Dandolo, Lisa and Telkmann, Klaus and Hartig, Christina and Horstmann, Sophie and Pedron, Sara and Schwettmann, Lars and Selsam, Peter and Schneider, Alexandra and Bolte, Gabriele (2023) Do multiple sex/gender dimensions play a role in the association of green space and self-rated health? Model-based recursive partitioning results from the KORA INGER study. International journal of environmental research and public health, 20 (7,5241). pp. 1-23. ISSN 1660-4601

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Abstract

Exposure to green space has a positive impact on health. Whether sex/gender modifies the green space–health association has so far only been studied through the use of a binary sex/gender category; however, sex/gender should be considered more comprehensively as a multidimensional concept based on theoretical approaches. We therefore explored whether sex/gender, operationalized through multiple sex/gender- and intersectionality-related covariates, modifies the green space–self-rated health association. We collected data from participants involved in the German KORA study (Cooperative Health Research in the Region of Augsburg) in 2019. Self-rated health was assessed as a one-question item. The availability of green spaces was measured subjectively as well as objectively. The multiple sex/gender- and intersectionality-related covariates were measured via self-assessment. To analyze the data, we used model-based recursive partitioning, a decision tree method that can handle complex data, considering both multiple covariates and their possible interactions. We showed that none of the covariates operationalizing an individual sex/gender self-concept led to subgroups with heterogeneous effects in the model-based tree analyses; however, we found effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective, although they did not show the intersectional structuring of sex/gender dimensions. In one identified subgroup, those with a lower education level or a feeling of discrimination based on social position showed a positive green space–self-rated health association, while participants with a higher education level or no feeling of discrimination based on social position had a high level of self-rated health regardless of the availability of green spaces. Model-based recursive partitioning has the potential to detect subgroups exhibiting different exposure–outcome associations, with the possibility of integrating multiple sex/gender- and intersectionality-related covariates as potential effect modifiers. A comprehensive assessment of the relevance of sex/gender showed effect heterogeneity based on covariates representing structural aspects from an intersectionality perspective.

Item Type:	Article
Uncontrolled Keywords:	sex; gender; intersectionality; model-based recursive partitioning; decision trees; green spaces
Subjects:	Technology, medicine, applied sciences > Medicine and health
Divisions:	Faculty of Medicine and Health Sciences > Department of Public Health and Medical Education
Date Deposited:	29 Mar 2023 11:35
Last Modified:	29 Mar 2023 11:35
URI:	https://oops.uni-oldenburg.de/id/eprint/5791
URN:	urn:nbn:de:gbv:715-oops-58725
DOI:	10.3390/ijerph20075241
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