Fear of crime and the environment: systematic review of UK qualitative evidence

Mobility-oriented measurements of people's exposure to outdoor artificial light at night (ALAN) and the uncertain geographic context problem (UGCoP)

Advanced nighttime light (NTL) remote sensing techniques enable the large-scope epidemiological investigations of people's exposure to outdoor artificial light at night (ALAN) and its health effects. However, multiple uncertainties remain in the measurements of people's exposure to outdoor ALAN, including the representations of outdoor ALAN, the contextual settings of exposure measurements, and measurement approaches. Non-exposed but included outdoor ALAN and causally irrelevant outdoor ALAN may manifest as contextual errors, and these uncertain contextual errors may lead to biased measurements and erroneous interpretations when modeling people's health outcomes. In this study, we systematically investigated outdoor ALAN exposure measurements in different geographic contexts using either residence-based or mobility-oriented measurements, different spatial scales, and multiple NTL data sources. Based on the GPS data collected from 208 participants in Hong Kong, outdoor ALAN exposures were measured from NTL imagery at 10 m, 130 m, and 500 m spatial resolutions using in-situ methods or 100 m, 300 m, and 500 m buffer zone averaging. Descriptive analysis, multiple t-tests, and logistic regression were employed to examine the differences between outdoor ALAN exposure measurements using various contextual settings and their effects on modeling people's overall health. Our results confirmed that different contextual settings may lead to significantly different outdoor ALAN exposure measurements. Our results also confirmed that contextual errors may lead to erroneous conclusions when using improper contextual settings to model people's overall health. Consequentially, we suggest measuring people's exposure to outdoor ALAN using the mobility-oriented approach, NTL representation with the high spatial resolution, and a very small buffer zone as a contextual unit to derive outdoor ALAN exposure. This study articulates essential methodological issues induced by uncertainties in outdoor ALAN exposure measurements and can provide essential implications and suggestions for a broad scope of studies that need accurate outdoor ALAN exposure measurements.

Cities and mental health: The role of the built environment, and environmental and lifestyle factors in Barcelona

Built environment characteristics and related environmental exposures and behaviors have been, separately, implicated in the development of poor mental health. However, it is unclear how these factors act together in relation to mental health. We studied these factors simultaneously to evaluate the impact of the built environment, and the mediating role of environmental exposures and physical activity, on mental health, while also studying moderation by sex, age, and length of residence. We used a cross-sectional population-based sample of 3145 individuals aged 15-97 years from Barcelona, Spain. Time spent walking and mental health status were assessed with validated questionnaires, administered through a face-to-face interview. We characterized the built environment (e.g., building, population and intersection density and green space), road traffic noise, and ambient air pollution at the residential level using land cover maps, remote sensing, noise maps and land use regression models. Adjusted regression models accounting for spatial clustering were analyzed to study associations between built environment attributes and mental health, and mediation and moderation effects. Density attributes were directly or indirectly, through air pollution and less consistently through walking, associated with poor mental health. Green space indicators were associated with lower prevalence of poor mental health, partly through lower air pollution exposure and more walking. In some cases, these associations differed by sex, age or length of residence. Non-linear associations of density indicators with environmental exposures, and of particulate matter with poor mental health indicated threshold effects. We conclude that living in dense areas with high air pollution concentrations was associated with poor mental health. On the other hand, green areas with lower air pollution concentrations were protective against poor mental health. Greater urban density might benefit health, but might only do so when air pollution concentrations are low.

Perceived neighborhood disorder, social cohesion, and depressive symptoms in spousal caregivers

OBJECTIVES

Prior research into the factors linked to mental health of caregivers of older adults have largely focused on individual- or household-level characteristics, but neighborhood supports and stressors may also matter for caregiver mental health. The current study fills this knowledge gap by examining the association of neighborhood social cohesion and disorder and depressive symptoms among spousal caregivers.

METHOD

We used data from the 2006 to 2016 waves of the Health and Retirement Study, which include 2,322 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood social cohesion and disorder with depressive symptoms.

RESULTS

A higher level of perceived neighborhood social cohesion was associated with fewer depressive symptoms (b = -0.06, 95% CI: -0.10, -0.02). On the other hand, greater perceived neighborhood disorder was associated with more symptoms (b = 0.04, 95% CI: 0.01, 0.08). The association of perceived social cohesion with depressive symptoms remained even after controlling for perceived disorder, but neighborhood disorder was no longer associated with depressive symptoms after accounting for reported neighborhood social cohesion.

CONCLUSIONS

This study suggests neighborhood supports and stressors matter for caregiver well-being. Neighborhood-based social support may be particularly important for caregivers as they navigate the challenges caregiving for an aging spouse can bring. Future studies should determine if enhancing positive characteristics of the neighborhood promotes well-being of spousal caregivers.

The contribution of objective and perceived crime to neighbourhood socio-inequity in loneliness

Loneliness tends to be more prevalent in socioeconomically disadvantaged neighbourhoods, yet few studies explore the environmental differences contributing to area-based inequity in loneliness. This study examined how perceived and objective crime contributed to differences in loneliness between advantaged and disadvantaged neighbourhoods. The study used cross-sectional data from 3749 individuals aged between 48 and 77 years, residing in 200 neighbourhoods in Brisbane, Australia. We found that participants in disadvantaged neighbourhoods reported higher levels of loneliness and perceived crime, and the most disadvantaged neighbourhoods also had highest prevalence of objective crime. However, while perceived and objective crime were positively correlated with loneliness, only perceived crime accounted for socio-economic inequity in loneliness. Consequently, perceived crime plays an important role in addressing loneliness in disadvantaged communities and requires equitable resourcing for multiple strategies that aim to decrease crime and increase perceived safety.

Subjective and objective indicators of neighbourhood safety and physical activity among UK adolescents

BACKGROUND

The health benefits of regular physical activity in adolescence are well-documented and many health-related behaviours are established in adolescence. The neighbourhood environment is a key setting for physical activity for adolescents and feeling unsafe in their neighbourhood may be a potential barrier to physical activity.

AIM

This study aimed to examine associations between neighbourhood safety and physical activity using objective and subjective measures for both.

METHODS

Participants (n = 10,913) came from the Millennium Cohort Study, a nationally representative UK longitudinal birth cohort. Linear regression and Zero Inflated Poisson models were used to examine associations between subjective and objective indicators of safety (self-reported safety, Index of Multiple Deprivation crime, Reported Crime Incidence) and physical activity (self-reported weekly and device-measured physical activity).

RESULTS

Adolescents who feel unsafe in their neighbourhood, or who live in areas with high IMD crime or violent crime rates report 0.29 (95% CI -0.49, -0.09) 0.32 (95% CI -0.47, -0.16) and 0.20 (95% CI -0.39, -0.20) fewer days of physical activity, respectively. No associations were found between Reported Crime Incidence and either objective or subjective measures of physical activity.

CONCLUSIONS

This study demonstrates varying associations between subjective safety and objective crime with physical activity levels in adolescence, highlighting the complexities around subjective and objective measurements and their associations with health outcomes.

The Association between Fear of Crime, Educational Attainment, and Health

Fear of crime is an important public health problem that impacts people's quality of life, health, and wellbeing, and causes mental health ailments (e.g., anxiety). This study aimed to determine whether there was an association between fear of crime, educational attainment, and self-rated health and anxiety among women residing in a county in east-central Sweden. A sample (n = 3002) of women aged 18-84 years surveyed in the Health on Equal Terms survey carried out in 2018 was included in the study. Bivariate and multivariate regression analysis was performed on the relationship between the composite variables fear of crime, educational attainment, and self-rated health and anxiety. Women with primary education or similar who reported fear of crime had increased odds of poor health (odds ratio (OR) 3.17; 95% confidence interval (CI) 2.40-4.18) compared with women with primary education/similar and no fear of crime (OR 2.90; CI 1.90-3.20). A statistically significant relationship persisted in the multivariate analysis after controlling for other covariates, although the odds were reduced (OR 1.70; CI 1.14-2.53 and 1.73; CI 1.21-2.48, respectively). Similarly, in the bivariate analysis, women who reported fear of crime and who only had primary education had statistically significant odds of anxiety (OR 2.12; CI 1.64-2.74); the significance was removed, and the odds were reduced (OR 1.30; CI 0.93-1.82) after adjusting for demographic, socioeconomic, and health-related covariates. Women with only primary education or similar who reported fear of crime had higher odds of poor health and anxiety compared with those with university education or similar, with and without fear of crime. Future studies (including longitudinal ones) are warranted-on the one hand, to understand possible mechanisms of the relationship between educational attainment and fear of crime and its consequences to health, and on the other, to explore low-educated women's own perceptions regarding factors underlining their fear of crime (qualitative studies).

The fear-increasing and fear-decreasing effects of a pilot policy to reduce fear of crime

Fear of crime has been rising persistently in Chile, even in periods where actual crime rates have decreased, making the perception of crime an important policy issue. This paper presents the results of the impact evaluation of a pilot public policy designed to reduce fear of crime around a shopping centre in Santiago, Chile. The pilot policy consisted of installing a team including police officers and local government officials that handed out information leaflets and talked to passers-by about crime prevention. Pre-intervention and post-intervention surveys were conducted in the shopping centre where the programme was implemented and in a control shopping centre nearby to identify the causal effects of the policy using a difference-in-differences empirical strategy. The results indicate that the programme was effective in reducing fear of crime around the shopping centre, especially at night among its workers, and that it reduced actual crime. However, a deeper analysis suggests that the programme might have actually increased fear of crime among the individuals who directly interacted with the programme. The reduction in crime might have indirectly resulted in an overall reduction in fear among workers, who are likely to be up to date on criminal occurrences in the area, explaining how an increase in fear in those directly contacted is consistent with an overall reduction in fear across workers.

Perceived neighbourhood environment and falls among community-dwelling adults: cross-sectional and prospective findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)

We investigated the association between perceived neighbourhood characteristics and falls in community-dwelling adults, using data from Wave 5 and 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). We included 25,467 participants aged 50 to 103 years (mean age 66.2 ± 9.6, 58.5% women), from fourteen European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Israel, Italy, Luxembourg, Slovenia, Spain, Sweden, Switzerland). At baseline, we recorded individual-level factors (socio-demographic, socio-economic and clinical factors), contextual-level factors (country, urban versus rural area, European region) and perceived neighbourhood characteristics (vandalism or crime, cleanliness, feeling part of neighbourhood, helpful neighbours, accessibility to services) for each participant. We recorded falls in the six months prior to the baseline and 2-year follow-up interviews. The associations between neighbourhood characteristics and falls were analysed by binary logistic regression models; odds ratios (95% confidence intervals) were calculated. Participants reporting-versus not reporting-vandalism or crime had an increased falls risk of 1.16 (1.02-1.31) at follow-up, after full adjustment; lack of cleanliness, feeling part of the neighbourhood, perceiving neighbours as helpful and difficult accessibility to services were not associated with falls. Vandalism or crime was consistently associated with increased falls risks in women, adults without functional impairment and urban areas residents. In conclusion, adverse neighbourhood environments may account for inequality in falls risk among middle-aged and older adults and could be added to fall risk stratification tools.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00685-3.

Violence and unsafety in Italian hospitals: Experience and perceptions of nursing students

BACKGROUND: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers’ experience and perceived risk of violence may have a serious impact on job satisfaction and retention of workers. To date, no studies have been conducted on nursing students. OBJECTIVES: To assess the prevalence of physical and non-physical violence among nursing students during their clinical experiences and to analyze the perceived risk of violence. METHODS: Multicentre, cross-sectional survey. We enrolled a convenience sample of nursing students of the bachelor’s degree in Nursing of the University of Milan (Italy). The students completed a structured questionnaire prepared in accordance with the available literature on violence in healthcare settings. RESULTS: Out of 1185 questionnaires sent, 603 were collected (50.89%). 35.1% had experience of verbal violence during the clinical internship training period, while 8.1% were victims of physical violence. 202 students (33.5%) reported unsafety, which was related to experience of physical or psychological violence, witnessed episodes of violence, gender, hospital structure and efficacy of the safety policies. CONCLUSIONS: Our findings highlight that nursing students are exposed to the risk of violence which influences their perception of risk.

Reviewing the Role of Outdoor Lighting in Achieving Sustainable Development Goals

The Sustainable Development Goals (SDGs) aim at providing a healthier planet for present and future generations. At the most recent SDG summit held in 2019, Member States recognized that the achievements accomplished to date have been insufficient to achieve this mission. This paper presents a comprehensive literature review of 227 documents contextualizing outdoor lighting with SDGs, showing its potential to resolve some existing issues related to the SDG targets. From a list of 17 goals, six SDGs were identified to have relevant synergies with outdoor lighting in smart cities, including SDG 3 (Good health and well-being), SDG 11 (Sustainable cities and communities), SDG 14 (Life below water) and SDG 15 (Life on land). This review also links efficient lighting roles partially with SDG 7 (Affordable and clean energy) and SDG 13 (Climate action) through Target 7.3 and Target 13.2, respectively. This paper identifies outdoor lighting as a vector directly impacting 16 of the 50 targets in the six SDGs involved. Each section in this review discusses the main aspects of outdoor lighting by a human-centric, energy efficiency and environmental impacts. Each aspect addresses the most recent studies contributing to lighting solutions in the literature, helping us to understand the positive and negative impacts of artificial lighting on living beings. In addition, the work summarizes the proposed solutions and results tackling specific topics impacting SDG demands.

Perceptions of Risk: Perspectives on Crime and Safety in Public Housing for Older Adults

BACKGROUND AND OBJECTIVES

An increasing number of older adults are aging-in-place in public housing. Public housing is perceived to have higher rates of crime that have detrimental impacts on health and wellbeing. We used a qualitative approach to understand the experiences of safety and unsafety for older adults in public housing.

RESEARCH DESIGN AND METHODS

Participants included older adult tenants (n=58) as well as service providers (n=58) that offer supports directly in the buildings. Semi-structured qualitative interviews and focus groups were used to explore: (1) what makes the buildings feel unsafe; (2) how safety concerns impact access to support services; and (3) strategies used to promote safety.

RESULTS

Participants acknowledged the importance of safety for creating a home-like environment; however, many described feeling unsafe at home or work. Participants described extreme examples of antisocial behaviors that were pervasive and viewed as commonplace. Lack of building security was a key issue, which was compounded by a perceived lack of accountability. While service providers were willing to accept a certain level of risk, many acknowledged that unsafe situations forced them to withdraw in-home services or stop community programs, further contributing to feelings of unsafety. In the absence of effective formal security, participants described several measures taken to mitigate risk.

DISCUSSION AND IMPLICATIONS

Our findings point to the need for enhanced physical and environmental safety infrastructure, improved building management, increased on-site security, as well as other proactive measures to reduce risk by creating greater sense of connection and community within the buildings.

Influence of Replacement of Sodium Lamps in Park Luminaires with LED Sources of Different Closest Color Temperature on the Effect of Light Pollution and Energy Efficiency

According to the European Union (EU) regulations, EU members are obligated, among others, to improve the energy efficiency in the outdoor lighting sector. One of the ways to consider this fact is to install LED sources in luminaires. Due to the reasonable lighting requirements for the lighting of squares and parks, the cheapest way to modernize lighting is to replace conventional discharge lamps with LED sources in park luminaires. Using nine typical park luminaires, the influence of replacing classic sodium lamps with LED sources on the effect of light pollution and energy efficiency was analyzed. Using data, such as a photometric solid and a relative spectral distribution, simulation calculations were carried out in DIALux software and our own calculation tool to consider this issue. The studies considered 156 LED sources of different spectral distributions and a wide range of color temperatures from 1000 K to 9753 K as well as different color rendering index (CRI) values. The conducted studies showed that the replacement of sodium lamps with LED sources is not necessarily associated with an increased negative impact on the effect of light pollution. It was also found also that the CRI value has an influence on the degree of light pollution.

Investigating the practical viability of walk-sharing in improving pedestrian safety

Walk-sharing is a cost-effective and proactive approach that promises to improve pedestrian safety and has been shown to be technically (theoretically) viable. Yet, the practical viability of walk-sharing is largely dependent on community acceptance, which has not, until now, been explored. Gaining useful insights on the community's spatio-temporal and social preferences in regard to walk-sharing will ensure the establishment of practical viability of walk-sharing in a real-world urban scenario. We aim to derive practical viability using defined performance metrics (waiting time, detour distance, walk-alone distance and matching rate) and by investigating the effectiveness of walk-sharing in terms of its major objective of improving pedestrian safety and safety perception. We make use of the results from a web-based survey on the public perception on our proposed walk-sharing scheme. Findings are fed into an existing agent-based walk-sharing model to investigate the performance of walk-sharing and deduce its practical viability in urban scenarios.

Is there a correlation between children's outdoor active mobility behaviour and neighbourhood safety? A systematic review of the evidence

OBJECTIVE

To identify, summarise and evaluate evidence on the correlation between perceived and actual neighbourhood safety (personal and road danger) and diverse forms of outdoor active mobility behaviour (ie, active play, exercise, and travel) among primary-school-aged children.

DESIGN

A systematic review of evidence from observational studies exploring children's active mobility behaviour and safety.

DATA SOURCES

Six electronic databases were searched: Google Scholar, PubMed, Scopus, Science Direct, ProQuest and Web of Science from study inception until July 2020.

DATA EXTRACTION AND SYNTHESIS

Study selection and quality assessment were conducted independently by two reviewers. We expanded on a quality assessment tool and adopted a vote-counting technique to determine strength of evidence. The outcomes were categorised by individual, family and neighbourhood levels.

RESULTS

A total of 29 studies were included, with a majority of cross-sectional design. Higher parental perceived personal safety correlated with increased children's active mobility behaviour, but most commonly in active travel (eg, independent walking or cycling to a local destination). Increased concerns regarding road danger correlated with a decrease in each type of children's active behaviour; active travel, play and exercise. However, these correlations were influenced by child's sex/gender, age, car ownership, neighbourhood types, across time, and proximity to destination. Limited or inconclusive evidence was found on correlate of children's outdoor active mobility behaviour to 'stranger danger', children's perceived personal safety, race/ethnicity, socioeconomic status or measured safety.

CONCLUSION

Children are restricted by perception of safety. Encouraging children's active travel may require future strategies to address characteristics relevant to types of the neighbourhood that promote a high sense of personal safety. Children and parents may embrace other types of active mobility behaviour if road danger is mitigated. Sex/gender and age-specific interventions and redesign of public places could lead to child-friendly cities. Future studies may benefit from adopting validated measurement methods and fill existing research gaps.

Associations between neighborhood violence during pregnancy and birth outcomes: evidence from São Paulo's Western Region Birth Cohort

BACKGROUND

Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Although extensive literature has highlighted the importance of socioenvironmental characteristics for birth outcomes, the role of indirect violence on health remains fairly understudied.

METHODS

Using geocoded birth records from the ongoing Western Region Birth Cohort (Região Oeste Coorte - ROC-Cohort) of infants born between 2012 and 2014 and geocoded crime reports, we assessed the associations between exposure to violent crimes during pregnancy within a 1-km radius of the mother's residence and low birth weight, preterm delivery, and being born small-for-gestational-age. Violent crime exposure was categorized into quintiles. Multivariate logistic regressions were used to examine the associations between violence exposure and birth outcomes. Models were adjusted for sex, maternal age and education, socioeconomic status, and risk factors such as hypertension, diabetes, smoking, and drinking during pregnancy.

RESULTS

Among the 5268 children included, the average crime exposure during the first two trimesters of pregnancy ranged from 0.44 violent crimes in the least exposed quintile to 12.74 crimes in the most exposed. Compared to children with the lowest violence exposure, children in the highest exposure quintile had higher odds of being born small-for-gestational-age (1.41[1.06-1.89]), preterm (1.35[1.01-1.80]), and low birth weight (1.42[1.03-1.98]). While socioeconomic status and maternal education were positively associated with lower violence exposure, no associations were found between these characteristics and birth outcomes.

CONCLUSIONS

Higher exposure to violent crimes in the close vicinity of pregnant women's residence is associated with substantial increases in the odds of adverse birth outcomes. Policies to improve neighborhood safety can potentially contribute not only to the short-term wellbeing of populations but may also have large social, economic, and health benefits in the long term.

The Influence of Urban Park Attributes on User Preferences: Evaluation of Virtual Parks in an Online Stated-Choice Experiment

Urban green areas, such as parks, are becoming increasingly important in densifying cities. Urban parks encourage physical and social activity, recreation and relaxation, and thus eventually promote people's well-being. The aim of the current study is to examine which urban park attributes influence the preferences of park users, in order to offer recommendations regarding how urban parks of quality can be designed. To elicit the preferences of park visitors we designed an online stated-choice experiment. Seven park attributes, in particular the number and composition of trees and the presence of benches, side paths, a playground, litter, and flowers, were manipulated in a virtual park. In an online stated-choice task, videos of these park alternatives were presented and the preferences of 697 participants were measured. It is found that especially the number of trees and the presence of flowerbeds, particularly with a diversity of flowers, influenced participants' preferences. The presence of many benches and a playground were valued as well, but to a lesser extent. The presence of litter was found to be less troublesome than expected. Alternatives with all trees placed in one cluster were disliked. Moreover, significant standard deviations were found for the presence of side paths, a playground, and the absence of litter, which indicates that preference heterogeneity for these attributes exist. In a latent class analysis, two groups were identified, namely a Nature-loving group, who mainly valued the trees and the flowers, and an Amenity-appreciating group, who valued almost all attributes. It can be concluded that natural elements and a variety of flower species are important in an urban park, while facilities are evaluated differently by different groups of people. These findings may support park designers and policymakers in decision-making. Moreover, it illustrates the usefulness of creating a virtual park in environmental preference research.

Subjective Environmental Experiences and Women's Breastfeeding Journeys: A Survival Analysis Using an Online Survey of UK Mothers

Local physical and social environmental factors are important drivers of human health and behaviour. Environmental perception has been linked with both reproduction and parenting, but links between subjective environmental experiences and breastfeeding remain unclear. Using retrospective data from an online survey of UK mothers of children aged 0-24 months, Cox-Aalen survival models test whether negative subjective environmental experiences negatively correlated with any and exclusive breastfeeding (max n = 473). Matching predictions, hazards of stopping any breastfeeding were increased, albeit non-significantly, across the five environmental measures (HR: 1.05-1.26) Hazards for stopping exclusive breastfeeding were however (non-significantly) reduced (HR: 0.65-0.87). Score processes found no significant time-varying effects. However, estimated cumulative coefficient graphs showed that the first few weeks postpartum were most susceptible to environmental influences and that contrary to our predictions, mothers with worse subjective environmental experiences were less likely to stop breastfeeding at this time. In addition, the hazard of stopping exclusive breastfeeding declined over time for mothers who thought that littering was a problem. The predicted increased hazards of stopping breastfeeding were only evident in the later stages of any breastfeeding and only for mothers who reported littering as a problem or that people tended not to know each other. Perceived harsher physical and social environmental conditions are assumed to deter women from breastfeeding, but this may not always be the case. Women's hazards of stopping breastfeeding change over time and there may be particular timepoints in their breastfeeding journeys where subjective environmental experiences play a role.

Designing healthier neighbourhoods: a systematic review of the impact of the neighbourhood design on health and wellbeing

Several studies have investigated the impact of neighbourhood design on health and wellbeing, yet there are limited reviews investigating the quality of the evidence and the most effective interventions at a population level. This systematic review aims to clarify the impact of the neighbourhood design on health and wellbeing and evaluate the quality of the evidence underpinning such associations. Eight electronic databases were searched for studies conducted between 2000 and 2016. Additional searches were conducted on Google to identify potentially eligible grey literature. A total of 7694 studies were returned from the literature search, and a final selection of 39 studies were deemed eligible for inclusion. Quality appraisal was conducted using the Quality Assessment Tool for Quantitative Studies. Findings from the studies showed important associations between neighbourhood design principles such as walkability, access to green space and amenities on health and wellbeing. Findings from this review also highlight areas with inconsistent findings and gaps in the evidence for future research.

Active design of built environments for increasing levels of physical activity in adults: the ENABLE London natural experiment study

Background

Low physical activity is widespread and poses a serious public health challenge both globally and in the UK. The need to increase population levels of physical activity is recognised in current health policy recommendations. There is considerable interest in whether or not the built environment influences health behaviours, particularly physical activity levels, but longitudinal evidence is limited.

Objectives

The effect of moving into East Village (the former London 2012 Olympic and Paralympic Games Athletes’ Village, repurposed on active design principles) on the levels of physical activity and adiposity, as well as other health-related and well-being outcomes among adults, was examined.

Design

The Examining Neighbourhood Activities in Built Environments in London (ENABLE London) study was a longitudinal cohort study based on a natural experiment.

Setting

East Village, London, UK.

Participants

A cohort of 1278 adults (aged ≥ 16 years) and 219 children seeking to move into social, intermediate and market-rent East Village accommodation were recruited in 2013–15 and followed up after 2 years.

Intervention

The East Village neighbourhood, the former London 2012 Olympic and Paralympic Games Athletes’ Village, is a purpose-built, mixed-use residential development specifically designed to encourage healthy active living by improving walkability and access to public transport.

Main outcome measure

Change in objectively measured daily steps from baseline to follow-up.

Methods

Change in environmental exposures associated with physical activity was assessed using Geographic Information System-derived measures. Individual objective measures of physical activity using accelerometry, body mass index and bioelectrical impedance (per cent of fat mass) were obtained, as were perceptions of change in crime and quality of the built environment. We examined changes in levels of physical activity and adiposity using multilevel models adjusting for sex, age group, ethnic group, housing sector (fixed effects) and baseline household (random effect), comparing the change in those who moved to East Village (intervention group) with the change in those who did not move to East Village (control group). Effects of housing sector (i.e. social, intermediate/affordable, market-rent) as an effect modifier were also examined. Qualitative work was carried out to provide contextual information about the perceived effects of moving to East Village.

Results

A total of 877 adults (69%) were followed up after 2 years (mean 24 months, range 19–34 months, postponed from 1 year owing to the delayed opening of East Village), of whom 50% had moved to East Village; insufficient numbers of children moved to East Village to be considered further. In adults, moving to East Village was associated with only a small, non-significant, increase in mean daily steps (154 steps, 95% confidence interval –231 to 539 steps), more so in the intermediate sector (433 steps, 95% confidence interval –175 to 1042 steps) than in the social and market-rent sectors (although differences between housing sectors were not statistically significant), despite sizeable improvements in walkability, access to public transport and neighbourhood perceptions of crime and quality of the built environment. There were no appreciable effects on time spent in moderate to vigorous physical activity or sedentary time, body mass index or percentage fat mass, either overall or by housing sector. Qualitative findings indicated that, although participants enjoyed their new homes, certain design features might actually serve to reduce levels of activity.

Conclusions

Despite strong evidence of large positive changes in neighbourhood perceptions and walkability, there was only weak evidence that moving to East Village was associated with increased physical activity. There was no evidence of an effect on markers of adiposity. Hence, improving the physical activity environment on its own may not be sufficient to increase population physical activity or other health behaviours.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information. This research was also supported by project grants from the Medical Research Council National Prevention Research Initiative (MR/J000345/1).

Evaluating the effect of change in the built environment on mental health and subjective well-being: a natural experiment

BACKGROUND

Neighbourhood characteristics may affect mental health and well-being, but longitudinal evidence is limited. We examined the effect of relocating to East Village (the former London 2012 Olympic Athletes' Village), repurposed to encourage healthy active living, on mental health and well-being.

METHODS

1278 adults seeking different housing tenures in East village were recruited and examined during 2013-2015. 877 (69%) were followed-up after 2  years; 50% had moved to East Village. Analysis examined change in objective measures of the built environment, neighbourhood perceptions (scored from low to high; quality -12 to 12, safety -10 to 10 units), self-reported mental health (depression and anxiety) and well-being (life satisfaction, life being worthwhile and happiness) among East Village participants compared with controls who did not move to East Village. Follow-up measures were regressed on baseline for each outcome with group status as a binary variable, adjusted for age, sex, ethnicity, housing tenure and household clustering (random effect).

RESULTS

Participants who moved to East Village lived closer to their nearest park (528 m, 95% CI 482 to 575 m), in more walkable areas, and had better access to public transport, compared with controls. Living in East Village was associated with marked improvements in neighbourhood perceptions (quality 5.0, 95% CI 4.5 to 5.4 units; safety 3.4, 95% CI 2.9 to 3.9 units), but there was no overall effect on mental health and well-being outcomes.

CONCLUSION

Despite large improvements in the built environment, there was no evidence that moving to East Village improved mental health and well-being. Changes in the built environment alone are insufficient to improve mental health and well-being.

Effect of fear of victimization on hazardous alcohol drinking, tobacco, and marijuana use among university students: A tale of two sexes

BACKGROUND

Fear of victimization has been associated with poorer physical and mental health, yet is understudied in public health. Few studies have examined sex differences in the effects of fear of victimization on substance use. We examined associations between fear of victimization and hazardous alcohol drinking, tobacco, and marijuana use among female and male university students.

METHODS

A cross-sectional study was conducted among university students in an urban location (n = 1415). Socio-demographics, substance use, and fear related to various crimes were measured using online surveys. All fear types were summed into a total fear score and categorized into quartiles: no/little fear, moderate fear, high fear, and very high fear. Chi-square tests and multiple logistic regression models were used to examine associations between fear of victimization, hazardous alcohol drinking, tobacco and marijuana use, by sex.

RESULTS

Females were more likely to report high and very high fear of victimization (26.6% and 33.1%) than male students (19.8% and 16.3%; p < 0.001). In multiple logistic regression models, associations differed by sex: moderate, high, and very high fear were all independently associated with hazardous drinking among females but not males. Female students with very high fear of victimization were more likely to report tobacco use. High and very high fear was also independently associated with marijuana use among female only.

CONCLUSIONS

Higher fear of victimization was associated with substance use among females but not male students. Public health and health care professionals should acknowledge fear of victimization as a potential risk factor for substance use, particularly among women.

What is the qualitative evidence concerning the risks, diagnosis, management and consequences of gastrointestinal infections in the community in the United Kingdom? A systematic review and meta-ethnography

BACKGROUND

Gastrointestinal (GI) infections cause a significant public health burden worldwide and in the UK with evidence pointing to socio-economic inequalities, particularly among children. Qualitative studies can help us understand why inequalities occur and contribute to developing more effective interventions. This study had two aims: 1. Conduct a systematic review to determine the extent and nature of UK qualitative evidence on gastrointestinal infections; 2. Use meta-ethnography to examine the influences of the differing social contexts in which people live.

METHODS

MEDLINE, Scopus, Web of science, CINAHL and JSTOR were searched for UK qualitative studies engaging with the risk, diagnosis, management or consequences of gastrointestinal infections from 1980 to July 2019. Five reviewers were involved in applying inclusion and exclusion criteria, extracting and synthesising data (PROSPERO CRD 42017055157).

RESULTS

Searches identified 4080 studies, 18 met the inclusion criteria. The majority (n = 16) contained data relating to the risk of gastrointestinal infection and these made up the main synthesis. The tenets of meta-ethnography were used to glean new understandings of the role of social and environmental contexts in shaping the risk of gastrointestinal infection, specifically with respect to foodborne GI illness. Three main explanations concerning risk emerged from the data: explanations of risk in the community were underpinned by understandings of 'bugs', dirt and where food comes from; risks were negotiated in households alongside diverse processes of decision making around food; and resources available to households shaped food practices.

CONCLUSION

This systematic review highlights the scarcity of UK qualitative evidence examining gastrointestinal infections. Apart from risk, questions around diagnosis, management and consequences of illness were largely untouched. No studies investigated patterning by socio-economic status. Nevertheless, the meta-ethnography yielded wider contextual theories and explanations as to why people might not follow food hygiene guidance, giving pointers to the types of qualitative enquiry needed to develop more effective interventions.

Longitudinal associations between perceptions of the neighbourhood environment and physical activity in adolescents: evidence from the Olympic Regeneration in East London (ORiEL) study

BACKGROUND

Most UK adolescents do not achieve recommended levels of physical activity. Previous studies suggested that perceptions of the neighbourhood environment could contribute to explain differences in physical activity behaviours. We aimed to examine whether five measures of perceptions - perceived bus stop proximity, traffic safety, street connectivity, enjoyment of the neighbourhood for walking/cycling, and personal safety - were longitudinally associated with common forms of physical activity, namely walking to school, walking for leisure, and a composite measure of outdoor physical activity. We further aimed to investigate the moderating role of gender.

METHODS

We used longitudinal data from the Olympic Regeneration in East London (ORiEL) study, a prospective cohort study. In 2012, 3106 adolescents aged 11 to 12 were recruited from 25 schools in 4 deprived boroughs of East London. Adolescents were followed-up in 2013 and 2014. The final sample includes 2260 adolescents surveyed at three occasions. We estimated logistic regression models using Generalised Estimating Equations to test the plausibility of hypotheses on the nature of the longitudinal associations (general association, cumulative effect, co-varying trajectories), adjusting for potential confounders. Item non-response was handled using multiple imputation.

RESULTS

Longitudinal analyses indicate little evidence that perceptions of the neighbourhood are important predictors of younger adolescent physical activity. There was weak evidence that greater perceived proximity to bus stops is associated with a small decrease in the probability of walking for leisure. Results also indicate that poorer perception of personal safety decreases the probability of walking for leisure. There was some indication that better perception of street connectivity is associated with more outdoor physical activity. Finally, we found very little evidence that the associations between perceptions of the neighbourhood and physical activity differed by gender.

CONCLUSIONS

This study suggests that younger adolescents' perceptions of their neighbourhood environment, and changes in these perceptions, did not consistently predict physical activity in a deprived and ethnically diverse urban population. Future studies should use situation-specific measures of the neighbourhood environment and physical activity to better capture the hypothesised processes and explore the relative roles of the objective environment, parental and adolescents' perceptions in examining differences in types of physical activity.

Older people's experiences of everyday travel in the urban environment: a thematic synthesis of qualitative studies in the United Kingdom

Compared to younger age groups, older people spend more time in their locality and rely more heavily on its pedestrian and public transport infrastructure. Qualitative studies provide unique insight into people's experiences. We conducted a qualitative evidence synthesis of United Kingdom-based studies of older people's experiences of travelling in the urban environment. We searched health, social science, age-related and transport-related databases from 1998 to 2017. Fourteen papers (from 12 studies) were included in a thematic synthesis, a three-staged process that moves iteratively between codes, descriptive themes and cross-cutting analytical themes. Emerging themes were discussed with policy advisers. Four overarching themes were identified. The first and second theme pointed to the importance of ‘getting out’ and of being independent travellers. The third and fourth themes highlighted how local environments and travel systems enabled (or prevented) older people from realising these valued dimensions of travel. The loss of local amenities and micro-environmental features, such as pavement quality, personal safety and aesthetic appearance, were recurrent concerns. Free modes of travel like walking and bus travel were highly valued, including the social engagement they facilitated. Our review suggests that, while its extrinsic value (reaching destinations) matters, the intrinsic value of travel matters too. The process of travel is experienced and enjoyed for its own sake, with older people describing its contribution to their wellbeing.

Illuminating for Safety: Investigating the Role of Lighting Appraisals on the Perception of Safety in the Urban Environment

In two studies, we took a prospect-refuge based perspective to investigate how lighting and other physical attributes (i.e., prospect, concealment, and entrapment) affect people's judgments of the safety of urban streets during nighttime. Both studies complement existing research, which predominantly use factorial designs, with more ecologically valid correlational research using a large and representative sample of urban streets as stimulus materials. Results from Study 1 corroborate existing research demonstrating that differences in prospect, concealment, and entrapment predicted, to a large extent, variation in the perceived safety of urban streets-thus demonstrating the utility of such environmental information for making safety judgments in real-life settings. Results from a mediation analysis conducted in Study 2 showed that the relation between appraisals of lighting quality and safety judgments was completely accounted for by co-occurring variation in appraisals of prospect and entrapment. Implications for theory and methodology are discussed.

Risk perception and the influence on uptake and use of biomedical prevention interventions for HIV in sub-Saharan Africa: A systematic literature review

BACKGROUND

Risk perception has been found to be a crucial factor explaining inconsistent or non-use of HIV prevention interventions. Considerations of risk need to expand beyond risk of infection to also include the personal, social, emotional, and economic risks associated with prevention intervention use.

OBJECTIVES

This systematic review of qualitative peer-reviewed literature from sub-Saharan Africa examines perceptions of risk associated with HIV infection and HIV prevention intervention use.

DATA SOURCES

We searched Medline, Embase, PsychInfo, Africa Wide Info, CINAHL, and Global Health for publications and screened them for relevance.

STUDY ELIGIBILITY CRITERIA

Peer-reviewed qualitative studies published since 2003 were eligible for inclusion if they examined risk perception or uncertainty in the context of a medically regulated intervention. Only studies focusing on adults were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

Included publications were quality assessed using the Hawker method and coded thematically.

RESULTS

10318 unique papers were identified, of which 29 are included. Among the themes identified, a particularly salient one was the potential of HIV prevention interventions to threaten the stability of a relationship and impact on how and when people may-or may not-choose to use prevention interventions.

LIMITATIONS

This literature review excludes grey-literature, which may have distinct valuable insights. We also excluded quantitative studies that may have challenged or triangulated our findings.

CONCLUSIONS AND IMPLICATIONS

When considering the risk of HIV acquisition, it is insufficient to examine biological risk in isolation from the personal, relational and economic costs associated with intervention use. This loss of emotional, physical, or material support may be perceived as more consequential than the prevention of a potential infection.

Neighborhood Perceptions and Cumulative Impacts of Low Level Chronic Exposure to Fine Particular Matter (PM2.5) on Cardiopulmonary Health

Adverse perceptions of neighborhood safety, aesthetics and quality including access to resources can induce stress and may make individuals more sensitive to cardiopulmonary effects of air pollution exposure. Few studies have examined neighborhood perceptions as important and modifiable non-chemical stressors of the built environment that may exacerbate effects of air pollution on cardiopulmonary health outcomes, particularly among general population based cohorts. This study examined associations between low-level chronic exposure to fine particulate matter (PM2.5) and cardiopulmonary health, and the potential mediating or modifying effects of adverse neighborhood perceptions. Using data from the Survey of the Health of Wisconsin (SHOW), 2230 non-asthmatic adults age 21-74 were included in the analyses. The overall goals of this study were to assess if individuals who experience stress from neighborhood environments in which they live were more sensitive to low levels of fine particular matter (PM2.5 μg/m³). Demographic predictors of air pollution exposure included younger age, non-White race, lower education and middle class income. After adjustments, objective lung function measures (FEV1 and FEV1 to FVC ratio) were the only cardiopulmonary health indicators significantly associated with chronic three-year annual averages of PM2.5. Among all non-asthmatics, a ten unit increase in estimated three year annual average PM2.5 exposure was significantly associated with lower forced expiratory volume (L) in one second FEV1 (β = -0.40 μg/L; 95% CI -0.45, -0.06). Among all individuals, adverse perceptions of the neighborhood built environment did not appear to statistically moderate or mediate associations. However, stratified analysis did reveal significant associations between PM2.5 and lung function (FEV1) only among individuals with negative perceptions and increased reports of neighborhood stressors. These findings included individuals who felt their neighborhoods were poorly maintained (β = -0.82; 95% CI -1.35, -0.28), experienced stress from crime (β = -0.45; 95% CI -0.94, 0.04) or reported neighborhood is not well maintained (β = -1.13, CI -2.04, -0.24). These significant associations were similar for FEV1 to FVC ratio. Multi-pronged approaches addressing both neighborhood built environment aesthetics and air pollution regulation may be necessary to protect vulnerable and susceptible individuals and reduce persistent inequalities.

Cross-sectional interactions between quality of the physical and social environment and self-reported physical activity in adults living in income-deprived communities

Background

Understanding the environmental determinants of physical activity in populations at high risk of inactivity could contribute to the development of effective interventions. Socioecological models of activity propose that environmental factors have independent and interactive effects of physical activity but there is a lack of research into interactive effects.

Objectives

This study aimed to explore independent and interactive effects of social and physical environmental factors on self-reported physical activity in income-deprived communities.

Methods

Participants were 5,923 adults in Glasgow, United Kingdom. Features of the social environment were self-reported. Quality of the physical environment was objectively-measured. Neighbourhood walking and participation in moderate physical activity [MPA] on ≥5 days/week was self-reported. Multilevel multivariate logistic regression models tested independent and interactive effects of environmental factors on activity.

Results

‘Social support’ (walking: OR:1.22,95%CI = 1.06–1.41,p<0.01; MPA: OR:0.79,95%CI = 0.67–0.94,p<0.01), ‘social interaction’ (walking: OR:1.25,95%CI = 1.10–1.42,p<0.01; MPA: OR:6.16,95%CI = 5.14–7.37,p<0.001) and ‘cohesion and safety’ (walking: OR:1.78,95%CI = 1.56–2.03,p<0.001; MPA: OR:1.93,95%CI = 1.65–2.27,p<0.001), but not ‘trust and empowerment’, had independent effects on physical activity. ‘Aesthetics of built form’ (OR:1.47,95%CI = 1.22–1.77,p<0.001) and ‘aesthetics and maintenance of open space’ (OR:1.32, 95%CI = 1.13–1.54,p<0.01) were related to walking. ‘Physical disorder’ (OR:1.63,95%CI = 1.31–2.03,p<0.001) had an independent effect on MPA. Interactive effects of social and physical factors on walking and MPA were revealed.

Conclusions

Findings suggest that intervening to create activity-supportive environments in deprived communities may be most effective when simultaneously targeting the social and physical neighbourhood environment.

Does heightened fear of crime lead to poorer mental health in new suburbs, or vice versa?

Fear of crime is implicated as a risk factor for poorer mental health, yet few studies have explored whether there is a causal relationship between fear of crime and health, or tested the direction of the relationship. Does, for example, heightened fear of crime lead to poorer mental health, or could poorer mental health exacerbate fear of crime? RESIDE participants in Perth, Australia, completed a questionnaire three years after moving to their neighbourhood (2007-2008, n = 1230), and again four years later (2011-2012, n = 531). The impact of fear of crime on psychological distress (Kessler-6) was examined in SAS using the Proc Mixed procedure (marginal repeated measures model with unrestricted variance pattern). Models controlled for demographics and time, and progressively adjusted for avoidance behaviours (i.e., walking, community participation, social cohesion). This approach was repeated with psychological distress as the independent variable and fear of crime as the outcome. For each increase in one standard deviation (SD) in fear of crime, psychological distress increased by 0.680 (p = 0.0001), however in the reversed models, for each one SD increase in psychological distress, fear of crime increased by 0.152 (p = 0.0001). To help explain these results, temporal order models examined whether baseline values predicted follow-up values. There was a significant association between psychological distress (at baseline) and fear of crime (at follow-up), but no association between fear of crime (at baseline) and psychological distress (at follow-up). The findings suggest a bi-directional relationship exists between fear of crime and mental health, however it appears that higher psychological distress over time leads to higher fear of crime, rather than the reverse. Furthermore, the pathway connecting fear of crime and mental health appears to be direct, rather than via constrained social and physical activities.

Facilitators and barriers to the adoption of telehealth in older adults: an integrative review

Telehealth offers a great opportunity to provide follow-up care and daily monitoring of older adults in their homes. Although there is a significant body of literature related to telehealth in regard to design and adoption, little attention has been given by researchers to the perceptions of the older-adult end users of telehealth. As the numbers of older adults increases, there is a need to evaluate the perceptions of this population as they will most likely be the major users of telehealth. This review identified the current telehealth technologies that are available to older adults with a discussion on the facilitators of and barriers to those technologies. Literature published between 2003 and 2013 was reviewed using MEDLINE, PsycINFO, and CINAHL. A total of 2387 references were retrieved, but only 14 studies met the inclusion criteria. This review indicates that 50% of the studies did not specifically address facilitators of and barriers to adopting telehealth with older adults. Also, studies in this population did not address caregivers' perceptions on the facilitators of and barriers to telehealth. The use of telehealth among older adults is expected to rise, but effective adoption will be successful if the patient's perspective is kept at the forefront.

Community Lenses Revealing the Role of Sociocultural Environment on Physical Activity

PURPOSE

To identify perceptions of how sociocultural environment enabled and hindered physical activity (PA) participation.

DESIGN

Community-based participatory research.

SETTING

Two semirural and two urban communities located in Alberta, Canada.

PARTICIPANTS

Thirty-five people (74.3% females, 71.4% aged 25-64 years) across the four communities.

METHOD

PhotoVoice activities occurred over 3 months during the spring of 2009. Participants were asked to document perceived environmental attributes that might foster or inhibit PA in their community. Photographs and narratives were shared in one-on-one interviews. Line-by-line coding of the transcripts was independently conducted by two researchers using an inductive approach. Codes were arranged into themes and subthemes, which were then organized into the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.

RESULTS

Six main themes (accompanied by subthemes) emerged: sociocultural aesthetics, safety, social involvement, PA motivation, cultural ideas of recreation, and car culture. Representative quotes and photographs illustrate enablers and obstacles identified by participants.

CONCLUSION

This PhotoVoice study revealed how aspects of participants' sociocultural environments shaped their decisions to be physically active. Providing more PA resources is only one step in the promotion of supportive environments. Strategies should also account for the beautification and maintenance of communities, increasing feelings of safety, enhancement of social support among community members, popularization of PA, and mitigating car culture, among others.

From built environment to health inequalities: An explanatory framework based on evidence

OBJECTIVE

The Health in All Policies strategy aims to engage every policy domain in health promotion. The more socially disadvantaged groups are usually more affected by potential negative impacts of policies if they are not health oriented. The built environment represents an important policy domain and, apart from its housing component, its impact on health inequalities is seldom assessed.

METHODS

A scoping review of evidence on the built environment and its health equity impact was carried out, searching both urban and medical literature since 2000 analysing socio-economic inequalities in relation to different components of the built environment.

RESULTS

The proposed explanatory framework assumes that key features of built environment (identified as density, functional mix and public spaces and services), may influence individual health through their impact on both natural environment and social context, as well as behaviours, and that these effects may be unequally distributed according to the social position of individuals.

CONCLUSION

In general, the expected links proposed by the framework are well documented in the literature; however, evidence of their impact on health inequalities remains uncertain due to confounding factors, heterogeneity in study design, and difficulty to generalize evidence that is still very embedded to local contexts.

Are area-based initiatives able to improve area safety in deprived areas? A quasi-experimental evaluation of the Dutch District Approach

Background

Numerous area-based initiatives have been implemented in deprived areas across Western-Europe with the aim to improve the socio-economic and environmental conditions in these areas. Only few of these initiatives have been scientifically evaluated for their impact on key social determinants of health, like perceived area safety. Therefore, this study aimed to assess the impact of a Dutch area-based initiative called the District Approach on trends in perceived area safety and underlying problems in deprived target districts.

Methods

A quasi-experimental design was used. Repeated cross-sectional data on perceived area safety and underlying problems were obtained from the National Safety Monitor (2005–2008) and its successor the Integrated Safety Monitor (2008–2011). Study population consisted of 133,522 Dutch adults, including 3,595 adults from target districts. Multilevel logistic regression analyses were performed to assess trends in self-reported general safety, physical order, social order, and non-victimization before and after the start of the District Approach mid-2008. Trends in target districts were compared with trends in various control groups.

Results

Residents of target districts felt less safe, perceived less physical and social order, and were victimized more often than adults elsewhere in the Netherlands. For non-victimization, target districts showed a somewhat more positive change in trend after the start of the District Approach than the rest of the Netherlands or other deprived districts. Differences were only statistically significant in women, older adults, and lower educated adults. For general safety, physical order, and social order, there were no differences in trend change between target districts and control groups.

Conclusions

Results suggest that the District Approach has been unable to improve perceptions of area safety and disorder in deprived areas, but that it did result in declining victimization rates.

Reduced street lighting at night and health: A rapid appraisal of public views in England and Wales

Financial and carbon reduction incentives have prompted many local authorities to reduce street lighting at night. Debate on the public health implications has centred on road accidents, fear of crime and putative health gains from reduced exposure to artificial light. However, little is known about public views of the relationship between reduced street lighting and health. We undertook a rapid appraisal in eight areas of England and Wales using ethnographic data, a household survey and documentary sources. Public concern focused on road safety, fear of crime, mobility and seeing the night sky but, for the majority in areas with interventions, reductions went unnoticed. However, more private concerns tapped into deep-seated anxieties about darkness, modernity 'going backwards', and local governance. Pathways linking lighting reductions and health are mediated by place, expectations of how localities should be lit, and trust in local authorities to act in the best interests of local communities.

Using structured observation and content analysis to explore the presence of older people in public fora in developing countries

There is a lack of research on the everyday lives of older people in developing countries. This exploratory study used structured observation and content analysis to examine the presence of older people in public fora and considered the methods' potential for understanding older people's social integration and inclusion. Structured observation occurred of public social spaces in six cities each located in a different developing country and in one city in the United Kingdom, together with content analysis of the presence of people in newspaper pictures and on television in the selected countries. Results indicated that across all fieldwork sites and data sources, there was a low presence of older people, with women considerably less present than men in developing countries. There was variation across fieldwork sites in older people's presence by place and time of day and in their accompanied status. The presence of older people in images drawn from newspapers was associated with the news/non-news nature of the source. The utility of the study's methodological approach is considered, as is the degree to which the presence of older people in public fora might relate to social integration and inclusion in different cultural contexts.

Considering methodological options for reviews of theory: illustrated by a review of theories linking income and health

BACKGROUND

Review of theory is an area of growing methodological advancement. Theoretical reviews are particularly useful where the literature is complex, multi-discipline, or contested. It has been suggested that adopting methods from systematic reviews may help address these challenges. However, the methodological approaches to reviews of theory, including the degree to which systematic review methods can be incorporated, have received little discussion in the literature. We recently employed systematic review methods in a review of theories about the causal relationship between income and health.

METHODS

This article discusses some of the methodological issues we considered in developing the review and offers lessons learnt from our experiences. It examines the stages of a systematic review in relation to how they could be adapted for a review of theory. The issues arising and the approaches taken in the review of theories in income and health are considered, drawing on the approaches of other reviews of theory.

RESULTS

Different approaches to searching were required, including electronic and manual searches, and electronic citation tracking to follow the development of theories. Determining inclusion criteria was an iterative process to ensure that inclusion criteria were specific enough to make the review practical and focused, but not so narrow that key literature was excluded. Involving subject specialists was valuable in the literature searches to ensure principal papers were identified and during the inductive approaches used in synthesis of theories to provide detailed understanding of how theories related to another. Reviews of theory are likely to involve iterations and inductive processes throughout, and some of the concepts and techniques that have been developed for qualitative evidence synthesis can be usefully translated to theoretical reviews of this kind.

CONCLUSIONS

It may be useful at the outset of a review of theory to consider whether the key aim of the review is to scope out theories relating to a particular issue; to conduct in-depth analysis of key theoretical works with the aim of developing new, overarching theories and interpretations; or to combine both these processes in the review. This can help decide the most appropriate methodological approach to take at particular stages of the review.

Considering methodological options for reviews of theory: illustrated by a review of theories linking income and health

BACKGROUND

Review of theory is an area of growing methodological advancement. Theoretical reviews are particularly useful where the literature is complex, multi-discipline, or contested. It has been suggested that adopting methods from systematic reviews may help address these challenges. However, the methodological approaches to reviews of theory, including the degree to which systematic review methods can be incorporated, have received little discussion in the literature. We recently employed systematic review methods in a review of theories about the causal relationship between income and health.

METHODS

This article discusses some of the methodological issues we considered in developing the review and offers lessons learnt from our experiences. It examines the stages of a systematic review in relation to how they could be adapted for a review of theory. The issues arising and the approaches taken in the review of theories in income and health are considered, drawing on the approaches of other reviews of theory.

RESULTS

Different approaches to searching were required, including electronic and manual searches, and electronic citation tracking to follow the development of theories. Determining inclusion criteria was an iterative process to ensure that inclusion criteria were specific enough to make the review practical and focused, but not so narrow that key literature was excluded. Involving subject specialists was valuable in the literature searches to ensure principal papers were identified and during the inductive approaches used in synthesis of theories to provide detailed understanding of how theories related to another. Reviews of theory are likely to involve iterations and inductive processes throughout, and some of the concepts and techniques that have been developed for qualitative evidence synthesis can be usefully translated to theoretical reviews of this kind.

CONCLUSIONS

It may be useful at the outset of a review of theory to consider whether the key aim of the review is to scope out theories relating to a particular issue; to conduct in-depth analysis of key theoretical works with the aim of developing new, overarching theories and interpretations; or to combine both these processes in the review. This can help decide the most appropriate methodological approach to take at particular stages of the review.

Associations between neighbourhood environmental characteristics and obesity and related behaviours among adult New Zealanders

Background

The prevalence of adult obesity is escalating in most wealthy and middle income countries. Due to the magnitude of this issue, research and interventions at the individual-level abound. However, the limited success and high costs of such interventions has led to a growing recognition of the potential role of environmental factors in reducing obesity and promoting physical activity and healthy diets.

Methods

This study utilised individual-level data from the 2006/7 New Zealand Health Survey on obesity, physical activity, diet and socio-economic variables linked to geographic information from other sources on potentially aetiologically-relevant environmental factors, based on the respondent’s residential address. We fitted logistic regression models for eight binary measures of weight or weight-related behaviours: 1) overweight; 2) obesity; 3) overweight + obesity; 4) active at least 30 minutes a day for 5+ days per week; 5) active <30 minutes per week; 6) walk 150 minutes + per week; 7) walk <30 minutes per week; and 8) consumption of 5+ fruits and vegetables per day. We included a range of independent environmental characteristics of interest in separate models.

Results

We found that increased neighbourhood deprivation and decreased access to neighbourhood greenspace were both significantly associated with increased odds of overweight and/or obesity. The results for weight-related behaviours indicate that meeting the recommended level of physical activity per week was associated with urban/rural status, with higher activity in the more rural areas and a surprising tendency for less activity among those living in areas with higher levels of active travel to work. Increased access to greenspace was associated with high levels of walking, while decreased access to greenspace was associated with low levels of walking. There was also a significant trend for low levels of walking to be positively associated with neighbourhood deprivation. Results for adequate fruit and vegetable consumption show a significant urban/rural gradient, with more people meeting recommended levels in the more rural compared to more urban areas.

Conclusion

Similar to findings from other international studies, these results highlight greenspace as an amenable environmental factor associated with obesity/overweight and also indicate the potential benefit of targeted health promotion in both urban and deprived areas in New Zealand.

Do changes in residents' fear of crime impact their walking? Longitudinal results from RESIDE

OBJECTIVE

To examine the influence of fear of crime on walking for participants in a longitudinal study of residents in new suburbs.

METHODS

Participants (n=485) in Perth, Australia, completed a questionnaire about three years after moving to their neighbourhood (2007-2008), and again four years later (2011-2012). Measures included fear of crime, neighbourhood perceptions and walking (min/week). Objective environmental measures were generated for each participant's neighbourhood, defined as the 1600 m road network distance from home, at each time-point. Linear regression models examined the impact of changes in fear of crime on changes in walking, with progressive adjustment for other changes in the built environment, neighbourhood perceptions and demographics.

RESULTS

An increase in fear of crime was associated with a decrease in residents' walking inside the local neighbourhood. For each increase in fear of crime (i.e., one level on a five-point Likert scale) total walking decreased by 22 min/week (p=0.002), recreational walking by 13 min/week (p=0.031) and transport walking by 7 min/week (p=0.064).

CONCLUSION

This study provides longitudinal evidence that changes in residents' fear of crime influence their walking behaviours. Interventions that reduce fear of crime are likely to increase walking and produce public health gains.

No effect of ambient odor on the affective appraisal of a desktop virtual environment with signs of disorder

Background

Desktop virtual environments (VEs) are increasingly deployed to study the effects of environmental qualities and interventions on human behavior and safety related concerns in built environments. For these applications it is essential that users appraise the affective qualities of the VE similar to those of its real world counterpart. Previous studies have shown that factors like simulated lighting, sound and dynamic elements all contribute to the affective appraisal of a desktop VE. Since ambient odor is known to affect the affective appraisal of real environments, and has been shown to increase the sense of presence in immersive VEs, it may also be an effective tool to tune the affective appraisal of desktop VEs. This study investigated if exposure to ambient odor can modulate the affective appraisal of a desktop VE with signs of public disorder.

Method

Participants explored a desktop VE representing a suburban neighborhood with signs of public disorder (neglect, vandalism and crime), while being exposed to either room air or subliminal levels of unpleasant (tar) or pleasant (cut grass) ambient odor. Whenever they encountered signs of disorder they reported their safety related concerns and associated affective feelings.

Results

Signs of crime in the desktop VE were associated with negative affective feelings and concerns for personal safety and personal property. However, there was no significant difference between reported safety related concerns and affective connotations in the control (no-odor) and in each of the two ambient odor conditions.

Conclusion

Ambient odor did not affect safety related concerns and affective connotations associated with signs of disorder in the desktop VE. Thus, semantic congruency between ambient odor and a desktop VE may not be sufficient to influence its affective appraisal, and a more realistic simulation in which simulated objects appear to emit scents may be required to achieve this goal.