Residential self-selection, perceived built environment and type 2 diabetes incidence: A longitudinal analysis of 36,224 middle to older age adults

Neighborhood Built Environments and Health in Later Life: A Literature Review

Objectives: This literature review aims to assess the current state of the field linking neighborhood environments to later-life health and wellbeing. Methods: We used electronic databases (e.g., PubMed, Google Scholar, and ProQuest) to search for studies published between 2010 and 2022 examining associations between neighborhood built environmental variables and later-life physical, cognitive, mental, and social health outcomes. Results: Among 168 studies reviewed, the majority were quantitative (n = 144) and cross-sectional (n = 122). Neighborhood environmental variables significantly associated with later-life health outcomes included population density/rurality, walkability/street connectivity, access to services and amenities, neighborhood quality and disorder, and parks/green/blue/open space. Neighborhoods operated through behavioral and biological pathways including hazardous exposures, affective states (e.g., stress and restoration), and lifestyle (e.g., exercise, socialization, and diet). Discussion: Neighborhoods and healthy aging research is a burgeoning interdisciplinary and international area of scholarship. Findings can inform upstream community interventions and strengthen clinical care.

The built environment and its association with type 2 diabetes mellitus incidence: A systematic review and meta-analysis of longitudinal studies

This study aimed to systematically review longitudinal studies examining associations between the incidence of type 2 diabetes mellitus (T2DM) and built environmental factors. This review adhered to the 2020 PRISMA guidelines. Longitudinal studies examining associations between T2DM incidence and built environmental features were eligible. Built environment constructs corresponded to the following themes: 1) Walkability - factors such as sidewalks/footpaths, crosswalks, parks, and density of businesses and services; (2) Green/open space - size, greenness, and type of available public outdoor spaces; (3) Food environment - ratio of healthful food outlets (e.g., greengrocers, butchers, supermarkets, and health food shops) to unhealthful food outlets (e.g., fast-food outlets, sweet food retailers, and convenience stores). Five databases (e.g., Medline) were searched from inception until July 2023. Qualitative and quantitative synthesis were used to summarise key findings, including a meta-analysis of adjusted Hazard Ratios (aHR). Of 3,343 articles, 16 longitudinal studies from seven countries, published between 2015 and 2023, involving 13,403,902 baseline participants (median of 83,898), were included. In four of the five studies, unhealthful food environment was significantly associated with higher incident T2DM. Five of seven greenspace studies and two of four walkability studies showed that greater greenery and greater walkability were statistically significantly associated with lesser incident T2DM. In pooled analyses, greater T2DM incidence was associated with unhealthful relative to healthful food environments (pooled HR: 1.21; 95% CI: 1.04, 1.42), and T2DM incidence was inversely associated with green/open space environments (pooled HR: 0.82; 95% CI: 0.74, 0.92). Greater walkability was associated with a slight 2% lesser incidence of T2DM (pooled HR: 0.98; 95% CI: 0.98, 0.99). This review underscores consistency in the nature of associations between built environment features related to T2DM. We observed statistically significant inverse or "protective" associations between T2DM and walkability and healthful food environments. These results support calls for policies and guidelines that promote healthful food environments and walkability.

Unlocking the night: Exploring the health impacts of night-time walking environments on health outcomes of older adults

Walking remains the primary form of physical activity for many older adults in China, and the quality of the walking environment at night may determine the frequency and duration of evening outings. This study reveals how night-time environmental features influence the health outcomes of older adults. Using the medical check-up records of 87,578 older adults from a public health service in the Beilin district of Xi'an city, China, the role of the night-time walking environment in managing chronic conditions was examined. A favorable night-time walking environment reduced the prevalence of chronic conditions and comorbidities among older adults. However, the health effects stemming from the night-time walking environment exhibited heterogeneity, with significant impacts only on metabolic conditions, such as hypertension and diabetes, while the effects on other conditions were not significant. Our findings supplement the theory of healthy aging by highlighting the potential value of the environment in managing chronic conditions, which may serve as a cost-effective health intervention for aging societies.

Provision of Stroke Care Services by Community Disadvantage Status in the US, 2009-2022

Importance

Stroke center certification is granted to facilities that demonstrate distinct capabilities for treating patients with stroke. A thorough understanding of structural discrimination in the provision of stroke centers is critical for identifying and implementing effective interventions to improve health inequities for socioeconomically disadvantaged populations.

Objective

To determine whether (1) hospitals in socioeconomically disadvantaged communities (defined using the Area Deprivation Index) are less likely to adopt any stroke certification and (2) adoption rates differ between entry-level (acute stroke-ready hospitals) and higher-level certifications (primary, thrombectomy capable, and comprehensive) by community disadvantage status.

Design, Setting, and Participants

This cohort study used newly collected stroke center data merged with data from the American Hospital Association, Healthcare Cost Report Information datasets, and the US Census. All general acute hospitals in the continental US between January 1, 2009, and December 31, 2022, were included. Data analysis was conducted from July 2023 to May 2024.

Main Outcomes and Measures

The primary outcome was the likelihood of hospitals adopting stroke care certification. Cox proportional hazard and competing risk models were used to estimate the likelihood of a hospital becoming stroke certified based on the socioeconomic disadvantage status of the community.

Results

Among the 5055 hospitals studied from 2009 to 2022, 2415 (47.8%) never achieved stroke certification, 602 (11.9%) were certified as acute stroke-ready hospitals, and 2038 (40.3%) were certified as primary stroke centers or higher. When compared with mixed-advantage communities, adoption of any stroke certification was most likely to occur near the most advantaged communities (hazard ratio [HR], 1.24; 95% CI, 1.07-1.44) and least likely near the most disadvantaged communities (HR, 0.43; 95% CI, 0.34-0.55). Adoption of acute stroke-ready certification was most likely in mixed-advantage communities, while adoption of higher-level certification was more likely in the most advantaged communities (HR,1.41; 95% CI, 1.22-1.62) and less likely for the most disadvantaged communities (HR, 0.31; 95% CI, 0.21-0.45). After adjusting for population size and hospital capacity, compared with mixed-advantage communities, stroke certification adoption hazard was still 20% lower for relatively disadvantaged communities (adjusted HR, 0.80; 95% CI, 0.73-0.87) and 42% lower for the most disadvantaged communities (adjusted HR, 0.58; 95% CI, 0.45-0.74).

Conclusions and Relevance

In this cohort study examining hospital adoption of stroke services, when compared with mixed-advantage communities, hospitals located in the most disadvantaged communities had a 42% lower hazard of adopting any stroke certification and relatively disadvantaged communities had a 20% lower hazard of adopting any stroke certification. These findings suggest that there is a need to support hospitals in disadvantaged communities to obtain stroke certification as a way to reduce stroke disparities.

Contribution of environmental determinants to the risk of developing type 2 diabetes mellitus in a life-course perspective: a systematic review protocol

BACKGROUND

Prevention policies against type 2 diabetes mellitus (T2DM) focus solely on individual healthy lifestyle behaviours, while an increasing body of research recognises the involvement of environmental determinants (ED) (cultural norms of land management and planning, local foodscape, built environment, pollution, and neighbourhood deprivation). Precise knowledge of this relationship is essential to proposing a prevention strategy integrating public health and spatial planning. Unfortunately, issues related to the consistency and synthesis of methods, and results in this field of research limit the development of preventive strategies. This systematic review aims to improve knowledge about the relationship between the risk of developing T2DM in adulthood and long-term exposure to its ED during childhood or teenage years.

METHODS

This protocol is presented according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) tools. PubMed, Embase, CINAHL, Web of Science, EBSCO, and grey literature from the Laval University Libraries databases will be used for data collection on main concepts such as 'type 2 diabetes mellitus', 'zoning' or 'regional, urban, or rural areas land uses', 'local food landscape', 'built environment', 'pollution', and 'deprivation'. The Covidence application will store the collected data for selection and extraction based on the Population Exposure Comparator Outcome and Study design approach (PECOS). Studies published until December 31, 2023, in English or French, used quantitative data about individuals aged 18 and over that report on T2DM, ED (cultural norms of land management and planning, local foodscape, built environment, and neighbourhood deprivation), and their association (involving only risk estimators) will be included. Then, study quality and risk of bias will be conducted according to the combined criteria and ratings from the ROBINS-E (Risk of Bias in Non-randomised Studies-of Exposures) tools and the 'Effective Public Health Practice Project' (EPHPP). Finally, the analytical synthesis will be produced using the 'Synthesis Without Meta-analysis' (SWiM) guidelines.

DISCUSSION

This systematic review will summarise available evidence on ED associated with T2DM. The results will contribute to improving current knowledge and developing more efficient cross-sectoral interventions in land management and public health in this field of research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42023392073.

Does the quality of street greenspace matter? Examining the associations between multiple greenspace exposures and chronic health conditions of urban residents in a rapidly urbanising Chinese city

BACKGROUND

Numerous studies have demonstrated that greenspace(GS) exposure is associated with health improvements in individuals with hypertension and diabetes. However, studies examining the associations between multiple GS exposures and chronic health conditions in developing countries are limited.

METHODS

Geospatial data and spatial analysis were employed to objectively measure the total neighbourhood vegetative cover (mean value of normalised difference vegetation index [NDVI] within specific buffer zone) and proximity to park-based GS (network distance from home to the entrance of park-based GS). Street view imagery and machine learning techniques were used to measure the subjective perceptions of street GS quality. A multiple linear regression model was applied to examine the associations between multiple GS exposures and the prevalence of hypertension and diabetes in neighbourhoods located in Qingdao, China.

RESULTS

The model explained 29.8% and 28.2% of the prevalence of hypertension and diabetes, respectively. The results suggested that: 1) the total vegetative cover of the neighbourhood was inversely correlated with the prevalence of hypertension (β = -0.272, p = 0.013, 95% confidence interval (CI): [-1.332, -0.162]) and diabetes (β = -0.230, p = 0.037, 95% CI: [-0.720, -0.008]). 2) The street GS quality was negatively correlated with the prevalence of hypertension (β = -0.303, p = 0.007, 95% CI: [-2.981, -0.491]) and diabetes (β = -0.309, p = 0.006, 95% CI: [-1.839, -0.314]). 3) Proximity to park-based GS and the prevalence of hypertension and diabetes mellitus were not significantly correlated.

CONCLUSIONS

This study used subjective and objective methods to comprehensively assess the greenspace exposure from overhead to eye level, from quantity, proximity to quality. The results demonstrated the beneficial relationships between street GS quality, total vegetative cover, and chronic health in a rapidly urbanising Chinese city. Furthermore. the effect of street GS quality was more pronounced in potentially mitigating chronic health problems, and improving the quality of street GS might be an efficient and effective intervention pathway for addressing chronic health issues in densely populated cities.

The Relationship between Perceptions and Objective Measures of Greenness

Exposure to greenness has been studied through objective measures of remote visualization of greenspace; however, the link to how individuals interpret spaces as green is missing. We examined the associations between three objective greenspace measures with perceptions of greenness. We used a subsample (n = 175; 2018-2019) from an environmental cardiovascular risk cohort to investigate perceptions of residential greenness. Participants completed a 17-item survey electronically. Objective measurements of greenness within 300 m buffer around participants home included normalized difference vegetation index (NDVI), tree canopy and leaf area index. Principal component analysis reduced the perceived greenspaces to three dimensions reflecting natural vegetation, tree cover and built greenspace such as parks. Our results suggest significant positive associations between NDVI, tree canopy and leaf area and perceived greenness reflecting playgrounds; also, associations between tree canopy and perceived greenness reflecting tree cover. These findings indicate that the most used objective greenness measure, NDVI, as well as tree canopy and leaf area may most align with perceptions of parks, whereas tree canopy alone captures individuals' perceptions of tree cover. This highlights the need for research to understand the complexity of green metrics and careful interpretation of data based on the use of subjective or objective measures of greenness.

Urban and rural differences in new onset type 2 diabetes: Comparisons across national and regional samples in the diabetes LEAD network

Introduction

Geographic disparities in diabetes burden exist throughout the United States (US), with many risk factors for diabetes clustering at a community or neighborhood level. We hypothesized that the likelihood of new onset type 2 diabetes (T2D) would differ by community type in three large study samples covering the US.

Research design and methods

We evaluated the likelihood of new onset T2D by a census tract-level measure of community type, a modification of RUCA designations (higher density urban, lower density urban, suburban/small town, and rural) in three longitudinal US study samples (REGARDS [REasons for Geographic and Racial Differences in Stroke] cohort, VADR [Veterans Affairs Diabetes Risk] cohort, Geisinger electronic health records) representing the CDC Diabetes LEAD (Location, Environmental Attributes, and Disparities) Network.

Results

In the REGARDS sample, residing in higher density urban community types was associated with the lowest odds of new onset T2D (OR [95% CI]: 0.80 [0.66, 0.97]) compared to rural community types; in the Geisinger sample, residing in higher density urban community types was associated with the highest odds of new onset T2D (OR [95% CI]: 1.20 [1.06, 1.35]) compared to rural community types. In the VADR sample, suburban/small town community types had the lowest hazard ratios of new onset T2D (HR [95% CI]: 0.99 [0.98, 1.00]). However, in a regional stratified analysis of the VADR sample, the likelihood of new onset T2D was consistent with findings in the REGARDS and Geisinger samples, with highest likelihood of T2D in the rural South and in the higher density urban communities of the Northeast and West regions; likelihood of T2D did not differ by community type in the Midwest.

Conclusions

The likelihood of new onset T2D by community type varied by region of the US. In the South, the likelihood of new onset T2D was higher among those residing in rural communities.

The Relationship Between Built Environment and Mental Health of Older Adults: Mediating Effects of Perceptions of Community Cohesion and Community Safety and the Moderating Effect of Income

Many studies revealed a significant correlation between low-density built environment and the mental health of older adults in developed countries. However, scholars and decision-makers recently began to pay close attention to the effect of this relationship in high-density built environments and in developing countries. Using point-of-interest (POI) data from Baidu and data on 20 communities in Guangzhou, China, which were collected through a questionnaire survey, this study aimed to examine the relationship between built environment and the mental health of older adults as well as the physiological–psychological mediating paths between the two, so as to enrich the research on population aging in the high-density urban context in developing countries. The findings indicated that facility accessibility and distance to parks significantly positively correlated with the mental health of older adults and the number of public transit stations, and the distance to these stations significantly negatively correlated with the mental health of older adults. Also, the perceptions of community cohesion and community safety had a significant mediating effect between the built environment and the mental health of older adults. Furthermore, the moderating effect analysis results verified the moderating effect of income: with an increase in income, the perception of community cohesion enhanced the protection of the mental health of older adults and reduced the mediating effect of the perception of community safety. The results provided a reference for policy-makers and urban planners in their efforts to plan and build health-supporting communities and a healthy aging society.

Long-term exposure to objective and perceived residential greenness and diabetes mortality: A census-based cohort study

BACKGROUND

Residing close to green spaces might reduce diabetes mellitus (DM) risk; however, evidence for diabetes mortality is limited. Moreover, individual and neighbourhood social factors may determine DM risk. Exposure to green spaces may also depend on socioeconomic position (SEP). This study examined the associations between residential greenness and diabetes-related mortality, and the role of the social environment in these associations.

METHODS

We used the 2001 Belgian census linked to mortality register data for the period 2001-2014. We included individuals aged 40-79 years old and residing in the five largest Belgian urban areas at baseline. Exposure to residential greenness was assessed with surrounding greenness using the Normalized Difference Vegetation Index (NDVI) within 500-m of residence (objective indicator), and perceived neighbourhood greenness (subjective indicator). We conducted mixed-effects Cox proportional hazards models to obtain hazard ratios (HR) for diabetes-related mortality per interquartile range (IQR) increments of residential greenness. We assessed effect modification by social factors through stratification.

RESULTS

From 2,309,236 individuals included at baseline, 1.2% died from DM during follow-up. Both residential greenness indicators were inversely associated with diabetes-related mortality after adjustment for individual social factors. After controlling for neighbourhood SEP, the beneficial association with surrounding greenness disappeared [HR 1.02 (95%CI:0.99,1.06)], but persisted with perceived neighbourhood greenness [HR 0.93 (95%CI:0.91,0.95)]. After stratification the inverse associations with perceived neighbourhood greenness were strongest for women, the lowest educated, and individuals residing in least deprived neighbourhoods.

CONCLUSIONS

Our findings suggest that an overall positive perception of neighbourhood green spaces reduces independently the risk of diabetes-related mortality, regardless of the neighbourhood social environment. Nevertheless, neighbourhood SEP may be a strong confounder in the associations between diabetes-related mortality and greenness indicators derived from satellite images. Perception factors not captured by objective measurements of green spaces are potentially relevant in the association with DM, especially among disadvantaged groups.

Research on the Aging-Friendly Kitchen Based on Space Syntax Theory

As a result of aging populations globally, a growing number of older adults prefer to age in place; therefore, it is essential to study the spatial adaptability of the house. This study aimed to explore the relationship between the efficiency of daily activities and the spatial layout of home kitchens in the elderly population, and to assess the moderating role of cognitive function. Twenty-one elderly participants completed the experiment, including non-cognitively impaired (n = 12) and cognitively impaired groups (n = 9). Their home kitchen space was partitioned in plan and elevation based on space syntax theory. They were required to complete three tasks (i.e., an easy task, a medium task, and a difficult task) in their respective kitchens. The relationship between the efficiency of different tasks’ completion and the corresponding kitchen space attributes (integration, mean depth) was examined. The results showed a significant association between the home kitchen space layout of homebound older adults and their kitchen activity efficiency. In addition, a positive moderating effect of cognitive ability was found in the association between moderate and difficult tasks (p < 0.05), and its effect appeared to be stronger under challenging tasks (p < 0.01). The results of this study may help provide a basis for future design and optimization of aging-friendly residential spaces.

Amount of and proximity to blue spaces and general health among older Chinese adults in private and public housing: A national population study

A growing body of research indicates that exposure to outdoor blue spaces is associated with better physical and mental health. However, few studies have explored the associations between different blue space indicators (e.g., amount of and proximity to freshwater and seawater) and general health. Moreover, research has rarely attempted to address the residential selection bias associated with the salutogenic effect of access to blue spaces. Therefore, this study explores the associations between the amount (percentage of blue space within a 1 km circular buffer) of and proximity (Euclidean distance to the edge of the nearest blue space) to blue space and older adults' general health across the entire country of China using the micro-data sample of one-percent national population sample survey in 2015. It adds to the existing literature by taking into account the neighbourhood selection mechanism for different housing tenures and examining the salutogenic effect of blue spaces separately for public housing residents and private housing residents. The results indicated that greater neighbourhood seawater coverage and living near a coastline were associated with better general health among older adults in both private and public housing, while the percentage of freshwater blue spaces within neighbourhoods and the distance to freshwater blue spaces were associated with better general health among private housing residents only. The blue spaces-general health associations were stronger among urban participants, participants in deprived neighbourhoods, males, participants aged under 80 years, and low- and medium-educated participants. Our findings indicated that living near the coast was beneficial to older adults' health, and residential selection bias confounded the association between freshwater blue spaces and health.

Environmental risk factors of type 2 diabetes-an exposome approach

Type 2 diabetes is one of the major chronic diseases accounting for a substantial proportion of disease burden in Western countries. The majority of the burden of type 2 diabetes is attributed to environmental risks and modifiable risk factors such as lifestyle. The environment we live in, and changes to it, can thus contribute substantially to the prevention of type 2 diabetes at a population level. The 'exposome' represents the (measurable) totality of environmental, i.e. nongenetic, drivers of health and disease. The external exposome comprises aspects of the built environment, the social environment, the physico-chemical environment and the lifestyle/food environment. The internal exposome comprises measurements at the epigenetic, transcript, proteome, microbiome or metabolome level to study either the exposures directly, the imprints these exposures leave in the biological system, the potential of the body to combat environmental insults and/or the biology itself. In this review, we describe the evidence for environmental risk factors of type 2 diabetes, focusing on both the general external exposome and imprints of this on the internal exposome. Studies provided established associations of air pollution, residential noise and area-level socioeconomic deprivation with an increased risk of type 2 diabetes, while neighbourhood walkability and green space are consistently associated with a reduced risk of type 2 diabetes. There is little or inconsistent evidence on the contribution of the food environment, other aspects of the social environment and outdoor temperature. These environmental factors are thought to affect type 2 diabetes risk mainly through mechanisms incorporating lifestyle factors such as physical activity or diet, the microbiome, inflammation or chronic stress. To further assess causality of these associations, future studies should focus on investigating the longitudinal effects of our environment (and changes to it) in relation to type 2 diabetes risk and whether these associations are explained by these proposed mechanisms.

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.

Community design and hypertension: Walkability and park access relationships with cardiovascular health

BACKGROUND

There is an increased literature focusing on the role of the built and natural environments in preventing hypertension. However, very few studies have quantitively analyzed specific pathways through which urban form affects blood pressure levels.

OBJECTIVES

To examine how features of the built and natural environments relate to hypertension and the mediating role of transportation and leisure walking and body mass index in this relationship.

METHODS

We examined the association between neighbourhood walkability and park availability with hypertension through generalized linear models in two independent population cohorts. One Cohort was 22,418 adults (My Health My Community) and the other cohort was 11,972 adults (BC Generations Project). We employed a path analysis modelling approach to explore the presence and significance of mediating factors that may contribute to any association between walkability or park availability and hypertension. This study intentionally employed walkability measures enforced through municipal zoning and subdivision regulations legally underpinned by health, safety, and welfare. All models were adjusted for socioeconomic and other characteristics where data were available.

RESULTS

Our analysis of two population-based Canadian cohorts consistently found that higher levels of walkability and park accessibility were both associated with significantly lower odds of self-reported hypertension, especially for lower income individuals. Mediation analysis showed that obesity accounted for 50% and 52.9% of the total effect of walkability and park accessibility on hypertension, respectively.

DISCUSSION

We suggest an integrated population health approach that considers multimorbidity as a result of exposure to car-dependent areas and the lack of green spaces. Longitudinal research is needed to document causal effects of built and natural environments on hypertension.

Perceived built environment and type 2 diabetes incidence: Exploring potential mediating pathways through physical and mental health, and behavioural factors in a longitudinal study

AIMS

The evidence on the pathways through which the built environment may influence type 2 diabetes (T2D) risk is limited. This study explored whether behavioural, physical and mental health factors mediate the associations between perceived built environment and T2D.

METHODS

Longitudinal data on 36,224 participants aged ≥45 years (The Sax Institute's 45 and Up Study) was analysed. Causal mediation analysis that uses the counterfactual approach to decompose the total effect into direct and indirect effects was performed.

RESULTS

The results showed that physical activity, recreational walking, and BMI mediated around 6%, 11%, and 30%, respectively, of the association between perceived lack of access to local amenities and T2D incidence. Physical activity (4.8% for day-time crime), recreational walking (2.3% for day-time crime), psychological distress (5.2% for day-time, 3.7% for night-time crime), and BMI (29.6% for day-time crime, 17.4% for night-time crime) also partially mediated the effect of perceived crime. Mediated effects appeared larger at wave 3 than the same wave 2 mediators.

CONCLUSIONS

The findings demonstrate that physical activity, psychological distress, and BMI mediate the pathways between the built environment and T2D. Policies aimed to bring amenities closer to homes, prevent crime, and address mental health may help reduce T2D risk.

Children's Experiences of Their Journey to School: Integrating Behaviour Change Frameworks to Inform the Role of the Built Environment in Active School Travel Promotion

Childhood obesity is a public health problem with multiple effects on children’s life. Promoting Active School Travel (AST) could provide an inclusive opportunity for physical activity and shape healthy behaviours. Data for this cross-sectional study were drawn from questionnaires carried out in five primary schools located in Newcastle upon Tyne, UK, in neighbourhoods chosen for their variability in IMD (index of multiple deprivation) and spatial structure of street networks (measured through space syntax measure of integration). A randomly selected and heterogenic sample of 145 pupils (aged 9–10) completed an open-ended questionnaire to state what they like and dislike about their journey to school. Thematic analysis identified four typologies (environmental context, emotions, social influences and trip factors) based on the Theoretical Domains Framework (TDF) and specific themes and sub-themes underlying children’s affective experiences of their journeys to school. This study is the first known to authors to attempt to adapt the Capability, Opportunity and Motivation Behaviour (COM-B) model into AST and children’s experiences and associated behavioural domains with design aspects. Such an insight into children’s attitudes could inform urban planners and designers about how to apply more effective behaviour change interventions, targeting an AST increase among children.

Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities

Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.

Leveraging 31 Million Google Street View Images to Characterize Built Environments and Examine County Health Outcomes

OBJECTIVES

Built environments can affect health, but data in many geographic areas are limited. We used a big data source to create national indicators of neighborhood quality and assess their associations with health.

METHODS

We leveraged computer vision and Google Street View images accessed from December 15, 2017, through July 17, 2018, to detect features of the built environment (presence of a crosswalk, non-single-family home, single-lane roads, and visible utility wires) for 2916 US counties. We used multivariate linear regression models to determine associations between features of the built environment and county-level health outcomes (prevalence of adult obesity, prevalence of diabetes, physical inactivity, frequent physical and mental distress, poor or fair self-rated health, and premature death [in years of potential life lost]).

RESULTS

Compared with counties with the least number of crosswalks, counties with the most crosswalks were associated with decreases of 1.3%, 2.7%, and 1.3% of adult obesity, physical inactivity, and fair or poor self-rated health, respectively, and 477 fewer years of potential life lost before age 75 (per 100 000 population). The presence of non-single-family homes was associated with lower levels of all health outcomes except for premature death. The presence of single-lane roads was associated with an increase in physical inactivity, frequent physical distress, and fair or poor self-rated health. Visible utility wires were associated with increases in adult obesity, diabetes, physical and mental distress, and fair or poor self-rated health.

CONCLUSIONS

The use of computer vision and big data image sources makes possible national studies of the built environment's effects on health, producing data and results that may inform national and local decision-making.

Residential environment and depressive symptoms among Chinese middle- and old-aged adults: A longitudinal population-based study

Despite growing evidence of the relationship between residential environment and depressive symptoms, little is known about this longitudinal relationship for elderly. Based on the follow-up survey (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study (CHARLS), this study investigated the association between residential environment and depressive symptoms among Chinese middle- and old-aged adults using repeated measures mixed models and Cox proportional hazards regression models. We found that external building characteristics, indoor space layout, household facilities, and indoor environment have significant effects on depressive symptoms in the elderly. Therefore, residential environment interventions such as external built environments promotion, reasonable indoor space layout, and indoor household facilities and environment improvement can be effective ways to reduce risk of depressive symptoms among Chinese middle- and old-aged adults as well as decrease related public health burden.

Role of perceived neighbourhood crime in the longitudinal association between perceived built environment and type 2 diabetes mellitus: a moderated mediation analysis

BACKGROUND

We examined to what extent perceived neighbourhood crime moderates, associations between type 2 diabetes mellitus (T2DM) and perceived local amenities, recreational facilities, footpaths and public transit, and potential mediation of environmental characteristics-T2DM association by physical activity, social contact, sleep and body mass index (BMI).

METHODS

The 45 and Up Study data of 36, 224 individuals collected from 2010 to 2015 were analysed in 2019 using multilevel logistic regression to examine the association between T2DM and clustering of unfavourable built environment, and any difference in the association with increasing unfavourable environment and area disadvantage. We performed causal mediation analyses stratified by crime to examine whether crime moderated the strength of identified local amenities-T2DM pathways.

RESULTS

The results showed that irrespective of crime, perceived lack of local amenities was associated with increased odds of developing T2DM, and BMI mediated 40% and 30.3% of this association among those who reported unsafe and safe daytime crime, respectively. The proportion mediated by BMI among those who reported unsafe and safe night-time crime was 27.3% and 35.1%, respectively. Walking mediated 5.7% of the local amenities-T2DM association among those who reported safe daytime crime. The odds of T2DM increased with rising unfavourable environment and area disadvantage.

CONCLUSIONS

The results suggest that the availability of neighbourhood amenities may lower T2DM risk by increasing walking and reducing BMI regardless of area crime. Policies to enhance access to local amenities and prevent crime, especially in disadvantaged areas, may support healthy behaviour and physical health that can potentially reduce T2DM risk.

Health and the built environment in United States cities: measuring associations using Google Street View-derived indicators of the built environment

BACKGROUND

The built environment is a structural determinant of health and has been shown to influence health expenditures, behaviors, and outcomes. Traditional methods of assessing built environment characteristics are time-consuming and difficult to combine or compare. Google Street View (GSV) images represent a large, publicly available data source that can be used to create indicators of characteristics of the physical environment with machine learning techniques. The aim of this study is to use GSV images to measure the association of built environment features with health-related behaviors and outcomes at the census tract level.

METHODS

We used computer vision techniques to derive built environment indicators from approximately 31 million GSV images at 7.8 million intersections. Associations between derived indicators and health-related behaviors and outcomes on the census-tract level were assessed using multivariate regression models, controlling for demographic factors and socioeconomic position. Statistical significance was assessed at the α = 0.05 level.

RESULTS

Single lane roads were associated with increased diabetes and obesity, while non-single-family home buildings were associated with decreased obesity, diabetes and inactivity. Street greenness was associated with decreased prevalence of physical and mental distress, as well as decreased binge drinking, but with increased obesity. Socioeconomic disadvantage was negatively associated with binge drinking prevalence and positively associated with all other health-related behaviors and outcomes.

CONCLUSIONS

Structural determinants of health such as the built environment can influence population health. Our study suggests that higher levels of urban development have mixed effects on health and adds further evidence that socioeconomic distress has adverse impacts on multiple physical and mental health outcomes.

Neighborhood Environment and Type 2 Diabetes Comorbidity in Serious Mental Illness

Aim: The aim of this study was to examine the association between neighborhood characteristics and type 2 diabetes (T2D) comorbidity in serious mental illness (SMI). We investigated associations of neighborhood-level crime, accessibility to health care services, availability of green spaces, neighborhood obesity, and fast food availability with SMI-T2D comorbidity. Method: A series of multilevel logistic regression models accounting for neighborhood-level clustering were used to examine the associations between 5 neighborhood variables and SMI-T2D comorbidity, sequentially adjusting for individual-level variables and neighborhood-level socioeconomic disadvantage. Results: Individuals with SMI residing in areas with higher crime rates per 1000 population had 2.5 times increased odds of reporting T2D comorbidity compared to the individuals with SMI residing in lower crime rate areas after controlling for individual and areal level factors (95% CI 0.91-6.74). There was no evidence of association between SMI-T2D comorbidity and other neighborhood variables investigated. Conclusion: Public health strategies to reduce SMI-T2D comorbidity might benefit by targeting on individuals with SMI living in high-crime neighborhoods. Future research incorporating longitudinal designs and/or mediation analysis are warranted to fully elucidate the mechanisms of association between neighborhoods and SMI-T2D comorbidity.

Impact of Residential Self-Selection on Low-Carbon Behavior: Evidence from Zhengzhou, China

Current resident lifestyles pose a significant threat to urban sustainable development. Therefore, low-carbon behavior is receiving increasing attention from scholars and policy makers. Ascertaining residential self-selection is essential in order to study the relationship between the built environment and travel behavior. While several studies have explored the relationship between the urban form, socioeconomic factors, and travel behavior, only a few of them have studied the impact of self-selection on household energy consumption and other forms of consumption, which are also contribute to household carbon emissions. Using large-scale field surveys of 1,485 households and high-resolution images, sourced from Google Maps in 2018, of Zhengzhou city, the present study estimated the low-carbon level of three kinds of behavior: daily energy use at home, daily travel, and daily consumption. The study investigated the influence factors on low-carbon behavior using the hierarchical linear model. We found that residential self-selection impacts both energy use and daily travel. Residents in some built environments consumed less energy at home and contributed less CO2 emissions through daily travel than others. In particular, individual-level variables significantly affected the low-carbon energy use behavior. The female, elderly, highly educated, married, and working-class residents with children had higher levels of low-carbon energy use. Community-level variables significantly affected the level of low-carbon travel and low-carbon consumption. If residents lived in areas with high density, mixed land use, and high accessibility, their travel mode and consumption behavior would entail low carbon emissions. There is a relationship between individual variables and community variables. Different individual attributes living in the same built environment have different impacts on low-carbon behaviors.