Adventures in the Exposome with Ecological Momentary Assessment - - PowerPoint PPT Presentation

The Role of Place in Mental Health for Urban Adolescents: Adventures in the Exposome with Ecological Momentary Assessment

Jeremy Mennis, Ph.D., GISP Department of Geography and Urban Studies Temple University University of Pittsburgh PHDL October 8, 2018

An Example: Poverty and Smoking

“Tobacco and poverty are inextricably linked.”

• (WHO, 2017)

Disadvantage

(https://www.nytime s.com/2014/06/26/u pshot/where-are- the-hardest-places- to-live-in-the- us.html)

Smoking

(https://www.nyti mes.com/interact ive/2014/03/25/u s/smoking-rate- map.html)

Compositional Mechanisms of Health Behaviors

Individual Poverty Smoking Compositional Stress

Contextual Mechanisms of Health Behaviors

Tobacco Advertising Attitude Smoking Contextual Individual Poverty Smoking Compositional Stress

Mediated and Moderated Contextual Mechanisms of Health Behaviors

Tobacco Advertising Attitude Smoking Contextual Family Support, Peer Support Age, Gender, Prior Experience Individual Poverty Smoking Compositional Stress

How Does Place Influence Health Behavior?

• Through the physical,

social, and emotional character of the places people encounter in their everyday lives;

• As mediated by

individuals’ interpretations

• f those places;
• And where interpretations

are molded by individual and social characteristics and prior experiences.

(Bronfrenbrenner, 1979)

Social-Ecological Model

Place from a Humanistic Perspective

Place may be said to have “spirit” or “personality” but only human beings can have a sense of place.

– Yi Fu Tuan, 1977, Space and Place

The Collective Subjective Experience Matters Too

If you think something's real, its consequences are real…shared perceptions of disorder lead to future rates of poverty. What this suggests is that perceptions, not just the reality of how many broken windows or broken beer bottles there are in the street really matter.

– Robert Sampson, 2012, Governing

The Exposome

“…every exposure to which an individual is subjected from conception to death” (Wild, 2010)

(Wild, 2010)

Measuring the Exposome

Measuring the exposome requires sampling at key periods of development (e.g. adolescence).

Activity Space

(after Hagerstrand, 1970)

Activity Space

(after Hagerstrand, 1970) (Torrens, http://www.geosimulation.org/space-time-analysis/)

How Do We Measure Place and Health Behavior?

Interviews/ Surveys Ecological Momentary Assessment

EMA ‘..allows subjects … to report repeatedly on their experiences in real-time, in real-world settings, over time and across contexts.’ (Shiffman et al., 2009)

How Do We Measure Place and Health Behavior?

Geographic Information Systems Interviews/ Surveys Ecological Momentary Assessment

EMA ‘..allows subjects … to report repeatedly on their experiences in real-time, in real-world settings, over time and across contexts.’ (Shiffman et al., 2009)

Global Positioning Systems

Geographic Ecological Momentary Assessment (GEMA)

The integration of EMA with GPS and GIS to investigate contextual effects on mood and behavior. “…most useful for the study of ‘‘places’’ imbued with meaning by subjects – representing each subject’s personal eco-system.” (Kirchner

and Shiffman, 2016)

The Social-Spatial Adolescent Study

• A two year longitudinal study of the interacting effects of peer networks

and activity space on teen substance use

(with M. Mason (PI), J. Light, J. Rusby, E. Westling, T. Way, N. Zaharakis, NIH #R01DA031724-02)

• Adolescence is a key developmental period when youth often

experiment with drugs and alcohol for the first time. Adolescents are particularly susceptible to peer (and place) influences on risky behaviors.

• Substance use in adolescence can impact brain development and

social functioning, is associated with other unhealthy behaviors, can negatively affect school performance, and can lead to drug dependence in adulthood (Squeglia et al., 2009; Pardini et al., 2015).

Description of the Sample

• 248 adolescents enrolled
• Recruitment: Primarily from an outpatient medical clinic
• Criteria: Ages 13-14, residing in Richmond, VA area
• Gender
• 57% female, 43% male
• Race
• 88% African American, 9% other, 3% white

Full Battery Assessment

At enrollment and every 6 months after

• Substance Use
• Alcohol and Drug Involvement Scale (AADIS) (Moberg and Hahn, 1991)
• Social Networks
• Adolescent Social Network Assessment (ASNA) (Mason et al., 2004)
• Other Measures
• Family, school, depression, anxiety, … (BASC, YRBS, …)

Geographic Ecological Momentary Assessment

• Each subject was provided with an LG mobile phone with embedded GPS
• EMA delivery schedule
• Delivered via text message with URL link
• Every two months following enrollment
• Thursday-Sunday, 4-6 EMAs / day
• Survey Items and Location
• Place, mood, behavior, social interactions, GPS position

Example Activity Space and Happiness for One Subject (spatially randomized)

Wave 1 Wave 2 Wave 3 Wave 4 Wave 5

Geographic Data

Percent Receiving Public Assistance Income by Tract Index of Assaults by Tract

Socioeconomic Crime

Research 1: Neighborhood Disadvantage, Substance Use, and Stress

• Exposure to neighborhood disadvantage is psychologically stressful (Latkin and Curry,

2003).

• Substance use can serve as a coping mechanism for stressful and unsafe

environments (Jackson et al., 2009).

• Observational studies have been largely limited to residential measures of

neighborhood disadvantage and recall-based measures of stress and safety.

Research 1: Neighborhood Disadvantage, Stress, and Substance Use

• Exposure to neighborhood disadvantage is psychologically stressful (Latkin and Curry,

2003).

• Substance use can serve as a coping mechanism for stressful and unsafe

environments (Jackson et al., 2009).

• Observational studies have been largely limited to residential measures of

neighborhood disadvantage and recall-based measures of stress and safety.

• Research Questions:
• Is exposure to neighborhood disadvantage in the activity space associated with

momentary stress and perceived safety?

• Does the association of exposure to neighborhood disadvantage with

momentary stress and perceived safety differ between substance users and non-users?

Research 1: Neighborhood Disadvantage, Stress, and Substance Use

Measures (data over first year)

• Demographics
• Age, sex, race (African American or not)
• Substance Use
• AADIS continuous measure of substance use involvement
• Stress and Safety
• “How stressed out are you right now?” (1-9 scale)
• “How safe are you right now?” (1-9 scale)
• Relative Neighborhood Disadvantage
• Index of poverty, female headed HH, education, owner occupied
• Relative Disadvantage = Momentary – Home Disadvantage

Measures (data over first year)

• Demographics
• Age, sex, race (African American or not)
• Substance Use
• AADIS continuous measure of substance use involvement
• Stress and Safety
• “How stressed out are you right now?” (1-9 scale)
• “How safe are you right now?” (1-9 scale)
• Relative Neighborhood Disadvantage
• Index of poverty, female headed HH, education, owner occupied
• Relative Disadvantage = Momentary – Home Disadvantage

Analytic Plan

• Generalized Estimating Equations (GEE)
• Controlling for within-person
• Estimate the effect of neighborhood disadvantage on substance

use, stress, and safety, while adjusting for age, sex, and race

• Models:
• Direct effects
• Moderation: Neighborhood disadvantage effect on stress and

safety moderated by substance use

Summary of Research 1 Findings

• Relative neighborhood disadvantage is associated with substance

use.

• Relative neighborhood disadvantage and substance use are both

associated with higher stress and lower perceived safety.

• The association of relative neighborhood disadvantage with stress

(but not safety) is stronger for substance users.

The Effect of Relative Neighborhood Disadvantage on Stress: Moderation by Substance Use

Research 2: Urban Greenspace and Stress

Research 2: Urban Greenspace and Stress

• Cities can be stressful places due to noise and crowding, (Lambert et al., 2015).
• Exposure to urban greenspace can reduce stress, and enhance memory span and

mood, via attention restoration (Bratman et al., 2015).

• Observational studies have been limited to residential measures of greenspace

exposure and asynchronous measures of stress.

Research 2: Urban Greenspace and Stress

• Cities can be stressful places due to noise and crowding, (Lambert et al., 2015).
• Exposure to urban greenspace can reduce stress, and enhance memory span and

mood, via attention restoration (Bratman et al., 2015).

• Observational studies have been limited to residential measures of greenspace

exposure and asynchronous measures of stress.

• Research Questions:
• Is exposure to urban greenspace in the residential location and activity space

associated with lower stress?

• Does the association of exposure to urban greenspace with momentary stress

differ according to the characteristics of the individual adolescent and environmental context of the observation?

Measures

• Stress
• “How stressed out are you right now?” (0-9; low, med, high)
• Demographics
• Age, sex, race (African American or not)
• Emotional Dysregulation
• Index of control of emotional response to stimuli
• Neighborhood Disadvantage
• Index of poverty, female headed HH, education, owner occupied
• Season
• Leaf-on (April-Oct) and Leaf-off (Nov-March)
• Setting
• Home and away-from-home
• Greenspace
• Mean NDVI (9/12/2013 Landsat EMT+ image) w/in 100 m

Examples of Greenspace Exposure

Low Medium- Low High Medium- High

Analytic Plan

• Generalized Estimating Equations (GEE)
• Controlling for within person
• Estimate the effect of greenspace on stress, while adjusting for

age, sex, and race, emotional dysregulation, season, setting, and neighborhood disadvantage

• Models:
• Direct effects
• Moderation: Greenspace effect moderated by sex, dysregulation,

setting, season, and neighborhood disadvantage

• 3-Way Moderation: Moderating effect of setting moderated by

season, sex, dysregulation, and neighborhood disadvantage

Summary of Research 2 Findings

• Greenspace exposure is associated with lower stress, but only

away from home.

• High emotional dysregulation and being home are associated with

higher stress.

• No other moderating, or three-way moderating, effects were found.

Home vs. Away-from-Home Moderates the Effect of Greenspace on Stress

Place and Health Behaviors: The Take-Home Messages

• 1. To capture the role of place, one must focus not only on the home

location, but also on the activity space.

• 2. Social networks are embedded within place, and play an important

role in creating place meaning.

• 3. The perceptions and interactions of an individual with their social

and geographic contexts are paramount.

• 4. Geospatial and mobile technologies provide unprecedented
• pportunities for collecting individual-level activity space, mood, social,

and behavioral data.

Challenges

• 1. Developing sophisticated and coherent theoretical models of

place and health behaviors (e.g. differential susceptibility).

• 2. Collecting diverse multidimensional data on integrated social

networks, activity spaces, moods, and behaviors.

• 3. Developing analytical approaches that will enable us to test for

cause and effect, and distinguish selection from influence.

• 4. Implementing geographic momentary interventions (GMI), i.e.

geographic just-in-time adaptive interventions (JITAI) for health.

REAL Collaboration is Key

Acknowledgments

Contact Jeremy Mennis, Temple University Email: jmennis@temple.edu Thanks to My collaborators, particularly Michael Mason and Jerry Stahler Support NIH #R01DA031724 (Mason, PI)

More Information: Mennis, J. and Yoo, E.-H.E., 2018. Geographic information science and the analysis of place and health. Transactions in GIS, 22: 842-854. Mennis, J., Mason, M., Ambrus, A., 2018. Urban greenspace is associated with reduced psychological stress among adolescents: A Geographic Ecological Momentary Assessment (GEMA) analysis of activity space. Landscape and Urban Planning, 174: 1-9. Mennis, J., Mason, M., Light, J., Rusby, J., Westling, E., Way, T., Zahakaris, N., and Flay, B., 2016. Does substance use moderate the association of neighborhood disadvantage with perceived stress and safety in the activity spaces of urban youth? Drug and Alcohol Dependence, 165: 288-292. Stahler, G.J., Mennis, J., and Baron, D., 2013. Geospatial technology and the exposome: New perspectives on

• addiction. American Journal of Public Health, 103(8): 1354-1356.