Use of science to guide city planning policy and practice: how to achieve healthy and sustainable future cities

Validation of the physical activity neighborhood environment scale using geographic information systems among urban men and women in regional China

Aims

To examine the concurrent validity of the Chinese version of Physical Activity Neighborhood Environment Scale (PANES-CHN) among urban adults in regional China.

Methods

With multistage sampling approaches, 801 eligible urban adults aged 35-74 years were recruited from Nanjing municipality of China between July and September of 2019. The neighbourhood built environment features were measured subjectively with PANES-CHN and objectively with geographic information system. The concurrent validity of PANES was assessed using Spearman's correlations (rs).

Results

Among the total 801 participants, the mean age was 54.4 (standard deviation = 11.5), while 48.7 % were men. Overall, of all the five objectively-measurable built environment characteristics, the Spearman correlations were examined significant between subjective and objective measurements for commercial facilities (item 2) (rs = 0.19, 95CI%=0.12, 0.25), recreational facilities (item 6) (rs = 0.10, 95CI%=0.02, 0.16), traffic junctions (item 12) (rs = 0.15, 95CI%=0.07, 0.22), medical/education facilities (item 17) (rs = 0.22, 95CI%=0.15, 0.29), but not for public transport stops. Similar scenarios were observed for participants aged 35-60 years, with sufficient physical activity, men or women. The rs value for medical/education facilities (item 17) was significantly higher in participants aged 35-59 years (0.28 vs. 0.13; p = 0.04) than those aged 60 + years.

Conclusions

PANES-CHN generally has an acceptable validity for assessing built environment characteristics among urban adults in China, which implies that PANES-CHN can be used to measure built environment attributes in health-related population studies.

Large walking and wellbeing behaviour benefits of co-designed sustainable park improvements: A natural experimental study in a UK deprived urban area

There is little robust evidence of how sustainable park interventions impact on physical activity and other behaviours important for wellbeing. This controlled natural experimental study aimed to examine the effects of co-designing a sustainable park intervention, in a deprived UK urban area, on walking and other wellbeing behaviours. Behaviour observations were conducted at two intervention sites and two matched comparison sites (n = 4,783). Walking observations (primary outcome), wellbeing behaviours (vigorous, sedentary, social and take notice activities) and demographic characteristics were assessed at pre-intervention, and post-intervention (3 and 15 months). Outcomes were compared between intervention and comparison groups, controlling for pre-intervention using multilevel negative binomial regression models. Additional behaviour observations were conducted in two unchanged nearby sites to assess changes in general local activity. Intercept surveys (n = 623) assessed change in self-reported outdoor space usage at intervention and control areas. Post-intervention, walking increased 203 % at 3 months (IRR 2·03, 95 % CI 1·01-4·09) and 351 % at 15 months (IRR 3·51, 95 % CI 2·07-5·93), for intervention sites relative to comparison sites. Large increases for other wellbeing behaviours were also observed. The proportion of non-white persons increased substantially post-intervention, compared to comparison sites. Nearby unchanged sites showed little evidence of general increased activity. Self-reported outdoor usage increased more in the intervention sites (p=<0·001). Sustainable solutions can yield large increases in walking and wellbeing in deprived areas, especially where interventions are co-designed with residents. More collaborative and robust natural experimental studies like this are needed to better inform decision-makers how to maximise health and wellbeing outcomes from sustainable interventions.

Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities

INTRODUCTION

Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not.

METHODS AND ANALYSIS

Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities.

ETHICS AND DISSEMINATION

This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association

Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.

How to Achieve a Healthy City: a Scoping Review with Ten City Examples

This scoping review of the literature explores the following question: what systematic measures are needed to achieve a healthy city? The World Health Organization (WHO) suggests 11 characteristics of a healthy city. Measures contributing to these characteristics are extracted and classified into 29 themes. Implementation of some of these measures is illustrated by examples from Freiburg, Greater Vancouver, Singapore, Seattle, New York City, London, Nantes, Exeter, Copenhagen, and Washington, DC. The identified measures and examples indicate that a healthy city is a system of healthy sectors. A discussion section suggests healthy directions for nine sectors in a healthy city. These sectors include transportation, housing, schools, city planning, local government, environmental management, retail, heritage, and healthcare. Future work is advised to put more focus on characteristic 5 (i.e., the meeting of basic needs for all the city's people) and characteristic 10 (i.e., public health and sick care services accessible to all) of a healthy city.

Prioritizing a research agenda on built environments and physical activity: a twin panel Delphi consensus process with researchers and knowledge users

BACKGROUND

The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners).

METHODS

Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin 'top 10' lists of the most important research needs.

RESULTS

From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT.

CONCLUSIONS

Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.

Validating the Perceived Active School Travel Enablers and Barriers - Child (PASTEB-C) questionnaire

OBJECTIVES

Presently, child-specific tools and instruments related to active school travel (AST) are lacking. This methodological shortcoming often contributes to suboptimal AST behaviour evaluations and intervention programming. The aim of this paper was to develop and validate a theoretically informed child-specific scale regarding multiple perceived barriers and enablers known to impact children's participation in AST.

STUDY DESIGN

Mixed methods.

METHODS

A mixed-methods and multistudy scale development approach featuring the application of social-ecological theory, a validation pilot study (n = 80), and test-retest study (n = 96) was conducted in collaboration with children in Ontario, Canada. In tandem with completing cognitive interviews and online surveys, multiple analyses, including a qualitative thematic analysis, along with weighted Cohen's kappa, Cronbach's alpha, and confirmatory factor analysis were undertaken.

RESULTS

Qualitative analyses of the developed tool addressed face validity concerns related to the response options and definitions of terms used. Following the reliability analyses of 40 items, two confirmatory factor analyses were run to assess the construct validation of perceived AST barriers and enablers, and resulted in the development of the 24-item Perceived Active School Travel Enablers and Barriers - Child (PASTEB-C) questionnaire.

CONCLUSION

The developed PASTEB-C questionnaire may be used to inform the programming and development of AST interventions, as well as conduct child-specific AST research.

Road safety, health equity, and the built environment: perspectives of transport and injury prevention professionals in five Canadian municipalities

BACKGROUND

Concerns regarding health equity (HE) and the built environment (BE) are well established in the Canadian urban context. Transport and injury prevention professionals across sectors, such as transportation and public health, are involved in designing and implementing BE interventions that enhance the safety of vulnerable road users (VRUs). Results from a larger study examining barriers and facilitators to BE change are used to illustrate how transport and injury prevention professionals perceive HE concerns in their work in five Canadian municipalities. Broadening our understanding of how HE influences the professional BE change context is crucial when advocating for modifications that enhance the safety of equity-deserving VRUs and groups who experience marginalization.

METHODS

Interview and focus group data were gathered from transport and injury prevention professionals working in policy/decision-making, transport, police services, public health, non-profit organizations, schools/school boards, community associations, and private sectors across five Canadian urban municipalities: Vancouver, Calgary, Peel Region, Toronto, and Montréal. Data were analyzed using thematic analysis (TA) to illustrate how equity considerations were perceived and applied in participants' BE change work.

RESULTS

The results of this study illustrate transport and injury prevention professionals' awareness of the varying needs of VRUs, as well as the inadequacies of current BEs in the Canadian urban context and consultation processes utilized to guide change. Participants emphasized the importance of equitable community consultation strategies, as well as specific BE changes that would support the health and safety of VRUs. Overall, the results highlight how HE concerns inform transport and injury prevention professionals' BE change work in the Canadian urban context.

CONCLUSION

For professionals working in urban Canadian transport and injury prevention sectors HE concerns influenced their perspectives of the BE and BE change. These results illustrate a growing need for HE to guide BE change work and consultation processes. Further, these results contribute to ongoing efforts in the Canadian urban context to ensure that HE is at the forefront of BE policy change and decision-making, while promoting existing strategies to ensure that the BE, and related decision-making processes, are accessible and informed by a HE lens.

Examining African contributions to global health: Reflections on knowledge circulation and innovation

This article unites different disciplinary debates on 'southern innovation', 'theory from the South', and 'decolonisation of knowledge' in order to discuss existing understandings around the role of Africa in the production of health-related knowledge, public health policy, and medical innovation. Arguing that high-income countries have much to learn from the global South when it comes to health-related knowledge and practices, we propose an interdisciplinary research approach to uncovering and examining African contributions to global health, drawing on an ongoing collaborative project funded by the Swiss National Science Foundation. We present four empirical case studies concerning drug development, healthcare systems, and urban planning to critically enquire into both historical and contemporary transcontinental knowledge circulation and learning potentials, as much as cases of forgetting and silencing. On this basis, we argue that 'learning from the South' must mean more than transplanting quick and cheap technological fixes to serve societies in the global North, but rather recognising the vast contributions that Africans have made to global epistemologies, without losing sight of the asymmetries inherent in South-North knowledge exchanges. Lessons learned might apply to fields other than those discussed here and go far beyond 'reverse innovation'.

Disability and pedestrian road traffic injury: A scoping review

Disability and ableism remain a nascent area of inquiry in road traffic injury research. A scoping review of academic literature was conducted to understand the state of knowledge on disability and pedestrian-motor vehicle collisions. Sixty-two eligible articles were identified and included. A significantly higher risk of pedestrian collisions, injuries, and fatalities was consistently found among disabled people. Risk factors included individualized factors such as walking speed and crossing decisions of disabled people. The roles of social/political environments in injury risk were less commonly explored. More research is needed to assess how inaccessible or disabling environments may produce elevated risk of pedestrian injury among disabled populations.

Physical Activity and Public Health among People with Disabilities: Research Gaps and Recommendations

Physical activity has become an integral component of public health systems modeling the public health core functions of assessment, policy development, and assurance. However, people with disabilities have often not been included in public health efforts to assess, develop policies, or evaluate the impact of physical activity interventions to promote health and prevent disease among people with disabilities. Addressing the core function of assessment, current physical activity epidemiology, and surveillance among people with disabilities across the globe highlights the paucity of surveillance systems that include physical activity estimates among people with disabilities. The status of valid and reliable physical activity measures among people with condition-specific disabilities is explored, including self-report measures along with wearable devices, and deficiencies in measurement of physical activity. The core functions of policy development and assurance are described in the context of community-based intervention strategies to promote physical activity among people with disabilities. The identification of research gaps in health behavior change, policy, and environmental approaches to promoting physical activity among people with disabilities is explored, along with recommendations based on the principles of inclusive and engaged research partnerships between investigators and the members of the disability community.

Green Infrastructure and Urban-Renewal Simulation for Street Tree Design Decision-Making: Moderating Demands of Stormwater Management, Sunlight and Visual Aesthetics

The design of green infrastructure in urban renewal sites is complex, requiring engagement with existing communities and future sustainable development goals, consideration of existing and future urban forms, changing climatic conditions, and the sites often being in low-lying and flood-prone areas. Traditional street tree decision-making approaches are inadequate for addressing the scale, environmental complexity, and mutability of decisions involved in urban renewal projects—new tree selection approaches that consider complex competing criteria for tree selections addressing stormwater management systems, visual assessment and solar amenity are needed. This paper describes a new method of multi-criteria street design decision modelling that combines outputs from hydrology modelling, digital procedural tree modelling and urban form analysis, with animation and gaming technologies. We evaluate our approach through application to the design of a large-scale, urban renewal project underway in Melbourne, Australia. The results of the study demonstrate the functionality of our model, which allowed the simultaneous output of streetscape visualisation, with tree selection responding to integrated stormwater management infrastructure and flooding, along with the likely overshadowing conditions of urban renewal built-form. Our multi-criteria approach makes a significant contribution to the tools available to urban designers, planners and landscape architects in their pursuit of smarter streetscape design decisions that respond to complex spatial, cultural and climatic urban challenges.

Cross-sectional and longitudinal associations between the built environment and walking: effect modification by socioeconomic status

BACKGROUND

Although socioeconomic status (SES) has been shown to modify associations between the neighborhood built environment and physical activity, contradictory results exist. Objectives of this cross-sectional and longitudinal analysis were to: 1) examine whether overall neighborhood walkability and specific built characteristics were associated with walking among adults at a single point in time and after they relocate neighborhoods, and 2) test for effect modification of these associations by SES.

METHODS

We linked longitudinal data from 703 adults who relocated urban neighborhoods between two waves of Alberta's Tomorrow Project (2008-2015) to neighborhood built environment data. We created a walkability index from measures of population counts, street connectivity, and destination diversity within 400 m of participants' homes. In cross-sectional analyses, we used generalized linear models to estimate associations between built characteristics and minutes walked per week at baseline. For the longitudinal analyses, we used fixed-effects linear regression models to estimate associations between changes in built characteristics and minutes walked per week. We also assessed if indicators of SES (individual education or household income) modified both sets of associations.

RESULTS

Most cross-sectional and longitudinal associations were small and statistically non-significant. Neighborhood population count (b = 0.03, 95% CI: 0.01, 0.07) and street connectivity (b = - 1.75, 95% CI: - 3.26, - 0.24) were cross-sectionally associated with walking duration among the overall sample. None of the longitudinal associations were statistically significant among the overall sample. There was limited evidence of effect modification by SES, however, we found negative cross-sectional associations between street connectivity and walking among adults with lower education and income, and a positive association between percent change in walkability and change in walking among lower educated adults.

CONCLUSIONS

Despite population count and street connectivity being associated with walking at baseline, changes in these built environment variables were not associated with changes in walking following residential relocation. Our findings also provide evidence, albeit weak, that changes in neighborhood walkability, resulting from residential relocation, might more strongly affect walking among low SES adults. Further longitudinal research is needed to examine built environment characteristics with walking for different purposes and to test for inequitable socioeconomic impacts.

City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

Climate change, behavior change and health: a multidisciplinary, translational and multilevel perspective

The climate crisis provides a critical new lens through which health and health behaviors need to be viewed. This paper has three goals. First, it provides background on the climate crisis, the role of human behavior in creating this crisis, and the health impacts of climate change. Second, it proposes a multilevel, translational approach to investigating health behavior change in the context of the climate crisis. Third, it identifies specific challenges and opportunities for increasing the rigor of behavioral medicine research in the context of the climate crisis. The paper closes with a call for behavioral medicine to be responsive to the climate crisis.

Urban-Rural Differences in Children's and Adolescent's Physical Activity and Screen-Time Trends Across 15 Years

BACKGROUND

Urban and rural areas have been experiencing major demographic and structural changes, characterized by an aging population in rural areas and a growth of cities in number and size. However, it is poorly researched how children's physical activity and screen time developed in urban and rural areas. To address this deficit, we investigated physical activity and screen-time trends in Germany's pediatric population across four urbanicity levels (rural, small town, medium-sized town, city).

METHOD

We obtained weighted data at three cross-sectional timepoints between 2003 and 2017, representative for Germany's child and adolescent population. Physical activity and screen time were self-reported. We analyzed trends using a structural equation modeling framework for the overall sample and calculated interactions between the trends and age and gender, respectively.

RESULTS

In total, 12,161 children and adolescents between 4 and 17 years participated in the study. Children and adolescents in rural areas experienced a downward trend in total physical activity. Outdoor play and leisure-time physical activity decreased across all areas, with the strongest decline in rural areas. Computer and gaming time increased across all areas except for cities, with the sharpest increase in rural areas. The decline in outdoor play and the incline in computer and gaming time were driven by adolescents. Females showed stronger increases in computer and gaming time than males.

CONCLUSION

Our findings suggest that in a representative sample of children and adolescents in Germany, detrimental trends in children's physical activity and screen time occur at a higher rate in rural areas compared with urban environments. This provides critical information for health policy: While all children and adolescents should be targeted for physical activity promotion, a special focus should be on tailoring interventions for rural areas to prevent and mitigate inequalities in physical activity across urban and rural areas.

Selected Research Issues of Urban Public Health

Health is created within the urban settings of people’s everyday lives. In this paper we define Urban Public Health and compile existing evidence regarding the spatial component of health and disease in urban environments. Although there is already a substantial body of single evidence on the links between urban environments and human health, focus is mostly on individual health behaviors. We look at Urban Public Health through a structural lens that addresses health conditions beyond individual health behaviors and identify not only health risks but also health resources associated with urban structures. Based on existing conceptual frameworks, we structured evidence in the following categories: (i) build and natural environment, (ii) social environment, (iii) governance and urban development. We focused our search to review articles and reviews of reviews for each of the keywords via database PubMed, Cochrane, and Google Scholar in order to cover the range of issues in urban environments. Our results show that linking findings from different disciplines and developing spatial thinking can overcome existing single evidence and make other correlations visible. Further research should use interdisciplinary approaches and focus on health resources and the transformation of urban structures rather than merely on health risks and behavior.

Will improvements in transportation infrastructure help reduce urban carbon emissions?--motor vehicles as transmission channels

Achieving the "dual carbon" goal requires focusing on the issue of urban transportation carbon emissions. This study derives the mechanism of transportation infrastructure on urban carbon emissions and uses panel data from 284 cities in China from 2004 to 2017 as a basis for empirical analysis through the two-stage least squares method (2SLS). The results of the study show that the improvement of transportation infrastructure has a significant negative effect on the level of urban carbon emissions, and it is greater than the positive spillover of the increase in the number of motor vehicles on urban carbon emissions. Further, research has shown that improvement of transportation infrastructure has no significant impact on the purchase of motor vehicles; therefore, the transportation infrastructure will not affect the "induced traffic" through the purchase of motor vehicles, thereby further affecting the level of urban carbon emissions. The enlightenment of this article include the following: In urban planning and construction, attention should be paid to reducing urban carbon emissions by improving the construction of transportation infrastructure to help China achieve its carbon peak and carbon neutral goals at an early date.

Data Intelligence in Public Transportation: Sustainable and Equitable Solutions to Urban Modals in Strategic Digital City Subproject

Transport infrastructure investments must be linked to the public transport demand strategically. User behavior and decision-making process bring several possible alternative transportation options due to a series of factors that define it. Municipalities must manage these factors to promote equal and sustainable transport solutions through urban infrastructure, public transport competitiveness, and attractiveness, and fossil fuels use and pricing policy. The research objective is to determine these factors to monitor and use them for citizens’ benefit by means of analytical tools and methods to gain a superior knowledge of reality with a focus on improving investments and services in an agile and efficient manner. Methodologically, the number of passengers of main Curitiba’s (Brazil) bus rapid transit (BRT) lines is operated in two linear regression models combined with the number of private vehicles, public transport fare, and fuel price for the period between January/2010 and December/2019. Research analysis indicates direct causal relationships between the studied factors and that the necessary data for decision-making is available in the government information systems. In conclusion, urban management and strategic digital city project can be more balanced and assertive in transport infrastructure investments and citizen services provision.

Barriers and Enablers for Integrating Public Health Cobenefits in Urban Climate Policy

Urban climate policy offers a significant opportunity to promote improved public health. The evidence around climate and health cobenefits is growing but has yet to translate into widespread integrated policies. This article presents two systematic reviews: first, looking at quantified cobenefits of urban climate policies, where transportation, land use, and buildings emerge as the most studied sectors; and second, looking at review papers exploring the barriers and enablers for integrating these health cobenefits into urban policies. The latter reveals wide agreement concerning the need to improve the evidence base for cobenefits and consensus about the need for greater political will and leadership on this issue. Systems thinking may offer a way forward to help embrace complexity and integrate health cobenefits into decision making. Knowledge coproduction to bring stakeholders together and advance policy-relevant research for urban health will also be required. Action is needed to bring these two important policy agendas together.

Time trends and inequalities of physical activity domains and sitting time in South America

Background

We aimed to investigate time trends and inequalities of different physical activity (PA) domains and sitting time (ST) in adults from South American countries.

Methods

We included cross-sectional data of nationally representative surveys on adults (n = 597 843) from nine South American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Peru, Uruguay, and Venezuela), with data collection time frames ranging from 2005 to 2020. Data on different PA domains (leisure-time, transport, and occupational) and ST were assessed through questionnaires. Trends according to education level (quintiles), gender (m/w), and age group (18-34 years, 35-49 years, 50-64 years) were estimated for the harmonized indicators of nonzero PA in the different domains, ≥150 min/week of total PA and ≥8 hours/d of ST.

Results

Chile (2009/2010 = 78.9% vs 2016/2017 = 70.5%), and Peru (2009/2010 = 78.6% vs 2011 = 69.6%) reduced total PA, while Brazil (2013 = 57.3% vs 2019 = 67.0%) and Uruguay (2006 = 69.4% vs 2013 = 79.4%) increased, and Argentina and Venezuela maintained. There was an increasing trend for ST in Argentina, Peru, and Uruguay. Leisure-time PA increased in most countries (6/8 countries). Transport PA was relatively stable, while occupational PA presented mixed findings. Education inequalities increased over time for total and leisure-time PA, while age and gender inequalities were relatively constant.

Conclusions

Future South American countries' efforts may be warranted to promote PA and reduce ST in adults, while addressing inequalities when implementing actions.

Supporting a Healthy Planet, Healthy People and Health Equity through Urban and Territorial Planning

The form of human settlements impacts on planetary health, population health and health equity. Yet goals for urban and territorial planning are only tangentially linked to public health outcomes. The WHO and UN-Habitat support actions to bring health to the fore in planning and design of human settlements, recently publishing 'Integrating Health in Urban and Territorial Planning: a sourcebook' focusing on 'why' action is needed, 'how' to initiate it; and curating several existing resources on 'what' to do. Recommendations for research, policy and practice include calls for rapid development of closer relationships between public health and spatial planning.

Physical inactivity in early pregnancy and the determinants in an urban city setting of Kuala Lumpur, Malaysia

BACKGROUND

Physical inactivity in pregnancy has been associated with excessive gestational weight gain, hypertensive disorders, gestational diabetes mellitus and postpartum depression. Despite these risks, physical inactivity level remains high especially in higher income countries. The prevalence of physical inactivity among women in Malaysia aged ≥16 years was 28.2% in 2019 exceeding men by 6.1%. However, little is known regarding the subpopulation of pregnant women especially in Kuala Lumpur which is the most urbanized and highly populated city in Malaysia. Therefore, the aim of this study is to measure the physical inactivity prevalence among first trimester pregnant women in Kuala Lumpur and to identify its determining factors.

METHODS

This was a cross-sectional study in which 339 first trimester pregnant women were sampled from 13 maternal and child health clinics located in all four parliament districts of Kuala Lumpur. Self-administered questionnaires which contained the Malay version of the pregnancy physical activity questionnaire (PPAQ) were used. Descriptive analysis was conducted to determine the physical inactivity prevalence followed by simple and multiple logistic regression to identify the determinants of physical inactivity with significant level of 5%.

RESULTS

The prevalence of physical inactivity was 38.3%. The highest activity was seen in the household activity domain, despite only 24.8% of the respondents were housewives/unemployed. There was little to no participation observed in the vigorous intensity category. The determinants of physical inactivity were primigravida (aOR 3.54 95% CI 1.40, 8.97), education level (aOR 3.77 95% CI 1.35, 10.52) and body mass index (aOR 0.88 95% CI 0.80, 0.97) which explained 22.6% variation of physical inactivity in the final adjusted model.

CONCLUSION

The prevalence of physical inactivity among first trimester pregnant mothers in this study was 38.3%, and the highest activity was seen in the household category. Health education on physical activity in pregnancy should be focused on those who are primigravida and have no tertiary education. The educational content should be updated and tailored to current pandemic situation where self-isolation is the new norm, by advocating for home-based, moderate to vigorous intensity physical activities.

Towards healthy One Planet cities and communities: planetary health promotion at the local level

Health promotion has paid a lot of attention to the social determinants of health and to health equity but much less attention to the ecological determinants. Yet the most fundamental determinants of health are the natural systems that make the Earth liveable and are the source of our air, water, food, fuels and materials. Yet they are threatened by the very economic and social development that we have created to meet the social determinants of health. Moreover, the benefits and burdens of that development are inequitably distributed, resulting in both ecological and social injustice. In the past few years the new field of planetary health-'the health of human civilization and the state of the natural systems on which it depends'-has emerged, while WHO has confirmed that 'the source of human health [is] nature'. So arguably the most important task facing health promotion in the 21st century is to turn its attention to planetary health: health promotion workers must become planetary health promoters. Local health promotion in the 21st century needs to incorporate the concept of planetary health promotion and its application in the creation of healthy 'One Planet' communities and must become part of the emerging network of community organizations and individuals working to create sustainable, just and healthy communities.

Validity of a Global Positioning System-Based Algorithm and Consumer Wearables for Classifying Active Trips in Children and Adults

OBJECTIVE

To investigate the convergent validity of a global positioning system (GPS)-based and two consumer-based measures with trip logs for classifying pedestrian, cycling, and vehicle trips in children and adults.

METHODS

Participants (N = 34) wore a Qstarz GPS tracker, Fitbit Alta, and Garmin vivosmart 3 on multiple days and logged their outdoor pedestrian, cycling, and vehicle trips. Logged trips were compared with device-measured trips using the Personal Activity Location Measurement System (PALMS) GPS-based algorithms, Fitbit's SmartTrack, and Garmin's Move IQ. Trip- and day-level agreement were tested.

RESULTS

The PALMS identified and correctly classified the mode of 75.6%, 94.5%, and 96.9% of pedestrian, cycling, and vehicle trips (84.5% of active trips, F1 = 0.84 and 0.87) as compared with the log. Fitbit and Garmin identified and correctly classified the mode of 26.8% and 17.8% (22.6% of active trips, F1 = 0.40 and 0.30) and 46.3% and 43.8% (45.2% of active trips, F1 = 0.58 and 0.59) of pedestrian and cycling trips. Garmin was more prone to false positives (false trips not logged). Day-level agreement for PALMS and Garmin versus logs was favorable across trip modes, though PALMS performed best. Fitbit significantly underestimated daily cycling. Results were similar but slightly less favorable for children than adults.

CONCLUSIONS

The PALMS showed good convergent validity in children and adults and were about 50% and 27% more accurate than Fitbit and Garmin (based on F1). Empirically-based recommendations for improving PALMS' pedestrian classification are provided. Since the consumer devices capture both indoor and outdoor walking/running and cycling, they are less appropriate for trip-based research.

Urban Climate Policy and Action through a Health Lens-An Untapped Opportunity

Motivated by a growing recognition of the climate emergency, reflected in the 26th Conference of the Parties (COP26), we outline untapped opportunities to improve health through ambitious climate actions in cities. Health is a primary reason for climate action yet is rarely integrated in urban climate plans as a policy goal. This is a missed opportunity to create sustainable alliances across sectors and groups, to engage a broad set of stakeholders, and to develop structural health promotion. In this statement, we first briefly review the literature on health co-benefits of urban climate change strategies and make the case for health-promoting climate action; we then describe barriers to integrating health in climate action. We found that the evidence-base is often insufficiently policy-relevant to be impactful. Research rarely integrates the complexity of real-world systems, including multiple and dynamic impacts of strategies, and consideration of how decision-making processes contend with competing interests and short-term electoral cycles. Due to siloed-thinking and restrictive funding opportunities, research often falls short of the type of evidence that would be most useful for decision-making, and research outputs can be cryptic to decision makers. As a way forward, we urge researchers and stakeholders to engage in co-production and systems thinking approaches. Partnering across sectors and disciplines is urgently needed so pathways to climate change mitigation and adaptation fully embrace their health-promoting potential and engage society towards the huge transformations needed. This commentary is endorsed by the International Society for Environmental Epidemiology (ISEE) and the International Society for Urban Health (ISUH) and accompanies a sister statement oriented towards stakeholders (published on the societies' websites).

A study protocol for a randomised controlled feasibility trial of an intervention to increase activity and reduce sedentary behaviour in people with severe mental illness: Walking fOR Health (WORtH) Study

Background

People with severe mental illness (SMI) are less physically active and more sedentary than healthy controls, contributing to poorer physical health outcomes in this population. There is a need to understand the feasibility and acceptability, and explore the effective components, of health behaviour change interventions targeting physical activity and sedentary behaviour in this population in rural and semi-rural settings.

Methods

This 13-week randomised controlled feasibility trial compares the Walking fOR Health (WORtH) multi-component behaviour change intervention, which includes education, goal-setting and self-monitoring, with a one-off education session. It aims to recruit 60 inactive adults with SMI via three community mental health teams in Ireland and Northern Ireland. Primary outcomes are related to feasibility and acceptability, including recruitment, retention and adherence rates, adverse events and qualitative feedback from participants and clinicians. Secondary outcome measures include self-reported and accelerometer-measured physical activity and sedentary behaviour, anthropometry measures, physical function and mental wellbeing. A mixed-methods process evaluation will be undertaken. This study protocol outlines changes to the study in response to the COVID-19 pandemic.

Discussion

This study will address the challenges and implications of remote delivery of the WORtH intervention due to the COVID-19 pandemic and inform the design of a future definitive randomised controlled trial if it is shown to be feasible.

Trial registration

The trial was registered on clinicaltrials.gov (NCT04134871) on 22 October 2019.

A Critique of National Physical Activity Policy in Oman Using 3 Established Policy Frameworks

BACKGROUND

This paper aimed to assess the development process, content, and early implementation of Oman's national physical activity plan of action to identify strengths and areas for improvement.

METHODS

Data were extracted from 4 documents: national noncommunicable diseases policy, physical activity plan of action, and 2 World Health Organization Mission Reports. Three policy frameworks and approaches (physical activity content analysis grid, health-enhancing physical activity policy audit tool, and policy cube approach for diet-related noncommunicable diseases) were used.

RESULTS

The findings demonstrated that policymakers engaged a broad range of sectors in developing a national plan. It aligned with many of the elements from the 3 policy frameworks (ie, multisectoral approach, political commitment/leadership, identification of national goals and targets, time frame for implementation). The main gaps included the lack of a specified sustainable funding mechanism, systems for monitoring progress, and an emphasis on general interventions, with limited focus on specific target groups.

CONCLUSION

A range of sectors were engaged in the development of Oman's national physical activity plan of action, with strong political commitment and using global guidance and local evidence. Establishing a strong accountability framework, including a clear financing mechanism, is critical for Oman to meet its target for a 10% relative reduction in physical inactivity by 2025.

Treating two pandemics for the price of one: Chronic and infectious disease impacts of the built and natural environment

Compact walkable environments with greenspace support physical activity and reduce the risk for depression and several obesity-related chronic diseases, including diabetes and heart disease. Recent evidence confirms that these chronic diseases increase the severity of COVID-19 infection and mortality risk. Conversely, denser transit supportive environments may increase risk of exposure to COVID-19 suggesting the potential for contrasting chronic versus infectious disease impacts of community design. A handful of recent studies have examined links between density and COVID-19 mortality rates reporting conflicting results. Population density has been used as a surrogate of urban form to capture the degree of walkability and public transit versus private vehicle travel demand. The current study employs a broader range of built environment features (density, design, and destination accessibility) and assesses how chronic disease mediates the relationship between built and natural environment and COVID-19 mortality. Negative and significant relationships are observed between built and natural environment features and COVID-19 mortality when accounting for the mediating effect of chronic disease. Findings underscore the importance of chronic disease when assessing relationships between COVID-19 mortality and community design. Based on a rigorous simulation-assisted random parameter path analysis framework, we further find that the relationships between COVID-19 mortality, obesity, and key correlates exhibit significant heterogeneity. Ignoring this heterogeneity in highly aggregate spatial data can lead to incorrect conclusions with regards to the relationship between built environment and COVID-19 transmission. Results presented here suggest that creating walkable environments with greenspace is associated with reduced risk of chronic disease and/or COVID-19 infection and mortality.

Impact of thermal condition on vegetation feedback under greening trend of China

In China, an unambiguous greening trend was observed over the last three decades. The feedback induced by vegetation growth can affect regional climate. Here, we investigated how vegetation feeds back to land surface temperature (LST) in temperature zones and land-use types in China using 18-years (2001-2018) of Moderate Resolution Imaging Spectroradiometer (MODIS) LST and Normalized Difference Vegetation Index (NDVI) data. We first showed that vegetation feedback was significantly negative (p < 0.1, t-test) in most parts of China. Specifically, we discovered a downtrend of vegetation feedback from the coldest temperature zone to the hottest temperature zone. Moreover, vegetation feedback and thermal condition showed an inverse relationship among temperature zones. The inverse relationship clarified that vegetation growth can cool most parts of China during climate change. In the end, we showed the pattern of vegetation feedback among land-use types. Due to the expansion of grassland, vegetation feedback may temporarily positive. Suitable vegetation coverage in urban land, banning deforestation, and cultivating land reasonably can decrease the local temperature by inducing negative vegetation feedback.

Sharing believable stories: A qualitative study exploring the relevance of case studies for influencing the creation of healthy environments

Case study examples can inform policy recommendations and action to create healthy environments. This qualitative study, using semi-structured interviews with nine cross-sectoral stakeholders in England, explored the role of context in case study examples. We found that case studies can not only be a 'practical example' but also used as a 'believable story' with the power to influence decision-making. Case studies may be deemed believable if similar and locally relevant, but judgements can be inherently political and politicised. Metrics used to measure case study outcomes can differ in believability. Storytellers who understand different audiences can be used to build support.

A multi-scalar perspective on health and urban housing: an umbrella review

With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.

Developing a programme theory for a transdisciplinary research collaboration: Complex Urban Systems for Sustainability and Health

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to "work" in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an 'action model'), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a 'change model'). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be 'about', and the inherent unpredictability of complex initiatives.

Developing a programme theory for a transdisciplinary research collaboration: Complex Urban Systems for Sustainability and Health

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence.

Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities.

Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’).

Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.

Population density predicts youth's physical activity changes during Covid-19 - Results from the MoMo study

Children in Germany showed positive physical activity changes during the first Covid-19 lockdown in April 2020, but it is unclear how the changes relate to population density, which we investigated in a longitudinal sample of 1711 youth (4–17 years). For each ten citizens more per km², less positive physical activity changes were observed. For example, a child living in an area with 100 citizens/km² increased daily life physical activity by 44.50 min/day, whereas a child living in an area with 3000 citizens/km² only engaged in an additional 9.70 min/day. Policymakers should ensure that youth in densely populated areas have access to physical activity opportunities during the pandemic.

Decision-making for active living infrastructure in new communities: a qualitative study in England

BACKGROUND

Urban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for 'active living' infrastructure (ALI)-walking and cycling infrastructure and open spaces in new communities.

METHODS

Thirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically.

RESULTS

Public health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. 'Evidence' for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant.

CONCLUSION

We have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.

Environmental Preferences and Concerns of Recreational Road Runners

Recreational road running is growing in popularity and has been linked to numerous mental and physical health benefits. However, we know little about what environmental preferences or concerns runners have regarding participation in the sport, and whether differences exist across age and gender. We conducted a cross-sectional survey on recreational road runners to investigate the type of built and natural environments road runners prefer, as well as the safety and health concerns that may affect runners’ choice of environment. Responses were analyzed by age and gender. A total of 1228 road runners responded to the survey; 59.6% of respondents were women and 32.1% of respondents were men. Most respondents preferred to run on asphalt or sidewalk surfaces, and preferred well-lit, tree-lined routes. Major concerns for both men and women include animals and dangerous road conditions. Men and women differed significantly in their responses to the importance of running around others and their primary concerns while running. Results of this study serve to deepen our understanding of recreational road runners’ environmental preferences and concerns, providing valuable information for public health officials and city planners alike. This information must be considered if we are to continue to encourage uptake of running as a sport and reap its health effects.

Eight Investments That Work for Physical Activity

BACKGROUND

The International Society for Physical Activity and Health (ISPAH) is a leading global organization working to advance research, policy, and practice to promote physical activity. Given the expanding evidence base on interventions to promote physical activity, it was timely to review and update a major ISPAH advocacy document-Investments that Work for Physical Activity (2011).

METHODS

Eight investment areas were agreed upon through consensus. Literature reviews were conducted to identify key evidence relevant to policymakers in each sector or setting.

RESULTS

The 8 investment areas were as follows: whole-of-school programs; active transport; active urban design; health care; public education; sport and recreation; workplaces; and community-wide programs. Evidence suggests that the largest population health benefit will be achieved by combining these investments and implementing a systems-based approach.

CONCLUSIONS

Establishing consensus on 'what works' to change physical activity behavior is a cornerstone of successful advocacy, as is having appropriate resources to communicate key messages to a wide range of stakeholders. ISPAH has created a range of resources related to the new investments described in this paper. These resources are available in the 'advocacy toolkit' on the ISPAH website (www.ispah.org/resources).

Urban-rural differences in trajectories of physical activity in Europe from 2002 to 2017

Here we evaluate the time trends of urban-rural differences in physical activity in the European Union between 2002 and 2017 and the contribution of urbanization on total physical activity changes, using four Eurobarometer surveys (n = 101,373). Trajectories of urban-rural differences in physical activity varied considerably among EU-28 countries. Hierarchical linear regression models revealed that inactivity increased in both urban and rural settings, although it was higher in the latter. Thereby, the urban-rural gap diminished and was even eliminated in some countries. Also, national changes across time were driven by urban places, showing little contribution from urbanization. Our findings suggest that inactivity has risen in Europe regardless of living environments and with regional urbanization development having little influence.

The relationship between air pollution and diabetes: A study on the municipalities of the Metropolitan City of Milan

AIMS

Urbanisation has been linked with an increased risk of developing diabetes mellitus, dramatically worsening the healthcare system's financial burden. Environmental influences are emerging among the causing factors of the urban diabetes epidemic. We evaluated the relationship between air pollution and the prevalence of diabetes in the Municipalities of the Metropolitan City of Milan, comprising more than 3,4 million citizens.

METHODS

The prevalence of diabetes in the resident population and the mean annual air concentrations of PM10 and NO2 were retrieved from the municipal Agency for Health Protection and the regional Agency for Ambient Protection datasets. Two linear regression models were estimated to inspect the relationships between the (logit-based transformed) diabetes prevalence and air pollution concentrations, namely: (i) PM10, and (ii) NO2. Both models were adjusted for five control variables, including the qualitative variable year (2011-2018).

RESULTS

Both models highlight a statistically significant positive relationship between air pollutants and diabetes prevalence. An increase of one PM10 or NO2 concentrations' unit translates into a rise of 0.81% or 0.41% in diabetes prevalence, respectively.

CONCLUSION

Our results contribute to the ongoing research regarding health outcomes of urbanisation dynamics and should be considered in city planning policies.

Promoting knowledge to policy translation for urban health using community-based system dynamics in Brazil

Background

Effectively bridging the knowledge–policy gap to support the development of evidence-based policies that promote health and well-being remains a challenge for both the research and policy communities. Community-based system dynamics (CBSD) is a participatory modelling approach that aims to build stakeholders’ capacity to learn and address complex problems collaboratively. However, limited evidence is available about the contributions of CBSD to knowledge-generating and policy processes across sectors and policy spheres. In the context of a multi-country research project focused on creating an evidence base to inform urban health policies across Latin America, a series of CBSD workshops convened stakeholders from research, policy-making, and other backgrounds working in food and transportation systems. Diverse participants were selected aiming to incorporate multiple perspectives relevant to understanding complex urban systems linked to food and transportation. This study focuses on one of these workshops, whose avenue was São Paulo, Brazil, assembling country-based participants representing local, regional, national, and international institutions with multidisciplinary backgrounds linked to food and transportation systems.

Objective

The aim of this case study is to explore the perceived influence of one of these workshops on attendees’ understandings of food and transportation systems and their relationship to healthy urban environments, with attention to the role of the workshop in supporting knowledge to policy translation for urban health.

Methods

We conducted 18 semi-structured qualitative interviews with attendees one year after their participation in a CBSD workshop held in São Paulo, Brazil. A framework method approach was used to code participants’ responses and identify emerging themes.

Results

Participants reported that the workshop’s group model-building activities influenced their understanding of the knowledge–policy process as it relates to food and transport systems. Workshop contributed to participants’ (1) abilities to engage with multisectoral stakeholders, (2) construct a shared language and understanding of urban challenges, (3) improve understanding of the interconnectedness across food and transportation systems, (4) facilitate dialogue across sectors, and (5) apply a systems thinking approach within their sector and professional context. Participants continued to draw on the tools developed during the workshop, and to apply systems thinking to their research and policy-making activities.

Conclusions

CBSD may offer valuable opportunities to connect the research sector to the policy-making process. This possibility may contribute to knowledge to policy translation in the interconnection between the urban context, food and transportation systems, and health.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12961-020-00663-0.

An ecological study of the relationship between urban built environment and cardiovascular hospital admissions (2004-2016) in an Asian developing country

This study aims to evaluate the relationship between urban built environment and hospital admissions from cardiovascular diseases in Kuala Lumpur, Malaysia. Hospital admission data from 2004 to 2016 for cardiovascular diseases were used with patient residential postcodes as the unit of analysis. Data was split into 2004-2009 (12,551 cases) and 2010-2016 (17,154 cases) periods corresponding to land use data. We used generalized linear mixed model to analyse population density, property value, entropy index, and the kernel density (800 m) of specific land use, bus and rail stations, and road junctions, with time period and postcodes as the random effects to generate incidence rate ratios (IRRs). Results indicated that entropy index and recreational area density were associated with fewer hypertensive disease and ischemic heart disease hospital admissions (IRR range: 0.49-0.68, 95%CI: 0.27, 0.97). Population density and property value were associated with fewer cerebrovascular disease hospital admissions (IRR range: 0.29-0.34, 95%CI: 0.11, 0.75). Contrarily, density of road junctions was associated with 2.5-6.3 times more hospital admissions for cardiovascular disease hospital admissions (IRR range: 2.53-6.34, 95%CI: 1.07,17.91). There were no significant association between hospital admission and density of residential area, undeveloped land, rail and bus stations. The shapes of relationships for all attributes were non-linear, and changed markedly at the third quartile except for recreational area density. The findings suggest that land use attributes have some protective effects on the cardiovascular disease admission cases as compared to the transport attributes. These findings have important merits for integrating health into urban planning.

Coupled models using radar network database to assess vehicular emissions in current and future scenarios

Vehicles are one of the most significant sources of air pollutant emissions in urban areas, and their real contribution always needs to be updated to predict impacts on air quality. Radar databases and traffic counts using statistical modeling is an alternative and low-cost approach to produce traffic activities data in each urban street to be used as input to predict vehicular emissions. In this work, we carried out a spatial statistical analysis of local radar data and calculated traffic flow using local radar data combined with different statistical models. Future scenarios about vehicle emission inventory to define public policies were also proposed and analyzed for Belo Horizonte (BH), a Brazilian State capital, with the third-largest metropolitan region in the country. The Normal-Neighborhood Model (i.e., the mixed effect model with random effect in the neighborhood, radar type, and in the regional area) was used to calculate traffic flow in each urban street. Results showed average reductions in CO (4.5%), NMHC (3.0%), NOx (3.0%) and PM_2.5 (6.2%) emissions even with an increase in fleet composition (25% in average). The decrease is a result of the implementation of emission control programs by the government, improvements vehicles technologies, and the quality of fuels. Prediction of traffic data from radar databases has proven to be useful for avoiding the high costs of performing origin-destination surveys and traffic modeling using commercial software. Radar databases can provide many potential benefits for research and analysis in environmental and transportation planning. These findings can be incorporated in future investigations to implement public policies on vehicular emission reduction in urban areas and to advance environmental health effects research and human health risk assessment.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Land use mix and physical activity in middle-aged and older adults: a longitudinal study examining changes in land use mix in two Dutch cohorts

Background

With urbanization and aging increasing in coming decades, societies face the challenge of keeping aging populations active. Land use mix (LUM) has been associated with cycling and walking, but whether changes in LUM relate to changes in cycling/walking is less known.

Objectives

Our objective was to study the effect of LUM on cycling/walking in two Dutch aging cohorts using data with 10 years of follow-up.

Methods

Data from 1183 respondents from the Health and Living Conditions of the Population of Eindhoven and Surroundings (GLOBE) study and 918 respondents from the Longitudinal Aging Study Amsterdam (LASA) were linked to LUM in 1000-m sausage network buffers at three time-points. Cycling/walking outcomes were harmonized to include average minutes spent cycling/walking per week. Data was pooled and limited to respondents that did not relocate between follow-up waves. Associations between LUM and cycling/walking were estimated using a Random Effects Within-Between (REWB) model that allows for the estimation of both within and between effects. Sensitivity analyses were performed on smaller (500-m) and larger (1600-m) buffers.

Results

We found evidence of between-individual associations of LUM in 1000-m buffers and walking (β: 11.10, 95% CI: 0.08; 21.12), but no evidence of within-associations in 1000-m buffers. Sensitivity analyses using 500-m buffers showed similar between-associations, but negative within-associations (β: -35.67, 95% CI: − 68.85; − 2.49). We did not find evidence of between-individual associations of LUM in any buffer size and cycling, but did find evidence of negative within-associations between LUM in 1600-m buffers and cycling (β: -7.49, 95% CI: − 14.31; − 0.66).

Discussion

Our study found evidence of positive associations between LUM and average walking time, but also some evidence of negative associations between a change in LUM and cycling/walking. LUM appears to be related to cycling/walking, but the effect of changes in LUM on cycling/walking is unclear.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01083-1.

A Transdisciplinary Approach to Recovering Natural and Cultural Landscape and Place Identification: A Case Study of Can Moritz Spring (Rubí, Spain)

The perception of the quality of green and blue spaces can be key in the relationship between a community and its local landscape (i.e., place identification). The lack of transdisciplinary training and social-specific education of landscape architects regarding the complexity of landscape as a participative cultural artefact limits reaching the general population. Bridging this gap of landscape and place identification and evaluation by a local community was the main objective of the present case study conducted at an abandoned spring and seasonal stream area in Rubí (Spain). The "Steinitz method" of landscape evaluation was used as a participatory method to activate community members to learn about and express their visual preferences regarding this neglected landscape. Bottom-up interventions applying an "urban acupuncture" approach in the area identified as the least attractive by the residents were co-designed and combined with a top-down restoration of a nearby, existing but derelict and hidden, spring. In addition, before and after planning and implementing the intervention, we conducted surveys about the community perception, sense of belonging and use of the space. We observed that the lack of awareness of the inhabitants about this spring was an obstacle preventing the community from embracing the potential for health and wellbeing presented by the spring and adjacent landscape. Following the work, the landscape saw increasing use, and the historic spring was brought back to life as a resource to help people to improve their health and wellbeing.

How Do Urban Environments Affect Young People's Mental Health? A Novel Conceptual Framework to Bridge Public Health, Planning, and Neurourbanism

Childhood and adolescence are crucial periods for mental and social development. Currently, mental illness among young people is a global epidemic, and rates of disorders such as depression and anxiety are rising. Urban living, compared with rural living, is linked with a higher risk of serious mental illness, which is important because the world is urbanizing faster than ever before. Urban environments and their landscapes, designs, and features influence mental health and well-being. However, no conceptual frameworks to date have detailed the effect of urban environments on young people's mental health, and few studies have considered the growing role of digital and social media in this relationship, leading to calls for the development of holistic approaches to describe this relationship. This article synthesizes existing knowledge on urban places (both built and natural environments) and mental health in the public health and urban planning literature and examines the emerging field of neurourbanism (a multidisciplinary study of the effect of urban environments on mental health and brain activity) to enhance current practice and research. We developed 2 novel conceptual frameworks (1 research-oriented, 1 practice-oriented), adapted from Bronfenbrenner's socioecological model, that focus on the relationship between urban environments and young people's mental health. We added a digital and social media contextual level to the socioecological model, and we applied a multilayer concept to highlight potential cross-field interactions and collaborations. The proposed frameworks can help to guide future practice and research in this area.

Decoding the Street-Based Spatiality of Urban Gyms: Implications for Healthy City Planning

Many cities face health issues that result from ineffective urban planning strategies. The chances of doing exercises in sportive venues implicate public health and citizen quality of life. With the advent of the geo-big data era, it is crucial to explore the spatial pattern of sports facilities to reflect urban health issues. This study aims to decode the street-based spatiality of gyms (one prevailing type of sportive venues) from a comprehensive perspective by both geometric methods (i.e., segment streets) and topological analytics in the context of complexity science (i.e., complex network derived from the topology of natural streets). We found that: (1) gyms are spatially clustered and distributed unevenly; (2) community-to-gym walkability fits the power-law with a heavy-tailed distribution at the 10-min and 20-min temporal scales; (3) the model for the street connectivity and the multi-distance reachability of gyms is with high polynomial fitting goodness. This article is conducive to strategies-making of healthy city planning and the further optimization of urban spatial structure.