Perceived Neighborhood Environment and Its Association with Health Screening and Exercise Participation amongst Low-Income Public Rental Flat Residents in Singapore
Abstract
:1. Introduction
2. Methodology
2.1. Study Population
2.2. Study Methodology
2.2.1. Baseline Information
2.2.2. Perceptions of the Neighborhood Environment
2.3. Statistical Analysis
2.4. Ethics Approval
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Overall Neighborhood Perception | |||
---|---|---|---|
Geographical, Sociodemographic, Medical, and Social Factors | Less Disadvantaged (n = 361) n (%) 1 | More Disadvantaged (n = 167) (n %) 1 | OR (95% CI) |
Geographical | |||
Site | |||
Staying in a mixed block | 171 (73.1) | 63 (26.9) | 1.00 |
Staying in a stand-alone block | 190 (64.6) | 10 (35.4) | 1.49 (1.02–2.16) * |
Stayed in neighborhood for >8 years | |||
No | 223 (72.9) | 83 (27.1) | 1.00 |
Yes | 138 (62.2) | 84 (37.8) | 1.64 (1.13–2.37) * |
Staying in rental apartment vs. owner-occupied | |||
Owner-occupied | 191 (75.8) | 61 (24.2) | 1.00 |
Rental | 170 (61.6) | 106 (38.4) | 1.95 (1.34–2.85) *** |
Number of rooms | |||
3 rooms or smaller | 240 (65.4) | 127 (34.6) | 1.00 |
4–5 rooms | 121 (75.2) | 40 (24.8) | 0.63 (0.41–0.95) * |
Socio-demographic | |||
Gender | |||
Female | 211 (68.5) | 97 (31.5) | 1.00 |
Male | 150 (68.2) | 70 (31.8) | 1.02 (0.70–1.47) |
Marital status | |||
Not married | 141 (58.8) | 99 (41.2) | 1.00 |
Married | 220 (76.4) | 68 (23.6) | 0.44 (0.30–0.64) *** |
Religious | |||
No | 101 (60.8) | 65 (39.2) | 1.00 |
Yes | 260 (71.8) | 102 (28.2) | 0.61 (0.41–0.90) * |
Age | |||
Age 60–75 years | 175 (72.6) | 66 (27.4) | 1.00 |
Age ≥75 years | 186 (64.8) | 101 (35.2) | 1.14 (0.99–2.09) |
Currently employed | |||
No | 192 (66.2) | 98 (33.8) | 1.00 |
Yes | 169 (71.0) | 69 (29.0) | 0.80 (0.55–1.16) |
Education | |||
Secondary and below | 109 (69.0) | 49 (31.0) | 1.00 |
Post-secondary and above | 252 (68.1) | 118 (31.9) | 1.04 (0.70–1.56) |
Number of people in household | |||
2 or less people | 211 (72.0) | 82 (28.0) | 1.00 |
3 or more people | 150 (63.8) | 85 (36.2) | 1.46 (1.01–2.11) * |
Average household income | |||
≤$1500/month | 229 (65.6) | 120 (34.4) | 1.00 |
>$1500/month | 132 (73.7) | 47 (26.3) | 0.68 (0.46–1.01) |
Medical and functional status | |||
Comorbidity (Charlson Comorbidity Index) | |||
CCMI = 0 | 280 (71.1) | 114 (28.9) | 1.00 |
CCMI ≥ 1 | 81 (60.4) | 53 (39.6) | 1.61 (1.07–2.42) * |
Chronic pain (pain >6 months) | |||
No | 318 (67.9) | 150 (32.1) | 1.00 |
Yes | 43 (71.7) | 17 (28.3) | 0.84 (0.46–1.52) |
Anxiety/mood issues | |||
No | 335 (68.4) | 155 (31.6) | 1.00 |
Yes | 26 (68.4) | 12 (31.6) | 1.00 (0.49–2.03) |
Functional status (basic activities of daily living) | |||
Dependent in at least 1 bADL | 9 (52.9) | 8 (47.1) | 1.00 |
Independent in all bADLs | 352 (68.9) | 159 (31.1) | 0.51 (0.19–1.34) |
Social network | |||
Has caregiver | |||
No | 297 (70.7) | 123 (29.3) | 1.00 |
Yes | 64 (59.3) | 44 (40.7) | 1.66 (1.08–2.57) * |
Social isolation (Lubben Social Network Score-6) | |||
No (LSNS < 12) | 166 (77.9) | 47 (22.1) | 1.00 |
Yes (LSNS ≥ 12) | 195 (61.9) | 120 (38.1) | 2.17 (1.46–3.23) *** |
Loneliness (UCLA Loneliness Scale) | |||
No (<6) | 288 (71.8) | 113 (28.2) | 1.00 |
Yes (≥6) | 73 (57.5) | 54 (42.5) | 1.89 (1.25–2.85) ** |
Principal Components Analysis (Perceived Safety and Convenience; Perceived Physical Environment; Perceived Proximity to Recreational Areas) | ||||||
---|---|---|---|---|---|---|
Geographical, Sociodemographic, Medical, and Social Factors | Less Safe and Convenient (n = 248) 1 | OR (95% CI) | Poorer Physical Environment (n = 162) 1 | OR (95% CI) | Lower Perceived Proximity to Recreational Areas (n = 203) 1 | OR (95% CI) |
Geographical | ||||||
Site | ||||||
Staying in a mixed block | 102 (43.6) | 1.00 | 57 (24.4) | 1.00 | 72 (30.8) | 1.00 |
Staying in a stand-alone block | 146 (49.7) | 1.12 (0.96–1.31) | 105 (35.7) | 1.73 (1.18–2.53) ** | 131 (44.6) | 1.80 (1.26–2.59) ** |
Stayed in neighborhood for >8 years | ||||||
No | 130 (42.5) | 1.00 | 84 (27.5) | 1.00 | 101 (33.0) | 1.00 |
Yes | 118 (53.2) | 1.23 (1.04–1.46) * | 78 (35.1) | 1.43 (0.99–2.08) | 102 (45.9) | 1.73 (1.21–2.46) ** |
Staying in rental apartment vs. owner-occupied | ||||||
Owner-occupied | 101 (40.1) | 1.00 | 65 (25.8) | 1.00 | 86 (34.1) | 1.00 |
Rental | 147 (53.3) | 1.28 (1.09–1.51) ** | 97 (35.1) | 1.56 (1.07–2.27) * | 117 (42.4) | 1.42 (1.01–2.02) * |
Number of rooms | ||||||
3 rooms or smaller | 180 (49.0) | 1.00 | 118 (32.2) | 1.00 | 154 (42.0) | 1.00 |
4–5 rooms | 68 (42.2) | 0.88 (0.75–1.04) | 44 (27.3) | 0.79 (0.53–1.20) | 49 (30.4) | 0.61 (0.41–0.90) * |
Socio-demographic | ||||||
Gender | ||||||
Female | 145 (47.1) | 1.00 | 105 (34.1) | 1.00 | 124 (40.3) | 1.00 |
Male | 103 (46.8) | 1.00 (0.85–1.17) | 57 (25.9) | 0.68 (0.46–0.99) * | 79 (35.9) | 0.83 (0.58–1.20) |
Marital status | ||||||
Not married | 132 (55.0) | 1.00 | 74 (30.8) | 1.00 | 97 (40.4) | 1.00 |
Married | 116 (40.3) | 0.75 (0.64–0.89) *** | 88 (30.6) | 0.99 (0.68–1.43) | 106 (36.8) | 0.86 (0.60–1.22) |
Religious | ||||||
No | 93 (56.0) | 1.00 | 57 (34.3) | 1.00 | 71 (42.8) | 1.00 |
Yes | 155 (42.8) | 0.77 (0.63–0.93) ** | 105 (29.0) | 0.78 (0.53–1.16) | 132 (36.5) | 0.77 (0.53–1.12) |
Age | ||||||
Age 60–75 years | 105 (43.6) | 1.00 | 78 (32.4) | 1.00 | 75 (31.1) | 1.00 |
Age ≥75 years | 143 (49.8) | 1.12 (0.96–1.32) | 84 (29.3) | 0.87 (0.60–1.25) | 128 (44.6) | 1.78 (1.25–2.55) ** |
Currently employed | ||||||
No | 143 (49.3) | 1.00 | 82 (28.3) | 1.00 | 120 (41.4) | 1.00 |
Yes | 105 (44.1) | 0.91 (0.77–1.07) | 80 (33.6) | 1.28 (0.89–1.86) | 83 (34.9) | 76 (0.53–1.08) |
Education | ||||||
Secondary and below | 79 (50.0) | 1.00 | 48 (30.4) | 1.00 | 68 (43.0) | 1.00 |
Post-secondary and above | 169 (45.7) | 0.92 (0.78–1.10) | 114 (30.8) | 1.02 (0.68–1.53) | 135 (36.5) | 0.76 (0.52–1.11) |
Number of people in household | ||||||
2 or less people | 131 (44.7) | 1.00 | 88 (30.0) | 1.00 | 105 (35.8) | 1.00 |
3 or more people | 117 (49.8) | 1.10 (0.94–1.30) | 74 (31.5) | 1.08 (0.74–1.55) | 98 (41.7) | 1.28 (0.90–1.82) |
Average household income | ||||||
≤$1500/month | 176 (50.4) | 1.00 | 111 (31.8) | 1.00 | 148 (42.4) | 1.00 |
>$1500/month | 72 (40.2) | 0.83 (0.71–0.97) * | 51 (28.5) | 0.85 (0.58–1.27) | 55 (30.7) | 0.60 (0.41–0.88) * |
Medical and functional status | ||||||
Comorbidity (Charlson Comorbidity Index) | ||||||
CCMI = 0 | 179 (45.4) | 1.00 | 125 (31.7) | 1.00 | 141 (35.8) | 1.00 |
CCMI ≥ 1 | 69 (51.5) | 1.12 (0.92–1.37) | 37 (27.6) | 0.82 (0.53–1.27) | 62 (46.3) | 1.55 (1.04–2.30) * |
Chronic pain (pain >6 months) | ||||||
No | 220 (47.0) | 1.00 | 141 (30.1) | 1.00 | 173 (37.0) | 1.00 |
Yes | 28 (46.7) | 0.99 (0.77–1.28) | 21 (35.0) | 1.25 (0.71–2.20) | 30 (50.0) | 1.71 (0.99–2.93) |
Anxiety/mood issues | ||||||
No | 227 (46.3) | 1.00 | 147 (30.0) | 1.00 | 190 (38.8) | 1.00 |
Yes | 21 (55.3) | 1.20 (0.84–1.73) | 15 (39.5) | 1.52 (0.77–3.00) | 13 (34.2) | 0.82 (0.41–1.64) |
Functional status (basic activities of daily living) | ||||||
Dependent in at least 1 bADL | 11 (64.7) | 1.00 | 5 (29.4) | 1.00 | 9 (52.9) | 1.00 |
Independent in all bADLs | 237 (46.4) | 0.66 (0.34–1.26) | 157 (30.7) | 1.07 (0.37–3.07) | 194 (38.0) | 0.54 (0.21–1.43) |
Social network | ||||||
Has caregiver | ||||||
No | 190 (45.2) | 1.00 | 138 (32.9) | 1.00 | 164 (39.0) | 1.00 |
Yes | 58 (53.7) | 1.18 (0.95–1.48) | 24 (22.2) | 0.58 (0.36–0.96) * | 39 (36.1) | 0.88 (0.57–1.37) |
Social isolation (Lubben Social Network Score-6) | ||||||
No (LSNS < 12) | 82 (38.5) | 1.00 | 73 (34.3) | 1.00 | 72 (33.8) | 1.00 |
Yes (LSNS ≥ 12) | 166 (52.7) | 1.30 (1.11–1.52) *** | 89 (28.3) | 0.76 (0.52–1.10) | 131 (41.6) | 1.39 (0.97–2.00) |
Loneliness (UCLA Loneliness Scale) | ||||||
No (<6) | 175 (43.6) | 1.00 | 132 (32.9) | 1.00 | 150 (37.4) | 1.00 |
Yes (≥6) | 73 (57.5) | 1.33 (1.07–1.65) ** | 30 (23.6) | 0.63 (0.40–1.00) | 53 (41.7) | 1.20 (0.80–1.80) |
Overall Neighborhood Perception | ||
---|---|---|
Perception of Neighborhood Environment as More Disadvantaged | Adjusted Odds Ratio, aOR (95% CI) 1,2 | p-Value |
Staying in rental apartment block vs. owner-occupied apartment block | ||
Owner-occupied | 1.00 | 0.024 |
Rental apartment | 1.58 (1.06–2.35) | |
Marital status | ||
Not married | 1.00 | <0.001 |
Married | 0.49 (0.33–0.73) | |
Social isolation (Lubben Social Network Score-6) | ||
No (LSNS < 12) | 1.00 | <0.001 |
Yes (LSNS ≥ 12) | 2.04 (1.36–3.01) | |
Perceived neighborhood safety; physical living environment; proximity to recreational areas | ||
Perception of neighborhood environment as less safe and convenient | Adjusted odds ratio, aOR (95% CI) 1,3 | p-value |
Staying in rental apartment block vs. owner-occupied apartment block | ||
Owner-occupied | 1.00 | 0.046 |
Rental apartment | 1.44 (1.01–2.08) | |
Marital status | ||
Not married | 1.00 | 0.004 |
Married | 0.60 (0.42–0.85) | |
Social isolation (Lubben Social Network Score-6) | ||
No (LSNS < 12) | 1.00 | 0.004 |
Yes (LSNS ≥ 12) | 1.69(1.18–2.43) | |
Perception of poorer physical environment | Adjusted odds ratio, aOR (95% CI) 1,4 | p-value |
Site | ||
Staying in mixed development | 1.00 | 0.003 |
Staying in stand-alone block | 1.81 (1.22–2.68) | |
Gender | ||
Male | 1.00 | 0.016 |
Female | 1.61 (1.09–2.38) | |
Has a caregiver | ||
No caregiver | 1.00 | 0.030 |
Has a caregiver | 0.57 (0.35–0.95) | |
Perceived lower proximity to recreational areas | Adjusted odds ratio, aOR (95% CI) 1,5 | p-value |
Site | ||
Staying in mixed development | 1.00 | 0.006 |
Staying in stand-alone block | 1.14 (1.04–1.25) | |
Age | ||
Age 60–75 years | 1.00 | 0.008 |
Age ≥75 years | 1.64 (1.14–2.36) |
Overall Neighborhood Perception | Principal Components Analysis (Perceived Safety and Convenience; Perceived Physical Environment; Perceived Proximity to Recreational Areas) | ||||||||
---|---|---|---|---|---|---|---|---|---|
Perception of Neighborhood Environment | Less Disadvantaged (n = 361) n (%) | More Disadvantaged (n = 167) (n %) | OR (95% CI) | Less Safe and Convenient (n = 248) | OR (95% CI) | Poorer Living Environment (n = 162) | OR (95% CI) | Lower Perceived Proximity to Recreational Areas (n = 203) | OR (95% CI) |
Health screening participation | |||||||||
Regular diabetes screening in non-diabetics | |||||||||
Not going for regular screening | 128 (64.6) | 70 (35.4) | 1.00 | 100 (50.5) | 1.00 | 57 (28.8) | 1.00 | 70 (35.4) | 1.00 |
Going for regular screening | 181 (73.9) | 64 (26.1) | 0.65 (0.43–0.97) * | 104 (42.4) | 0.86 (0.72–1.03) | 80 (32.7) | 1.20 (0.80–1.80) | 93 (38.0) | 1.12 (0.76–1.65) |
Regular hyperlipidemia screening in non-dyslipidemics | |||||||||
Not going for regular screening | 112 (65.5) | 59 (34.5) | 1.00 | 85 (49.7) | 1.00 | 44 (25.7) | 1.00 | 61 (35.7) | 1.00 |
Going for regular screening | 115 (74.2) | 40 (25.8) | 0.66 (0.41–1.07) | 64 (41.3) | 0.86 (0.70–1.05) | 55 (35.5) | 1.59 (0.99–2.55) | 49 (31.6) | 0.83 (0.53–1.32) |
Regular blood pressure screening in non-hypertensives | |||||||||
Not going for regular screening | 84 (74.3) | 29 (25.7) | 1.00 | 47 (41.6) | 1.00 | 36 (31.9) | 1.00 | 47 (41.6) | 1.00 |
Going for regular screening | 157 (69.2) | 70 (30.8) | 1.29 (0.78–2.15) | 106 (46.7) | 1.10 (0.90–1.34) | 79 (34.8) | 1.14 (0.71–1.85) | 79 (34.8) | 0.75 (0.47–1.19) |
Regular pap smear in females | |||||||||
Not going for regular screening | 160 (65.8) | 83 (34.2) | 1.00 | 120 (49.4) | 1.00 | 80 (32.9) | 1.00 | 103 (42.4) | 1.00 |
Going for regular screening | 51 (78.5) | 14 (21.5) | 0.53 (0.28–1.01) | 25 (38.5) | 0.82 (0.65–1.03) | 25 (38.5) | 1.27 (0.72–2.25) | 21 (32.3) | 0.65 (0.36–1.16) |
Regular mammogram in females aged 40–65 years | |||||||||
Not going for regular screening | 92 (75.4) | 30 (24.6) | 1.00 | 50 (41.0) | 1.00 | 44 (36.1) | 1.00 | 44 (36.1) | 1.00 |
Going for regular screening | 22 (71.0) | 9 (29.0) | 1.26 (0.52–3.02) | 15 (48.4) | 1.14 (0.80–1.67) | 10 (32.3) | 0.84 (0.36–1.95) | 10 (32.3) | 0.84 (0.37–1.95) |
Exercise participation | |||||||||
Exercise regularly (at least 30 mins, 5 or more times a week) | |||||||||
No | 168 (63.9) | 95 (36.1) | 1.00 | 139 (52.8) | 1.00 | 77 (29.3) | 1.00 | 107 (40.7) | 1.00 |
Yes | 193 (72.8) | 72 (27.2) | 0.66 (0.46–0.96) * | 109 (41.1) | 0.80 (0.68–0.94) ** | 85 (32.1) | 1.14 (0.79–1.65) | 96 (36.2) | 0.83 (0.58–1.18) |
Participating in Regular Exercise (at Least 30 mins, 5 or More Times a Week) | Adjusted Odds Ratio, aOR (95% CI) 1,2 | p-Value |
---|---|---|
Geographic Factors | ||
Perception of neighborhood environment | ||
Less disadvantaged | 1.00 | 0.045 |
More disadvantaged | 0.67 (0.45–0.98) | |
Number of rooms | ||
3 rooms or smaller | 1.00 | 0.012 |
4-5 rooms | 1.67 (1.12–2.49) | |
Demographic factors | ||
Age | ||
Age 60–75 years | 1.00 | <0.001 |
Age ≥75 years | 1.91 (1.32–2.78) | |
Medical factors | ||
Chronic pain (pain >6 months) | ||
No chronic pain | 1.00 | 0.024 |
Has chronic pain | 0.51 (0.29–0.92) | |
Social factors | ||
Participate in community activities | ||
Not participating actively in community activities | 1.00 | 0.005 |
Participating actively in community activities | 1.71 (1.18–2.50) | |
Social isolation (Lubben Social Network Score-6) | ||
No (LSNS < 12) | 1.00 | 0.043 |
Yes (LSNS ≥ 12) | 0.68 (0.47–0.98) | |
Geographic factors | ||
Perception of neighborhood environment | ||
Less disadvantaged | 1.00 | 0.027 |
More disadvantaged | 0.63 (0.41–0.95) | |
Medical factors | ||
On regular medical follow-up | ||
No | 1.00 | 0.047 |
Yes | 1.48 (1.01–2.18) | |
Has dyslipidemia | ||
No | 1.00 | 0.011 |
Yes | 1.72 (1.13–2.62) | |
In a state of perfect self-reported health (EQ5D) | ||
No | 1.00 | 0.023 |
Yes | 0.62 (0.41–0.94) |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Wee, L.E.; Tsang, Y.Y.T.; Tay, S.M.; Cheah, A.; Puhaindran, M.; Yee, J.; Lee, S.; Oen, K.; Koh, C.H.G. Perceived Neighborhood Environment and Its Association with Health Screening and Exercise Participation amongst Low-Income Public Rental Flat Residents in Singapore. Int. J. Environ. Res. Public Health 2019, 16, 1384. https://doi.org/10.3390/ijerph16081384
Wee LE, Tsang YYT, Tay SM, Cheah A, Puhaindran M, Yee J, Lee S, Oen K, Koh CHG. Perceived Neighborhood Environment and Its Association with Health Screening and Exercise Participation amongst Low-Income Public Rental Flat Residents in Singapore. International Journal of Environmental Research and Public Health. 2019; 16(8):1384. https://doi.org/10.3390/ijerph16081384
Chicago/Turabian StyleWee, Liang En, Yun Ying Tammy Tsang, Sook Muay Tay, Andre Cheah, Mark Puhaindran, Jaime Yee, Shannon Lee, Kellynn Oen, and Choon Huat Gerald Koh. 2019. "Perceived Neighborhood Environment and Its Association with Health Screening and Exercise Participation amongst Low-Income Public Rental Flat Residents in Singapore" International Journal of Environmental Research and Public Health 16, no. 8: 1384. https://doi.org/10.3390/ijerph16081384