Participation among adults with disability: the role of the urban environment

Abstract

Increasing attention is being paid to the importance of built environment characteristics for participation, especially among people with various levels of impairment or activity limitations. The purpose of this research was to examine the role of specific characteristics in the urban environment as they interact with underlying impairments and activity limitations to either promote or hinder participation in life situations. Using data from the Chicago Community Adult Health Study (2001-2003) in the United States, we used logistic regression to examine the effect of built environment characteristics on three indicators of participation (interpersonal interaction, obtaining preventive health care, and voting) among adults age 45+ (N = 1225). We examined effects across two levels of spatial scale: the census tract and block group. One in five adults reported difficulty walking 2-3 blocks unaided, but their odds of engaging in regular interpersonal interaction was 45% higher when they lived in areas with higher residential security. For the thirty-six percent of adults who reported visual impairment, and the odds of obtaining preventive health care were over 20% lower when living in an area with heavy traffic. Residing in an area with a high proportion of streets in poor condition was associated with 60% lower odds of voting among those with underlying difficulty with mobility activities. Results varied across levels of spatial scale. Simple changes in urban built environments may facilitate the full participation of all persons in society.

Figure 1

Interactions between the Components of the ICF Model (adapted from WHO, 2001)

Figure 2

Figure 2a. Odds Ratios for Interpersonal Interaction by Walking Difficulty and Residential Security*: Chicago Community Adult Health Study, Age 45+ Figure 2b. Odds Ratios for Obtaining Preventive Health Care by Visual Impairment and Traffic Volume*: Chicago Community Adult Health Study, Age 45+ Figure 2c. Odds Ratios for Voting by Mobility Difficulty and Quality of Street Conditions*: Chicago Community Adult Health Study, Age 45+ *Models control for age, gender, race/ethnicity, marital status, living arrangements, education, income, multiple health indicators, cognitive function, heavy traffic, street conditions, public transit lines, and neighborhood social disorder. Predicted values are calculated for a married, white female, age 45–59, with college education, and no chronic health problems (with health insurance for preventive health care model).

Figure 2

Figure 2a. Odds Ratios for Interpersonal Interaction by Walking Difficulty and Residential Security*: Chicago Community Adult Health Study, Age 45+ Figure 2b. Odds Ratios for Obtaining Preventive Health Care by Visual Impairment and Traffic Volume*: Chicago Community Adult Health Study, Age 45+ Figure 2c. Odds Ratios for Voting by Mobility Difficulty and Quality of Street Conditions*: Chicago Community Adult Health Study, Age 45+ *Models control for age, gender, race/ethnicity, marital status, living arrangements, education, income, multiple health indicators, cognitive function, heavy traffic, street conditions, public transit lines, and neighborhood social disorder. Predicted values are calculated for a married, white female, age 45–59, with college education, and no chronic health problems (with health insurance for preventive health care model).

Figure 2

Figure 2a. Odds Ratios for Interpersonal Interaction by Walking Difficulty and Residential Security*: Chicago Community Adult Health Study, Age 45+ Figure 2b. Odds Ratios for Obtaining Preventive Health Care by Visual Impairment and Traffic Volume*: Chicago Community Adult Health Study, Age 45+ Figure 2c. Odds Ratios for Voting by Mobility Difficulty and Quality of Street Conditions*: Chicago Community Adult Health Study, Age 45+ *Models control for age, gender, race/ethnicity, marital status, living arrangements, education, income, multiple health indicators, cognitive function, heavy traffic, street conditions, public transit lines, and neighborhood social disorder. Predicted values are calculated for a married, white female, age 45–59, with college education, and no chronic health problems (with health insurance for preventive health care model).