AbstractsMedical & Health Science

Contextual determinants of chronic diseases: cardiovascular disease and cancer

by Ayesha Rana

Institution: McMaster University
Degree: MSc
Year: 2014
Record ID: 2025453
Full text PDF: http://hdl.handle.net/11375/15971


Background: In Canada, cardiovascular disease (CVD) and cancer are the leading causes of mortality and morbidity in adults. Research in health geography has established the importance of contextual factors (e.g., community nutrition, and physical activity environments) as significant contributors to CVD and cancer. Objectives: The objectives of this project are to: 1) systematically review the Canadian literature on the effects of contextual exposures on chronic diseases (CVD and cancer); 2) develop a method of assessment of measuring key contextual factors; and 3) explore the variations in contextual characteristics of urban and rural areas using the pilot data collected by a Canada-wide cohort study (CVCD Alliance). Methods: Objective (1): MEDLINE, EMBASE, and CINAHL databases, and reference list of articles were searched from inception through Jan 20, 2014. English language human studies, conducted in Canada, that relate to contextual factors/built environment and chronic diseases were eligible for inclusion. Objective (2): EPOCH-1 was modified to correspond with definition of community used in CVCD. Mean agreement was calculated to measure the reliability of the modified EPOCH-1. Objective (3): Physical activity (walkscore) and nutrition (cost of food basket) environments of urban and rural areas were compared using t-test. Results: Objective (1): Review of the literature indicated that fewer fast food outlets, increased density of destinations and higher socio-economic status were associated with positive health outcomes. Objective (2): Mean agreement between raters of modified EPOCH-1 was excellent (close to 0). Objective (3): Analysis of pilot data showed that as compared to urban areas, there was a trend towards higher food costs and lower walkability in rural areas. However, this trend was not statistically significant (p>0.05). Conclusion: This project will add to the current understanding of the impact of contextual characteristics on health, and promote the development of new interventions that aim to change modifiable environmental exposures. Thesis Master of Science (MSc)