Walkable Areas Research Articles

Tingkat Walkability dan Kepuasan Pejalan Kaki di Kawasan Pendidikan Jatinangor dan Kawasan Perdagangan Sudirman

Walkability is a condition in an area that is friendly to pedestrians. To find out the comparison of the conditions of the pedestrian path, 2 (two) areas with different land uses but having the same characteristics are high pedestrians and problems related to walkability that have not been resolved. This study aims to identify the differences between the two research areas and the level of satisfaction of pedestrian users using the Global Walkability Index. The Jatinangor Education Area has a value of 45.5 which means not walkable, while the Sudirman Commercial Area has a value of 60.0 which means waiting to walk. Pedestrians show their dissatisfaction walking in the Jatinangor Education Area and pedestrians show their satisfaction in the Sudirman Commercial Area. This indicates that the Sudirman Commercial Area is more walkable than the Jatinangor Education Area. The results of the research are expected to serve as a direction for the development of the built environment's capacity to achieve a walkable area

Urban Environment and Growth and Obesity in Preschool Children from Six European Birth Cohorts

BACKGROUND AND AIM: Urban environmental exposures have been investigated separately in relation to growth and childhood obesity. In this study we aim to determine which prenatal and postnatal outdoor exposures are associated with childhood BMI, weight and height at age 3-4 years. METHODS: Height and weight were measured in 11,325 children aged 3-4 years from a multi-centre European cohort (France, Greece, Lithuania, Norway, Spain, and UK). BMI was calculated using the formula weight/height². Age-and-sex–standardized {z}-scores were calculated for height, weight and BMI. Urban environment exposures were estimated during pregnancy and childhood, including air pollution, built environment, green spaces, traffic, noise, meteorology, and socioeconomic deprivation index. Exposure-wide association study was performed using multiple single exposure linear regression models and accounting for multiple testing. RESULTS:Non linear associations were observed between exposure to Normalized Difference Vegetation Index (NDVI), a measure of greeness, and the outcomes leading to its categorization into tertiles. Pregnancy and postnatal NDVI in the first tertile were associated with greater height compared to the reference (second tertile), and remained statistically significant after correction for multiple testing (prenatal corrected {p}-value threshold for significance = 0.002; postnatal corrected {p}-value = 0.003). Other prenatal and postnatal markers of the urban environment such as walkability, building density and land use, nitrogen dioxide and fine particles were also associated with greater height, but were no longer statistically significant after correction for multiple testing. Fine particles during pregnancy were associated with higher BMI, and prenatal NDVI in the first tertile and air pollution were also associated with higher weight, but the {p}-values for these associations were above the corrected threshold for multiple testing. CONCLUSIONS:Living in a less green and more densely built and walkable area may affect preschool height in a positve manner. KEYWORDS: External exposome, Green space, Built environment, Children's environmental health, Obesity and metabolic disorders

Transportation Amenities and High-Tech Firm Location: An Empirical Study of High-Tech Clusters

Clustering and active transportation infrastructures have a significant impact on economic development strategies for attracting high-tech firms. High-tech firms cluster to create economies of scale. In theory, such clusters favor walkable and transit-accessible locations following the preferences of footloose workers of the creative class, an expectation that underpins pro-walkability and transit-accessible development strategies. Such approaches, however, fail to consider countervailing factors including changes in logistics, land values, the rise of the e-economy, and gig workers, which could result in a preference for auto-centric locations. This study addresses the knowledge gap by investigating differences in location behaviors of six high-tech sectoral categories with respect to transportation infrastructures. The analysis uses a firm-level micro dataset provided by Esri along with multiple logit regressions to explore the relationship between high-tech firm locations and transportation amenities in 627 high-tech clusters from the 52 largest U.S. regions. The results show that not all high-tech industries opt for walkable and transit-accessible locations. Compared with other high-tech specializations, professional services (i.e., data processing/computer or engineering and architectural services), which account for the largest share of high-tech employees, are drawn to walkable and transit rich areas near central business districts. On the other hand, auto-centric locations on the peripheries are home to aerospace and bio-pharmaceutical industries. In light of these findings, it is essential that economic development officials aiming to achieve balanced growth consider major local high-tech sector(s) and sectoral differences when making policy decisions.

Revisiting Transit-Oriented Development Evaluation for Urban Master Plans in the Context of Developing Countries

Transit-oriented development (TOD) advocates sustainable development and the building of livable neighborhoods. Several measures are proposed to evaluate TOD principles; however, the suitability of these measures is not fully explored in the context of developing countries. This paper provides a systematic method for multivariate analysis of TOD measures in the context of developing countries. A bivariate analysis is conducted to simultaneously study all TOD measures against the distance to transit measure because of its essential role in TOD. A dynamic zoning system is introduced to capture a realistic reflection of neighborhood that is walkable for its residents. In the proposed zoning system, neighboring zones can overlap, as the walkable areas for the nearby residences may overlap. The adherence of Tehran’s Master Plan to TOD principles is examined with a focus on TOD measures and multidimensionality in assessment. The results highlight the curse and the blessing of the high-density urban sprawl in sustainable development.

Do Walking-Friendly Built Environments Influence Frailty and Long-Term Care Insurance Service Needs?

Our study examined the associations between neighborhood walkability, frailty, and the incidence of long-term care insurance (LTCI) service needs using a prospective cohort survey in a suburban town in Japan. The final sample for analyses comprised 2867 community-dwelling older adults (mean age: 73.0 years). Neighborhood walkability was measured using the Walk Score®. A total of 387 participants (13.5%) exhibited frailty. The odds of frailty, adjusted for the covariates (sex, age, educational status, marital status, residential status, employment status, subjective economic status) among participants who lived in somewhat walkable/very walkable areas, was 0.750 (95% Confidence Interval, CI: 0.597–0.943) versus those who lived in car-dependent areas. During the 23-month follow-up, 102 participants needed LTCI services (19.0 per 1000 person-years), 41 of whom (21.0 per 1000 person-years) lived in car-dependent areas, and 61 of whom (17.9 per 1000 person-years) lived in somewhat walkable/very walkable areas. As compared with participants who lived in car-dependent areas, the incidence of LTCI service needs was not significantly lower than that of those who lived in somewhat walkable/very walkable areas. Walk Score® can provide the critical information for the strategies to improve walkability and prevent older adults’ frailty in less walkable areas, contributing to achieving the United Nation’s Sustainable Development Goals (SDGs).

The sustainability of the urban layer of e-commerce deliveries: the Belgian collection and delivery point networks

ABSTRACT The increase in at-home deliveries of online ordered goods has led to a rise in urban logistics facilities. One such facility in particular, the collection and delivery point (CDP), is an increasingly popular delivery option amongst carriers and holds the promise of more sustainable e-commerce logistics. A prerequisite to achieve this promise is that the pick-up trip occurs in an environmentally friendly manner. By delineating 1 km catchment areas – the car is the preferred transportation mode for longer distances – we test whether the current Belgian CDP networks encourage this type of pick-up. We find that only one courier catches just over half of the population within walking distance of its points and conclude that the current network set-ups thus jeopardize the sustainability promise. We attribute this finding to a quality over quantity mindset by logistics companies when expanding their network. However, the fact that 75% of the points’ walkable catchment areas overlap paves the way towards the installation of shared CDPs. As this solution would improve the sustainability of the delivery alternative, we urge urban governments to facilitate the process towards these multi-carrier CDPs, for example by providing supporting infrastructure or by safeguarding dedicated spaces in urban plans.

'It's just one of those natural progressions': Stories of relocating to neighbourhoods of high and low walkability.

Walkable neighbourhood characteristics, such as connectivity and land use mix, have been found to correlate with people walking more and being active. However, the relationship between the built environment and behaviour is highly complex making it difficult to develop generalisable and predictive models. This paper reports qualitative findings from 21 in-depth interviews conducted with urban residents who had relocated between neighbourhoods of high and low walkability. Participants' preferences are reported within key domains (shop access, green space and travel links). These reveal that walkable characteristics were preferred and desired regardless of whether the participant had moved to a high or low walkable area. We contrast surface preferences with an analysis of relocation stories: complex assemblages of biographical narratives, identity work and cultural representations. The findings reveal how neighbourhood types are consistently associated with life stages and that moving to a suburban home was felt to be a definitive type of relocation in which it was acceptable to put neighbourhood preferences aside. Residential self-selection is not yet properly understood and we recommend studies of relocation stories for examining the sociocultural meanings that are likely to inform relocation decisions.

Interaction effect of neighborhood walkability and season on adults’ step count

IntroductionWalking activity shows differences by season or neighborhood walkability (NW). Elucidation of interactions between season and NW may contribute to the identification of high-risk populations. We examined the interaction effect of objectively measured NW and season on step counts in a large population. MethodsWe analyzed consecutively measured pedometer data collected from 47,233 adults aged 40–79 years who participated in the Yokohama Walking Point Program. Step counts in May 2018 (spring) and August (summer) as well as October (autumn) and January 2019 (winter) were compared. Neighborhoods (postal code areas) were classified into quartiles for each of the three NW variables (i.e., distance to the nearest railway station, population density, and street intersection density). The interaction effect of each of the NW variables and season on step count was examined using mixed-effects linear regression analyses. ResultsThe average daily step counts were fewer in summer and winter and higher in areas near the railway stations and areas with higher population density. We found a significant interaction effect of NW and season on step counts in summer. Participants residing in areas farther from the nearest railway station (P < 0.001) or areas with the lowest quartile of population or intersection density (P = 0.001, 0.030, respectively) showed a decline in step counts in summer by up to 118.4 steps/day compared with participants in other areas, which was not found when comparing the step counts between winter and autumn. ConclusionsNW and season showed interaction effect on adults’ step counts, indicating that in low walkable areas where residents generally walk less, their step counts decrease more in summer when compared with those in other areas; however, this was not the case in winter. Promoting walking in the less walkable neighborhoods, specifically during summer, is required.

Neighborhood Walkability as a Predictor of Incident Hypertension in a National Cohort Study.

The built environment (BE) has been associated with health outcomes in prior studies. Few have investigated the association between neighborhood walkability, a component of BE, and hypertension. We examined the association between neighborhood walkability and incident hypertension in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Walkability was measured using Street Smart Walk Score based on participants' residential information at baseline (collected between 2003 and 2007) and was dichotomized as more (score ≥70) and less (score <70) walkable. The primary outcome was incident hypertension defined at the second visit (collected between 2013 and 2017). We derived risk ratios (RR) using modified Poisson regression adjusting for age, race, sex, geographic region, income, alcohol use, smoking, exercise, BMI, dyslipidemia, diabetes, and baseline blood pressure (BP). We further stratified by race, age, and geographic region. Among 6,894 participants, 6.8% lived in more walkable areas and 38% (N = 2,515) had incident hypertension. In adjusted analysis, neighborhood walkability (Walk Score ≥70) was associated with a lower risk of incident hypertension (RR [95%CI]: 0.85[0.74, 0.98], P = 0.02), with similar but non-significant trends in race and age strata. In secondary analyses, living in a more walkable neighborhood was protective against being hypertensive at both study visits (OR [95%CI]: 0.70[0.59, 0.84], P < 0.001). Neighborhood walkability was associated with incident hypertension in the REGARDS cohort, with the relationship consistent across race groups. The results of this study suggest increased neighborhood walkability may be protective for high blood pressure in black and white adults from the general US population.

Barreras estructurales en la caminabilidad y accesibilidad a escala de barrio. Estudio de tres casos en Santiago de Chile

Dada la relevancia de la accesibilidad a bienes y servicios urbanos en la calidad de vida de los habitantes, y considerando que la caminata representa el principal modo de transporte en el Gran Santiago —34,6% de los viajes, según la Encuesta de Origen y Destino de 2012 (Universidad Alberto Hurtado, 2014)—, la presente investigación tiene como objetivo analizar y comparar las barreras estructurales que inciden en el área caminable a escala de barrio y estimar sus posibles efectos en los patrones de movilidad y acceso a bienes y servicios, en tres conjuntos habitacionales del Gran Santiago: población Juan Antonio Ríos sector 3B (Independencia), villa San Cristóbal (Recoleta) y villa Los Sauces (La Florida). Para cada caso, se identificaron las principales barreras materiales, ya sean naturales (ríos, cerros) o artificiales (carreteras, pasos bajo/sobre nivel) y algunas barreras intangibles (asociadas a la seguridad vial o delictual). Se comparó la superficie teórica máxima del barrio caminable (euclidiana) con la “real” calculada mediante análisis de red (sobre la base de recorridos de 20 min), considerando las condiciones de cruce de las principales vías, cuantificando sus efectos en tiempo y distancia y la consiguiente accesibilidad a equipamiento y servicios. Además, se analizó la configuración de la trama vial y peatonal, contrastando su integración a escala local y global basada en mapas axiales. Finalmente, se analizaron los patrones de movilidad de la población según datos de zona EOD 2012.Los resultados muestran una clara disminución del área real del barrio caminable (a un tercio del área euclidiana), producto de la trama y de las diversas barreras existentes, lo que se refleja en la accesibilidad a bienes y servicios vía caminata. Estos resultados permiten proponer además que, si bien una mayor distancia promedio de caminata no se relaciona con una mayor área caminable, la cercanía a centralidades sí se asocia con la prevalencia de este modo de transporte.

Walkability as the key element of urban planning within the Healthy Cities concept (systematic review)

The purpose of the study. The purpose of this work is the exploration and generalization of scientific researches on walkability to determine its advantages as an element of public policy in human-centered cities. Over the past fifty years, the world community has actively discussed the issue of healthy and sustainable urban development planning, which has gained particular relevance with the recent World Health Organization publication of the “Healthy Cities: An Effective Approach to a Rapidly Changing World” concept (2020). One of the Healthy Cities approach goals is to promote healthy urban planning and design centered on human well-being (unlike prevalent in the past vehicle orientation), and the main component of such planning is pedestrianization or walkability. The systematic reviews and meta-analyses reporting method (PRISMA) were used in the review. The search was carried out in the bibliographic databases Elibrary, PubMed, MEDLINE, Scopus, Google Scholar. The study of the structure, types, and relationship between pedestrianization and the type of urban planning revealed the global advantages of creating walkable areas, such as maintaining the physical, mental and social health of citizens, increasing social capital, and improving the city’s ecological and economic atmosphere. Conclusion. Thus the promoting walkability was concluded to be a public policy as a relatively simple and highly effective way to benefit in the short, medium, and long term. This fact ultimately makes pedestrianization one of the most important tools for healthy urban planning and design.

Are people willing to pay more to live in a walking environment? A multigroup analysis of the impact of walkability on real estate values and their moderation effects in two Global South cities

The walkability premium on real estate price has been evaluated, and positive and significant results have been found using different European and North American cities as case studies. The aim of this research was to test this effect in a Global South context, in two Brazilian cities where pedestrian-oriented urban environments are scarce and where modal choice is conditioned on economic constraints. We used multigroup structural equation models to represent the perception of walkability and to assess its interrelations with perceptions of personal safety and quality of life. The impact of walkability on sales price was tested using buying opportunities and walking frequency as moderator variables to see whether this effect can be scaled up. The results show that the prices of multifamily residential properties in the two study areas increase as perceived walkability increases but the magnitude of the effect is city-independent demonstrating that exist demand to live in walkable areas even in restricted conditions. Also, although the effects are positive and significant, the impact of safety on walkability and the impact of walkability on quality of life, as the moderator effects, are not the same in the two study areas.

Towards a Walkable City: Principal Component Analysis for Defining Sub-Centralities in the Santiago Metropolitan Area

This article presents a methodology for evaluating the potential for an urban area to become a 15-min city based on its existing essential urban functions. To elaborate this methodology, the research focused on the Metropolitan Area of Santiago de Chile, by identifying 28 urban functions and applying principal component analysis to review how these georeferenced variables are grouped into synthetic components that illustrate the walkability of each block concerning access to these functions. Variables are mapped by GIS software to review where concentrations of essential urban functions occur and where there is a need to increase availability of these missing uses. One of the findings of this study in the Metropolitan Area of Santiago is that essential urban functions provided by the state present a relatively equitable distribution in the metropolis. In contrast, essential urban functions provided by the market are highly concentrated in specific clusters, segregating walkability areas in the metropolitan space. The methodology presented here is replicable for other cities, and the findings offer a critical perspective on land management and urban planning for this case study, where normative frameworks must change to implement the 15-min city.

The different roles of neighborhood spatial boundary on residential satisfaction of rental household living in social-mix apartments

This study quantifies the different roles of neighborhood physical environments with different spatial boundaries on residential satisfaction of rental households in social-mix apartments. Employing public rental housing survey in Seoul(2016), this study specifies three ordered logit models by neighborhood spatial boundaries(400m, 800m, 1200m). The results showed that, in 400m model, explanatory power(r-square) was the highest(18.4%) and the relative importance of land-use mix(OR=2.063) was the highest among the neighborhood physical environments. While the statistically significant influence of land-use mix was found only in 400m model, the significant influence of police-station was not in 1,200m model(p<0.05). Therefore, it is recommendable that social-mix apartment should be located in the walkable areas with the high level of land-use mix in order to improve residential performance of rental households.

Walkability and Fitness Center Prices, Opening Hours, and Extra Services: The Case of Madrid, Spain.

Walkability has been associated with urban development and political plans, contributing to more connected cities with improvements in communication, shopping, and pedestrian base. Among these services, fitness centers are becoming important elements for communities due to their impact on the health and welfare of citizens. The present study aims to examine how an area’s Walk Score® affects fitness center services, specifically membership costs, opening hours, and aquatic services. Data from 193 fitness centers were retrieved, representing all the areas of the municipality of Madrid, Spain, including fitness centers in the 21 city districts. A nonlinear relationship between an area’s Walk Score® and fitness centers’ monthly fees is observed. Only in premium fitness centers, a weak curvilinear model is observed, following a quadratic equation, showing that fitness centers with higher prices are in less walkable areas. Additionally, the association between Walk Score® and a fitness center’s opening hours reveals that fitness centers with wider hours of operation tend to be in moderately to highly walkable locations. Lastly, the existence of a swimming pool is related to a lower Walk Score®. Thus, fitness centers in less walkable areas try to offer additional services as differentiation from competitors, whereas centers in walkable locations use this advantage as a strength.

Determining If Walkability and Bikeability Indices Reflect Pedestrian and Cyclist Safety

Walkability and bikeability indices are used to succinctly quantify how conducive an environment is to walking and cycling, often including factors related to comfort and perceived safety. The potential assumption that “walkable” and “bikeable” mean safe for walking and cycling (i.e., the association with objective safety or crash risk) has not yet been examined. This study investigates the association between two widely used measures (walk score and bike score) and pedestrian and cyclist crashes in Vancouver, Canada, to determine whether more walkable and bikeable areas of the city are also safer for walking and biking, after controlling for exposure. Multivariate Bayesian crash models with random and spatial effects are developed for pedestrian–motor-vehicle and cyclist–motor-vehicle crashes in 134 traffic analysis zones using 5 years of crash data with walking, cycling, and motor-vehicle traffic volume controls for exposure. Results indicate that areas of the city with higher walkability and bikeability can be potentially associated with greater pedestrian and cyclist crash risk, respectively, even after controlling for exposure. While the clear answer is that neighborhood walkability and bikeability does not indicate safety for pedestrians and cyclists, questions remain as to whether they should, and if so, how they could be modified to better incorporate objective risk.

Early delivery of equitable and healthy transport options in new suburbs: Policy, place and people

IntroductionPlanning policies support the development of healthy, liveable cities. Yet, recent research suggests they may not offer enough detail to provide on-the-ground delivery of social and transport infrastructure that supports and impacts healthy, active behaviours and the subjective wellbeing of residents in new developments and growth areas. MethodsThree analyses were conducted. First, planning policies were reviewed using a content analysis to identify environmental features known to support healthy and active behaviours. Then, for two growth area estates located in Melbourne, Australia (Allura and Selandra Rise), the on-the-ground delivery of these planning policies were evaluated using spatial data of key destinations (e.g., shops, schools, and transport) and geographic information systems analysis. Finally, the health and subjective wellbeing of adult residents from these two estates combined (n = 352) was assessed using survey methodology. This included asking residents about the importance and satisfaction with access to transport and key destinations. ResultsWe found that many built environment features were mentioned in the policy documents; however policy standards for dwelling density remain low at 15 dph and distances for accessing activity centres too long at 1 km to adequately support the walkability of new growth areas. We found generally, that average distances to key destinations were longer and more variable in growth areas in comparison to inner city areas and Greater Melbourne overall. For residents, satisfaction with access to destinations differed between the two case study areas. Residents in Allura, where destination and transport access was generally poorer were less satisfied, whilst those in the more walkable and established Selandra Rise area were more satisfied. ConclusionsAlthough planning policies support the development of active transport and healthy, liveable cities they are insufficient for influencing healthy behaviours when not well implemented. Early delivery of social and transport infrastructure and services must occur early in the development cycle of new growth areas to support healthier and more sustainable behaviours.

Integrating node-place and trip end models to explore drivers of rail ridership in Flanders, Belgium

The node-place model is an analytical framework that was devised to identify spatial development opportunities for railway stations and their surroundings at the regional scale. Today, the model is predominantly invoked and applied in the context of ‘transit-oriented development’ planning debates. As a corollary, these model applications share the pursuit of supporting a transition towards increased rail ridership (and walking and cycling), and therefore assumingly a transition to more sustainable travel behavior. Surprisingly, analyses of the importance of node and place interventions in explaining rail ridership remain thin on the ground. Against this backdrop, this paper aims to integrate the node-place model approach with current insights that derive from the trip end modeling literature. To this end, we apply a series of regression analyses in order to appraise the most important explanatory factors that impact rail ridership in Flanders, Belgium, today. This appraisal is based on both geographical and temporal data segmentations, in order to test for different types of railway stations and for different periods of the day. Additionally, we explore spatial nonstationarity by calibrating geographically weighted regression models, and this for different time windows. The models developed should allow policy and planning professionals to investigate the possible demand impacts of changes to existing stations and the walkable area surrounding them.

Abstract D042: Perceptions and barriers to physical activity among Latino adults

Abstract Introduction: Latino adults are less likely than their non-Latinos counterparts to meet physical activity recommendations. Perceptions (e.g., physical activity is important for health) and barriers to physical activity (e.g., lack of time, lack of energy) have been examined among Latinos; however, less is known about how perceptions and barriers differ from childhood to adulthood among Latinos. Further, identifying perceptions and barriers to physical activity in childhood and adulthood among foreign-born Latinos may provide further insight into how immigration to the US influences physical activity, given the unique experiences of immigrants. The objective of this study was to utilize a qualitative approach to identify perceptions and barriers to physical activity in childhood and adulthood among Latino adults. Methods: Twenty-six participants were recruited from Southeast Houston, TX between September–December 2018. Participants were individuals that self-identified as Latino and between the ages of 21-36. Five focus groups and one one-on-one individual interview were conducted in English and Spanish using semi-structured interview guides, audio recorded and transcribed by bilingual researchers. Atlas.ti 8 was used to facilitate data management. Thematic analysis employing inductive and deductive coding was used to code, categorize and summarize data into themes. Results: Data analysis yielded themes relevant to perceptions and barriers to physical activity in Latinos. Participants mentioned that the presence and lack of family support influenced their physical activity in both childhood and adulthood. Responsibilities particularly in adulthood (e.g., work, caregiving) were cited as barriers to engaging in physical activity. The participants also expressed that in adulthood they perceived physical activity important for their health. Participants also mentioned that they found physical activity enjoyable in both childhood and adulthood. Lastly, foreign-born participants cited a different way of life in the US, compared with life in their countries of origin, (e.g., living in walkable areas in their country of origin versus living in unfamiliar and less walkable areas in US, lack of social ties in US) as barriers to physical activity. Conclusions: Participants mentioned commonly reported perceptions and barriers to physical activity by Latinos. Additionally, foreign-born participants also expressed that changes in physical environment and social ties had an impact on their physical activity. This study helps fill the gap in research on understanding the perceptions and barriers to physical activity experienced by Latinos in the US. Study findings should be considered in the development of culturally-tailored interventions to promote physical activity among Latinos. Citation Format: Rosenda Murillo, Mariana Vazquez, Isabel M Leal, Daphne C Hernandez, Lorraine R Reitzel. Perceptions and barriers to physical activity among Latino adults [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D042.

Neighborhood walkability and pre-diabetes incidence in a multiethnic population

IntroductionWe examined whether adults living in highly walkable areas are less likely to develop pre-diabetes and if so, whether this association is consistent according to immigration status and ethnicity.Research design...