Mixed land use and walkability: Variations in land use measures and relationships with BMI, overweight, and obesity

The association between urban land use and depressive symptoms in young adulthood: a FinnTwin12 cohort study

BACKGROUND

Depressive symptoms lead to a serious public health burden and are considerably affected by the environment. Land use, describing the urban living environment, influences mental health, but complex relationship assessment is rare.

OBJECTIVE

We aimed to examine the complicated association between urban land use and depressive symptoms among young adults with differential land use environments, by applying multiple models.

METHODS

We included 1804 individual twins from the FinnTwin12 cohort, living in urban areas in 2012. There were eight types of land use exposures in three buffer radii. The depressive symptoms were assessed through the General Behavior Inventory (GBI) in young adulthood (mean age: 24.1). First, K-means clustering was performed to distinguish participants with differential land use environments. Then, linear elastic net penalized regression and eXtreme Gradient Boosting (XGBoost) were used to reduce dimensions or prioritize for importance and examine the linear and nonlinear relationships.

RESULTS

Two clusters were identified: one is more typical of city centers and another of suburban areas. A heterogeneous pattern in results was detected from the linear elastic net penalized regression model among the overall sample and the two separated clusters. Agricultural residential land use in a 100 m buffer contributed to GBI most (coefficient: 0.097) in the "suburban" cluster among 11 selected exposures after adjustment with demographic covariates. In the "city center" cluster, none of the land use exposures was associated with GBI, even after further adjustment with social indicators. From the XGBoost models, we observed that ranks of the importance of land use exposures on GBI and their nonlinear relationships are also heterogeneous in the two clusters.

IMPACT

This study examined the complex relationship between urban land use and depressive symptoms among young adults in Finland. Based on the FinnTwin12 cohort, two distinct clusters of participants were identified with different urban land use environments at first. We then employed two pluralistic models, elastic net penalized regression and XGBoost, and revealed both linear and nonlinear relationships between urban land use and depressive symptoms, which also varied in the two clusters. The findings suggest that analyses, involving land use and the broader environmental profile, should consider aspects such as population heterogeneity and linearity for comprehensive assessment in the future.

Exploring the group heterogeneity in the impact of social cohesion on the walking frequency of older adults in China

Background

Walkable neighborhoods are closely related to an increase in walking frequency and the strengthening of social cohesion. These factors, in turn, contribute to lower BMI and other positive health-related outcomes. However, with a rapid increase in aging populations in China and the fact that women are facing more challenges than men as they age, especially mobility challenges because they tend to live longer leading to probabilities to become widowed. Nevertheless, less attention has been paid to understanding the gender difference between these relationships.

Methods

Based on a survey of 533 older adults in Dalian, China, this study tried to investigate the intertwined relationship between perceived walkability, social cohesion, walking frequency, and BMI. A Structural Equation Model (SEM) and multiple-group analysis were applied to test the proposed framework.

Results

First, results show that gender differences existed among the above interrelationships, and the most substantial gender gap was found in effects of social cohesion on BMI. Second, perceived walkability only has a direct effect (0.149) on walking frequencies for female seniors. Third, although the relationships between perceived walkability and BMI are not directly related in both male and female models, the indirect connection (-0.053) is substituted for female seniors. Besides, the inhibiting effect of walking on BMI, which is -0.511, is also valid for female seniors. Finally, in terms of the role of social cohesion, both the positive impacts of perceived walkability on it (0.225 for males and 0.325 for females) and its promoting effects on walking have been confirmed in male (0.142) and female models (0.103). The negative direct effect of social cohesion on BMI (-0.083) is only confirmed in male seniors.

Conclusion

Insights derived from this analysis can help bring forward gender-specific interventions to build a more inclusive walkable and social environment to improve the mobility and physical health of older adults.

Neighborhood built environment, obesity, and diabetes: A Utah siblings study

Background

This study utilizes innovative computer vision methods alongside Google Street View images to characterize neighborhood built environments across Utah.

Methods

Convolutional Neural Networks were used to create indicators of street greenness, crosswalks, and building type on 1.4 million Google Street View images. The demographic and medical profiles of Utah residents came from the Utah Population Database (UPDB). We implemented hierarchical linear models with individuals nested within zip codes to estimate associations between neighborhood built environment features and individual-level obesity and diabetes, controlling for individual- and zip code-level characteristics (n = 1,899,175 adults living in Utah in 2015). Sibling random effects models were implemented to account for shared family attributes among siblings (n = 972,150) and twins (n = 14,122).

Results

Consistent with prior neighborhood research, the variance partition coefficients (VPC) of our unadjusted models nesting individuals within zip codes were relatively small (0.5%-5.3%), except for HbA1c (VPC = 23%), suggesting a small percentage of the outcome variance is at the zip code-level. However, proportional change in variance (PCV) attributable to zip codes after the inclusion of neighborhood built environment variables and covariates ranged between 11% and 67%, suggesting that these characteristics account for a substantial portion of the zip code-level effects. Non-single-family homes (indicator of mixed land use), sidewalks (indicator of walkability), and green streets (indicator of neighborhood aesthetics) were associated with reduced diabetes and obesity. Zip codes in the third tertile for non-single-family homes were associated with a 15% reduction (PR: 0.85; 95% CI: 0.79, 0.91) in obesity and a 20% reduction (PR: 0.80; 95% CI: 0.70, 0.91) in diabetes. This tertile was also associated with a BMI reduction of -0.68 kg/m2 (95% CI: -0.95, -0.40).

Conclusion

We observe associations between neighborhood characteristics and chronic diseases, accounting for biological, social, and cultural factors shared among siblings in this large population-based study.

Built environment and loneliness in later life: productive engagement as the pathway

OBJECTIVES

The built environment is increasingly recognized as being associated with late-life loneliness. However, the pathway remains understudied. This study investigated the mediating effects of productive engagement in relationships between the built environment and loneliness.

METHODS

We conducted a cross-sectional analysis of data from 4,409 community-dwelling people aged 65 years and above in China. We employed the Chinese version of the De Jong Gierveld Loneliness Scale to assess loneliness. The built environment comprises residential density, street connectivity, park-based and vegetation-based green space, land use mix, and the number of and distance to the nearest recreational, health, shopping and community services within 300-meter and 500-meter buffer areas. Structural equation modeling was used.

RESULTS

Only green space (parks) had a direct effect on loneliness. Residential density and green space (parks) had an indirect effect on loneliness through volunteering. The number of recreational services had an indirect effect on loneliness through recreational and sporting activities, although distance to the nearest recreational services did not. All the significant results were only found within 300-meter rather than 500-meter buffers.

CONCLUSIONS

Our findings have implications for environmental gerontology theory and practice. Providing more green space and recreational services can significantly improve older adults' helping behavior, social activities and sporting activities, which can further reduce older adults' loneliness.

Association of greenspaces exposure with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Cardiometabolic conditions are major contributors to the global burden of disease. An emerging body of evidence has associated access to and surrounding public open spaces (POS) and greenspace with cardiometabolic risk factors, including obesity, body mass index (BMI), hypertension (HTN), blood glucose (BG), and lipid profiles. This systematic review aimed to synthesize this evidence.

METHODS

This systematic review was conducted based on the PRISMA guidelines. Four electronic databases including Web of Science, PubMed, Scopus, and Google Scholar were searched for eligible articles published until July 2023. All observational studies which assessed the association of greenspace and POS with cardiometabolic risk factors including obesity, BMI, HTN, BG, and lipid profiles were included and reviewed by two authors independently. Heterogeneity between studies was assessed using the I2 index and Cochrane's Q test. Random/fixed effect meta-analyses were used to combine the association between greenspace exposure with cardiometabolic risk factors.

RESULTS

Overall, 118 relevant articles were included in our review. The majority of the articles were conducted in North America or Europe. In qualitative synthesis, access or proximity to greenspaces or POS impacts BMI and blood pressure or HTN, BG, and lipid profiles via various mechanisms. According to the random effect meta-analysis, more access to greenspace was significantly associated with lower odds of HTN (odds ratio (OR): 0.81, 95% confidence intervals (CIs): 0.61-0.99), obesity (OR: 0.83, 95% CIs: 0.77-0.90), and diabetes (OR:0.79, 95% CI: 0.67,0.90).

CONCLUSIONS

Findings of this systematic review and meta-analysis suggested that greenspace accessibility is associated with some cardiometabolic risk factors. Improving greenspace accessibility could be considered as one of the main strategies to reduce cardiometabolic risk factors at population level.

Effects of built and natural environments on leisure physical activity in residential and workplace neighborhoods

Few studies have investigated relative contributions of the built and natural environments to and their nonlinear associations with leisure physical activity (PA) in different spatial contexts. Applying gradient boosting decision tree models to data comprising 1049 adults collected in Shanghai, we investigated the associations between built and natural environments and leisure PA in residential and workplace neighborhoods. Results show that the built environment is more important than the natural environment to leisure PA in both residences and workplaces. Environmental attributes have nonlinear and threshold effects. Within certain ranges, land use mix and population density have opposite associations with leisure PA in residences and workplaces, whereas the distance to the city center and the area of water are associated with leisure PA in residences and workplaces with the same direction. These findings help urban planners design context-specific environmental interventions for supporting leisure PA.

The role of residential greenness levels, green land cover types and diversity in overweight/obesity among older adults: A cohort study

BACKGROUND

Few studies have investigated the effects of greenness exposure, green land cover types and diversity and their interaction with particulate matter (PM) to adiposity.

METHOD

Cohort data were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Baseline data on greenness levels, green land cover types and diversity were assessed by the Normalized Difference Vegetation Index (NDVI), three greenery types (trees, shrublands and grassland) and Shannon's diversity index, respectively. Body mass index (BMI) and waist circumference (WC) were separately used as dependent variables and represented for peripheral overweight/obesity and central obesity, respectively. The mixed Cox model with random intercept was used to estimate the effects of greenness levels, types and diversity on overweight/obesity using single and multiple exposure models. We also examined the interaction of PM and the aforementioned indicators on overweight/obesity on both additive and multiplicative scales.

RESULTS

Single exposure models showed that higher levels of residential greenness, tree coverage and ratio of trees to shrublands/grassland were inversely associated with peripheral overweight/obesity and central obesity. An increase in shrublands, grassland and diversity of green was related to lower odds of peripheral overweight/obesity. Multiple exposure models confirmed the association between greenness levels and peripheral overweight/obesity. Males, educated participants and elderly who lived in southern regions and areas with cleaner air environments acquired more benefits from greenspace exposure. Single and multiple exposure models indicated that an antagonistic effect of increasing PM and decreasing greenness levels on peripheral overweight/obesity and central obesity. Single exposure models showed the potential interaction of tree coverage, ratio of trees to grassland and PM_2.5 exposures on the risk of peripheral overweight/obesity.

CONCLUSION

Increasing residential greenness and diversity of green were associated with healthy weight status. The relationship between greenery and overweight/obesity varied, and the effects of greenspace exposure on overweight/obesity were associated with air pollution.

Spatial Coupling Coordination Evaluation of Mixed Land Use and Urban Vitality in Major Cities in China

Based on the data from 35 major cities in China in 2020, this paper applies the Simpson's diversity index, the entropy value method, and the coupling coordination degree model to comprehensively measure the coupling coordination level of mixed land use and urban vitality in major cities in China and further analyze their spatial distribution characteristics. In addition, this paper analyzes the factors affecting the spatial variation of the coupling coordination level with the help of the geographic probe model. The study finds that: (1) The overall level of coupling coordination between mixed land use and urban vitality is high in 35 major cities in China. There is no disorder between mixed land use and urban vitality. (2) In terms of the spatial distribution of the coupling coordination between mixed land use and urban vitality in 35 cities in China, five cities, namely Beijing, Shenzhen, Shanghai, Guangzhou, and Chengdu, have the highest level of coupling coordination between mixed land use and urban vitality, reaching "good coordination" with a discrete spatial distribution. Central cities such as Hangzhou and Nanjing have the second highest level of coupling coordination and are at the "intermediate coordinate" with a "strip-like distribution" in space. Twenty cities in the north and south have the lowest coupling coordination levels and are in the "primary coordination." Among these twenty cities, seven cities in the south have a higher level of coupling coordination than thirteen cities in the north, with a spatial distribution of a "C" shape. The northern cities have the lowest level of coupling coordination, with a "W"-shaped distribution in space. (3) Population size plays an essential role in guiding the level of coupling coordination between mixed land use and urban vitality in major cities in China, followed by government regulation and economic level. At the same time, transportation conditions and industrial structure have the weakest influence on the level of coupling coordination between mixed land use and urban vitality in major cities in China.

Differences in Weight Gain Following Residential Relocation in the Moving to Health (M2H) Study

BACKGROUND

Neighborhoods may play an important role in shaping long-term weight trajectory and obesity risk. Studying the impact of moving to another neighborhood may be the most efficient way to determine the impact of the built environment on health. We explored whether residential moves were associated with changes in body weight.

METHODS

Kaiser Permanente Washington electronic health records were used to identify 21,502 members aged 18-64 who moved within King County, WA between 2005 and 2017. We linked body weight measures to environment measures, including population, residential, and street intersection densities (800 m and 1,600 m Euclidian buffers) and access to supermarkets and fast foods (1,600 m and 5,000 m network distances). We used linear mixed models to estimate associations between postmove changes in environment and changes in body weight.

RESULTS

In general, moving from high-density to moderate- or low-density neighborhoods was associated with greater weight gain postmove. For example, those moving from high to low residential density neighborhoods (within 1,600 m) gained an average of 4.5 (95% confidence interval [CI] = 3.0, 5.9) lbs 3 years after moving, whereas those moving from low to high-density neighborhoods gained an average of 1.3 (95% CI = -0.2, 2.9) lbs. Also, those moving from neighborhoods without fast-food access (within 1600m) to other neighborhoods without fast-food access gained less weight (average 1.6 lbs [95% CI = 0.9, 2.4]) than those moving from and to neighborhoods with fast-food access (average 2.8 lbs [95% CI = 2.5, 3.2]).

CONCLUSIONS

Moving to higher-density neighborhoods may be associated with reductions in adult weight gain.

Conceptualizing the Socio-Built Environment: An Expanded Theoretical Framework to Promote a Better Understanding of Risk for Nonmedical Opioid Overdose Outcomes in Urban and Non-Urban Settings

Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. Likewise, there is strong extant literature suggesting that social characteristics of environments also predict NMO overdoses and other NMO use outcomes, but limited research that considers the combined effects of both physical and social characteristics of environments on NMO outcomes. As a result, important gaps in the scientific literature currently limit our understanding of how both physical and social features of environments shape risk for NMO overdose in rural and suburban settings and therefore limit our ability to intervene effectively. In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes "socio-built environments" as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.

Nonlinear Relationships among the Natural Environment, Health, and Sociodemographic Characteristics across US Counties

Background: The aim of this study was to explore the nonlinear relationships between natural amenities and health at the intersection of sociodemographic characteristics among primary care patients with chronic conditions. Methods: We used survey data from 3409 adults across 119 US counties. PROMIS-29 mental and physical health summary scores were the primary outcomes. The natural environment (measured using the County USDA Natural Amenities Scale (NAS)) was the primary predictor. Piecewise spline regression models were used to explore the relationships between NAS and health at the intersection of sociodemographic factors. Results: We identified a nonlinear relationship between NAS and health. Low-income individuals had a negative association with health with each increase in NAS in high-amenity areas only. However, White individuals had a stronger association with health with each increase in NAS in low-amenity areas. Conclusions: In areas with low natural amenities, more amenities are associated with better physical and mental health, but only for advantaged populations. Meanwhile, for disadvantaged populations, an increase in amenities in high-amenity areas is associated with decreases in mental and physical health. Understanding how traditionally advantaged populations utilize the natural environment could provide insight into the mechanisms driving these disparities.

Benchmarking the driver acceleration impact on vehicle energy consumption and CO2 emissions

The study proposes a methodology for quantifying the impact of real-world heterogeneous driving behavior on vehicle energy consumption, linking instantaneous acceleration heterogeneity and CO₂ emissions. Data recorded from 20 different drivers under real driving are benchmarked against the Worldwide Harmonized Light Vehicle Test Cycle (WLTC), first by correlating the speed cycle with individual driver behavior and then by quantifying the CO₂ emissions and consumption. The vehicle-Independent Driving Style metric (IDS) is used to quantify acceleration dynamicity, introducing driving style stochasticity by means of probability distribution functions. Results show that the WLTC cycle assumes a relatively smooth acceleration style compared to the observed ones. The method successfully associates acceleration dynamicity to CO₂ emissions. We observe a 5% difference in the CO₂ emissions between the most favourable and the least favourable case. The intra-driver variance reached 3%, while the inter-driver variance is below 2%. The approach can be used for quantifying the driving style induced emissions divergence.

Mixed Land Use Levels in Rural Settlements and Their Influencing Factors: A Case Study of Pingba Village in Chongqing, China

Mixed land use provides an important means of promoting the intensive and efficient use of land resources and stimulating endogenous development power in rural areas. This paper selected Pingba Village in Chongqing as the research area; the land use status data and the social and economic data on rural settlements in the study area for 2021 were obtained through field visits and interviews. Moreover, the land use types in the rural settlements were subdivided according to the principle of dominant function. Based on these subdivisions, a land mixed-use measurement system for rural settlements was constructed to analyze their levels of mixed land use. Furthermore, the influences of natural environmental, social, economic and other factors on mixed land use were comprehensively explored. The results showed that, (1) the mixed land use of rural settlements in the study area was at a medium level and showed significant spatial variability, and rural settlements in the high, medium and low mixed land use index zones accounted for 12.5%, 35% and 52.5% of the total, respectively. (2) The differences in the natural environment determined the level of mixed land use and the basic pattern of its spatial differentiation. Social and economic factors, such as resident population and average household income, were key impact factors. Rural tourism resources, homestead agglomeration policies and other factors had important impacts on the level of mixed land use. In conclusion, the research suggests that mixed land use is an important way to boost rural revitalization. In the future, village planning could introduce the concept of mixed land use to improve the efficiency of land use, optimize the land use structure according to local conditions and promote the integrated development of rural primary, secondary and tertiary industries. In addition, it is necessary to scientifically and rationally guide rural settlements to agglomerate appropriately to improve the utilization efficiency of land resources and public service resources.

Development of an objectively measured walkability index for the Netherlands

Background

Walkability indices have been developed and linked to behavioural and health outcomes elsewhere in the world, but not comprehensively for Europe. We aimed to 1) develop a theory-based and evidence-informed Dutch walkability index, 2) examine its cross-sectional associations with total and purpose-specific walking behaviours of adults across socioeconomic (SES) and urbanisation strata, 3) explore which walkability components drive these associations.

Methods

Components of the index included: population density, retail and service density, land use mix, street connectivity, green space, sidewalk density and public transport density. Each of the seven components was calculated for three Euclidean buffers: 150 m, 500 m and 1000 m around every 6-digit postal code location and for every administrative neighbourhood in GIS. Componential z-scores were averaged, and final indices normalized between 0 and 100. Data on self-reported demographic characteristics and walking behaviours of 16,055 adult respondents (aged 18–65) were extracted from the Dutch National Travel Survey 2017. Using Tobit regression modelling adjusted for individual- and household-level confounders, we assessed the associations between walkability and minutes walking in total, for non-discretionary and discretionary purposes. By assessing the attenuation in associations between partial indices and walking outcomes, we identified which of the seven components drive these associations. We also tested for effect modification by urbanization degree, SES, age and sex.

Results

In fully adjusted models, a 10% increase in walkability was associated with a maximum increase of 8.5 min of total walking per day (95%CI: 7.1–9.9). This association was consistent across buffer sizes and purposes of walking. Public transport density was driving the index’s association with walking outcomes. Stratified results showed that associations with minutes of non-discretionary walking were stronger in rural compared to very urban areas, in neighbourhoods with low SES compared to high SES, and in middle-aged (36–49 years) compared to young (18–35 years old) and older adults (50–65 years old).

Conclusions

The walkability index was cross-sectionally associated with Dutch adult’s walking behaviours, indicating its validity for further use in research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01270-8.

Exploring the Mediating Effect of Physical Activities on Built Environment and Obesity for Elderly People: Evidence From Shanghai, China

There is still a scarcity of literature on the specific mechanisms of the linkage between the built environment and obesity. As a result, this study investigated whether and how physical activities mediate the associations between the objective built environment and the BMI of elderly people. To investigate the effect of the duration and intensity of physical activity on the effect of the built environment, the study made use of the bootstrap method. In general, we discovered that physical activity duration has a huge mediating effect on the elderly people in Shanghai, especially with respect to the density and accessibility of facilities (gyms, parks, fast-food restaurants) that can greatly stimulate physical activity in elderly people to reduce their BMI. There were both direct and indirect effects on their BMI, which means that the health benefits of green spaces for older people may be more complicated than first thought.

Association between Land Use Mix and Respiratory Symptoms and Asthma in Children from the Generation XXI Birth Cohort

Land use mix (LUM) in the neighbourhoods has been associated with healthier lifestyles. However, less is known about the association between LUM and health outcomes, namely during childhood. The objective of this study was to evaluate the association between different LUM indexes for Porto Metropolitan Area and asthma and respiratory symptoms in children. A cross-sectional analysis was performed involving 6260 children enrolled in Generation XXI. Land use around the child's residence was assessed with the Portuguese official map of land cover using a GIS. Generalized linear mixed-effects models were fitted to estimate the association between LUM and respiratory symptoms and asthma at 7 years of age. Adjusted associations were quantified using odds ratio (OR) and 95% confidence interval (95% CI). After adjustment, LUM was associated with a lower odds of wheezing in the last 12 months [OR (95% CI) = 0.37 (0.15; 0.93) using Shannon's Evenness Index within 500 m; and OR = 0.93 (0.89; 0.98) using the number of different land use types within 250 m]. Living in neighbourhoods with high LUM has a protective effect on current wheezing symptoms. Our results highlight the association between LUM and respiratory symptoms among children, suggesting that public health considerations should be incorporated in land use decision-making.

Pedestrian Safety in Compact and Mixed-Use Urban Environments: Evaluation of 5D Measures on Pedestrian Crashes

This study examined the impact of density, diversity, design, distance to transit, and destination accessibility, five measures, known as the 5Ds, that characterize the built environment, on pedestrian–vehicle crashes in Seoul, Korea. Using spatial analysis based on 500-m grid cells, this study employed negative binomial regression models on the frequencies of three specific types of pedestrian–vehicle crashes: crashes causing death, major injury, and minor injury to pedestrians. Analysis shows that compact and mixed-use urban environments represented by 5D measures have mixed effects on pedestrian safety. Trade-off effects are found between a higher risk for all types of pedestrian crashes, and a lower risk for fatal pedestrian crashes in 5D urban environments. As a design variable, a higher number of intersections is more likely to increase some types of pedestrian crashes, including fatal crashes, a finding which warrants policy attention to promote pedestrian safety near intersection areas. This study also confirms an urgent need to secure the travel safety of pedestrians near public transit stations due to the higher risk of pedestrian crashes near such facilities. Various destinations, such as retail stores, traditional markets, and hospitals, are associated with pedestrian crashes. Pedestrian safety measures should be implemented to reduce the likelihood of pedestrian crashes near major destination facilities.

Perceived Neighborhood Walkability is Associated with Recent Falls in Urban Dwelling Older Adults

BACKGROUND AND PURPOSE

In rural communities, perceptions of neighborhood walkability, the rating of how easy it is to walk in an area, influence engagement in physical activity outside the home. This has not been studied in older adults residing in urban settings. Additionally, it is not known how perceived walkability is associated with falls. Therefore, the purpose of this study was to first describe the perceptions of neighborhood walkability in urban-dwelling older adults based on recent fall history and then examine associations between recent falls and neighborhood walkability constructs after controlling for fall risk factors.

METHODS

Urban-dwelling older adults (N = 132) 65 years and older without cognitive dysfunction or uncontrolled comorbidity completed a survey assessing health status, physical activity, and walkability using the Neighborhood Environment Walkability Scale-Abbreviated. Group assignment was based on recent fall history. Between-group comparisons of demographic and walkability constructs were completed using analysis of variance. Logistic regression was used to examine associations between walkability constructs and recent falls after controlling for covariates.

RESULTS AND DISCUSSION

Poorer perception of land use was significantly associated with recent falls. Questions assessing the ease of walking to a store or transit stop may be valuable in understanding fall risk in older adults living in urban settings.

CONCLUSIONS

Perceptions of neighborhood walkability are lower in urban-dwelling older adults with a history of falling.

Community planning for a "healthy built environment" via a human-environment nexus? A multifactorial assessment of environmental characteristics and age-specific stroke mortality in Hong Kong

With the prevalence of stroke rising due to both aging societies and more people getting strokes at a younger age, a comprehensive investigation into the relationship between urban characteristics and age-specific stroke mortality for the development of a healthy built environment is necessary. Specifically, assessment of various dimensions of urban characteristics (e.g. short-term environmental change, long-term environmental conditions) is needed for healthy built environment designs and protocols. A multifactorial assessment was conducted to evaluate associations between environmental and sociodemographic characteristics with age-stroke mortality in Hong Kong. We found that short-term (and temporally varying) daily PM₁₀, older age and being female were more strongly associated with all types of stroke deaths compared to all-cause deaths in general. Colder days, being employed and being married were more strongly associated with hemorrhagic stroke deaths in general. Long-term (and spatially varying) regional-level air pollution were more strongly associated with non-hemorrhagic stroke deaths in general. These associations varied by age. Employment (manual workers) and low education were risk factors for stroke mortality at younger ages (age <65). Greenness and open space did not have a significant association with stroke mortality. Since a significant connection was expected, this leads to questions about the health-inducing efficacy of Hong Kong's compact open spaces (natural greenery being limited to steep slopes, and extensive impervious surfaces on public open spaces). In conclusion, urban plans and designs for stroke mortality prevention should implement age-specific health care to neighborhoods with particular population segments.

Conceptualizing Walking and Walkability in the Smart City through a Model Composite w2 Smart City Utility Index

This paper explores walking and walkability in the smart city and makes a case for their centrality in the debate on the resilience and sustainability of smart cities, as outlined in the United Nations’ (UN) Sustainable Development Goals (SDGs). It is argued that, while the human/inhabitant-centric paradigm of urban development consolidates, and research on walking, walkability, and pedestrian satisfaction flourishes, the inroads of ICT render it necessary to reflect on these issues in the conceptually- and geographically-delimited space of the smart city. More importantly, it becomes imperative to make respective findings useful and usable for policymakers. To this end, by approaching walking and walkability through the lens of utility, the objective of this paper is to develop a conceptual framework in which the relevance of walking and walkability, hereafter referred to as w2, as a distinct subject of research in the smart cities debate is validated. This framework is then employed to construct a model of a composite w2 smart city utility index. With the focus on the development of the conceptual framework, in which the w2 utility index is embedded, this paper constitutes the first conceptual step of the composite index development process. The value added of this paper is three-fold: First, the relevance of walking and walkability as a distinct subject of research in the realm of smart cities research is established. Second, a mismatch between end-users’ satisfaction derived from walking and their perception of walkability and the objective factors influencing walking and walkability is identified and conceptualized by referencing the concept of utility. Third, a model smart city w2 utility index is proposed as a diagnostic and prognostic tool that, in the subsequent stages of research and implementation, will prove useful for decisionmakers and other stakeholders involved in the process of managing smart cities.

Land-Use Mix and Urban Sustainability: Benefits and Indicators Analysis

Sustainable development is one of the biggest challenges for the future of our cities. With this in mind, eco-districts are essentially designed to respond to four challenges that place emphasis mainly on complexity and resilience by acting on aspects such as urban green spaces, mobility, energy, water management and waste management. In this study, the focus is on the concept of mixitè, from both a functional and social perspective, which is seen as a tool to increase the sustainability of urban settlements and bring benefits to the social, environmental and economic system. Despite the growing interest of research into the impacts of an urban land-use mix, there have been few methodological analyses on how to measure the functional mix in an urban environment. Therefore, the goal of this study is to define one or more indicators that are able to represent the diversity of the soil through their application to different areas. It is therefore possible to define a tool that helps to design, evaluate and support decision makers in urban planning choices. Indeed, it is important to understand how the soil mix, and subsequently the social mix, affects sustainability and how planners can take it into account in planning and developing urban policies. In this document: (a) we will highlight the theories and concepts underlying both functional and social mixitè; (b) the benefits it brings both to the city and to the individual; (c) a review of the main methods of measurement of the mixitè; (d) application and a subsequent comparison of the methods identified in case studies represented by three areas related to the establishment of the University of Salerno, in Italy, consisting of its two campuses as well as an adjacent site. The results obtained show that some of the indicators analyzed are more effective at representing the phenomenon of mixitè than others. Therefore, widening research, especially for those concerning the social mixitè, is advisable. Despite this, the results show that proper planning and management of urban devices bring about a series of advantages by increasing the sustainability and urban efficiency of settlements.

Nonlinear relationship between nonresidential destinations and body mass index across a wide range of development

BACKGROUND

Destination accessibility is an important measure of the built environment that is associated with active transport and body mass index (BMI). In higher density settings, an inverse association has been consistently found, but in lower density settings, findings are limited. We previously found a positive relationship between the density of nonresidential destinations (NRD) and BMI in a low-density state. We sought to test the generalizability of this unexpected finding using data from six other states that include a broader range of settlement densities.

METHODS

We obtained the address, height, and weight of 16.9 million residents with a driver's license or state identification cards, as well as the location of 3.8 million NRDs in Washington, Oregon, Texas, Illinois, Michigan, and Maine from Dun & Bradstreet. We tested the association between NRDs∙ha^-1 within 1 km of the home address, and self-reported BMI (kg∙m^-2). Visualization by locally-weighted smoothing curves (LOWESS) revealed an inverted U-shape. A multivariable piecewise regression with a random intercept for state was used to assess the relationship.

RESULTS

After accounting for age, sex, year of issue, and census tract social and economic variables, BMI correlated positively with NRDs in the low-to-mid density stratum (β = +0.005 kg∙m^-2/nonresidential building∙ha^-1; 95% CI: +0.004,+0.006) and negatively in the mid-to-high density stratum (β = -0.002; 95% CI: -0.004,-0.0003); a significant difference in slopes (P < 0.001).

CONCLUSIONS

BMI peaked in the middle density, with lower values in both the low and high-density extremes. These results suggest that the mechanisms by which NRDs are associated with obesity may differ by density level.

Associations of changes in neighbourhood walkability with changes in walking activity in older adults: a fixed effects analysis

Background

Supporting older adults to engage in physically active lifestyles requires supporting environments. Walkable environments may increase walking activity in older adults, but evidence for this subgroup is scarce, and longitudinal studies are lacking. This study therefore examined whether changes in neighbourhood walkability were associated with changes in walking activity in older adults, and whether this association differed by individual-level characteristics and by contextual conditions beyond the built environment.

Methods

Data from 668 participants (57.8–93.4 years at baseline) across three waves (2005/06, 2008/09 and 2011/12) of the Longitudinal Aging Study Amsterdam (LASA) were used. These individuals did not relocate during follow-up. Self-reported outdoor walking activity in minutes per week was assessed using the LASA Physical Activity Questionnaire. Composite exposure measures of neighbourhood walkability (range: 0 (low)-100 (high)) within 500-m Euclidean buffer zones around each participant’s residential address were constructed by combining objectively measured high-resolution Geographic Information System data on population density, retail and service destination density, land use mix, street connectivity, green space density, and sidewalk density. Fixed effects linear regression analyses were applied, adjusted for relevant time-varying confounders.

Results

Changes in neighbourhood walkability were not statistically significantly associated with changes in walking activity in older adults (β_500m = − 0.99, 95% CI = -6.17–4.20). The association of changes in neighbourhood walkability with changes in walking activity did not differ by any of the individual-level characteristics (i.e., age, sex, educational level, cognitive impairment, mobility disability, and season) and area-level characteristics (i.e., road traffic noise, air pollution, and socioeconomic status).

Conclusions

This study did not show evidence for an association between changes in neighbourhood walkability and changes in walking activity in older adults. If neighbourhood walkability and walking activity are causally linked, then changes in neighbourhood walkability between 2005/06 and 2011/12 might have been not substantial enough to produce meaningful changes in walking activity in older adults.

Urban resilience assessment based on contradiction between supply and demand of the daily activity-environment system: A case study on Nanjing, China

In addition to safety and risk issues, urban resilience research should focus more comprehensive and universal contradictions. Considering the main contradictions of Chinese urban development, and the connotation of urban resilience, a theoretical framework is constructed based on the contradiction between supply and demand of the daily activity-environment system. Furthermore, an assessment index system of urban resilience is also developed that considers both volume and quality of demand and supply and has a grade standard. Finally, utilizing multi-source geographic big data, Nanjing is taken as a case study, the spatial characteristics and optimization path of urban resilience are identified. The main conclusions are as follows: (1) The activity-environment system resilience presents a "center-periphery" sprawling spatial structure, and it is mainly at the level of "reluctant resilience" and "almost lack of resilience". (2) The evolution of the activity-environment system resilience is still absolutely volume driven, and the positive drive of relative quality is limited or even reversed. In addition, all the bilateral local spatial autocorrelations are generally represented as "center-periphery" separated spatial structures, but it is not always consistent with the overall trend. (3) For the governance of urban resilience, it is necessary to focus on common improvement and matching of absolute volume and relative quality in contents, orderly flow, accumulation and dispersion of supply and demand in ideas, and the strong support of new ideas and technologies in methods.

Spatio-Temporal Evolution and Driving Factors of Rural Settlements in Low Hilly Region-A Case Study of 17 Cities in Hubei Province, China

With the rapid development of the social economy, factors of social and economic development in China's rural areas have been continuously reorganized, and the pattern and distribution of rural residential areas have undergone significant changes. In rural areas, there have been many peculiar phenomena of "reducing people but not reducing land in rural areas, which has caused tremendous pressure on land resource protection. We used geographic detectors and a geographically temporally weighted regression model (GTWR) to explore the rural settlements' evolution and driving mechanism in Hubei Province from 1990 to 2015. The results show that the kernel density of rural settlements decreased from 1.62 villages/km² in 1990 to 1.60 villages/km² in 2015. The scale of rural residential patches has obvious regional differentiation characteristics. From southeast to northwest, there is a wave-like distribution structure of "high-low-high-low-high", and the clustering characteristics of "cold and hot spots" are strengthened with time. Based on GTWR analysis, the total rural population, total power of agricultural machinery, and rural electricity consumption have promoted the expansion of rural settlements, with the regression coefficients 0.096, 0.484, and 0.878, respectively. Cultivated land, agricultural output value, and rural labor force have negative impacts on the expansion, the regression coefficients of the village were -0.584, -0.510, and -0.109, respectively.

Assessing Community-Level Livability Using Combined Remote Sensing and Internet-Based Big Geospatial Data

With rapid urbanization, retrieving livability information of human settlements in time is essential for urban planning and governance. However, livability assessments are often limited by data availability and data update cycle, and this problem is more serious when making an assessment at finer spatial scales (e.g., community level). Here we aim to develop a reliable and dynamic model for community-level livability assessment taking Linyi city in Shandong Province, China as a case study. First, we constructed a hierarchical index system for livability assessment, and derived data for each index and community from remotely sensed data or Internet-based geospatial data. Next, we calculated the livability scores for all communities and assessed their uncertainties using Monte Carlo simulations. The results showed that the mean livability score of all communities was 59. The old urban and newly developed districts of our study area had the best livability, and got a livability score of 62 and 58 respectively, while industrial districts had the poorest conditions with an average livability score of 48. Results by dimension showed that the old urban district had better conditions of living amenity and travel convenience, but poorer conditions of environmental health and comfort. The newly developed districts were the opposite. We conclude that our model is effective and extendible for rapidly assessing community-level livability, which provides detailed and useful information of human settlements for sustainable urban planning and governance.

Greenspace with overweight and obesity: A systematic review and meta-analysis of epidemiological studies up to 2020

Several reviews have been conducted to assess the association between greenspace and overweight or obesity, but the conclusions were inconsistent. However, an updated comprehensive review and meta-analysis is warranted, because several high-quality papers have been published more recently. The objectives of this study are to systematically and quantitatively assess the evidence for a link between greenspace with overweight/obesity and to make specific recommendations for further research. We searched three English language databases, four Chinese language databases and the reference lists of previously published reviews for epidemiological studies on greenspace and overweight/obesity published before January 2020. We developed inclusion criteria, screened the literature and extracted key data from selected papers. We assessed methodological quality and risk of bias, and we graded the credibility of the pooled evidence. We also performed sensitivity analyses. Fifty-seven records met our inclusion criteria and were included in the study. Most studies were cross-sectional designs (81%) and were from developed nations (88%). More than half (55%) of the included studies found beneficial associations between greenspace and overweight/obesity in overall or subpopulations. Our meta-analytical results showed that greater normalized difference vegetation index was associated with lower odds of overweight/obesity in a statistically significant fashion (odds ratio [OR]: 0.88; 95% CI: 0.84, 0.91) but not residential proximity to greenspace (OR: 0.99; 95% CI: 0.99, 1.00), proportion of greenspace (OR: 0.96; 95% CI: 0.85, 1.08) or number of parks in an area (OR: 0.99; 95% CI: 0.97, 1.01). However, we detected high between-study heterogeneity in two of the four meta-analyses, which reduced the credibility of the pooled evidence. Current evidence indicates that there might be an association between greater access to greenspace and lower odds of overweight/obesity. However, additional high-quality studies are needed to more definitively assess the evidence for a causal association.

Walkable Urban Environments: An Ergonomic Approach of Evaluation

Background. The salutogenicity of urban environments is significantly affected by their ergonomics, i.e., by the quality of the interactions between citizens and the elements of the built environment. Measuring and modelling urban ergonomics is thus a key issue to provide urban policy makers with planning solutions to increase the well-being, usability and safety of the urban environment. However, this is a difficult task due to the complexity of the interrelations between the urban environment and human activities. The paper contributes to the definition of a generalized model of urban ergonomics and salutogenicity, focusing on walkability, by discussing the relevant parameters from the large and variegated sets proposed in the literature, by discussing the emerging model structure from a data mining process, by considering the background of the relevant functional dependency already established in the literature, and by providing evidence of the solutions’ effectiveness. The methodology is developed for a case study in central Italy, with a focus on the mobility issue, which is a catalyst to generate more salutogenic and sustainable behaviors.

The Study on Spatial Elements of Health-Supportive Environment in Residential Streets Promoting Residents' Walking Trips

Residents’ walking trips are a kind of natural motion that promotes health and wellbeing by modifying individual behavior. The purpose of this study was to evaluate the major influence of the spatial elements of a health-supportive environment on residents’ walking trips. This study analyzes residents’ walking trips’ elements based on the spatiotemporal characteristics of walking trips, as well as the spatial elements of a health-supportive environment in residential streets based on residential health needs. To obtain the spatial elements that promote residents’ walking trips and to build an ordered logistic regression model, two methods—a correlation analysis and a logistic regression analysis—were applied to analyze the elements of residents’ walking trips as well as the spatial elements of a health-supportive environment in residential streets by means of SPSS software, using on-site survey results of ten residential streets and 2738 pieces of research data. The research showed that the nine kinds of spatial elements that significantly affect residents’ walking trips are density of pedestrian access, density of bus routes, near-line rate of roadside buildings, average pedestrian access distance, square area within a 500 m walking distance, distance to the nearest garden, green shade ratio, density of street intersections, and the mixed proportion of differently aged residential buildings. In order to construct a spatial environment that promotes walking trips, it is necessary to improve the convenience of residents’ walking trips, to increase the safety of roadside buildings and pedestrian access, to expand the comfort of “getting out to the nature”, and to enrich the diversity of different architectural styles and street density.

The association between spatial access to physical activity facilities within home and workplace neighborhoods and time spent on physical activities: evidence from Guangzhou, China

BACKGROUND

Urban residents from the developing world have increasingly adopted a sedentary lifestyle and spend less time on physical activities (PA). Previous studies on the association between PA facilities and individuals' PA levels are based on the assumption that individuals have opportunities to use PA facilities within neighborhoods all day long, ignoring the fact that their willingness and opportunities to use nearby facilities depend on how much discretionary time (any time when people have a choice what to do) they have. Further, scant attention has been paid to the influence of PA facilities within both residential and workplace neighborhoods in the dense urban context. To address the above research gaps, this study investigated the links between the spatial access to PA facilities within home/workplace neighborhoods and time spent on PA among working adults, focusing on whether results were different when different measures of accessibility were used and whether participants' discretionary time over a week affected their time spent on PA.

METHOD

This study used data from a questionnaire survey (n = 1002) in Guangzhou between June and July 2017 and point of interest (POI) data from online mapping resources. Outcome variables included the amount of time spent on physical activity/moderate and vigorous intensity physical activity (PA/MVPA) over the past week. Home/workplace neighborhoods were measured as different distance buffers (500 m circular buffers, 1000 m circular buffers, and 1080 m network buffers) around each respondent's home/workplace. Spatial access to PA facilities was measured using two indicators: the counts of PA facilities and proximity to PA facilities within home/workplace neighborhoods. The amount of discretionary time was calculated based on activity log data of working day/weekend day from the Guangzhou questionnaire survey, and regression models were used to examine relationships between the spatial access of PA facilities, the time spent on PA/MVPA, and the amount of discretionary time, adjusted for covariates. Associations were stratified by gender, age, education, and income.

RESULTS

Using different measures of accessibility (the counts of and proximity to PA facilities) generated different results. Specifically, participants spent more time on PA/MVPA when they lived in neighborhoods with more PA facilities and spent more time on MVPA when worked in closer proximity to PA facilities. A larger amount of discretionary time was associated with more time spent on PA/MVPA, but it did not strengthen the relationship between access to PA facilities and PA/MVPA time. In addition, relationships between access to PA facilities and PA levels varied by gender, age, education, and income.

CONCLUSION

This study contributes to the knowledge of PA-promoting environments by considering both the home and workplace contexts and by taking into account the temporal attributes of contextual influences. Policymakers and urban planners are advised to take into account the workplace context and the temporal variability of neighborhood influences when allocating public PA facilities and public spaces.

Walkability and its association with walking/cycling and body mass index among adults in different regions of Germany: a cross-sectional analysis of pooled data from five German cohorts

OBJECTIVES

To examine three walkability measures (points of interest (POI), transit stations and impedance (restrictions to walking) within 640 m of participant's addresses) in different regions in Germany and assess the relationships between walkability, walking/cycling and body mass index (BMI) using generalised additive models.

SETTING

Five different regions and cities of Germany using data from five cohort studies.

PARTICIPANTS

For analysing walking/cycling behaviour, there were 6269 participants of a pooled sample from three cohorts with a mean age of 59.2 years (SD: 14.3) and of them 48.9% were male. For analysing BMI, there were 9441 participants of a pooled sample of five cohorts with a mean age of 62.3 years (SD: 12.8) and of them 48.5% were male.

OUTCOMES

(1) Self-reported walking/cycling (dichotomised into more than 30 min and 30 min and less per day; (2) BMI calculated with anthropological measures from weight and height.

RESULTS

Higher impedance was associated with lower prevalence of walking/cycling more than 30 min/day (prevalence ratio (PR): 0.95; 95% CI 0.93 to 0.97), while higher number of POI and transit stations were associated with higher prevalence (PR 1.03; 95% CI 1.02 to 1.05 for both measures). Higher impedance was associated with higher BMI (ß: 0.15; 95% CI 0.04 to 0.25) and a higher number of POI with lower BMI (ß: -0.14; 95% CI -0.24 to 0.04). No association was found between transit stations and BMI (ß: 0.005, 95% CI -0.11 to 0.12). Stratified by cohort we observed heterogeneous associations between BMI and transit stations and impedance.

CONCLUSION

We found evidence for associations of walking/cycling with walkability measures. Associations for BMI differed across cohorts.

Neighborhood Walkability and Active Transportation: A Correlation Study in Leisure and Shopping Purposes

A walkable environment is a crucial factor for promoting active transportation. The purpose of this study is to examine the association between neighborhood walkability and active transportation for noncommuting purposes (leisure and shopping) in Seoul, Korea. The Walkability Score is used as a measure of walkability, and a multilevel logistic regression model is employed to measure the odds of active transportation (i.e., walking and cycling; nonmotorized trips) at two levels: individual (level 1) and neighborhood (level 2). The results of the study showed that the Walkability Score was significantly correlated with higher odds of active transportation in shopping models. Specifically, every one-point increase in the Walkability Score was associated with 1.5%–1.8% higher odds of active transportation in shopping models. However, there was no significant correlation between the two in leisure models. Meanwhile, individual characteristics associated with the odds of active transportation differed in the leisure and shopping models. Older age was positively correlated with the odds of active transportation in the leisure model, while females showed a positive correlation in the shopping model. Based on the study, urban and transportation planners can recommend urban policies to promote active transportation in an urban setting.

Does Environmental Walkability Matter? The Role of Walkable Environment in Active Commuting

Since walkability plays an important role in active commuting, several cities are actively promoting its integration into urban and environmental planning policies. This study examined the association between walkability and active commuting in Seoul, Korea. A multilevel logistic regression model was used to examine the correlation between Walkability Score and the probability of active commuting after controlling for individual variables. The analysis used 129,044 individual samples nested within 424 administrative districts (dongs). In this study, three models were tested: Model 1 contained only individual variables, Model 2 contained individual variables and Walkability Score, and Model 3 included neighborhood-level variables in addition to the variables of Model 2. The results showed that the Walkability Score was significantly correlated with the odds of active commuting. Specifically, every additional one-point increase in Walkability Score was associated with 0.3% higher odds of active commuting (Model 2: odds ratio (OR) = 1.003, 95% confidence interval (CI) = 1.001-1.005; Model 3: OR = 1.003, 95% CI = 1.001-1.006). Additionally, public transportation density was also positively correlated with the odds of active commuting. The odds of active commuting were positively correlated with younger age, female, lower-income, and having no car. Based on the findings, policy recommendations in urban planning and design, transport engineering, and environmental planning are provided.

Neighborhood characteristics associated with park use and park-based physical activity among children in low-income diverse neighborhoods in New York City

Urban parks provide spaces and facilities for children's physical activity (PA) and can be a free resource in low-income communities. This study examined whether neighborhood characteristics were associated with children's park use and park-based moderate-to-vigorous PA (MVPA) in low-income diverse communities and how associations differed between ethnic groups. Data on park visits and MVPA came from 16,402 children 5-10-years old directly observed using the System for Observing Play and Recreation in Communities in 20 parks in low-income neighborhoods with majority Latino or Asian populations in New York City. Neighborhood characteristics included land use mix (LUM), street audits, crime rates, and an area deprivation index. We employed Poisson and negative binomial models to estimate effects of neighborhood-level variables on the number of children observed in parks and engaging in MVPA, overall and by ethnicity. Results for Asian, Latino, and African American children indicated that higher levels of LUM and pedestrian-friendly streets were associated with greater numbers of children in parks and higher MVPA across all three groups. For Asian and Latino children only, quality of environment was positively associated with MVPA, whereas level of deprivation and crime rates in the surrounding neighborhood were negatively associated with children's park-based MVPA. In contrast, a park's access to public transportation was negatively associated with number of all children observed and engaging in MVPA. Study findings suggest that park-based MVPA interventions can be informed by understanding how neighborhood characteristics facilitate and constrain park use and park-based MVPA.

Walkability and its association with prevalent and incident diabetes among adults in different regions of Germany: results of pooled data from five German cohorts

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.

Improvement in food environments may help prevent childhood obesity: Evidence from a 9-year cohort study

BACKGROUND

Effects of food environments (FEs) on childhood obesity are mixed.

OBJECTIVES

To examine the association of residential FEs with childhood obesity and variation of the association across gender and urbanicity.

METHODS

We used the US Early Childhood Longitudinal Study-Kindergarten Cohort data, with 9440 kindergarteners followed up from 1998 to 2007. The Dun and Bradstreet commercial datasets in 1998 and 2007 were used to construct 12 FE measures of children, ie, changes in the food outlet mix and density of supermarkets, convenience stores, full-service restaurants, fast-food restaurants, retail bakery, dairy-product stores, health/dietetic food stores, confectionery stores, fruit/vegetable markets, meat/fish markets, and beverage stores. Two-level mixed-effect and cluster robust logistic regression models were fitted to examine associations.

RESULTS

Decreased exposures to full-service restaurants, retail bakeries, fruit/vegetable markets, and beverage stores were generally obesogenic, while decreased exposure to dairy-product stores was generally obesoprotective; the magnitude and statistical significance of these associations varied by gender and urbanicity of residence. Higher obesity risk was associated with increased exposure to full-service restaurants among girls, and with decreased exposures to fruit/vegetable markets in urban children, to beverage stores in suburban children, and to health/dietetic food stores in rural children. Mixed findings existed between genders on the associations of fruit/vegetable markets with child weight status.

CONCLUSION

In the United States, exposure to different FEs seemed to lead to different childhood obesity risks during 1998 to 2007; the association varied across gender and urbanicity. This study has important implications for future urban design and community-based interventions in fighting the obesity epidemic.

How Does the Built Environment in Compact Metropolitan Cities Affect Health? A Systematic Review of Korean Studies

This systematic review aimed to examine the associations between health-related outcomes and the built environment (BE) characteristics of compact metropolitan cities in Korea using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Searching the three Korean academic databases and PubMed, two independent reviewers identified 27 empirical articles published between 2011 and 2016. Data extracted for review included the study characteristics, the variables and measurement methods related to the BE and health-related outcomes, and the findings on the associations between the BE characteristics and health-related outcomes. Vote counting was used to assess the consistency of associations and the direction of associations between the BE characteristics and health-related outcomes. All of the reviewed studies used cross-sectional designs. The objective BE qualities were commonly examined. The BE characteristics associated with health-related outcomes in the reviewed articles included land use, street environment, transportation infrastructure, green and open spaces, and neighborhood facilities. Street environment, transportation infrastructure, and green and open spaces had consistent positive associations with physical health. Mixed land use and neighborhood facilities, however, had inconsistent associations with physical health. Generally, insufficient findings were reported in the association between the BE characteristics and mental and social health. The accessibility of the BE in a compact urban environment was the prominent attribute related to health promotion, health challenges, and health equity. An international comparative analysis of compact cities with different urban contexts and scale is required. Interdisciplinary urban health strategies are recommended based on the associations between the BE characteristics and health-related outcomes.

Modal Shift from Cars and Promotion of Walking by Providing Pedometers in Yokohama City, Japan

Mobility management is a transportation policy aiming to change travel behavior from car use to sustainable transportation modes while increasing people’s physical activity. Providing pedometers and visualizing step counts, popular interventions in public health practice, may constitute a mobility management program. However, the ease of modal shifts and changeability of walking habits differ across neighborhood environments. Using questionnaire data from 2023 middle-aged and older participants from Yokohama, Japan, in May 2017, this study examined (1) the relationship between the physical and social environments of Yokohama Walking Point Program participants who volunteered to use free pedometers and their modal shifts from cars to walking and public transport, and (2) whether participants’ modal shifts were associated with increases in step counts. Multivariate categorical regression analyses identified the frequency of greetings and conversations with neighbors as well as health motivation as important explanatory variables in both analyses. Participants living in neighborhoods far from railway stations and in neighborhoods with a high bus stop density tended to shift to walking and public transport, a modal shift that was highly associated with increased step counts. These results suggest that mobility management should be promoted in collaboration with public health and city planning professionals.

Exploring the links between population density, lifestyle, and being overweight: secondary data analyses of middle-aged and older Chinese adults

BACKGROUND

The increasing prevalence of obesity across all age groups has become a major health concern in China. Previous studies have found strong links between population density, sedentary lifestyle, and the risk of being overweight among adults and adolescents in Western countries. However, little research has been conducted to disentangle this relationship in China, which is rapidly urbanizing and densely populated. Compared to other age groups, middle-aged and older adults tend to have a higher risk of being overweight, which increases their risk of diabetes, high blood pressure, and other weight-related chronic diseases. In addition, they are especially sensitive to neighbourhood environmental factors such as population density. Therefore, we aimed to unravel the link between population density and the risk of being overweight among Chinese middle-aged and older adults, with a particular focus on the mediating role of lifestyle choices.

METHODS

Data from the 2011 China Health and Retirement Longitudinal Study were analysed. Individuals (N = 5285) were sampled from 405 neighbourhoods nested within 150 cities. Body Mass Index (BMI) was calculated based on self-reported body weight and height (being overweight was defined as a BMI ≥ 24 kg/m2). Multilevel regression and mediation analyses were applied to explore associations between population density, a sedentary lifestyle, and the risk of being overweight.

RESULTS

Middle-aged and older adults who lived in densely populated neighbourhoods had higher odds of being overweight. Further, this link was mediated by residents' mode of travel and physical exercise; specifically, these residents had higher odds of owning a car and spending lesser time on weekly physical exercise, thereby increasing their risk of being overweight. Furthermore, the association between car ownership and the odds of being overweight varied by neighbourhood population density.

CONCLUSIONS

There was a positive association between neighbourhood population density and middle-aged and older adults' risk of being overweight. This relationship may exist because people who live in densely populated neighbourhoods tend to lead a sedentary lifestyle. Our findings also suggest that, in rapidly urbanizing countries, a sedentary lifestyle may be especially harmful to middle-aged and older adults who live in densely populated neighbourhoods.

Associations between types of greenery along neighborhood roads and weight status in different climates

Obesity is a major international health concern. Neighborhood greenery has been identified as a critical factor for promoting health in urban areas, due in part to its apparent role in facilitating healthy weight by promoting physical activity. However, studies have used diverse greenery measures and spatial analysis units to ascertain this relationship. This study examined associations between street greenery and weight status at the residential address level across 500 to 2000m buffers in two climatically distinct communities, Phoenix, AZ, and Portland, OR. Greenery was measured using one-meter landcover data. Street greenery measures were designed to quantify the pedestrian environment along a gradient of suitability for promoting physical exercise. Weight status was defined by body mass index (BMI) calculated from weight and height information on driver's license records. BMI values were dichotomized at 25 into overweight or obese vs. neither. Approximately 500,000 BMI values in Phoenix and 225,000 in Portland were modelled by community using logistic regression. Street tree cover was consistently protective for healthy weight status across all buffer sizes after adjusting for potential confounders. Herbaceous street cover showed protective associations in Phoenix but harmful associations in Portland. Every 10% increase in street tree cover within 2000m was associated with 18% lower odds of being overweight or obese (adjusted odds ratio [AOR]: 0.82, 95% CI: 0.81 - 0.84 in Phoenix; 0.82, 95% CI: 0.81 - 0.83 in Portland). When compared to residents with less than 10% street tree cover within 2000m, those with greater than 10% tree cover had at least 13% (AOR for Portland: 0.87, 95% CI: 0.81 - 0.92) lower odds of being overweight or obese. Findings support the importance of urban street trees in very different climates for facilitating healthy weight status. They can inform greenery management to prioritize vegetation type and allocation decisions in limited urban spaces.

Does time spent in the residential neighbourhood moderate the relationship between neighbourhood walkability and transport-related walking? a cross-sectional study from Toronto, Canada

OBJECTIVES

Studies have investigated the influence of neighbourhood walkability on residents' walking behaviour, aiming to increase physical activity and reduce dependence on automobiles. Previous research, however, has not considered how the amount of time spent in the residential neighbourhood may modify this relationship. Our objective was to determine how time spent in the residential neighbourhood affects the relationship between neighbourhood walkability and walking for transport.

DESIGN

Using a cross-sectional sample of 2411 adults, we analysed the association between walkability (an index combining land-use mix, dwelling density and street connectivity) and transport-related walking (controlling for the effects of gender, age, income, self-rated health and regular access to private transport) testing for interactions by time spent in the neighbourhood.

PRIMARY OUTCOME MEASURE

Minutes spent walking for transport per week.

SETTING

Toronto, Canada.

PARTICIPANTS

Participants were aged 25 to 65. The survey had a 72% response rate.

RESULTS

After adjusting for potential confounders, the walkability index was weakly associated with walking (1 SD of walkability score is associated with 0.25 more minutes walking/week, p<0.01). Land-use mix was more strongly associated with walking than the walkability index. Time spent at the residential neighbourhood modified the relationship between land-use mix and transport-related walking in a dose-effect manner (p<0.01), those spending 5 hours on average at their residential neighbourhood have 0.2 min/day more walking for each additional land-use mix score and those spending 12 hours have 0.5 min/day more walking for each additional land-use mix score.

CONCLUSIONS

Our findings suggest that walkability is associated with increased walking time, but it is modified by time spent in the neighbourhood. Our study underscores the importance of testing 'time spent in the neighbourhood' as a modifier of environmental exposures in studies of environmental correlates of walking.

Impact of Population Density on PM2.5 Concentrations: A Case Study in Shanghai, China

We examine the effects of the urban built environment on PM2.5 (fine particulate matter with diameters equal or smaller than 2.5 μm) concentrations by using an improved region-wide database, a spatial econometric model, and five built environment attributes: Density, design, diversity, distance to transit, and destination accessibility (the 5Ds). Our study uses Shanghai as a relevant case study and focuses on the role of density at the jiedao scale, the smallest administrative unit in China. The results suggest that population density is positively associated with PM2.5 concentrations, pointing to pollution centralization and congestion effects dominating the mitigating effects of mode-shifting associated with density. Other built environment variables, such as the proportion of road intersections, degree of mixed land use, and density of bus stops, are all positively associated with PM2.5 concentrations while distance to nearest primary or sub-center is negatively associated. Regional heterogeneity shows that suburban jiedao have lower PM2.5 concentrations when a subway station is present.

Characteristics of the built environment and spatial patterning of type 2 diabetes in the urban core of Durham, North Carolina

BACKGROUND

Few studies examine relationships between built environment (BE) and type 2 diabetes mellitus (T2DM) using spatial models, investigate BE domains apart from food environment or physical activity resources or conduct sensitivity analysis of methodological choices made in measuring BE. We examine geographic heterogeneity of T2DM, describe how heterogeneity in T2DM relates to BE and estimate associations of T2DM with BE.

METHODS

Individual-level electronic health records (n=41 203) from the Duke Medicine Enterprise Data Warehouse (2007-2011) were linked to BE based on census block. Data on housing damage, property disorder, territoriality, vacancy and public nuisances were used to estimate BE based on four different construction methods (CMs). We used race-stratified aspatial and spatial Bayesian models to assess geographic heterogeneity in T2DM and associations of T2DM with BE.

RESULTS

Among whites, a 1 SD increase in poor quality BE was associated with a 1.03 (95% credible interval 1.01 to 1.06) and 1.06 (95 % credible interval 1.02 to 1.11) increased risk of T2DM for poor quality BE CM1 and CM2, respectively. Among blacks/African Americans, associations between T2DM and BE overlapped with the null for all CMs. The addition of BE to white models reduced residual geographic heterogeneity in T2DM by 4%-15%, depending on CM. In black/African-American models, BE did not affect residual heterogeneity.

CONCLUSION

Associations of T2DM with BE were sensitive to CM and geographic heterogeneity in T2DM differed by race/ethnicity. Findings underscore the need to consider multiple methods of estimating BE and consider differences in relationships by race/ethnicity.

Land use proportion and walking: Application of isometric substitution analysis

Entropy measures of land use mix are a commonly used component of walkability. However, they present methodological challenges, and studies on their associations with walking have produced mixed findings. This study examined associations of the proportion of discrete land uses with walking, using isometric substitution models that take the complementary nature of land use proportions into account. Analysis of data collected from middle-aged adults living in Brisbane, Australia (n = 10,794) found that replacing residential or other land with commercial land was associated with higher levels of walking. The isometric substitution approach may explain the potential impact of land use changes on residents' walking.

A Meta-analysis of the Literature on the Association of the Social and Built Environment With Obesity: Identifying Factors in Need of More In-Depth Research

Objective:

This study aims to identify groups of the social and built environment factors that have been studied substantially along with factors that need further attention, to guide the research, designing, and planning of the social and built environment for reducing obesity prevalence.

Data Source:

A systematic search of literature was undertaken from PubMed, Google Scholar, and Web of Knowledge.

Study Inclusion and Exclusion Criteria:

Keyword combination of “built environment,” “social environment,” and “obesity” were used to expand the search scope. Exclusion criteria included (1) any article with less than 50 citations from 2005 to 2010, and those with less than 25 citations from 2011 to 2015. In this way we included the most prominent peer-reviewed studies published in recent years while excluding less influential publications; (2) any article published in a language other than English; (3) literature review articles; (4) any article studying health outcomes not obesity related. We included research on eating behaviors since the studies contributed profoundly to food environment research.

Data Synthesis:

A meta-analysis of 153 empirical studies, selected from 2005 to 2015 based on a series of criteria, was conducted using factor analysis. The exploratory factor analysis was undertaken to group the prevalence and use of the social and built environment factors associated with obesity.

Results:

The findings suggested that the research community has gained a substantial understanding of the D variables of the built environment, including density, diversity, design, distance to transit, and destination access. Factors concerning different age groups, minority populations, groups with low socioeconomic status, food environment, and street-level urban design features have been less examined.

Conclusions:

The findings are important to guide future research directions, giving more attention to the factors in need of more in-depth research.

Development of a Neighbourhood Walkability Index for Porto Metropolitan Area. How Strongly Is Walkability Associated with Walking for Transport?

The creation of walkable communities constitutes a cost-effective health promotion strategy, as walking is an accessible and free intervention for increasing physical activity and health. In this cross-sectional ecological study, we developed a walkability index for the Porto Metropolitan Area and we validated it by assessing its association with walking for transportation. Neighborhood walkability was measured using a geographic information system and resulted from the weighted sum of residential density, street connectivity, and a destination-based entropy index. The index was categorized into quintiles of increasing walkability. Among the 1,112,555 individuals living in the study area, 28.1% resided in neighborhoods in the upper quintile of walkability and 15.8% resided in the least walkable neighborhoods. Adjusted regression models revealed that individuals residing in the most walkable neighborhoods are 81% more likely to report walking for transportation, compared with those from the least walkable neighborhoods (odds ratio: 1.81; 95% confidence intervals: 1.76–1.87). These results suggest that community design strategies to improve walkability may promote walking behavior.

Relationship Between the Built Environment and Body Mass Index in a Rural Context: A Cross-Sectional Study from Vermont

Objective

To evaluate the association between a marker of urban development (commercial building density) and body mass index (BMI) in a predominantly rural context.

Methods

A cross-sectional analysis of two geocoded datasets from Vermont. The first includes subjects from the Vermont Diabetes Information System (VDIS), an extensively attributed dataset of adult diabetics (n = 610); the second was the complete driver's license records for Vermont (n = 401,367). The dependent variable was BMI, measured objectively for the VDIS data and self-reported for the driver's license data. The explanatory variable was commercial buildings per hectare within 250 m of the home address used as a proxy for walkability. We regressed BMI against density in both datasets, controlling for age and gender; a separate regression was run for the VDIS data, controlling for a number of additional confounders related to health, activity, diet, and income.

Results

All models demonstrated a significant positive relationship between BMI and commercial building density. For the three VDIS data models, coefficients of density were +0.75, +0.79, and +0.90, all of which indicate an approximate ¾ kg/m² increase in BMI for each additional commercial facility per hectare (p < 0.01). For the driver’s license data, the coefficient was +0.16, which also indicates an increase in BMI with increasing density (p < 0.01).

Discussion

We found that BMI displays a positive association with commercial building density in Vermont, which is inconsistent with previous findings. The difference may be due to the unique rural focus of this study. Other characteristics of rural life may be associated with lower incidence of obesity and should be studied further.

Do Income, Race and Ethnicity, and Sprawl Influence the Greenspace-Human Health Link in City-Level Analyses? Findings from 496 Cities in the United States

Examination of the greenspace—human health relationship operates in at least four dimensions: what is considered greenspace? which moderators and mediators are included? what outcomes are measured? and which units of analysis (e.g., individuals, cities) are studied? We examined three of these four dimensions in a cross-sectional study of 496 of the 500 most populated US cities (total population size = 97,574,613, average population per city = 197,920). Spatial average models tested the effect of two greenspace measures (Normalized Difference Vegetation Index greenness and tree cover) on two outcomes (obesity and mental health), while adjusting for income, race and ethnicity, sprawl, age, sex, physical inactivity, median age of housing, and total population. We conducted analyses at the city scale, which is an understudied unit of analysis, and compared findings to individual- and neighborhood-level studies. In two of four models, greenspace was associated with better health. We found race and ethnicity moderated this relationship with varying results. In full sample analyses, cities with greater percentages of non-Hispanic Whites showed links between higher tree cover and lower obesity but marginal relationships between higher greenness and lower obesity. In subsample analyses with majority-non-Hispanic Black cities, higher tree cover was associated with lower obesity and better mental health. These findings advance previous research by showing that race and ethnicity moderate the greenspace—health link at the city level.