The relationship of place to substance use and perceptions of risk and safety in urban adolescents

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Abstract

Geographic and substance use data were collected from 301 urban adolescents to compare the perceived and observed risk and safety associated with their home and activity space locations (routine locations). The geographic characteristics of the neighborhood surrounding each location was summarized according to features theorized to be risky, such as criminal activity and alcohol sales, and features theorized to be safe, such as recreation centers and churches. Data on socioeconomic status, derived from U.S. Bureau of the Census data, were also used to characterize locations. Adolescents' homes were typically perceived as safe despite observed measures of risk such as density of crimes and proximity to alcohol outlets. This held for both substance users and non-users. Differences in geographic characteristics for safe and risky activity spaces were observed for both substance users and non-users, with non-users appearing to be more sensitive to the presence of risky characteristics in the environment than substance users. Results highlight the need and provide a methodology to collect fine-grained activity space data instead of relying only on home residence when attempting to represent place and health behaviors with urban youth.

Introduction

A small body of research has demonstrated that subjective ratings of the physical and social characteristics of home neighborhoods have been found to be important and strong predictors of behavior such as substance use and mental health outcomes (Ellaway et al., 2002, Golledge and Stimson, 1997; Kawachi & Berkman, 2003; Lambert et al., 2005, Latkin and Curry, 2003). Similarly, qualitative studies have shown that perceptions of particular places are thought to influence health and health-related behaviors and are particularly suggestive of causal pathways linking place with health outcomes (Airey, 2003, Popay et al., 2003). What is less clear is how place is perceived by individuals within the context of their routine activities, or activity spaces – not just home locations – and how these unique place-based interpretations are linked to particular health behaviors such as substance use. Research that explores perceptions and objective indicators of activity spaces' risk and safety, and associated health outcomes, is likely to produce important new methods and findings (Hirsch, 2005, Korpela et al., 2002, Korpela and Ylén, 2007, Twigger-Ross et al., 2003; Winkel, Saegert & Evans, 2009).

An important construct that provides methodological guidance for spatial processes is activity space. Activity space has an interdisciplinary history with disciplines such as geography, public health, sociology, transportation studies, time-space studies, social psychology, and human-environment interactions. It can be defined as all the locations that an individual has direct contact with as a result of his or her daily activities (Miller, 1991). More broadly, activity spaces are the manifestation of our spatial lives, serving as an index representing routine locations and all the accompanying psychological, social, and health-related experiences of these places (Golledge and Stimson, 1997, Sherman et al., 2005). Recent research with urban youth informs us that the type of locations in which youth spend their time are varied and geographically dispersed, and are not delimited by traditional geographical boundaries such as census tract, home neighborhood, block group, or political ward (Mason, Cheung, & Walker, 2004). It is due to this unique spatial behavior of urban youth that traditional geographic boundaries are not effective in capturing teens' spatial signatures and associated health outcomes.

Often, researchers quantify environmental influences on human behavior by simply tallying geographic features hypothesized as risky within prescribed locations. For example, one may count the number of liquor stores within the census tract where someone lives to investigate how the availability of alcohol influences alcohol abuse. Recent research asserts, however, that this approach fails to address the primacy of meaning of place for individuals (Cummins et al., 2007, Frohlick et al., 2002). Likewise, we argue here that the meaning ascribed to various places is important, and is linked to and expressed through social practices and health behaviors. Specifically, the interpretation of meaning of places is the psychosocial mechanism by which geographic features exert influence on individuals. Therefore, without understanding the interpretative meaning of places by individuals, researchers mistakenly apply nomothetic approaches to idiographic problems (Cummins et al., 2007, Daykin, 1993, Frohlick et al., 2002, Goodchild and Janelle, 2004, Pavis et al., 1997, Popay et al., 1998). A goal of this study is to integrate data reflecting the meaning adolescents' ascribe to risky and safe activity spaces and to compare these perceptions with objective measurements of risk and safety for the same locations.

Foundational to our theoretical framework is Bronfenbrenner's (1979) work on the social ecology of human development that provided a language to organize the interaction between the developing person and their environment. Specifically, this study is guided by the more recent Bioecological model (Bronfenbrenner & Morris, 1998) that understands individuals through an interaction of the developmental processes and social and environmental contexts that produce outcomes of competence or dysfunction. This model has demonstrated that without strong, close, overlapping connections between youth and their nested, interrelated systems, such as peers and neighborhoods, healthful development is threatened. In the present study, substance use is regarded as a dysfunctional outcome that is a product of individual, social, and environmental factors.

The present research advances the literature by focusing on independently measured conditions of participants' weekly routine locations (activity spaces) that go beyond residential location. Further, these objectively measured conditions are compared with adolescents' perceptions of their activity spaces in terms of safety and risk. Finally, our study uses both subjective (perceptions of spaces) and objective (physical environment) data to test associations with our primary outcome variable of interest, substance use involvement. In total, the present study addresses several recent recommendations made by Winkel, Saegert, & Evans (2009) for environmental psychology research: (1) studying environmental, social, and cultural contexts, (2) employing new measurement approaches to model multiple environmental contexts, (3) involving temporal factors, and (4) using both self-reports and objective environmental data.

We focused on two primary research questions to guide our analyses and to frame our hypotheses: (1) How do subjects characterize and interact with their activity spaces in terms of risk and safety, and are there differences by substance use involvement and (2) do adolescent perceptions of relative risk and safety differ from observed geographic characteristics which theory suggests actually make a place safe or risky? Based on the Bioecological model and the existing literature, we hypothesized that adolescent activity space locations, perceptions of safety and risk, and time spent at these locations would vary by substance use involvement. We further hypothesized that locations perceived as risky would be associated with a concentration of observed risky features, such as crime, vacant housing, poverty, and alcohol availability, as compared with locations perceived as non-risky. Finally, we hypothesized that locations perceived as safe would be associated with observed protective features such as recreation centers, churches, and after-school programs as compared with locations perceived as non-safe.

Section snippets

Participants

The sample comprised 301 adolescent primary care patients at a Philadelphia Department of Public Health, health care center. Table 1 presents demographic data for this sample. As indicated in the table, the sample was 87% African American and 13% self-identified as mixed or other race/ethnicity, with the majority (60%) female which corresponds with other primary care gender distributions (Mason et al., 2004). The high African American rate is representative of the urban area served by the

Characterization of home and activity spaces

Home is perceived to be a safe place far more often than a risky place, despite the fact that many of the subjects lived in neighborhoods characterized by theoretically risky properties, such as high levels of violent crime and drug sale arrests. However, less than half of the entire sample (48%) rated their home as their safest place. Subjects were also asked when they identified a location as either safe or risky, “What makes this place safe/risky?” For safe locations, the results were

Discussion

The present study revealed that environmental characteristics influence urban adolescents' perceptions of safety and risk and that these perceptions vary between substance users and non-users. This study also supported the importance of investigating adolescents' routine locations (activity space) instead of using only their home location. Very few studies have taken into account the kinds and amount of objective spatial data that we used (16 different geographic variables) and coupled these

Acknowledgements

The project described was supported by Award Number R21DA020146 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. The project would not have succeeded without the cooperation of the Philadelphia Department of Public Health, the efforts of project coordinator, Amber Pomponio, MPH, interviewers Kayilu Sovinho, M.S. &

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