The Relationship between Urbanization, the Built Environment, and Physical Activity among Older Adults in Taiwan

Predicting the Use of New Multi-Use Trails and Parks in Historically Black, Low-Income Neighborhoods: The Role of Interpersonal Discussion and Civic Engagement

BACKGROUND

Residents of historically Black low-income neighborhoods experience disproportionately poorer health. Public infrastructure redevelopment projects (eg, multi-use trails, parks, and public transportation) may improve quality of life and health outcomes in these neighborhoods.

OBJECTIVES

The current study draws from communication infrastructure theory to examine the role of interpersonal discussion and civic engagement (belonging, collective efficacy) in intentions to use newly built trails and parks for physical activity.

METHODS

Community-based survey data from 398 randomly selected households in historically Black low-income neighborhoods impacted by health inequities were used to identify factors associated with intention to use multi-use trails being developed in the neighborhoods.

RESULTS

Interpersonal discussion, belonging, and collective efficacy were positively and independently associated with intentions to use parks and trails. Additionally, the civic engagement factors (belonging and collective efficacy) mediate the relationship between interpersonal discussion and intentions to use parks and trails.

CONCLUSION

Interpersonal discussions and civic engagement can promote new parks and trails in low-income neighborhoods, which in turn may increase physical activity and improve overall health of community members.

Association between neighborhood availability of physical activity facilities and cognitive performance in older adults

The existing evidence on the contextual influence of the availability of local facilities for physical activity on the cognitive health of elderly residents is sparse. This study examined the association between neighborhood physical activity facilities and cognitive health in older individuals. A cohort study of community-dwelling older adults was performed using baseline data and follow-up data from the Taiwan Biobank. Cognitive health was measured in 32,396 individuals aged 60-70 years using the Mini-Mental State Examination (MMSE) with follow-up information on 8025 participants. The district was used as the proxy for local neighborhood. To determine neighborhood physical activity facilities, school campuses, parks, activity centers, gyms, swimming pools, and stadiums were included. Multilevel linear regression models were applied to examine the associations of neighborhood physical activity facilities with baseline MMSE and MMSE decline during follow-up, with adjustment for individual factors and neighborhood socioeconomic characteristics. Multilevel analyses revealed that there was a neighborhood-level effect on cognitive health among older adults. After adjusting for compositional and neighborhood socioeconomic characteristics, baseline MMSE was higher in individuals living in the middle- (beta = 0.12, p-value = 0.140) and high-density facility (beta = 0.22, p-value = 0.025) groups than in the low-density group (p-value for trend-test = 0.031). MMSE decline during follow-up was slower in the middle- (beta = 0.15, p-value = 0.114) and high-density facility (beta = 0.27, p-value = 0.052) groups than in the low-density group (p-value for trend-test = 0.032). Greater neighborhood availability of physical activity facilities was associated with better cognitive health among older residents. These findings have implications for designing communities and developing strategies to support cognitive health of an aging population.

Potential pathways of association from green space to smartphone addiction

Green space is increasingly known to improve physical and mental health. Based on these benefits, green space might also be expected to help mitigate related harmful behavioral patterns, such as obsessive Internet use and relevant addictions. In response, we conducted a study on smartphone addiction, a new form of Internet addiction. We carried out a cross-sectional investigation in August 2022. We recruited 1011 smartphone users across China, measured the Normalized Difference Vegetation Index (NDVI) in their residential neighborhoods (in 1, 2, and 3 km buffers), and captured data on smartphone addiction via the Smartphone Addiction Scale - Short version (SAS-SV). Potential mediators between green space and smartphone addiction, including physical activity, stress, and loneliness, were also reported by participants using the Physical Activity Rating Scale-3 (PRS-3), Depression, Anxiety and Stress Scale-21 Items (DASS-21), and 8-items UCLA Loneliness Scale scales (ULS-8). Multiple linear regression was employed to examine the relationships between green space and smartphone addiction. Structural equation modeling was performed to examine the potential pathways between these variables. Unexpectedly, NDVI in 1 km buffers was positively associated with smartphone addiction. By contrast, population density, an indicator of urbanization, was associated with lower levels of smartphone addiction levels in all NDVI buffer sizes. Meanwhile, we found NDVI was strongly associated with population density as well as other indicators of urbanization. Generally, our findings are unexpected and suggest that greenness may serve as an indicator of urbanization at national levels and that urbanization may buffer against smartphone addiction. During the hot summer, green space and indoor facilities may have competitive land uses, so future research should examine whether this association exists in other seasons and scenarios. We also recommend alternative models to systematically evaluate the effects of different components of residential environments.

Physical Inactivity, Sedentary Behavior and Quality of Life in the Chilean Population: ENCAVI Results, 2015-2016

Regular physical activity (PA) is indicated to be one of the main healthy habits that allow populations to achieve a good quality of life (QoL); however, levels of physical inactivity (PI) and sedentary behavior (SB) have risen worldwide, with negative health effects. The aim of this study is to analyze PI and SB levels, as well as their association with QoL in the Chilean population. A secondary analysis was performed based on the database from the 2015-2016 National Quality of Life Survey (ENCAVI) in Chile, using the modules for sociodemographic characteristics, health, and PA. Contingency tables and logistic regressions were conducted to determine the association between PI (low-intensity PA, LIPA; low-moderate PA, LMPA), SB (P75), and QoL adjusted for sociodemographic variables. Approximately 84%, 83%, and 47% of the participants presented LIPA, LMPA, and moderate-high SB, respectively. Participants that presented high PI and SB had lower QoL scores than those who were more active (p < 0.05). We observe that, in people with PI (LIPA), there is a higher risk of a low QoL regarding mental and physical components (OR 1.941; OR 1.189, p < 0.001) among females (OR 1.473; OR 1.513, p < 0.001) and those of a low educational level (OR 2.170; OR 1.410 p < 0.001). People with PI (LMPA) increased their risk for a low QoL in regard to mental and physical components (OR 1.750; OR 1.458, p < 0.001) among females (OR 1.528; OR 1.507, p < 0.001) and those of a low educational level (OR 2.195; OR 1.402 p < 0.001). We observe that people with SB (P75) increased their risk of a low QoL concerning physical and mental components (OR 1.475; OR 1.257, p < 0.001) for those of the female gender (OR 1.615; OR 1.563, p < 0.001) and a low educational level (OR 2.248; OR 1.423 p < 0.001). High levels of PI in both intensities and SB impact QoL in the Chilean population. It is crucial to generate public policies for more PA, especially for females and those of lower educational levels.

Urbanization and physical activity in the global Prospective Urban and Rural Epidemiology study

Urbanization may influence physical activity (PA) levels, although little evidence is available for low- and middle- income countries where urbanization is occurring fastest. We evaluated associations between urbanization and total PA, as well as work-, leisure-, home-, and transport-specific PA, for 138,206 adults living in 698 communities across 22 countries within the Prospective Urban and Rural Epidemiology (PURE) study. The 1-week long-form International PA Questionnaire was administered at baseline (2003-2015). We used satellite-derived population density and impervious surface area estimates to quantify baseline urbanization levels for study communities, as well as change measures for 5- and 10-years prior to PA surveys. We used generalized linear mixed effects models to examine associations between urbanization measures and PA levels, controlling for individual, household and community factors. Higher community baseline levels of population density (- 12.4% per IQR, 95% CI - 16.0, - 8.7) and impervious surface area (- 29.2% per IQR, 95% CI - 37.5, - 19.7), as well as the rate of change in 5-year population density (- 17.2% per IQR, 95% CI - 25.7, - 7.7), were associated with lower total PA levels. Important differences in the associations between urbanization and PA were observed between PA domains, country-income levels, urban/rural status, and sex. These findings provide new information on the complex associations between urbanization and PA.

Benefit of Uracil-Tegafur Used as a Postoperative Adjuvant Chemotherapy for Stage IIA Colon Cancer

Background and Objectives: Postoperative adjuvant therapy with uracil and tegafur (UFT) is often used for stage II colon cancer in Japan, but a limited number of studies have investigated the effects of UFT in these patients. Materials and Methods: We conducted a population-based cohort study in patients with resected stage II colon cancer comparing the outcomes after postoperative adjuvant chemotherapy with UFT with an observation-only group. The data were collected from the Taiwan National Health Insurance Research Database from 2000 to 2015. The outcomes of the study were disease-free survival (DFS) and overall survival (OS). The hazard ratios (HRs) were calculated using multivariate Cox proportional hazard regression models. Results: No differences in the DFS and OS were detected between the UFT (1137 patients) and observation (2779 patients) cohorts (DFS: adjusted HR 0.702; 95% confidence interval (CI) 0.489-1.024; p = 0.074) (OS: adjusted HR 0.894; 95% CI 0.542-1.186; p = 0.477). In the subgroup analyses of the different substages, UFT prolonged DFS in patients with stage IIA colon cancer (adjusted HR 0.652; 95% CI 0.352-0.951; p = 0.001) compared with DFS in the observation cohort, but no differences in the OS were detected (adjusted HR 0.734; 95% CI 0.475-1.093; p = 0.503). Conclusions: Our results show that DFS improved significantly in patients with stage IIA colon cancer receiving UFT as a postoperative adjuvant chemotherapy compared with DFS in the observation group.

The Role of Molecular and Hormonal Factors in Obesity and the Effects of Physical Activity in Children

Obesity and overweight are defined as abnormal fat accumulations. Adipose tissue consists of more than merely adipocytes; each adipocyte is closely coupled with the extracellular matrix. Adipose tissue stores excess energy through expansion. Obesity is caused by the abnormal expansion of adipose tissue as a result of adipocyte hypertrophy and hyperplasia. The process of obesity is controlled by several molecules, such as integrins, kindlins, or matrix metalloproteinases. In children with obesity, metabolomics studies have provided insight into the existence of unique metabolic profiles. As a result of low-grade inflammation in the system, abnormalities were observed in several metabolites associated with lipid, carbohydrate, and amino acid pathways. In addition, obesity and related hormones, such as leptin, play an instrumental role in regulating food intake and contributing to childhood obesity. The World Health Organization states that physical activity benefits the heart, the body, and the mind. Several noncommunicable diseases, such as cardiovascular disease, cancer, and diabetes, can be prevented and managed through physical activity. In this work, we reviewed pediatric studies that examined the molecular and hormonal control of obesity and the influence of physical activity on children with obesity or overweight. The purpose of this review was to examine some orchestrators involved in this disease and how they are related to pediatric populations. A larger number of randomized clinical trials with larger sample sizes and long-term studies could lead to the discovery of new key molecules as well as the detection of significant factors in the coming years. In order to improve the health of the pediatric population, omics analyses and machine learning techniques can be combined in order to improve treatment decisions.

Life Satisfaction of Rural-To-Urban Migrants: Exploring the Influence of Socio-Demographic and Urbanisation Features in China

Objectives: China has experienced an ongoing urbanisation that associated with spatial transformation and personal changes, which are expected to have direct or indirect impacts on migrants’ health and well-being. This study aims to investigate their life satisfaction and the significant influences.

Method: A quantitative research strategy was adopted, with the questionnaire survey towards 877 migrants across Hangzhou and Ningbo cities. Descriptive statistics showed migrants’ life satisfaction, socio-demographic characteristics and urbanisation features. Three logistic regression models examined key factors that influenced life satisfaction.

Results: Over one third of migrants were unsatisfied with their life. They mainly received education lower than high school and had an annual household income less than 60k. Comparatively, migrants, who worked in formal sectors, moved into resettlement communities and adapted to city life, tended to have higher levels of life satisfaction.

Conclusion: There should be an improvement in migrants’ life satisfaction. This could be achieved by building up their educational level and financial capability. Meanwhile, positive actions such as professional training are required to maximise their participation in formal sectors as well as community life.

The Effect of Built Environment on Physical Health and Mental Health of Adults: A Nationwide Cross-Sectional Study in China

At present, there is a lack of research examining the relationships between the built environment and health status from a social epidemiological perspective. With this in mind, the present study aimed to explore the construct validity of housing/neighborhood conditions and evaluate the associations between the built environment and self-rated health among Chinese residents. To conduct the analysis, data from 4906 participants were derived from the 2016 China Labor-force Dynamics Survey (CLDS). Specifically, we used exploratory factor analysis to identify construct of housing/neighborhood factors and performed principal component regression (PCR) to assess the relationship between the built environment and both self-rated physical health and mental health. This process identified five common factors that corresponded to the built environment, including housing affordability, housing quality, neighborhood services, neighborhood physical environment, and perceived environment. The regression results suggested that housing affordability was negatively related to health status. Meanwhile, the services, physical environment, and perceived environment of neighborhoods were related to positive health outcomes. The influence of housing on health exhibits group heterogeneity: respondents in the 41 to 65 age group were most vulnerable to poor built environments. Whilst the results indicated that housing factors and neighborhood conditions were related to health outcomes, their influence varied across different age groups. Future interventions should be intentionally designed to target housing affordability and neighborhood factors, which may include the provision of housing assistance programs and planning layouts.

Cross-Sectional Associations between Living and Built Environments and Depression Symptoms among Chinese Older Adults

In this study, we explored the cross-sectional associations between living and built environments and depression among older Chinese adults. Data from 5822 participants were obtained. Depression symptoms were evaluated through the use of the Patient Health Questionnaire (PHQ-9), with a score higher than 4 categorized as having depression symptoms. The living environment was assessed by asking about dust in the environment and barrier-free facilities. We considered the presence of amenities within a 10 min walking distance and the proportion of green space within an 800 m distance from participants’ dwellings to reflect the built environment. Data were analyzed by multilevel logistic regression. Participants living in a non-dusty environment with proximity to green space had a lower risk of depression (non-dusty environment: OR = 0.784, 95% CI = 0.642, 0.956; green space: OR = 0.834, 95% CI = 0.697, 0.998). However, having no access to barrier-free facilities and hospital proximity increased the depression risk (barrier-free facilities: OR = 1.253, 95% CI = 1.078, 1.457; hospital: OR = 1.318, 95% CI = 1.104, 1.574). Dusty environments, access to barrier-free facilities and proximity to hospitals and green spaces were associated with depression symptoms among older Chinese adults.

Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries-A Qualitative Systematic Review with Meta-Synthesis

Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context.

Effects and Environmental Features of Mountainous Urban Greenways (MUGs) on Physical Activity

The role played by urban greenways in supporting physical activity (PA) for public health benefits has been receiving increasing attention. Most studies on this topic have been conducted in plains, whereas studies in mountainous regions have been limited as a result of the complexity of these areas. To address this knowledge gap, this article aims to analyze the effects of the environmental features for a mountainous urban greenway (MUG) on PA, leading to better support for greenway practice in mountainous areas. A volunteered geographic information (VGI) method was applied through the mobile app KEEP to collect 1314 valid records of PA including its density (total PA distance per unit area within the buffer zone) and attributes (distance, duration and speed) in the Yuzhong Peninsula, Chongqing, China. Similar to those of the studies conducted in the plains, our results showed that PA density was affected by the MUG and its surrounding environment. The key environmental features included residential density, open-space POI, the slope, the transportation-MUG (T-MUG) ratio and the recreational-MUG (R-MUG) ratio. For the PA attributes, the MUG showed stronger effects than the surrounding environment. The key environmental features included the slope and type of MUG, of which the former was negatively associated with distance and speed. The T-MUG ratio was positively related to duration and speed, while the R-MUG ratio was positively related to duration and distance. No association was found between livelihood (L-MUG) and PA. Hence, to support both the PA density and attributes, the environmental qualities for recreation and the types of R-MUGs should be given more consideration in practice.

Exploring the role of built environments and depressive symptoms in community-dwelling older adults: A case of Taiwan

OBJECTIVES

Depression in older adults is a growing public health concern. However, limited research has focused on the issues of physical environments and depression in the elderly in Asia. The purpose of the study is to examine the relationship between the built environments and depressive symptoms in older adults using Taiwan as an example.

METHODS

Two national datasets were used in this study, including the 2009 National Health Interview Survey and the 2006 National Land Use Investigation in Taiwan. A total of 2,155 older adults were recruited, and eight built environments were examined among 161 townships. Depressive symptoms were measured using a 10-item CES-D scale, and four sophisticated models were built using a multi-level analysis.

RESULTS

Five types of built environments were found to be significantly associated with depressive symptoms in older adults. Among them, two types of built environments, 'health and medical services' and 'schools' were highly related to a lower CES-D score and lower odds of being depressed, whereas the other three built environments, 'cultural and historical facilities,' 'recreational and amusement areas,' and 'playgrounds and sports venues' were significantly associated with an increasing risk of being depressed.

CONCLUSIONS

Different built environments had different effects on depression and some even showed a dose-response relationship. These results can help urban planners or city designers reconsider how to facilitate the construction of built environments in neighborhoods that will improve the mental health of older adults.

Review of Ecological Approach Factors Affecting Physical Activity among Older People

This review aimed to investigate factors affecting physical activity among older people at the individual, social, and environmental levels based on an ecological approach. We searched PubMed, EMBASE, Web of Science, Cochrane Library, and Korean databases to identify all relevant studies that examined physical activity of older people using an ecological approach. Individual factors included socio-demographic characteristics, physical function components, and subjective health perceptions. Social factors included intimate relationships and social support. Environmental factors included physical living conditions, movement-related components, and policies and programs that affect the environment. This review analyzed the factors affecting physical activity of older people in three levels based on the ecological approach. This result provides a basis for managing, preventing, and promoting physical activity in older people based on an ecological approach and highlights the importance of environmental factors for improving physical activity among older people when applying foundational data for health prevention and management.

Uracil-tegafur vs fluorouracil as postoperative adjuvant chemotherapy in Stage II and III colon cancer: A nationwide cohort study and meta-analysis

We conducted a population-based cohort study enrolling patients with Stage II and III colon cancer receiving postoperative adjuvant chemotherapy with uracil and tegafur (UFT) or fluorouracil (5-FU) from the Taiwan National Health Insurance Research Database from 2000 to 2015. The outcomes of the current study were disease-free survival (DFS) and overall survival (OS). Hazard ratios (HRs) were calculated by multivariate Cox proportional hazard regression models. We compared our effectiveness results from the literature by meta-analysis, which provided the best evidence. Severe adverse events were compared in meta-analysis of reported clinical trials. In the nationwide cohort study, UFT (14,486 patients) showed DFS similar to postoperative adjuvant chemotherapy (adjusted HR 1.037; 95% confidence interval [CI] 0.954-1.126; P = .397) and OS (adjusted HR 0.964; 95% CI 0.891-1.041; P = .349) compared with the 5-FU (866 patients). Our meta-analysis confirmed the similarity of effectiveness and found the incidence of leucopaenia was statistically significantly reduced in UFT (risk ratio 0.12; 95% CI 0.02-0.67; I2 = 0%). Through our analysis, we have confirmed that UFT is a well-tolerated adjuvant therapy choice, and has similar treatment efficacy as 5-FU in terms of DFS and OS in patients with Stage II and III colon cancer.

Rural-urban disparities in the prevalence of mild cognitive impairment and dementia in Taiwan: A door-to-door nationwide study

BACKGROUND

Screening or diagnosis for the elderly with dementia in rural regions might be delayed and underestimated due to limited utilization of healthcare resources. This study aimed to evaluate the disparities of prevalence and risk factors of mild cognitive impairment (MCI) and dementia between urban and rural residence.

METHODS

In this nationwide door-to-door survey, 10,432 participants aged 65 years and more were selected by computerized random sampling from all administrative districts in Taiwan and were assessed by an in-person interview. We calculated the prevalence of MCI and dementia with their risk factors examined by multivariable logistic regression.

RESULTS

The prevalence of dementia in rural, suburban, and urban areas among the elderly was 8.69% (95% CI, 8.68-8.69), 6.63% (95% CI, 6.62-6.63), and 4.46% (95% CI, 4.46-4.47), respectively. A similar rural-suburban-urban gradient relationship on the dementia prevalence was observed in any age and sex group. The rural/urban ratio was higher in women than in men for both MCI and dementia. Urbanization remained to be an independent factor for both MCI and dementia after adjustment for age, gender, education, lifestyle, and health status. The beneficial effects of exercise on dementia were more evident in rural areas than in urban ones.

CONCLUSIONS

Significantly higher prevalence of MCI and dementia were found in rural areas than in urban ones, especially for women. The odds of risk factors for MCI and dementia varied between urbanization statuses. Focus on the rural-urban inequality and the modification of associated factors specifically for different urbanization levels are needed.

Virtual Reality Representations of Nature to Improve Well-Being amongst Older Adults: a Rapid Review

Poor well-being amongst older adults poses a serious health concern. Simultaneously, research shows that contact with nature can improve various facets of well-being, including physical, social, and mental well-being. However, nature is not always accessible for older adults due to mobility restrictions and related care needs that come with age. A promising strategy aims at bringing nature inside through pervasive technologies. However, so far, there is little academic understanding of essential nature characteristics, psychological processes involved, and means for implementation in practice. The current study used a three-folded rapid review to assess current understanding and strategies used for improving well-being for older adults through virtual reality representations of nature. Searches were performed across three databases, followed-up by content-based evaluation of abstracts. In total, a set of 25 relevant articles was identified. Only three studies specifically focus on digital nature as an intervention strategy for improving well-being amongst older adults. Although these studies provide useful starting points for the design and (technological) development of such environments, they do not generate understanding of how specific characteristics of virtual nature representations impact social well-being measures in particular, and of the underlying psychological processes involved. We conclude that follow-up research is warranted to close the gap between insights and findings from nature research, gerontology, health research, and human-technology interaction.

Effects of Enriched Physical Activity Environments on Balance and Fall Prevention in Older Adults: A Scoping Review

The incidence of falling, due to aging, is related to both personal and environmental factors. There is a clear need to understand the nature of the major risk factors and design features of a safe and navigable living environment for potential fallers. The aim of this scoping review was to identify studies that have examined the effectiveness of environments, which promote physical activity and have an impact on falls prevention. Selected studies were identified and categorized into four main topics: built environment, environment modifications, enriched environments, and task constraints. The results of this analysis showed that there are a limited number of studies aiming to enhance dynamic postural stability and fall prevention through designing more functional environments. This scoping review study suggests that the design of interventions and the evaluation of an environment to support fall prevention are topics for future research.

"Enticing" but Not Necessarily a "Space Designed for Me": Experiences of Urban Park Use by Older Adults with Disability

Urban parks are spaces that can enhance older adults’ physical, social and psychological wellbeing. As the prevalence of older adults with disability increases, it is important that urban parks are accessible to this population so that they too might gain health benefits. There is limited literature investigating the experiences of urban parks by older adults with disability. This qualitative study, set in a region of New Zealand, explored the experiences, including accessibility, of urban parks by 17 older adults (55 years and older) with self-reported disabilities. Three focus groups (n = 4, 5 and 4 people) and four individual interviews were undertaken. Data were analyzed using the General Inductive Approach. Two primary themes of “Enticing” and “Park use considerations” are presented. Urban parks and green spaces are perceived to provide an environment for older adults with a disability to improve their physical, psychosocial and spiritual health, and social connectedness. Parks that are not age, ability or culture diverse are uninviting and exclusive. Meaningful collaboration between park designers, city councils and people with disability is required to maximize the public health benefits of parks and make parks inviting and accessible for users of all ages, cultures and abilities. Park co-design with people with disability may provide one means of improving accessibility and park usability and thus park participation by older adults with disability.

The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys

Background: Research on social distancing from patients with depression has primarily focused on individual-level factors rather than context-level factors. This study aimed to investigate the relationship between individual-level and context-level factors and social distancing from depressive patients. Methods: Sample data were collected via computer-assisted telephone interviews with 800 Taiwanese adults aged 20 to 65 years in 2016. All effects were tested using multilevel analysis. Results: With regard to individual-level variables, male sex, older age, people with more perceived dangerousness and those with more emotional reaction of fear were associated with greater social distancing from depressive patients. After controlling for individual-level variables, a positive association was found between the degree of urbanization and social distancing. We also found the interaction between the density of psychiatric rehabilitation services and perceived dangerousness to be associated with social distance. This finding revealed that persons with more perceived dangerousness and living in a region with higher density of psychiatric rehabilitation services were associated with greater social distance. Conclusions: We found that social distancing from depressive patients is not only determined by individual-level factors but influenced by the surroundings. This study provides useful directions for the implementation of optimal anti-stigma interventions for patients with depression.

Cross-sectional associations between the neighborhood built environment and physical activity in a rural setting: the Bogalusa Heart Study

BACKGROUND

Insufficient physical activity (PA) is a common health risk and more prevalent in rural populations. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies.

METHODS

Participants in the Bogalusa Heart Study, a longitudinal study in rural Louisiana, with International Physical Activity Questionnaire data from 2012 to 2013 and a valid residential address (N = 1245) were included. PA was summarized as the number of weekly metabolic equivalent (MET)-minutes of total, transportation, and leisure time PA. The Rural Active Living Assessment street segment audit tool and Google Street View were used to assess features of the built environment overall and in six categories (path features, pedestrian safety features, aesthetics, physical security, destinations and land use) that influence PA. Scores for street segment built environment (overall and in categories) were calculated, for segments and buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations between built environment scores and PA were assessed with generalized estimating equations.

RESULTS

Participants reported little weekly total, leisure time, and transportation PA (mean 470, 230 and 43 MET-minutes per week, respectively). A 1-point increase in the overall built environment score was associated with 10.30 additional weekly leisure time MET-minutes within a 1.50 mile buffer (p-value 0.05), with a similar magnitude observed for a 1.00-mile buffer. A 1-point increase in the aesthetic score was associated with significantly higher leisure time PA for all geographic units (from 22.21 to 38.75 MET-minutes weekly) when adjusted for individual covariates, but was attenuated and only significant for the segment of the residence after accounting for other neighborhood characteristics.

CONCLUSIONS

Significant associations between features of the environment (overall and aesthetic scores) with leisure time PA were observed among adults in this rural population. Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA.

Effects of physical and social environments on the risk of dementia among Taiwanese older adults: a population-based case-control study

Background

Physical and social environments may influence cognition health in older adults. However, evidence regarding physical and social environments linked to dementia is lacking, especially in Asia. This study aims to explore the influence of physical and social environments on the incidence of dementia through a population-based case-control design in Taiwan.

Methods

We identified 26,206 incident cases with dementia aged≧65 years in 2010, with the same no. of controls from National Health Insurance claims. Environmental measures were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CI) of the association between dementia incidence and the environmental measures at the township level.

Results

We observed a significant reduction of 12% in the odds ratios of dementia in areas with higher availability of playgrounds and sport venues (OR 0.88, 95% CI 0.81–0.95), after controlling for individual and other environmental characteristics. Community center availability was also significantly associated with an 8% decreased odds for dementia (OR 0.92, 95% CI 0.87–0.99), but the association was not significant after further consideration of individual-level characteristics. Although higher odds of dementia were found in areas with high median annual family income (OR 1.14, 95% CI 1.04–1.25), such a significant relationship did not appear in the full model.

Conclusions

Our study suggests that specific physical and social environmental features have different influences on the risk of dementia. Public health interventions may consider these environmental aspects for preventing dementia incidence.

Physical activity and sedentary behaviour in the Middle East and North Africa: An overview of systematic reviews and meta-analysis

To support the global strategy to reduce risk factors for obesity, we synthesized the evidence on physical activity (PA) and sedentary behaviour in the Middle East and North Africa (MENA) region. Our systematic overview included seven systematic reviews reporting 229 primary studies. The meta-analysis included 125 prevalence measures from 20 MENA countries. After 2000, 50.8% of adults (ranging from 13.2% in Sudan to 94.9% in Jordan) and 25.6% of youth (ranging from 8.3% in Egypt to 51.0% in Lebanon) were sufficiently active. Limited data on PA behaviours is available for MENA countries, with the exception of Gulf Cooperation Council countries. The meta-regression identified gender and geographical coverage among youth, and the PA measurement as predictors of PA prevalence for both adults and youth. Our analysis suggests a significant PA prevalence increase among adults over the last two decades. The inconsistency in sedentary behaviour measurement is related to the absence of standardized guidelines for its quantification and interpretation. The global epidemic of insufficient PA is prevalent in MENA. Lower PA participation among youth and specifically females should be addressed by focused lifestyle interventions. The recognition of sedentary behaviour as a public health issue in the region remains unclear. Additional data on PA behaviours is needed from low- and middle-income countries in the region.

A systematic framework for understanding environmental design influences on physical activity in the elderly population

Purpose

This paper aims to synthesize the published literature regarding the impact of environmental design on the improvement of elderly residents’ physical activity.

Design/methodology/approach

To provide convergent evidence about the association between facility design/management and physical activity of elderly population, searches were conducted in the PubMed and Google Scholar databases, as well as in specific active living design journals such as Applied Gerontology, Aging and Physical Activity, Housing for the Elderly and Sports Sciences. The inclusion criteria for the final list were the articles that were qualitative, quantitative and mixed-methods studies as well as systematic reviews; written in English; related to the built environmental design; wholly or partially focused on physical activity in elderly population; and published in peer-reviewed journals between 1984 and 2019.

Findings

Overall, 30 studies were included in the final list. The results of this review demonstrate that design interventions can raise physical functioning inside and outside of long-term residential facilities. Increasing opportunities for walkable spaces and reducing physical barriers can result in higher levels of physical activity for the elderly population.

Research limitations/implications

This systematic review discloses the design strategies to enhance the level of physical activity by the elderly population based on the findings of the published literature. Overall space layout and accessibility to outdoor walkable spaces were addressed to generally promote the moderate levels of physical activity in elderly population.

Practical implications

Increasing opportunities for walkable spaces and reducing physical barriers result in higher level of activity for the elderly population. Corridor design and interior design ergonomic considerations were highlighted in the literature. Space layout and accessibility to outdoor walkable spaces promote the moderate levels of physical activity.

Social implications

Environmental design considerations are unique aspects of enhancement of activity level in the elderly population.

Originality/value

This systematic review discloses the design strategies to enhance the level of physical activity by the elderly population based on the findings of the published literature. Overall space layout and accessibility to outdoor walkable spaces were addressed to generally promote the moderate levels of physical activity in elderly population.

Association of Environmental Features and the Risk of Alzheimer's Dementia in Older Adults: A Nationwide Longitudinal Case-Control Study

Little is known about the association between environmental features and the risk of Alzheimer’s dementia (AD). This study aims to investigate the association of physical and social environments with the incidence of AD. We identified 12,401 newly diagnosed AD cases aged ≥65 years in 2010, with the same no. of matched controls from National Health Insurance claims in Taiwan. Environmental data were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was conducted to calculate the odds ratios (OR) of AD in association with environmental features at the township level. Results showed that living in the areas with higher availability of playgrounds and sport venues was associated with a 3% decreased odds of AD (95% CI = 0.96–0.99), while higher density of elderly living alone was associated with a 5% increased odds of AD (95% CI = 1.01–1.11), after controlling for individual and other environmental factors. In further examination by urbanization level, the above relationships were found only in rural areas but not in urban areas. This study provides evidence that specific physical and social environmental features have different impacts on the risk of AD.

Association of the built environments and health-related quality of life in community-dwelling older adults: a cross-sectional study

PURPOSE

The relationship between built environments and the quality of life (QoL) of the elderly has gained great attention in recent years. However, most QoL studies have been conducted in western countries; thus, limited research was found in Asia, in which the population density, urban forms, narrow roadways, and land use patterns are more compact and highly mixed in terms of use. Therefore, the purpose of this study was an interdisciplinary analysis of two national datasets, the National Land Use Investigation and the National Health Interview Survey, to explore the relationship between built environments and the health-related quality of life of older adults in Taiwan.

METHODS

Eight types of built environments at the township level were calculated, and 1222 nationally representative older adults aged 65 and older were recruited. The outcome variable was health-related QoL as measured using the EQ-5D, including utility score and the EQ-VAS. Statistical methods included descriptive analysis, bivariate analysis, and mixed-effects logistic regression analysis, which were conducted using SAS 9.4 software.

RESULTS

The results showed that a significant relationship exists between cultural and historical facilities and low EQ-VAS; none of the built environments were found to be related to the EQ-5D. Individual factors are the main determinants of the EQ-5D of older adults in Taiwan. Positive relationships were found if older adults were engaging in physical activities and social participation.

CONCLUSIONS

We suggest that building a supportive environment in which elderly people could consistently engage in physical activities and social participation is another potential approach that might contribute to active aging.