Absence of direct association between variables does not always mean no evidence of association: Indirect pathways between neighbourhood characteristics and physical activity

Conference paper


Watts, Paul, Phillips, Gemma and Renton, A. 2013. Absence of direct association between variables does not always mean no evidence of association: Indirect pathways between neighbourhood characteristics and physical activity. UEL Research and Knowledge Exchange Conference 2013. University of East London, London 26 Jun 2013 London University of East London.
AuthorsWatts, Paul, Phillips, Gemma and Renton, A.
TypeConference paper
Abstract

Background
There is a growing evidence base to suggest that neighbourhoods may support or constrain opportunities to lead healthy lifestyles through the influence of a range of social, cultural, structural and physical environment characteristics of neighbourhoods. These neighbourhood characteristics are seldom proposed to influence healthy behaviours such as physical activity directly, but are instead expected to trigger processes that may form part of chain of processes leading to influences more proximal to the individual. There are very few examples of studies that have investigated ‘indirect’ or ‘mediated’ pathways between neighbourhood characteristics and physical activity.
Understanding mediators of behaviour change is an important step in advancing theory and developing more effective interventions and is one of the most commonly made
recommendations for future research by reviewers of the literature. In the public health epidemiology literature and in other fields there has been much debate about the most appropriate methods for assessing ‘indirect’ or ‘mediated’ pathways between exposures and outcomes. One point consistently made in recent commentaries that where there is no direct association between an independent and dependant variable, this does not necessarily mean that there is no indirect association that operates through one or more mediating variable.
Methods
Quantitative analysis of correlations between a range of individual and neighbourhood characteristics and physical activity levels of residents in 40 deprived London neighbourhoods. Data on individual and neighbourhood characteristics was collected from household survey and physical environment audit data, Geographical Information Systems and routine data regarding physical characteristics the 40 neighbourhoods. Multilevel modelling in Stata 11 was used to examine associations between individual and neighbourhood characteristics and physical activity levels. The product of coefficient approach with bias-adjusted bootstrapped confidence intervals were used to estimate indirect effects.
Results
Mental wellbeing mediated indirect associations between neighbourhood characteristics and physical activity where there was no evidence of a direct effect. Safety and incivilities mediated indirect associations between crime and physical activity where there was no evidence of a direct effect. The strength of association for these indirect pathways translates into modest changes in physical activity levels.
Discussion
Evidence of indirect pathways between neighbourhood characteristics and physical activity were found in the absence of direct effects. This study demonstrates the importance of investigating the role of mediators in studies that where there is no evidence of direct associations between independent and dependant variables.

Keywordsmediation; indirect effects; physical activity
Year2013
ConferenceUEL Research and Knowledge Exchange Conference 2013
PublisherUniversity of East London
Publisher's version
Publication dates
Print26 Jun 2013
Publication process dates
Deposited10 Jun 2013
Place of publicationLondon
Permalink -

https://repository.uel.ac.uk/item/85wzv

  • 13
    total views
  • 7
    total downloads
  • 2
    views this month
  • 1
    downloads this month

Related outputs

The Impact of Academies on School Connectedness, Future Aspirations and Mental Health in Adolescents from Areas of Deprivation in London
Frostick, C., Tong, Jin, Moore, D., Renton, A. and Netuveli, G. 2018. The Impact of Academies on School Connectedness, Future Aspirations and Mental Health in Adolescents from Areas of Deprivation in London. Pastoral Care in Education. 36 (4), pp. 325-342.
Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations
Sawtell, Mary, Sweeney, L., Wiggins, Meg, Salisbury, C., Eldridge, Sandra, Greenberg, Lauren, Hunter, Rachael, Kaur, Inderjeet, McCourt, Christine, Hatherall, B., Findlay, G., Morris, Joanne, Reading, Sandra, Renton, A., Adekoya, Ruth, Green, Belinda, Harvey, Belinda, Latham, Sarah, Patel, Kanta, VanLessen, Logan and Harden, A. 2018. Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations. Trials. 19 (163).
Well London: Results of a community engagement approach to improving health among adolescents from areas of deprivation in London
Frostick, C., Watts, P., Netuveli, G., Renton, A. and Moore, D. 2017. Well London: Results of a community engagement approach to improving health among adolescents from areas of deprivation in London. Journal of Community Practice. 25 (2), pp. 235-252.
Clustering of lifestyle risk behaviours among residents of forty deprived neighbourhoods in London: lessons for targeting public health interventions
Watts, P., Buck, David, Netuveli, G. and Renton, A. 2015. Clustering of lifestyle risk behaviours among residents of forty deprived neighbourhoods in London: lessons for targeting public health interventions. Journal of Public Health. 38 (2), pp. 308-315.
Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?
Dowdy, David W., Rao, Mala, Singh, Prabal Vikram, Katyal, Anuradha, Samarth, Amit, Bergkvist, Sofi, Renton, A. and Netuveli, G. 2016. Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care? PLOS ONE. 11 (1), p. e0145707.
The Educational and Employment Aspirations of Adolescents from Areas of High Deprivation in London
Frostick, C., Phillips, G., Renton, A. and Moore, D. 2015. The Educational and Employment Aspirations of Adolescents from Areas of High Deprivation in London. Journal of Youth and Adolescence. 45 (6), pp. 1126-1140.
Internet Access at Home and its Relationship to Well-being in Deprived Areas of London
Boniwell, Ilona, Osin, Evgeny N. and Renton, A. 2015. Internet Access at Home and its Relationship to Well-being in Deprived Areas of London. Open Psychology Journal. 8 (1), pp. 44-53.
Strengthening primary health systems in India
Rao, M., Narasimhan, H., Bergkvist, Sofi, Singh, Prabal V., Anuradha, Katyal, Amit, Samarth, Katyal, Anuradha, Samarth, Amit, Kancharla, Manjusha, Wagstaff, Adam, Netuveli, G., Renton, A. and Boddu, V. 2015. Strengthening primary health systems in India. UK Data Archive. doi:10.15123/DATA.11
Measures of exposure to the Well London Phase-1 intervention and their association with health well-being and social outcomes
Phillips, G., Bottomley, Christian, Schmidt, Elena, Tobi, P., Lais, Shahana, Yu, Ge, Lynch, Rebecca, Lock, Karen, Draper, Alizon, Moore, D., Clow, Angela, Petticrew, Mark, Hayes, Richard and Renton, A. 2014. Measures of exposure to the Well London Phase-1 intervention and their association with health well-being and social outcomes. Journal of Epidemiology and Community Health. 68 (7), pp. 597-605.
Changes in addressing inequalities in access to hospital care in Andhra Pradesh and Maharashtra states of India: a difference-in-differences study using repeated cross-sectional surveys
Rao, M., Katyal, Anuradha, Singh, Prabal V., Samarth, Amit, Bergkvist, Sofi, Kancharla, Manjusha, Wagstaff, Adam, Netuveli, G. and Renton, A. 2014. Changes in addressing inequalities in access to hospital care in Andhra Pradesh and Maharashtra states of India: a difference-in-differences study using repeated cross-sectional surveys. BMJ Open. 4 (6), p. e004471.
'Well London' and the benefits of participation: results of a qualitative study nested in a cluster randomised trial
Derges, Jane, Clow, Angela, Lynch, Rebecca, Jain, Sumeet, Phillips, G., Petticrew, Mark, Renton, A. and Draper, Alizon 2014. 'Well London' and the benefits of participation: results of a qualitative study nested in a cluster randomised trial. BMJ Open. 4 (4), pp. e003596-e003596.
Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods
Phillips, G., Bottomley, Christian, Schmidt, Elena, Tobi, P., Lais, Shahana, Yu, Ge, Lynch, Rebecca, Lock, Karen, Draper, Alizon, Moore, D., Clow, Angela, Petticrew, Mark, Hayes, Richard and Renton, A. 2014. Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods. Journal of Epidemiology and Community Health.
Types of Social Capital and Mental Disorder in Deprived Urban Areas: A Multilevel Study of 40 Disadvantaged London Neighbourhoods
Bertotti, M., Watts, Paul, Netuveli, G., Yu, Ge, Schmidt, Elena, Tobi, P., Lais, Shahana and Renton, A. 2013. Types of Social Capital and Mental Disorder in Deprived Urban Areas: A Multilevel Study of 40 Disadvantaged London Neighbourhoods. PLOS ONE. 8 (12), p. e80127.
Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK
Cresswell, Jenny A, Yu, Ge, Hatherall, B., Morris, Joanne, Jamal, Farah, Harden, A. and Renton, A. 2013. Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK. BMC Pregnancy and Childbirth. 13 (1), p. 103.
Physical activity in deprived communities in London: examining individual and neighbourhood-level factors
Watts, Paul, Phillips, G., Petticrew, Mark, Hayes, Richard, Bottomley, Christian, Yu, Ge, Schmidt, Elena, Tobi, P., Moore, D., Frostick, C., Lock, Karen and Renton, A. 2013. Physical activity in deprived communities in London: examining individual and neighbourhood-level factors. PLOS ONE. 8 (7), p. e69472.
Energy, Development and Health Futures in Poorer Countries
Renton, A. 2013. Energy, Development and Health Futures in Poorer Countries. UEL Research and Knowledge Exchange Conference 2013. University of East London, London 26 Jun 2013 London University of East London.
Environmental interventions to reduce fear of crime: systematic review of effectiveness
Lorenc, Theo, Petticrew, Mark, Whitehead, Margaret, Neary, David, Clayton, Stephen, Wright, Kath, Thomson, Hilary, Cummins, Steven, Sowden, Amanda and Renton, A. 2013. Environmental interventions to reduce fear of crime: systematic review of effectiveness. Systematic Reviews. 2 (1), p. 30.
Fear of crime and the environment: systematic review of UK qualitative evidence
Lorenc, Theo, Petticrew, Mark, Whitehead, Margaret, Neary, David, Clayton, Stephen, Wright, Kath, Thomson, Hilary, Cummins, Steven, Sowden, Amanda and Renton, A. 2013. Fear of crime and the environment: systematic review of UK qualitative evidence. BMC Public Health. 13 (1), p. 496.
The Olympic Regeneration in East London (ORiEL) study: protocol for a prospective controlled quasi-experiment to evaluate the impact of urban regeneration on young people and their families
Smith, N. R., Clark, C., Fahy, A. E., Tharmaratnam, V., Lewis, D. J., Thompson, C., Renton, A., Moore, D., Bhui, K. S., Taylor, S. J. C., Eldridge, S., Petticrew, M., Greenhalgh, T., Stansfeld, S. A. and Cummins, S. 2012. The Olympic Regeneration in East London (ORiEL) study: protocol for a prospective controlled quasi-experiment to evaluate the impact of urban regeneration on young people and their families. BMJ Open. 2 (4), p. e001840.
Key barriers to community cohesion: views from residents of 20 London deprived neighbourhoods
Bertotti, M., Adams-Eaton, F., Sheridan, K. and Renton, A. 2011. Key barriers to community cohesion: views from residents of 20 London deprived neighbourhoods. GeoJournal. 47 (2), pp. 168-183.
The contribution of a social enterprise to the building of social capital in a disadvantaged urban area of London
Bertotti, M., Harden, A., Renton, A. and Sheridan, K. 2012. The contribution of a social enterprise to the building of social capital in a disadvantaged urban area of London. Community Development Journal. 47 (2), pp. 168-183.
Think of your art-eries: Arts participation, behavioural cardiovascular risk factors and mental well-being in deprived communities in London
Renton, A., Phillips, Gemma, Daykin, N, Yu, Ge, Taylor, K and Petticrew, Mark 2012. Think of your art-eries: Arts participation, behavioural cardiovascular risk factors and mental well-being in deprived communities in London. Public Health. 126 (Supp 1), pp. S57-S64.
A multilevel analysis of the association between social networks and support on leisure time physical activity: evidence from 40 disadvantaged areas in London
Yu, Ge, Renton, A., Schmidt, Elena, Tobi, Patrick, Bertotti, M., Watts, P. and Lais, Shahana 2011. A multilevel analysis of the association between social networks and support on leisure time physical activity: evidence from 40 disadvantaged areas in London. Health & Place. 17 (5), pp. 1023-1029.
The Well London program - a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results
Phillips, G., Renton, A., Moore, D., Bottomley, Christian, Schmidt, Elena, Lais, Shahana, Yu, Ge, Wall, Martin, Tobi, P., Frostick, C., Clow, Angela, Lock, Karen, Petticrew, Mark and Hayes, Richard 2012. The Well London program - a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results. Trials. 13 (105).
The influence of environmental factors on the generalisability of public health research evidence: physical activity as a worked example
Watts, P., Phillips, Gemma, Harden, A. and Renton, A. 2011. The influence of environmental factors on the generalisability of public health research evidence: physical activity as a worked example. International Journal of Behavioural Nutrition and Physical Activity. 8 (1), pp. 1479-5868.
Antiretroviral treatment and the health workforce in South Africa: how have ART workers been affected by scaling up?
Tobi, Patrick, George, Gavin, Schmidt, Elena and Renton, A. 2008. Antiretroviral treatment and the health workforce in South Africa: how have ART workers been affected by scaling up? Tropical Medicine and International Health. 13 (12), pp. 1452-1458.
Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial
Wall, Martin, Hayes, Richard, Moore, D., Petticrew, Mark, Clow, Angela, Schmidt, Elena, Draper, Alizon, Lock, Karen, Lynch, Rebecca and Renton, A. 2009. Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial. BMC Public Health. 9 (207).