Relationship between urban sprawl and physical activity, obesity, and morbidity – Update and refinement

Depression and obesity, data from a national administrative database study: Geographic evidence for an epidemiological overlap

Background

Depression and obesity are two major conditions with both psychological and somatic burdens. Some data suggest strong connections between depression and obesity and more particularly associated prevalence of both disorders. However, little is known about the geographical distribution of these two diseases. This study aimed to determine if there is spatial overlap between obesity and depression using data from the entire French territory.

Methods

Data for 5,627 geographic codes for metropolitan France were collected from the two national hospital databases (PMSI-MCO and RIM-P) for the year 2016. We identified people who were depressed, obese or both registered in the two public medico-administrative databases, and we assessed their location. In addition, a multivariable analysis was performed in order to determine geographic interactions between obesity and depression after controlling for age, sex, environmental and socio-economic factors (social/material deprivation, urbanicity/rurality).

Results

1,045,682 people aged 18 years and older were identified. The mapping analysis showed several cold and hot regional clusters of coinciding obesity and depression. The multivariable analysis demonstrated significant geographic interactions, with an increasing probability of finding a high prevalence of obesity in regions with major depression (OR 1.29 95% CI 1.13–1.49, p = 0.0002) and an increased probability of finding a high prevalence of depression in regions with a high ration of obesity (OR 1.32, 95% CI 1.15–1.52, p<0.0001).

Conclusion

Our study confirms the significant bidirectional relationships between obesity and depression at a group level. French geographic patterns reveal a partial overlap between obesity and depression, suggesting these two diseases can be included in a common approach. Further studies should be done to increase the understanding of this complex comorbidity.

Urban Sprawl Sustainability of Mountainous Cities in the Context of Climate Change Adaptability Using a Coupled Coordination Model: A Case Study of Chongqing, China

In recent years, a noticeable contradiction has emerged between the disorderly sprawl and fragile climate environment of many cities, especially in mountainous cities. Therefore, this paper respectively constructed evaluation indicators for urban sprawl sustainability (USS) and climate change adaptability (CCA). Next, a coupling coordination degree model was used to measure the coordinated development of USS and CCA. Finally, this paper analyzed the coordinated development type of USS and CCA in the Chongqing metropolitan area from 2007 to 2017. The results of this paper show that USS and CCA have gradually shifted to coordinated development in the Chongqing metropolitan area during the study period. However, there were obvious regional differences in the type of coordinated development in the Chongqing metropolitan area. The coordinated development degree of USS and CCA in nine districts ranged from 0.635 to 0.721 in 2017. It can be divided into three types: slightly coordinated development with lagging CCA; slightly coordinated development with lagging USS; and moderately coordinated development with lagging CCA. Those districts should give priority to the use of Nature-Based Solutions (NBS), and multi-center and multi-group approaches to enhance the coordinated development between USS and CCA, which is also helpful for mountainous cities in China and other countries.

Perceived Walkability, Social Capital, and Self-Reported Physical Activity in Las Vegas College Students

College students are an understudied, vulnerable population, whose inactivity rates exceed those reported by U.S. adults. Walkability in sprawling cities, such as Las Vegas, is challenged due to automobile-oriented development. The purpose of this study was to assess the relationship between perceived neighborhood walkability, social capital, and meeting physical activity recommendations among University of Nevada-Las Vegas college students. Of the 410 participants, 42.2% met physical activity recommendations, 77.1% were female, 37.3% were white, and 79.5% owned a vehicle. Logistic regression showed that social capital (odds ratio (OR) = 1.25, p = 0.04) and gender (OR = 0.49, p <0.01) were the only positive indicators of physical activity; no perceived walkability subscales were significant. Findings confirm that social factors remain an important health determinant and that females continue to be less active than males. The authors speculate that sprawl characteristics may impact perceived walkability and act as a deterrent, or that it is the social norm to commute and complete errands by vehicle. It may also be that the survey tool used was unable to account for confounding variables associated with sprawl. Supporting social capital may be one approach to increase physical activity. Fostering walkability makes urban environments more livable, sustainable, healthy, and equitable; thus, further research into the relationship between walkability and physical activity in college students is needed.

Estimated global overweight and obesity burden in pregnant women based on panel data model

Objective

To estimate the global and country-level burden of overweight and obesity among pregnant women from 2005 to 2014.

Methods

Publicly accessible country-level data were collected from the World Health Organization, the World Bank and the Food and Agricultural Organization. We estimated the number of overweight and obese pregnant women among 184 countries and determined the time-related trend from 2005 to 2014. Based on panel data model, we determined the effects of food energy supply, urbanization, gross national income and female employment on the number of overweight and obese pregnant women.

Results

We estimated that 38.9 million overweight and obese pregnant women and 14.6 million obese pregnant women existed globally in 2014. In upper middle income countries and lower middle income countries, there were sharp increases in the number of overweight and obese pregnant women. In 2014, the percentage of female with overweight and obesity in India was 21.7%, and India had the largest number of overweight and obese pregnant women (4.3 million), which accounted for 11.1% in the world. In the United States of America, a third of women were obese, and the number of obese pregnant women was 1.1 million. In high income countries, caloric supply and urbanization were positively associated with the number of overweight and obese pregnant women. The percentage of employment in agriculture was inversely associated with the number of overweight and obese pregnant women, but only in upper middle income countries and lower middle income countries.

Conclusion

The number of overweight and obese pregnant women has increased in high income and middle income countries. Environmental changes could lead to increased caloric supply and decreased energy expenditure among women. National and local governments should work together to create a healthy food environment.

Local Food Environments, Suburban Development, and BMI: A Mixed Methods Study

More than half the world’s population now live in urban settlements. Worldwide, cities are expanding at their fringe to accommodate population growth. Low-density residential development, urban sprawl, and car dependency are common, contributing to physical inactivity and obesity. However, urban design and planning can modify urban form and enhance health by improving access to healthy food, public transport, and services. This study used a sequential mixed methods approach to investigate associations between food outlet access and body mass index (BMI) across urban-growth and established areas of Melbourne, Australia, and identify factors that influence local food environments. Population survey data for 3141 adults were analyzed to examine associations, and 27 interviews with government, non-government, and private sector stakeholders were conducted to contextualize results. Fast food density was positively associated with BMI in established areas and negatively associated in urban-growth areas. Interrelated challenges of car dependency, poor public transport, and low-density development hampered healthy food access. This study showed how patterns of suburban development influence local food environments and health outcomes in an urbanized city context and provides insights for other rapidly growing cities. More nuanced understandings of the differential effect of food environments within cities have potential to guide intra-city planning for improving health and reducing inequities.

Associations between Urban Sprawl and Life Expectancy in the United States

In recent years, the United States has had a relatively poor performance with respect to life expectancy compared to the other developed nations. Urban sprawl is one of the potential causes of the high rate of mortality in the United States. This study investigated cross-sectional associations between sprawl and life expectancy for metropolitan counties in the United States in 2010. In this study, the measure of life expectancy in 2010 came from a recently released dataset of life expectancies by county. This study modeled average life expectancy with a structural equation model that included five mediators: annual vehicle miles traveled (VMT) per household, average body mass index, crime rate, and air quality index as mediators of sprawl, as well as percentage of smokers as a mediator of socioeconomic status. After controlling for sociodemographic characteristics, this study found that life expectancy was significantly higher in compact counties than in sprawling counties. Compactness affects mortality directly, but the causal mechanism is unclear. For example, it may be that sprawling areas have higher traffic speeds and longer emergency response times, lower quality and less accessible health care facilities, or less availability of healthy foods. Compactness affects mortality indirectly through vehicle miles traveled, which is a contributor to traffic fatalities, and through body mass index, which is a contributor to many chronic diseases. This study identified significant direct and indirect associations between urban sprawl and life expectancy. These findings support further research and practice aimed at identifying and implementing changes to urban planning designed to support health and healthy behaviors.

Do Transit-Oriented Developments (TODs) and Established Urban Neighborhoods Have Similar Walking Levels in Hong Kong?

A sharp drop in physical activity and skyrocketing obesity rate has accompanied rapid urbanization in China. The urban planning concept of transit-oriented development (TOD) has been widely advocated in China to promote physical activity, especially walking. Indeed, many design features thought to promote walking—e.g., mixed land use, densification, and well-connected street network—often characterize both TODs and established urban neighborhoods. Thus, it is often assumed that TODs have similar physical activity benefits as established urban neighborhoods. To verify this assumption, this study compared walking behaviors in established urban neighborhoods and transit-oriented new towns in Hong Kong. To address the limitation of self-selection bias, we conducted a study using Hong Kong citywide public housing scheme, which assigns residents to different housing estates by flat availability and family size rather than personal preference. The results show new town residents walked less for transportation purpose than urban residents. New town residents far from the transit station (800–1200 m) walked less for recreational purpose than TOD residents close to a rail transit station (<400 m) or urban residents. The observed disparity in walking behaviors challenges the common assumption that TOD and established urban neighborhoods have similar impact on walking behavior. The results suggest the necessity for more nuanced planning strategies, taking local-level factors into account to promote walking of TOD residents who live far from transit stations.

Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review

Different elements of the environment have been posited to influence type 2 diabetes mellitus (T2DM). This systematic review summarizes evidence on the environmental determinants of T2DM identified in four databases. It proposes a theoretical framework illustrating the link between environment and T2DM, and briefly discusses some methodological challenges and potential solutions, and opportunities for future research. Walkability, air pollution, food and physical activity environment and roadways proximity were the most common environmental characteristics studied. Of the more than 200 reported and extracted relationships assessed in 60 studies, 82 showed significant association in the expected direction. In general, higher levels of walkability and green space were associated with lower T2DM risk, while increased levels of noise and air pollution were associated with greater risk. Current evidence is limited in terms of volume and study quality prohibiting causal inferences. However, the evidence suggests that environmental characteristics may influence T2DM prevention, and also provides a reasonable basis for further investigation with better quality data and longitudinal studies with policy-relevant environmental measures. This pursuit of better evidence is critical to support health-orientated urban design and city planning.

The shelf space and strategic placement of healthy and discretionary foods in urban, urban-fringe and rural/non-metropolitan Australian supermarkets

Objective

Supermarkets are a key influence on eating behaviours, but it is unknown if the promotion of food within stores varies on a geographic gradient from urban, to urban-fringe and non-metropolitan areas. The present study aimed to assess the shelf space and strategic placement of healthy and discretionary foods in each of urban, urban-fringe and non-metropolitan Australian supermarkets.

Design/Setting

In-store audits were conducted in stores from one of the two major Australian supermarket chains in urban (n19), urban-fringe (n20) and non-metropolitan (n26) areas of Victoria. These audits examined selected food items (crisps/chips, chocolate, confectionery, soft drinks/sodas, fruits and vegetables) and measured the shelf space and the proportion of end-of-aisle and cash register displays containing these products. Store size was measured as the sum of aisle length. Differences in the supermarket food environment with respect to location were assessed, before and after adjustment for neighbourhood socio-economic position.

Results

The strategic placement of discretionary foods was commonly observed in all supermarkets. Adjusting for store size (larger in urban-fringe and rural areas), urban stores had greater shelf space devoted to fruits and vegetables, and less checkouts with soft drinks, than urban-fringe and rural/non-metropolitan areas. Differences remained following adjustment for neighbourhood socio-economic position. No clear pattern was observed for end-of-aisle displays, or the placement of chocolate and confectionery at checkouts.

Conclusions

The shelf space of healthy and discretionary foods in urban-fringe and rural stores parallels the prevalence of overweight and obesity in these areas. Interventions in urban-fringe and rural stores targeting the shelf space of healthy foods and the placement of soft drinks at key displays may be useful obesity prevention initiatives.

The Cardiovascular Health of Young Adults: Disparities along the Urban-Rural Continuum

U.S. young adults coming of age in the early 21st Century are the first cohort to grow up during the obesity epidemic; justifiably, there is much concern about their cardiovascular health. To date, however, no research has examined the extent to which there are disparities in young adult cardiovascular health across the urban-rural continuum. We examine this topic using data from the National Longitudinal Study of Adolescent to Adult Health. We find that young adults who live in metropolitan core areas exhibit more favorable cardiovascular health than individuals who live in smaller types of communities, and that population density largely accounts for this association. Further, individuals living in more densely populated areas in young adulthood relative to adolescence have better cardiovascular health than those who live in areas similar or less dense than their adolescent residence. Our results strongly suggest that the physical and social features of communities represent important contexts for young adult cardiovascular health.

The Relationship Between Objectively Measured Walking and Risk of Pedestrian-Motor Vehicle Collision

Safe urban walking environments may improve health by encouraging physical activity, but the relationship between an individual's location and walking pattern and the risk of pedestrian-motor vehicle collision is unknown. We examined associations between individuals' walking bouts and walking risk, measured as mean exposure to the risk of pedestrian-vehicle collision. Walking bouts were ascertained through integrated accelerometry and global positioning system data and from individual travel-diary data obtained from adults in the Travel Assessment and Community Study (King County, Washington) in 2008-2009. Walking patterns were superimposed onto maps of the historical probabilities of pedestrian-vehicle collisions for intersections and midblock segments within Seattle, Washington. Mean risk of pedestrian-vehicle collision in specific walking locations was assessed according to walking exposure (duration, distance, and intensity) and participant demographic characteristics in linear mixed models. Participants typically walked in areas with low pedestrian collision risk when walking for recreation, walking at a faster pace, or taking longer-duration walks. Mean daily walking duration and distance were not associated with collision risk. Males walked in areas with higher collision risk compared with females, while vehicle owners, residents of single-family homes, and parents of young children walked in areas with lower collision risk. These findings may suggest that pedestrians moderate collision risk by using lower-risk routes.

What Is Driving Obesity? A Review on the Connections Between Obesity and Motorized Transportation

PURPOSE OF REVIEW

Traveling by automobile rather than walking or cycling can encourage obesity by eliminating physical activity. As national obesity rates in the USA have reached 37.9% in 2014, understanding the connections between obesity and transportation choices can help policymakers in the public health community propose effective obesity interventions at the national level.

RECENT FINDINGS

Following from foundational studies examining associations between the built environment and leisure walking, recent studies consider a diverse set of transportation choices regarding mode (e.g., automobile, walking, public transit) and purpose (e.g., commuting, leisure), along with studies on the effectiveness of several transportation-related interventions for obesity. The reviewed studies point toward potential interventions for obesity; there is emerging evidence that commuting by public transit may be one such intervention. Moreover, new data-gathering tools such as global positioning systems, geographic information systems, and accelerometers may alleviate statistical obstacles in conducting future studies.

Associations between active living-oriented zoning and no adult leisure-time physical activity in the U.S

Nearly one-third of adults report no leisure-time physical activity (LTPA). Governmental and authoritative bodies recognize the role that community design through zoning code changes can play in enabling LTPA. This study examined the association between zoning and no adult LTPA in the U.S. This study was conducted between 2012 and 2016, with analyses occurring in 2015-2016. Zoning codes effective as of 2010 were compiled for jurisdictions located in the 495 most populous U.S. counties and were evaluated for pedestrian-oriented code reform zoning, 11 active living-oriented provisions (e.g., sidewalks, bike-pedestrian connectivity, mixed use, bike lanes) and a summated zoning scale (max=12). Individual-level LTPA data were obtained from the 2012 CDC Behavioral Risk Factor Surveillance System (BRFSS). County-aggregated, population-weighted zoning variables were constructed for linking to BRFSS. Log-log multivariate regressions (N=147,517 adults), controlling for individual and county characteristics and with robust standard errors clustered on county, were conducted to examine associations between zoning and no LTPA. Relative risks (RR) compared predicted lack of LTPA at 0% and 100% county-level population exposure to each zoning predictor. Zoning code reforms were associated with a 13% lower probability of no LTPA (RR: 0.87, 95% CI: 0.82-0.92). Except for crosswalks, all zoning provisions were associated with an 11-16% lower probability of no LTPA. Having all 12 zoning provisions was associated with a 22% lower probability of no LTPA (RR: 0.78, 95% CI: 0.72-0.83). The results suggest that active living-oriented zoning is a policy lever available to communities seeking to reduce rates of no LTPA.

Are rural places less safe for motorists? Definitions of urban and rural to understand road safety disparities

The objectives of the study are to understand road safety within the context of regional development processes and to assess how urban-rural categories represent differences in motor vehicle occupant fatality risk. We analysed 2015 motor vehicle occupant deaths in Wisconsin from 2010 to 2014, using three definitions of urban-rural continua and negative binomial regression to adjust for population density, travel exposure and the proportion of teen residents. Rural-Urban Commuting Area codes, Beale codes and the Census definition of urban and rural places do not explain differences in urban and rural transportation fatality rates when controlling for population density. Although it is widely believed that rural places are uniquely dangerous for motorised travel, this understanding may be an artefact of inaccurate constructs. Instead, population density is a more helpful way to represent transportation hazards across different types of settlement patterns, including commuter suburbs and exurbs.

Status report, The Public Health and Planning 101 project: strengthening collaborations between the public health and planning professions

INTRODUCTION

Land use planning is a complex field comprised of legislation, policies, processes and tools. A growing body of evidence supports the relationship between land use planning decisions, community design and health. The built environment has been shown to be associated with physical inactivity, obesity, cardiovascular disease, respiratory disease and mental illness. Consequently, there is a growing interest within public health to work with planners on land use planning initiatives such as official plans and transportation master plans.

METHODS

Two surveys were developed: one for public health professionals and the other for planning professionals (survey questions available upon request to the corresponding author). The surveys were pilot tested in two separate focus group sessions with public health and planning professionals. Focus group volunteers helped to validate the surveys by verifying survey questions, design and overall flow.

RESULTS

In early 2012, 304 public health professionals and 301 planning professionals completed the two separate surveys, comprising the total survey respondents for each respective profession used to calculate proportions. The survey results represent a convenience sample and are not generalizable to the entire population of public health and planning professionals in Ontario. Results compare survey responses from both groups where appropriate. Most respondents worked either as public health staff (78%) or planners/senior planners (58%). A smaller percentage of public health and planning professionals worked either as managers (15% and 11%, respectively) or directors (5% and 9%, respectively).

CONCLUSION

Health is associated with how communities are planned and built, and the services and resources provided within them. Inspired by the results of our survey and based on user feedback from the pilot tests, a free online training program entitled "Public Health and Planning 101: An Online Course for Public Health and Planning Professionals to Create Healthier Built Environments" was launched in 2016 by OPHA as a collaborative project with OPPI and PHAC. This course is designed to bridge the gaps between the two professions, as well as provide greater opportunities for developing collaborative partnerships to help create and foster healthy built environments.

PM2.5 and Mortality in 207 US Cities: Modification by Temperature and City Characteristics

BACKGROUND

The reported estimated effects between long-term PM2.5 exposures and mortality vary spatially. We assessed whether community-level variables, including socioeconomic status indicators and temperature, modify this association.

METHODS

We used data from >35 million Medicare enrollees from 207 US cities (2000-2010). For each city, we calculated annual PM2.5 averages, measured at ambient central monitoring sites. We used a variation of a causal modeling approach and fitted city-specific Cox models, which we then pooled using a random effects meta-regression. In this second stage, we assessed whether temperature and city-level variables, including smoking and obesity rates, poverty, education and greenness, modify the long-term PM2.5-mortality association.

RESULTS

We found an association between long-term PM2.5 and survival (hazard ratio = 1.2; 95% confidence interval [CI]: 1.1, 1.3 per 10 μg/m increase in the annual PM2.5 average concentrations). We observed elevated estimates in the Southeastern, South and Northwestern US (hazard ratio = 1.9; 95% CI: 1.7, 2.2, and 1.4; 95% CI: 1.2, 1.7, and 1.4; 95% CI: 1.1, 1.9, respectively). We observed a higher association between long-term PM2.5 exposure and mortality in warmer cities. Furthermore, we observed increasing estimates with increasing obesity rates, %residents and families in poverty, %black residents and %population without a high school degree, and lower effects with increasing median household income and %white residents.

CONCLUSIONS

To the best of our knowledge, this is the first study to assess modification by temperature and community-level characteristics on the long-term PM2.5-survival association. Our findings suggest that living in cities with high temperatures and low socio economic status (SES) is associated with higher effect estimates.

How do the definitions of urban and rural matter for transportation safety? Re-interpreting transportation fatalities as an outcome of regional development processes

Urban and rural places are integrated through economic ties and population flows. Despite their integration, most studies of road safety dichotomize urban and rural places, and studies have consistently demonstrated that rural places are more dangerous for motorists than urban places. Our study investigates whether these findings are sensitive to the definition of urban and rural. We use three different definitions of urban-rural continua to quantify and compare motor vehicle occupant fatality rates per person-trip and person-mile for the state of Wisconsin. The three urban-rural continua are defined by: (1) popular impressions of urban, suburban, and rural places using a system from regional economics; (2) population density; and (3) the intensity of commute flows to core urbanized areas. In this analysis, the three definitions captured different people and places within each continuum level, highlighting rural heterogeneity. Despite this heterogeneity, the three definitions resulted in similar fatality rate gradients, suggesting a potentially latent "rural" characteristic. We then used field observations of urban-rural transects to refine the definitions. When accounting for the presence of higher-density towns and villages in rural places, we found that low-density urban places such as suburbs and exurbs have fatality rates more similar to those in rural places. These findings support the need to understand road safety within the context of regional development processes instead of urban-rural categories.

Residential proximity to urban centres, local-area walkability and change in waist circumference among Australian adults

Consistent associations have been observed between macro-level urban sprawl and overweight/obesity, but whether residential proximity to urban centres predicts adiposity change over time has not been established. Further, studies of local-area walkability and overweight/obesity have generated mixed results. This study examined 4-year change in adults' waist circumference in relation to proximity to city centre, proximity to closest suburban centre, and local-area walkability. Data were from adult participants (n=2080) of a cohort study on chronic conditions and health risk factors in Adelaide, Australia. Baseline data were collected in 2000-03 with a follow-up in 2005-06. Multilevel regression models examined in 2015 the independent and joint associations of the three environmental measures with change in waist circumference, accounting for socio-demographic covariates. On average, waist circumference rose by 1.8cm over approximately 4years. Greater distance to city centre was associated with a greater increase in waist circumference. Participants living in distal areas (20km or further from city centre) had a greater increase in waist circumference (mean increase: 2.4cm) compared to those in proximal areas (9km or less, mean increase: 1.2cm). Counterintuitively, living in the vicinity of a suburban centre was associated with a greater increase in adiposity. Local-area walkability was not significantly associated with the outcome. Residential proximity to city centre appears to be protective against excessive increases in waist circumference. Controlled development and targeted interventions in the urban fringe may be needed to tackle obesity. Additional research needs to assess behaviours that mediate relationships between sprawl and obesity.

A Multilevel Test of Constrained Choices Theory: The Case of Tobacco Clean Air Restrictions

According to Bird and Rieker's sociology of constrained choices, decisions and priorities concerning health are shaped by the contexts-including policy, community, and work/family-in which they are formulated. While each level received attention in the original and subsequent research, we contend their constrained choices theory provides a powerful multilevel framework for modeling health outcomes. We apply this framework to tobacco clean air restrictions, combining a comprehensive database of tobacco policies with the National Longitudinal Survey of Youth 1997 from ages 19 to 31. Using multilevel panel models, we find that clean air policies lower the odds of past 30 day smoking and dependence while controlling for other policy-, city-, and individual-level constraints. We also find unique between- and within-person effects, as well as gender effects, for the constraint levied by smoking bans. We argue for the theory's broad applicability beyond commonly cited findings regarding gender and biological influences.

But Where Can We Buy an Ounce of Prevention? Sprawl, Access, and Fresh Fruit and Vegetable Consumption

Fresh fruit and vegetable consumption (FFV) is integral to a healthy diet and increased longevity, yet 25.8 million Americans live in areas of restricted access, with under-resourced communities particularly vulnerable. To consider how immediate environment influences FFV, this study uses the Behavioral Risk Factor Surveillance System (BRFSS) survey (N = 122,265) to examine the influence of sprawl on FFV consumption. Findings indicate that higher sprawl relates to lower FFV consumption, and this relationship persists net of demographic covariates. Implications offer that social work's person-in-environment approach can increase FFV access in under-resourced communities.

What Explains Differences in Availability of Community Health-Related Services for Seniors in the United States?

OBJECTIVE

This study analyzes the links between planning, the built environment, and availability of health-related community services across U.S. urban and rural communities.

METHOD

We analyze the first national survey of health-related community services for seniors (2010 Maturing of America), covering 1,459 U.S. cities and counties. We tested the influence of morbidity (diabetes and obesity), city management, socioeconomic characteristics, planning and the built environment, metro status, and government finance.

RESULTS

Community health-related services are more common in places that plan for and involve seniors in planning processes. Places with higher need and government capacity also show higher levels. Service levels in rural communities are not lower after controlling for other population characteristics. Morbidity measures (diabetes and obesity) do not explain differences in service availability.

DISCUSSION

Policies promoting planning for aging and elder involvement in the planning process have the greatest impact on the level of community health-related services for seniors.

Communities on the Move: Pedestrian-Oriented Zoning as a Facilitator of Adult Active Travel to Work in the United States

BACKGROUND

Communities across the United States have been reforming their zoning codes to create pedestrian-friendly neighborhoods with increased street connectivity, mixed use and higher density, open space, transportation infrastructure, and a traditional neighborhood structure. Zoning code reforms include new urbanist zoning such as the SmartCode, form-based codes, transects, transportation and pedestrian-oriented developments, and traditional neighborhood developments.

PURPOSE

To examine the relationship of zoning code reforms and more active living--oriented zoning provisions with adult active travel to work via walking, biking, or by using public transit.

METHODS

Zoning codes effective as of 2010 were compiled for 3,914 municipal-level jurisdictions located in 471 counties and 2 consolidated cities in 48 states and the District of Columbia, and that collectively covered 72.9% of the U.S. population. Zoning codes were evaluated for the presence of code reform zoning and nine pedestrian-oriented zoning provisions (1 = yes): sidewalks, crosswalks, bike-pedestrian connectivity, street connectivity, bike lanes, bike parking, bike-pedestrian trails/paths, mixed-use development, and other walkability/pedestrian orientation. A zoning scale reflected the number of provisions addressed (out of 10). Five continuous outcome measures were constructed using 2010-2014 American Community Survey municipal-level 5-year estimates to assess the percentage of workers: walking, biking, walking or biking, or taking public transit to work OR engaged in any active travel to work. Regression models controlled for municipal-level socioeconomic characteristics and a GIS-constructed walkability scale and were clustered on county with robust standard errors.

RESULTS

Adjusted models indicated that several pedestrian-oriented zoning provisions were statistically associated (p < 0.05 or lower) with increased rates of walking, biking, or engaging in any active travel (walking, biking, or any active travel) to work: code reform zoning, bike parking (street furniture), bike lanes, bike-pedestrian trails/paths, other walkability, mixed-use zoning, and a higher score on the zoning scale. Public transit use was associated with code reform zoning and a number of zoning measures in Southern jurisdictions but not in non-Southern jurisdictions.

CONCLUSION

As jurisdictions revisit their zoning and land use policies, they may want to evaluate the pedestrian-orientation of their zoning codes so that they can plan for pedestrian improvements that will help to encourage active travel to work.

Associations between urban metrics and mortality rates in England

BACKGROUND

Seventy-five percent of the population in Europe live in urban areas and analysing the effects of urban form on the health of the urban population is of great public health interest. Not much is known, however, on the effects of urban form on the health of city dwellers. This study uses a novel approach to investigate whether associations exist between different measures of urban form and mortality risks in cities in England.

METHODS

We conducted an ecological, cross-sectional study for urban areas in England with more than 100,000 residents (n = 50) and included all registered premature deaths (<65 years) between 1(st) January 2002 and 31(st) December 2009. To describe and categorise urban form we quantified the distribution and density of population, land cover and transport networks and measures of geographical characteristics. We used Poisson regression models to examine associations between the measures of urban form and age-standardised risks of deaths from all causes, cardiovascular disease, and traffic accidents after adjustment for socioeconomic status and smoking. Analysis was stratified by gender to explore differential associations between females and males.

RESULTS

There were a total of 200,200 premature deaths during the study period (Females: 37 %; Males: 63 %). Transport network patterns were associated with overall and cardiovascular mortality rates in cities. We saw 12 % higher mortality risk after adjustment in cities with high junction density compared to cities with low density [Females: RR 1.12 (95 % CI 1.10 - 1.15); Males: RR 1.12 (95 % CI 1.10-1.14)]; the risk was slightly higher for cardiovascular mortality [Females: RR 1.16 (95 % CI 1.10 - 1.22); Males: RR 1.12 (95 % CI 1.09 - 1.16)]. Associations between mortality and population patterns were of similar magnitude [Females: RR 1.10 (95 % CI 1.09 - 1.13); Males: RR 1.09 (95 % CI 1.07-1.10)]; associations between mortality and land cover patterns were inconclusive.

CONCLUSIONS

We found an association between transport patterns and risk of premature mortality. Associations between urban form and mortality observed in this study suggest that characteristics of city structure might have negative effects on the overall health of urban communities. Future urban planning and regeneration strategies can benefit from such knowledge to promote a healthy living environment for an increasing urban population.

Place matters: Mitigating obesity with the person-in-environment approach

Research demonstrates that environmental and community-level variables contribute to obesity. Many of these variables are outside of personal volitional control, such as the characteristics of the places in which people live. Social work's unique person-in-environment (PIE) approach is an ideal perspective from which to address obesity. This study employs the PIE perspective to examine sprawl, one environmental-level factor. We employed secondary data analysis to examine the effect of sprawl on obesity while controlling for covariates. Region of residence and sprawl significantly predicted obesity, net of covariates. Given that obesity varies among communities, social workers can respond with PIE-oriented solutions.

Incidence and potential risk factors of obesity among Tehranian adults

AIM

Evaluating the incidence of obesity and its risk factors among Tehranian adults.

MATERIAL & METHODS

In this population-based cohort, non-obese participants, aged ≥20years, were followed for development of obesity (Body Mass Index (BMI) ≥30). Incidence density and cumulative incidence rates of obesity were calculated for each sex. Cox proportional hazard regression was used to determine the association of potential obesity risk factors including: age, BMI, metabolic syndrome, waist circumference (WC), smoking, marital status, education, and physical activity.

RESULT

A total of 7257 participants (3536 men) were followed for a median of 8years. At baseline, mean age, BMI and WC were 41.3±14.6years, 25.1±2.9kg/m(2) (24.9±3kg/m(2) men and 25.2±3kg/m(2) women), and 84.8±9.8cm (87.06±9.2cm men and 82.6±9.9cm women) respectively. During the follow-up, 1345 participants (876 women) developed obesity contributing to cumulative incidences of 31.3% (CI: 29.9%-32.7%), 38.1% (CI: 36.2%-40.1%), and 23.4% (CI: 21.6%-25.3%) for the whole population, women, and men, respectively. Corresponding incidence density rates per 1000 person-year were 25.9 (CI: 24.5-27.3), 33.67 (CI: 31.5-36.0), and 18.0 (CI: 16.5-19.7), respectively. Highest incidence rates were observed during their 40s and 20s for women and men, respectively. Participants with metabolic syndrome, lower educational level, higher BMI and WC, were at higher risk of obesity development in both sexes.

CONCLUSION

High incidence of obesity was observed among Tehranian adults with higher incidence of obesity in women. Different modifiable variables may act as risk factors for obesity development which should be targeted to control the epidemic of obesity.

More Active Living-oriented County and Municipal Zoning is Associated with Increased Adult Leisure Time Physical Activity-United States, 2011

Although zoning is recognized for its role in facilitating healthy communities, no study has examined whether active living-oriented zoning codes are associated with adult leisure time physical activity (PA). This study sought to fill this gap and hypothesized that adult leisure time PA would be greater in communities with more progressive zoning code reforms and more active living-oriented zoning. Zoning codes for 1,617 county and municipal jurisdictions located in 30 states (covering ~40% of the U.S. population) were evaluated for code reform zoning and 11 active living markers. County-aggregated zoning measures were created for linking with five adult PA behaviors obtained from the 2011 Behavioral Risk Factor Surveillance System controlling for individual and county sociodemographics. Zoning elements most associated with adult PA included requirements for mixed use, active and passive recreation, bike parking/street furniture, and bike-pedestrian trails/paths. This study provides new insights as to the role that zoning can play in facilitating adult PA.

From built environment to health inequalities: An explanatory framework based on evidence

OBJECTIVE

The Health in All Policies strategy aims to engage every policy domain in health promotion. The more socially disadvantaged groups are usually more affected by potential negative impacts of policies if they are not health oriented. The built environment represents an important policy domain and, apart from its housing component, its impact on health inequalities is seldom assessed.

METHODS

A scoping review of evidence on the built environment and its health equity impact was carried out, searching both urban and medical literature since 2000 analysing socio-economic inequalities in relation to different components of the built environment.

RESULTS

The proposed explanatory framework assumes that key features of built environment (identified as density, functional mix and public spaces and services), may influence individual health through their impact on both natural environment and social context, as well as behaviours, and that these effects may be unequally distributed according to the social position of individuals.

CONCLUSION

In general, the expected links proposed by the framework are well documented in the literature; however, evidence of their impact on health inequalities remains uncertain due to confounding factors, heterogeneity in study design, and difficulty to generalize evidence that is still very embedded to local contexts.

Built environment and obesity by urbanicity in the U.S

Based on the data from the Behavioral Risk Factor Surveillance System 2012, this study examines the association of neighborhood built environments with individual physical inactivity and obesity in the U.S. Multilevel modeling is used to control for the effects of individual socio-demographic characteristics. Neighborhood variables include built environment, poverty level and urbanicity at the county level. Among the built environment variables, a poorer street connectivity and a more prominent presence of fast-food restaurants are associated with a higher obesity risk (especially for areas of certain urbanicity levels). Analysis of data subsets divided by areas of different urbanicity levels and by gender reveals the variability of effects of independent variables, more so for the neighborhood variables than individual variables. This implies that some obesity risk factors are geographically specific and vary between men and women. The results lend support to the role of built environment in influencing people's health behavior and outcome, and promote public policies that need to be geographically adaptable and sensitive to the diversity of demographic groups.

Adult active transport in the Netherlands: an analysis of its contribution to physical activity requirements

Introduction

Modern, urban lifestyles have engineered physical activity out of everyday life and this presents a major threat to human health. The Netherlands is a world leader in active travel, particularly cycling, but little research has sought to quantify the cumulative amount of physical activity through everyday walking and cycling.

Methods

Using data collected as part of the Dutch National Travel Survey (2010 – 2012), this paper determines the degree to which Dutch walking and cycling contributes to meeting minimum level of physical activity of 150 minutes of moderate intensity aerobic activity throughout the week. The sample includes 74,465 individuals who recorded at least some travel on the day surveyed. As physical activity benefits are cumulative, all walking and cycling trips are analysed, including those to and from public transport. These trips are then converted into an established measure of physical activity intensity, known as metabolic equivalents of tasks. Multivariate Tobit regression models were performed on a range of socio-demographic, transport resources, urban form and meteorological characteristics.

Results

The results reveal that Dutch men and women participate in 24 and 28 minutes of daily physical activity through walking and cycling, which is 41% and 55% more than the minimum recommended level. It should be noted however that some 57% of the entire sample failed to record any walking or cycling, and an investigation of this particular group serves as an important topic of future research. Active transport was positively related with age, income, bicycle ownership, urban density and air temperature. Car ownership had a strong negative relationship with physically active travel.

Conclusion

The results of this analysis demonstrate the significance of active transport to counter the emerging issue of sedentary lifestyle disease. The Dutch experience provides other countries with a highly relevant case study in the creation of environments and cultures that support healthy, active living.

An ecological analysis of environmental correlates of active commuting in urban U.S

We conduct a cross-sectional ecological analysis to examine environmental correlates of active commuting in 39,660 urban tracts using data from the 2010 Census, 2007-2011 American Community Survey, and other sources. The five-year average (2007-2011) prevalence is 3.05% for walking, 0.63% for biking, and 7.28% for public transportation to work, with higher prevalence for all modes in lower-income tracts. Environmental factors account for more variances in public transportation to work but economic and demographic factors account for more variances in walking and biking to work. Population density, median housing age, street connectivity, tree canopy, distance to parks, air quality, and county sprawl index are associated with active commuting, but the association can vary in size and direction for different transportation mode and for higher-income and lower-income tracts.