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Neighbourhood greenness or vegetative presence has been associated with indicators of health and well-being, but its relationship to depression in older adults has been less studied. Understanding the role of environmental factors in depression may inform and complement traditional depression interventions, including both prevention and treatment.
This study examines the relationship between neighbourhood greenness and depression diagnoses among older adults in Miami-Dade County, Florida, USA.
Analyses examined 249 405 beneficiaries enrolled in Medicare, a USA federal health insurance programme for older adults. Participants were 65 years and older, living in the same Miami location across 2 years (2010–2011). Multilevel analyses assessed the relationship between neighbourhood greenness, assessed by average block-level normalised difference vegetative index via satellite imagery, and depression diagnosis using USA Medicare claims data. Covariates were individual age, gender, race/ethnicity, number of comorbid health conditions and neighbourhood median household income.
Over 9% of beneficiaries had a depression diagnosis. Higher levels of greenness were associated with lower odds of depression, even after adjusting for demographics and health comorbidities. When compared with individuals residing in the lowest tertile of greenness, individuals from the middle tertile (medium greenness) had 8% lower odds of depression (odds ratio 0.92; 95% CI 0.88, 0.96; P = 0.0004) and those from the high tertile (high greenness) had 16% lower odds of depression (odds ratio 0.84; 95% CI 0.79, 0.88; P < 0.0001).
Higher levels of greenness may reduce depression odds among older adults. Increasing greenery – even to moderate levels – may enhance individual-level approaches to promoting wellness.
None.
Background: While smoking rates in the United States have decreased, some population subgroups have smoking rates that exceed national and state averages. These higher rates often are associated with higher incidence rates of tobacco-associated cancers. Over time, a decrease in smoking rates leads to lower cancer incidence. Methods: Using spatial modelling techniques, we identified an underserved geographic locale in South Florida with higher than expected incidence rates of tobacco-associated cancers. We then used a community-based participatory research (CBPR) design to conduct focus groups in 2011 to elicit information about the acceptability of a smoking cessation intervention delivered by trained former smokers from within peer networks. Results: A variety of smoking cessation strategies was presented and discussed in separate, gender-stratified focus groups comprised of former and current smokers (n = 39). Focus group findings consistently indicated that support groups were the preferred cessation mechanism in this community. Based on this finding, we changed our initially proposed cessation approach to one which employed support groups as a quit method. Conclusions: Currently, we are collecting pilot data to test this intervention and to reach smokers who might not otherwise be directly targeted with cessation messaging from larger tobacco control initiatives. If successful, this strategy can be adapted to effect other important changes in health behaviours in at-risk populations.
Objectives: The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland.
Methods: Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care.
Results: The intervention strategy resulted in mean cost savings per patient of €512.77 (95 percent confidence interval [CI], −1086.46–91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, −0.0101–0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay €45,000 per additional QALY.
Conclusions: Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice.
This study aimed to explore how the views of patients with coronary heart disease (CHD) could inform the design of an information booklet aimed at providing patients and practitioners with a resource to help influence positive health behavioural outcomes.
Coronary heart disease has major consequences in terms of patient suffering and economic costs, with morbidity and mortality figures in the United Kingdom and the Republic of Ireland among the highest in Europe. Lifestyle behaviours such as smoking, eating an unhealthy diet and a lack of exercise are strongly associated with an increased CHD risk, and practitioners report that health education materials are used in practice to help advise and educate patients about the consequences of their lifestyle.
Opinions of patients with CHD were explored concerning their information needs, particularly lifestyle advice, using a qualitative approach in four general practices. This information was used to design a booklet for a pilot study aimed at promoting healthy lifestyle behaviours and medication adherence among people with CHD. Focus group discussions explored patients’ opinions about the booklet’s ‘fitness for purpose’; semi-structured interviews with practitioners examined their views on the booklet’s usefulness.
In initial focus groups, patients identified gaps in their information provision regarding coping with stress, available local community support and medication purpose. Previously published literature was modified to address these gaps. Patients in the pilot study were satisfied with the re-designed booklet. Practitioners reported that its use in consultations enabled change implementation and facilitated patients’ understanding of connections between lifestyle and health outcomes.
Acknowledging the opinions of CHD patients in producing health information booklets emphasized a patient-centred approach and therefore supported practitioner–patient partnerships for choosing healthy lifestyle choices.
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