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Sá R, Roquette R, Rebecchi A, Matias J, Rocha J, Buffoli M, Capolongo S, Ribeiro AI, Nunes B, Dias C, Sousa Uva M. Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study. BMC Public Health 2024; 24:1116. [PMID: 38654178 PMCID: PMC11036776 DOI: 10.1186/s12889-024-18627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
Diabetes poses a substantial disease burden, prompting preventive interventions. Physical inactivity, a major risk factor for type 2 diabetes, can potentially be mitigated by enhancing area-level walkability. Despite this, limited population-based studies have investigated the link between walkability and objective diabetes measures. Our study aims to estimate the association between area-level walkability and individual glycated haemoglobin levels in the Portuguese adult population without the diagnosis of diabetes. Data from the 2011 census and an updated street map were obtained to construct a walkability index based on residential density, land-use mix, and street connectivity. Individual health data were sourced from The National Health Examination Survey (INSEF) 2015, a representative survey of the Portuguese adult population. Gamma regression was employed for estimation of the main associations, revealing that residing in moderately walkable areas significantly reduced average glycated haemoglobin levels (Exp(β) = 0.906; 95% CI: 0.821, 0.999) compared to the least walkable areas. The association was less pronounced and not statistically significant for the third tertile of walkability (Exp(β) = 0.919; 95% CI: 0.822, 1.028). Our findings highlight a nonlinear protective association between walkability and glycated haemoglobin, emphasizing the potential policy implications for urban planning, diabetes prevention, and health promotion.
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Affiliation(s)
- Regina Sá
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) do Baixo Vouga, Aveiro, Portugal.
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) Algarve I, Faro, Portugal.
| | - Rita Roquette
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
| | - Andrea Rebecchi
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Judite Matias
- Unidade de Saúde Pública, Agrupamento de Centros de Saúde (ACES) do Baixo Vouga, Aveiro, Portugal
| | - Jorge Rocha
- Instituto de Geografia e Ordenamento do Território (IGOT), Universidade de Lisboa e Laboratório Associado TERRA, Lisbon, Portugal
| | - Maddalena Buffoli
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Stefano Capolongo
- Design & Health Lab, Department of Architecture, Built environment and Construction Engineering, Politecnico di Milano, Milan, Italy
| | - Ana Isabel Ribeiro
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Carlos Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Mafalda Sousa Uva
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP-NOVA), Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Cerci RJ, Fernandes-Silva MM, Vitola JV, Cerci JJ, Pereira Neto CC, Masukawa M, Gracia APW, Silvello LL, Prado P, Guedes M, Hino AAF, Baena CP. Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability. Arq Bras Cardiol 2023; 120:e20220844. [PMID: 38055417 DOI: 10.36660/abc.20220844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C). BACKGROUND Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association. OBJECTIVES To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association. METHODS This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant. RESULTS From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = -0.3%). CONCLUSIONS Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.
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Affiliation(s)
- Rodrigo Julio Cerci
- Quanta Diagnóstico por Imagem - Cardiovascular CT, Curitiba, PR - Brasil
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | - Miguel Morita Fernandes-Silva
- Quanta Diagnóstico por Imagem - Cardiovascular CT, Curitiba, PR - Brasil
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | | | | | | | - Margaret Masukawa
- Quanta Diagnóstico por Imagem - Cardiovascular CT, Curitiba, PR - Brasil
| | | | | | - Pedro Prado
- Quanta Diagnóstico por Imagem - Cardiovascular CT, Curitiba, PR - Brasil
| | - Murilo Guedes
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
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Koohsari MJ, Oka K, Nakaya T, Vena J, Williamson T, Quan H, McCormack GR. Urban design and cardio-metabolic risk factors. Prev Med 2023; 173:107552. [PMID: 37211251 DOI: 10.1016/j.ypmed.2023.107552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
Accumulating evidence suggests that the built environment may be associated with cardiovascular disease via its influence on health behaviours. The aim of this study was to estimate the associations between traditional and novel neighbourhood built environment metrics and clinically assessed cardio-metabolic risk factors among a sample of adults in Canada. A total of 7171 participants from Albertas Tomorrow Project living in Alberta, Canada, were included. Cardio-metabolic risk factors were clinically measured. Two composite built environment metrics of traditional walkability and space syntax walkability were calculated. Among men, space syntax walkability was negatively associated with systolic and diastolic blood pressure (b = -0.87, 95% CI -1.43, -0.31 and b = -0.45, 95% CI -0.86, -0.04, respectively). Space syntax walkability was also associated with lower odds of overweight/obese among women and men (OR = 0.93, 95% CI 0.87, 0.99 and OR = 0.88, 95% CI 0.79, 0.97, respectively). No significant associations were observed between traditional walkability and cardio-metabolic outcomes. This study showed that the novel built environment metric based on the space syntax theory was associated with some cardio-metabolic risk factors.
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Affiliation(s)
- Mohammad Javad Koohsari
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Japan; Faculty of Sport Sciences, Waseda University, Japan; School of Exercise and Nutrition Sciences, Deakin University, Australia.
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Japan
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Japan.
| | - Jennifer Vena
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
| | - Tyler Williamson
- Centre for Health Informatics and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
| | - Hude Quan
- Centre for Health Informatics and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
| | - Gavin R McCormack
- Faculty of Sport Sciences, Waseda University, Japan; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Faculty of Kinesiology, University of Calgary, Canada; School of Architecture, Planning and Landscape, University of Calgary, Canada.
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Lai KY, Webster C, Gallacher JE, Sarkar C. Associations of Urban Built Environment with Cardiovascular Risks and Mortality: a Systematic Review. J Urban Health 2023; 100:745-787. [PMID: 37580546 PMCID: PMC10447831 DOI: 10.1007/s11524-023-00764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/16/2023]
Abstract
With rapid urbanization, built environment has emerged as a set of modifiable factors of cardiovascular disease (CVD) risks. We conducted a systematic review to synthesize evidence on the associations of attributes of urban built environment (e.g. residential density, land use mix, greenness and walkability) with cardiovascular risk factors (e.g. hypertension and arterial stiffness) and major CVD events including mortality. A total of 63 studies, including 31 of cross-sectional design and 32 of longitudinal design conducted across 21 geographical locations and published between 2012 and 2023 were extracted for review. Overall, we report moderately consistent evidence of protective associations of greenness with cardiovascular risks and major CVD events (cross-sectional studies: 12 of 15 on hypertension/blood pressure (BP) and 2 of 3 on arterial stiffness; and longitudinal studies: 6 of 8 on hypertension/BP, 7 of 8 on CVD mortality, 3 of 3 on ischemic heart disease mortality and 5 of 8 studies on stroke hospitalization or mortality reporting significant inverse associations). Consistently, walkability was associated with lower risks of hypertension, arterial stiffness and major CVD events (cross-sectional studies: 11 of 12 on hypertension/BP and 1 of 1 on arterial stiffness; and longitudinal studies: 3 of 6 on hypertension/BP and 1 of 2 studies on CVD events being protective). Sixty-seven percent of the studies were rated as "probably high" risk of confounding bias because of inability to adjust for underlying comorbidities/family history of diseases in their statistical models. Forty-six percent and 14% of the studies were rated as "probably high" risk of bias for exposure and outcome measurements, respectively. Future studies with robust design will further help elucidate the linkages between urban built environment and cardiovascular health, thereby informing planning policies for creating healthy cities.
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Affiliation(s)
- Ka Yan Lai
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China.
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China.
| | - Chris Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Urban Systems Institute, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - John Ej Gallacher
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong Special Administrative Region, China
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Hanifah L, Nasrulloh N, Sufyan DL. Sedentary Behavior and Lack of Physical Activity among Children in Indonesia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1283. [PMID: 37628282 PMCID: PMC10453900 DOI: 10.3390/children10081283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/10/2023] [Accepted: 07/13/2023] [Indexed: 08/27/2023]
Abstract
Sedentary behavior and lack of physical activity among children in Indonesia is an important issue that needs to be addressed. It is estimated that 57% of children in Indonesia have insufficient physical activity. Studies have shown that children who engage in sedentary behaviors are at an increased risk for various negative health outcomes, including obesity, type 2 diabetes, cardiovascular disease, and poor mental health, compared to physically active ones. This article aims to provide recommendations to increase physical activity and reduce passive behavior in children in Indonesia. This is a commentary article developed from observing the recent progress of sedentary behavior and lack of physical activity among children in Indonesia and the potential consequences. The level of inactive behavior in children in Indonesia is relatively high. Factors that contribute to sedentary behavior and lack of physical activity among children in Indonesia are the increasing use of electronic devices and screen time, the lack of safe and accessible places to be physically active, the COVID-19 pandemic, as well as cultural and social norms that prioritize academic achievement over physical activity. To address sedentary lifestyles among children, there is a need for a comprehensive approach that addresses both the individual and societal factors contributing to the problem. This might include increasing access to healthy food options, promoting physical activity, and implementing education programs to raise awareness about the importance of healthy eating and physical activity, as well as limiting screen time.
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Affiliation(s)
- Laily Hanifah
- Faculty of Health Science, Universitas Pembangunan Nasional Veteran Jakarta, Jl. Raya Limo, Depok 16515, Indonesia
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Tharrey M, Malisoux L, Klein O, Bohn T, Perchoux C. Urban densification over 9 years and change in the metabolic syndrome: A nationwide investigation from the ORISCAV-LUX cohort study. Soc Sci Med 2023; 331:116002. [PMID: 37478660 DOI: 10.1016/j.socscimed.2023.116002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 07/23/2023]
Abstract
A growing body of evidence suggests that urban densification may be protective against obesity, type 2 diabetes, and cardiometabolic diseases, yet studies on how built environmental features relate to metabolic syndrome (MetS) and its components are scarce. This longitudinal study examines the associations of baseline urban density and densification over 9 years with MetS and MetS components, among 510 participants enrolled in both waves of the ORISCAV-LUX study (2007-2017) in Luxembourg. A continuous MetS score (siMS) was calculated for each participant. Six features of residential built environments were computed around participants' home address: street connectivity, population density, density of amenities, street network distance to the nearest bus station, density of public transport stations, and land use mix. A composite index of urban densification (UDI) was calculated by averaging the six standardized built environment variables. Using adjusted generalized estimating equation (GEE) models, one-SD increase in UDI was associated with a worsening of the siMS score (β = 0.07, 95% CI: 0.02, 0.13), higher triglyceride levels (β = 0.05, 95% CI: 0.02, 0.09), and lower HDL-c levels (β = -1.29, 95% CI: -2.20, -0.38). The detrimental effect of UDI on lipid levels was significant only for participants living in dense areas at baseline. Higher baseline UDI, as well as increased UDI over time among movers, were also associated with greater waist circumference. There were no associations between UDI, fasting plasma glucose and systolic blood pressure. Sex and neighborhood socio-economic status did not moderate the associations between UDI and the cardiometabolic outcomes. Overall, we found limited evidence for an effect of urban densification on MetS and its components. Understanding urban dynamics remains a challenge, and more research investigating the independent and joint health effect of built environment features is needed to support urban planning and design that promote cardiometabolic health.
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Affiliation(s)
- Marion Tharrey
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg; Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - Laurent Malisoux
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Olivier Klein
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Torsten Bohn
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Camille Perchoux
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
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Huguet N, Green BB, Voss RW, Larson AE, Angier H, Miguel M, Liu S, Latkovic-Taber M, DeVoe JE. Factors Associated With Blood Pressure Control Among Patients in Community Health Centers. Am J Prev Med 2023; 64:631-641. [PMID: 36609093 PMCID: PMC10121771 DOI: 10.1016/j.amepre.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Understanding the multilevel factors associated with controlled blood pressure is important to determine modifiable factors for future interventions, especially among populations living in poverty. This study identified clinically important factors associated with blood pressure control among patients receiving care in community health centers. METHODS This study includes 31,089 patients with diagnosed hypertension by 2015 receiving care from 103 community health centers; aged 19-64 years; and with ≥1 yearly visit with ≥1 recorded blood pressure in 2015, 2016, and 2017. Blood pressure control was operationalized as an average of all blood pressure measurements during all the 3 years and categorized as controlled (blood pressure <140/90), partially controlled (mixture of controlled and uncontrolled blood pressure), or never controlled. Multinomial mixed-effects logistic regression models, conducted in 2022, were used to calculate unadjusted ORs and AORs of being in the never- or partially controlled blood pressure groups versus in the always-controlled group. RESULTS A total of 50.5% had always controlled, 39.7% had partially controlled, and 9.9% never had controlled blood pressure during the study period. The odds of being partially or never in blood pressure control were higher for patients without continuous insurance (AOR=1.09; 95% CI=1.03, 1.16; AOR=1.18; 95% CI=1.07, 1.30, respectively), with low provider continuity (AOR=1.24; 95% CI=1.15, 1.34; AOR=1.28; 95% CI=1.13, 1.45, respectively), with a recent diagnosis of hypertension (AOR=1.34; 95% CI=1.20, 1.49; AOR=1.19; 95% CI=1.00, 1.42), with inconsistent antihypertensive medications (AOR=1.19; 95% CI=1.11, 1.27; AOR=1.26; 95% CI=1.13, 1.41, respectively), and with fewer blood pressure checks (AOR=2.14; 95% CI=1.97, 2.33; AOR=2.17; 95% CI=1.90, 2.48, respectively) than for their counterparts. CONCLUSIONS Efforts targeting continuous and consistent access to care, antihypertensive medications, and regular blood pressure monitoring may improve blood pressure control among populations living in poverty.
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Affiliation(s)
- Nathalie Huguet
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | | | - Heather Angier
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Marino Miguel
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Shuling Liu
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon; Biostatistics Group, Oregon Health & Science University, Portland, Oregon
| | | | - Jennifer E DeVoe
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
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Koh G, Sekine M, Yamada M, Fujimura Y, Tatsuse T. Neighbourhood walkability and obesity among adults in rural Japan: results from a Japanese health database. J Public Health (Oxf) 2022; 44:e467-e474. [PMID: 34387690 DOI: 10.1093/pubmed/fdab319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Walkable neighbourhoods promote physical activity and prevent obesity, but there is limited evidence to inform urban planning strategies for public health within the context of rural Japan. This study describes associations between neighbourhood walkability and obesity in Toyama, a regional municipality in Japan. METHODS A cross-sectional analysis of the Toyama Prefecture National Health Insurance data (n = 3454) in 2016 using Analysis of Covariance (ANCOVA) and binary logistic regression. Walk Score® was used to estimate neighbourhood walkability. RESULTS Residents from highly walkable neighbourhoods generally had lower mean body mass index (BMI), but significant associations between neighbourhood walkability and BMI and prevalence of obesity were only observed in women (adjusted OR: 0.46, 95% CI: 0.26-0.80). Men below 65 years old had higher obesity prevalence (adjusted OR: 1.76, 95% CI: 1.34-2.30). Daily alcohol consumption was associated with lower odds of being obese among men (adjusted OR: 0.72, 95% CI: 0.55-0.95). Hypertension, diabetes mellitus and dyslipidaemia were associated with higher obesity prevalence among residents, regardless of gender. CONCLUSIONS Walkable environment may improve health outcomes for rural communities in Japan. Further studies are required to create equitable and inclusive living spaces for men and women to access healthier lifestyle choices.
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Affiliation(s)
- Grace Koh
- Department of Epidemiology and Health Policy, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Michikazu Sekine
- Department of Epidemiology and Health Policy, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan.,Organization for Promotion of Regional Collaboration, Community Medicine and Health Support Division, University of Toyama, Toyama 930-0194, Japan
| | - Masaaki Yamada
- Department of Epidemiology and Health Policy, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan.,Organization for Promotion of Regional Collaboration, Community Medicine and Health Support Division, University of Toyama, Toyama 930-0194, Japan
| | - Yuko Fujimura
- Department of Epidemiology and Health Policy, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan.,Organization for Promotion of Regional Collaboration, Community Medicine and Health Support Division, University of Toyama, Toyama 930-0194, Japan
| | - Takashi Tatsuse
- Department of Epidemiology and Health Policy, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
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Howell NA, Booth GL. The Weight of Place: Built Environment Correlates of Obesity and Diabetes. Endocr Rev 2022; 43:966-983. [PMID: 35201344 PMCID: PMC9695105 DOI: 10.1210/endrev/bnac005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Indexed: 11/19/2022]
Abstract
In recent decades, the prevalence of obesity and diabetes has risen substantially in North America and worldwide. To address these dual epidemics, researchers and policymakers alike have been searching for effective means to promote healthy lifestyles at a population level. As a consequence, there has been a proliferation of research examining how the "built" environment in which we live influences physical activity levels, by promoting active forms of transportation, such as walking and cycling, over passive ones, such as car use. Shifting the transportation choices of local residents may mean that more members of the population can participate in physical activity during their daily routine without structured exercise programs. Increasingly, this line of research has considered the downstream metabolic consequences of the environment in which we live, raising the possibility that "healthier" community designs could help mitigate the rise in obesity and diabetes prevalence. This review discusses the evidence examining the relationship between the built environment, physical activity, and obesity-related diseases. We also consider how other environmental factors may interact with the built environment to influence metabolic health, highlighting challenges in understanding causal relationships in this area of research.
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Affiliation(s)
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
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10
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Huang H. Moderating Effects of Racial Segregation on the Associations of Cardiovascular Outcomes with Walkability in Chicago Metropolitan Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14252. [PMID: 36361132 PMCID: PMC9657023 DOI: 10.3390/ijerph192114252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Cardiovascular diseases (CVDs), as the leading cause of death in the U.S., pose a disproportionate burden to racial/ethnic minorities. Walkability, as a key concept of the built environment, reflecting walking and physical activity, is associated with health behaviors that help to reduce CVDs risk. While the unequal social variation and spatial distribution inequality of the CVDs and the role of walkability in preventing CVDs have been explored, the moderating factors through which walkability affects CVDs have not been quantitatively analyzed. In this paper, the spatial statistical techniques combined with the regression model are conducted to study the distribution of the CVDs' health outcomes and factors influencing their variation in the Chicago metropolitan area. The spatial statistical results for the CVDs' health outcomes reveal that clusters of low-value incidence are concentrated in the suburban rural areas and areas on the north side of the city, while the high-value clusters are concentrated in the west and south sides of the city and areas extending beyond the western and southern city boundaries. The regression results indicate that racial segregation reduced the positive association between health outcomes and walkability, although both racial segregation and walkability factors were positively associated with CVDs' health outcomes.
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Affiliation(s)
- Hao Huang
- Department of Social Sciences, Illinois Institute of Technology, Chicago, IL 60616, USA
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Pedrick-Case R, Bailey R, Beck B, Beesley B, Boruff B, Brophy S, Cross D, Dhamrait G, Duncan J, Gething P, Johnson RD, Lyons RA, Mizen A, Murray K, Pouliou T, Rafferty J, Robinson T, Rosenberg M, Schipperijn J, Thompson DA, Trost SG, Watkins A, Stratton G, Fry R, Christian H, Griffiths LJ. Built Environments And Child Health in WalEs and AuStralia (BEACHES): a study protocol. BMJ Open 2022; 12:e061978. [PMID: 36283749 PMCID: PMC9608521 DOI: 10.1136/bmjopen-2022-061978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Childhood obesity and physical inactivity are two of the most significant modifiable risk factors for the prevention of non-communicable diseases (NCDs). Yet, a third of children in Wales and Australia are overweight or obese, and only 20% of UK and Australian children are sufficiently active. The purpose of the Built Environments And Child Health in WalEs and AuStralia (BEACHES) study is to identify and understand how complex and interacting factors in the built environment influence modifiable risk factors for NCDs across childhood. METHODS AND ANALYSIS This is an observational study using data from five established cohorts from Wales and Australia: (1) Wales Electronic Cohort for Children; (2) Millennium Cohort Study; (3) PLAY Spaces and Environments for Children's Physical Activity study; (4) The ORIGINS Project; and (5) Growing Up in Australia: the Longitudinal Study of Australian Children. The study will incorporate a comprehensive suite of longitudinal quantitative data (surveys, anthropometry, accelerometry, and Geographic Information Systems data) to understand how the built environment influences children's modifiable risk factors for NCDs (body mass index, physical activity, sedentary behaviour and diet). ETHICS AND DISSEMINATION This study has received the following approvals: University of Western Australia Human Research Ethics Committee (2020/ET000353), Ramsay Human Research Ethics Committee (under review) and Swansea University Information Governance Review Panel (Project ID: 1001). Findings will be reported to the following: (1) funding bodies, research institutes and hospitals supporting the BEACHES project; (2) parents and children; (3) school management teams; (4) existing and new industry partner networks; (5) federal, state and local governments to inform policy; as well as (6) presented at local, national and international conferences; and (7) disseminated by peer-reviewed publications.
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Affiliation(s)
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bridget Beesley
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Bryan Boruff
- School of Agriculture and Environment, University of Western Australia, Perth, Western Australia, Australia
| | - Sinead Brophy
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Donna Cross
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Gursimran Dhamrait
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - John Duncan
- School of Agriculture and Environment, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Gething
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Rhodri D Johnson
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Amy Mizen
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Theodora Pouliou
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - James Rafferty
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Trina Robinson
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Rosenberg
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Daniel A Thompson
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stewart G Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Gareth Stratton
- Research Centre in Applied Sports, Technology, Exercise and Medicine, Swansea University, Swansea, UK
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Hayley Christian
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Lucy J Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
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12
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Meng L, Xu J, Li J, Hu J, Xu H, Wu D, Hu X, Zeng X, Zhang Q, Li J, Gong T, Liu D. Self-reported prevalence and potential factors influencing cardio-cerebral vascular disease among the Chinese elderly: A national cross-sectional study. Front Cardiovasc Med 2022; 9:979015. [PMID: 36337863 PMCID: PMC9630358 DOI: 10.3389/fcvm.2022.979015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Aging is an essential national condition throughout China in the 21st century. Cardio-cerebral vascular disease (CCVD) is a common chronic vascular disease in the elderly. Despite aging becoming an increasingly pressing issue, there has been no comprehensive national investigation into the risk factors, prevalence, and management of CCVD among the elderly population in China. MATERIALS AND METHODS Through the 4th Survey of the Aged Population in Urban and Rural China (SSAPUR), a nationally representative sample of 224,142 adults aged more than 60 years was surveyed using a multistage, stratified sampling method. The 4th SSAPUR was used to investigate CCVD in the elderly. Univariate and multivariate logistic proportional regression analyses explored the risk factors. These risk factors were then entered into a multivariate linear regression model to identify independent predictive factors for CCVD. Disease management was assessed from the self-reported history of physician diagnosis, treatments, and hospital visits among individuals with CCVD. RESULTS After excluding samples with missing information, 215,041 individuals were included in the analysis. The overall prevalence of CCVD was 26%. Living in a rural area, being older, being female, having low literacy, smoking, getting little sleep, losing a spouse, being single, not getting enough exercise, having a bad financial situation, and not taking part in public welfare programs were the main risk factors for CCVD among the elderly in China (P < 0.05). In the multivariate linear regression model, holding all other variables at any fixed value, CCVD remained associated with "urban and rural" (β = 0.012, P < 0.001), "age" (β = -0.003, P < 0.001), "sex" (β = -0.022, P < 0.001), "education level" (β = -0.017, P < 0.001), "marriage" (β = 0.004, P = 0.047), "smoking" (β = 0.012, P = 0.003), "drinking" (β = -0.015, P = 0.001), and "sleep" (β = 0.008, P = 0.005). There were no collinearity problems among these factors. CONCLUSION Major risk factors for prevalent CCVD among the elderly in China include the following: rural residence, female, low literacy level, poor sleep quality, bereavement, non-marriage, living alone, lack of exercise, poor financial situation, and non-participation in public welfare activities. Chinese national policies for preventing, controlling, and managing risk factors for CCVD in the elderly must be urgently developed.
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Affiliation(s)
- Lingbing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiapei Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Peking University Fifth School of Clinical Medicine (Beijing Hospital), Beijing, China
| | - Jianyi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiabin Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Hongxuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Dishan Wu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Xuezhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Juan Li
- Center on Aging Psychology, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Deping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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India-Aldana S, Kanchi R, Adhikari S, Lopez P, Schwartz MD, Elbel BD, Rummo PE, Meeker MA, Lovasi GS, Siegel KR, Chen Y, Thorpe LE. Impact of land use and food environment on risk of type 2 diabetes: A national study of veterans, 2008-2018. ENVIRONMENTAL RESEARCH 2022; 212:113146. [PMID: 35337829 PMCID: PMC10424702 DOI: 10.1016/j.envres.2022.113146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/20/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Large-scale longitudinal studies evaluating influences of the built environment on risk for type 2 diabetes (T2D) are scarce, and findings have been inconsistent. OBJECTIVE To evaluate whether land use environment (LUE), a proxy of neighborhood walkability, is associated with T2D risk across different US community types, and to assess whether the association is modified by food environment. METHODS The Veteran's Administration Diabetes Risk (VADR) study is a retrospective cohort of diabetes-free US veteran patients enrolled in VA primary care facilities nationwide from January 1, 2008, to December 31, 2016, and followed longitudinally through December 31, 2018. A total of 4,096,629 patients had baseline addresses available in electronic health records that were geocoded and assigned a census tract-level LUE score. LUE scores were divided into quartiles, where a higher score indicated higher neighborhood walkability levels. New diagnoses for T2D were identified using a published computable phenotype. Adjusted time-to-event analyses using piecewise exponential models were fit within four strata of community types (higher-density urban, lower-density urban, suburban/small town, and rural). We also evaluated effect modification by tract-level food environment measures within each stratum. RESULTS In adjusted analyses, higher LUE had a protective effect on T2D risk in rural and suburban/small town communities (linear quartile trend test p-value <0.001). However, in lower density urban communities, higher LUE increased T2D risk (linear quartile trend test p-value <0.001) and no association was found in higher density urban communities (linear quartile trend test p-value = 0.317). Particularly strong protective effects were observed for veterans living in suburban/small towns with more supermarkets and more walkable spaces (p-interaction = 0.001). CONCLUSION Among veterans, LUE may influence T2D risk, particularly in rural and suburban communities. Food environment may modify the association between LUE and T2D.
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Affiliation(s)
- Sandra India-Aldana
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Rania Kanchi
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Samrachana Adhikari
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Priscilla Lopez
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Mark D Schwartz
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 9th Fl., New York, NY, 10016, USA; VA New York Harbor Healthcare System, 423 E 23rd, New York, NY, 10010, USA
| | - Brian D Elbel
- Division of Health and Behavior, Section on Health Choice, Policy and Evaluation, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 3rd Fl., New York, NY, 10016, USA; NYU Wagner Graduate School of Public Service, 295 Lafayette Street, New York, NY, 10012, USA
| | - Pasquale E Rummo
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA
| | - Melissa A Meeker
- Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104, USA
| | - Gina S Lovasi
- Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104, USA
| | - Karen R Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA; Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorna E Thorpe
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5th Fl., New York, NY, 10016, USA.
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Physical Activity and Food Environments in and around Schools: A Case Study in Regional North-West Tasmania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106238. [PMID: 35627775 PMCID: PMC9140536 DOI: 10.3390/ijerph19106238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
A better understanding of the physical activity (PA) infrastructure in schools, the walkability of neighborhoods close to schools, and the food environments around schools, particularly in rural, socioeconomically challenged areas such as the North-West (NW) of Tasmania, could be important in the wider effort to improve the health of school-age children. Accordingly, this research aimed to assess PA resources, walkability, and food environments in and around schools in three socioeconomically disadvantaged, regional/rural Local Government Areas (LGAs) of Tasmania, Australia. A census of schools (including assessment of the PA infrastructure quality within school grounds), a walkability assessment, and a census of food outlets surrounding schools (through geospatial mapping) were executed. Most of the schools in the study region had access to an oval, basketball/volleyball/netball court, and free-standing exercise equipment. In all instances (i.e., regardless of school type), the quality of the available infrastructure was substantially higher than the number of incivilities observed. Most schools also had good (i.e., within the first four deciles) walkability. Numerous food outlets were within the walking zones of all schools in the study region, with an abundance of food outlets that predominantly sold processed unhealthy food.
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Avila-Palencia I, Rodríguez DA, Miranda JJ, Moore K, Gouveia N, Moran MR, Caiaffa WT, Diez Roux AV. Associations of Urban Environment Features with Hypertension and Blood Pressure across 230 Latin American Cities. ENVIRONMENTAL HEALTH PERSPECTIVES 2022. [PMID: 35167325 DOI: 10.1289/isee.2021.o-lt-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease. OBJECTIVES We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities. METHODS In this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment. RESULTS A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase=1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR=1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase=0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase=1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment. DISCUSSION Our results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870.
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Affiliation(s)
- Ione Avila-Palencia
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel A Rodríguez
- Department of City and Regional Planning, University of California, Berkeley, Berkeley, California, USA
- Institute for Transportation Studies, University of California, Berkeley, Berkeley, California, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mika R Moran
- Institute of Urban and Regional Development, University of California, Berkeley, Berkeley, California, USA
| | - Waleska T Caiaffa
- Observatory for Urban Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerals, Brazil
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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16
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Avila-Palencia I, Rodríguez DA, Miranda JJ, Moore K, Gouveia N, Moran MR, Caiaffa WT, Diez Roux AV. Associations of Urban Environment Features with Hypertension and Blood Pressure across 230 Latin American Cities. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:27010. [PMID: 35167325 PMCID: PMC8846315 DOI: 10.1289/ehp7870] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease. OBJECTIVES We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities. METHODS In this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment. RESULTS A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase=1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR=1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase=0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase=1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment. DISCUSSION Our results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870.
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Affiliation(s)
- Ione Avila-Palencia
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel A. Rodríguez
- Department of City and Regional Planning, University of California, Berkeley, Berkeley, California, USA
- Institute for Transportation Studies, University of California, Berkeley, Berkeley, California, USA
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mika R. Moran
- Institute of Urban and Regional Development, University of California, Berkeley, Berkeley, California, USA
| | - Waleska T. Caiaffa
- Observatory for Urban Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerals, Brazil
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Frank LD, Adhikari B, White KR, Dummer T, Sandhu J, Demlow E, Hu Y, Hong A, Van den Bosch M. Chronic disease and where you live: Built and natural environment relationships with physical activity, obesity, and diabetes. ENVIRONMENT INTERNATIONAL 2022; 158:106959. [PMID: 34768046 DOI: 10.1016/j.envint.2021.106959] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/24/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Diabetes is among the most prevalent non-communicable diseases causing significant morbidity and mortality globally. The aetiology and disease development of diabetes are influenced by genetic, lifestyle, and environmental factors. Due to an increasing number of cases each year, it is imperative to improve the understanding of modifiable environmental risk and protective factors. In this study we aimed to analyse associations between built and natural environment features and diabetes prevalence; and two major risk factors: physical activity and obesity and their mediation effects. METHODS We analysed relationships between walkability and park availability with physical activity, obesity, and diabetes, using self-reported data from a large cross-sectional survey in British Columbia, Canada (n = 22,418). We validated results with an independent cohort (n = 11,972) in a subset of the analyses. The outcome measures included walking, moderate to vigorous physical activity (MVPA), body mass index (BMI), and diabetes. Built and natural environment features within a 1 km road network buffer around residential postal code centroids were assessed using validated indicators of walkability and park availability. We used general linear multivariable models (GLM) to examine the direct relationship between environmental features, physical activity, obesity, and diabetes respectively. Path models were developed to analyse mediation effects of physical activity and obesity on the association between environmental indicators and diabetes. The relative contribution of direct versus indirect effects was assessed. All models were adjusted for age, gender, income. ethnicity, years lived in neighbourhood and regional accessibility. RESULTS Walkable neighbourhoods and areas with greater park availability were associated with lower rates of diabetes. There was a direct association of walkability and park availability on physical activity (highest vs. lowest quintile OR = 1.15; 95% CI: 1.00, 1.33 and OR = 1.28, 95% CI: 1.13, 1.45 respectively), obesity (highest vs. lowest quintile OR = 0.58, 95% CI: 0.49, 0.70 and OR = 0.57, 95% CI: 0.48, 0.68 respectively) and diabetes (highest vs. lowest quintile OR = 0.62, 95% CI: 0.45, 0.85, and OR = 0.63, 95% CI: 0.47, 0.84 respectively). Results were similar in the independent cohort. The associations between diabetes and walkability and park availability respectively were partly mediated by obesity (41% of total association for walkability and 53% of total association for park availability). The mediating effect of physical activity was negligible. CONCLUSION Results support investments in walkability through active transportation and transit infrastructure. Changes in zoning and subdivision regulations governing land use actions are required to enable compact mixed-use environments with access to parks and high quality transit service. Future studies including cost-benefit analyses of health-related economic impacts of such investments can contribute to evidence-based decisions for healthier cities.
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Affiliation(s)
- Lawrence D Frank
- Department of Urban Studies and Planning, University of California at San Diego, La Jolla, CA 92093, USA; School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Binay Adhikari
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Katherine R White
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Trevor Dummer
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Cancer Control Research, BC Cancer, Canada
| | - Jat Sandhu
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Ellen Demlow
- Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Yumian Hu
- Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Andy Hong
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada; The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Matilda Van den Bosch
- School of Population and Public Health, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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18
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Horwitz J, Retnakaran R. Neighbourhood Walkability and Risk of Diabetes: Causal Relationship or Epidemiologic Association? Curr Diab Rep 2021; 21:57. [PMID: 34902065 DOI: 10.1007/s11892-021-01419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW We aim to evaluate whether the current literature supports (i) a causal relationship between neighbourhood walkability and risk of diabetes or instead (ii) a strictly epidemiologic association. RECENT FINDINGS Both cross-sectional and longitudinal studies have reported that neighbourhoods that are scored as having higher levels of walkability have lower rates of prevalent and incident diabetes, respectively. However, other studies have been inconclusive, with more nuanced findings suggesting that this association may be limited to particular demographic groups defined by age and socio-economics. Key factors limiting this literature include disparities in the measurement of walkability, the necessary reliance on observational study designs (recognizing the infeasibility of randomized controlled trials for addressing this question), and the difficulty of disentangling the potential concomitant effects of other components of the built environment. At this time, causality cannot be ascertained in the relationship between neighbourhood walkability and risk of diabetes.
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Affiliation(s)
- Jennifer Horwitz
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.
- Division of Endocrinology, University of Toronto, Toronto, Canada.
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada.
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Dendup T, Feng X, O'Shaughnessy P, Astell-Burt T. Perceived built environment and type 2 diabetes incidence: Exploring potential mediating pathways through physical and mental health, and behavioural factors in a longitudinal study. Diabetes Res Clin Pract 2021; 176:108841. [PMID: 33933500 DOI: 10.1016/j.diabres.2021.108841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/10/2021] [Accepted: 04/23/2021] [Indexed: 12/23/2022]
Abstract
AIMS The evidence on the pathways through which the built environment may influence type 2 diabetes (T2D) risk is limited. This study explored whether behavioural, physical and mental health factors mediate the associations between perceived built environment and T2D. METHODS Longitudinal data on 36,224 participants aged ≥45 years (The Sax Institute's 45 and Up Study) was analysed. Causal mediation analysis that uses the counterfactual approach to decompose the total effect into direct and indirect effects was performed. RESULTS The results showed that physical activity, recreational walking, and BMI mediated around 6%, 11%, and 30%, respectively, of the association between perceived lack of access to local amenities and T2D incidence. Physical activity (4.8% for day-time crime), recreational walking (2.3% for day-time crime), psychological distress (5.2% for day-time, 3.7% for night-time crime), and BMI (29.6% for day-time crime, 17.4% for night-time crime) also partially mediated the effect of perceived crime. Mediated effects appeared larger at wave 3 than the same wave 2 mediators. CONCLUSIONS The findings demonstrate that physical activity, psychological distress, and BMI mediate the pathways between the built environment and T2D. Policies aimed to bring amenities closer to homes, prevent crime, and address mental health may help reduce T2D risk.
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Affiliation(s)
- Tashi Dendup
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW 2522, Australia.
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW 2522, Australia; School of Population Health, Faculty of Medicine and Health, UNSW, Sydney, NSW 2052, Australia; Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia; National Institute of Environmental Health (NIEH), Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Pauline O'Shaughnessy
- School of Mathematics and Applied Statistics, University of Wollongong, NSW 2522, Australia.
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, NSW 2522, Australia; Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia; National Institute of Environmental Health (NIEH), Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health, Peking Union Medical College and the Chinese Academy of Medical Sciences, Beijing, China.
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20
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Kokkinos P, Myers J. Fitness for Richer, for Poorer. Eur J Prev Cardiol 2021; 28:448-449. [PMID: 33611463 DOI: 10.1177/2047487320905024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Kokkinos
- Cardiology Department, Veterans Affairs Medical Center Washington, USA
- Department of Kinesiology and Health, Rutgers University, USA
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto, USA
- Cardiology Department, Stanford University, USA
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21
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Coci M, Saunders J, Christian H. Barriers and motivators for preschoolers playing and walking with their dog: Results from qualitative research. Health Promot J Austr 2021; 33:19-27. [PMID: 33749951 DOI: 10.1002/hpja.483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 11/07/2022] Open
Abstract
ISSUES ADDRESSED A large proportion of preschoolers do not meet the recommended three hours of daily physical activity. A potential source of daily physical activity could be that provided via the family dog. This qualitative study aimed to explore the barriers and motivators to preschoolers playing with their dog and participating in family dog walks. METHODS Twelve in-depth interviews were conducted with parents of preschoolers who owned a dog. A semistructured interview guide was used, and transcripts were analysed thematically. RESULTS Factors influencing preschoolers playing with their dog and participating in family dog walks included parents' level of attachment to their dog, parental history of dog ownership, parent modelling of safe dog play, type of play the family dog enjoys and proximity to dog- and child-friendly destinations. Other factors such as the size, level of socialisation and perceived exercise requirements of the dog, physical environment factors such as backyard size and individual factors such as time and existing commitments were also reported. CONCLUSIONS A number of dog, individual and physical environment specific factors should be considered when promoting preschooler physical activity through dog walking and play. SO WHAT?: A large proportion of preschoolers do not meet the recommended three hours of daily physical activity. In Australia, 43% of Australian households with children aged four to five own a dog. Dog-facilitated physical activity through family dog walks and active play could be an effective strategy for increasing preschooler physical activity.
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Affiliation(s)
- Melissa Coci
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Julie Saunders
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Hayley Christian
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
- Telethon Kids Institute, University of Western Australia, Crawley, WA, Australia
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22
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Lee EY, Choi J, Lee S, Choi BY. Objectively Measured Built Environments and Cardiovascular Diseases in Middle-Aged and Older Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041861. [PMID: 33672927 PMCID: PMC7917898 DOI: 10.3390/ijerph18041861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Abstract
This study assesses the association between the objectively measured built environment and cardiovascular diseases (CVDs) in 50,741 adults from the Korean Community Health Survey. The CVD outcomes of hypertension, diabetes, dyslipidemia, stroke, and myocardial infarction (MI) or angina were derived from self-reported histories of physician diagnoses. Using ArcGIS software and Korean government databases, this study measured the built environment variables for the 546 administrative areas of Gyeonggi province. A Bayesian spatial multilevel model was performed independently in two age groups (i.e., 40–59 years or ≥60 years). After adjusting for statistical significant individual- and community-level factors with the spatial associations, living far from public transit was associated with an increase in the odds of MI or angina in middle-aged adults, while living in neighborhoods in which fast-food restaurants were concentrated was associated with a decrease in the odds of hypertension and stroke. For adults 60 or older, living farther from public physical-activity (PA) facilities was associated with a 15% increased odds for dyslipidemia, compared with living in neighborhoods nearer to PA facilities. These findings suggest that creating a built environment that provides more opportunities to engage in PA in everyday life should be considered a strategy to reduce the prevalence of CVD.
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Affiliation(s)
- Eun Young Lee
- Department of Nursing, Kkottongnae University, Cheongju 28211, Korea;
| | - Jungsoon Choi
- Department of Mathematics, Hanyang University, Seoul 04763, Korea
- Research Institute for Natural Sciences, Hanyang University, Seoul 04763, Korea
- Correspondence: ; Tel.: +82-2-2220-2621; Fax: +82-2-2281-0019
| | - Sugie Lee
- Department of Urban Planning and Engineering, Hanyang University, Seoul 04763, Korea;
| | - Bo Youl Choi
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea;
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23
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Florindo AA, Teixeira IP, Barrozo LV, Sarti FM, Fisberg RM, Andrade DR, Garcia LMT. Study protocol: health survey of Sao Paulo: ISA-Physical Activity and Environment. BMC Public Health 2021; 21:283. [PMID: 33541300 PMCID: PMC7859902 DOI: 10.1186/s12889-021-10262-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Many studies have investigated the association between the built environment and physical activity behavior in urban settings. However, most of the studies conducted in low- and middle-income countries were cross-sectional, which are limited to identify behavioral determinants. We propose a prospective cohort study to verify the relationship between built environment features and leisure-time and transport-related physical activity in adults from Sao Paulo city, Brazil. Methods Prospective multilevel cohort, denominated “ISA-Physical Activity and Environment”. It will build on the Health Survey of Sao Paulo in 2015 (“Inquérito de Saúde de São Paulo (ISA)” in Portuguese). The Health Survey of Sao Paulo, originally designed as a cross-sectional survey, had a multi-stage sample, covering 150 census tracts distributed in five health administrative areas. Data collection was performed by face-to-face interviews until December 2015 and the sample comprised 4043 individuals aged 12 years or more. The ISA-Physical Activity and Environment study will reassess people who are aged 18 years or more in 2020, including telephone and household interviews. The primary outcome will be leisure-time and transport-related physical activity, assessed through the International Physical Activity Questionnaire long version. Exposure variables will be built environment features in the areas participants live and work in the follow-up. Data analysis will include multivariate multilevel linear and logistic models. We will also conduct cost-effectiveness analysis and develop agent-based models to help inform decision-makers. The study will be conducted by an interdisciplinary research team specialized in physical activity epidemiology, nutritional epidemiology, georeferencing applied to health, statistics, agent-based modeling, public health policy, and health economics. Discussion There are few longitudinal studies on the relationship between the built environment and physical activity behavior in low- and middle-income countries. We believe that the ISA-Physical Activity and Environment study will contribute with important results for the progress of the knowledge in this field and for the implementation of policies that promote leisure-time physical activity and active travel in Sao Paulo and similar cities across the world.
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Affiliation(s)
- Alex Antonio Florindo
- School of Arts, Sciences and Humanities, University of Sao Paulo, Rua Arlindo Bettio, 1000, Sao Paulo, SP, 03828-000, Brazil. .,Graduate Program in Nutrition in Public Health, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil. .,Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo, Brazil.
| | - Inaian Pignatti Teixeira
- School of Arts, Sciences and Humanities, University of Sao Paulo, Rua Arlindo Bettio, 1000, Sao Paulo, SP, 03828-000, Brazil.,Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Ligia Vizeu Barrozo
- Department of Geography, School of Philosophy, Literature and Human Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Flávia Mori Sarti
- School of Arts, Sciences and Humanities, University of Sao Paulo, Rua Arlindo Bettio, 1000, Sao Paulo, SP, 03828-000, Brazil.,Graduate Program in Nutrition in Public Health, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Regina Mara Fisberg
- Graduate Program in Nutrition in Public Health, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.,Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
| | - Douglas Roque Andrade
- School of Arts, Sciences and Humanities, University of Sao Paulo, Rua Arlindo Bettio, 1000, Sao Paulo, SP, 03828-000, Brazil.,Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Leandro Martin Totaro Garcia
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo, Brazil.,Centre for Public Health, Queen's University Belfast, Belfast, UK
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Bácsné-Bába É, Ráthonyi G, Pfau C, Müller A, Szabados GN, Harangi-Rákos M. Sustainability-Sport-Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041455. [PMID: 33557153 PMCID: PMC7913963 DOI: 10.3390/ijerph18041455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/05/2023]
Abstract
The present study is a synthesizing analysis of international literature on correlations between sustainability, sport, and physical activity. The study of sustainability is considered essential in modern research; its multidisciplinary approach relies on sports science and sports economics as well. There are several aspects of sustainability that are closely associated with health and health preservation; the beneficial effect of exercise on health is also widely known. For the analysis of this complex matter, our current study relied on secondary sources, and besides exploring specialist literature, it also illustrates and analyzes related statistical data. Our results highlight the correlations between living environment and physical activity, the importance of increasing individual commitment towards sustainability and using green spaces for exercising, as well as questions on social and environmental development in relation to physical activity. The study revealed the existence of highly complex links between physical environment, physical activities, and sustainability. The results section of our study provides a brief summary on the possible ways of making people physically active. Increasing physical activity is of paramount importance for achieving the objectives formulated in relation to sustainability.
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Affiliation(s)
- Éva Bácsné-Bába
- Institute of Sport Management, University of Debrecen, H-4032 Debrecen, Hungary; (É.B.-B.); (C.P.); (A.M.)
| | - Gergely Ráthonyi
- Institute of Applied Informatics and Logistics, University of Debrecen, H-4032 Debrecen, Hungary
- Correspondence: ; Tel.: +36-52-508-390
| | - Christa Pfau
- Institute of Sport Management, University of Debrecen, H-4032 Debrecen, Hungary; (É.B.-B.); (C.P.); (A.M.)
| | - Anetta Müller
- Institute of Sport Management, University of Debrecen, H-4032 Debrecen, Hungary; (É.B.-B.); (C.P.); (A.M.)
| | - György Norbert Szabados
- Institute of Management and Organization Sciences, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Mónika Harangi-Rákos
- Institute of Rural Development, Regional Economy and Tourism Management, University of Debrecen, H-4032 Debrecen, Hungary;
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25
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Nichani V, Koohsari MJ, Oka K, Nakaya T, Shibata A, Ishii K, Yasunaga A, Turley L, McCormack GR. Associations between the traditional and novel neighbourhood built environment metrics and weight status among Canadian men and women. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:166-174. [PMID: 32696142 PMCID: PMC7851194 DOI: 10.17269/s41997-020-00365-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/08/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Neighbourhood characteristics can impact the health of residents. This study investigated associations between objectively derived neighbourhood characteristics, including novel space syntax metrics, and self-reported body mass index (BMI) among Canadian men and women. METHODS Our study included survey data collected from a random cross-section of adults residing in Calgary, Alberta (n = 1718). The survey, conducted in 2007/2008, captured participants' socio-demographic characteristics, health, and weight status (BMI). Participants' household postal codes were geocoded and 1600-m line-based network buffers estimated. Using a geographical information system, we estimated neighbourhood characteristics within each buffer including business destination density, street intersection density, sidewalk length, and population density. Using space syntax, we estimated street integration and walkability (street integration plus population density) within each buffer. Using adjusted regression models, we estimated associations between neighbourhood characteristics and BMI (continuous) and BMI categories (healthy weight vs. overweight including obese). Gender-stratified analysis was also performed. RESULTS Business destination density was negatively associated with BMI and the odds of being overweight. Among men, street intersection density and sidewalk length were negatively associated with BMI and street intersection density, business destination density, street integration, and space syntax walkability were negatively associated with odds of being overweight. Among women, business destination density was negatively associated with BMI. CONCLUSION Urban planning policies that impact neighbourhood design have the potential to influence weight among adults living in urban Canadian settings. Some characteristics may have a differential association with weight among men and women and should be considered in urban planning and in neighbourhood-focussed public health interventions.
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Affiliation(s)
- Vikram Nichani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| | - Mohammad Javad Koohsari
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
- Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, 980-8577, Japan
| | - Ai Shibata
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, 305-8577, Japan
| | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Akitomo Yasunaga
- Faculty of Liberal Arts and Sciences, Bunka Gakuen University, Shibuya City, Tokyo, 151-8523, Japan
| | - Liam Turley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Gavin R McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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26
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Jones AC, Chaudhary NS, Patki A, Howard VJ, Howard G, Colabianchi N, Judd SE, Irvin MR. Neighborhood Walkability as a Predictor of Incident Hypertension in a National Cohort Study. Front Public Health 2021; 9:611895. [PMID: 33598444 PMCID: PMC7882902 DOI: 10.3389/fpubh.2021.611895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
The built environment (BE) has been associated with health outcomes in prior studies. Few have investigated the association between neighborhood walkability, a component of BE, and hypertension. We examined the association between neighborhood walkability and incident hypertension in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Walkability was measured using Street Smart Walk Score based on participants' residential information at baseline (collected between 2003 and 2007) and was dichotomized as more (score ≥70) and less (score <70) walkable. The primary outcome was incident hypertension defined at the second visit (collected between 2013 and 2017). We derived risk ratios (RR) using modified Poisson regression adjusting for age, race, sex, geographic region, income, alcohol use, smoking, exercise, BMI, dyslipidemia, diabetes, and baseline blood pressure (BP). We further stratified by race, age, and geographic region. Among 6,894 participants, 6.8% lived in more walkable areas and 38% (N = 2,515) had incident hypertension. In adjusted analysis, neighborhood walkability (Walk Score ≥70) was associated with a lower risk of incident hypertension (RR [95%CI]: 0.85[0.74, 0.98], P = 0.02), with similar but non-significant trends in race and age strata. In secondary analyses, living in a more walkable neighborhood was protective against being hypertensive at both study visits (OR [95%CI]: 0.70[0.59, 0.84], P < 0.001). Neighborhood walkability was associated with incident hypertension in the REGARDS cohort, with the relationship consistent across race groups. The results of this study suggest increased neighborhood walkability may be protective for high blood pressure in black and white adults from the general US population.
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Affiliation(s)
- Alana C. Jones
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ninad S. Chaudhary
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amit Patki
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Virginia J. Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Natalie Colabianchi
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
- Department of Biostatistics, School of Public Health (M.R.E.), University of Michigan, Ann Arbor, MI, United States
| | - Suzanne E. Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Marguerite R. Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
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27
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Nichani V, Turley L, Vena JE, McCormack GR. Associations between the neighbourhood characteristics and body mass index, waist circumference, and waist-to-hip ratio: Findings from Alberta's Tomorrow Project. Health Place 2020; 64:102357. [PMID: 32479266 DOI: 10.1016/j.healthplace.2020.102357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
This study estimated the associations between neighbourhood characteristics and self-reported body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) risk categories among Canadian men and women. Using data from the Alberta's Tomorrow Project (n = 14,550), we estimated 3- and 4-way intersections, business destinations, population count, and normalized difference vegetation index (NDVI) within a 400 m radius of participant's home. Intersections, business destinations, and population count (z-scores) were summed to create a walkability score. Four-way intersections and walkability were negatively associated with overweight and obesity. Walkability was negatively associated with obesity. NDVI was negatively associated with high-risk WHR and population count and walkability positively associated with high-risk WHR. Among men, population count and walkability were negatively associated with obesity, and business destinations and walkability were negatively associated with overweight and obesity. Among women, NDVI was negatively associated with overweight (including obesity), obesity, and high-risk WC. Interventions promoting healthy weight could incorporate strategies that take into consideration local built environment characteristics.
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Affiliation(s)
- Vikram Nichani
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| | - Liam Turley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| | - Jennifer E Vena
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada; Cancer Control Alberta, Alberta Health Services, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada.
| | - Gavin R McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
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Buregeya JM, Loignon C, Brousselle A. Contribution analysis to analyze the effects of the health impact assessment at the local level: A case of urban revitalization. EVALUATION AND PROGRAM PLANNING 2020; 79:101746. [PMID: 31835151 DOI: 10.1016/j.evalprogplan.2019.101746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 10/04/2019] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
The health impact assessment (HIA) is a tool used to estimate the potential impact on health of non-health-related proposals prior to implementation. While it is increasingly used in Quebec, Canada, studies have not analyzed its medium-term impacts and potential long-term impacts. We conducted a contribution analysis using in-depth interviews with key stakeholders, as well as documents, observation and images related to HIA in order to analyze its impacts on the revitalization of road infrastructure, parks and green spaces, and residential housing. Our analysis not only reflects on the decision-making process through the adoption and implementation of HIA recommendations, but also on the link between actions implemented in the field and health outcomes.
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Affiliation(s)
- Jean Marie Buregeya
- Université de Sherbrooke, Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé, Canada.
| | - Christine Loignon
- Université de Sherbrooke, Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé, Canada
| | - Astrid Brousselle
- Université de Sherbrooke, Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé, Canada
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29
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Carroll SJ, Dale MJ, Taylor AW, Daniel M. Contributions of Multiple Built Environment Features to 10-Year Change in Body Mass Index and Waist Circumference in a South Australian Middle-Aged Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030870. [PMID: 32019246 PMCID: PMC7038103 DOI: 10.3390/ijerph17030870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/24/2022]
Abstract
Residential areas may shape health, yet few studies are longitudinal or concurrently test relationships between multiple residential features and health. This longitudinal study concurrently assessed the contributions of multiple environmental features to 10-year change in clinically measured body mass index (BMI) and waist circumference (WC). Longitudinal data for adults (18+ years of age, n = 2253) from the north-west of Adelaide, Australia were linked to built environment measures representing the physical activity and food environment (expressed for residence-based 1600 m road-network buffers) and area education. Associations were concurrently estimated using latent growth models. In models including all environmental exposure measures, area education was associated with change in BMI and WC (protective effects). Dwelling density was associated with worsening BMI and WC but also highly correlated with area education and moderately correlated with count of fast food outlets. Public open space (POS) area was associated with worsening WC. Intersection density, land use mix, greenness, and a retail food environment index were not associated with change in BMI or WC. This study found greater dwelling density and POS area exacerbated increases in BMI and WC. Greater area education was protective against worsening body size. Interventions should consider dwelling density and POS, and target areas with low SES.
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Affiliation(s)
- Suzanne J. Carroll
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia; (M.J.D.); (M.D.)
- Correspondence: ; Tel.: +61-2-6201-2851
| | - Michael J. Dale
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia; (M.J.D.); (M.D.)
| | - Anne W. Taylor
- Discipline of Medicine, The University of Adelaide, Adelaide, SA 5000, Australia;
| | - Mark Daniel
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia; (M.J.D.); (M.D.)
- Department of Medicine, St. Vincent’s Hospital, The University of Melbourne, Fitzroy, VIC 3065, Australia
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Kartschmit N, Sutcliffe R, Sheldon MP, Moebus S, Greiser KH, Hartwig S, Thürkow D, Stentzel U, van den Berg N, Wolf K, Maier W, Peters A, Ahmed S, Köhnke C, Mikolajczyk R, Wienke A, Kluttig A, Rudge G. Walkability and its association with prevalent and incident diabetes among adults in different regions of Germany: results of pooled data from five German cohorts. BMC Endocr Disord 2020; 20:7. [PMID: 31931801 PMCID: PMC6958624 DOI: 10.1186/s12902-019-0485-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/27/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Highly walkable neighbourhoods may increase transport-related and leisure-time physical activity and thus decrease the risk for obesity and obesity-related diseases, such as type 2 diabetes (T2D). METHODS We investigated the association between walkability and prevalent/incident T2D in a pooled sample from five German cohorts. Three walkability measures were assigned to participant's addresses: number of transit stations, points of interest, and impedance (restrictions to walking due to absence of intersections and physical barriers) within 640 m. We estimated associations between walkability and prevalent/incident T2D with modified Poisson regressions and adjusted for education, sex, age at baseline, and cohort. RESULTS Of the baseline 16,008 participants, 1256 participants had prevalent T2D. Participants free from T2D at baseline were followed over a mean of 9.2 years (SD: 3.5, minimum: 1.6, maximum: 14.8 years). Of these, 1032 participants developed T2D. The three walkability measures were not associated with T2D. The estimates pointed toward a zero effect or were within 7% relative risk increase per 1 standard deviation with 95% confidence intervals including 1. CONCLUSION In the studied German settings, walkability differences might not explain differences in T2D.
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Affiliation(s)
- Nadja Kartschmit
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Robynne Sutcliffe
- Centre for Urban Epidemiology, University Clinics Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Mark Patrick Sheldon
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Susanne Moebus
- Centre for Urban Epidemiology, University Clinics Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Karin Halina Greiser
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
- German Cancer Research Center DKFZ (Deutsches Krebsforschungszentrum) Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Saskia Hartwig
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Detlef Thürkow
- Institute of Geosciences and Geography, Martin-Luther-University Halle-Wittenberg, 06099, Halle (Saale), Germany
| | - Ulrike Stentzel
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany
| | - Neeltje van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany
| | - Kathrin Wolf
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Werner Maier
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Annette Peters
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Salman Ahmed
- Centre for Urban Epidemiology, University Clinics Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Corinna Köhnke
- Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
- German Center for Diabetes Research (Deutsches Zentrum für Diabetesforschung DZD), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - Gavin Rudge
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Abstract
This study aims to examine the relationship between the level of walkability and housing prices in Seoul, Korea. The average transaction price per square meter for each apartment complex was set as a dependent variable and the walkability score was used as an independent variable. This study divided a total of 5986 apartment complexes into areas with high and low housing prices for analysis. Based on the strong spatial autocorrelations of housing prices, this study employed spatial regression models in addition to the Ordinary Least Squares (OLS) model. Results showed that housing prices positively correlated with the walkability score in areas with low housing prices, whereas no significant association was observed in areas with high housing prices. Additional findings showed that housing prices were associated with building age (−), number of households in the complex (+), slope (−), and greenness (+) in both subsamples. Results also showed that high school quality had a different association with housing prices depending on the subsample (e.g., the sign was positive in areas with high housing prices and no significance in areas with low housing prices). The results herein support public policy proposals relevant to urban planning, environmental design, and housing policies.
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Abstract
The purpose of this study is to evaluate walkability levels using popular indices and check the measurement reliability between those indices. This study evaluates the city of Seoul, using 100 × 100 m grid points (N = 44,000) as spatial units of analysis. In this study, four types of indices were used to measure walkability levels: Walkability index (WI), Walk score (WS), Pedshed (Ps), and Movability index (MI). This study utilizes Pearson’s R, Brand–Altman plot with limit of agreement (LOA), and intraclass correlation coefficient (ICC) as reliability check methods. The measurement reliability among the four indices was found to be relatively high. The Pearson’s R values were between 0.308 and 0.645, and the range of inside LOA of Brand–Altman plots was 94.5% to 95.5%. The ICC value of the four indices was 0.544, indicating moderate reliability. The results reveal a relatively high level of measurement reliability between the four indices. On the basis of this study’s results, the level of walkability in other cities in Korea can be ascertained. The study may provide future direction for walkability index development that considers urban environmental characteristics. From the results, we expect that future urban planning and policies will aim to improve walkability.
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Is Seoul Walkable? Assessing a Walkability Score and Examining Its Relationship with Pedestrian Satisfaction in Seoul, Korea. SUSTAINABILITY 2019. [DOI: 10.3390/su11246915] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have assessed neighborhood walkability responding to increasing interest in academics, practitioners, and policy makers. While Walk Score is a well-operationalized and efficient measure of neighborhood walkability, it is not supported in the Asian context. We thus developed a “Walkability Score” for use in Seoul, South Korea, following the Walk Score algorithm and then conducted a logistic regression for a satisfied versus dissatisfied binary outcome in order to conduct an empirical test. Results showed a significant association between Walkability Score and pedestrian satisfaction. We also explored sample locations and found some discrepancies between Walkability Score and the degree of pedestrian satisfaction. While some sample locations near parks, and rivers and waterfront spaces (but without destinations for walking trips such as banking or shopping) revealed low Walkability Scores, the degree of pedestrian satisfaction was relatively high in these areas. Some samples located in residential areas with well-designed sidewalks and greenery revealed relatively high pedestrian satisfaction, but Walkability Scores were insufficient. This study’s Walkability Score was somewhat valid for approaching the issue, but further research is needed to complete this measure, especially in high-density areas with well-equipped pedestrian infrastructures (e.g., crosswalks, pedestrian streets).
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Valson JS, Kutty VR, Soman B, Jissa VT. Spatial Clusters of Diabetes and Physical Inactivity: Do Neighborhood Characteristics in High and Low Clusters Differ? Asia Pac J Public Health 2019; 31:612-621. [PMID: 31602998 DOI: 10.1177/1010539519879322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to find spatial clusters of diabetes and physical inactivity among a sample population in Kerala, India, and evaluate built environment characteristics within the high and low spatial clusters. Spatial clusters with a higher and lower likelihood of diabetes and physical inactivity were identified using spatial scan statistic at various radii. Built environment characteristics were captured at panchayat level and 1600 m buffer around participant location using Geographical Information Systems. Comparison of sociodemographic and built environment factors was carried out for participants within high and low spatial clusters using t tests. Ten high and 8 low spatial clusters of diabetes and 17 high and 23 low spatial clusters of physical inactivity were identified in urban and rural areas of Kerala. Significant differences in built environment characteristics were consistent for low spatial clusters of diabetes and physical inactivity in the urban scenario. Built environment characteristics were found to be relevant in both urban and rural areas of Kerala. There is an urgent call to explore spatial clustering of non-communicable diseases in Kerala and undo the one-size-fits-all approach for prevention and control of non-communicable diseases.
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Affiliation(s)
- Joanna Sara Valson
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - V Raman Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
| | - V T Jissa
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India
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Paulo Dos Anjos Souza Barbosa J, Henrique Guerra P, de Oliveira Santos C, de Oliveira Barbosa Nunes AP, Turrell G, Antonio Florindo A. Walkability, Overweight, and Obesity in Adults: A Systematic Review of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173135. [PMID: 31466371 PMCID: PMC6747269 DOI: 10.3390/ijerph16173135] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/13/2019] [Accepted: 07/13/2019] [Indexed: 11/16/2022]
Abstract
We conducted a systematic review to describe and summarize possible associations between the walkability index, overweight, and obesity. Systematic searches using seven electronic databases and reference lists were conducted to identify papers published until December 2017. Observational studies, describing associations using regression-based statistical methods, published in English and Portuguese, reporting markers of overweight and obesity, and involving adults (≥18 years) were included. Of the 2469 references initially retrieved, ten were used for the descriptive synthesis. Seven studies showed significant inverse associations between walkability and overweight and obesity, however, all were cross-sectional studies. High risk of bias scores were observed in "selection bias" and "withdrawals and dropouts". All studies were published in high-income countries with sample sizes ranging among 75 to 649,513 participants. Weight and height as measures for determining BMI tended to be self-reported. Indicators of walkability, such as land-use mix, street connectivity and residential density were used as components of the indices. Based on this review, more studies should be conducted in low, middle, and middle-high income countries, using longitudinal designs that control neighborhood self-selection; other indicators of the neighborhood environment, such as food access, physical activity facilities, sidewalks, and safety and crime prevention should be considered.
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Affiliation(s)
- João Paulo Dos Anjos Souza Barbosa
- Nutrition Department, Graduate Program in Public Health Nutrition, School of Public Health, University of São Paulo, Sao Paulo City 01246-904, Brazil.
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo City 03828-000, Brazil.
| | - Paulo Henrique Guerra
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
- Federal University of Fronteira Sul, Chapecó Campus, Chapecó 89815-899, Brazil
| | - Crislaine de Oliveira Santos
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
- School of Arts, Sciences and Humanities, Graduate Program in Physical Activity Sciences, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
| | | | - Gavin Turrell
- Centre for Urban Research, School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC 3000, Australia
| | - Alex Antonio Florindo
- Nutrition Department, Graduate Program in Public Health Nutrition, School of Public Health, University of São Paulo, Sao Paulo City 01246-904, Brazil
- Physical Activity Epidemiology Group, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
- School of Arts, Sciences and Humanities, Graduate Program in Physical Activity Sciences, University of Sao Paulo, Sao Paulo City 03828-000, Brazil
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Dendup T, Astell-Burt T, Feng X. Residential self-selection, perceived built environment and type 2 diabetes incidence: A longitudinal analysis of 36,224 middle to older age adults. Health Place 2019; 58:102154. [PMID: 31234122 DOI: 10.1016/j.healthplace.2019.102154] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
Abstract
Much of the existing studies on the built environment and type 2 diabetes are cross-sectional and prone to residential self-selection bias. Using multilevel logistic regression analysis of 36,224 participants from a longitudinal study, we examined whether perceived built environment characteristics are associated with type 2 diabetes. We found that the odds of diabetes incidence varied geographically. Those who reported that there were no local amenities and reported day- and night-time crime rates made walking unsafe in the neighbourhood had higher odds of developing incident type 2 diabetes. These associations persisted after accounting for some predictors of residential self-selection. More longitudinal studies are needed to corroborate the findings. Changing the features of the residential built environment may be an important point of intervention for type 2 diabetes prevention.
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Affiliation(s)
- Tashi Dendup
- Population Wellbeing and Environment Research Lab, School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia.
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab, School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales Australia; School of Public Health, Peking Union Medical College and The Chinese Academy of Medical Sciences, Beijing, China.
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab, School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales Australia.
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Wilkie S, Townshend T, Thompson E, Ling J. Restructuring the built environment to change adult health behaviors: a scoping review integrated with behavior change frameworks. ACTA ACUST UNITED AC 2019; 2:198-211. [PMID: 31650034 PMCID: PMC6777541 DOI: 10.1080/23748834.2019.1574954] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/16/2019] [Indexed: 12/30/2022]
Abstract
Built environment restructuring can improve public health through increased opportunity for healthy behaviors. Behavioral science targets individual health behaviors within place, suggesting the potential to integrate these approaches. This scoping review was one of the first to summarise the impact built environment restructuring has on health outcomes and behaviors and integrate these findings with the Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework of behavior change. Potential studies were identified from 12 academic databases in urban design, psychology and public health. Search parameters involved 50 environment types, for example green space or healthy cities, combined with both an intervention (e.g. green infrastructure, active transport) and a measurable health outcome (e.g. exercise, wellbeing). Searches were limited to North America, Europe, or Australia/New Zealand. Of 536 potential studies reviewed against defined inclusion/exclusion criteria, 23 contributed to the findings. Evidence supported the positive influence of restructuring on varied health outcomes, many of which were drivers and domains of health behavior. Most studies indicated a clear contribution to increased physical activity. Recommendations include the need for explicit communication of theories guiding restructuring project design, consideration of health outcomes beyond physical activity, and better investigation of unanticipated barriers to health behaviors arising from built environment restructuring projects.
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Affiliation(s)
- Stephanie Wilkie
- School of Psychology, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Tim Townshend
- School of Architecture, Planning and Landscape, Newcastle University, Newcastle, UK
| | - Emine Thompson
- Department of Architecture and Built Environment, Northumbria University, Newcastle Upon Tyne, UK
| | - Jonathan Ling
- School of Nursing and Health Sciences, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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Booth GL, Creatore MI, Luo J, Fazli GS, Johns A, Rosella LC, Glazier RH, Moineddin R, Gozdyra P, Austin PC. Neighbourhood walkability and the incidence of diabetes: an inverse probability of treatment weighting analysis. J Epidemiol Community Health 2019; 73:287-294. [PMID: 30696690 DOI: 10.1136/jech-2018-210510] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/04/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND People living in highly walkable neighbourhoods tend to be more physically active and less likely to be obese. Whether walkable urban design reduces the future risk of diabetes is less clear. METHODS We used inverse probability of treatment weighting to compare 10-year diabetes incidence between residents living in high-walkability and low-walkability neighbourhoods within five urban regions in Ontario, Canada. Adults (aged 30-85 years) who were diabetes-free on 1 April 2002 were identified from administrative health databases and followed until 31 March 2012 (n=958 567). Within each region, weights reflecting the propensity to live in each neighbourhood type were created based on sociodemographic characteristics, comorbidities and healthcare utilisation and incorporated into region-specific Cox proportional hazards models. RESULTS Low-walkability areas were more affluent and had more South Asian residents (6.4%vs3.6%, p<0.001) but fewer residents from other minority groups (16.6%vs21.7%, p<0.001). Baseline characteristics were well balanced between low-walkability and high-walkability neighbourhoods after applying individual weights (standardised differences all <0.1). In each region, high walkability was associated with lower diabetes incidence among adults aged <65 years (overall weighted incidence: 8.2vs9.2 per 1000; HR 0.85, 95% CI 0.78 to 0.93), but not among adults aged ≥65 years (weighted incidence: 20.7vs19.5 per 1000; HR 1.01, 95% CI 0.91 to 1.12). Findings were consistent regardless of income and immigration status. CONCLUSIONS Younger adults living in high-walkability neighbourhoods had a lower 10-year incidence of diabetes than similarly aged adults living in low-walkability neighbourhoods. Urban designs that support walking may have important benefits for diabetes prevention.
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Affiliation(s)
- Gillian L Booth
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Maria I Creatore
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jin Luo
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ghazal S Fazli
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Johns
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laura C Rosella
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Richard H Glazier
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rahim Moineddin
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Gozdyra
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter C Austin
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Lee K. The Relationship Between Housing Types and Metabolic and Weight Phenotypes: A Nationwide Survey. Metab Syndr Relat Disord 2019; 17:129-136. [PMID: 30668278 DOI: 10.1089/met.2018.0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compared to studies evaluating the effect of environmental factors on weight and health, relationships between housing types and health conditions are understudied. This study aimed to assess the relationship between housing types and metabolic and weight phenotypes using data from the 2014 to 2015 Korea National Health and Nutrition Examination Survey. METHODS A total of 9586 Korean adults (4128 men and 5458 women; mean age, 50.7 ± 16.5 years) were considered for this study. Four metabolic and weight phenotypes were created using presence/absence of metabolic syndrome and body mass index (<25 kg/m2 for normal weight vs. ≥25 kg/m2 for overweight). RESULTS Nonapartment residents were 1.23-fold (95% confidence interval: 1.07-1.42) more likely to have metabolically unhealthy and overweight phenotype compared to apartment residents, after adjusting for sociodemographic characteristics, residence area, health behaviors, and nutritional information awareness. In a subgroup analysis, nonapartment living was associated with higher odds for the metabolically unhealthy and overweight phenotype than living in an apartment in individuals with the following characteristics: age <60 years, education ≥ college, second-third quartile income level, married, living in urban area, alcohol <16 drinks/week, noncurrent smokers, and aware of nutritional information. CONCLUSIONS Housing types may be an indicator for increased risk of metabolic and weight phenotypes in Korean adults and used to select high risk individuals. Uncontrolled confounding factors related to housing types, including property assets and environmental attributes, may contribute to the findings.
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Affiliation(s)
- Kayoung Lee
- Department of Family Medicine, College of Medicine, Busan Paik Hospital, Inje University, Busan, Republic of Korea
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Jia X, Yu Y, Xia W, Masri S, Sami M, Hu Z, Yu Z, Wu J. Cardiovascular diseases in middle aged and older adults in China: the joint effects and mediation of different types of physical exercise and neighborhood greenness and walkability. ENVIRONMENTAL RESEARCH 2018; 167:175-183. [PMID: 30029039 DOI: 10.1016/j.envres.2018.07.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 06/12/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Both physical exercise and the built environment are associated with cardiovascular diseases (CVDs). Yet, the influence of the multiple dimensions of the built environment and different types of physical exercise on CVDs is not well understood. Further, little is known about the joint effects of physical exercise and the built environment, nor whether one mediates the effect of the other on the risk of CVDs. We aim to investigate the risk of CVDs on middle aged and older Chinese adult populations by analyzing the independent effects, as well as potential interactions and mediation effects of different types of physical exercise and two dimensions of the built environment; namely, greenness and walkability. METHODS Data were collected from a community-based cross-sectional study (n = 1944). The study participants, aged 40 years or older, came from 32 communities across urban, suburban, and rural areas in Longzihu district of Bengbu, a typical second-tier city in eastern China. Physical exercise data were obtained from the International Physical Activity Questionnaire (IPAQ) question survey. We used a satellite-based Normalized Difference Vegetation Index (NDVI) score to assess greenness exposure. We used both the Walk Score index and the Neighborhood Environment Walkability Scale (NEWS) to assess walkability. Multilevel logistic regression, also known as mixed-effects logistic regression, was used to estimate the associations between physical exercise and the built environment (greenness and walkability) on CVD outcomes while accounting for within-community and within-subdistrict correlations. We followed Baron and Kenny's framework and used bootstrapping to quantify the mediation of physical exercise between built environment and CVD outcomes. Stratified analysis was conducted by age (middle aged and older adults) and gender. RESULTS Compared to the reference group with little to low physical activities, we found a significantly reduced risk of hypertension (about 20-45% reduction) and coronary heart disease (about 35-55% reduction) among those with moderate to high activities in walking/square dancing or morning exercising/Tai Chi, and a significantly reduced risk of stroke (about 25% reduction) among those with moderate to high activities in walking/square dancing. Compared to the reference group with low NDVI-based greenness exposure, we found a significant reduction in risk of hypertension (about 55-85% reduction), coronary heart disease (about 75% reduction) and stroke (about 45% reduction) among those with moderate to high levels of exposure. Compared to the reference groups with low walkability, we observed about 30-60% lower risk of hypertension and coronary heart disease associated with moderate to high levels of Walk score, and about 20-30% lower risk of hypertension and stroke associated with moderate to high levels of NEWS-based walkability. We found no interactions between physical exercise and the built environment. The associations of greenness and walkability with CVDs were partially explained by physical exercise (up to 55% of the total effect). CONCLUSIONS Both physical exercise and built environment factors were associated with the risk of CVDs. Our observed association between CVDs and neighborhood greenness exposure and walkability was explained, in part, by physical exercises. Such a role, if confirmed in future studies, could have important implications for policies and programs aimed at increasing green spaces and improving walkability in both urban and rural settings as strategies to promote physical exercise in middle aged and older population.
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Affiliation(s)
- Xianjie Jia
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Ying Yu
- Department of Physiology, Bengbu Medical College, Bengbu, China
| | - Wanning Xia
- Department of Epidemiology and Statistics, Bengbu Medical College, Bengbu, China
| | - Shahir Masri
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA
| | - Mojgan Sami
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA
| | - Zhixiong Hu
- Department of Statistics, University of California, Irvine, USA
| | - Zhaoxia Yu
- Department of Statistics, University of California, Irvine, USA
| | - Jun Wu
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA.
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Laboratory-Assessed Markers of Cardiometabolic Health and Associations with GIS-Based Measures of Active-Living Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102079. [PMID: 30248924 PMCID: PMC6211066 DOI: 10.3390/ijerph15102079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022]
Abstract
Active-living-friendly environments have been linked to physical activity, but their relationships with specific markers of cardiometabolic health remain unclear. We estimated the associations between active-living environments and markers of cardiometabolic health, and explored the potential mediating role of physical activity in these associations. We used data collected on 2809 middle-aged adults who participated in the Canadian Health Measures Survey (2007⁻2009; 41.5 years, SD = 15.1). Environments were assessed using an index that combined GIS-derived measures of street connectivity, land use mix, and population density. Body mass index (BMI), systolic blood pressure (SBP), hemoglobin A1c, and cholesterol were assessed in a laboratory setting. Daily step counts and moderate-to-vigorous intensity physical activity (MVPA) were assessed for seven days using accelerometers. Associations were estimated using robust multivariable linear regressions adjusted for sociodemographic factors that were assessed via questionnaire. BMI was 0.79 kg/m² lower (95% confidence interval (CI) -1.31, -0.27) and SBP was 1.65 mmHg lower (95% CI -3.10, -0.20) in participants living in the most active-living-friendly environments compared to the least, independent of daily step counts or MVPA. A 35.4 min/week difference in MPVA (95% CI 24.2, 46.6) was observed between residents of neighborhoods in the highest compared to the lowest active-living-environment quartiles. Cycling to work rates were also the highest in participants living in the highest living-environment quartiles (e.g., Q4 vs. Q1: 10.4% vs. 4.9%). Although active-living environments are associated with lower BMI and SBP, and higher MVPA and cycling rates, neither daily step counts nor MVPA appear to account for environment⁻BMI/SBP relationships. This suggests that other factors not assessed in this study (e.g., food environment or unmeasured features of the social environment) may explain this relationship.
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Abstract
PURPOSE OF REVIEW The objective of this review is to highlight the evidence on the association between contextual characteristics of residential environments and type 2 diabetes, to provide an overview of the methodological challenges and to outline potential topics for future research in this field. RECENT FINDINGS The link between neighborhood socioeconomic status or deprivation and diabetes prevalence, incidence, and control is robust and has been replicated in numerous settings, including in experimental and quasi-experimental studies. The association between characteristics of the built environment that affect physical activity, other aspects of the built environment, and diabetes risk is robust. There is also evidence for an association between food environments and diabetes risk, but some conflicting results have emerged in this area. While the evidence base on the association of neighborhood socioeconomic status and built and physical environments and diabetes is large and robust, challenges remain related to confounding due to neighborhood selection. Moreover, we also outline five paths forward for future research on the role of neighborhood environments on diabetes.
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Affiliation(s)
- Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, 7th floor, Philadelphia, PA, 19104, USA.
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, 7th floor, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, 7th floor, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
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Nathan A, Villanueva K, Rozek J, Davern M, Gunn L, Trapp G, Boulangé C, Christian H. The Role of the Built Environment on Health Across the Life Course: A Call for CollaborACTION. Am J Health Promot 2018; 32:1460-1468. [DOI: 10.1177/0890117118779463a] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, Quyyumi AA, Taylor HA, Gulati M, Harold JG, Mieres JH, Ferdinand KC, Mensah GA, Sperling LS. Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. Circulation 2018; 137:2166-2178. [PMID: 29760227 PMCID: PMC5958918 DOI: 10.1161/circulationaha.117.029652] [Citation(s) in RCA: 675] [Impact Index Per Article: 112.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.
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Affiliation(s)
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | | | - Jia Shen
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Pratik Sandesara
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | - Martha Gulati
- University of Arizona-Phoenix College of Medicine (M.G.)
| | - John G Harold
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.G.H.)
| | | | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
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Nieuwenhuijsen MJ. Influence of urban and transport planning and the city environment on cardiovascular disease. Nat Rev Cardiol 2018; 15:432-438. [DOI: 10.1038/s41569-018-0003-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Sarkar C, Webster C, Gallacher J. Neighbourhood walkability and incidence of hypertension: Findings from the study of 429,334 UK Biobank participants. Int J Hyg Environ Health 2018; 221:458-468. [PMID: 29398408 DOI: 10.1016/j.ijheh.2018.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 01/04/2018] [Accepted: 01/17/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND With an estimated one billion hypertension cases worldwide, the role of the built environment in its prevention and control is still uncertain. The present study aims to examine the associations between neighbourhood walkability and hypertension in a large and diverse population-based cohort. MATERIALS AND METHODS We examined the association between neighbourhood walkability and blood pressure outcomes for N = 429,334 participants drawn from the UK Biobank and aged 38-73 years. Neighbourhood walkability was objectively modelled from detailed building footprint-level data within multi-scale functional neighbourhoods (1.0-, 1.5- and 2.0-kilometer street catchments of geocoded dwelling). A series of linear and modified Poisson regression models were employed to examine the association between walkability and outcomes of diastolic blood pressure (DBP in mmHg), systolic blood pressure (SBP in mmHg) and prevalent hypertension adjusting for socio-demographic, lifestyle and related physical environmental covariates. We also examined the relationship between walkability and change in blood pressure for a sub-sample of participants with follow-up data and tested for interaction effects of age, sex, employment status, neighbourhood SES, residential density and green exposure. RESULTS Neighbourhood walkability within one-kilometer street catchment was beneficially associated with all the three blood pressure outcomes, independent of all other factors. Each interquartile increment in walkability was associated with the lower blood pressure outcomes of DBP (β = -0.358, 95% CI: -0.42, -0.29 mmHg), SBP (β = -0.833, 95% CI: -0.95, -0.72 mmHg) as well as reduced hypertension risk (RR = 0.970, 95% CI: 0.96, 0.98). The results remained consistent across spatial and temporal scales and were sensitive to sub-groups, with pronounced protective effects among female participants, those aged between 50 and 60 years, in employment, residing in deprived, high density and greener areas. CONCLUSION This large population-based cohort found evidence of protective association between neighbourhood walkability and blood pressure outcomes. Given the enduring public health impact of community design on individual behaviour and lifestyle, of particular interest, are the targetted upstream-level interventions in city design aimed at optimizing walkability. Further long term studies are required to assess its sustained effects upon hypertension prevention and control.
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Affiliation(s)
- Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong, Hong Kong Special Administrative Region, China.
| | - Chris Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Hong Kong, Hong Kong Special Administrative Region, China
| | - John Gallacher
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX, United Kingdom
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den Braver NR, Lakerveld J, Rutters F, Schoonmade LJ, Brug J, Beulens JWJ. Built environmental characteristics and diabetes: a systematic review and meta-analysis. BMC Med 2018; 16:12. [PMID: 29382337 PMCID: PMC5791730 DOI: 10.1186/s12916-017-0997-z] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). This study systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk/prevalence, worldwide. METHODS We systematically searched PubMed, EMBASE.com and Web of Science from their inception to 6 June 2017. Studies were included with adult populations (>18 years), T2DM or glycaemic markers as outcomes, and physical activity and/or food environment and/or residential noise as independent variables. We excluded studies of specific subsamples of the population, that focused on built environmental characteristics that directly affect the cardiovascular system, that performed prediction analyses and that do not report original research. Data appraisal and extraction were based on published reports (PROSPERO-ID: CRD42016035663). RESULTS From 11,279 studies, 109 were eligible and 40 were meta-analysed. Living in an urban residence was associated with higher T2DM risk/prevalence (n = 19, odds ratio (OR) = 1.40; 95% CI, 1.2-1.6; I2 = 83%) compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence (n = 8, OR = 0.79; 95% CI, 0.7-0.9; I2 = 92%) and more green space tended to be associated with lower T2DM risk/prevalence (n = 6, OR = 0.90; 95% CI, 0.8-1.0; I2 = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence. CONCLUSIONS An important strength of the study was the comprehensive overview of the literature, but our study was limited by the conclusion of mainly cross-sectional studies. In addition to other positive consequences of walkability and access to green space, these environmental characteristics may also contribute to T2DM prevention. These results may be relevant for infrastructure planning.
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Affiliation(s)
- N R den Braver
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.
| | - J Lakerveld
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | | | - J Brug
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Amsterdam School for Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - J W J Beulens
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010078. [PMID: 29304014 PMCID: PMC5800177 DOI: 10.3390/ijerph15010078] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/19/2017] [Accepted: 12/23/2017] [Indexed: 12/12/2022]
Abstract
Different elements of the environment have been posited to influence type 2 diabetes mellitus (T2DM). This systematic review summarizes evidence on the environmental determinants of T2DM identified in four databases. It proposes a theoretical framework illustrating the link between environment and T2DM, and briefly discusses some methodological challenges and potential solutions, and opportunities for future research. Walkability, air pollution, food and physical activity environment and roadways proximity were the most common environmental characteristics studied. Of the more than 200 reported and extracted relationships assessed in 60 studies, 82 showed significant association in the expected direction. In general, higher levels of walkability and green space were associated with lower T2DM risk, while increased levels of noise and air pollution were associated with greater risk. Current evidence is limited in terms of volume and study quality prohibiting causal inferences. However, the evidence suggests that environmental characteristics may influence T2DM prevention, and also provides a reasonable basis for further investigation with better quality data and longitudinal studies with policy-relevant environmental measures. This pursuit of better evidence is critical to support health-orientated urban design and city planning.
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Conroy SM, Shariff-Marco S, Yang J, Hertz A, Cockburn M, Shvetsov YB, Clarke CA, Abright CL, Haiman CA, Le Marchand L, Kolonel LN, Monroe KR, Wilkens LR, Gomez SL, Cheng I. Characterizing the neighborhood obesogenic environment in the Multiethnic Cohort: a multi-level infrastructure for cancer health disparities research. Cancer Causes Control 2018; 29:167-183. [PMID: 29222610 PMCID: PMC5806518 DOI: 10.1007/s10552-017-0980-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE We characterized the neighborhood obesogenic environment in the Multiethnic Cohort (MEC) by examining the associations of obesity with attributes of the social and built environment, establishing a multi-level infrastructure for future cancer research. METHODS For 102,906 African American, Japanese American, Latino, and white MEC participants residing predominately in Los Angeles County, baseline residential addresses (1993-1996) were linked to census and geospatial data, capturing neighborhood socioeconomic status (nSES), population density, commuting, food outlets, amenities, walkability, and traffic density. We examined neighborhood attributes and obesity (body mass index ≥ 30 kg/m2) associations using multinomial logistic regression, adjusting for individual-level (e.g., demographics, physical activity, and diet) and neighborhood-level factors. RESULTS NSES was associated with obesity among African Americans, Latinos, and whites (p-trend ≤ 0.02), with twofold higher odds (adjusted odds ratios, 95% confidence intervals) for living in the lowest versus highest quintile among African American women (2.07, 1.62-2.65), white men (2.11, 1.29-3.44), and white women (2.50, 1.73-3.61). Lower density of businesses among African American and white women and lower traffic density among white men were also associated with obesity (p-trends ≤ 0.02). CONCLUSIONS Our study highlights differential impacts of neighborhood factors across racial/ethnic groups and establishes the foundation for multi-level studies of the neighborhood context and obesity-related cancers.
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Affiliation(s)
- Shannon M Conroy
- Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | | | - Juan Yang
- Cancer Prevention Institute of California, Fremont, CA, USA
| | - Andrew Hertz
- Cancer Prevention Institute of California, Fremont, CA, USA
| | - Myles Cockburn
- Colorado School of Public Health, University of Colorado, Denver, CO, USA
| | | | | | - Cheryl L Abright
- University of Hawaii at Manoa School of Nursing and Dental Hygiene, Honolulu, HI, USA
| | | | | | | | | | | | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
- Cancer Prevention Institute of California, Fremont, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA, USA.
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Méline J, Chaix B, Pannier B, Ogedegbe G, Trasande L, Athens J, Duncan DT. Neighborhood walk score and selected Cardiometabolic factors in the French RECORD cohort study. BMC Public Health 2017; 17:960. [PMID: 29258476 PMCID: PMC5735827 DOI: 10.1186/s12889-017-4962-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/29/2017] [Indexed: 11/21/2022] Open
Abstract
Background Walkable neighborhoods are purported to impact a range of cardiometabolic outcomes through increased walking, but there is limited research that examines multiple cardiometabolic outcomes. Additionally, few Walk Score (a novel measure of neighborhood walkability) studies have been conducted in a European context. We evaluated associations between neighborhood Walk Score and selected cardiometabolic outcomes, including obesity, hypertension and heart rate, among adults in the Paris metropolitan area. Methods and results We used data from the second wave of the RECORD Study on 5993 participants recruited in 2011–2014, aged 34–84 years, and residing in Paris (France). To this existing dataset, we added Walk Score values for participants’ residential address. We used multilevel linear models for the continuous outcomes and modified Poisson models were used for our categorical outcomes to estimate associations between the neighborhood Walk Score (both as a continuous and categorical variable) (0–100 score) and body mass index (BMI) (weight/height2 in kg/m2), obesity (kg/m2), waist circumference (cm), systolic blood pressure (SBP) (mmHg), diastolic blood pressure (DBP) (mmHg), hypertension (mmHg), resting heart rate (RHR) (beats per minute), and neighborhood recreational walking (minutes per week). Most participants lived in Walker’s Paradise (48.3%). In multivariate models (adjusted for individual variables, neighborhood variables, and risk factors for cardiometabolic outcomes), we found that neighborhood Walk Score was associated with decreased BMI (β: -0.010, 95% CI: -0.019 to −0.002 per unit increase), decreased waist circumference (β: -0.031, 95% CI: -0.054 to −0.008), increased neighborhood recreational walking (β: +0.73, 95% CI: +0.37 to +1.10), decreased SBP (β: -0.030, 95% CI: -0.063 to −0.0004), decreased DBP (β: -0.028, 95% CI: -0.047 to −0.008), and decreased resting heart rate (β: -0.026 95% CI: -0.046 to −0.005). Conclusions In this large population-based study, we found that, even in a European context, living in a highly walkable neighborhood was associated with improved cardiometabolic health. Designing walkable neighborhoods may be a viable strategy in reducing cardiovascular disease prevalence at the population level.
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Affiliation(s)
- Julie Méline
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, 1 rue Victor Cousin, 75230, 05, Paris cedex, France.,Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, 56, boulevard Vincent Auriol CS 81393, 75646, Paris Cedex 13, France
| | - Basile Chaix
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, 1 rue Victor Cousin, 75230, 05, Paris cedex, France.,Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, 56, boulevard Vincent Auriol CS 81393, 75646, Paris Cedex 13, France
| | - Bruno Pannier
- IPC Medical Center, 6 Rue la Pérouse, 75016, Paris, France
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Leonardo Trasande
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.,Departments of Pediatrics and Environmental Medicine, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Jessica Athens
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Dustin T Duncan
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA. .,Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, Room 621, New York, NY, 10016, USA.
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