Built environment, physical activity, and obesity: what have we learned from reviewing the literature?

Virtual audits of streetscapes by crowdworkers

Audits have been used to provide objective ratings of neighborhood environments. Physical audits, however, are time- and resource-intensive. This study examines the efficiency and reliability of virtual auditing using Google Street View and crowdsourcing to conduct walkability audits of streets in Japan. Overall, 830 street segments were physically and virtually audited by two trained auditors; 300 untrained crowdworkers also virtually audited 3 street segments. Statistical analysis found good inter-source and inter-rater reliability. This study helps establish crowdsourced virtual auditing as a valuable method of measuring neighborhood walkability, reducing audit costs as well as enabling large-scale auditor recruitment while maintaining reliability.

Cognitive resources moderate the adverse impact of poor perceived neighborhood conditions on self-reported physical activity of older adults

Poor neighborhood conditions are associated with lower levels of physical activity for older adults but socio-ecological models posit that physical activity depends on both environmental and individual factors. Older adults' ability to overcome environmental barriers to physical activity may partially rely on cognitive resources. However, evidence on the moderating role of these cognitive resources in the associations between environmental barriers and physical activity is still lacking. We analyzed cross-national and longitudinal data on 28,393 adults aged 50 to 96 years as part of the SHARE. Lack of access to services and neighborhood nuisances were used as indicators of poor neighborhood conditions. Delayed recall and verbal fluency were used as indicators of cognitive resources. Confounder-adjusted generalized estimation equations were conducted to test associations between neighborhood conditions and self-reported moderate physical activity, as well as the moderating role of cognitive resources. Results showed that poor neighborhood conditions reduced the odds of engagement in physical activity. Cognitive resources robustly reduced the adverse influence of poor neighborhood conditions on physical activity. Participants with lower cognitive resource scores showed lower odds of engaging in physical activity when neighborhood conditions were poorer, whereas these conditions were not related to this engagement for participants with higher cognitive resource scores. These findings suggest that cognitive resources can temper the detrimental effect of poor neighborhood conditions on physical activity. Public policies should target both individual and environmental factors to tackle the current pandemic of physical inactivity more comprehensively.

Critical Hours and Important Environments: Relationships between Afterschool Physical Activity and the Physical Environment Using GPS, GIS and Accelerometers in 10-12-Year-Old Children

Introduction: The objective of this study was to assess relationships between children’s physical environment and afterschool leisure time physical activity (PA) and active transport. Methods: Children aged 10–12 years participated in a 7-day accelerometer and Global Positioning Systems (GPS) protocol. Afterschool leisure time PA and active transport were identified based on location- and speed-algorithms based on accelerometer, GPS and Geospatial Information Systems (GIS) data. We operationalized children’s exposure to the environment by combining home, school and the daily transport environment in individualized daily activity-spaces. Results: In total, 255 children from 20 Dutch primary schools from suburban areas provided valid data. This study showed that greenspaces and smaller distances from the children’s home to school were associated with afterschool leisure time PA and walking. Greater distances between home and school, as well as pedestrian infrastructure were associated with increased cycling. Conclusion: We demonstrated associations between environments and afterschool PA within several behavioral contexts. Future studies are encouraged to target specific behavioral domains and to develop natural experiments based on interactions between several types of the environment, child characteristics and potential socio-cognitive processes.

Men on the Move: A Randomized Controlled Feasibility Trial of a Scalable, Choice-Based, Physical Activity and Active Transportation Intervention for Older Men

We conducted Men on the Move, a 12-week randomized controlled feasibility trial of a scalable, choice-based, physical activity (PA) and active transportation intervention. Participants were community-dwelling men aged 60 years and older (n = 29 intervention [INT] and n = 29 waitlist control [CON]). Trained activity coaches delivered: (a) one-on-one participant consultations to develop personal action plans for PA and active transportation, (b) monthly group-based motivational meetings, (c) weekly telephone support, (d) complimentary recreation and transit passes, and (e) pedometers and diaries for self-monitoring. Men on the Move demonstrated high rates of recruitment, retention, and intervention adherence. INT chose a variety of group-based and individual PAs and destinations for their personal action plans. At 12 weeks, INT achieved more steps, moderate-vigorous PA, and energy expenditure than CON. INT was also more likely to take transit and meet national guideline levels of PA. At 24 weeks follow-up, INT benefits were sustained for moderate-vigorous PA and energy expenditure.

Closing the loop: short term impacts on physical activity of the completion of a loop trail in Sydney, Australia

BACKGROUND

In Australia, an estimated 57% of the population do not meet physical activity recommendations for health. The built environment is important for active living, and recreational trails provide safe and pleasant settings for this purpose. However, evidence for positive impacts on physical activity from real world natural experiments is sparse. We describe the impact of transforming a recreational trail into a loop on usage by cyclists and pedestrians and users' physical activity levels.

METHOD

We conducted time series analyses of pre and post-completion (November 2013-July 2015) counts taken from infrared electronic counters of pedestrians and cyclists on two established sections of the trail adjusted for underlying trend, trend change, weather, holidays and trail closures. Chi-square analyses of pre and post-completion visual counts examined change in the distribution of pedestrian/cyclist, adult/child, and male/female users. Descriptive and bivariate analyses of post-completion intercept survey data of 249 trail users were conducted to examine user characteristics and impact on physical activity.

RESULTS

Pedestrian and cyclist counts on established trail sections increased by between 200 and 340% from pre to post-completion. Visual count data showed a significant 7% increase in children (vs adults) using the trail at one site pre to post (p = 0.008). Of previous users, 48% reported doing more physical activity at the trail and this was additional to (not replacing) physical activity done elsewhere. Those users not meeting physical activity recommendations were more likely to report increased total physical activity since the loop was created (55.5% vs 39.2%, p = 0.031). The connected loop nature of the trail and its length was perceived to encourage more and different forms of physical activity.

CONCLUSION

Creating an accessible loop trail away from motorised traffic can lead to increased trail use and potentially total physical activity. The modification to the trail encouraged proportionate and real increases in usage among vulnerable populations such as children and perhaps greater total physical activity especially for people not meeting physical activity recommendations. The findings suggest that the benefits of environmental changes such as these can accrue to those most in need of support for being physically active.

A Case Study of a Natural Experiment Bridging the 'Research into Policy' and 'Evidence-Based Policy' Gap for Active-Living Science

The translation of research into tangible health benefits via changes to urban planning policy and practice is a key intended outcome of academic active-living research endeavours. Conversely, policy-makers and planners identify the need for policy-specific evidence to ensure policy decisions and practices are informed and validated by rigorously established evidence. In practice, however, these two aspirations rarely meet and a research-translation gap remains. The RESIDE project is a unique longitudinal natural experiment designed to evaluate the health impacts of the ‘Liveable Neighbourhoods’ planning policy, which was introduced by the Western Australian Government to create more walkable suburbs. This commentary provides an overview and discussion of the policy-specific study methodologies undertaken to quantitatively assess the implementation of the policy and assess its active living and health impacts. It outlines the key research-translation successes and impact of the findings on the Liveable Neighbourhoods policy and discusses lessons learnt from the RESIDE project to inform future natural experiments of policy evaluation.

Neighborhood Walkability and Aerobic Physical Activity among Latinos

Objective: In this study, we examined neighborhood social cohesion (NSC) as a moderator in the association between neighborhood walkability and meeting the aerobic physical activity guideline among US Latino adults. Methods: We used 2015 National Health Interview Survey cross-sectional data from 4525 adult US Latino participants ≥18 years of age. NSC and walkability measures were self-reported. Higher walkability scores indicating higher walkability. Aerobic activity was assessed based on self-reported frequency and duration of activity. Minutes per week of moderate and vigorous aerobic activity were then categorized based on the 2018 Physical Activity Guidelines for Americans. Survey logistic regression was used to compute odds ratios [OR] and 95% confidence intervals [CI]. Effect modification by neighborhood social cohesion was tested by inclusion of a walkability*NSC interaction term. Results: A one-unit higher walkability score was associated with higher odds of meeting the aerobic activity guideline (OR = 1.06; 95% CI: 1.02, 1.11). After adding NSC to the model, the association remained statistically significant (OR = 1.05; 95% CI: 1.01, 1.10). The walkability*NSC interaction term was not statistically significant. Conclusions: NSC did not moderate the association between neighborhood walkability and meeting the aerobic activity guideline among US Latino adults.

Use of Geographic Information Systems in Physical Activity Interventions: a Systematic Review

INTRODUCTION

The promotion of physical activity is inextricably dependent on the environment. This systematic review summarizes studies that used geographic information systems to account for the role of geographic features in the design, implementation, or evaluation of interventions that promoted physical activity.

METHODS

Pubmed, ProQuest/PsycInfo, and Cochrane Library were searched for physical activity interventions that employed geographic information systems. The search was conducted with an algorithm that included 10 geographic, 28 intervention, and 9 physical activity search terms. Data were systematically reviewed using a standardized form based on the PICOS framework (participants, interventions, comparison, outcomes, and study design). Quality of the studies included was independently rated on 14 criteria (Registration number CRD42016046011).

RESULTS

Search yield 12,518 published articles, of which, 19 studies satisfied our inclusion criteria. Proximity to recreational areas and neighborhood walkability were the most common geographic factors measured in studies of physical activity interventions. Interventions focused on supporting physical activity by providing recreational spaces and adequate infrastructure to participants. Fifteen intervention studies assessed socioeconomic environmental factors along with physical environmental factors. Support groups were introduced by 4 of the interventions to offset social environmental barriers in the geographical environment. Given the lack of consistency in measurements of physical activity, and long-term assessments, it was not possible to determine if findings are attributable to the geographic environment or a novelty effect.

CONCLUSION

More research is needed to better understand the physical and social factors within the geographic environment that work as barriers or facilitators of physical activity changes.

A Systematic Measurement of Street Quality through Multi-Sourced Urban Data: A Human-Oriented Analysis

Many studies have been made on street quality, physical activity and public health. However, most studies so far have focused on only few features, such as street greenery or accessibility. These features fail to capture people's holistic perceptions. The potential of fine grained, multi-sourced urban data creates new research avenues for addressing multi-feature, intangible, human-oriented issues related to the built environment. This study proposes a systematic, multi-factor quantitative approach for measuring street quality with the support of multi-sourced urban data taking Yangpu District in Shanghai as case study. This holistic approach combines typical and new urban data in order to measure street quality with a human-oriented perspective. This composite measure of street quality is based on the well-established 5Ds dimensions: Density, Diversity, Design, Destination accessibility and Distance to transit. They are combined as a collection of new urban data and research techniques, including location-based service (LBS) positioning data, points of interest (PoIs), elements and visual quality of street-view images extraction with supervised machine learning, and accessibility metrics using network science. According to these quantitative measurements from the five aspects, streets were classified into eight feature clusters and three types reflecting the value of street quality using a hierarchical clustering method. The classification was tested with experts. The analytical framework developed through this study contributes to human-oriented urban planning practices to further encourage physical activity and public health.

A scoping review of simulation modeling in built environment and physical activity research: Current status, gaps, and future directions for improving translation

Existing reviews have suggested that simulation studies of physical activity and environments are an emerging area, but none have explored findings in this area systematically. We used a scoping review framework to assess the use of simulation modeling to inform decision-making about built environment influences on physical activity. A systematic literature search was conducted in multiple databases in January 2018. Sixteen articles met the inclusion criteria. The studies evaluated interventions and features that were related to neighborhood safety (crime or traffic), active transportation, land use design, and walking and biking infrastructure. All of the studies focused on urban areas and most considered heterogeneity of outcomes based on local context. The majority of studies (70%) did not appear to have engaged or been used by practitioners or policy-makers to inform real-world decisions. There has been a growth of simulation modeling studies, but there remain gaps. The studies evaluated built environment interventions that have been recommended by expert panels, but more were of interventions related to active transportation; few considered recommended interventions to support recreational activity. Furthermore, studies have all focused on urban settings and there is a need to consider non-urban settings and how heterogeneity could reduce or exacerbate health disparities. More work to involve and evaluate practices for engaging stakeholders in model development and interpretation is also needed to overcome the translation of simulation research to practice gap, and realize its potential impact on the built environment and physical activity.

Built Environment and Health Behaviors: Deconstructing the Black Box of Interactions-A Review of Reviews

A review of reviews following a scoping review study design was conducted in order to deconstruct the black box of interactions between the built environment and human behaviors pertaining to physical activity and/or diet. In the qualitative analysis 107 records were included, 45 of which were also coded. Most review papers confirmed the influence of the built environment on the behaviors of interest with some noting that a same built environment feature could have different behavioral outcomes. The conceptual model developed sheds light on these mixed results and brings out the role of several personal and behavioral factors in the shift from the measured to the perceived built environment. This shift was found to shape individuals' behaviors critically and to have the power of redefining the strength of every interaction. Apart from its theoretical relevance, this model has high practical relevance especially for the design and implementation of interventions with a behavioral component. Intervention researchers can use the model developed to identify and label the built environment and individual factors that can be measured objectively or perceived as facilitators, concurrent options and barriers, in order to develop comprehensive and multi-component intervention strategies.

Moderating effect of the neighbourhood physical activity environment on the relation between psychosocial factors and physical activity in children: a longitudinal study

Background

Few studies have examined the moderating role of neighbourhood environments on the relation between psychosocial factors and physical activity, and results of these studies are mixed. This study examined this relationship in 636 fifth to seventh graders from South Carolina, USA.

Methods

From 2010 to 2013, children and their parent/guardian completed annual self-reported surveys assessing psychosocial factors, and children wore accelerometers for 1 week each year. Neighbourhood environments were classified as supportive or non-supportive for physical activity (PA) based on in-person audits of facilities near children’s homes and windshield surveys of children’s streets. Growth curve analyses were completed to assess the moderating effect of the neighbourhood physical activity environment (NPAE) on the relation between psychosocial factors and total physical activity (TPA) over time.

Results

Significant interactions on TPA were found for (1) time, NPAE and parent-reported parent support for PA; (2) time, NPAE and child-reported equipment in the home; (3) child-reported parental support for PA and time; (4) child-reported parental support for PA and NPAE; (5) PA self-schema and time and (6) child-reported parental encouragement and time. Parental support and a supportive NPAE were important for TPA, especially as children transitioned to middle school, whereas home equipment and a supportive NPAE were important for fifth graders’ TPA.

Conclusion

Consistent with the socioecological model, PA behaviour was dependent on interacting effects across levels of influence. Generally, both a supportive NPAE and positive psychosocial factors were needed to support TPA. Factors influencing PA across multiple levels should be addressed in PA interventions.

Identifying determinants of obesity in Athens, Greece through global and local statistical models

Individual socioeconomic status is linked to obesity risk, though, less is known about the influence of an area's socio-environmental conditions on obesity/overweight prevalence. This association was investigated using obesity/overweight data collected from 2445 individuals in Athens greater area, who were randomly enrolled in ATTICA study, during 2001 to 2002, and factors related to educational and economic level, population density, immigrants and green urban areas. Thematic mapping illustrated the socio-environmental status and highlighted the obesity/overweight prevalence across the municipalities of Athens. Global statistical models revealed that high socio-environmental status, educational and economic level were inversely associated with obesity/overweight (p < 0.001). Furthermore, local Geographically Weighted Regression revealed spatial non-stationarity in the relationship between green urban areas and obesity/overweight. The findings of the study lead to the better understanding of the factors affecting obesity/overweight and may support the development of policies that target to well-being, decrease of obesity/overweight prevalence and improvement of public health.

The Moving to Health (M2H) approach to natural experiment research: A paradigm shift for studies on built environment and health

Improving the built environment (BE) is viewed as one strategy to improve community diets and health. The present goal is to review the literature on the effects of BE on health, highlight its limitations, and explore the growing use of natural experiments in BE research, such as the advent of new supermarkets, revitalized parks, or new transportation systems. Based on recent studies on movers, a paradigm shift in built-environment health research may be imminent. Following the classic Moving to Opportunity study in the US, the present Moving to Health (M2H) strategy takes advantage of the fact that changing residential location can entail overnight changes in multiple BE variables. The necessary conditions for applying the M2H strategy to Geographic Information Systems (GIS) databases and to large longitudinal cohorts are outlined below. Also outlined are significant limitations of this approach, including the use of electronic medical records in lieu of survey data. The key research question is whether documented changes in BE exposure can be linked to changes in health outcomes in a causal manner. The use of geo-localized clinical information from regional health care systems should permit new insights into the social and environmental determinants of health.

Results from a natural experiment: initial neighbourhood investments do not change objectively-assessed physical activity, psychological distress or perceptions of the neighbourhood

BACKGROUND

Few studies have assessed objectively measured physical activity (PA), active transportation, psychological distress and neighborhood perceptions among residents of a neighborhood before and after substantial improvements in its physical environment. Also, most research-to-date has employed study designs subject to neighborhood selection, which may introduce bias in reported findings. We built upon a previously enrolled cohort of households from two low-income predominantly African American Pittsburgh neighborhoods, matched on socio-demographic composition including race/ethnicity, income and education. One of the two neighborhoods received substantial neighborhood investments over the course of this study including, but not limited to public housing development and greenspace/landscaping. We implemented a natural experiment using matched intervention and control neighborhoods and conducted pre-post assessments among the cohort. Our comprehensive assessments included accelerometry-based PA, active transportation, psychological distress and perceptions of the neighborhood, with assessments conducted both prior to and following the neighborhood changes. In 2013, we collected data from 1003 neighborhood participants and in 2016, we re-interviewed 676 of those participants. We conducted an intent to treat analysis, with a difference-in-difference estimator using attrition weighting to account for nonresponse between 2013 and 2016. In addition, we derived an individual-level indicator of exposure to neighbourhood investment and estimated effect of exposure to investment on the same set of outcomes using covariate-adjusted models.

RESULTS

We observed no statistically significant differences in activity, psychological distress, satisfaction with one's neighborhood as a place to live or any of the other measures we observed prior to and after the neighborhood investments between the intervention and control neighborhoods or those exposed vs not exposed to investments.

CONCLUSIONS

Using this rigorous study design, we observed no significant changes in the intervention neighborhood above and beyond secular trends present in the control neighborhood. Although neighborhood investment may have other benefits, we failed to see improvement in PA, psychological distress or related outcomes in the low-income African American neighborhoods in our study. This may be an indication that improvements in the physical environment may not directly translate into improvements in residents' physical activity or health outcomes without additional individual-level interventions. It is also possible that these investments were not dramatic enough to spur change within the three year period. Additional studies employing similar design with other cohorts in other settings are needed to confirm these results.

TRIAL REGISTRATION

Trial Registration is not applicable since we did not prospectively assign individuals to a health-related intervention.

The Influence of Home and School Environments on Children's Diet and Physical Activity, and Body Mass Index: A Structural Equation Modelling Approach

Introduction The home and school environments play important roles in influencing children's health behaviours. However, their simultaneous influence on childhood obesity has not yet been examined. We explore the relationship of the home and school environments with childhood obesity, to determine whether this relationship is mediated by children's fruit and vegetable intake and physical behaviours. Methods This study uses baseline data from 9 to 11 year old children, their parents and school principals (matched data n = 2466) from the Obesity Prevention and Lifestyle Project. Child-reported behaviours, parent-reported home environment and principal-reported school environment data were collected via questionnaires. Trained researchers measured children's height and weight, and Body Mass Index (BMI, kg/m²) was calculated. Structural equation modelling was used to assess the relationship of the home and school environments with children's fruit and vegetable intake, physical activity behaviours, and children's BMI. Result The home diet environment was positively associated with child diet (β = 0.18, p < 0.001). The home physical activity environment had the largest inverse association with BMI (β = - 0.11, p < 0.001), indirectly through child physical activity (β = 0.28 ,p < 0.001). Schools' healthy eating policy implementation was significantly associated with child diet (β = 0.52, p < 0.05), but physical activity policy was not associated with child activity (β = - 0.007, p > 0.05). The school environment was not associated with child BMI. Discussion The home environment had a stronger association with healthier child behaviours, compared to the school environment. These findings suggest that future childhood obesity interventions targeting healthier home environments and supporting parents can promote healthier child eating and physical activity behaviours.

Examining the Associations between Walk Score, Perceived Built Environment, and Physical Activity Behaviors among Women Participating in a Community-Randomized Lifestyle Change Intervention Trial: Strong Hearts, Healthy Communities

Little is known about the relationship between perceived and objective measures of the built environment and physical activity behavior among rural populations. Within the context of a lifestyle-change intervention trial for rural women, Strong Hearts, Healthy Communities (SHHC), we examined: (1) if Walk Score (WS), an objective built environment measure, was associated with perceived built environment (PBE); (2) if WS and PBE were associated with moderate-to-vigorous physical activity (MVPA); and (3) if MVPA changes were modified by WS and/or PBE. Accelerometers and questionnaires were used to collect MVPA and PBE. Bivariate analyses and linear mixed models were used for statistical analyses. We found that WS was positively associated with perceived proximity to destinations (p < 0.001) and street shoulder availability (p = 0.001). MVPA was generally not associated with WS or PBE. Compared to controls, intervention group participants increased MVPA if they lived in communities with the lowest WS (WS = 0), fewer perceived walkable destinations, or extremely safe perceived traffic (all p < 0.05). Findings suggest that WS appears to be a relevant indicator of walkable amenities in rural towns; results also suggest that the SHHC intervention likely helped rural women with the greatest dearth of built environment assets to improve MVPA.

Impact of built environment on physical activity and obesity among children and adolescents in China: A narrative systematic review

BACKGROUND

Neighborhood built environment may profoundly influence children's physical activity (PA) and body weight. This study systematically reviewed scientific evidence regarding the impact of built environment on PA and obesity among children and adolescents in China.

METHODS

A keyword and reference search was conducted in Active Living Research, Cochrane Library, PubMed, and Web of Science. Studies that met all of the following criteria were included in the review: (1) study designs-experimental studies, observational studies, and qualitative studies; (2) study subjects-Chinese children and/or adolescents aged ≤17 years; (3) exposures-neighborhood built environment; (4) outcomes-PA and/or body weight status; (5) article type-peer-reviewed publications; (6) time window of search-from the inception of an electronicbibliographic database to May 31, 2018; (7) country-China; and (8) language-articles written in English.

RESULTS

A total of 20 studies, including 16 cross-sectional studies, 3 longitudinal studies, and 1 descriptive study, met the predetermined selection criteria and were included in the review. A total of 13 studies adopted subjective built environment measures reported by parents and/or children,2 adopted objective measures (e.g., geographical information system, field observations), and 5 adopted both objective and subjective measures. PA behaviors included PA, physical inactivity, sedentary behavior, active/passive commuting from/to school, and park visits. Among the 16 studies that provided some quantitative estimates of the influence of built environment on PA and body weight status, all reported a statistically significant relationship in the expected direction. Availability and accessibility in proximity to greenspaces, parks, recreational facilities, and sidewalks were found to be associated with increased PA levels, reduced sedentary behaviors, and/or active commuting among Chinese childrenand adolescents. In contrast, the absence of bike lanes and living in higher density residential areas were associated with increased likelihood of childhood overweight and obesity.

CONCLUSION

Neighborhood built environment plays an important role in Chinese children's PA engagement and weight outcomes. Building new exercise facilities and enhancing the accessibility of existing facilities hold the potential to enhance PA engagement among Chinese children and adolescents. In addition, urban designs that incorporate sidewalks, bike lanes, walking paths, less motorized traffic, and lower residential density are likely to promote PA and prevent childhood obesity in China.

Evidence synthesis - Where are children and adults physically active and sedentary? - a rapid review of location-based studies

INTRODUCTION

Geographical positioning systems (GPS) have the capacity to provide further context around where physical activity (PA) and sedentary time (ST) are accrued especially when overlaid onto objectively measured movement. The objective of this rapid review was to summarize evidence from location-based studies which employed the simultaneous use of GPS and objective measures of PA and/or ST.

METHODS

Six databases were searched to identify studies that employed the simultaneous use of GPS and objective measures of PA or ST to quantify location of movement. Risk of bias was assessed, and a qualitative synthesis completed.

RESULTS

Searching identified 3446 articles; 59 were included in the review. A total of 22 studies in children, 17 in youth and 20 in adults were captured. The active transportation environment emerged as an important location for moderate-to-vigorous intensity physical activity (MVPA) in children, youth and adults. In children and youth, the school is an important location for MVPA, especially the schoolyard for children. Indoor locations (e.g., schools, homes) appear to be greater sources of lighter intensities of PA and ST. The review was limited by a lack of standardization in the nomenclature used to describe the locations and methods, as well as measures of variance.

CONCLUSION

Evidence suggests that the active transportation environment is a potentially important contributor of MVPA across an individual's lifespan. There is a need for future location-based studies to report on locations of all intensity of movement (including minutes and proportion) using a whole-day approach in larger representative samples.

Home and neighbourhood built environment features in family-based treatment for childhood obesity

BACKGROUND

Family-based behavioural weight loss treatment (FBT) for childhood obesity helps families develop strategies to facilitate healthy choices in their home and other environments (e.g. home neighbourhood). The current study examines how the home food environment, both pre-FBT and post-FBT, and the neighbourhoods in which families live are associated with child weight and weight-related outcomes in FBT.

METHODS

Parent-child dyads (n = 181) completed a 16-session FBT programme and completed home environment, anthropometric and child dietary/activity assessments at pre-FBT and post-FBT. Parents reported on availability of food, electronics and physical activity equipment in the home. The neighbourhood food and recreation environments around each dyad's residence was characterized using existing data within a geographic information system.

RESULTS

Families successfully made healthy home environment modifications during FBT. Regression models showed reducing RED (e.g. high-energy-dense and low-nutrient-dense) foods and electronics in the home during FBT had positive effects on child weight and weight-related outcomes. No neighbourhood food or recreation environment variables were significantly related to outcomes, although having a larger density of public recreation spaces was associated with increases in physical activity at the trend-level.

CONCLUSIONS

Modifying the home environment, specifically reducing RED foods and electronics, may be particularly important for FBT success.

Would increasing access to recreational places promote healthier weights and a healthier nation?

Addressing gaps in evidence on causal associations, this study tested the hypothesis that better access to recreational places close to home helps people to maintain lower body mass index (BMI) using a retrospective longitudinal study design and up to 6 years of data for the same individuals (1,522,803 men and 183,618 women). Participants were military veterans aged 20-64 who received healthcare through the U.S. Department of Veterans Affairs in 2009-2014 and lived in a metropolitan area. Although there were cross-sectional associations, we found no longitudinal evidence that access to parks and fitness facilities was associated with BMI for either men or women in the full sample or in subgroups of residential movers and stayers. Our findings suggest that simply increasing the number of parks and fitness facilities may not be enough to achieve needed population-level reductions in weight.

Foot-based audit of streets adjacent to new light rail stations in Houston, Texas: measurement of health-related characteristics of the built environment for physical activity research

Background

Active travel to and from a transit station may provide significant amounts of physical activity and improve health. The ease with which people can traverse the distance to the transit station may impede or support active travel. Therefore, transit stations that have features that are supportive of utilitarian physical activity would be desirable. This study aimed to characterize the built environment surrounding new light rail transit (LRT) stations in the City of Houston, Texas.

Methods

In 2014, we used a series of systematic protocols and a standardized environmental audit instrument, the Analytic Audit Tool, to collect data on segments (streets) that surround 22 LRT stations that were being newly built. Using Geographic Information System (GIS), we assembled all the segments that intersect a 0.25-mile circular buffer around each station for the audit exercise. Several 3- to 4-member teams of trained auditors completed the audit exercise on a subset of these identified segments. Our analysis were descriptive in nature. We provided the frequency distributions of audited features across the study area. We also followed an original algorithm to produce several composite index scores for our study area. The composite index score is indicative of the prevalence of physical activity friendly/unfriendly features in the study area.

Results

In all, we audited a total of 590 segments covering a total of 218 US Census blocks, and eight City of Houston super neighborhoods. Findings suggest the environment around the new LRT stations may not be supportive of physical activity. In general, the audited segments lacked land use integration; had abandoned buildings, had uneven sidewalks; were not bike-friendly, had minimal presence of public-recreational facilities that would support physical activity; and had significant physical disorder. Notably, certain attractive and comfort features were frequently to usually available.

Conclusions

Current findings, which will be compared to follow-up audit data, can be useful for future researchers and practitioners interested in the built environment around LRT stations.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6560-4) contains supplementary material, which is available to authorized users.

Area-Level Walkability and the Geographic Distribution of High Body Mass in Sydney, Australia: A Spatial Analysis Using the 45 and Up Study

Improving the walkability of built environments to promote healthy lifestyles and reduce high body mass is increasingly considered in regional development plans. Walkability indexes have the potential to inform, benchmark and monitor these plans if they are associated with variation in body mass outcomes at spatial scales used for health and urban planning. We assessed relationships between area-level walkability and prevalence and geographic variation in overweight and obesity using an Australian population-based cohort comprising 92,157 Sydney respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. Individual-level data on overweight and obesity were aggregated to 2006 Australian postal areas and analysed as a function of area-level Sydney Walkability Index quartiles using conditional auto regression spatial models adjusted for demographic, social, economic, health and socioeconomic factors. Both overweight and obesity were highly clustered with higher-than-expected prevalence concentrated in the urban sprawl region of western Sydney, and lower-than-expected prevalence in central and eastern Sydney. In fully adjusted spatial models, prevalence of overweight and obesity was 6% and 11% lower in medium-high versus low, and 10% and 15% lower in high versus low walkability postcodes, respectively. Postal area walkability explained approximately 20% and 9% of the excess spatial variation in overweight and obesity that remained after accounting for other individual- and area-level factors. These findings provide support for the potential of area-level walkability indexes to inform, benchmark and monitor regional plans aimed at targeted approaches to reducing population-levels of high body mass through environmental interventions. Future research should consider potential confounding due to neighbourhood self-selection on area-level walkability relations.

Determinants of post-migration changes in dietary and physical activity behaviours and implications for health promotion: Evidence from Australian residents of sub-Saharan African ancestry

ISSUE ADDRESSED

Several studies have attributed excess weight gain after immigration to changes in dietary and physical activity behaviours. However, recognising the main factors that influence post-migration changes in dietary and physical activity behaviours is less clear, particularly among Australian residents of sub-Saharan African (SSA) ancestry. Drawing on acculturation theory, this study examines main factors driving changes in dietary and physical activity behaviours among Australian residents who were born in SSA and provides insight into the extent to which the factors are related to immigration.

METHODS

A qualitative design based on a phenomenological approach was employed and a quota sampling technique was used to recruit 24 study participants for in-depth interviews.

RESULTS

The study found significant self-reported changes in dietary and physical activity behaviours after immigration that increase the risk of excess weight gain. The changes in dietary and physical activity behaviours were mainly driven by issues related to availability, accessibility and affordability of dietary and physical activity products. Time management and factors related to convenience also emerged as key determinants of change in dietary and physical activity behaviours. Apparently, some factors noted by participants shape dietary and physical activity behaviours irrespective of immigration, and these factors include: tastes and cravings for foods; friends and family influence on behaviour; and misconceptions about food and exercise.

CONCLUSION

Migration from SSA to Australia contributed to changes (mainly less healthy) in dietary and physical activity behaviours. To a large extent, post-migration changes in dietary and physical activity behaviours were driven by socio-economic and environmental factors. SO WHAT?: Health promotion programs that address the risky behaviours associated with excess weight gain among Australian residents of SSA ancestry should pay more attention to socio-economic and environmental factors.

Protocol for a cross sectional study of cancer risk, environmental exposures and lifestyle behaviors in a diverse community sample: the Community of Mine study

Background

Physical inactivity and unhealthy diet are modifiable behaviors that lead to several cancers. Biologically, these behaviors are linked to cancer through obesity-related insulin resistance, inflammation, and oxidative stress. Individual strategies to change physical activity and diet are often short lived with limited effects. Interventions are expected to be more successful when guided by multi-level frameworks that include environmental components for supporting lifestyle changes. Understanding the role of environment in the pathways between behavior and cancer can help identify what environmental conditions are needed for individual behavioral change approaches to be successful, and better recognize how environments may be fueling underlying racial and ethnic cancer disparities.

Methods

This cross-sectional study was designed to select participants (n = 602 adults, 40% Hispanic, in San Diego County) from a range of neighborhoods ensuring environmental variability in walkability and food access. Biomarkers measuring cancer risk were measured with fasting blood draw including insulin resistance (fasting plasma insulin and glucose levels), systemic inflammation (levels of CRP), and oxidative stress measured from urine samples. Objective physical activity, sedentary behavior, and sleep were measured by participants wearing a GT3X+ ActiGraph on the hip and wrist. Objective measures of locations were obtained through participants wearing a Qstarz Global Positioning System (GPS) device on the waist. Dietary measures were based on a 24-h food recall collected on two days (weekday and weekend). Environmental exposure will be calculated using static measures around the home and work, and dynamic measures of mobility derived from GPS traces. Associations of environment with physical activity, obesity, diet, and biomarkers will be measured using generalized estimating equation models.

Discussion

Our study is the largest study of objectively measured physical activity, dietary behaviors, environmental context/exposure, and cancer-related biomarkers in a Hispanic population. It is the first to perform high quality measures of physical activity, sedentary behavior, sleep, diet and locations in which these behaviors occur in relation to cancer-associated biomarkers including insulin resistance, inflammation, impaired lipid metabolism, and oxidative stress. Results will add to the evidence-base of how behaviors and the built environment interact to influence biomarkers that increase cancer risk.

Trial registration

ClinicalTrials.gov NCT02094170, 03/21/2014.

Characteristics of the built environment and spatial patterning of type 2 diabetes in the urban core of Durham, North Carolina

BACKGROUND

Few studies examine relationships between built environment (BE) and type 2 diabetes mellitus (T2DM) using spatial models, investigate BE domains apart from food environment or physical activity resources or conduct sensitivity analysis of methodological choices made in measuring BE. We examine geographic heterogeneity of T2DM, describe how heterogeneity in T2DM relates to BE and estimate associations of T2DM with BE.

METHODS

Individual-level electronic health records (n=41 203) from the Duke Medicine Enterprise Data Warehouse (2007-2011) were linked to BE based on census block. Data on housing damage, property disorder, territoriality, vacancy and public nuisances were used to estimate BE based on four different construction methods (CMs). We used race-stratified aspatial and spatial Bayesian models to assess geographic heterogeneity in T2DM and associations of T2DM with BE.

RESULTS

Among whites, a 1 SD increase in poor quality BE was associated with a 1.03 (95% credible interval 1.01 to 1.06) and 1.06 (95 % credible interval 1.02 to 1.11) increased risk of T2DM for poor quality BE CM1 and CM2, respectively. Among blacks/African Americans, associations between T2DM and BE overlapped with the null for all CMs. The addition of BE to white models reduced residual geographic heterogeneity in T2DM by 4%-15%, depending on CM. In black/African-American models, BE did not affect residual heterogeneity.

CONCLUSION

Associations of T2DM with BE were sensitive to CM and geographic heterogeneity in T2DM differed by race/ethnicity. Findings underscore the need to consider multiple methods of estimating BE and consider differences in relationships by race/ethnicity.

Relationships Between Neighbourhood Physical Environmental Attributes and Older Adults' Leisure-Time Physical Activity: A Systematic Review and Meta-Analysis

BACKGROUND

Activity-friendly neighbourhood physical environments with access to recreational facilities are hypothesised to facilitate leisure-time physical activity (LTPA) among older adults (≥ 65 years old). The aim of the current study was to systematically review and quantitatively summarise study findings on the relationships between physical environmental attributes and LTPA among older adults.

METHODS

An extensive search of literature, including grey literature, yielded 72 articles eligible for inclusion. The reported associations between seven categories of environmental attributes and six LTPA outcomes were extracted, weighted by sample size and study quality, and quantitatively summarised. Reported moderating effects of individual and environmental characteristics and neighbourhood definition were also examined.

RESULTS

We observed positive associations for walkability (p = 0.01), land-use mix-access (p = 0.02) and aesthetically pleasing scenery (p < 0.001) with leisure-time walking. For leisure-time walking within the neighbourhood, evidence was found for positive associations with land-use mix-access (p = 0.03) and access to public transit (p = 0.05), and a negative association with barriers to walking/cycling (p = 0.03). Evidence for positive relationships between overall LTPA and access to recreational facilities (p = 0.01) and parks/open space (p = 0.04) was found. Several environmental attribute-LTPA outcome combinations were insufficiently studied to draw conclusions. No consistent moderating effects were observed for individual and environmental characteristics and neighbourhood definition.

CONCLUSIONS

The observed significant relationships can be used to inform policy makers and planners on how to (re-)design neighbourhoods that promote LTPA among older adults. Many environmental attribute-LTPA outcome relationships have been studied insufficiently and several methodological issues remain to be addressed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO 2016:CRD42016051180.

INTERACT: A comprehensive approach to assess urban form interventions through natural experiments

BACKGROUND

Urban form interventions can result in positive and negative impacts on physical activity, social participation, and well-being, and inequities in these outcomes. Natural experiment studies can advance our understanding of causal effects and processes related to urban form interventions. The INTErventions, Research, and Action in Cities Team (INTERACT) is a pan-Canadian collaboration of interdisciplinary scientists, urban planners, and public health decision makers advancing research on the design of healthy and sustainable cities for all. Our objectives are to use natural experiment studies to deliver timely evidence about how urban form interventions influence health, and to develop methods and tools to facilitate such studies going forward.

METHODS

INTERACT will evaluate natural experiments in four Canadian cities: the Arbutus Greenway in Vancouver, British Columbia; the All Ages and Abilities Cycling Network in Victoria, BC; a new Bus Rapid Transit system in Saskatoon, Saskatchewan; and components of the Sustainable Development Plan 2016-2020 in Montreal, Quebec, a plan that includes urban form changes initiated by the city and approximately 230 partnering organizations. We will recruit a cohort of between 300 and 3000 adult participants, age 18 or older, in each city and collect data at three time points. Participants will complete health and activity space surveys and provide sensor-based location and physical activity data. We will conduct qualitative interviews with a subsample of participants in each city. Our analysis methods will combine machine learning methods for detecting transportation mode use and physical activity, use temporal Geographic Information Systems to quantify changes to urban intervention exposure, and apply analytic methods for natural experiment studies including interrupted time series analysis.

DISCUSSION

INTERACT aims to advance the evidence base on population health intervention research and address challenges related to big data, knowledge mobilization and engagement, ethics, and causality. We will collect ~ 100 TB of sensor data from participants over 5 years. We will address these challenges using interdisciplinary partnerships, training of highly qualified personnel, and modern methodologies for using sensor-based data.

Built environment and cardio-metabolic health: systematic review and meta-analysis of longitudinal studies

Built environment attributes may be related to cardio-metabolic diseases (e.g. type 2 diabetes, heart disease and stroke) and their risk factors, potentially by influencing residents' physical activity. However, existing literature reviews on the built environment and health for the most part focus on obesity as the outcome and rely on cross-sectional studies. This systematic review synthesized current evidence on longitudinal relationships between built environment attributes and cardio-metabolic health outcomes among adults and on the potential mediating role of physical inactivity. By searching eight databases for peer-reviewed journal articles published in the English language between January 2000 and July 2016, the review identified 36 articles. A meta-analysis method, weighted Z-test, was used to quantify the strength of evidence by incorporating the methodological quality of the studies. We found strong evidence for longitudinal relationships of walkability with obesity, type 2 diabetes and hypertension outcomes in the expected direction. There was strong evidence for the impact of urban sprawl on obesity outcomes. The evidence on potential mediation by physical activity was inconclusive. Further longitudinal studies are warranted to examine which specific built environment attributes influence residents' cardio-metabolic health outcomes and how physical inactivity may be involved in these relationships.

Evidence synthesis - A systematized literature review on the associations between neighbourhood built characteristics and walking among Canadian adults

INTRODUCTION

Evidence to date suggests that the built environment has the potential to facilitate and even discourage physical activity. A limitation of previous reviews is that they have typically not been country-specific. We conducted a systematized literature review of quantitative studies that estimated associations between the built environment-which were objectively measured-and walking among Canadian adults.

METHODS

Five scientific databases were searched for peer-reviewed studies published in all years up to December 31, 2016, that estimated the association between the built environment (i.e. objectively measured using audits and Geographic Information Systems [GIS]) and physical activity among a sample of Canadian adults. The database searches, title and abstract screen, full-text review and data extraction were undertaken by two reviewers.

RESULTS

Of 4140 articles identified, 25 met the inclusion criteria. Most studies included data from a single Canadian province. All but two studies were cross-sectional. Most studies captured self-reported walking for transportation and walking for any purpose. Overall walkability and land use were consistently associated with walking for transportation, while proximity to destinations was associated with walking for any purpose.

CONCLUSION

Our review findings suggest that the built environment is potentially important for supporting adult walking. Overall walkability, land use and proximity to destinations appear to be important given their association with transportation walking and walking for any purpose.

Unpacking walkability indices and their inherent assumptions

Walkability indices are used to characterize the relationship between health and place. Indices make assumptions that affect analysis of the built environment and resulting walkability scores. This study compares three walkability indices created by health researchers focusing on the methods, variables, and walkability scores resulting from differences in definitions and methods. This paper deconstructs the walkability algorithms utilized by each index and rebuilds them in Vancouver, Canada. We find that neighbourhoods in the northern core closer to the downtown area have similar walkability scores across all three indices, while the outer peripheral neighbourhoods with moderate to low walkability have more variation in walkability scores across indices. Most walkability variables - residential density, street connectivity, and land-use - lack a rationale for inclusion, often assumed by researchers. Walkability indices used in health research prove to be incongruent with each other and misrepresentative of actual human behavior. We explore the impact of variable selection and methodologies on indices in the interest of more rigorous health research.

Profile Resemblance in Health-Related Markers: The Portuguese Sibling Study on Growth, Fitness, Lifestyle, and Health

The co-occurrence of health-related markers and their associations with individual, family, and environmental characteristics have not yet been widely explored in siblings. We aimed to identify multivariate profiles of health-related markers, analyze their associations with biological, sociodemographic, and built environment characteristics, and estimate sibling resemblance in these profiles. The sample includes 736 biological siblings aged 9⁻20 years. Body fat was measured with a portable bioelectrical impedance scale; biological maturation was assessed with the maturity offset; handgrip strength, standing long jump, one-mile run, and shuttle run were used to mark physical fitness. Health behaviors, sociodemographic, and built environmental characteristics were recorded by questionnaire. Latent profile analysis and multilevel logistic regression models were used; sibling resemblance was estimated with the intraclass correlation (ρ). Two multivariate profiles emerged: "P1 = fit, lower fat and poorer diet" (86.7%) and "P2 = higher fat and lower fit, but better diet" (13.3%). Siblings whose fathers were less qualified in their occupation were more likely to belong to P2 (OR = 1.24, p = 0.04); those whose fathers with Grade 12 and university level education were more likely to fit in P2 compared to peers living with fathers having an educational level below Grade 12 (OR = 3.18, p = 0.03, and OR = 6.40, p = 0.02, Grade 12 and university level, respectively). A moderate sibling profile resemblance was found (0.46 ≤ ρ ≤ 0.55). In conclusion, youth health-related markers present substantial differences linked with their body composition, physical fitness and unhealthy diet. Furthermore, only father socio-demographic characteristics were associated with profile membership. Sibling´s profile resemblance mirrors the effects of genetics and shared characteristics.

Fast-food outlet availability and obesity: Considering variation by age and methodological diversity in 22,889 Yorkshire Health Study participants

This study investigated if the relationship between residential fast-food outlet availability and obesity varied due to methodological diversity or by age. Cross-sectional data (n = 22,889) from the Yorkshire Health Study, England were used. Obesity was defined using self-reported height and weight (BMI ≥ 30). Food outlets ("fast-food", "large supermarkets", and "convenience or other food retail outlets") were mapped using Ordnance Survey Points of Interest (PoI) database. Logistic regression was used for all analyses. Methodological diversity included adjustment for other food outlets as covariates and continuous count vs. quartile. The association between residential fast-food outlets and obesity was inconsistent and effects remained substantively the same when considering methodological diversity. This study contributes to evidence by proposing the use of a more comprehensive conceptual model adjusting for wider markers of the food environment. This study offers tentative evidence that the association between fast-food outlets and obesity varies by age.

Neighborhood Environment Measurements and Anthropometric Indicators of Obesity: Results from the Women and Their Children's Health (WaTCH) Study

We compared geographic information system (GIS)- and Census-based approaches for measuring the physical and social neighborhood environment at the census tract-level versus and audit approach on associations with body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Data were used from the 2012-2014 Women and Their Children's Health (WaTCH) Study (n=940). Generalized linear models were used to obtain odds ratios (ORs) for BMI (≥30 kg/m²), WC (>88 cm), and WHR (>0.85). Using an audit approach, more adverse neighborhood characteristics were associated with a higher odds of WC (OR: 1.10; 95% CI: 1.05, 1.15) and WHR (OR: 1.09; 95% CI: 1.05, 1.14) after adjustment for age, race/ethnicity, income, and oil spill exposure. There were no significant associations between GIS- and Census- based measures with obesity in adjusted models. Quality aspects of the neighborhood environment captured by audits at the individual-level may be more relevant to obesity than physical or social aspects at the census-tract level.

Promotion of physical activity in rural, remote and northern settings: a Canadian call to action

INTRODUCTION

The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings.

METHODS

We conducted a "synopses of syntheses" scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action.

RESULTS

We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the prioritysetting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities.

CONCLUSION

Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action.

Cardiovascular diseases in middle aged and older adults in China: the joint effects and mediation of different types of physical exercise and neighborhood greenness and walkability

BACKGROUND

Both physical exercise and the built environment are associated with cardiovascular diseases (CVDs). Yet, the influence of the multiple dimensions of the built environment and different types of physical exercise on CVDs is not well understood. Further, little is known about the joint effects of physical exercise and the built environment, nor whether one mediates the effect of the other on the risk of CVDs. We aim to investigate the risk of CVDs on middle aged and older Chinese adult populations by analyzing the independent effects, as well as potential interactions and mediation effects of different types of physical exercise and two dimensions of the built environment; namely, greenness and walkability.

METHODS

Data were collected from a community-based cross-sectional study (n = 1944). The study participants, aged 40 years or older, came from 32 communities across urban, suburban, and rural areas in Longzihu district of Bengbu, a typical second-tier city in eastern China. Physical exercise data were obtained from the International Physical Activity Questionnaire (IPAQ) question survey. We used a satellite-based Normalized Difference Vegetation Index (NDVI) score to assess greenness exposure. We used both the Walk Score index and the Neighborhood Environment Walkability Scale (NEWS) to assess walkability. Multilevel logistic regression, also known as mixed-effects logistic regression, was used to estimate the associations between physical exercise and the built environment (greenness and walkability) on CVD outcomes while accounting for within-community and within-subdistrict correlations. We followed Baron and Kenny's framework and used bootstrapping to quantify the mediation of physical exercise between built environment and CVD outcomes. Stratified analysis was conducted by age (middle aged and older adults) and gender.

RESULTS

Compared to the reference group with little to low physical activities, we found a significantly reduced risk of hypertension (about 20-45% reduction) and coronary heart disease (about 35-55% reduction) among those with moderate to high activities in walking/square dancing or morning exercising/Tai Chi, and a significantly reduced risk of stroke (about 25% reduction) among those with moderate to high activities in walking/square dancing. Compared to the reference group with low NDVI-based greenness exposure, we found a significant reduction in risk of hypertension (about 55-85% reduction), coronary heart disease (about 75% reduction) and stroke (about 45% reduction) among those with moderate to high levels of exposure. Compared to the reference groups with low walkability, we observed about 30-60% lower risk of hypertension and coronary heart disease associated with moderate to high levels of Walk score, and about 20-30% lower risk of hypertension and stroke associated with moderate to high levels of NEWS-based walkability. We found no interactions between physical exercise and the built environment. The associations of greenness and walkability with CVDs were partially explained by physical exercise (up to 55% of the total effect).

CONCLUSIONS

Both physical exercise and built environment factors were associated with the risk of CVDs. Our observed association between CVDs and neighborhood greenness exposure and walkability was explained, in part, by physical exercises. Such a role, if confirmed in future studies, could have important implications for policies and programs aimed at increasing green spaces and improving walkability in both urban and rural settings as strategies to promote physical exercise in middle aged and older population.

Neighborhood walkability and physical activity among older women: Tests of mediation by environmental perceptions and moderation by depressive symptoms

Features that enhance neighborhood walkability (higher population density, street connectivity and access to destinations) are associated with higher levels of physical activity among older adults. The perceived neighborhood environment appears to mediate associations between the objective built environment and physical activity. The role of depressed mood in these associations is poorly understood. We examined the degree to which depressive symptoms moderated indirect associations between the objective neighborhood environment and physical activity via the perceived neighborhood environment in older women. We analyzed data on 60,133 women (mean age = 73.1 ± 6.7 years) in the U.S. Nurses' Health Study cohort who completed the 2008 questionnaire. Self-reported measures included the Geriatric Depression Scale, perceived presence of recreational facilities, retail destinations, sidewalks, and crime, and participation in recreational physical activity and neighborhood walking. We created an objective walkability index by summing z-scores of intersection and facility counts within 1200-meter residential network buffers and census tract-level population density. We used multiple regression with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation and moderated mediation. Objective walkability was associated with 1.99 times greater odds of neighborhood walking (95% BC CI = 1.92, 2.06) and 1.38 times greater odds of meeting physical activity recommendations (95% BC CI = 1.34, 1.43) via the perceived neighborhood environment. These indirect associations were weaker among women with higher depressive symptom scores. Positive associations between objective neighborhood walkability and physical activities such as walking among older women may be strengthened with a reduction in their depressive symptoms.

Actual neighborhood-level crime predicts body mass index z-score changes in a multi-racial/ethnic sample of children

Longitudinal studies are warranted to clarify the influence crime has on health outcomes in children especially children representing multiple racial/ethnic backgrounds. To address this need, the current study examined whether neighborhood-level crime predicted changes in body mass index z (BMIz) scores in 373 White (W), 627 African American (AA), 1020 Hispanic (H), and 88 Asian (A), five to ten year-old boys and girls living in urban neighborhoods. Heights and weights were assessed at baseline (2012) and three-years later and used to calculate BMIz scores. Characteristics of zip codes where students lived during the three-year period were obtained at baseline from various sources. The Crime Risk Index (CRI) for each zip code was calculated using actual crime statistics. Multiple linear regression analyses were conducted to examine associations between baseline CRI and follow-up BMIz scores while controlling for other variables including BMIz at baseline. The CRI and BMIz scores differed significantly by race/ethnicity with the highest values for both noted in H. Regression analyses indicated that the CRI accounted for a significant percentage of the variance in follow-up BMIz scores in the overall sample. When race/ethnicity was considered, the CRI predicted follow-up BMIz scores only in W children. The CRI was not significantly associated with BMIz scores in the other races/ethnicities. The impact actual, neighborhood-level crime has on BMI in children is complex. Based on the existing evidence, considering actual crime as a primary target in obesity prevention would be premature especially in racial/ethnicity minority children living in urban areas.

•

Crime and body mass index differ significantly by race/ethnicity in children.

•

The association between crime and body mass index varies by race/ethnicity.

•

Crime predicts changes in body mass index only in White children.

Study protocol: healthy urban living and ageing in place (HULAP): an international, mixed methods study examining the associations between physical activity, built and social environments for older adults the UK and Brazil

BACKGROUND

The ability to 'age in place' is dependent on a range of inter-personal, social and built environment attributes, with the latter being a key area for potential intervention. There is an emerging body of evidence that indicates the type of built environment features that may best support age friendly communities, but there is a need to expand and consolidate this, while generating a better understanding of how on how research findings can be most effectively be translated in to policy and practice.

METHODS

The study is based on two case study cities, Curtiba (Brazil) and Belfast (UK), which have highly contrasting physical, social and policy environments. The study deploys a mix methods approach, mirrored in each city. This includes the recruitment of 300 participants in each city to wear GPS and accelerometers, a survey capturing physical functioning and other personal attributes, as well as their perception of their local environment using NEWS-A. The study will also measure the built environments of the cities using GIS and develop a tool for auditing the routes used by participants around their neighbourhoods. The study seeks to comparatively map the policy actors and resources involved in healthy ageing in the two cities through interviews, focus groups and discourse analysis. Finally, the study has a significant knowledge exchange component, including the development of a tool to assess the capacities of both researchers and research users to maximise the impact of the research findings.

DISCUSSION

The HULAP study has been designed and implemented by a multi-disciplinary team and integrates differing methodologies to purposefully impact on policy and practice on healthy ageing in high and low-middle income countries. It has particular strengths in its combination of objective and self-reported measures using validated tools and the integration of GPS, accelerometer and GIS data to provide a robust assessment of 'spatial energetics'. The strong knowledge exchange strand means that the study is expected to also contribute to our understanding of how to maximise research impact in this field and create effective evidence for linking older adult's physical activity with the social, built and policy environments.

Increased Risk of Hepatocellular Carcinoma Associated With Neighborhood Concentrated Disadvantage

Purpose: Over the past three decades, Hepatocellular Carcinoma (HCC) is one of few cancers for which incidence has increased in the United States (US). It is likely social determinants at the population level are driving this increase. We designed a population-based study to explore whether social determinants at the neighborhood level are geographically associated with HCC incidence in Louisiana by examining the association of HCC incidence with neighborhood concentrated disadvantage. Methods: Primary HCC cases diagnosed from 2008 to 2012 identified from the Louisiana Tumor Registry were geocoded to census tract of residence at the time of diagnosis. Neighborhood concentrated disadvantage index (CDI) for each census tract was calculated according to the PhenX Toolkit data protocol based on population and socioeconomic measures from the US Census. The incidence of HCC was modeled using multilevel binomial regression with individuals nested within neighborhoods. Results: The study included 1,418 HCC cases. Incidence of HCC was greater among males than females and among black than white. In multilevel models controlling for age, race, and sex, neighborhood CDI was positively associated with the incidence of HCC. A one standard deviation increase in CDI was associated with a 22% increase in HCC risk [Risk Ratio (RR) = 1.22; 95% CI (1.15, 1.31)]. Adjusting for contextual effects of an individual's neighborhood reduced the disparity in HCC incidence. Conclusion: Neighborhood concentrated disadvantage, a robust measure of an adverse social environment, was found to be a geographically associated with HCC incidence. Differential exposure to neighborhoods characterized by concentrated disadvantage partially explained the racial disparity in HCC for Louisiana. Our results suggest that increasing rates of HCC, and existing racial disparities for the disease, are partially explained by measures of an adverse social environment.

Examining the relationships between walkability and physical activity among older persons: what about stairs?

BACKGROUND

Walkability is considered an important dimension of healthy communities. However, variable associations between measures of walkability and physical activity have been observed, particularly among older persons. Given the challenges older persons may have navigating stairs on walking routes, the presence of stairs may be an explanatory factor for these mixed associations. The purposes of this scoping review were to determine whether studies examining the relationship between walkability and physical activity included items that assessed stairs and what relationships were found.

METHODS

Systematic reviews were identified by entering search terms into five database search engines. Eligibility criteria were: a) published between 2008 and 2017, b) examined the relationship between walkability and physical activity, c) included a focus on persons aged 65 years and older, and d) written in English. The full articles for all primary studies included in eligible systematic reviews were then retrieved. Duplicates were removed. Information about where the study took place, walkability measures used, types of walkability data obtained (objective and/or subjective) and questions asked about stairs were extracted from the full text articles.

RESULTS

Eleven systematic reviews were identified; seven were eligible. After removing duplicates, 289 primary studies remained for review. Measures of neighborhood walkability were present in 205 studies; a minority (n = 5, 2.4%) included items about stairs. No information was obtained on the structural features of the stairs.

CONCLUSIONS

The presence of stairs may deter older persons (and others) from walking outdoors. Standard measures to document the presence and characteristics of stairs, and sampling approaches to select stairs for assessment are needed. The inclusion of these measures would augment the utility and comparability of studies examining relationships between walkability and physical activity and better inform planning and policy decisions.

Neighbourhood built environment and walking behaviours: evidence from the rural American South

This study examines the perceived neighbourhood characteristics and environmental barriers in association with two different types of walking - recreational and destination - in the context of a rural town in Mississippi. A cross-sectional survey was used to assess residents' walking behaviours, perceived neighbourhood characteristics, and perceived environmental barriers to walking in three types of neighbourhoods: traditional, early conventional suburban and late conventional suburban. Descriptive statistics, one-way analysis of variance (ANOVA) and regression analyses identified environmental factors correlated with walking. A total of 362 surveys were completed and returned by random adult members of the households contacted, for a 38.5% response rate. Perceived aesthetics are significantly associated with more frequent recreational and destination walking in this rural town. Higher perceived accessibility are associated with more frequent destination walking, and greater perceived social environment barriers to walking are associated with sedentary behaviour in the rural population studied. Of all factors related to a neighbourhood's built environment, the most important factor in promoting walking in rural towns is aesthetics. The relationships among accessibility, social environment and walking underscore the importance of community planning in incorporating mixed land uses, providing a connected pedestrian infrastructure and facilitating targeted social interventions to encourage more walking.

Capturing exposure in environmental health research: challenges and opportunities of different activity space models

Background

The built environment health promotion has attracted notable attention across a wide spectrum of health-related research over the past decade. However, the results about the contextual effects on health and PA are highly heterogeneous. The discrepancies between the results can potentially be partly explained by the diverse use of different spatial units of analysis in assessing individuals’ exposure to various environment characteristics. This study investigated whether different residential and activity space units of analysis yield distinct results regarding the association between the built environment and health. In addition, this study examines the challenges and opportunities of the different spatial units of analysis for environmental health-related research.

Methods

Two common residential units of analysis and two novel activity space models were used to examine older adults’ wellbeing in relation to the built environment features in the Helsinki Metropolitan Area, Finland. An administrative unit, 500 m residential buffer, home range model and individualized residential exposure model were used to assess the associations between the built environment and wellbeing of respondent’s (n = 844).

Results

All four different spatial units of analysis yield distinct results regarding the associations between the built environment characteristics and wellbeing. A positive association between green space and health was found only when exposure was assessed with individualized residential exposure model. Walkability index and the length of pedestrian and bicycle roads were found to positively correlate with perceived wellbeing measures only with a home range model. Additionally, all units of analysis differed from each other in terms of size, shape, and how they capture different contextual measures.

Conclusions

The results show that different spatial units of analysis result in considerably different measurements of built environment. In turn, the differences derived from the use of different spatial units seem to considerably affect the associations between environment characteristics and wellbeing measures. Although it is not easy to argue about the correctness of these measurements, what is evident is that they can reveal different wellbeing outcomes. While some methods are especially usable to determine the availability of environmental opportunities that promote active travel and the related health outcomes, others can provide us with insight into the mechanisms how the actual exposure to green structure can enhance wellbeing.

The Association of Urban Greenness and Walking Behavior: Using Google Street View and Deep Learning Techniques to Estimate Residents' Exposure to Urban Greenness

Many studies have established that urban greenness is associated with better health outcomes. Yet most studies assess urban greenness with overhead-view measures, such as park area or tree count, which often differs from the amount of greenness perceived by a person at eye-level on the ground. Furthermore, those studies are often criticized for the limitation of residential self-selection bias. In this study, urban greenness was extracted and assessed from profile view of streetscape images by Google Street View (GSV), in conjunction with deep learning techniques. We also explored a unique research opportunity arising in a citywide residential reallocation scheme of Hong Kong to reduce residential self-selection bias. Two multilevel regression analyses were conducted to examine the relationships between urban greenness and (1) the odds of walking for 24,773 public housing residents in Hong Kong, (2) total walking time of 1994 residents, while controlling for potential confounders. The results suggested that eye-level greenness was significantly related to higher odds of walking and longer walking time in both 400 m and 800 m buffers. Distance to the closest Mass Transit Rail (MTR) station was also associated with higher odds of walking. Number of shops was related to higher odds of walking in the 800 m buffer, but not in 400 m. Eye-level greenness, assessed by GSV images and deep learning techniques, can effectively estimate residents’ daily exposure to urban greenness, which is in turn associated with their walking behavior. Our findings apply to the entire public housing residents in Hong Kong, because of the large sample size.

Relations between Objective and Perceived Built Environments and the Modifying Role of Individual Socioeconomic Position. A Cross-Sectional Study on Traffic Noise and Urban Green Space in a Large German City

Perceived annoyance due to traffic noise and lack of urban green space is mostly determined using data from self-administered questionnaires. However, there is still no clear evidence to what extent such perceived measures are related to objectively assessed environmental data and whether socioeconomic dimensions modify such relationships. In a cross-sectional study in Dortmund, Germany, georeferenced home addresses from parents with preschool aged children were used to analyse relations between exposures to objectively measured green space and traffic noise and subjective annoyance due to noise and lack of green space with the additional consideration of socioeconomic characteristics as effect modifiers. Higher perceived annoyance correlated with higher objectively measured traffic noise and lower objectively measured green, respectively. Stratified logistic regression models indicated a modifying role of socioeconomic characteristics. The strengths of associations between objectively measured environmental exposures and perceived annoyance differed by socioeconomic strata. Especially for noise, odds ratios were higher in low socioeconomic strata than in high socioeconomic strata. Therefore, using objective measures of the built environment as a proxy for individual perception should be made with caution as negative relations between objectively assessed built environments and health could be underestimated when considering individual socioeconomic position only as a confounder.

Validity of environmental audits using GigaPan® and Google Earth Technology

Background

Health behaviors are shaped by the context in which people live. However, documenting environmental context has remained a challenge. More specifically, direct observation techniques require large investments in time and resources and auditing the environment through web-based platforms has limited stability in spatio-temporal imagery. This study examined the validity of a new methodology, using GigaPan^® imagery, where we took photos locally and, stitched them together using GigaPan^® technology, and quantified environmental attributes from the resulting panoramic photo. For comparison, we examined validity using Google Earth imagery.

Methods

A total of 464 street segments were assessed using three methods: GigaPan^® audits, Google Earth audits, and direct observation audits. Thirty-seven different attributes were captured representing three broad constructs: land use, traffic and safety, and amenities. Sensitivity (i.e. the proportion of true positives) and specificity (i.e. the proportion of true negatives) were used to estimate the validity of GigaPan^® and Google Earth audits using direct observation audits as the gold standard.

Results

Using GigaPan^®, sensitivity was 80% or higher for 6 of 37 items and specificity was 80% or higher for 31 of 37 items. Using Google Earth, sensitivity was 80% or higher for 8 of 37 items and specificity was 80% or higher for 30 of 37 items. The validity of GigaPan^® and Google Earth was similar, with significant differences in sensitivity and specificity for 7 items and 2 items, respectively.

Conclusion

GigaPan^® performed well, especially when identifying features absent from the environment. A major strength of the GigaPan^® technology is its ability to be implemented quickly in the field relative to direct observation. GigaPan^® is a method to consider as an alternative to direct observation when temporality is prioritized or Google Earth imagery is unavailable.