Neighborhood Recreation Facilities and Facility Membership Are Jointly Associated with Objectively Measured Physical Activity

Public libraries and functional disability: A cohort study of Japanese older adults

This study examined the association between the presence of public libraries and functional disability risk among community-dwelling older adults. We studied 73,138 participants aged 65 years or older in 19 Japanese municipalities using data from the Japan Gerontological Evaluation Study. They were physically and cognitively independent at baseline and followed up between 2013 and 2021 (mean follow-up: 7.3 years). The onset of functional disability was ascertained by linking participants to the public registries of long-term care insurance. The exposures were the number of library books and that of libraries per population in each municipality. During the study period, we observed 16,336 cases (22.3%) of functional disability onset. Our Cox proportional hazards model revealed that the number of library books (hazard ratio [HR] = 0.96, 95% confidence interval [CI]: 0.95-0.97) and that of libraries (HR = 0.52, 95% CI: 0.28-1.00) were associated with the onset of functional disability. The association was consistent even after adjusting for individuals' reading habits and other potential confounders, which suggested the contextual effect of public libraries on older adults' functional ability. Additionally, the magnitude of association was larger for the younger, women, and people with reading habits than their counterparts. Building new libraries and increasing the number of library books in a community may contribute to lowering the functional disability risk among older adults.

Expert Opinions about Barriers and Facilitators to Physical Activity Participation in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study

Most adults with type 2 diabetes mellitus (T2DM) do not meet their physical activity (PA) goals despite its importance in improving their health outcomes. Our study aim was to explore the opinions of healthcare professionals regarding barriers and facilitators to PA participation in Ghanaian adults with T2DM. Using qualitative descriptive design, data were collected through semi-structured interviews with 13 healthcare professionals experienced in diabetes management in Ghana. Three main themes relating to PA barriers and facilitators were identified in a thematic analysis: health system-related factors, healthcare practitioner factors, and patient factors. Inadequate accessibility to physical therapists and therapy centres hindered the provision of PA programs. Nurses and doctors lacked sufficient knowledge and training on effective PA interventions for individuals with T2DM. Time constraints during patient consultations limited discussions on PA, while the cost associated with accessing physical therapy posed a significant challenge. Patients often disregarded PA advice from physical therapists due to their reliance on doctors, and some perceived PA as irrelevant for diabetes treatment. Despite these barriers, healthcare professionals expressed belief in PA facilitators, including integrating physical therapists and diabetes educators into diabetes care, providing structured exercise resources, improving curriculum planning to emphasise PA in health science education, and addressing knowledge gaps and misconceptions. Overall, this study highlights patient-related and healthcare system-related factors that influence PA behaviour in Ghanaian adults with T2DM. Findings from this study should inform the development of tailored PA programs for this population.

How the natural environment in downtown neighborhood affects physical activity and sentiment: Using social media data and machine learning

BACKGROUND

Natural environment might encourage physical exercise, hence enhancing human health and wellbeing. Social media offers an extensive repository of spatiotemporal data, containing details on the feelings and behaviors of individuals. However, investigations on physical activity and public sentiment in the natural environment of the downtown neighborhood are lacking in the existing literature.

METHODS

To extract environmental and behavioral information from social media data and other multi-source data, natural language processing, semantic segmentation, instance segmentation, and fully convolutional neural networks are employed. The research examines how neighborhood blue-green spaces and other health-promoting facilities affect physical activity and public sentiment.

RESULTS

The results reveal that blue space visibility, activity facilities, street furniture, and safety all have a favorable influence on physical activity with a social gradient. Amenities, perceived street safety and beauty positively correlated to public sentiment. The findings from social media about the environment and physical activity are consistent with traditional surveys from the same time period with a 0.588 kappa value.

CONCLUSION

According to our findings, social media data might be utilized to learn more about how urban environments influence people's physical activity patterns. Also, the health-promoting effects of blue space require more investigation.

Multilevel Factors for Adiposity Change in a Population-Based Prospective Study of Black Breast Cancer Survivors

PURPOSE

Unfavorable weight change after breast cancer diagnosis increases the risk of mortality, but individual and neighborhood risk factors affecting postdiagnosis weight and body fat changes are unclear among Black women, who have higher rates of obesity and mortality than any other racial/ethnic group.

METHODS

Adiposity changes during the period approximately 10 months-24 months after diagnosis were evaluated among 785 women diagnosed between 2012 and 2018 and enrolled in the Women's Circle of Health Follow-Up Study, a population-based prospective cohort of Black breast cancer survivors in New Jersey. Multilevel factors for weight and fat mass change (with gain or loss defined as a relative difference of 3% or more, and considering whether changes were intentional or unintentional) were estimated using multivariable polytomous logistic regressions and multilevel models.

RESULTS

Adiposity gain was prevalent: 28% and 47% gained weight and body fat, respectively, despite a high baseline prevalence of overweight or obesity (86%). Risk factors for fat mass gain included receiving chemotherapy (relative risk ratio: 1.59, 95% CI, 1.08 to 2.33) and residing in neighborhoods with a greater density of fast-food restaurants (relative risk ratio comparing highest with lowest tertile: 2.18, 95% CI, 1.38 to 3.46); findings were similar for weight gain. Only 9% of women had intentional weight loss, and multilevel risk factors differed vastly from unintentional loss.

CONCLUSION

Both individual and neighborhood factors were associated with adiposity change among Black breast cancer survivors. Residential environment characteristics may offer clinically meaningful information to identify cancer survivors at higher risk for unfavorable weight change and to address barriers to postdiagnosis weight management.

The Gatekeepers to Fitness: A Correspondence Study to Examine Disabling Practices Among Fitness Center Personnel

Fitness centers may be an ideal setting for physical activity, yet qualitative findings suggest social-level barriers constrain access for people with disabilities. To further test this, I employed an online message correspondence study to investigate the effect of impairment status on the responsiveness of a national sample of fitness centers to requests for services. Email requests were sent to 800 fitness centers, of which 200 were tailored to each of the four investigative conditions (i.e., control, vision loss, spinal cord injury, or being autistic). The odds of receiving a positive response were 40.5% lower for individuals with vision loss (p = .011) and 33.3% lower for individuals with spinal cord injury (p = .055), as compared with individuals without an impairment. Specifically, the odds of receiving a positive response for personal training were 58.8% lower among individuals with vision loss (p = .003) and 41.1% lower for individuals with spinal cord injury (p = .065).

Environmental inequity in hilly neighborhood using multi-source data from a health promotion view

The study focused on the justice of residents' opportunity to engage in healthy behavior under different environments is not vast, especially in a hilly dwelling environment. Therefore, this paper investigates environmental inequalities in a hilly urban environment in the context of the booming real estate market in China, comprised of health promotion-related elements, namely, built environment, physical activity facilities, street infrastructure, green spaces, and environmental perceptions. The multi-source data are used to calculate environmental attributes and the socioeconomic status of communities. We take the central districts of Dalian city as the research area and measure environmental equity across different socioeconomic residential areas using the Kruskal-Wallis one-way analysis of variance. The results reveal the spatial disparities in physical activity facilities, street greening, and positive perceptions between different communities. However, green injustice is mitigated in the hilly neighborhoods when we consider only ground-level greenness. This paper studies environmental justice by taking a health-enhancing view, and the results of this study can provide guidance on hilly urban development for government leaders and planners.

Exercise facilities and the prevalence of obesity and type 2 diabetes in the city of Madrid

AIMS/HYPOTHESIS

We aimed to study the association between the availability of exercise facilities and the likelihood of obesity and type 2 diabetes in the adult population of Madrid, Spain.

METHODS

We analysed the electronic medical records of all 1,270,512 residents of Madrid aged 40-75 years in 2017. Exercise facility availability was defined as the count of exercise facilities in a 1000 m street network buffer around each residential building entrance. Poisson regression with standard errors clustered at census tract level was used to assess prevalence ratios of exercise facility availability tertiles and obesity and type 2 diabetes. We also examined stratified results by tertiles of area-level socioeconomic status (SES) and sex.

RESULTS

People living in areas with lower availability of exercise facilities had a higher prevalence of obesity (prevalence ratio [PR] 1.22 [95% CI 1.20, 1.25]) and diabetes (PR 1.38 [95% CI 1.34, 1.43]). We observed effect modification by area-level SES (p<0.001), with stronger associations for residents living in low-SES areas and no association for residents living in high-SES areas. Associations with type 2 diabetes were stronger among women compared with men, while associations with obesity were similar by sex.

CONCLUSIONS/INTERPRETATION

People living in areas with low availability of exercise facilities had a higher prevalence of obesity and type 2 diabetes, and this association was strongest in low-SES areas and for women. Understanding the potential role of exercise facilities in driving inequities in obesity and type 2 diabetes prevalence may inform interventions to reduce health inequities.

Exploring the Relationship Between Community Program Location and Community Needs

INTRODUCTION

Health behaviors, mental health, and social needs impact health, but addressing these needs is difficult. Clinicians can partner with community programs to provide patients support. The relationship between program location and community need is uncertain.

METHODS

We identified and geolocated community programs in Richmond, Virginia, that aid with 9 domains of needs (mental health, smoking, unhealthy alcohol use, nutrition, physical activity, transportation, financial, housing, food insecurity). For each census tract, we identified needs from public data sources. We used 2 methods to compare program location and need: (1) hotspot analysis and (2) a negative binomial regression model.

RESULTS

We identified 280 community programs that provide aid for the 9 domains. Programs most often provided financial assistance (n = 121) and housing support (n = 73). The regression analysis showed no relationship between the number of community programs and the level of need in census tracts, with 2 exceptions. There was a positive association between financial programs and financial need and a negative association between housing programs and housing need.

CONCLUSIONS

Community programs are generally not colocated with need. This poses a barrier for people who need help addressing these domains.

Associations between individual and environmental determinants and physical activity levels of an active population during the Spanish lockdown

Restrictions during the COVID-19 pandemic are likely to decrease physical activity (PA) levels. The purpose of the study was to explore the associations between age, gender, and exercise facilities-type membership and physical activity levels during COVID-19 lockdown among users of exercise facilities from Spain. Participants were recruited among the members of 84 exercise facilities across Spain. Data was collected through an online questionnaire between 5th and 20th of April 2020 during the COVID-19 lockdown. A total of 7062 participants met inclusion criteria and responded correctly to the International Physical Activity Questionnaire. Lower levels of total PA were found in women compared with men (β = -26, 95%CI: -40 to -13), and among older adults (β = -48, 95%CI: -10 to -85) compared with younger ones. Moreover, users of private facilities showed higher levels of PA (β = 40, 95%CI: 13 to 66) than those from low-cost and public facilities (reference). Lastly, women from private facilities showed greater levels of PA (β = 63, 95%CI: 29 to 96) than low cost and public's users, an increase higher than what was found in men (β = 7, 95%CI: -38 to 52). Therefore, gender, age and the type of exercise facility's subscription had a relevant influence on PA levels during COVID-19 lockdown in an active population. These findings are useful for public health recommendations, in order to identify subpopulations of previously active people at risk of being physically inactive during and after this pandemic.

Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease?

BACKGROUND

Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA).

METHODS

We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000-US$74 000, (3) US$20 000-US$34 000 and (4)

RESULTS

We found a 25% (95% CI 1.17% to 1.34%) increased hazard of CHD per 1-category decrease in household income category. Adjusting for PA-supportive environments slightly reduced this association (HR=1.24). The income-CHD association was strongest in areas without walking destinations (HR=1.57), an interaction which reached statistical significance in analyses among men. In contrast, the income-CHD association showed a trend towards being strongest in areas with the highest percentage of green land cover.

CONCLUSIONS

Indicators of a PA supportive environment show divergent trends to modify socioeconomic inequities in CHD . Built environment interventions should measure the effect on socioeconomic inequities.

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Key Words

• cardiovascular disease
• neighborhood/place
• socio-economic

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MESH Headings Collapse

Grants

• DP5 OD026429 NIH HHS
• R01 AG049970 NIA NIH HHS
• U01 NS041588 NINDS NIH HHS

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Affiliation(s)

Pedro Gullon Public Health and Epidemiology Research Group, Universidad de Alcala de Henares Facultad de Medicina y Ciencias de la Salud, Alcala de Henares, Spain Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
Usama Bilal Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
Jana A Hirsch Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
Andrew G Rundle Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
Suzanne Judd Department of Biostatistics, University of Alabama at Birmingham College of Arts and Sciences, Birmingham, Alabama, USA
Monika M Safford Department of Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, New York, USA
Gina S Lovasi Urban Health Collaborative, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA Epidemiology and Statistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA

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Collaborators Collapse

Association of neighborhood physical activity opportunities with incident cardiovascular disease in the Cardiovascular Health Study

We determined associations of cumulative exposures to neighborhood physical activity opportunities with risk of incident cardiovascular disease (CVD). We included 3595 participants from the Cardiovascular Health Study recruited between 1989 and 1993 (mean age = 73; 60% women; 11% black). Neighborhood environment measures were calculated using Geographic Information Systems (GIS) and annual information from the National Establishment Time Series database, including the density of (1) walking destinations and (2) physical activity/recreational facilities in a 1- and 5-km radius around the respondent's home. Incident CVD was defined as the development of myocardial infarction, stroke, or cardiovascular death and associations with time to incident CVD were estimated using Cox proportional hazards models. A total of 1986 incident CVD cases occurred over a median follow-up of 11.2 years. After adjusting for baseline and time-varying individual and neighborhood-level confounding, a one standard deviation increase in walking destinations and physical activity/recreational facilities within 5 km of home was associated with a respective 7% (95% confidence interval (CI) = 0.87-0.99) and 12% (95% CI = 0.73-1.0) decreased risk of incident CVD. No significant associations were noted within a 1-km radius. Efforts to improve the availability of physical activity resources in neighborhoods may be an important strategy for lowering CVD.

Home and Neighborhood Physical Activity Location Availability among African American Adolescent Girls Living in Low-Income, Urban Communities: Associations with Objectively Measured Physical Activity

Based on the ecological model of active living, the neighborhood environment may relate to individual physical activity (PA) behaviors. The purposes of this study were to (1) generate a replicable neighborhood-level physical activity location availability score (PALAS) from data variables associated with physical activity among adolescents and adults, and apply this score to Baltimore City, Maryland, and (2) determine if relationships exist between PA and PA location availability. Geographic information systems (GISs) were used to create the PALAS. Using linear regression models, we examined relations between objectively measured PA among low-income, urban, predominantly African American adolescent girls (n = 555, 2009-2012 data collection), and the PALAS rating of their neighborhood environment (neighborhood PALAS) and their home neighborhood area (PALAS variables/subcomponents within 0.25 miles of the home). A PALAS map of the study area was created, illustrating neighborhoods varying in availability and variety of PA locations. After adjusting for confounders, a higher neighborhood PALAS (β = 0.10, p = 0.041) and the presence of a recreation center in the home neighborhood area (β = 0.46, p = 0.011) were associated with more minutes per day spent in moderate to vigorous PA. Policy makers and stakeholders should consider increasing access to PA locations as a strategy to promote PA among adolescent girls.

Business Data Categorization and Refinement for Application in Longitudinal Neighborhood Health Research: a Methodology

Retail environments, such as healthcare locations, food stores, and recreation facilities, may be relevant to many health behaviors and outcomes. However, minimal guidance on how to collect, process, aggregate, and link these data results in inconsistent or incomplete measurement that can introduce misclassification bias and limit replication of existing research. We describe the following steps to leverage business data for longitudinal neighborhood health research: re-geolocating establishment addresses, preliminary classification using standard industrial codes, systematic checks to refine classifications, incorporation and integration of complementary data sources, documentation of a flexible hierarchical classification system and variable naming conventions, and linking to neighborhoods and participant residences. We show results of this classification from a dataset of locations (over 77 million establishment locations) across the contiguous U.S. from 1990 to 2014. By incorporating complementary data sources, through manual spot checks in Google StreetView and word and name searches, we enhanced a basic classification using only standard industrial codes. Ultimately, providing these enhanced longitudinal data and supplying detailed methods for researchers to replicate our work promotes consistency, replicability, and new opportunities in neighborhood health research.

Built environment, physical activity, and obesity of adults in Pingshan District, Shenzhen City in Southern China

BACKGROUND

The relation between neighbourhood built environment and obesity has been described as both nuanced and complex.

AIM

The objective of this study was to examine the relationship between the built environment, physical activity, and obesity in a rapidly urbanised area of China.

SUBJECTS AND METHODS

This is a cross-sectional study. Descriptive statistics were used to describe the socio-demographic variables, physical activity levels and BMI status. Multivariable logistic regression models were used to examine the association between neighbourhood environment, the likelihood of engaging in different types of physical activity, and BMI.

RESULTS

A total of 842 respondents completed the questionnaires and were included (84.1% response rate). Among them, 56.4% reported meeting high physical activity levels, while 40.7% were overweight or obese. Multivariable regression analysis showed that better road conditions (β = 0.122, t = 2.999, p = 0.003) and access to physical activity facilities (β = 0.121, t = 3.193, p = 0.001) were significantly associated with higher levels of physical activity. Physical activity levels were inversely associated with the likelihood of being overweight (OR = 0.565, 95%CI: 0.3 4 9-0.917) or obese (OR = 0.614, 95%CI: 0.3 9 0-0.966).

CONCLUSION

The built environment has an important impact on physical activity. However, the direct impact of leisure physical activity on BMI is not significant. This research provides a summary of recent evidence in Pingshan District on built environments that are most favourable for physical activity and obesity.

Neighborhood social environments, healthy resources, and adult diabetes: Accounting for activity space exposures

This study broadens contextual environments to include adults' activity spaces-inside and outside the residential neighborhood-to examine how contextual exposures shape type 2 diabetes risk. We use novel longitudinal data from the Los Angeles Family and Neighborhood Survey, construct time-weighted exposure measures of adults' social-structural and healthy resource environments, and execute random effects logistic models predicting the probability of being diabetic. Results indicate that residential and activity space exposures are independently associated with adult diabetes, and that residential and activity space healthy resources combine to influence diabetes risk in synergistic ways. Living in more socioeconomically advantaged neighborhoods reduces diabetes risk, particularly when spending time in activity spaces with greater access to recreational facilities. Moreover, healthier activity space environments may compensate for living in neighborhoods devoid of healthy food options to lessen diabetes risk. Adopting an activity space framework can inform multilevel interventions aimed at alleviating type 2 diabetes and other chronic ailments.

The association between spatial access to physical activity facilities within home and workplace neighborhoods and time spent on physical activities: evidence from Guangzhou, China

BACKGROUND

Urban residents from the developing world have increasingly adopted a sedentary lifestyle and spend less time on physical activities (PA). Previous studies on the association between PA facilities and individuals' PA levels are based on the assumption that individuals have opportunities to use PA facilities within neighborhoods all day long, ignoring the fact that their willingness and opportunities to use nearby facilities depend on how much discretionary time (any time when people have a choice what to do) they have. Further, scant attention has been paid to the influence of PA facilities within both residential and workplace neighborhoods in the dense urban context. To address the above research gaps, this study investigated the links between the spatial access to PA facilities within home/workplace neighborhoods and time spent on PA among working adults, focusing on whether results were different when different measures of accessibility were used and whether participants' discretionary time over a week affected their time spent on PA.

METHOD

This study used data from a questionnaire survey (n = 1002) in Guangzhou between June and July 2017 and point of interest (POI) data from online mapping resources. Outcome variables included the amount of time spent on physical activity/moderate and vigorous intensity physical activity (PA/MVPA) over the past week. Home/workplace neighborhoods were measured as different distance buffers (500 m circular buffers, 1000 m circular buffers, and 1080 m network buffers) around each respondent's home/workplace. Spatial access to PA facilities was measured using two indicators: the counts of PA facilities and proximity to PA facilities within home/workplace neighborhoods. The amount of discretionary time was calculated based on activity log data of working day/weekend day from the Guangzhou questionnaire survey, and regression models were used to examine relationships between the spatial access of PA facilities, the time spent on PA/MVPA, and the amount of discretionary time, adjusted for covariates. Associations were stratified by gender, age, education, and income.

RESULTS

Using different measures of accessibility (the counts of and proximity to PA facilities) generated different results. Specifically, participants spent more time on PA/MVPA when they lived in neighborhoods with more PA facilities and spent more time on MVPA when worked in closer proximity to PA facilities. A larger amount of discretionary time was associated with more time spent on PA/MVPA, but it did not strengthen the relationship between access to PA facilities and PA/MVPA time. In addition, relationships between access to PA facilities and PA levels varied by gender, age, education, and income.

CONCLUSION

This study contributes to the knowledge of PA-promoting environments by considering both the home and workplace contexts and by taking into account the temporal attributes of contextual influences. Policymakers and urban planners are advised to take into account the workplace context and the temporal variability of neighborhood influences when allocating public PA facilities and public spaces.

Access to and availability of exercise facilities in Madrid: an equity perspective

BACKGROUND

Identifying socioeconomic determinants that are associated with access to and availability of exercise facilities is fundamental to supporting physical activity engagement in urban populations, which in turn, may reduce health inequities. This study analysed the relationship between area-level socioeconomic status (SES) and access to, and availability of, exercise facilities in Madrid, Spain.

METHODS

Area-level SES was measured using a composite index based on seven sociodemographic indicators. Exercise facilities were geocoded using Google Maps and classified into four types: public, private, low-cost and sessional. Accessibility was operationalized as the street network distance to the nearest exercise facility from each of the 125,427 residential building entrances (i.e. portals) in Madrid. Availability was defined as the count of exercise facilities in a 1000 m street network buffer around each portal. We used a multilevel linear regression and a zero inflated Poisson regression analyses to assess the association between area-level SES and exercise facility accessibility and availability.

RESULTS

Lower SES areas had a lower average distance to the closest facility, especially for public and low-cost facilities. Higher SES areas had higher availability of exercise facilities, especially for private and seasonal facilities.

CONCLUSION

Public and low-cost exercise facilities were more proximate in low SES areas, but the overall number of facilities was lower in these areas compared with higher SES areas. Increasing the number of exercise facilities in lower SES areas may be an intervention to improve health equity.