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Background: The association between neighborhood environment and health may be biased due to confounding by residential self-selection. The displacement of disaster victims can act as a natural experiment that exposes residents to neighborhood environments they did not select, allowing for the study of neighborhood effects on health., Methods: We leveraged data from a cohort of older adults 65 years of age or older living in Iwanuma, Japan, located 80 km west of the 2011 Great East Japan Earthquake and Tsunami. Surveys were conducted 7 months before the disaster, as well as 2.5 and 5.5 years afterward, and linked with medical records. We classified each individual's type of exposure to neighborhood environment based on proximity to local food and recreation destinations and walkability., Results: Fixed-effect models indicated that change in the exposure type from low to high urban density was associated with increased body mass index (0.46 kg/m; 95% confidence interval [CI] = 0.20, 0.73), waist circumference (1.8 cm; 95% CI = 0.56, 3.0), low-density lipoprotein cholesterol (11 mg/dl; 95% CI = 5.0, 17), and decreased high-density lipoprotein cholesterol (-3.1 mg/dl; 95% CI = -5.0, -1.3). We observed similar trends when we analyzed only the individuals who experienced postdisaster relocation to temporary homes., Conclusions: Increased proximity to food outlets was simultaneously correlated with greater walkability and accessibility to recreational destinations; however, any protective association of physical activity-promoting built environment appeared to be offset by proximity to unhealthy food outlets, especially fast-food restaurants and bars.

Purpose: Community-level group participation is a structural aspect of social capital that may have a contextual influence on individual health. We investigated the contextual effect of community-level prevalence of sports group participation on the risk of cognitive impairment among older individuals., Methods: We analyzed prospective cohort data from the Japan Gerontological Evaluation Study, a nationwide survey of 40,308 functionally independent older individuals from 346 communities. Cognitive impairment was assessed by the nationally standardized dementia scale proposed by the Ministry of Health, Labour and Welfare of Japan. Participation in a sports group 1 d per month or more frequently was defined as "participation." We applied a two-level multilevel survival analysis to calculate hazard ratios (HR) and 95% confidence intervals (CI)., Results: The cumulative incidence of cognitive impairment during the 6-yr follow-up period was 9.8%. The mean proportion of sports group participation was 25.2% (range, 0.0%-56.5%). Higher prevalence of community-level sports group participation was associated with a lower risk of cognitive impairment (HR, 0.92; 95% CI, 0.86-0.99, estimated by 10 percentage points of participation proportion) after adjusting for individual-level sports group participation, sex, age, disease, obesity, social isolation, alcohol, smoking, education, income, depression, daily walking time, population density, and sunlight hours. We found cross-level interaction between individual- and community-level sports group participation (HR, 0.87; 95% CI, 0.76-0.99)., Conclusions: We found a contextual preventive effect of community-level sports group participation on developing cognitive impairment among older individuals. Furthermore, the benefit may favor sports group participants. Therefore, promoting sports groups in a community setting may be effective as a population-based strategy for the prevention of dementia.

Purpose: Community-level group participation is a structural aspect of social capital that may have a contextual influence on an individual's health. Herein, we sought to investigate a contextual relationship between community-level prevalence of sports group participation and depressive symptoms in older individuals., Methods: We used data from the 2010 Japan Gerontological Evaluation Study, a population-based, cross-sectional study of individuals 65 yr or older without long-term care needs in Japan. Overall, 74,681 participants in 516 communities were analyzed. Depressive symptoms were diagnosed as a 15-item Geriatric Depression Scale score of ≥5. Participation in a sports group 1 d·month or more often was defined as "participation." For this study, we applied two-level multilevel Poisson regression analysis stratified by sex, calculated prevalence ratios (PR), and 95% confidence intervals (CI)., Results: Overall, 17,420 individuals (23.3%) had depressive symptoms, and 16,915 (22.6%) participated in a sports group. Higher prevalence of community-level sports group participation had a statistically significant relationship with a lower likelihood of depressive symptoms (male: PR, 0.89 (95% CI, 0.85-0.92); female: PR, 0.96 (95% CI, 0.92-0.99), estimated by 10% of participation proportion) after adjusting for individual-level sports group participation, age, diseases, family form, alcohol, smoking, education, equivalent income, and population density. We found statistically significant cross-level interaction terms in male participants only (PR, 0.86; 95% CI, 0.77-0.95)., Conclusions: We found a contextual preventive relationship between community-level sports group participation and depressive symptoms in older individuals. Therefore, promoting sports groups in a community may be effective as a population-based strategy for the prevention of depression in older individuals. Furthermore, the benefit may favor male sports group participants.