Browsing by Author "Ortigoza, Ana"
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- ItemAssociation of socio-economic environment and women’s empowerment with daily fruit and vegetable intake in Latin American cities: a multilevel study(2025) Valentino, Giovanna; Auchincloss, Amy H.; Tumas, Natalia; López-Olmedo, Nancy; Ortigoza, Ana; de Menezes, Mariana C.; Mazariegos, Mónica; Nazzal, CarolinaBackground In Latin America, a low proportion of the population meets the recommended fruit and vegetable (F&V) intake. The region is highly urbanized, with significant socioeconomic inequalities. The objective of this study was to analyze the association of the socio-economic environment (GDP per capita, living conditions) and women's empowerment (WE) with daily F&V intake in adults from Latin American cities, and whether these associations vary by individual education. Methods Cross-sectional study using secondary data from the SALURBAL project (Urban Health in Latin America), which compiled data from health surveys, censuses, and other surveys from cities with ≥ 100,000 inhabitants in 11 Latin American countries. The sample included 91,977 adults from 234 cities in 8 countries with self-reported F&V intake data. The outcome was daily F&V intake, defined as consuming F&V 7 days a week. City-level exposures included GDP per capita (tertiles), living conditions score (overcrowding, piped water, and education access; Z-scores), and WE score (labor force participation and early marriage; Z-scores). We estimated prevalence ratios (PR) for the association between each exposure and daily F&V intake using gender-stratified two-level Poisson models with random intercepts for cities adjusted by city and individual-level covariates. Interaction terms were included to evaluate effect-modification by individual education. Results Participants from cities in the upper GDP tertiles (T2 and T3) showed a ~ 7% higher prevalence of daily F&V intake among men (T2 PR = 1.08, 95% CI: 1.00–1.15; T3 PR = 1.06, 95% CI: 0.99–1.14) and women (T2 PR = 1.07, 95% CI: 1.01–1.13; T3 PR = 1.06, 95% CI: 0.99–1.12). A one standard deviation increase in WE and living conditions scores was associated with a ~ 10% higher prevalence of daily F&V intake in men (WE PR = 1.10, 95% CI: 1.02–1.19; living conditions PR = 1.10, 95% CI: 1.04–1.16) and women (WE PR = 1.11, 95% CI: 1.04–1.17; living conditions PR = 1.10, 95% CI: 1.05–1.15). Individual education levels significantly modified these associations (p < 0.05), which were stronger among those with lower educational attainment. Conclusions City GDP per capita, living conditions and WE were directly associated with fruit and vegetable daily intake, particularly among individuals with lower education levels in Latin America.
- ItemBuilding a Data Platform for Cross-Country Urban Health Studies: the SALURBAL Study(2019) Diez Roux, Ana V.; Bilal, Usama; Moore, Karia; Ortigoza, Ana; Rodriguez, Daniel A.; Sarmiento, Olga; Frenz, Patriciae; Friche, Amélia Augustaf; Caiaffa, Waleska Teixeiraf; Vives, Alejandrag; Miranda, J. Jaimeh; Alazraqui, Marcio; Spinelli, Hugoi; Guevel, Carlosi; Di Cecco, Vanessai; Tisnés, Adelai; Leveau, Carlos; Santoro, Adrián; Vives Vergara, AlejandraStudies examining urban health and the environment must ensure comparability of measures across cities and countries. We describe a data platform and process that integrates health outcomes together with physical and social environment data to examine multilevel aspects of health across cities in 11 Latin American countries. We used two complementary sources to identify cities with 100,000 inhabitants as of 2010 in Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Nicaragua, Panama, and Peru. We defined cities in three ways: administratively, quantitatively from satellite imagery, and based on country-defined metropolitan areas. In addition to cities, we identified sub-city units and smaller neighborhoods within them using census hierarchies. Selected physical environment (e.g., urban form, air pollution and transport) and social environment (e.g., income, education, safety) data were compiled for cities, sub-city units, and neighborhoods whenever possible using a range of sources. Harmonized mortality and health survey data were linked to city and sub-city units. Finer georeferencing is underway. We identified 371 cities and 1436 sub-city units in the 11 countries. The median city population was 234,553 inhabitants (IQR 141,942; 500,398). The systematic organization of cities, the initial task of this platform, was accomplished and further ongoing developments include the harmonization of mortality and survey measures using available sources for between country comparisons. A range of physical and social environment indicators can be created using available data. The flexible multilevel data structure accommodates heterogeneity in the data available and allows for varied multilevel research questions related to the associations of physical and social environment variables with variability in health outcomes within and across cities. The creation of such data platforms holds great promise to support researching with greater granularity the field of urban health in Latin America as well as serving as a resource for the evaluation of policies oriented to improve the health and environmental sustainability of cities.
- ItemEvaluating the health effects of place-based slum upgrading physical environment interventions: A systematic review (2012-2018)(PERGAMON-ELSEVIER SCIENCE LTD, 2020) Henson, Rosie Mae; Ortigoza, Ana; Martinez Folgar, Kevin; Baeza, Fernando; Caiaffa, Waleska; Vives Vergara, Alejandra; Diez Roux, Ana, V; Lovasi, GinaRapid urbanization in low- and middle-income countries (LMIC) is associated with increasing population living in informal settlements. Inadequate infrastructure and disenfranchisement in settlements can create environments hazardous to health. Placed-based physical environment upgrading interventions have potential to improve environmental and economic conditions linked to health outcomes. Summarizing and assessing evidence of the impact of prior interventions is critical to motivating and selecting the most effective upgrading strategies moving forward. Scientific and grey literature were systematically reviewed to identify evaluations of physical environment slum upgrading interventions in LMICs published between 2012 and 2018. Thirteen evaluations that fulfilled inclusion criteria were reviewed. Quality of evaluations was assessed using an adapted Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Findings were then pooled with those published prior to 2012. Narrative analysis was performed. Of thirteen evaluations, eight used a long-itudinal study design ("primary evaluations"). All primary evaluations were based in Latin America and included two housing, two transportation, and four comprehensive intervention evaluations. Three supporting evaluations assessed housing interventions in Argentina and South Africa; two assessed a comprehensive intervention in India. Effects by intervention-type included improvements in quality of life and communicable diseases after housing interventions, possible improvements in safety after transportation and comprehensive interventions, and possible non-statistically significant effects on social capital after comprehensive interventions. Effects due to interventions may vary by regional context and intervention scope. Limited strong evidence and the diffuse nature of comprehensive interventions suggests a need for attention to measurement of intervention exposure and analytic approaches to account for confounding and selection bias in evaluation. In addition to health improvements, evaluators should consider unintended health consequences and environmental impact. Understanding and isolating the effects of place-based interventions can inform necessary policy decisions to address inadequate living conditions as rapid urban growth continues across the globe.
- ItemLife expectancy and mortality in 363 cities of Latin America(2021) Bilal, Usama; Hessel, Philipp; Perez-Ferrer, Carolina; Michael, Yvonne L.; Alfaro, Tania; Tenorio-Mucha, Janeth; Friche, Amelia A. L.; Pina, Maria Fatima; Vives, Alejandra; Quick, Harrison; Alazraqui, Marcio; Rodriguez, Daniel A.; Miranda, J. Jaime; Diez-Roux, Ana V.; Alazraqui, Marcio; Alazraqui, Marcio; Spinelli, Hugo; Guevel, Carlos; Di Cecco, Vanessa; Tisnes, Adela; Leveau, Carlos; Santoro, Adrian; Herkovits, Damian; Trotta, Andres; Aguirre, Patricia; Lopez, Santiago Rodriguez; Tumas, Natalia; Gouveia, Nelson; Mascolli, Maria Antonietta; Slovic, Anne Dorothee; Martins, Lucas Soriano; Kanai, Claudio Makoto; Barreto, Mauricio; Santos, Gervasio; de Freitas, Anderson Dias; De Castro, Caio Porto; Filho, Jose Firmino de Sousa; Bell, Maria Izabel dos Santos; Andrade, Roberto Fernandes Silva; Cardoso, Leticia; Menezes, Mariana Carvalho de; Pina, Maria de Fatima de; Skaba, Daniel Albert; Guimaraes, Joanna Miguez Nery; Matos, Vanderlei Pascoal de; Caiaffa, Waleska Teixeira; Friche, Amelia Augusta de Lima; Andrade, Amanda Cristina de Souza; Vaz, Camila Teixeira; Coelho, Debora Moraes; Sales, Denise Marques; Aguilar, Guilherme Aparecido Santos; Nascimento, Julia de Carvalho; Morais, Lidia Maria de Oliveira; Santos, Mariana de Melo; Silva, Uriel Moreira; Frenz, Patricia; Alfaro, Tania; Cordova, Cynthia; Ruiz, Pablo; Fuentes, Mauricio; Castillo, Marianela; Pedrero, Sebastian; Rodriguez, Lorena; Doberti, Tamara; Vergara, Alejandra Vives; Salazar, Alejandro; Cortinez-O'Ryan, Andrea; Schmitt, Cristian; Gonzalez, Francisca; Baeza, Fernando; Angelini, Flavia; Orlando, Laura; Sarmiento, Olga Lucia; Higuera, Diana; Gonzalez, Catalina; Montes, Felipe; Useche, Andres F.; Guaje, Oscar; Jaramillo, Ana Maria; Guzman, Luis Angel; Cuesta, Diego Lucumi; Guerra, John Alexis; Bonilla, Jorge Alexander; Guzman, Luis Angel; Linares, Mario; Hessel, Philipp; Morales, Ricardo; Triana, Camilo; Wilches, Maria Alejandra; Palacio, Alejandro; Pena, Fabian Camilo; Sabogal, Joaquin Hernando Jaramillo; Lopez, Julieth; Fajardo, Karen; Botero, Marcelo; Cely, Natalia; Martinez, Paola; Moncada, Carlos; Meisel, Jose David; Martinez, Eliana; Kroker-Lobos, Maria Fernanda; Ramirez-Zea, Manuel; Mazariegos, Monica; Morales, Anali; Barrientos-Gutierrez, Tonatiuh; Perez-Ferrer, Carolina; Prado-Galbarro, Javier; Lopez-Olmedo, Nancy Paulina; de Castro, Filipa; Rojas-Martinez, Rosalba; Jauregui, Alejandra; Stern, Dalia; Riojas, Horacio; Texcalac, Jose Luis; Perez, Desiree Vidana; Miranda, J. Jaime; Vasquez, Akram Hernandez; Diez-Canseco, Francisco; Garcia, Lorena Saavedra; Hammond, Ross; Rodriguez, Daniel; Dronova, Iryna; Wang, Xize; Moran, Mika; Zhao, Yuanyuan; Ju, Yang; Delclos-Alio, Xavier; Hovmand, Peter; Ballard, Ellis; Kuhlberg, Jill; Diez-Roux, Ana V.; Auchincloss, Amy; Barber, Sharrelle; Bilal, Usama; Garcia-Espana, Felipe; Langellier, Brent; Lovasi, Gina; McClure, Leslie; Michael, Yvonne; Moore, Kari; Ortigoza, Ana; Quick, Harrison; Quistberg, D. Alex; Sanchez, Brisa N.; Stankov, Ivana; Tapia-Granados, Jose; Yamada, Goro; Rodriguez-Hernandez, Jordan; Melly, Steve; Avila-Palencia, Ione; Kephart, Josiah; Mullachery, Pricila; Trejo, Bricia; Braverman, Ariela; Fry, Dustin; Henson, Rosie Mae; Martinez-Folgar, Kevin; Slesinski, S. Claire; Indvik, Katherine; Bolinaga, Andrea; CEDEUS (Chile)The concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.
- ItemSmoking Ban Law in Chile: Impact in Newborns' Birth Weight by Women's Age Groups and by City Population Density(2022) Valentino, Giovanna; Ortigoza, Ana; Rodriguez Osiac, Lorena; Doberti, Tamara; Mullachery, Pricila; Nazzal, CarolinaObjectives: We examined the short-term impact of the Smoking Ban Law (SBL) enacted in Chile in 2013 on low birth weight (LBW) rates in cities and its differential effects by different maternal age groups and city density.Methods: We included 885,880 live births from 21 Chilean cities of >= 100,000 inhabitants. We examined the smoking and LBW prevalence distribution before and after the SBL. Through Poisson mixed effect models, we determined whether a meaningful change in LBW rate occurred after SBL implementation in the whole sample and stratified by city population density and maternal age group.Results: LBW prevalence remained stable before and after the SBL implementation (6.1% and 6.3%, respectively), while women's smoking prevalence had a relative reduction of 25.9% (p < 0.00001). No significant changes in LBW rate occurred after the implementation of SBL in the total sample or stratified by city density tertiles or maternal age groups.Conclusion: SBL implementation did not show short-term impact on LBW rate in Chile. Further studies need to examine long-term impact of SBL on low birthweight.