Review articleIlluminating the lifecourse of place in the longitudinal study of neighbourhoods and health
Introduction
Time and change complicate the evident associations between neighbourhoods and health with longitudinal methods providing an apparatus to inform these relationships. In considering neighbourhoods from a longitudinal perspective, there is often a sense that they are constantly evolving. In many respects they are. But neighbourhoods can also display persistent qualities. This durability of character can function to pattern and shape health disparities in space and over time. For example, using an ecological analysis, Dorling et al. (2000) observed that within inner London, at the level of local government wards, poverty for many localities remained invariant between 1896 and 1991. Moreover, mortality attributable to diseases such as lung cancer and stroke in 1991, was predicted more strongly by the spatial distribution of a historic 1896 measure of poverty than a more contemporaneous expression of this exposure.
Noteworthy as this analysis is, it only affords a disjointed view having compared neighbourhood contexts at junctures distant to each other. Moreover, it does not capture changes in the nature of areas temporally proximate to the experiences and lives of current dwellers; though such studies are beginning to emerge. For example, using the US-situated Geolytics Neighborhood Change Database (NCDB), Do (2009) observed historic multiple-year measures of census tract poverty (three time points, each ten years apart) to be stronger predictors of self-rated health than single-point-in-time measures. Critically, these historic exposures also explained a greater amount of the identified racial disparities in health status. More recently, Mair et al. (2015), used data from the Multi-Ethnic Study of Atherosclerosis to explore changes in neighbourhood social cohesion, stress, violence, safety and aesthetic environment in a sample of 103 US-based census tracts across a 2.5-to-4 year period. Although estimated associations were imprecise and non-significant following statistical adjustment for covariates, changes in neighbourhood contextual conditions were implicated in corresponding changes in levels of depressive symptoms.
Whilst there is an interest in the health impacts of exposure to changes in neighbourhood attributes, research needs to delve into the dynamics of neighbourhoods and the associated “dynamics of person/place experiences” (Kemp, 2011, p.4). Some time ago Pred (1984) contended that studies of human settlements were at risk of reducing analysed contexts to fragmented and frozen scenes, arguing that settlements, such as neighbourhoods, never materialise fully formed. Nor do they lay dormant. Rather, neighbourhoods are spatiotemporal products. This perspective has been echoed (Cummins et al., 2007, Pearce, 2015, Robert et al., 2010, Tunstall et al., 2004), with a call for enquiries to assess the developmental history and temporal progression of neighbourhoods, and the impact of these dynamics on the geographies of health, past, present and future (Pearce, 2015).
Explicating the temporal ebb and flow of neighbourhoods, and identifying if and how this evolution gets under the skin to influence population levels of health is integral to strengthening the evidence-base concerned with neighbourhood effects. In addition, by considering how structural and socio-political determinants function to prime and condition residential contexts over time, prospective place-based interventions may be grounded in an enriched understanding. Longitudinal enquiry can benefit these purposes. Focusing on neighbourhoods, this paper has two broad aims. The first is to advance the lifecourse perspective to the lifecourse of place. The second, is to introduce and discuss latent transition analysis (LTA); a longitudinal method of analysis able to operationalise conceptual models of the lifecourse of place in order to inform the study of neighbourhoods and health.
Section snippets
Lifecourse of place
The lifecourse perspective provides an organising framework for the study of health and its development over time (Ben-Shlomo and Kuh, 2002). A central aim of the lifecourse approach is to inform understandings of how health at later time points, or periods of life, is impacted by earlier experiences, such as during gestation, childhood, adolescence, or adulthood. In this manner, time, timing, and sequencing are instrumental factors in lifecourse analyses (Kuh et al., 2003). Furthermore, the
Latent transition analysis
Longitudinal analysis involves attending to the manner and form of change over time. From a conceptual perspective there are two theoretical models of time-related change – continuous and discrete (Collins, 2006). Continuous models of change assume that the change process unfolds in a smooth, linear or curvilinear fashion (Kim and Böckenholt, 2000). In addition, the mathematical function that models the change process is assumed to be analogous for each subject, though inter-subject variability
Latent transition analysis and the lifecourse of place
Classifying neighbourhoods into meaningful and dimensional categories has been a feature of place-health research, although much of this applied study has been cross-sectional. Longitudinal analyses of neighbourhoods have been challenged by temporal shifts that arise in spatial (administrative) boundaries, making it difficult to compare data for given areas across time (Logan et al., 2014). They have also been constrained by the availability of diverse area-level indicators that have been
Assumptions of latent transition models and recommendations for practice
Attention is drawn to three model assumptions as they relate to the applied study of neighbourhoods. The first assumption is that neighbourhood sub-types exist and the manner in which neighbourhoods evolve, develop, and transition between states can be defined. This is relevant as finite mixture models, of which LTA is a variant, can serve two purposes (Bauer and Curran, 2003a, Bauer and Curran, 2003b). One purpose is to expose qualitatively distinct sub-groups that are not directly observed.
Conclusion
Neighbourhoods and health are multidimensional constructs. The inter-relationships between neighbourhoods and health are also heterogeneous and dynamic, transpiring in evolving socio-cultural and socio-historic circumstances. Understanding these associations is likely to be facilitated and enriched by longitudinal forms of enquiry. It is these notions that underpin the call for the application of LTA to the study of neighbourhoods and health across time. As a methodological tool LTA is adept at
Funding/disclosures
Mr Peter Lekkas was supported by: an Australian Postgraduate Award, Department of Education and Training, Australian Government; a University of South Australia Scholarship; and the School of Health Sciences, University of South Australia through the Research Chair, Social Epidemiology.
Dr Catherine Paquet was funded by a National Health and Medical Research Council (Australia) Program Grant (#0631947).
Prof. Mark Daniel was funded by a Research Chair, Social Epidemiology, University of South
Author contributions and acknowledgements
Mr Peter Lekkas initiated the idea for the research, conceptualised the manuscript, wrote the first draft of the manuscript, and critically revised subsequent versions of the manuscript.
Dr Catherine Paquet contributed to the conceptualisation of the paper, helped with methodological interpretations, provided critical feedback, suggested additional discussion and provided revisions to the manuscript.
Dr Natasha Howard contributed to the conceptualisation of the paper, provided critical feedback
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