Suburban sprawl and physical and mental health

Urban built environment and its impact on university students' loneliness: a mechanistic study

Introduction

With the acceleration of urbanization and social changes, loneliness among university students is becoming increasingly common. The urban built environment is closely related to loneliness. This study explores the impact of the urban built environment on the loneliness of university students from multiple built environment elements such as road network density, land use mix, and service facilities. It is of great significance to optimize urban planning and improve the mental health of university students.

Methods

Based on questionnaire data and point interest data of various facilities, Spearman correlation analysis, Ridge regression model and geographic detector were used to explore the impact mechanism of urban built environment on loneliness of university students.

Results

The study shows that loneliness is widespread and relatively severe among university students. The urban built environment is closely related to university students' loneliness: the number of catering, transportation, tourist attractions, leisure and entertainment, healthcare, and sports facilities, as well as road network density, are significantly negatively correlated with loneliness, while the number of shopping facilities and land use mix are positively correlated with loneliness. Geographic detector analysis shows that tourist attractions, health care facilities and land mix have a significant impact on university students' loneliness, and the interaction of multidimensional factors significantly improves the explanatory power of loneliness.

Conclusion

To alleviate loneliness among university students, interventions should be approached from the perspective of urban planning and management. Firstly, it is essential to improve leisure, landscape, transportation, healthcare, and fitness facilities, enhancing their accessibility to foster social interactions. Secondly, increasing the availability of socially-oriented public spaces, such as student activity centers, community squares, and shared learning spaces, can strengthen interaction and communication. Additionally, policymakers should optimize the layout of urban transportation networks to encourage students to use public transit. Urban planners can support active transportation modes, such as walking and cycling, by rationally allocating road space. Lastly, the strategic placement of green and open spaces, such as parks and squares, should be prioritized to enhance access to natural environments, promote social activities, and mitigate feelings of loneliness.

Evaluating the impact of added greenery on perceived factors of an urban environment in virtual reality

The wellbeing effects of urban greenspace are well established, but may be more attributable to pedestrians' perceptions than objective levels of greenery. An immersive virtual environment was designed with three levels of roadside greenery: no trees, 200 trees, and 400 trees. Participants were asked to rate each for several perceived and objective factors, and gave their years lived experience in urban, rural, and suburban environments. Trees impacted perceptions of beauty and greenness, and, slightly, building heights. Controlling for urban experience significantly lessened the impact of trees, but showed that perceived greenness had higher significant correlations to all other outcomes.

Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial

ObjectivesWe examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures-memory (B = -1.17 (0.17)), reasoning (B = -1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.

An ecological analysis of walkability and housing affordability in Canada: Moderation by city size and neighbourhood property type composition

The neighbourhood built environment can support the physical activity of adults regardless of their individual-level socioeconomic status. However, physical activity supportive (walkable) neighbourhoods may not be accessible to those with lower incomes if homes in walkable neighbourhoods are too expensive. The objectives of this study were: 1) to estimate the associations between neighbourhood walkability and home values in Canadian cities, and 2) to test whether these associations differ by city size and residential property type composition within neighbourhoods. We linked built environment data from the 2016 Canadian Active Living Environments (Can-ALE) index with neighbourhood-level structural home characteristics and sociodemographic data from the 2016 Canadian census for 33,026 neighbourhoods across 31 Census Metropolitan Areas. We used multilevel linear regression models to estimate covariate-adjusted associations between neighbourhood walkability and natural-log median home values and tested city size and neighbourhood property type composition as moderators. There were no statistically significant associations between walkability and home values overall. The associations between neighbourhood walkability and home values were jointly moderated by city size and property type composition. For small and medium sized cities, within neighbourhoods containing a high proportion of detached homes, walkability was negatively associated with home values (b = -0.05, 95% CI: -0.10, -0.01; and, b = -0.04, 95% CI: -0.06, -0.02, for small and medium cities, respectively). However, for extra-large cities, within neighbourhoods containing a high proportion of detached homes, walkability was positively associated with home values (b = 0.06, 95% CI: 0.01, 0.10). Our findings suggest that, based on housing affordability, higher walkable neighbourhoods are likely accessible to lower income households that are situated in small and medium Canadian cities. In larger cities, however, municipal interventions (e.g., inclusionary zoning or targeted development of subsidized or social housing) may be needed to ensure equitable access to walkable neighbourhoods for lower income households.

Examining the impact of urban compactness on work and social life disruption during COVID-19 pandemic: evidence from Jakarta, Indonesia

The COVID-19 pandemic has hit urban areas particularly hard, yet there is a lack of research on the hypothesis that living in more compact cities can provide better support for work and social conditions during the pandemic. This study addresses this gap by examining whether city compactness can mitigate the negative impact of the pandemic on the work and social life of urban residents in Jakarta, Indonesia. The study uses a household phone survey combined with publicly available urban form data. Ordinary Least Squares (OLS) regression, supplemented with a matching technique to address potential selection bias, is employed. The results suggest that living in more compact locations can reduce the disruption to work and social life associated with COVID-19 in urban communities. This positive effect is particularly experienced by males, non-migrants, and individuals from wealthy families.

The Associations Between Urban Form and Major Non-communicable Diseases: a Systematic Review

In the current century, non-communicable diseases (NCDs), particularly cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, are the most important cause of mortality all over the world. Given the effect of the built environment on people's health, the present study seeks to conduct a systematic review in order to investigate the relationship between urban form and these four major NCDs as well as their main risk factors. Two independent reviewers in November 2020 after an extensive search through PubMed and Scopus identified 77 studies. Studies published in English were included if they addressed one or more attributes of urban form in relation to any major NCDs and their main risk factors. Publication date, country, geographical scale, study design, methods of built environment measurement, and findings of the relationships among variables were extracted from eligible studies. The findings suggest that the elements of urban form (density, transportation and accessibility, characteristics of building and streetscape, land use, spatial layouts and configuration) could increase or inhibit these diseases through their effect on physical activity, diet, air pollution, blood pressure, and obesity. However, there are study shortages, contradictions, and ambiguities in these relationships which are mainly due to methodological and conceptual challenges. As a result, more in-depth research is needed to achieve solid and consistent results that could be made into clear guidelines for planning and designing healthier cities.

COVID19 in Latin America: informal settlements and the politics of urbicide

Informal settlements in Latin America express pandemic idiosyncrasies, calling global attention to historical problems related to a specific urbanization pattern. This article stresses COVID19 implications in the main urban planning canon: the notion of densification as an urban solution. Traditionally invisible social groups and territories acquire relevance, but now as a source of biological risk. Urban density appears as a contradictory trigger point, outlining new debates about informal settlements and their metrics. Evidence shows that trends in health discourse are striving to legitimize and enhance "urbicides" in this scenario, already underway through State action or inaction.

Distinguishing the Effect of Time Spent at Home during COVID-19 Pandemic on the Mental Health of Urban and Suburban College Students Using Cell Phone Geolocation

The aim of this study was to assess the correlation of depression and anxiety with time spent at home among students at two universities-one urban and the other suburban-during the COVID-19 pandemic.

METHODS

Geolocation data from the smartphones of 124 participants were collected between February 2021 and May 2021. The level of depression was estimated by the PHQ-9 and PHQ-2 screening tools, and anxiety scores were estimated by the GAD-2 and GAD-7 screening tools.

RESULTS

51% of participants in the PHQ-9 surveys indicated mild to severe depression. Participants spent on average 75% of their time at home during COVID. Time spent at home had a positive correlation with the mental health of urban students but a negative correlation with suburban students. The relation between the time at home with mental health was stronger among female participants than among male participants. Correlations between female depression, anxiety, and time at home were significant.

CONCLUSIONS

Lockdown and distance learning contributed to the high levels of depression in university students. This research highlights the importance of time spent at home for mental health being during the pandemic and the importance of distinguishing between urban and suburban settings when formulating public health recommendations. Quality of time spent at home versus time spent outside differentiated the mental well-being of students located in different environments. Staying at home may be recommended for students without access to safe outdoor places as it is associated with lower levels of depression.

Assessing Trade-Offs and Optimal Ranges of Density for Life Expectancy and 12 Causes of Mortality in Metro Vancouver, Canada, 1990-2016

Background: Understanding and managing the impacts of population growth and densification are important steps for sustainable development. This study sought to evaluate the health trade-offs associated with increasing densification and to identify the optimal balance of neighbourhood densification for health. Methods: We linked population density with a 27-year mortality dataset in Metro Vancouver that includes census-tract levels of life expectancy (LE), cause-specific mortalities, and area-level deprivation. We applied two methods: (1) difference-in-differences (DID) models to study the impacts of densification changes from the early 1990s on changes in mortality over a 27-year period; and (2) smoothed cubic splines to identify thresholds of densification at which mortality rates accelerated. Results: At densities above ~9400 persons per km², LE began to decrease more rapidly. By cause, densification was linked to decreased mortality for major causes of mortality in the region, such as cardiovascular diseases, neoplasms, and diabetes. Greater inequality with increasing density was observed for causes such as human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), sexually transmitted infections, and self-harm and interpersonal violence. Conclusions: Areas with higher population densities generally have lower rates of mortality from the major causes, but these environments are also associated with higher relative inequality from largely preventable causes of death.

Photovoltaic Solar Energy from Urban Sprawl: Potential for Poland

Urban sprawl is a process that shapes contemporary urban spaces. Generally, this process is associated with negative effects due to the generation of high costs. However, not all the effects of urban sprawl should be considered in the context of the increasing costs of the use of space; some of them should be regarded as cost cutting factors, for example, the possibility of the use of roofed areas in generating energy from sunlight. Solar energy is believed to be one of the sources of clean energy that reduce pollution and greenhouse gas emissions into the atmosphere. However, solar energy generation necessitates the development of large areas for the purpose of installing photovoltaic modules and substantial funds for creating large solar farms. For this reason, a significant role in state energy policies is played by small dispersed installations mounted on the roofs of buildings. There is a gap in existing research on the assessment of urban sprawl in terms of the potential use of rooftops for solar installations in suburban areas. This research gap has not yet been filled, either conceptually and methodologically. Hence, the contribution of the research to the development of the current state of knowledge involves the identification of economic and environmental benefits of usually negatively perceived urban sprawl. The proposal of a method for the identification of suburban housing potential for solar energy generation constitutes another addition to the state of knowledge. The main objective of this article is to analyse the energy generating potential of buildings located in suburban and urban areas characterised by the confirmed occurrence of urban sprawl phenomena. CityGML data were used to conduct an analysis of the exposure of roofs to sunlight using algorithms based on vector data. The authors estimated the dynamics of changes in time and referred the existing photovoltaic installations to the total potential of a selected area. The use of the energy potential of the analysed roofs of buildings was used to evaluate the external costs and benefits of spatial planning. The discussion presented the current conditions of the energy sector and energy policies in Poland and the EU. In addition, recommendations were proposed for local spatial policies concerning the mitigation of the effects of suburbanization in the context of developing the system of PV micro-installations.

The Influence of Emotional Health on the Activity Characteristics of the Elderly and the Selection of Environmental Quality Factors in Residential Areas

The environment in urban residential areas is the main field of daily activity for the elderly. Environmental renewal has played a significant role in improving residents' quality of life and promoting physical and mental health. However, there is a general tendency that more attention has been focused on the environment during environmental renewal but not the residents. There is a continued lack of discussion on the emotional status of the elderly and its impact on outdoor activities. Based on the investigation of four types of typical residential environments in the Dalian residential area, a hierarchical linear model (HLM) has been constructed to reveal the influence of the emotional status of elderly persons on their activity characteristics and the selection of environmental quality factors. The results show that the distribution of older people with different emotional statuses varies among different residential types. The proportion of positive emotion is relatively high in the flat land in rows category, and the activity characteristics are significantly different under different emotional statuses. Among the four kinds of residential environments, which are (flat land in rows, flat land enclosed, slope, and mountainous) the environmental quality factors that have the highest impact on the emotional status of the elderly are greening quality (0.395), acoustic environment (0.167), environmental cleanliness (0.269), and greening quality (0.230), respectively. In the mountainous type, the impact of environmental quality factors on the emotional status of the elderly is the highest (39.7%), and the impact contributions of the other three environmental types are 23.3%, 8.9% and 20.1%, respectively. These research results provide helpful guidance for the scientific community about practical implementation of residential environmental renewal for the elderly.

A multilevel scenario based predictive analytics framework to model the community mental health and built environment nexus

The built environment affects mental health outcomes, but this relationship is less studied and understood. This article proposes a novel multi-level scenario-based predictive analytics framework (MSPAF) to explore the complex relationships between community mental health outcomes and the built environment conditions. The MSPAF combines rigorously validated interpretable machine learning algorithms and scenario-based sensitivity analysis to test various hypotheses on how the built environment impacts community mental health outcomes across the largest metropolitan areas in the US. Among other findings, our results suggest that declining socio-economic conditions of the built environment (e.g., poverty, low income, unemployment, decreased access to public health insurance) are significantly associated with increased reported mental health disorders. Similarly, physical conditions of the built environment (e.g., increased housing vacancies and increased travel costs) are significantly associated with increased reported mental health disorders. However, this positive relationship between the physical conditions of the built environment and mental health outcomes does not hold across all the metropolitan areas, suggesting a mixed effect of the built environment's physical conditions on community mental health. We conclude by highlighting future opportunities of incorporating other variables and datasets into the MSPAF framework to test additional hypotheses on how the built environment impacts community mental health.

Variation in Health Among Unstably Housed Youth From Cities, Suburbs, Towns, and Rural Areas

PURPOSE

Youth face similar rates of homelessness across rural and urban areas, yet little is known about how the health of unstably housed youth varies by location. We assessed differences in health by location (city, suburb, town, and rural) and housing status among youth facing a range of unstable housing experiences.

METHODS

This secondary data analysis from 8th, 9th, and 11th graders completing the 2019 Minnesota Student Survey examined youth who had experienced housing instability in the prior year (n = 10,757), including running away (48%) or experiencing homelessness (staying in shelter, couch-surfing, or rough sleeping) with (42%) or without (10%) an adult family member. We conducted multifactor analysis of variance to assess differences by location (urban, suburban, town, and rural) and housing experience for each of five health indicators: suboptimal health, depressive symptoms, suicide attempts, ≥2 sexual partners, and e-cigarette use.

RESULTS

In main effects models, all health indicators varied based on housing status; suboptimal health, ≥2 sexual partners, and e-cigarette use also varied by location. Interaction models showed that unaccompanied homeless youth in suburbs reported poorer health compared with those in cities. Compared with suburbs, youth in towns were more likely to report ≥2 sexual partners (19.9%, 24.1%) and e-cigarette use (39.5%, 43.3%).

CONCLUSIONS

Our findings suggest that unstably housed youth face a similar burden of poor health across locations, with only subtle differences in health indicators, yet most research focuses on urban youth. Future research is needed to identify how to best meet the health needs of unstably housed youth across locations.

Recent Literature about Urban Sprawl: A Renewed Relevance of the Phenomenon from the Perspective of Environmental Sustainability

The urban sprawl phenomenon has attracted the attention of social researchers since the mid-20th century. It seemed that all relevant aspects had been extensively studied and that it would be difficult to produce new studies with significant contributions. However, in the last decade, we have witnessed a revival of the literature on urban sprawl for three main reasons: (i) the existence of new methodologies to measure the phenomenon based on digital cartography and geo-referenced information, (ii) new hypotheses about the relevance of the formation of metropolitan areas not institutionally integrated into urban sprawl in many places and, mainly, (iii) the role of urban density in the environmental sustainability of cities. The recent literature on this third aspect has grown the most and around which it seems that new and interesting lines of future research will develop. The objective of this work is to present a synthetic review of the most recent literature on urban sprawl as of the end of the second decade of the XXI century. This review can serve to recapitulate the growing consensus that is being formed on the lower environmental sustainability of low-density cities and diffuse limits.

The Contemporary Economic Costs of Spatial Chaos: Evidence from Poland

This paper is based on the results of an extensive (840-page) report of the Committee on National Spatial Development of the Polish Academy of Sciences, entitled Studies on Spatial Chaos (edited by A. Kowalewski, T, Markowski and P. Śleszyński—Studia KPZK PAN, vol. 182, Warsaw 2018—in Polish). Its aim was to conduct a comprehensive and detailed study on the problem of spatial chaos (spatial disorder), including an estimate of economic costs in Poland. For this purpose, literature was queried (articles and reports, etc.) and special analyses were prepared for this purpose. The total annual costs of spatial chaos were estimated at not less than 20 billion euros per year. The conclusions also proposed solutions and suggestions (for the government and local governments), which may reduce the acute costs of spatial chaos in society and economy.

Cool Pavement Strategies for Urban Heat Island Mitigation in Suburban Phoenix, Arizona

Urban areas are characterized by a large proportion of artificial surfaces, such as concrete and asphalt, which absorb and store more heat than natural vegetation, leading to the Urban Heat Island (UHI) effect. Cool pavements, walls, and roofs have been suggested as a solution to mitigate UHI, but their effectiveness depends on local land-use patterns and surrounding urban forms. Meteorological data was collected using a mobile platform in the Power Ranch community of Gilbert, Arizona in the Phoenix Metropolitan Area, a region that experiences harsh summer temperatures. The warmest hour recorded during data collection was 13 August 2015 at 5:00 p.m., with a far-field air temperature of about 42 ∘ C and a low wind speed of 0.45 m/s from East-Southeast (ESE). An uncoupled pavement-urban canyon Computational Fluid Dynamics (CFD) model was developed and validated to study the microclimate of the area. Five scenarios were studied to investigate the effects of different pavements on UHI, replacing all pavements with surfaces of progressively higher albedo: New asphalt concrete, typical concrete, reflective concrete, making only roofs and walls reflective, and finally replacing all artificial surfaces with a reflective coating. While new asphalt surfaces increased the surrounding 2 m air temperatures by up to 0.5 ∘ C, replacing aged asphalt with typical concrete with higher albedo did not significantly decrease it. Reflective concrete pavements decreased air temperature by 0.2–0.4 ∘ C and reflective roofs and walls by 0.4–0.7 ∘ C, while replacing all roofs, walls, and pavements with a reflective coating led to a more significant decrease, of up to 0.8–1.0 ∘ C. Residences downstream of major collector roads experienced a decreased air temperature at the higher end of these ranges. However, large areas of natural surfaces for this community had a significant effect on downstream air temperatures, which limits the UHI mitigation potential of these strategies.

Eighteen-Year Trends in the Prevalence of, and Health Care Use for, Noncancer Pain in the United States: Data from the Medical Expenditure Panel Survey

We used data from the nationally representative Medical Expenditure Panel Survey to determine the 18-year trends in the overall rates of noncancer pain prevalence and pain-related interference, as well as in health care use attributable directly to pain management. The proportion of adults reporting painful health condition(s) increased from 32.9% (99.7% confidence interval [CI] = 31.6-34.2%;120 million adults) in 1997/1998 to 41.0% (99.7% CI = 39.2-42.4%; 178 million adults) in 2013/2014 (P_trend < .0001). Among adults with severe pain-related interference associated with their painful health condition(s), the use of strong opioids specifically for pain management more than doubled from 11.5% (99.7% CI = 9.6-13.4%) in 2001/2002 to 24.3% (99.7% CI = 21.3-27.3%) in 2013/2014 (P_trend < .0001). A smaller increase (P_interaction < .0001) in strong opioid use was seen in those with minimal pain-related interference: 1.2% (99.7% CI = 1.0-1.4%) in 2001/2002 to 2.3% (99.7% CI = 1.9-2.7%) in 2013/2014. Small but statistically significant decreases (P_trend < .0001) were seen in 1) the percentage of adults with painful health condition(s) who had ≥1 ambulatory office visit for their pain: 56.1% (99.7% CI = 54.2-58.0%) in 1997/1998 and 53.3% (99.7% CI = 51.4-55.4%) in 2013/2014; 2) the percentage who had ≥1 emergency room visit for their pain; 9.9% (99.7% CI = 8.6-11.2%) to 8.8% (99.7% CI = 7.9-9.7%); and 3) the percentage with ≥1 overnight hospitalization for their pain: 3.2% (99.7% CI = 2.6-4.0%) to 2.3% (99.7% CI = 1.8-2.8%). PERSPECTIVE: Our data illustrate changes in the management of painful health conditions over the last 2 decades in the United States. Strong opioid use remains high, especially in those with severe pain-related interference. Additional education of health care providers and the public concerning the risk/benefit ratio of opioids appears warranted.

Fast Identification of Urban Sprawl Based on K-Means Clustering with Population Density and Local Spatial Entropy

As urban sprawl is proven to jeopardize the sustainability system of cities, the identification of urban sprawl is essential for urban studies. Compared with previous related studies which tend to utilize more and more complicated variables to recognize urban sprawl while still retaining an element of uncertainty, this paper instead proposes a simplified model to identify urban sprawl patterns. This is a working theory which is based on a diagram interpretation of the classic urban spatial structure patterns of the Chicago School. The method used in our study is K-means clustering with gridded population density and local spatial entropy. The results and comparison with open population data and mobile phone data verify the assumption and furthermore indicate that the accuracy of source population data will limit the precision of output identification. This article concludes that urban sprawl is mainly dominated by population and surrounding unevenness. Moreover, the Floating Catchment Area (FCA) local spatial entropy method presented in this research brings about an integration of Shannon entropy, Tobler’s first law of geography and the Moore neighborhood, improving the spatial homogeneity and locality of Batty’s Spatial Entropy model which can only be used in a general scope.

Associations between Urban Sprawl and Life Expectancy in the United States

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

Does Walkability Contribute to Geographic Variation in Psychosocial Distress? A Spatial Analysis of 91,142 Members of the 45 and Up Study in Sydney, Australia

Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed “disease maps” for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial distress.

Community Restructuring and Depressive Symptoms of Rural Mature and Elderly Adults: A Multilevel Analysis Based on a National Dataset in China

Community restructuring is an important predictor for residents' mental health. However, few studies have investigated how it affects the depressive symptoms of rural ageing population. Using cross-sectional data from China Health and Retirement Longitudinal Study (CHARLS), this study examined how community restructuring was associated with depressive symptoms of Chinese rural mature and older adults and what community-level factors mediated the association. We found that people in restructuring communities reported .75 unit lower depression score (p < .01); community restructuring is associated with more infrastructure, recreational amenities, and grassroots organization (p < .001) in the community; and the availability of infrastructure (p < .01) and grassroots organization (p < .05) had significant indirect effect on the association between community restructuring and depressive symptoms. World countries' urbanization policy shall not only focus on community physical environment, but also on the development of grassroots organizations that involve and connect local people.

Happiness and health across the lifespan in five major cities: The impact of place and government performance

RATIONALE

A growing body of research suggests that urban design has an effect on health and well-being. There have been very few studies to date, however, that compare these effects across the lifespan.

OBJECTIVE

The current study examines the direct and indirect effects of the city environment on happiness. It was hypothesised that citizens' ratings of their city along dimensions of performance (e.g., basic - usually government - services related to education, healthcare, social services, and policing) and place (e.g., the beauty of the city and a built environment that provides access to cultural, sport, park, transport, and shopping amenities) would be significant predictors of happiness but that the nature of these effects would change over the lifespan.

METHODS

5000 adults aged 25-85 years old living in Berlin, Paris, London, New York, and Toronto completed the Quality of Life Survey in 2007. Respondents reported their happiness levels and evaluated their city along place and performance dimensions.

RESULTS

The results of the study demonstrate an interesting, and complex relationship between the city environment and happiness of residents across the lifespan. Findings suggest that the happiness of younger residents is a function of having easy access to cultural, shopping, transport, parks and sport amenities and the attractiveness of their cities (i.e. place variables). The happiness of older residents is associated more with the provision of quality governmental services (i.e., performance variables). Place and performance variables also have an effect on health and social connections, which are strongly linked to happiness for all residents.

CONCLUSION

Younger adults' happiness is more strongly related to the accessibility of amenities that add to the quality of a city's cultural and place characteristics; older adults' happiness is more strongly related to the quality of services provided within a city that enable residents to age in place. These results indicate that, in order to be all things to all people, cities should emphasize quality services (e.g., good policing, schools, healthcare access), beauty and character, and provide easy access to transport amenities and cultural and recreational opportunities.

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

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

The Effects of the Urban Built Environment on Mental Health: A Cohort Study in a Large Northern Italian City

Mental health (MH) has a relevant burden on the health of populations. Common MH disorders (anxiety and non-psychotic depression) are well associated to socioeconomic individual and neighborhood characteristics, but little is known about the influence of urban structure. We analyzed among a Turin (Northwest Italy) urban population the association at area level of different urban structure characteristics (density, accessibility by public transport, accessibility to services, green and public spaces) and consumption of antidepressants. Estimates were adjusted by individual socio-demographic variables (education, housing tenure, employment) and contextual social environment (SE) variables (social and physical disorder, crime rates). Data was extracted from the Turin Longitudinal Study (TLS)-a census-based cohort study following up prospectively the mortality and morbidity of the population. As expected, individual characteristics show the strongest association with antidepressant drug consumption, while among built environment (BE) indicators accessibility by public transport and urban density only are associated to MH, being slightly protective factors. Results from this study, in agreement with previous literature, suggest that BE has a stronger effect on MH for people who spend more time in the neighborhood. Therefore, this research suggests that good accessibility to public transport, as well as a dense urban structure (versus sprawl), could contribute to reduced risk of depression, especially for women and elderly, by increasing opportunities to move around and have an active social life.

Measuring physical neighborhood quality related to health

Although sociodemographic factors are one aspect of understanding the effects of neighborhood environments on health, equating neighborhood quality with socioeconomic status ignores the important role of physical neighborhood attributes. Prior work on neighborhood environments and health has relied primarily on level of socioeconomic disadvantage as the indicator of neighborhood quality without attention to physical neighborhood quality. A small but increasing number of studies have assessed neighborhood physical characteristics. Findings generally indicate that there is an association between living in deprived neighborhoods and poor health outcomes, but rigorous evidence linking specific physical neighborhood attributes to particular health outcomes is lacking. This paper discusses the methodological challenges and limitations of measuring physical neighborhood environments relevant to health and concludes with proposed directions for future work.

Incorporating consideration of health impacts into land use development approval processes: Development of a Health Background Study Framework

OBJECTIVES

This project involved development of a Health Background Study (HBS) Framework to support consideration of health impacts within municipalities' approval process for land use development.

PARTICIPANTS

Peel Public Health and Toronto Public Health led the project with the participation of planners, urban designers, engineers, public health staff and development industry representatives.

SETTING

Historical growth in the Region of Peel and suburban Toronto has resulted in extensive low-density development, creating car-dependent communities with disconnected streets and segregated land uses.

INTERVENTION

The inclusion of an HBS in developers' applications to municipalities is one approach by which health-related expectations for the built environment can be established within the approval process. Development of the HBS Framework used the six core elements of the built environment with the strongest evidence for impact on health and was informed by analysis of the provincial and local policy contexts, practices of other municipalities and stakeholder interviews. The Framework's contents were refined according to feedback from multidisciplinary stakeholder workshops.

OUTCOMES

The HBS Framework identifies minimum standards for built environment core elements that developers need to address in their applications. The Framework was created to be simple and instructive with applicability to a range of development locations and scales, and to various stages of the development approval process. Peel Public Health is leading several initiatives to support the use of the HBS as a part of the development application process.

CONCLUSION

The HBS Framework is a tool that public health and planning can use to support the consideration of health impacts within municipalities' land use development processes.

Obesity and economic environments

This review summarizes current understanding of economic factors during the obesity epidemic and dispels some widely held, but incorrect, beliefs. Rising obesity rates coincided with increases in leisure time (rather than increased work hours), increased fruit and vegetable availability (rather than a decline in healthier foods), and increased exercise uptake. As a share of disposable income, Americans now have the cheapest food available in history, which fueled the obesity epidemic. Weight gain was surprisingly similar across sociodemographic groups or geographic areas, rather than specific to some groups (at every point in time; however, there are clear disparities). It suggests that if one wants to understand the role of the environment in the obesity epidemic, one needs to understand changes over time affecting all groups, not differences between subgroups at a given time. Although economic and technological changes in the environment drove the obesity epidemic, the evidence for effective economic policies to prevent obesity remains limited. Taxes on foods with low nutritional value could nudge behavior toward healthier diets, as could subsidies/discounts for healthier foods. However, even a large price change for healthy foods could close only part of the gap between dietary guidelines and actual food consumption. Political support has been lacking for even moderate price interventions in the United States and this may continue until the role of environmental factors is accepted more widely. As opinion leaders, clinicians play an important role in shaping the understanding of the causes of obesity.

Urban sprawl, obesity, and cancer mortality in the United States: cross-sectional analysis and methodological challenges

BACKGROUND

Urban sprawl has the potential to influence cancer mortality via direct and indirect effects on obesity, access to health services, physical activity, transportation choices and other correlates of sprawl and urbanization.

METHODS

This paper presents a cross-sectional analysis of associations between urban sprawl and cancer mortality in urban and suburban counties of the United States. This ecological analysis was designed to examine whether urban sprawl is associated with total and obesity-related cancer mortality and to what extent these associations differed in different regions of the US. A major focus of our analyses was to adequately account for spatial heterogeneity in mortality. Therefore, we fit a series of regression models, stratified by gender, successively testing for the presence of spatial heterogeneity. Our resulting models included county level variables related to race, smoking, obesity, access to health services, insurance status, socioeconomic position, and broad geographic region as well as a measure of urban sprawl and several interactions. Our most complex models also included random effects to account for any county-level spatial autocorrelation that remained unexplained by these variables.

RESULTS

Total cancer mortality rates were higher in less sprawling areas and contrary to our initial hypothesis; this was also true of obesity related cancers in six of seven U.S. regions (census divisions) where there were statistically significant associations between the sprawl index and mortality. We also found significant interactions (p < 0.05) between region and urban sprawl for total and obesity related cancer mortality in both sexes. Thus, the association between urban sprawl and cancer mortality differs in different regions of the US.

CONCLUSIONS

Despite higher levels of obesity in more sprawling counties in the US, mortality from obesity related cancer was not greater in such counties. Identification of disparities in cancer mortality within and between geographic regions is an ongoing public health challenge and an opportunity for further analytical work identifying potential causes of these disparities. Future analyses of urban sprawl and health outcomes should consider exploring regional and international variation in associations between sprawl and health.

Steps toward validity in active living research: research design that limits accusations of physical determinism

"Active living research" has been accused of being overly "physically deterministic" and this article argues that urban planners must continue to evolve research and address biases in this area. The article first provides background on how researchers have dealt with the relationship between the built environment and health over years. This leads to a presentation of how active living research might be described as overly deterministic. The article then offers lessons for researchers planning to embark in active-living studies as to how they might increase validity and minimize criticism of physical determinism.

Neighborhoods and HIV: a social ecological approach to prevention and care

Neighborhood factors have been linked to HIV risk behaviors, HIV counseling and testing, and HIV medical care. However, the social-psychological mechanisms that connect neighborhood factors to HIV-related behaviors have not been fully determined. In this article we review the research on neighborhood factors and HIV-related behaviors, approaches to measuring neighborhoods, and mechanisms that may help to explain how the physical and social environment within neighborhoods may lead to HIV-related behaviors. We then discuss organizational, geographic, and social network approaches to intervening in neighborhoods to reduce HIV transmission and facilitate HIV medical care with the goal of reducing morbidity and mortality and increasing social and psychological well-being.

Suburban sprawl in the developing world: duplicating past mistakes? The case of Kuala Lumpur, Malaysia

Newly affluent developing world cities increasingly adopt the same unfortunate low-density suburban paradigm that shaped cities in the industrialized world. Identified by a World Bank report as a "mini-Los Angeles," Kuala Lumpur is a sentinel example of the results of unrestrained sprawl in the developing world. Factors driving sprawl included government policies favoring foreign investment, "mega-projects," and domestic automobile production; fragmented governance structures allowing federal and state government influence on local planning; increasing middle-class affluence; an oligopoly of local developers; and haphazard municipal zoning and transport planning. The city's present form contributes to Malaysia's dual burden of disease, with inner-city shantytown dwellers facing communicable disease and malnutrition while suburban citizens experience increasing chronic disease, injury, and mental health issues. Despite growing awareness in city plans targeted toward higher density development, Kuala Lumpur presents a warning to other emerging economies of the financial, societal, and population health costs imposed by quickly-built suburban sprawl.

The relationship between urban sprawl and coronary heart disease in women

Studies have reported relationships between urban sprawl, physical activity, and obesity, but - to date - no studies have considered the relationship between sprawl and coronary heart disease (CHD) endpoints. In this analysis, we use longitudinal data on post-menopausal women from the Women's Health Initiative (WHI) Clinical Trial to analyze the relationship between metropolitan statistical area (MSA)-level urban compactness (the opposite of sprawl) and CHD endpoints including death, any CHD event, and myocardial infarction. Models control for individual and neighborhood socio-demographic characteristics. Women who lived in more compact communities at baseline had a lower probability of experiencing a CHD event and CHD death or MI during the study follow-up period. One component of compactness, high residential density, had a particularly noteworthy effect on outcomes. Finally, exploratory analyses showed evidence that the effects of compactness were moderated by race and region.

Sense of Place and Health in Hamilton, Ontario: A Case Study

The concept of sense of place has received considerable attention by social scientists in recent years. Research has indicated that a person's sense of place is influenced by a number of factors including the built environment, socio-economic status (SES), well-being and health. Relatively few studies have examined sense of place at the neighbourhood level, particularly among communities exhibiting different levels of SES. This article investigates sense of place among three neighbourhood groups in Hamilton, Ontario representing areas of low, mixed and high SES. It analyses data from a 16-point sense of place scale derived from the Hamilton Household Quality of Life Survey carried out in 2010-2011 among 1,002 respondents. The paper found that sense of place was highest among residents of the high SES neighbourhood group as well as among home owners, people residing in single-detached homes, retired residents and those living in their neighbourhood for more than 10 years. From a health perspective, the paper found that a strong association existed between sense of place and self-perceived mental health across the three neighbourhood groups. Furthermore, by way of regression modeling, the paper examined the factors influencing health-related sense of place. Among the sample of respondents, a strong connection was found between housing, particularly home ownership, and high levels of health-related sense of place.

The association between sidewalk length and walking for different purposes in established neighborhoods

Background

Walking in neighborhood environments is undertaken for different purposes including for transportation and leisure. We examined whether sidewalk availability was associated with participation in, and minutes of neighborhood-based walking for transportation (NWT) and recreation (NWR) after controlling for neighborhood self-selection.

Method

Baseline survey data from respondents (n = 1813) who participated in the RESIDential Environment (RESIDE) project (Perth, Western Australia) were used. Respondents were recruited based on their plans to move to another neighborhood in the following year. Usual weekly neighborhood-based walking, residential preferences, walking attitudes, and demographics were measured. Characteristics of the respondent’s baseline neighborhood were measured including transportation-related walkability and sidewalk length. A Heckman two-stage modeling approach (multivariate Probit regression for walking participation, followed by a sample selection-bias corrected OLS regression for walking minutes) estimated the relative contribution of sidewalk length to NWT and NWR.

Results

After adjustment, neighborhood sidewalk length and walkability were positively associated with a 2.97 and 2.16 percentage point increase in the probability of NWT participation, respectively. For each 10 km increase in sidewalk length, NWT increased by 5.38 min/wk and overall neighborhood-based walking increased by 5.26 min/wk. Neighborhood walkability was not associated with NWT or NWR minutes. Moreover, sidewalk length was not associated with NWR minutes.

Conclusions

Sidewalk availability in established neighborhoods may be differentially associated with walking for different purposes. Our findings suggest that large investments in sidewalk construction alone would yield small increases in walking.

Commuting distance, cardiorespiratory fitness, and metabolic risk

BACKGROUND

Limited evidence exists on the metabolic and cardiovascular risk correlates of commuting by vehicle, a habitual form of sedentary behavior.

PURPOSE

To examine the association between commuting distance, physical activity, cardiorespiratory fitness (CRF), and metabolic risk indicators.

METHODS

This cross-sectional study included 4297 adults who had a comprehensive medical examination between 2000 and 2007 and geocoded home and work addresses in 12 Texas metropolitan counties. Commuting distance was measured along the road network. Outcome variables included weekly MET-minutes of self-reported physical activity, CRF, BMI, waist circumference, triglycerides, plasma glucose, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, and continuously measured metabolic syndrome. Outcomes were also dichotomized using established cut-points. Linear and logistic regression models were adjusted for sociodemographic characteristics, smoking, alcohol intake, family history of diabetes, and history of high cholesterol, as well as BMI and weekly MET-minutes of physical activity and CRF (for BMI and metabolic risk models). Analyses were conducted in 2011.

RESULTS

Commuting distance was negatively associated with physical activity and CRF and positively associated with BMI, waist circumference, systolic and diastolic blood pressure, and continuous metabolic score in fully adjusted linear regression models. Logistic regression analyses yielded similar associations; however, of the models with metabolic risk indicators as outcomes, only the associations with elevated blood pressure remained significant after adjustment for physical activity and CRF.

CONCLUSIONS

Commuting distance was adversely associated with physical activity, CRF, adiposity, and indicators of metabolic risk.

Role of built environments in physical activity, obesity, and cardiovascular disease

In industrialized nations like the United States and Sweden, the vast majority of adults do not meet the physical activity guidelines of 150 minutes per week.1 Inactive lifestyles put most adults at risk of cardiovascular diseases (CVD), diabetes, obesity, some cancers, osteoporosis, and psychological disorders.2 Physical activity can be effective at all phases of chronic disease management, from primordial prevention (prevention of risk factors) through treatment and rehabilitation.2 There is particular interest in the potential for physical activity to prevent chronic diseases, thereby improving quality of life and reducing health care costs.3 In the past decade, limitations of prevention approaches that target mainly individuals with educational and motivational programs have been recognized, triggering a trend to consider influences on behavior that are outside the person, such as the built environment.4 ,5 The purposes of the present paper are to describe multilevel ecological models of behavior as they apply to physical activity, describe key concepts, summarize evidence on the relation of built environment attributes to physical activity and obesity, and provide recommendations for built environment changes that could increase physical activity. The intent of this non-systematic review is to present conclusions from previous reviews then illustrate results by highlighting selected studies.

In search of causality: a systematic review of the relationship between the built environment and physical activity among adults

Background

Empirical evidence suggests that an association between the built environment and physical activity exists. This evidence is mostly derived from cross-sectional studies that do not account for other causal explanations such as neighborhood self-selection. Experimental and quasi-experimental designs can be used to isolate the effect of the built environment on physical activity, but in their absence, statistical techniques that adjust for neighborhood self-selection can be used with cross-sectional data. Previous reviews examining the built environment-physical activity relationship have not differentiated among findings based on study design. To deal with self-selection, we synthesized evidence regarding the relationship between objective measures of the built environment and physical activity by including in our review: 1) cross-sectional studies that adjust for neighborhood self-selection and 2) quasi-experiments.

Method

In September 2010, we searched for English-language studies on built environments and physical activity from all available years in health, leisure, transportation, social sciences, and geographical databases. Twenty cross-sectional and 13 quasi-experimental studies published between 1996 and 2010 were included in the review.

Results

Most associations between the built environment and physical activity were in the expected direction or null. Land use mix, connectivity and population density and overall neighborhood design were however, important determinants of physical activity. The built environment was more likely to be associated with transportation walking compared with other types of physical activity including recreational walking. Three studies found an attenuation in associations between built environment characteristics and physical activity after accounting for neighborhood self-selection.

Conclusion

More quasi-experiments that examine a broader range of environmental attributes in relation to context-specific physical activity and that measure changes in the built environment, neighborhood preferences and their effect on physical activity are needed.

Does urban sprawl impact on self-rated health and psychological distress? A multilevel study from Sydney, Australia

Mental health can be influenced by a number of neighbourhood physical and social environmental characteristics. We aimed to determine whether urban sprawl (based on population density) in Sydney, Australia, is associated with self-rated health and psychological distress. We used a cross-sectional multilevel study design. Individual level data on self-rated health and psychological distress were obtained from the 2006 and 2007 NSW Population Health Survey. We did not find significant associations between urban sprawl and self-rated health and psychological distress after controlling for individual and area level covariates. However, positive neighbourhood factors were generally associated with better self-rated health and lower psychological distress but few of these associations were statistically significant.

Multilevel analysis of habitual physical activity and metabolic syndrome in Northern Taiwan

OBJECTIVE

This study examines the relationship between the availability of public facilities for habitual physical activity in the community and metabolic syndrome in northern Taiwan, one of most densely populated countries in the world.

METHODS

Subjects consisted of 14,658 participants (43.3% men and 56.7% women) ≥40 years old (mean=59.5) from 10 districts of Taoyuan County in a health check-up program in 2004-2005. Public facilities for habitual physical activity included school campuses and parks, and the density of such facilities was categorized into four levels. Multilevel logistic regression models were created to examine the effect on metabolic syndrome at both the individual and the contextual level using MLwiN software.

RESULTS

The addition of the contextual variable to the model that included individual characteristics led to a further reduction of 7.2% in the variance. Using the facility density level I as the reference, the odds ratios (95% confidence interval) of metabolic syndrome for levels II, III, and IV were 0.87 (0.71-1.07), 0.87 (0.68-1.12), and 0.78 (0.61-0.99), respectively, with the trend test reaching significance.

CONCLUSION

Greater availability of free facilities for habitual physical activity in a district was associated with a lower risk of metabolic syndrome among its residents.

The built environment and physical activity levels: the Harvard Alumni Health Study

BACKGROUND

Physical activity is associated with better health, but many individuals are insufficiently active. Modifying the built environment may be an approach capable of influencing population-wide levels of physical activity, but few data exist from longitudinal studies that can minimize bias from active people choosing activity-friendly neighborhoods.

PURPOSE

This study aims to examine cross-sectional and longitudinal associations between the built environment and physical activity on a large scale.

METHODS

This study examined cross-sectional associations between urban sprawl (mapping addresses to corresponding counties) and physical activity (self-reported) among men throughout the U.S. in 1993 and in 1988, and longitudinal associations between changes in exposure to urban sprawl for movers and physical activity, 1988-1993. Included were 4997 men (mean age, 70 years) in the 1993 cross-sectional study; 4918 men in the 1988 cross-sectional study; and 3448 men in the longitudinal study, 1988-1993. Data were collected prospectively in 1988 and 1993, and analyses were performed in 2007-2008.

RESULTS

In cross-sectional analyses, less sprawl was significantly associated with more walking OR, comparing least with most sprawling areas, for meeting physical activity recommendations by walking=1.38 [95% CI=1.09, 1.76] in 1993 and 1.53 [1.19, 1.96] in 1988). Less sprawl also was associated with lower prevalence of overweight (corresponding OR=0.79 [0.64, 0.98] in 1993 and 0.81 [0.66, 1.00] in 1988). However, longitudinal analyses assessing change did not show that decreasing sprawl was associated with increased physical activity or decreased BMI.

CONCLUSIONS

These findings suggest that the cross-sectional results may reflect self-selection, rather than indicating that the built environment--as measured by urban sprawl--increases physical activity. However, the longitudinal findings were limited by small numbers of men changing residence and associated sprawl levels.

Stemming the global obesity epidemic: what can we learn from data about social and economic trends?

Although the policy debate is only slowly moving away from the focus on individual-level psychological and social factors, the research community has largely recognized that changes in dietary and physical activity patterns are driven by changes in the environment and by the incentives that people face. Many factors have been suggested as causes of the 'obesity epidemic'. Putting a multitude of isolated data points into a coherent picture is a challenging, but necessary, task to assess whether proposed solutions are promising or likely to lead down a blind alley. Conventional wisdom is an unreliable guide and some widely held beliefs are incorrect. Can one distinguish between important and less important behavioural changes and relate them to environmental incentives? People face trade-offs in allocating their scarce resources of time and money to best achieve their goals, including health. Studying what people are doing with their time and money is a good start towards understanding how economic incentives have altered energy intake and energy expenditure in a way that has led to weight gain. A challenging task for policy will be finding the right levers. Both economic and public health/medical perspectives play an important role in the policy process, but often approach policy questions in an incompatible way. Economics and public health perspectives can complement each other, but harnessing any synergy requires an understanding of the other perspective. Arguably the most effective community intervention would be multi-faceted and would include several goals about diet and physical activity. In practice, however, it appears that much more effort is devoted to promoting increased fruit/vegetable consumption, and exhorting individuals to increase physical activity than to environmental intervention that would make it easier for people to reduce energy intake and sedentary entertainment. Politically, it may often be more expedient to promote an increase than a decrease, but it may be far less effective.

Neighborhood and developmental differences in children's perceptions of opportunities for play and physical activity

The purposes of this study were to examine perceptions of places to play and be physically active among children from two different urban neighborhoods, and evaluate these perceptions for age-related developmental differences. One hundred and sixty-eight children from grades K-6 (aged 6-12 years old) completed mental maps depicting places where they could play and be physically active. The children were recruited from schools in two neighborhoods-one a high-walkability (H-W) grid-style neighborhood, the other a low-walkability (L-W) lollipop-style (i.e., cul-de-sacs) neighborhood. Analysis revealed that children in the H-W neighborhood depicted more active transportation and less non-active transportation than children in the L-W neighborhood. Children in the lowest grades (K-2) in the L-W neighborhood depicted more play in the home/yard environment than the oldest children, more good weather image events than children in Grades 3-6, and less play outside the home/yard environment than children in Grades 3 and 4. In the H-W neighborhood, the youngest children (K-2) depicted significantly less play in the home/yard environment and less play outside the home/yard environment than older children (Grades 3-6). Thus, both the type of urban neighborhood and children's age moderated perceptions of places to play and be physically active.