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Xie H, Yang C, Tan X. Does national forest city improve residents' health? Evidence from China. Front Public Health 2024; 12:1304600. [PMID: 38444443 PMCID: PMC10912504 DOI: 10.3389/fpubh.2024.1304600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Objective National health is essential for economic and social development. The aim of this article is to examine the relationship, heterogeneity effects and influential mechanisms between National Forest Cities and the residents' health. Methods The article matches the China Family Panel Studies data in 2018 (CFPS2018) with the 2016-2018 National Forest Cities Construction List, resulting in a final sample of 20,041. Oprobit, Ologit, Instrumental Variable technique (2SLS) and interaction term analysis were used as the main research methods in this article. Results The findings indicate that: (1) The construction of National Forest Cities significantly improves the residents' health in terms of both physical and mental health, and this conclusion is still valid after a series of robustness tests. (2) On the one hand, National Forest Cities promote residents' health by reducing air pollutants such as SO2 and soot to reduce residents' health risk exposure; On the other hand, it promotes residents' health by positively guiding them to engage in healthy behaviors. (3) National Forest Cities have a greater effect on the health of urban residents, older adult and lower-income group, suggesting that National Forest Cities are a public benefit. Conclusions The construction of National Forest Cities is a public welfare that promotes residents' health, and it is an important revelation for accelerating the realization of the Healthy China Strategy. The article provides new empirical evidence for understanding the welfare effects of forest cities and offers new practical paths for improving residents' health.
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Affiliation(s)
- Hanjin Xie
- School of Economics and Management, East China Jiaotong University, Nanchang, China
| | - Chunmei Yang
- School of Economics and Management, East China Jiaotong University, Nanchang, China
| | - Xi Tan
- School of Economics and Management, Wuhan University, Wuhan, China
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2
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Edwards N, Hooper P. The park physical activity questionnaire (Park-PAQ): A reliable measurement tool for park-based and total physical activity. Health Place 2023; 83:103085. [PMID: 37523876 DOI: 10.1016/j.healthplace.2023.103085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/31/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Few studies have explicitly quantified the proportion of park-based physical activity to park users' overall physical activity levels. Population studies need new context-specific physical activity measurement tools to achieve this. The objective of this study was to develop a reliable measure of self-reported park use and physical activity undertaken within and outside of parks to determine the contribution that park-based physical activity makes to overall physical activity levels. METHODS A test-retest reliability study (n = 104) was conducted using the Park Physical Activity Questionnaire (Park-PAQ), an instrument based on the Active Australia Survey. Park-PAQ items captured the frequency and duration of walking for recreation or exercise, walking for transport, moderate and vigorous physical activity and strength, conditioning and balance activities done in parks and elsewhere. RESULTS Recall of doing any walking for recreation (kappa = 0.649, p < 0.001) and any vigorous physical activity (kappa = 0.772, p < 0.001) was 'substantial', recall of doing any moderate physical activity (kappa = 0.553, p < 0.001) was 'moderate/acceptable', and recall of any walking for transport (kappa = 0.840, p < 0.001) 'near perfect'. Recall of the time spent walking for recreation in parks (ICC = 0.928, p < 0.001) was 'near perfect', whilst recall of time spent doing moderate activity in parks (ICC = 0.925, p < 0.001) and vigorous activity in parks (ICC = 0.962, p < 0.001) was 'near perfect'. Time spent walking for transport in a park (ICC = 0.200, p = 0.056) showed 'poor' agreement. Repeatability of the usual level of park use was 'substantial' (kappa = 0.744). CONCLUSIONS The Park-PAQ reliably measures six domains of physical activity and quantifies the proportion of physical activity done in parks as a proportion of total physical activity. The Park-PAQ, used alone or embedded into park or physical activity surveys, will reliably capture context-specific activities that will optimise population level physical activity interventions, park programming and park management and design.
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Affiliation(s)
- Nicole Edwards
- The Australian Urban Design Research Centre, School of Design, The University of Western Australia. Australia. Level 2, 1002 Hay Street, Perth, WA 6000, Australia.
| | - Paula Hooper
- The Australian Urban Design Research Centre, School of Design, The University of Western Australia. Australia. Level 2, 1002 Hay Street, Perth, WA 6000, Australia.
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3
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Stewart MT, Verma M, Rajbhandari A, Antonakos CL, Colabianchi N. Park Area and Physical Activity Among Children and Adolescents: Findings From the Healthy Communities Study. J Phys Act Health 2023; 20:792-798. [PMID: 37290766 PMCID: PMC10897581 DOI: 10.1123/jpah.2022-0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/26/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is currently a nationwide effort to bring parks and green spaces within a 10-minute walk of the home. We examined the association between park area within 1 km of a child's residence and self-reported park-specific physical activity (PA) along with accelerometer-derived moderate to vigorous physical activity (MVPA). METHODS A subsample of K through eighth-grade youth (n = 493) from the Healthy Communities Study reported whether they engaged in park-specific PA during the last 24 hours and wore an accelerometer for up to 7 days. Park area was defined as the percentage of park land in a 1 km Euclidean buffer around the participant's residence, categorized into quintiles. Analysis consisted of logistic and linear regression modeling with interaction effects that controlled for clustering within communities. RESULTS Regression models estimated greater park-specific PA for participants in the fourth and fifth quintiles of park land. Age, sex, race ethnicity, and family income were unrelated to park-specific PA. Accelerometer analysis indicated that total MVPA was unrelated to park area. Older children (β = -8.73, P < .001) and girls (β = -13.44, P < .001) engaged in less MVPA. Seasonality significantly predicted both park-specific PA and total MVPA. CONCLUSION Increasing park area is likely to improve youth PA patterns, lending support for the 10-minute walk initiative.
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Affiliation(s)
| | - Manish Verma
- Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, MI,USA
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Pontin FL, Jenneson VL, Morris MA, Clarke GP, Lomax NM. Objectively measuring the association between the built environment and physical activity: a systematic review and reporting framework. Int J Behav Nutr Phys Act 2022; 19:119. [PMID: 36104757 PMCID: PMC9476279 DOI: 10.1186/s12966-022-01352-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Objective measures of built environment and physical activity provide the opportunity to directly compare their relationship across different populations and spatial contexts. This systematic review synthesises the current body of knowledge and knowledge gaps around the impact of objectively measured built environment metrics on physical activity levels in adults (≥ 18 years). Additionally, this review aims to address the need for improved quality of methodological reporting to evaluate studies and improve inter-study comparability though the creation of a reporting framework.
Methods
A systematic search of the literature was conducted following the PRISMA guidelines. After abstract and full-text screening, 94 studies were included in the final review. Results were synthesised using an association matrix to show overall association between built environment and physical activity variables. Finally, the new PERFORM (’Physical and Environmental Reporting Framework for Objectively Recorded Measures’) checklist was created and applied to the included studies rating them on their reporting quality across four key areas: study design and characteristics, built environment exposures, physical activity metrics, and the association between built environment and physical activity.
Results
Studies came from 21 countries and ranged from two days to six years in duration. Accelerometers and using geographic information system (GIS) to define the spatial extent of exposure around a pre-defined geocoded location were the most popular tools to capture physical activity and built environment respectively. Ethnicity and socio-economic status of participants were generally poorly reported. Moderate-to-vigorous physical activity (MVPA) was the most common metric of physical activity used followed by walking. Commonly investigated elements of the built environment included walkability, access to parks and green space. Areas where there was a strong body of evidence for a positive or negative association between the built environment and physical activity were identified. The new PERFORM checklist was devised and poorly reported areas identified, included poor reporting of built environment data sources and poor justification of method choice.
Conclusions
This systematic review highlights key gaps in studies objectively measuring the built environment and physical activity both in terms of the breadth and quality of reporting. Broadening the variety measures of the built environment and physical activity across different demographic groups and spatial areas will grow the body and quality of evidence around built environment effect on activity behaviour. Whilst following the PERFORM reporting guidance will ensure the high quality, reproducibility, and comparability of future research.
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Motomura M, Koohsari MJ, Lin CY, Ishii K, Shibata A, Nakaya T, Kaczynski AT, Veitch J, Oka K. Associations of public open space attributes with active and sedentary behaviors in dense urban areas: A systematic review of observational studies. Health Place 2022; 75:102816. [PMID: 35580456 DOI: 10.1016/j.healthplace.2022.102816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
Abstract
In the context of rapid urbanization, public open spaces in dense urban areas are critical built environment elements to support active lifestyles. Several reviews have explored the associations of public open space attributes with physically active and sedentary behavior. However, few reviews have included studies from Asia, and no studies have focused on dense urban areas. This systematic review analyzed 18 observational studies investigating associations between public open space attributes with physical activity and sedentary behavior in dense urban areas of East Asian countries, including Japan, Taiwan, China, and Hong Kong. We found that closer distance to and a greater number of public open spaces and features within them were positively associated with leisure-time physical activity. Places near water features and corridors within public open spaces were associated with more sedentary behavior. These findings inform landscape and urban design guidelines for (re)designing public open spaces to support active lifestyles in high dense urban areas.
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Affiliation(s)
- Monica Motomura
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Japan.
| | | | - Chien-Yu Lin
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Japan.
| | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.
| | - Ai Shibata
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan.
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Japan.
| | - Andrew T Kaczynski
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States.
| | - Jenny Veitch
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.
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6
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Frank LD, Adhikari B, White KR, Dummer T, Sandhu J, Demlow E, Hu Y, Hong A, Van den Bosch M. Chronic disease and where you live: Built and natural environment relationships with physical activity, obesity, and diabetes. ENVIRONMENT INTERNATIONAL 2022; 158:106959. [PMID: 34768046 DOI: 10.1016/j.envint.2021.106959] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/24/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Diabetes is among the most prevalent non-communicable diseases causing significant morbidity and mortality globally. The aetiology and disease development of diabetes are influenced by genetic, lifestyle, and environmental factors. Due to an increasing number of cases each year, it is imperative to improve the understanding of modifiable environmental risk and protective factors. In this study we aimed to analyse associations between built and natural environment features and diabetes prevalence; and two major risk factors: physical activity and obesity and their mediation effects. METHODS We analysed relationships between walkability and park availability with physical activity, obesity, and diabetes, using self-reported data from a large cross-sectional survey in British Columbia, Canada (n = 22,418). We validated results with an independent cohort (n = 11,972) in a subset of the analyses. The outcome measures included walking, moderate to vigorous physical activity (MVPA), body mass index (BMI), and diabetes. Built and natural environment features within a 1 km road network buffer around residential postal code centroids were assessed using validated indicators of walkability and park availability. We used general linear multivariable models (GLM) to examine the direct relationship between environmental features, physical activity, obesity, and diabetes respectively. Path models were developed to analyse mediation effects of physical activity and obesity on the association between environmental indicators and diabetes. The relative contribution of direct versus indirect effects was assessed. All models were adjusted for age, gender, income. ethnicity, years lived in neighbourhood and regional accessibility. RESULTS Walkable neighbourhoods and areas with greater park availability were associated with lower rates of diabetes. There was a direct association of walkability and park availability on physical activity (highest vs. lowest quintile OR = 1.15; 95% CI: 1.00, 1.33 and OR = 1.28, 95% CI: 1.13, 1.45 respectively), obesity (highest vs. lowest quintile OR = 0.58, 95% CI: 0.49, 0.70 and OR = 0.57, 95% CI: 0.48, 0.68 respectively) and diabetes (highest vs. lowest quintile OR = 0.62, 95% CI: 0.45, 0.85, and OR = 0.63, 95% CI: 0.47, 0.84 respectively). Results were similar in the independent cohort. The associations between diabetes and walkability and park availability respectively were partly mediated by obesity (41% of total association for walkability and 53% of total association for park availability). The mediating effect of physical activity was negligible. CONCLUSION Results support investments in walkability through active transportation and transit infrastructure. Changes in zoning and subdivision regulations governing land use actions are required to enable compact mixed-use environments with access to parks and high quality transit service. Future studies including cost-benefit analyses of health-related economic impacts of such investments can contribute to evidence-based decisions for healthier cities.
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Affiliation(s)
- Lawrence D Frank
- Department of Urban Studies and Planning, University of California at San Diego, La Jolla, CA 92093, USA; School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Binay Adhikari
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Katherine R White
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Trevor Dummer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Cancer Control Research, BC Cancer, Canada
| | - Jat Sandhu
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Ellen Demlow
- Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Yumian Hu
- Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Andy Hong
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Matilda Van den Bosch
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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7
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Andrade L, Geffin R, Maguire M, Rodriguez P, Castro G, Alkhatib A, Barengo NC. The Associations Between Access to Recreational Facilities and Adherence to the American Heart Association's Physical Activity Guidelines in US Adults. Front Public Health 2021; 9:660624. [PMID: 34900883 PMCID: PMC8654348 DOI: 10.3389/fpubh.2021.660624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Physical activity decreases the risk of long-term health consequences including cardiac diseases. According to the American Health Association (AHA), adults should perform at least 75 min of vigorous physical activity (PA) or 150 min of moderate PA per week to impact long-term health. Results of previous studies are varied and have yet to integrate perceived access to facilities with AHA PA guidelines. We investigated whether access to free or low-cost recreational facilities was associated with meeting the AHA PA guidelines. Methodology: This cross-sectional study utilized data extracted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) database collected in 2017 (n = 1,750). The main exposure variable was access to free or low-cost recreational facilities. The main outcome variable was meeting the AHA guidelines of 150 min moderate PA or 75 min vigorous PA per week. Covariates included age, sex, level of education, overall health, BMI, ethnicity, hours of work per week, income, and time living at current address. Unadjusted and adjusted logistic regression analysis were used to calculate measures of odds ratio (OR) and corresponding 95% confidence interval (CI). Results: Of the 1,750 included participants, 61.7% (n = 1,079) reported to have access to recreational facilities. Of those with access to facilities, 69.9% met AHA PA guidelines while 30.4% did not. After adjusting for covariates, participants who reported access to recreational facilities were 42% more likely to meet AHA PA guidelines compared with participants who did not (adjusted OR 1.42; 95% CI 1.14-1.76). Secondary results suggest that healthier individuals were more likely to have met AHA PA guidelines. Conclusions: Having access to free or low-cost recreational facilities such as parks, walking trails, bike paths and courts was associated with meeting the AHA PA guidelines. Increasing prevalence and awareness of neighborhood recreational facilities could assist in access to these facilities and increase the ability of individuals to meet AHA PA guidelines. Future research should determine which types of recreational facilities impact physical activity strongest and discover methods of increasing their awareness.
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Affiliation(s)
- Larissa Andrade
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Ryan Geffin
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Mark Maguire
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Pura Rodriguez
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Grettel Castro
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Noël C Barengo
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
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8
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Yi L, Mason TB, Yang CH, Chu D, Dunton GF. Longitudinal Associations Between Neighborhood Park and Open Space Access and Children's Accelerometer-Assessed Measured Physical Activity: The Evidence From the MATCH Study. J Phys Act Health 2021; 18:1058-1066. [PMID: 34198261 PMCID: PMC10913531 DOI: 10.1123/jpah.2021-0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cross-sectional studies have shown positive associations between neighborhood park access and children's physical activity (PA); however, research that examines the relationship longitudinally is lacking. This study investigates how neighborhood park access affects the longitudinal trajectory of PA in 192 children across 3 years. METHODS Accelerometer-assessed PA data of children (N = 202) were collected across 6 semi-annual waves (7 d each) between 2014 and 2018. Geographical information systems was used to measure neighborhood park access (ie, coverage, density, and proximity) at baseline. Mixed-effects models examined the associations of park access with children's baseline and trajectory of moderate to vigorous PA (MVPA) minutes across 3 years and whether the associations differed by sex or weekends versus weekdays. RESULTS Higher neighborhood park density, coverage, and proximity were positively associated with children's baseline MVPA minutes per day. Longitudinally, higher park coverage was associated with smaller decreases in children's MVPA minutes per day, but only during weekends. Park density and proximity were not associated with change in MVPA minutes per day. The above associations did not differ by sex. CONCLUSIONS Having access to more neighborhood parklands protected against age-related declines in children's PA. These findings suggest that neighborhood park coverage should be considered by urban planners when evaluating the health impacts of their policies.
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Affiliation(s)
- Li Yi
- Spatial Sciences Institute, University of Southern California
| | - Tyler B. Mason
- Department of Preventive Medicine, University of Southern California
| | | | - Daniel Chu
- Department of Preventive Medicine, University of Southern California
| | - Genevieve F. Dunton
- Department of Preventive Medicine, University of Southern California
- Department of Psychology, University of Southern California
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9
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Virtual Reality Representations of Nature to Improve Well-Being amongst Older Adults: a Rapid Review. ACTA ACUST UNITED AC 2021; 6:464-485. [PMID: 33688575 PMCID: PMC7934124 DOI: 10.1007/s41347-021-00195-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/31/2022]
Abstract
Poor well-being amongst older adults poses a serious health concern. Simultaneously, research shows that contact with nature can improve various facets of well-being, including physical, social, and mental well-being. However, nature is not always accessible for older adults due to mobility restrictions and related care needs that come with age. A promising strategy aims at bringing nature inside through pervasive technologies. However, so far, there is little academic understanding of essential nature characteristics, psychological processes involved, and means for implementation in practice. The current study used a three-folded rapid review to assess current understanding and strategies used for improving well-being for older adults through virtual reality representations of nature. Searches were performed across three databases, followed-up by content-based evaluation of abstracts. In total, a set of 25 relevant articles was identified. Only three studies specifically focus on digital nature as an intervention strategy for improving well-being amongst older adults. Although these studies provide useful starting points for the design and (technological) development of such environments, they do not generate understanding of how specific characteristics of virtual nature representations impact social well-being measures in particular, and of the underlying psychological processes involved. We conclude that follow-up research is warranted to close the gap between insights and findings from nature research, gerontology, health research, and human-technology interaction.
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10
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Mueller W, Wilkinson P, Milner J, Vardoulakis S, Steinle S, Pärkkä J, Parmes E, Cluitmans L, Kuijpers E, Pronk A, Sarigiannis D, Karakitsios S, Chapizanis D, Maggos T, Stamatelopoulou A, Loh M. Neighbourhood and path-based greenspace in three European countries: associations with objective physical activity. BMC Public Health 2021; 21:282. [PMID: 33541323 PMCID: PMC7860634 DOI: 10.1186/s12889-021-10259-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Greenspace has been associated with health benefits in many contexts. An important pathway may be through outdoor physical activity. We use a novel approach to examine the link between greenspace microenvironments and outdoor physical activity levels in the HEALS study conducted in Edinburgh (UK), the Netherlands, and Athens and Thessaloniki (Greece). Methods Using physical activity tracker recordings, 118 HEALS participants with young children were classified with regard to daily minutes of moderate to vigorous physical activity (MVPA); 60 were classified with regard to the metabolic equivalent task (MET)-minutes for each of the 1014 active trips they made. Greenspace indicators were generated for Normalised Difference Vegetation Index (NDVI), tree cover density (TCD), and green land use (GLU). We employed linear mixed-effects models to analyse (1) daily MVPA in relation to greenspace within 300 m and 1000 m of residential addresses and (2) trip MET-minutes in relation to average greenspace within a 50 m buffer of walking/cycling routes. Models were adjusted for activity, walkability, bluespace, age, sex, car ownership, dog ownership, season, weekday/weekend day, and local meteorology. Results There was no clear association between MVPA-minutes and any residential greenspace measure. For example, in fully adjusted models, a 10 percentage point increase in NDVI within 300 m of home was associated with a daily increase of 1.14 (95% CI − 0.41 to 2.70) minutes of MVPA. However, we did find evidence to indicate greenspace markers were positively linked to intensity and duration of activity: in fully adjusted models, 10 percentage point increases in trip NDVI, TCD, and GLU were associated with increases of 10.4 (95% CI: 4.43 to 16.4), 10.6 (95% CI: 4.96 to 16.3), and 3.36 (95% CI: 0.00 to 6.72) MET-minutes, respectively. The magnitude of associations with greenspace tended to be greater for cycling. Conclusions More strenuous or longer walking and cycling trips occurred in environments with more greenspace, but levels of residential greenspace did not have a clear link with outdoor MVPA. To build on our research, we suggest future work examine larger, more diverse populations and investigate the influence of greenspace for trip purpose and route preference. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10259-0.
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Affiliation(s)
- William Mueller
- Institute of Occupational Medicine, Edinburgh, UK. .,London School of Hygiene & Tropical Medicine, London, UK.
| | - Paul Wilkinson
- London School of Hygiene & Tropical Medicine, London, UK
| | - James Milner
- London School of Hygiene & Tropical Medicine, London, UK
| | - Sotiris Vardoulakis
- Institute of Occupational Medicine, Edinburgh, UK.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | | | - Juha Pärkkä
- , VTT Technical Research Centre of Finland, Finland
| | - Eija Parmes
- , VTT Technical Research Centre of Finland, Finland
| | | | | | | | | | | | | | - Thomas Maggos
- National Centre for Scientific Research 'Demokritos', Athens, Greece
| | | | - Miranda Loh
- Institute of Occupational Medicine, Edinburgh, UK
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11
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Kelso A, Reimers AK, Abu-Omar K, Wunsch K, Niessner C, Wäsche H, Demetriou Y. Locations of Physical Activity: Where Are Children, Adolescents, and Adults Physically Active? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1240. [PMID: 33573181 PMCID: PMC7908101 DOI: 10.3390/ijerph18031240] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/14/2022]
Abstract
The aim of this systematic review was to examine where physical activity (PA) takes place and how much time children, adolescents and adults spend being physically active within the identified locations. A systematic literature search was carried out in five electronic databases (PubMed, CINAHL, SPORTDiscus, PsycInfo, Scopus). For inclusion, primary studies had to identify locations of PA using device-based or self-report tools, whereas minutes of PA had to be examined using device-based tools only. Thirty-two studies were included, methodological quality and sex/gender sensitivity of the studies were assessed. The narrative data synthesis revealed that the highest average amount of daily moderate-to-vigorous PA was found in home and recreational locations, followed by school and neighborhood locations. In adults, highest average amount of daily moderate-to-vigorous PA was found in neighborhood and home locations followed by workplace and recreational locations. The majority of studies had a low risk of bias in four out of six domains; eight studies reported significant sex/gender differences in location-based PA. The results indicate that different locations are used for PA to a varying degree across the lifespan. Future research on the promotion of PA should focus on location-specific design features that encourage children, adolescents and adults to be physically active.
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Affiliation(s)
- Anne Kelso
- Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany;
| | - Anne K Reimers
- Department of Sport Science and Sport, University Erlangen-Nuremberg, Gebbertstrasse 123b, 91058 Erlangen, Germany; (A.K.R.); (K.A.-O.)
| | - Karim Abu-Omar
- Department of Sport Science and Sport, University Erlangen-Nuremberg, Gebbertstrasse 123b, 91058 Erlangen, Germany; (A.K.R.); (K.A.-O.)
| | - Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany; (K.W.); (C.N.); (H.W.)
| | - Claudia Niessner
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany; (K.W.); (C.N.); (H.W.)
| | - Hagen Wäsche
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany; (K.W.); (C.N.); (H.W.)
| | - Yolanda Demetriou
- Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany;
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12
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Katapally TR, Bhawra J, Patel P. A systematic review of the evolution of GPS use in active living research: A state of the evidence for research, policy, and practice. Health Place 2020; 66:102453. [PMID: 33137684 DOI: 10.1016/j.healthplace.2020.102453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
This is the first systematic review to comprehensively capture Global Positioning Systems' (GPS) utilization in active living research by investigating the influence of physical contexts and social environment on all intensities of physical activity and sedentary behavior among all age groups. An extensive search of peer-reviewed literature was conducted using six databases. Out of 2026 articles identified, 129 studies met the inclusion criteria. After describing the evolution of GPS use across four themes (study designs and methods, physical contexts and social environment, active transportation, and behaviors), evidence-based recommendations for active living research, policy, and practice were generated.
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Affiliation(s)
- Tarun R Katapally
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Saskatchewan, Canada; Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Pinal Patel
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Saskatchewan, Canada
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13
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Adults' leisure-time physical activity and the neighborhood built environment: a contextual perspective. Int J Health Geogr 2020; 19:35. [PMID: 32917218 PMCID: PMC7488407 DOI: 10.1186/s12942-020-00227-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Context-free outcome measures, such as overall leisure-time physical activity (LTPA), are habitually applied to study the neighborhood built environment correlates of physical activity. This cross sectional study identifies and empirically tests potential methodological limitations related to the use of context-free measures and discusses how these may help in the interpretation of inconsistent associations between participation in moderate-to-vigorous LTPA and objectively measured neighborhood-level built environment attributes. METHODS We employ a public participation geographic information system (PPGIS), an advanced participatory mapping method, to study the spatial distribution of moderate-to-vigorous LTPA among adult urban Finnish residents (n 1322). Secondary sources of GIS land-use and sport facility data were used to disaggregate respondent-mapped LTPA by the behavioral context, such as indoor and outdoor sport facilities, green spaces, and other public open spaces. Associations between the use of the identified LTPA settings and a range of objectively measured neighborhood built environment attributes were studied with multilevel logistic regression models. RESULTS Disaggregated by behavioral context, we observed varied and partly opposite built environment correlates for LTPA. The use of indoor and outdoor sport facilities showed no significant associations with their neighborhood availability, but were significantly associated with personal-level attributes. By contrast, participation in LTPA in green and built public open space shared significant associations with access to and availability of neighborhood green space that persisted after controlling for personal-level covariates. Moreover, neighborhood distances up to 1600 m poorly captured participation in moderate-to-vigorous LTPA, as, on average, 40% of visits were located further from home. However, we found the immediate home environment to be an important LTPA setting for the least active participants. CONCLUSIONS This study demonstrates that LTPA can be a highly heterogeneous measure regarding both the spatial distribution and the environmental correlates of behavioral contexts. The results show that context-free LTPA outcome measures yield inconsistent associations with built environment exposure variables, challenging the applicability of such measures in designing neighborhood-level built environment interventions.
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14
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Reichert M, Giurgiu M, Koch E, Wieland LM, Lautenbach S, Neubauer AB, von Haaren-Mack B, Schilling R, Timm I, Notthoff N, Marzi I, Hill H, Brüβler S, Eckert T, Fiedler J, Burchartz A, Anedda B, Wunsch K, Gerber M, Jekauc D, Woll A, Dunton GF, Kanning M, Nigg CR, Ebner-Priemer U, Liao Y. Ambulatory Assessment for Physical Activity Research: State of the Science, Best Practices and Future Directions. PSYCHOLOGY OF SPORT AND EXERCISE 2020; 50:101742. [PMID: 32831643 PMCID: PMC7430559 DOI: 10.1016/j.psychsport.2020.101742] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Technological and digital progress benefits physical activity (PA) research. Here we compiled expert knowledge on how Ambulatory Assessment (AA) is utilized to advance PA research, i.e., we present results of the 2nd International CAPA Workshop 2019 "Physical Activity Assessment - State of the Science, Best Practices, Future Directions" where invited researchers with experience in PA assessment, evaluation, technology and application participated. First, we provide readers with the state of the AA science, then we give best practice recommendations on how to measure PA via AA and shed light on methodological frontiers, and we furthermore discuss future directions. AA encompasses a class of methods that allows the study of PA and its behavioral, biological and physiological correlates as they unfold in everyday life. AA includes monitoring of movement (e.g., via accelerometry), physiological function (e.g., via mobile electrocardiogram), contextual information (e.g., via geolocation-tracking), and ecological momentary assessment (EMA; e.g., electronic diaries) to capture self-reported information. The strengths of AA are data assessment that near realtime, which minimizes retrospective biases in real-world settings, consequentially enabling ecological valid findings. Importantly, AA enables multiple assessments across time within subjects resulting in intensive longitudinal data (ILD), which allows unraveling within-person determinants of PA in everyday life. In this paper, we show how AA methods such as triggered e-diaries and geolocation-tracking can be used to measure PA and its correlates, and furthermore how these findings may translate into real-life interventions. In sum, AA provides numerous possibilities for PA research, especially the opportunity to tackle within- subject antecedents, concomitants, and consequences of PA as they unfold in everyday life. In-depth insights on determinants of PA could help us design and deliver impactful interventions in real-world contexts, thus enabling us to solve critical health issues in the 21st century such as insufficient PA and high levels of sedentary behavior.
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Affiliation(s)
- Markus Reichert
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University; postal address: Central Institute of Mental Health (CIMH), Square J5, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Marco Giurgiu
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University; postal address: Central Institute of Mental Health (CIMH), Square J5, 68159 Mannheim, Baden-Wuerttemberg, Germany
| | - Elena Koch
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Lena M. Wieland
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Sven Lautenbach
- Heidelberg Institute for Geoinformation Technology (HeiGIT) at Heidelberg University; postal address: Heidelberg Institute for Geoinformation Technology, Schloss-Wolfsbrunnenweg 33, 69118 Heidelberg, Baden-Wuerttemberg, Germany
| | - Andreas B. Neubauer
- Department of Education and Human Development, DIPF | Leibniz Institute for Research and Information in Education; postal address: Rostocker Straße 6, 60323 Frankfurt am Main, Hessen, Germany
- Center for Research on Individual Development and Adaptive Education of Children at Risk (IDeA); postal address: Rostocker Straße 6, 60323 Frankfurt am Main, Hessen, Germany
| | - Birte von Haaren-Mack
- Department of Health and Social Psychology, Institute of Psychology, German Sport University Cologne; postal address: Am Sportpark Muengersdorf 6, 50933 Cologne, North Rhine-Westphalia, Germany
| | - Renè Schilling
- Department of Sport, Exercise and Health, University of Basel, Postal address: Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Irina Timm
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Nanna Notthoff
- Institute of Sport and Exercise Psychology, Department of Sports Science, Leipzig University; postal address: Jahnallee 59, 04109 Leipzig, Saxony, Germany
| | - Isabel Marzi
- Department of Sports Science and Sport, Friedrich-Alexander-University Erlangen-Nürnberg (FAU); postal address: Gebbertstrasse 123b, 91058 Erlangen, Bavaria, Germany
| | - Holger Hill
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Sarah Brüβler
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Tobias Eckert
- Departments of Preventive Medicine and Psychology, University of Southern California; postal address: 2001 N. Soto St., Los Angeles, CA, 90032, USA
| | - Janis Fiedler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Alexander Burchartz
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Bastian Anedda
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Postal address: Birsstrasse 320 B, 4052 Basel, Switzerland
| | - Darko Jekauc
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Genevieve F. Dunton
- Departments of Preventive Medicine and Psychology, University of Southern California; postal address: 2001 N. Soto St., Los Angeles, CA, 90032, USA
| | - Martina Kanning
- Department of Sport Science, Social and Health Sciences, University of Konstanz; postal address: Universitätsstraße 10, 78464 Konstanz, Baden-Wuerttemberg, Germany
| | - Claudio R. Nigg
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Ulrich Ebner-Priemer
- Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT); postal address: Engler-Bunte-Ring 15, 76131 Karlsruhe, Baden-Wuerttemberg, Germany
| | - Yue Liao
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, postal address: 1515 Holcombe Blvd., Houston, Texas 77030, USA
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Labib SM, Lindley S, Huck JJ. Spatial dimensions of the influence of urban green-blue spaces on human health: A systematic review. ENVIRONMENTAL RESEARCH 2020; 180:108869. [PMID: 31722804 DOI: 10.1016/j.envres.2019.108869] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND There is an increasing volume of literature investigating the links between urban environments and human health, much of which involves spatial conceptualisations and research designs involving various aspects of geographical information science. Despite intensifying research interest, there has been little systematic investigation of pragmatic methodological concerns, such as how studies are realised in terms of the types of data that are gathered and the analytical techniques that are applied, both of which have the potential to impact results. The aim of this systematic review is, therefore, to understand how spatial scale, datasets, methods, and analytics are currently applied in studies investigating the relationship between green and blue spaces and human health in urban areas. METHOD We systematically reviewed 93 articles following PRISMA protocol, extracted information regarding different spatial dimensions, and synthesised them in relation to various health indicators. RESULTS AND DISCUSSION We found a preponderance of the use of neighbourhood-scale in these studies, and a majority of the studies utilised land-use and vegetation indices gleaned from moderate resolution satellite imagery. We also observed the frequent adoption of fixed spatial units for measuring exposure to green and blue spaces based on physical proximity, typically ranging between 30 and 5000 m. The conceptual frameworks of the studies (e.g., the focus on physical vs. mental health or the definition of exposure to green space) were found to have an influence on the strength of association between exposure and health outcomes. Additionally, the strength and significance of associations also varied by study design, something which has not been considered systematically. CONCLUSION On the basis of our findings, we propose a set of recommendations for standardised protocols and methods for the evaluation of the impact of green-blue spaces on health. Our analysis suggests that future studies should consider conducting analyses at finer spatial scales and employing multiple exposure assessment methods to achieve a comprehensive and comparable evaluation of the association between greenspace and health along multiple pathways.
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Affiliation(s)
- S M Labib
- Department of Geography, School of Environment, Education and Development (SEED), University of Manchester, Arthur Lewis Building (1st Floor), Oxford Road, Manchester, M13 9PL, UK.
| | - Sarah Lindley
- Department of Geography, School of Environment, Education and Development (SEED), University of Manchester, Arthur Lewis Building (1st Floor), Oxford Road, Manchester, M13 9PL, UK.
| | - Jonny J Huck
- Department of Geography, School of Environment, Education and Development (SEED), University of Manchester, Arthur Lewis Building (1st Floor), Oxford Road, Manchester, M13 9PL, UK.
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16
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Moon KA, Pollak J, Poulsen MN, Hirsch AG, DeWalle J, Heaney CD, Aucott JN, Schwartz BS. Peridomestic and community-wide landscape risk factors for Lyme disease across a range of community contexts in Pennsylvania. ENVIRONMENTAL RESEARCH 2019; 178:108649. [PMID: 31465993 DOI: 10.1016/j.envres.2019.108649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
Land use and forest fragmentation are thought to be major drivers of Lyme disease incidence and its geographic distribution. We examined the association between landscape composition and configuration and Lyme disease in a population-based case control study in the Geisinger health system in Pennsylvania. Lyme disease cases (n = 9657) were identified using a combination of diagnosis codes, laboratory codes, and antibiotic orders from electronic health records (EHRs). Controls (5:1) were randomly selected and frequency matched on year, age, and sex. We measured six landscape variables based on prior literature, derived from the National Land Cover Database and MODIS satellite imagery: greenness (normalized difference vegetation index), percent forest, percent herbaceous, forest edge density, percent forest-herbaceous edge, and mean forest patch size. We assigned landscape variables within two spatial contexts (community and ½-mile [805 m] Euclidian residential buffer). In models stratified by community type, landscape variables were modeled as tertiles and flexible splines and associations were adjusted for demographic and clinical covariates. In general, we observed positive associations between landscape metrics and Lyme disease, except for percent herbaceous, where associations differed by community type. For example, compared to the lowest tertile, individuals with highest tertile of greenness in residential buffers had higher odds of Lyme disease (odds ratio: 95% confidence interval [CI]) in townships (1.73: 1.55, 1.93), boroughs (1.70: 1.40, 2.07), and cities (3.71: 1.74, 7.92). Similarly, corresponding odds ratios (95% CI) for forest edge density were 1.34 (1.22, 1.47), 1.56 (1.33, 1.82), and 1.90 (1.13, 3.18). Associations were generally higher in residential buffers, compared to community, and in cities, compared to boroughs or townships. Our results reinforce the importance of peridomestic landscape in Lyme disease risk, particularly measures that reflect human interaction with tick habitat. Linkage of EHR data to public data on residential and community context may lead to new health system-based approaches for improving Lyme disease diagnosis, treatment, and prevention.
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Affiliation(s)
- Katherine A Moon
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jonathan Pollak
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Melissa N Poulsen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA.
| | - Annemarie G Hirsch
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA.
| | - Joseph DeWalle
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA.
| | - Christopher D Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - John N Aucott
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, USA.
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, USA.
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