Neighborhood poverty and wellbeing in Hong Kong : a spatial and multilevel analysis

Abstract

Background: Many previous studies, mostly from the West, promulgated the influence of neighborhood environment on both physical and mental wellbeing. However, the aftermaths of interactions between neighborhood characteristics and wellbeing are less researched in the non-Western settings, including Hong Kong. Aims: The main aim of the dissertation is to better understand the relationships of neighborhood characteristics and wellbeing in Hong Kong. Specifically, we aim to: 1) study the spatial patterning and characteristics of neighborhood poverty; 2) examine whether poorer neighborhoods have poorer spatial access to services; 3) investigate into the association of neighborhood poverty, spatial accessibility of services, and neighborhood walkability, with five physical and mental wellbeing (i.e. overweight in children, overweight/obesity in adults, adults’ and self-rated health, older adults’ levels of depression and cognitive function); and 4) explore the potential mediators and moderators of neighborhood effect on the wellbeing Methods: Four interrelated studies were conducted to accomplish four specific aims. Individual-level data were obtained from two datasets, i.e., Hong Kong Panel Study of Social Dynamics (HKPSSD) and an elderly checkup database from the Department of Health, Hong Kong. Large street block (LSB) was used as proxy of neighborhood. Neighborhood social factors were created from the Census data (2006, 2011), while neighborhood physical factors were derived from the Geo-community and Geo-referenced data (2009). Geographic Information System (GIS) was applied to manage spatial data, create spatial variables, and conduct spatial analyses. Multilevel modeling was used to investigate into the neighborhood effect on individuals’ wellbeing. Results: High-poverty/distressed neighborhoods and their spatial distributions were identified. The distribution of services in Hong Kong did not always support the deprivation amplification theory, a pattern where poorer areas are more deprived of services. Children’s overweight was related to neighborhood walkability, while adults’ overweight/obesity was related to neighborhood food environment. Adults living in neighborhoods with higher accessibility to indoor physical activity services were less likely to report poor self-rated health, whereas older adults living in neighborhoods with lower accessibility to outdoor greenness were more likely to have higher degree of depression. Higher accessibility to public libraries was associated with better cognitive function among older adults. Both neighborhood poverty and neighborhood walkability have independent roles in older adults’ levels of depression and cognitive function. Physical activity was not the mediator of neighborhood effect on wellbeing. Neighborhood poverty moderated the association of neighborhood food environment with adults’ overweight/obesity, and the association of neighborhood walkability with older adults’ levels of depression and cognitive function. Gender played a moderating role in the association between neighborhood environment and older adults’ wellbeing. Conclusions: Our findings in Hong Kong, a high income and high density Asian city, show some distinct patterns compared with the results from the Western settings, and offer a better understanding to the relationships between neighborhood environments and wellbeing in a rapidly changing society. By using both spatial and multilevel approaches, our results help identify potential interventions and preventions to enhance wellbeing, and provide informed decisions regarding poverty polices, service provision, urban planning policies, and public health and wellbeing policies.