood and behavior. “…most useful for the study of ‘‘places’’ imbued with meaning by subjects – representing each subject’s personal eco-system .” (Kirchner and Shiffman, 2016)
The Social-Spatial Adolescent Study • A two year longitudinal study of the interacting effects of peer networks and activity space on teen substance use (with M. Mason (PI), J. Light, J. Rusby, E. Westling, T. Way, N. Zaharakis, NIH #R01DA031724-02) • Adolescence is a key developmental period when youth often experiment with drugs and alcohol for the first time. Adolescents are particularly susceptible to peer (and place) influences on risky behaviors. • Substance use in adolescence can impact brain development and social functioning, is associated with other unhealthy behaviors, can negatively affect school performance, and can lead to drug dependence in adulthood (Squeglia et al., 2009; Pardini et al., 2015) .
Description of the Sample • 248 adolescents enrolled o Recruitment: Primarily from an outpatient medical clinic o Criteria: Ages 13-14, residing in Richmond, VA area • Gender o 57% female, 43% male • Race o 88% African American, 9% other, 3% white
Full Battery Assessment At enrollment and every 6 months after • Substance Use o Alcohol and Drug Involvement Scale (AADIS) (Moberg and Hahn, 1991) • Social Networks o Adolescent Social Network Assessment (ASNA) (Mason et al., 2004) • Other Measures Family, school, depression, anxiety, … (BASC, YRBS, …) o
Geographic Ecological Momentary Assessment • Each subject was provided with an LG mobile phone with embedded GPS • EMA delivery schedule o Delivered via text message with URL link o Every two months following enrollment o Thursday-Sunday, 4-6 EMAs / day • Survey Items and Location o Place, mood, behavior, social interactions, GPS position
Example Activity Space and Happiness for One Subject (spatially randomized) Wave 1 Wave 2 Wave 4 Wave 5 Wave 3
Geographic Data Crime Socioeconomic Percent Receiving Index of Assaults by Public Assistance Tract Income by Tract
Research 1: Neighborhood Disadvantage, Substance Use, and Stress
Research 1: Neighborhood Disadvantage, Stress, and Substance Use • Exposure to neighborhood disadvantage is psychologically stressful (Latkin and Curry, 2003). • Substance use can serve as a coping mechanism for stressful and unsafe environments (Jackson et al., 2009) . • Observational studies have been largely limited to residential measures of neighborhood disadvantage and recall-based measures of stress and safety.
Research 1: Neighborhood Disadvantage, Stress, and Substance Use • Exposure to neighborhood disadvantage is psychologically stressful (Latkin and Curry, 2003). • Substance use can serve as a coping mechanism for stressful and unsafe environments (Jackson et al., 2009) . • Observational studies have been largely limited to residential measures of neighborhood disadvantage and recall-based measures of stress and safety. • Research Questions: o Is exposure to neighborhood disadvantage in the activity space associated with momentary stress and perceived safety? o Does the association of exposure to neighborhood disadvantage with momentary stress and perceived safety differ between substance users and non-users?
Measures (data over first year) • Demographics • Age, sex, race (African American or not) • Substance Use • AADIS continuous measure of substance use involvement • Stress and Safety • “How stressed out are you right now?” (1 -9 scale) • “How safe are you right now?” (1 -9 scale) • Relative Neighborhood Disadvantage • Index of poverty, female headed HH, education, owner occupied • Relative Disadvantage = Momentary – Home Disadvantage
Measures (data over first year) • Demographics • Age, sex, race (African American or not) • Substance Use • AADIS continuous measure of substance use involvement • Stress and Safety • “How stressed out are you right now?” (1 -9 scale) • “How safe are you right now?” (1 -9 scale) • Relative Neighborhood Disadvantage • Index of poverty, female headed HH, education, owner occupied • Relative Disadvantage = Momentary – Home Disadvantage
Analytic Plan • Generalized Estimating Equations (GEE) o Controlling for within-person o Estimate the effect of neighborhood disadvantage on substance use, stress, and safety, while adjusting for age, sex, and race • Models: o Direct effects o Moderation: Neighborhood disadvantage effect on stress and safety moderated by substance use
Summary of Research 1 Findings • Relative neighborhood disadvantage is associated with substance use. • Relative neighborhood disadvantage and substance use are both associated with higher stress and lower perceived safety. • The association of relative neighborhood disadvantage with stress (but not safety) is stronger for substance users.
The Effect of Relative Neighborhood Disadvantage on Stress: Moderation by Substance Use
Research 2: Urban Greenspace and Stress
Research 2: Urban Greenspace and Stress • Cities can be stressful places due to noise and crowding, (Lambert et al., 2015) . • Exposure to urban greenspace can reduce stress, and enhance memory span and mood, via attention restoration (Bratman et al., 2015) . • Observational studies have been limited to residential measures of greenspace exposure and asynchronous measures of stress.
Research 2: Urban Greenspace and Stress • Cities can be stressful places due to noise and crowding, (Lambert et al., 2015) . • Exposure to urban greenspace can reduce stress, and enhance memory span and mood, via attention restoration (Bratman et al., 2015) . • Observational studies have been limited to residential measures of greenspace exposure and asynchronous measures of stress. • Research Questions: o Is exposure to urban greenspace in the residential location and activity space associated with lower stress? o Does the association of exposure to urban greenspace with momentary stress differ according to the characteristics of the individual adolescent and environmental context of the observation?
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