Optimising methods for measuring effects of neighbourhood environments on diet, physical activity, smoking & alcohol intake in older people in the UK

这项研究的背景和潜在好处：吸烟、不良饮食、缺乏体育活动和酗酒是各种可预防的慢性病的众所周知的风险因素。据估计，包括心脏病在内的30%以上的循环系统疾病死亡是可以避免的，主要是通过戒烟、改善饮食和增加体力活动相结合(世卫组织)。虽然人的个体特征很重要，但人们越来越认识到，我们生活的环境也会影响我们的健康行为。塑造赋予和鼓励健康行为的邻里环境被认为是公共卫生政策的一种基本方法，并与英格兰地方公共卫生服务机构未来的搬迁越来越相关。然而，对于影响我们健康相关行为的当地邻里环境的哪些关键方面，几乎没有达成共识。它仍然是一个相对较新和不断发展的研究领域。需要进一步发展，以提高研究方法的技术质量，了解特定环境因素与不同人口群体(即儿童、工作和非工作的成年人、老年人)的相关性，以及它们对加强我们对饮食、体力活动和其他行为变化的了解的作用。这对疾病预防和决定未来卫生政策和干预措施的目标位置有影响。这项研究是新颖而重要的，因为它旨在对英国影响心血管疾病四个重要行为风险因素的邻里环境特征进行最全面的评估，并侧重于老年人(65岁以上)的健康行为和结果，这些研究方法很少应用于这一年龄组。老年人的健康可能特别容易受到当地社区的影响，因为由于个人健康和流动性因素，他们的能力和长途旅行的动力可能会降低。目的和目的：拟议研究的主要目的是了解不同邻里水平的环境因素(如建筑环境、犯罪率、娱乐空间的通达性、商店的通达性和食品的价格、医疗保健和其他服务的位置)如何影响个人的健康行为和心血管疾病风险。该项目将专门调查哪些地方环境水平因素会影响英国城市地区老年男女的烟酒使用、营养、体育活动和肥胖风险。这项研究将使用并比较一系列不同的研究方法来调查邻里环境对健康的影响。作为英国22个研究城镇正在进行的两项针对老年男性和女性的全国性研究的一部分，个人调查已经收集了4000多名老年人的生活方式、行为和健康数据。此外，将使用3种方法收集这些老年人居住的22个城镇的当地邻里环境数据(收集常规当地数据、新收集的街坊地貌调查数据和使用远程成像技术--如谷歌街景--收集的新数据)。这些信息将使我们能够比较个人、家庭或地方社区层面上的不同因素对吸烟、饮酒、饮食、体力活动和超重风险的影响，并确定哪些环境指标是这些行为的最强决定因素。这一结果应该有助于设计更有效的公共卫生政策，以改善健康的生活方式，预防心血管疾病。

Context and potential benefits of the research: Smoking, poor diet, lack of physical activity and high alcohol consumption are well known risk factors for a variety of preventable chronic diseases. It has been estimated that over 30% of deaths from circulatory disease, including heart disease, could be avoided, mainly through a combination of stopping smoking, improving diet and increasing physical activity (WHO). While characteristics of individual people are important, there is growing recognition that the environments in which we live also affect our health behaviours. The shaping of neighbourhood environments that empower and encourage healthy behaviours is recognised as an essential approach to public health policy, and is increasingly relevant with the future relocation of local public health services into local authorities in England. However, there is little consensus on what are the key aspects of the local neighbourhood environment that influence our health-related behaviours. It is still a relatively new and evolving field of research. Further development is needed to improve the technical quality of the research methods, understand the relevance of specific environmental factors to different population groups (ie children, working and non-working adults, old people) and their utility for enhancing our understanding of variations in diet, physical activity and other behaviours. This has implications for disease prevention and deciding where future health policy and interventions should be targeted. This study is novel and important as it aims to conduct the most comprehensive assessment of characteristics of neighbourhood environments in the UK that influence four important behavioural risk factors for CVD, and focuses on the health behaviours and outcomes of older people (over 65 years), an age group for which these study approaches have rarely been applied. The health of older adults may be particularly vulnerable to the impacts of their local neighbourhood as they are likely to have reduced capacity and motivation to travel longer distances due to personal health and mobility factors. Aims and Objectives: The main aim of the proposed research is understanding how different neighbourhood-level environmental factors (e.g. built environment, crime levels, access to recreational space, access to shops and price of food, location of healthcare and other services) influence individual health behaviours and cardiovascular disease risk. This project will specifically investigate which local environmental level factors influence tobacco and alcohol use, nutrition, physical activity and risk of obesity in older men and women living in urban areas across the UK. This study will use and compare a range of different research methods to investigate the effect of the neighbourhood environment on health. Data on the lifestyles, behaviours and health of over 4000 older people has already been collected by individual surveys as part of two ongoing national studies of older men and women in the 22 UK study towns. In addition, data on the local neighbourhood environment in the 22 towns where these older people live will be collected using 3 approaches (collecting routine local data, newly collected data from surveying the physical features of the neighbourhood at street level, and new data collected using remote imaging technology- such as google street view). This information will allow us to compare how different factors at individual, household or local community level impact on smoking, alcohol intake, diet, physical activity, and risk of overweight, and to identify which measures of the environment are the strongest determinants of these behaviours. The results should help design more effective public health policies to improve healthy liefstyles and prevent cardiovascular disease.