Complexity in built environment, health, and destination walking: a neighborhood-scale analysis

Correlation analysis of the urban community environment and health promotion among adults aged ≥ 55 years: the mediating role of physical activity

BACKGROUND

Physical health (PH), including muscle strength, endurance, and the ability to perform daily physical tasks, gradually declines with increasing age, leading to disability and an increased disease burden. Both the urban community environment (UCE) and physical activity (PA) were linked to PH.

METHODS

A total of 625 participants aged 55 years and older from Haidian and Chaoyang Districts in Beijing, China, were included in the study from September to December 2023.PH was assessed by a combined score of four tests, including BMI, chronic disease, depression and self-rated health.The Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A), Center for Epidemiological Survey-Depression Scale (CES-D), Physical Activity Scale for Elderly (PASE) and Social Support Rate Score (SSRS) were collected. The analysis was carried out with SPSS v.20 and Amos 24, and the results were validated via structural equation modeling (SEM).

RESULTS

The urban community environment was positively associated with the health level of older adults. Specifically, the standardized path coefficients indicate that the influence of the built environment (0.72-0.88) was greater than that of the social environment (0.43-0.55) and personal attributes (0.22-0.37) on older adults' health. Physical activity demonstrated both a mediating effect and an indirect effect, highlighting its significant value as a mediating variable.

CONCLUSIONS

The urban community environment has a positive impact on promoting the physical health of older adults, with the influence of the built environment being greater than that of the social environment and personal attributes on their physical health. Physical activity acts as a mediator between the urban community environment and the physical health of older adults.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A scoping review of complex systems methods used in population physical activity research: do they align with attributes of a whole system approach?

BACKGROUND

Complex systems approaches are increasingly used in health promotion and noncommunicable disease prevention research, policy and practice. Questions emerge as to the best ways to take a complex systems approach, specifically with respect to population physical activity (PA). Using an Attributes Model is one way to understand complex systems. We aimed to examine the types of complex systems methods used in current PA research and identify what methods align with a whole system approach as reflected by an Attributes Model.

METHODS

A scoping review was conducted and two databases were searched. Twenty-five articles were selected and data analysis was based upon the following: the complex systems research methods used, research aims, if participatory methods were used and evidence of discussion regarding attributes of systems.

RESULTS

There were three groups of methods used: system mapping, simulation modelling and network analysis. System mapping methods appeared to align best with a whole system approach to PA promotion because they largely aimed to understand complex systems, examined interactions and feedback among variables, and used participatory methods. Most of these articles focused on PA (as opposed to integrated studies). Simulation modelling methods were largely focused on examining complex problems and identifying interventions. These methods did not generally focus on PA or use participatory methods. While network analysis articles focused on examining complex systems and identifying interventions, they did not focus on PA nor use participatory methods. All attributes were discussed in some way in the articles. Attributes were explicitly reported on in terms of findings or were part of discussion and conclusion sections. System mapping methods appear to be well aligned with a whole system approach because these methods addressed all attributes in some way. We did not find this pattern with other methods.

CONCLUSIONS

Future research using complex systems methods may benefit from applying the Attributes Model in conjunction with system mapping methods. Simulation modelling and network analysis methods are seen as complementary and could be used when system mapping methods identify priorities for further investigation (e.g. what interventions to implement or how densely connected relationships are in systems).

Influence and Mechanism of a Multi-Scale Built Environment on the Leisure Activities of the Elderly: Evidence from Hefei City in China

Built environment characteristics such as walkability, land use diversity, infrastructure accessibility and attractiveness may support or hinder the elderly’s leisure activities, which in turn affects their health. Promoting the elderly’s leisure activities through the creation of a positive built environment is of great relevance to healthy aging. In the context of the continuous increasing of aging in China, promoting leisure activities for the elderly through improving the built environment has become an essential issue in urban geography and urban planning. Based on the questionnaire survey data of the elderly in Hefei City, a multilevel ordered probit regression model was used to investigate the mechanism of the multi-scale built environment on leisure activities of the elderly. The results show that: (1) more than 60% of the elderly can carry out leisure activities more than seven times a week, more than 50% of the elderly have a duration of fewer than 30 min for each leisure activity, and there are significant spatial differences in the frequency and duration of their trips at multiple scales in city, community and residential district. (2) Residential quality and community-level land use mixture, the density of leisure facilities, proximity to high-level urban roads, community security, living in the old city, and individual characteristic variables such as age, education, and satisfaction with neighborhood interaction positively contribute to the leisure activities of the elderly. In contrast, the community activity participation and the location close to expressways and railway lines have a significantly negative impact on the leisure activities of the elderly. (3) The mechanism of interactions between multi-scale built environments on the leisure activities of the elderly is mainly summarized as the transmission effect and substitution effect. The transmission effect shows that the differences in the community-level built environment are primarily caused by the differences in the city-level built environment. In contrast, the substitution effect shows that the multi-scale built environment such as residential districts, communities, and cities jointly affect the leisure activities of the elderly. Based on the mechanism of the built environment at different scales, this study can provide theoretical references and planning implications to improve the built environment through planning means such as enhancing the walkability of streets, the accessibility of facilities and the scale of greenery in order to promote active leisure activities and improve the health of the elderly.

Influence of the Built Environment on Community Flood Resilience: Evidence from Nanjing City, China

With the acceleration of global climate change and urbanization, many large and medium-sized cities in China have been frequently subjected to heavy rains and floods. Thus, the question of how to reduce the impact of floods and achieve rapid recovery has attracted much attention. We use the urban community as the basic unit to examine the living environment, internal facilities, and surrounding environment characteristics of six different types of communities in the Jianye District of Nanjing City. First, we use factor analysis and the binary logistic regression model to analyze pre-disaster preparation, disaster response, and post-disaster recovery. Second, we analyze the resilience of the community at different stages. Then, we explore the influencing factors of the built environment on the resilience of the community. Results show that the built-up environmental factors, such as topography, riverfront, building coverage ratio, green space rate, and land use diversity, have a significant impact on community resilience. Finally, we proposed several suggestions for improving the flood resilience of Nanjing City.

Built environment and health: a systematic review of studies in Germany

Objectives

Empirical research on the relationship between the built environment and health is increasing at a tremendous pace. However, findings from Anglo-American countries may not apply to the European context. Therefore, we systematically reviewed the existing evidence on the role of the built environment for leading risk factors and health behavior in Germany.

Methods

Through an extensive search via PubMed and Web of Science, using predefined selection criteria, two independent reviewers identified 25 empirical studies. We described the main study variables (year of publication, study design, data source, sample characteristics), classified the studies according to their respective operationalization of environmental features and health outcomes, and qualitatively summarized the main results.

Results

The majority of the studies focused on anthropometric measures and physical activity. Access to respective destinations was associated with sports-related physical activity but not with body composition. Also, people living in urban structures tended to show more health-adverse behaviors such as smoking and drinking. Some evidence indicated that higher levels of noise and air pollution were related to higher blood pressure levels. No association was observed between green spaces or street design and health.

Conclusions

Future research should investigate relationships using a sound theoretical basis and research designs that better account for the complex relationship between the built environment and health.

Is the built environment associated with morbidity and mortality? A systematic review of evidence from Germany

The empirical evidence on this relationship mainly comes from Anglo-American countries whereas evidence from Germany is only emerging. Our objective is to provide a narrative overview and critical appraisal of the existing empirical evidence on the relationship between the built environment and morbidity/mortality in Germany. We conducted a systematic literature search where we included all empirical studies that linked the built environment aspects with morbidity or mortality outcomes. Findings were summarized and critically evaluated according to the Newcastle Ottawa Scale. Eighteen studies met the inclusion criteria and underwent in-depth analysis. Findings indicate that traffic exposure and green space tend to be associated with acute respiratory symptoms but not with chronic respiratory conditions. Evidence was inconsistent for the role of infrastructural aspects and urbanicity. Our review confirms the well-established association between traffic and respiratory health. Yet, the consistency between self-reported and objective measures of respiratory health should be investigated in more detail.

Healthy urban living: Residential environment and health of older adults in Shanghai

A healthy residential environment, especially for older adults, has emerged as an important issue on political and planning agenda in China. This paper aims to investigate the direct and indirect impact of residential environment on the health of older adults in Shanghai, taking into account health-related behaviours, subjective well-being and socio-demographic factors in one comprehensive conceptual model. Our results show that the residential environment is associated with older adults' health directly, and also indirectly through a series of significant behavioural (physical and social activities) and perceptual (subjective well-being) factors. After combining the direct and indirect association, the results show that good housing and neighbourhood quality and a safe social environment contribute to better subjective, physical and mental health conditions of older adults. In addition, access to cultural facilities is positively related to older adults' mental and physical health and subjective well-being, while a higher proportion of older adults in a neighbourhood appears to promote physical and social activities but not health.

Influence of Personal Factors on Sound Perception and Overall Experience in Urban Green Areas. A Case Study of a Cycling Path Highly Exposed to Road Traffic Noise

In contemporary urban design, green public areas play a vital role. They have great societal value, but if exposed to undue environmental noise their restorative potential might be compromised. On the other hand, research has shown that the presence of greenery can moderate noise annoyance in areas with high sound levels, while personal factors are expected to play an important role too. A cycling path bordered by vegetation, but highly exposed to road traffic noise, was here considered as a case study. A sound perception survey was submitted to participants on site and they were subsequently sorted into groups according to their noise sensitivity, visual attention and attitude towards greenery. The aim of this study was testing whether these three personal factors could affect their noise perception and overall experience of the place. Results showed that people highly sensitive to noise and more sceptical towards greenery's potential as an environmental moderator reported worse soundscape quality, while visually attentive people reported better quality. These three personal factors were found to be statistically independent. This study shows that several person-related factors impact the assessment of the sound environment in green areas. Although the majority of the respondents benefit from the presence of visual green, policy-makers and planners should be aware that for a significant subset of the population, it should be accompanied by a tranquil soundscape to be fully appreciated.

A Conceptual Framework for Examining Healthcare Access and Navigation: A Behavioral-Ecological Perspective

This paper introduces a conceptual framework for investigating individual ability to navigate healthcare in the contexts of the built environment, social environment, and healthcare infrastructure in which a person is embedded. Given the complexity of healthcare delivery in the United States, consumers are expected to have an increasingly sophisticated set of skills in order to effectively navigate and benefit from the healthcare resources available to them. Addressing barriers to navigation in vulnerable populations may be essential to reducing health disparities. This paper builds on previous conceptual developments in the areas of healthcare use, navigation, and ecological perspectives on health in order to present a behavioral-ecological framework for examining healthcare navigation and access. The model posits that healthcare navigation is an ecologically informed process not only because of the spatial distribution of health services, but because of the spatial distribution of individual and environmental factors that influence decision-making and behavior with respect to service use. The paper discusses areas for further research on healthcare navigation, challenges for research, and implications for reducing health disparities.

The Relationship between the Neighborhood Built Environment and Active Transportation among Adults: A Systematic Literature Review

Active transportation (AT) has aroused great interest in recent years as it may benefit public health and reduce the dependency on cars. This article aims to summarize recent findings on the relationship between the objectively measured built environment and AT among adults, to examine if different study designs may generate different results, and to provide directions for future research. A systematic literature review of journal articles from different databases was conducted. Fifty-one articles published between 2005 and 2017 were identified, and twelve built environment factors were extracted. The results showed that residential density, land use mix, street connectivity, retail land use, walkability, sidewalk, and access to destinations had a convincing positive relationship with walking for transport. Regarding cycling for transport, while street connectivity and bike lane showed a convincing positive relationship, neighborhood aesthetics and access to destinations showed a convincing negative relationship. Studies that use different analyzed geographic units and different measurements of AT may generate different results, so choosing suitable geographic units and measurement of AT is necessary to reduce the mismatch in the relationships. In addition, we need more longitudinal studies, more studies on cycling for transport, and more studies in countries outside North America and Australasia.

Secondary GIS built environment data for health research: guidance for data development

Built environment (BE) data in geographic information system (GIS) format are increasingly available from public agencies and private providers. These data can provide objective, low-cost BE data over large regions and are often used in public health research and surveillance. Yet challenges exist in repurposing GIS data for health research. The GIS data do not always capture desired constructs; the data can be of varying quality and completeness; and the data definitions, structures, and spatial representations are often inconsistent across sources. Using the Small Town Walkability study as an illustration, we describe (a) the range of BE characteristics measurable in a GIS that may be associated with active living, (b) the availability of these data across nine U.S. small towns, (c) inconsistencies in the GIS BE data that were available, and (d) strategies for developing accurate, complete, and consistent GIS BE data appropriate for research. Based on a conceptual framework and existing literature, objectively measurable characteristics of the BE potentially related to active living were classified under nine domains: generalized land uses, morphology, density, destinations, transportation system, traffic conditions, neighborhood behavioral conditions, economic environment, and regional location. At least some secondary GIS data were available across all nine towns for seven of the nine BE domains. Data representing high-resolution or behavioral aspects of the BE were often not available. Available GIS BE data - especially tax parcel data - often contained varying attributes and levels of detail across sources. When GIS BE data were available from multiple sources, the accuracy, completeness, and consistency of the data could be reasonable ensured for use in research. But this required careful attention to the definition and spatial representation of the BE characteristic of interest. Manipulation of the secondary source data was often required, which was facilitated through protocols.

Complexity As Key to Designing Cognitive-Friendly Environments for Older People

The lived environment is the arena where our cognitive skills, preferences, and attitudes come together to determine our ability to interact with the world. The mechanisms through which lived environments can benefit cognitive health in older age are yet to be fully understood. The existing literature suggests that environments which are perceived as stimulating, usable and aesthetically appealing can improve or facilitate cognitive performance both in young and older age. Importantly, optimal stimulation for cognition seems to depend on experiencing sufficiently stimulating environments while not too challenging. Environmental complexity is an important contributor to determining whether an environment provides such an optimal stimulation. The present paper reviews a selection of studies which have explored complexity in relation to perceptual load, environmental preference and perceived usability to propose a framework which explores direct and indirect environmental influences on cognition, and to understand these influences in relation to aging processes. We identify ways to define complexity at different environmental scales, going from micro low-level perceptual features of scenes, to design qualities of proximal environments (e.g., streets, neighborhoods), to broad geographical areas (i.e., natural vs. urban environments). We propose that studying complexity at these different scales will provide new insight into the design of cognitive-friendly environments.

Environment as 'Brain Training': A review of geographical and physical environmental influences on cognitive ageing

Global ageing demographics coupled with increased urbanisation pose major challenges to the provision of optimal living environments for older persons, particularly in relation to cognitive health. Although animal studies emphasize the benefits of enriched environments for cognition, and brain training interventions have shown that maintaining or improving cognitive vitality in older age is possible, our knowledge of the characteristics of our physical environment which are protective for cognitive ageing is lacking. The present review analyses different environmental characteristics (e.g. urban vs. rural settings, presence of green) in relation to cognitive performance in ageing. Studies of direct and indirect associations between physical environment and cognitive performance are reviewed in order to describe the evidence that our living contexts constitute a measurable factor in determining cognitive ageing.

Primary care patients' perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis

Background

Primary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities.

Methods and Findings

A meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the context of chronic conditions were considered thus limiting extrapolation to other contexts.

Conclusions

Several factors affect PP&HP. This must be taken into account when designing PP&HP activities if they are to be successfully implemented and maintained in routine practice.

Measuring physical neighborhood quality related to health

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

Environments perceived as obesogenic have lower residential property values

BACKGROUND

Studies have tried to link obesity rates and physical activity with multiple aspects of the built environment.

PURPOSE

To determine the relation between residential property values and multiple perceived (self-reported) measures of the obesogenic environment.

METHODS

The Seattle Obesity Study (SOS) used a telephone survey of a representative, geographically distributed sample of 2,001 King County adults, collected in 2008-2009 and analyzed in 2012-2013. Home addresses were geocoded. Residential property values at the tax parcel level were obtained from the King County tax assessor. Mean residential property values within a 10-minute walk (833-m buffer) were calculated for each respondent. Data on multiple perceived measures of the obesogenic environment were collected by self-report. Correlations and multivariable linear regression analyses, stratified by residential density, were used to examine the associations among perceived environmental measures, property values, and BMI.

RESULTS

Perceived measures of the environment such as crime, heavy traffic, and proximity to bars, liquor stores, and fast food were all associated with lower property values. By contrast, living in neighborhoods that were perceived as safe, quiet, clean, and attractive was associated with higher property values. Higher property values were associated, in turn, with lower BMIs among women. The observed associations between perceived environment measures and BMI were largely attenuated after accounting for residential property values.

CONCLUSIONS

Environments perceived as obesogenic are associated with lower property values. Studies in additional locations need to explore to what extent other perceived environment measures can be reflected in residential property values.

Social determinants in an Australian urban region: a 'complexity' lens

Area-based strategies have been widely employed in efforts to improve population health and take action on social determinants of health (SDH) and health inequities, including in urban areas where many of the social, economic and environmental factors converge to influence health. Increasingly, these factors are recognized as being part of a complex system, where population health outcomes are shaped by multiple, interacting factors operating at different levels of social organization. This article reports on research to assess the extent to which an alliance of health and human service networks is able to promote action on SDH within an Australian urban region, using a complex systems frame. We found that such an alliance was able to promote some effective action which takes into account complex interactions between social factors affecting health, but also identified significant potential barriers to other forms of desired action identified by alliance members. We found that a complex systems lens was useful in assessing a collaborative intervention to address SDH within an urban region.

Self-assessed health of elderly people in Brussels: does the built environment matter?

The living environment plays a key role in the "Aging in Place" strategy. We studied the influence of the built environment on the health status of elderly people living in Brussels. Using census and geo-coded data, we analysed whether built environment factors were associated with poor self-assessed health status and functional limitations of elderly residents (aged 65 and over). We concluded that evidence of such an association is weak and vulnerable to the composition of the neighbourhood.

More than just an eyesore: local insights and solutions on vacant land and urban health

Vacant land is a significant economic problem for many cities, but also may affect the health and safety of residents. In order for community-based solutions to vacant land to be accepted by target populations, community members should be engaged in identifying local health impacts and generating solutions. We conducted 50 in-depth semi-structured interviews with people living in Philadelphia, Pennsylvania, a city with high vacancy, about the impact of vacant land on community and individual health and safety, as well as ideas for solutions to vacant land. Participants described a neighborhood physical environment dominated by decaying abandoned homes and overgrown vacant lots which affected community well-being, physical health, and mental health. Vacant land was thought to affect community well-being by overshadowing positive aspects of the community, contributing to fractures between neighbors, attracting crime, and making residents fearful. Vacant land was described as impacting physical health through injury, the buildup of trash, and attraction of rodents, as well as mental health through anxiety and stigma. Participants had several ideas for solutions to vacant land in their community, including transformation of vacant lots into small park spaces for the elderly and playgrounds for youth, and the use of abandoned homes for subsidized housing and homeless shelters. A few participants took pride in maintaining vacant lots on their block, and others expressed interest in performing maintenance but lacked the resources to do so. Public health researchers and practitioners, and urban planners should engage local residents in the design and implementation of vacant land strategies. Furthermore, municipalities should ensure that the health and safety impact of vacant land helps drive policy decisions around vacant land.

NEIGHBORHOOD PERCEPTION AND OBESITY IN AGED MEXICAN AMERICANS

BACKGROUND

Hypotheses on the relationship between neighborhood perception and obesity (as measured by body mass index) seem to generally posit that a positive neighborhood perception may be related with behaviors that positively moderate body weight.

OBJECTIVE

To determine if and how there is an association between positive neighborhood perception and obesity-while accounting for frailty- and disability-related factors.

DESIGN

Cross-sectional study from Wave-5 of the Hispanic Established Population for the Epidemiological Study of the Elderly (HEPESE).

SETTING

Data files housed by the Sociomedical Division in the department of Community Health and Preventive Medicine at the University of Texas Medical Branch in Galveston, Texas.

PARTICIPANTS

A total of 889, aged 75-90 community-dwelling Mexican Americans in the Southwest United States.

MEASUREMENTS

Body mass index (BMI=Kg/m(2)), neighborhood perception, grip strength, gait speed, depression symptomatology, chronic conditions, presence of limitations with basic and instrumental basic activities of daily living (ADLs), and other health and demographic variables are used in logistic regressions predicting the likelihood of being obese (BMI > 30 Kg/m(2)) versus being of normal weight (BMI 18.5-25.4 Kg/m(2)).

RESULTS

The odds of being obese increase: as the level of positive neighborhood perception increases; grip strength increases; and with having any limitations with basic-ADLs.

CONCLUSIONS

These findings provide evidence that a positive neighborhood perception need not always be accompanied with a reduced risk of being obese. Because functional limitations in older ages may influence how positive neighborhood perception affects BMI, more research is needed.