Neighborhood environments can both promote health (Ewing 2005) and encourage disease (Satterthwaite 1993). Differences in presence of health enhancing and health damaging messages and environments may account for some differences in health among neighborhoods with different socioeconomic and racial/ethnic characteristics (Kipke et al. 2007; Macdonald, Cummins, and Macintyre 2007; Pasch et al. 2007; Snyder et al. 2006; Stafford and Marmot 2003). In this pilot study, our hypothesis is that health-enhancing messages are more prevalent in wealthier neighborhoods and health damaging ones more prevalent in economically impoverished neighborhoods. For the purposes of this pilot study, we define “health enhancing” messages as messages which promote the consumption of whole grains, fresh fruit and vegetables, low fat dairy and meats or public health service advertisements (e.g., a smoking cessation ad) and “health damaging” as advertisements for alcohol, tobacco and high fat, low nutrient foods. In preparation for a larger scale study, our goal here was to test a methodology for comparing such messages across communities with differing sociodemographic and environmental characteristics
Disparate Urban Neighborhoods: Upper East Side, East Harlem
To carry out this study, we involved youth researchers in measuring the health enhancing and health damaging messages in two, disparate urban neighborhoods: the affluent and predominantly white Upper East Side of Manhattan, and the neighboring but economically impoverished and predominantly Black and Latino East Harlem. Lexington Avenue, a major thoroughfare, runs through both neighborhoods. The youth researchers worked in two phases measuring health enhancing and health damaging messages along Lexington Avenue in the two neighborhoods. The first phase included a class of thirty-three Hunter College undergraduate students; the second phase, a smaller group of three high-school-aged students recruited from Global Kids, a community-based youth organization. In each phase, the youth surveyed ten block segments of Lexington Avenue in the two neighborhoods.
Using Digital Technology to Measure Health Enhancing and Health Damaging Messages
Researchers at Hunter College partnered with the Fund for the City of New York (FCNY), a nonprofit research and policy group, to modify their ComNET software to measure health enhancing or damaging messages. FCNY developed the ComNET software to document problems in the urban environment and engage community members in notifying the responsible municipal agencies to address those problems in the urban environment. ComNET is designed for use on handheld digital devices, equipped with digital cameras. The use of ComNET and digital technology made this project possible and offered a number of advantages.
First, the handheld devices serve as an important incentive for the engaging the youth. Young people, most of whom have grown up immersed in digital technologies, quickly learn how to manipulate the devices and yet still see them as fun, innovative “toys.” It would be much more difficult to engage youth in this research without the use of digital technology. Second, the ability to quickly upload the data and have it almost immediately available for data cleaning and analysis is an invaluable asset of working with the ComNET software. The decade-long development of the technology by FCNY and the infrastructure that they have in place to ensure the smooth functioning of the devices, upload, cleaning and analysis of the data, provided a strong foundation for the methodology used here and obviated the research group from investing time and money in developing such a technology.
The hypothesis that health enhancing messages are more prevalent in better off neighborhoods and health damaging ones more prevalent in poorer neighborhoods appears to be supported by the data from our pilot study. Table and Figure 1 shows that in the 10-block segment our project surveyed, the percentage of health harming ads in East Harlem is 29% greater than in the Upper East Side. East Harlem also contains nearly 10% fewer health promoting ads than does the Upper East Side. Both neighborhoods have a higher concentration of health harming than health promoting advertisements. Tables 2 and 3 illustrate that tobacco and alcohol advertisements are more prevalent in East Harlem than in the Upper East Side where health-harming ads tend to be food-related.
The findings here are necessarily limited because this was a pilot study. First, the sample size (ten block segments measured by two groups) was too small to confidently generalize to all urban areas, all New York City, or even the two neighborhoods studied here. Further limitations include some challenges with digital technology. The ComNET software is very effective at measuring some types of problems in the urban environment, but needs further modification to accurately and efficiently measure health enhancing and health damaging messages. Specifically, the addition of a feature that would allow for multiple features for one entry would speed up the process considerably. The limitations of this admittedly small and suggestive pilot study can be addressed in a larger and more systematic follow-up study.
New York City neighborhoods of East Harlem and the Upper East Side represent stark disparities in income, racial composition and health outcomes. This pilot study examined one aspect of the disparities between these neighborhoods that may contribute to unequal health outcomes: health promoting and health damaging messages. In general, we found that East Harlem has more ads (of all kinds), more health harming ads, and fewer health-promoting ads than the Upper East Side. And, we also found that both neighborhoods have more health harming ads than health promoting. While the presence of health damaging ads cannot account for all the negative health outcomes in a particular urban neighborhood, the disproportionate display of the health damaging ads in East Harlem as compared to the Upper East Side, suggests that some New York City residents bear a greater burden of these messages. The disparity in the types of health ads that city residents in different neighborhoods are exposed to is a subject that demands further study. In addition, our pilot study demonstrates that young people can be engaged in studies to document the health characteristics of their communities, an activity that can be a first step in analysis of differences in health and action to reduce inequities in health.
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Kipke, M.D., E. Iverson, D. Moore, C. Booker, V. Ruelas, A.L. Peters, and F. Kaufman. 2007. Food and park environments: neighborhood-level risks for childhood obesity in East Los Angeles. J Adolesc Health 40 (4):325-33.
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Pasch, K.E. , K.A. Komro, C.L. Perry, M.O. Hearst, and K. Farbakhsh. 2007. Outdoor alcohol advertising near schools: what does it advertise and how is it related to intentions and use of alcohol among young adolescents? . J Stud Alcohol Drugs68 (4):587-96.
Satterthwaite, D. 1993. The impact on health of urban environments. Environ Urban 5 (2):87-111.
Snyder, L. , F. Milici, M. Slater, H. Sun, and Y. Strizhakova. 2006. Effects of alcohol exposure on youth drinking. Archives of pediatrics and adolescent medicine 160 (1):18-24.
Stafford, M., and M. Marmot. 2003. Neighbourhood deprivation and health: does it affect us all equally? Int J Epidemiol 32 (3):357-66.
For more information on this study contact Jessie Daniels at firstname.lastname@example.org