School site and the potential to walk to school: the impact of street connectivity and traffic exposure in school neighborhoods

Children's Independent Mobility, School Travel, and the Surrounding Neighborhood

INTRODUCTION

Children's active travel to and from school (AST) and children's independent mobility (CIM) are consistently positively associated with physical activity (PA); however, few researchers have investigated associations between objective measures of the environment and indicators of AST and CIM in national samples.

METHODS

A national sample of 2,067 Canadian parents of 7- to 12-year-old children was recruited in December 2020. Regression analyses were used in 2023 to assess the association between geographic information system measures of park density, blue space, population density, greenspace, intersection density, and CIM and AST to and from school.

RESULTS

Children in areas with high versus low park density (>0.025 vs. ≤0.025) had higher odds of travel to school via active modes (OR: 1.47 [1.14, 1.91], p=0.003). Children in neighborhoods in the highest quartile for neighborhood greenspace (Normalized Difference Vegetation Index) were more likely to travel to home actively than those in areas of lower greenspace (OR: 1.70 [1.18, 2.45], p=0.004). On average, children living in areas in the highest versus the lowest quartile for intersection density were more likely to engage in AST to (OR: 2.43 [1.58, 3.75], p<0.001) and from (OR: 2.77 [1.80, 4.29], p<0.001) school.

CONCLUSIONS

The observed associations underscore a need for city planners and policymakers to ensure sufficient access to parks and neighborhood greenspace, especially if findings are confirmed in longitudinal studies. More research is needed to investigate the role of intersection density in supporting AST and CIM.

Correlates of Active School Transportation During the COVID-19 Pandemic Among Canadian 7- to 12-Year-Olds: A National Study

BACKGROUND

Active school transportation (AST) is an important source of physical activity for children and a potentially important climate change mitigation strategy. However, few studies have examined factors associated with AST in the context of the COVID-19 pandemic.

METHODS

We used baseline data from a longitudinal survey to investigate correlates of AST during the second wave of COVID-19 (December 2020). We collected survey data from 2291 parents of 7- to 12-year-olds across Canada and linked this information with data on neighborhood walkability and weather from national databases. We assessed potential correlates representing multiple levels of influence of the social-ecological model. We used gender-stratified binary logistic regression models to determine the correlates of children's travel mode to/from school (dichotomized as active vs motorized), while controlling for household income. We examined the correlates of travel mode for both the morning and afternoon trips.

RESULTS

Consistent correlates of AST among Canadian children during the COVID-19 pandemic included greater independent mobility, warmer outdoor temperature, having a parent who actively commuted to work or school, living in a household owning fewer vehicles, and living in a more walkable neighborhood. These findings were largely consistent between boys and girls and between morning and afternoon school trips.

CONCLUSIONS

Policymakers, urban planners, and public health workers aiming to promote AST should focus on these correlates while ensuring that neighborhoods are safe for children. Future research should monitor the prevalence and correlates of AST as COVID-19 restrictions are removed.

The built environment and child obesity: A review of Australian policies

Child obesity is a serious public health challenge affected by both individual choice and societal and environmental factors. The main modifiable risk factors for child obesity are unhealthy eating and low levels of physical activity, both influenced by aspects of the built environment. Coordinated government policy across jurisdictions, developed using strong research evidence, can enable built environments that better support healthy lifestyles. This study reviewed current Australian and Western Australian government policies to understand if and how they address the impact of the built environment on child obesity, physical activity, sedentary behavior, and diet. Current government policy documents related to the built environment and child health were analyzed using the Comprehensive Analysis of Policy on Physical Activity framework. Ten Australian and 31 Western Australian government policy documents were identified. Most referred to the role of the built environment in supporting physical activity. Very few policies mentioned the built environment's role in reducing sedentary behaviors, supporting healthy eating, and addressing obesity. Few recognized the needs of children, and none mentioned children in policy development. Future government policy development should include the voices of children and child-specific built environment features. Inter-organizational policies with transparent implementation and evaluation plans are recommended.

Associations between school-level environment and individual-level factors of walking and cycling to school in Canadian youth

Identifying individual-level and school-level correlates of walking and cycling to school remains a public health priority as only one in four Canadian youth actively travels to school. This study aimed to estimate the prevalence of Canadian youth in grades 6 to 10 who walk, cycle, or use motorised transport to go to school, and to examine if school neighbourhood walkability, neighbourhood-level and individual-level correlates are associated with mode of transportation to school. Data come from the 2017/2018 Health Behaviour in School-aged Children study. The walkability of the schools' neighbourhood was measured using the Canadian Active Living Environments (Can-ALE) index. We observed that only 22.4% and 4.2% of youth walked and cycled to school, respectively. Most (73.4%) used motorised transport to school, including 53.2% of youth who lived less than 5 minutes from school. Schools located in neighbourhoods with higher Can-ALE classes (i.e., higher walkability) were positively associated with walking to school. No statistically significant association between school walkability and cycling to school was observed. Individual-level socioeconomic status (SES) was associated with walking, but not cycling, to school. Conversely, neighbourhood-level SES was associated with cycling, but not with walking, to school. Correlates of walking to school differed from those for cycling to school, suggesting that different approaches to promoting active transportation are needed.

Built and social indices for hazards in Children's environments

Leveraging the capabilities of the Historical Spatial Data Infrastructure (HSDI) and composite indices we explore the importance of children's built and social environments on health. We apply contemporary GIS methods to a set of 2000 historical school records contextualized within an existing HSDI to establish seven variables measuring the relative quality of each child's built and social environments. We then combined these variables to create a composite index that assesses acute (short-term) health risks generated by their environments. Our results show that higher acute index values significantly correlated with higher presence of disease in the home. Further, higher income significantly correlated with lower acute index values, indicating that the relative quality of children's environments in our study area were constrained by familial wealth. This work demonstrates the importance of analyzing multiple activity spaces when assessing built and social environments, as well as the importance of spatial microdata.

Canadian children's independent mobility during the COVID-19 pandemic: A national survey

Independent mobility (IM) is associated with children's physical activity and indicators of social, motor, and cognitive development. We surveyed Canadian parents of 7- to 12-year-olds (n = 2291) about social-ecological correlates of IM in the second wave of COVID-19 (December 2020). We used multi-variable linear regression models to identify correlates of children's IM. Our final model (R² = 0.353) included four individual-, eight family-, two social environment- and two built environment-level variables. The correlates of boys' and girls' IM were similar. Our findings suggest that interventions to support children's IM in a pandemic context should target multiple levels of influence.

How the Built Environment Moderates Gender Gap in Active Commuting to Schools

This study investigates the influences of built environmental (BE) factors, network design, and sociodemographic factors on active school travel (AST). Although numerous studies have explored these relationships, this study is trying to assess this issue with a focus on gender differences. Data from a cross-sectional sample of children from first to sixth grades from 16 public primary schools exclusive for girls and boys (N = 1260) in Shiraz collected in November 2019 was used. The analysis of the data revealed that, on average, boys are more willing to walk than girls, but that the boys' tendency to walk is less elastic with respect to distance. Moreover, it is shown that street connectivity for all distance thresholds has a positive relationship with walking level, but the street network choice parameter decreases the chance of walking within an 800 metre threshold. It is demonstrated the need to take gender differences into account in local planning policies to promote AST in a developing country context.

Perceived Safety Influencing Active Travel to School-A Built Environment Perspective

Despite the many research studies on active school travel (AST), the number of children walking/cycling to school is decreasing as there is a lack of implementable research evidence. This review through database searches from 2000 to 2020 aims to identify research gaps and explore new perspectives. The articles are selected and screened methodically for systematic presentation of the review. An existing active school travel framework is used to structure and discuss this review paper on mediating factors influencing children's active travel to school, that is the perceived traffic safety, neighborhood safety, and distance to school. Perception of traffic safety could be ameliorated through lateral separation from the traffic, and this could be a new area of research. The neighborhood safety perception may require more research to validate the previous findings. Schools should be located within high-density residential development so that many children can walk to school.

Validating a geospatial healthfulness index with self-reported chronic disease and health outcomes

Leveraging community engagement from past research may yield frameworks on which to build new inquiries. We previously integrated community voice into the development of a healthfulness index to increase awareness of social determinants of health in the built environment and inform deployment of public health interventions in the Flint (Michigan, USA) Center for Health Equity Solutions. Here we combine the healthfulness index with self-reported chronic disease and health outcomes (n = 12,279) from a community-based healthcare entity, the Genesee Health Plan. The healthfulness index purports to predict how health-promoting a neighborhood is based on many spatially varying characteristics; by linking our health plan data to this index, we validate the effectiveness of the healthfulness index. After geocoding all enrollees and joining their healthfulness scores, we conducted a series of logistic regressions to compare the relationship between self-reported outcomes and healthfulness. Matching the two intervention projects of our center (revolving around healthy eating & physical activity in project 1 and mental health sustainment & substance use prevention in project 2), our analyses also focused on classes of outcomes related to a) cardiovascular disease and b) mental health. In only select cases, higher (better) healthfulness scores from each project were independently associated with better cardiovascular and mental health outcomes, controlling for age, race, and sex. Generally, however, healthfulness did not add predictive strength to the association between health and sociodemographic covariates. Even so, the use of composite healthfulness indices to describe the health-promoting or degrading qualities of a neighborhood could be valuable in identifying differences in health outcomes. Future researchers could further explore healthcare claims datasets to increase understanding of the links between healthfulness and health outcomes. This and future work will be valuable in advocacy toward additional healthfulness indices to aid other communities in enriching understanding between the built environment and health.

Equity in temporary street closures: The case of London's Covid-19 'School Streets' schemes

School Streets are a street space reallocation scheme that has proliferated since the beginning of the Covid-19 pandemic in the UK, reducing motor traffic on streets outside many schools. Utilising a minimum-standards approach to equity, this paper examines the distribution of School Streets closures across social and environmental indicators of equity, and spatially across London's administrative geography. Using a multi-level regression analysis, we show that although School Streets have been equally distributed across several socio-demographic indicators, they are less likely to benefit schools in car-dominated areas of poor air quality, and their spatial distribution is highly unequal. This study presents an example of using environmental and spatial variables alongside more typical sociodemographic indicators in measuring the equity of school travel provision. For policymakers, the findings signal the need to implement complementary policies that can benefit schools with worse air quality, and to accelerate School Street implementation in slower districts.

How different are objective operationalizations of walkability for older adults compared to the general population? A systematic review

Background

Walking is an essential activity for everyone and for older adults in particular, given that it is the most accessible form of physical activity and one of the healthiest transportation modes. Understanding how walkability (the potential of the environment to enable and/or encourage walking) has been objectively measured and analyzed for older adults is critical to create more inclusive, healthy, and sustainable environments and to promote healthy aging. Despite the numerous reviews on physical activity among older adults and its relationship with the built environment, the literature still lacks comparison reviews focusing specifically on objective operationalizations of walkability for older adults vs. the general population.

Methods

We conducted a systematic review of 146 empirical studies that measured walkability objectively in relation to walking-related outcomes. We compared studies focused on older adults (n = 24) and the general population (n = 122). Content analysis included the characteristics of the study design, walkability measures, spatial extent, and associations found between walkability and walking-related outcomes.

Results

In both groups of publications, the majority of studies were conducted in the US, Canada, and Europe, and largely in high-income countries. They were mostly published in health-related journals and used cross-sectional designs, operationalized walkability by using indexes, employed self-reported measures for walking-related outcomes, and found positive associations between walkability and walking outcomes. However, we observed some differences among studies focusing on older adults. Compared to studies focusing on the general population, a larger proportion of studies on older adults was conducted in the Middle East and Asia, and they used longitudinal designs, mixed methods to measure walking-related outcomes, variables related with land-use characteristics, safety from traffic and crime, and greenery, and a larger proportion found positive, as well as no associations between walkability and walking-related outcomes.

Conclusion

Although there is a promising increase in interest in older adults-focused walkability studies in the last decade, there is still a need for more studies focusing on different settings, using wider spatial extents, longitudinal designs, objective or mixed methods to collect outcome data, and specific variables and/or specially created indexes for older adults and for settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03233-x.

Relationship between Children's Independent Activities and the Built Environment of Outdoor Activity Space in Residential Neighborhoods: A Case Study of Nanjing

Children are a vulnerable population that is frequently overlooked in urban planning. The spatial demands of children are garnering broader consideration in the development of public spaces in cities as efforts to promote child-friendly cities. Children's independent activities (CIAs) during childhood are undeniably beneficial to their physical and mental health. Residential areas are the main places for children's daily activities. Building a suitable outdoor activity space in the community for children's recreation is an essential foundation for improving CIAs and promoting the development of child-friendly neighborhoods. A sample of 15 typical children's outdoor activity spaces in residential neighborhoods of Nanjing, China, was selected for the study to observe and record CIAs. The built environment indicators of residential outdoor spaces were extracted, and correlation analysis was employed to investigate the residential outdoor space elements relevant to CIAs. The results indicated that at the site level, higher percentages of tree coverage and soft paving enhanced CIAs, while high functional mix inhibited them. Additionally, gated communities, top-notch sanitation, secure facilities, neighborhoods with higher residential densities, and a diversity of activity facilities all stimulated children to engage in independent activities. Furthermore, questionnaires for the guardian indicated that they placed a high priority on site safety, and that waterfront areas and activity sites where incidents had occurred decreased parents' willingness to allow participation in CIAs, whereas safety education or the use of positioning devices may promote CIAs. Based on the above results, we proposed appropriate adaptations for places in residential neighborhoods. The study expects to create a higher quality environment in residential neighborhoods for children to play in public spaces and provide beneficial help to improve the child-friendly neighborhood.

Perceived Walkability and Respective Urban Determinants: Insights from Bologna and Porto

Walking is undoubtedly a sustainable and healthy mode of transport. However, the decision to walk is influenced by many built environment and streetscape attributes. Specifically, the term walkability is used to describe the extent to which the urban environment is pedestrian-friendly, usually by quantifying multiple built environment attributes at the neighbourhood scale. The present study adopts a qualitative approach to evaluate perceived walkability. Based on a questionnaire (n = 1438) administered in the cities of Bologna and Porto, this paper analyses how respondents perceived and evaluated 19 built environment and streetscape attributes. An Exploratory Factor Analysis was carried out to examine the correlations between the various attributes and to identify the underlying walkability determinants. The analysis indicated that 13 attributes were highly correlated, resulting in four determinants: (i) urban ambiance, which includes land use and street design attributes, such as land use mix, enclosure, transparency, and architectural and landscape diversity; (ii) pedestrian infrastructure, which is related to sidewalk conditions; (iii) street connectivity and proximity to community facilities; and iv) access to other modes of transport. In turn, traffic safety and security were not correlated with perceived walkability in both cities. These findings suggest that specific urban design and pedestrian infrastructure attributes should be highly considered when formulating policies aiming to create more pedestrian-friendly cities, as well as in walkability studies and when developing walkability scores and indexes.

Analysis of Child Traffic Safety near Primary School Areas Using UAV Technology

Road safety in primary school areas is a delicate issue due to the vulnerability of children as road users. They are inexperienced traffic participants and sometimes their behavior in traffic situations is unpredictable. This paper reports a safety analysis conducted using video processing of conflict trajectories of vehicles and active transportation users (AT users). The videos were collected using unmanned aerial vehicles (UAVs) as this technology does not affect the actual behavior of traffic participants. Due to their airborne position, UAVs can conveniently gather information about driving behaviors and the exact positions of various participants. The safety analysis was conducted using surrogate indicators suitable for evaluating the risk of potential collisions as they incorporate both spatial proximity and speed. Three conflict indicators were used in the safety analysis: (i) time-to-collision, (ii) post-encroachment time, and (iii) heavy braking. The methodology was tested in a primary school area in the city of Zagreb. With the applied methodology, a total of 43 potential conflicts were identified in the school area (14 time-to-collision, 23 post-encroachment time, and 6 heavy braking). Based on the determined potential conflicts, safety measures were proposed to decrease the number and severity of potential conflicts and to increase traffic safety near school areas.

Associations between Children's Physical Activity and Neighborhood Environments Using GIS: A Secondary Analysis from a Systematic Scoping Review

Regular participation in physical activity is essential for children's physical, mental, and cognitive health. Neighborhood environments may be especially important for children who are more likely to spend time in the environment proximal to home. This article provides an update of evidence for associations between children's physical activity behaviors and objectively assessed environmental characteristics derived using geographical information system (GIS)-based approaches. A systematic scoping review yielded 36 relevant articles of varying study quality. Most studies were conducted in the USA. Findings highlight the need for neighborhoods that are well connected, have higher population densities, and have a variety of destinations in the proximal neighborhood to support children's physical activity behaviors. A shorter distance to school and safe traffic environments were significant factors in supporting children's active travel behaviors. Areas for improvement in the field include the consideration of neighborhood self-selection bias, including more diverse population groups, ground-truthing GIS databases, utilising data-driven approaches to derive environmental indices, and improving the temporal alignment of GIS datasets with behavioral outcomes.

Associations Between School Environments, Policies and Practices and Children's Physical Activity and Active Transportation

BACKGROUND

There is evidence of school-level variability in children's active behaviors. This study investigated the associations between school environments, policies and practices, and children's physical activity (PA) and active school transportation (AST), in a school ecology context.

METHODS

We recruited children (N = 1699, age = 10.2 ± 1.0 years, 55.0% girls) in 37 schools from 3 diverse regions of Canada. We then collected data using questionnaires (child, parent) and pedometers. In each school, an official completed a School Health Environment Survey. Multilevel regression models were used to examine associations with children's daily steps, and frequency and volume (frequency*distance) of AST.

RESULTS

Between-school variation ranged from 4.7% to 22.2% demonstrating that school environments are associated with children's active behaviors. None of the school environment variables were significantly associated with children's PA or frequency of AST. Nevertheless, their inclusion improved the PA model. Children's volume of AST increased in schools that reported more initiatives to promote AST.

CONCLUSIONS

Our findings suggest that multiple components are needed to effectively promote active behaviors in children. Schools should determine the areas in which they can improve and assess the feasibility of implementing measures to make their school environments, policies, and practices more conducive to PA and AST.

Influence of the Built Environment on Physical Activity Choices among Emirati Male and Female Adolescents: An Examination of Parents’ and Students’ Perceptions

The UN Human Development Report 2020 ranked the United Arab Emirates (UAE) as having achieved ‘very high human development’ and as being at the 31st position among all countries. Despite this, the ever increasing obesity rates among Emirati youth, higher than international standards, is alarming. This research aims at identifying how different perceptions of the built environment by parents and adolescents are likely to affect physical activity (PA) choices among male and female Emirati youth. This can help inform better health and education policies to achieve three of the interconnected UN Sustainable Development Goals (SDGs), namely good quality health and well-being, quality education, and gender equality, that the UAE strives to achieve. Responses from 335 students (aged 14–20) from six schools and 250 parent responses in the Al Ain region of Abu Dhabi Emirate were used to understand the mean variation in perception of five built environment constructs. Further, multinomial logit regression was used to assess the health condition using the perception, behavior, and built environment measures. Results indicate that Emirati males perceive the built environment factors as barriers more than female adolescents. Parents perceive street crossing (p < 0.016) and sidewalk characteristics (p < 0.020) to be more of a hindrance. Traffic exposure, self-reported physical activity, and walkability near homes and schools significantly affect Emirati adolescents’ health conditions. Recommendations are made for various stakeholders including parents, school authorities, Abu Dhabi Municipality and Transportation, and the Urban Planning department on ways to enhance the built environment and encourage PA and well-being of Emirati adolescents.

Evaluation and Optimization of Walkability of Children's School Travel Road for Accessibility and Safety Improvement

(1) Background: In the context of a children friendly city, accessibility and safety are the basic needs of children’s pedestrian school travel. This study proposes a comprehensive evaluation method of pedestrian accessibility and safety for children’s school travel. (2) Methods: Firstly, the school travel network was constructed by simulating the path of children walking to school. Secondly, from the meso and micro dimensions, the impact factors of pedestrian accessibility and safety were combed out, and an evaluation index system was constructed. Finally, pedestrian accessibility and safety were evaluated based on the Space Syntax analysis and ArcGIS spatial analysis, and the results were superimposed and spatially differentiated. The new evaluation method was tested in the Jintang Road area in Hedong District, Tianjin, China. (3) Results: The pedestrian accessibility and safety of children’s school travel road in the study area needed to be improved. It was found that the main impact factors were the effective walking width, the spatial connectivity, the visual integration, the obstruction of pedestrian safety, the completeness of crossing facilities and the influence of traffic flow and put forward optimization strategies. After optimized simulation verification, the overall improvement was achieved. (4) Conclusion: The evaluation method is helpful to calculate the pedestrian accessibility and safety of children’s school travel, and help decision makers determine the design and management strategies of child-friendly streets.

Associations of neighborhood built, safety, and social environment with walking to and from school among elementary school-aged children in Chiba, Japan

BACKGROUND

Although it is globally known that Japan has high prevalence of active school travel among children, there are few international studies on Japanese children's school travel. Moreover, only few studies have focused on the differences in their mode of travel between to-school and from-school. This study examined the associations of neighborhood built, safety, and social environments with walking to/from school among elementary school-aged children in Chiba, Japan.

METHODS

We conducted an online survey with 1545 parents of children aged 6-12 years residing in Chiba between 25 and 27 November 2020 during the COVID-19 pandemic. A neighborhood was defined as the area of a postcode provided by the participants. Each neighborhood environment was assessed based on the built environment (new town designation, walkability, distance to school, population density), social environment (neighborhood cohesion and connection), and safety (CCTVs, a road section for walking alone, safety volunteers). Neighborhood walkability was measured using subscales of the Neighborhood Environment Walkability Scale (youth and abbreviated versions) including crime safety and traffic safety. Parents' perceived influence of COVID-19 on school commuting and after-school activities were also included in the model as covariates. Walking to and from school were separately analyzed using multinomial logistic regressions, where new towns and walkability were computed separately as explanatory variables.

RESULTS

Four fifths of children walked to and from school daily. Walking to school was positively associated with crime safety, neighborhood connections, and schools sited in new towns. Walking from school had positive associations with traffic safety, neighborhood cohesion, and CCTVs, but negative associations with safety volunteers and after-school activities. The presence of a section for walking alone and perceived influence of COVID-19 had negative associations with walking to and from school.

CONCLUSIONS

Recent social changes such as declining birthrate, decline in public elementary schools, and increasing after-school activities may change parental attitudes toward children's walking to/from school, and subsequently, their mode of school travel over time. To maintain the high prevalence of walking to/from school in Japan, multidisciplinary approaches involving different stakeholders from education, public health, and urban planning are required to overcome sectionalism and support this behavior in the long term.

Measuring the Built Environment in Studies of Child Health-A Meta-Narrative Review of Associations

Although the built environment (BE) is important for children’s health, there is little consensus about which features are most important due to differences in measurement and outcomes across disciplines. This meta-narrative review was undertaken by a multi-disciplinary team of researchers to summarise ways in which the BE is measured, and how this links to children’s health. A structured search of four databases across the relevant disciplines retrieved 108 relevant references. The most commonly addressed health-related outcomes were active travel, physical activity and play, and obesity. Many studies used objective (GIS and street audits) or standardised subjective (perceived) measurements of the BE. However, there was a wide variety, and sometimes inconsistency, in their definition and use. There were clear associations between the BE and children’s health. Objective physical activity and self-reported active travel, or obesity, were positively associated with higher street connectivity or walkability measures, while self-reported physical activity and play had the strongest association with reduced street connectivity, indicated by quieter, one-way streets. Despite the high heterogeneity found in BE measures and health outcomes, the meta-narrative approach enabled us to identify ten BE categories that are likely to support children’s health and be protective against some non-communicable disease risk factors. Future research should implement consistent BE measures to ensure key features are explored. A systems approach will be particularly relevant for addressing place-based health inequalities, given potential unintended health consequences of making changes to the BE.

Evaluation of Walking Comfort in Children's School Travel at Street Scale: A Case Study in Tianjin (China)

(1) Background: school travel is an important part of a child's daily activities. A comfortable walking environment can encourage children to walk to school. The existing methods of evaluating walking environments are not specific to children's walks to school. (2) Methods: this study proposes a method of evaluating walking comfort in children traveling to school at street scale. Related indexes were selected that reflect children's school travel behavior and their needs in street environments based on walking environment audit tools. Factor analysis was then used to calculate the relative weight of each index. (3) Results: the new evaluation method was tested in the neighborhoods around the First Central Primary School in Hedong District, Tianjin, China. The walking comfort for children's school travel was evaluated in eight indexes: effective street width; street flatness; street cleanliness; interface diversity; buffer; shade coverage; green looking ratio; and sound decibels. Different classes and types of streets were found to have various vulnerabilities. (4) Conclusions: this evaluation method can accurately locate the weak spots in streets to improve the local policymakers' perception of street environments, which can greatly facilitate the implementation of precise measures to promote children walking to school.

Improving spatial data in health geographics: a practical approach for testing data to measure children's physical activity and food environments using Google Street View

Background

Geographic information systems (GIS) are often used to examine the association between both physical activity and nutrition environments, and children’s health. It is often assumed that geospatial datasets are accurate and complete. Furthermore, GIS datasets regularly lack metadata on the temporal specificity. Data is usually provided ‘as is’, and therefore may be unsuitable for retrospective or longitudinal studies of health outcomes. In this paper we outline a practical approach to both fill gaps in geospatial datasets, and to test their temporal validity. This approach is applied to both district council and open-source datasets in the Taranaki region of Aotearoa New Zealand.

Methods

We used the ‘streetview’ python script to download historic Google Street View (GSV) images taken between 2012 and 2016 across specific locations in the Taranaki region. Images were reviewed and relevant features were incorporated into GIS datasets.

Results

A total of 5166 coordinates with environmental features missing from council datasets were identified. The temporal validity of 402 (49%) environmental features was able to be confirmed from council dataset considered to be ‘complete’. A total of 664 (55%) food outlets were identified and temporally validated.

Conclusions

Our research indicates that geospatial datasets are not always complete or temporally valid. We have outlined an approach to test the sensitivity and specificity of GIS datasets using GSV images. A substantial number of features were identified, highlighting the limitations of many GIS datasets.

Living the journey to school: Conceptual asymmetry between parents and planners on the journey to school

Research about school travel and the built environment developed using positivist and post-positivist onto-epistemologies often relies heavily on travel surveys, activity diaries, GPS tracking, and the "objective" measurement of built environment features using geographical information systems and planimetric data. That work takes up and applies specialized disciplinary and practice-based language (e.g., planning and engineering) and concepts that are used to describe, measure, and design the built environment. In this paper, we explore differences in how parents think about the built environment and school transport and the ways in which the built environment and transport are conceptualized in planning. The presence of conceptual asymmetry between a scholar's "model" and the "lived experience" of parents and children may have implications for the efficacy of school travel-related policy and planning. We use Bronfenbrenner's social ecological model to guide a thematic analysis of 37 interviews with parents about school travel behaviour in Toronto, Canada. We found that parents' experiences of the built environment are complex and varied, with different features influencing individual parents differently, and at varying levels of the ecological model. For example, mixed-use development, often held up as a necessary condition for tackling automobility, was cited as a desirable aesthetic background for driving. We were able to locate examples of conceptual asymmetry but also agreement - particularly about traffic around schools. For example, parents expressed divergent views on the impact of heavy traffic on walking, with some describing traffic and traffic safety as barriers to walking, while others indicated that resistance to driving in traffic motivated a choice to walk. Our study serves as a call to planners and geographers to better attend to the lay, everyday onto-epistemologies that shape parents' lived experiences of travel to school.

Is the physical activity environment surrounding primary schools associated with students' weight status, physical activity or active transport, in regional areas of Victoria, Australia? A cross-sectional study

OBJECTIVES

To explore whether the physical activity (PA) environment (walkability, greenspace and recreational facilities) surrounding regional primary schools is associated with children's PA levels, active transport and weight status. Limited research on this topic has been conducted outside of major cities.

DESIGN

Cross-sectional ecological study using baseline data from two large-scale obesity prevention interventions.

SETTING

Eighty (n=80) primary schools across two regional areas in Victoria, Australia.

PARTICIPANTS

Students aged 8-13 years (n=2144) attending participating primary schools.

OUTCOME MEASURES

Measured weight status (body mass index z-score, proportion overweight/obese) and self-reported PA behaviours (meeting PA recommendations and active travel behaviour).

RESULTS

When adjusted for student and school demographics, students had significantly increased odds of using active transport to or from school when the school neighbourhood was more walkable (OR 1.21 (95% CI 1.09 to 1.35), had a greater number of greenspaces (OR 1.35 (95% CI 1.20 to 1.53)) and a greater number of recreational facilities (OR 1.18 (95% CI 1.07 to 1.31)). A higher cumulative PA environment score was also associated with a higher proportion of children using active transport (OR 1.33 (95% CI 1.28 to 1.51)). There were no significant associations between the PA environment measures and either weight status or meeting the PA recommendations in adjusted models.

CONCLUSIONS

This study is the first of its kind exploring school neighbourhood environments and child weight status and PA in regional areas of Australia. It highlights the potential of the environment surrounding primary schools in contributing to students' active travel to and from school. Further research with the use of objective PA measurement is warranted in regional areas that have been under-researched.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR.org.au) identifier 12616000980437; Results.

Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

Children's Experiences of Their Journey to School: Integrating Behaviour Change Frameworks to Inform the Role of the Built Environment in Active School Travel Promotion

Childhood obesity is a public health problem with multiple effects on children’s life. Promoting Active School Travel (AST) could provide an inclusive opportunity for physical activity and shape healthy behaviours. Data for this cross-sectional study were drawn from questionnaires carried out in five primary schools located in Newcastle upon Tyne, UK, in neighbourhoods chosen for their variability in IMD (index of multiple deprivation) and spatial structure of street networks (measured through space syntax measure of integration). A randomly selected and heterogenic sample of 145 pupils (aged 9–10) completed an open-ended questionnaire to state what they like and dislike about their journey to school. Thematic analysis identified four typologies (environmental context, emotions, social influences and trip factors) based on the Theoretical Domains Framework (TDF) and specific themes and sub-themes underlying children’s affective experiences of their journeys to school. This study is the first known to authors to attempt to adapt the Capability, Opportunity and Motivation Behaviour (COM-B) model into AST and children’s experiences and associated behavioural domains with design aspects. Such an insight into children’s attitudes could inform urban planners and designers about how to apply more effective behaviour change interventions, targeting an AST increase among children.

How Do Urban Environments Affect Young People's Mental Health? A Novel Conceptual Framework to Bridge Public Health, Planning, and Neurourbanism

Childhood and adolescence are crucial periods for mental and social development. Currently, mental illness among young people is a global epidemic, and rates of disorders such as depression and anxiety are rising. Urban living, compared with rural living, is linked with a higher risk of serious mental illness, which is important because the world is urbanizing faster than ever before. Urban environments and their landscapes, designs, and features influence mental health and well-being. However, no conceptual frameworks to date have detailed the effect of urban environments on young people's mental health, and few studies have considered the growing role of digital and social media in this relationship, leading to calls for the development of holistic approaches to describe this relationship. This article synthesizes existing knowledge on urban places (both built and natural environments) and mental health in the public health and urban planning literature and examines the emerging field of neurourbanism (a multidisciplinary study of the effect of urban environments on mental health and brain activity) to enhance current practice and research. We developed 2 novel conceptual frameworks (1 research-oriented, 1 practice-oriented), adapted from Bronfenbrenner's socioecological model, that focus on the relationship between urban environments and young people's mental health. We added a digital and social media contextual level to the socioecological model, and we applied a multilayer concept to highlight potential cross-field interactions and collaborations. The proposed frameworks can help to guide future practice and research in this area.

A cross-sectional study of the impact of school neighbourhood on children obesity and body composition

Schools' neighbourhoods provide an important environmental context that may influence the risk of obesity among children. The aim of this study was to assess the effect of neighbourhood surrounding schools on obesity and body composition in schoolchildren. Data on 845 children aged 7 to 12 years old from 20 primary schools were considered. Anthropometric measurements and bioelectrical impedance analysis were performed to assess body mass index (BMI) and characterize body composition. Land use characteristics were quantified within a 500-m buffer zone around schools. Mixed-effect models measured the effects of school neighbourhood on obesity and body composition. The results showed a tendency between green urban areas around schools and lower values of BMI and better body composition parameters compared with built areas, being BMI z-scores CDC, and body fat percentage significantly higher in-built than in green urban areas (β = 0.48, 95% CI 0.05; 0.90, and β = 2.56, 95% CI 0.39; 4.73, respectively).Conclusion: Our findings suggest that the school neighbourhood has an effect on BMI and body fat percentage in schoolchildren. These results may contribute to the creation of healthier cities and help reduce health expenses by focusing on prevention programmes towards the expansion of green spaces. What is Known: • Living in greener areas has been associated with healthy weight outcomes and to the lower impact of obesogenic urban environments. • The school environment may be especially important for youth health outcomes. What is New: • Neighbourhoods around schools may affect child health, specifically the development of obesity. • The presence of urban green areas around school may promote a framework of lifestyle or behaviours conducive to achieving a healthy weight.

Are school-based measures of walkability and greenness associated with modes of commuting to school? Findings from a student survey in Ontario, Canada

OBJECTIVES

In Canada, students are increasingly reliant on motorized vehicles to commute to school, and few meet the recommended overall physical activity guidelines. Infrastructure and built environments around schools may promote active commuting to and from school, thereby increasing physical activity. To date, few Canadian studies have examined this research question.

METHODS

This study is a cross-sectional analysis of 11,006 students, aged 11-20, who participated in the 2016/2017 Ontario Student Drug Use and Health Survey. The remote sensing-derived Normalized Difference Vegetation Index (NDVI), at a buffer of 500 m from the schools' locations, was used to characterize greenness, while the 2016 Canadian Active Living Environments (Can-ALE) measure was used for walkability. Students were asked about their mode of regular commuting to school, and to provide information on several socio-demographic variables. Multivariable logistic regression models were used to quantify associations between active commuting and greenness and the Can-ALE. The resulting odds ratios, and their 95% confidence intervals, were adjusted for a series of risk factors that were collected from the survey.

RESULTS

Overall, 21% of students reported active commuting (biking or walking) to school, and this prevalence decreased with increasing age. Students whose schools had higher Can-ALE scores were more likely to be active commuters. Specifically, the adjusted odds ratio (OR) of being an active commuter for schools in the highest quartile of the Can-ALE was 2.11 (95% CI = 1.64, 2.72) when compared with those in the lowest. For children, aged 11-14 years, who attended schools in high dwelling density areas, a higher odds of active commuting was observed among those in the upper quartile of greenness relative to the lowest (OR = 1.41; 95% CI = 0.92, 2.15). In contrast, for lower dwelling density areas, greenness was inversely associated with active commuting across all ages.

CONCLUSION

Our findings suggest that students attending schools with higher Can-ALE scores are more likely to actively commute to school, and that positive impacts of greenness on active commuting are evident only in younger children in more densely populated areas. Future studies should collect more detailed data on residential measures of the built environment, safety, distance between home and school, and mixed modes of commuting behaviours.

Assessing Walking and Cycling around Schools

To encourage students to walk and cycle to school and ensure their health and safety, it is essential to provide safe and operationally efficient infrastructure around schools. This study used an audit tool to assess the infrastructure and environment around schools in the city of Doha, Qatar, with a particular emphasis on active transport (walking and cycling). The aim was to identify strengths, weaknesses, and areas for improvement. Twenty-two schools with varied education levels were assessed. Among all assessed categories, active transport items scored the lowest, requiring the most improvements. A detailed analysis was conducted based on school type (elementary, primary, high, and mixed-schools) and revealed similar results except for elementary schools (scored acceptable for active transport). The study revealed that adding bike lanes, installing bicycle parking, and providing good separation of travel modes are the most needed improvements at school sites. In summary, improving active transport could significantly improve the overall quality of the infrastructure around schools in Qatar. Such improvements could greatly encourage more school children to walk and cycle to school instead of being primarily dropped-off and picked up by their parents’ vehicles or school buses.

Traffic Safety Perception, Attitude, and Feeder Mode Choice of Metro Commute: Evidence from Shenzhen

Like many other transit modes, the metro provides stop-to-stop services rather than door-to-door services, so its use undeniably involves first- and last-mile issues. Understanding the determinants of the first- and last-mile mode choice is essential. Existing literature, however, mostly overlooks the mode choice effects of traffic safety perception and attitudes toward the mode. To this end, based on a face-to-face questionnaire survey in Shenzhen, China, this study uses the two-sample t-test to confirm the systematic differences in traffic safety perception and attitudes between different subgroups and develops a series of multinomial logistic (MNL) models to identify the determinants of first- and last-mile mode choice for metro commuters. The results of this study show that: (1) Walking is the most frequently used travel mode, followed by dockless bike-sharing (DBS) and buses; (2) Variances in traffic safety perception and attitude exist across gender and location; (3) Vehicle-related crash risks discourage metro commuters from walking to/from the metro station but encourage them to use DBS and buses as feeder modes; (4) DBS–metro integration is encouraged by the attitude that DBS is quicker than buses and walking, and positive attitudes toward the bus and DBS availability are decisive for the bus–metro and DBS–metro integration, respectively; and (5) Substantial differences exist in the mode choice effects of traffic safety perception and attitudes for access and egress trips. This study provides a valuable reference for metro commuters’ first- and last-mile travel mode choice, contributing to developing a sustainable urban transport system.

Keeping kids safe for active travel to school: A mixed method examination of school policies and practices and children's school travel behaviour

Active school travel contributes to children's physical, mental and social wellbeing. The prevalence of children's active school travel, however, has been declining in many developed countries. Gaining insights into school culture and environments in relation to school travel behaviour is crucial to inform interventions. Using a multiphase mixed methods approach, this study aimed to provide a comprehensive understanding of how school policies and practices supported or inhibited school travel behaviour in Auckland, New Zealand. Data were drawn from Neighbourhoods for Active Kids, a cross-sectional study of 1085 children aged 8-13 years between February 2015 and December 2016. School representatives were interviewed regarding their policies and practices related to school travel behaviour and traffic around school, and the data were analysed thematically. An overarching theme, sub-themes and categories were contextualised for quantitative modelling using objectively measured school variables (school socioeconomic status, active school travel programme, built environments around school). Mixed effects multinomial logistic regression models were employed to determine associations between school travel mode and objectively measured child (sociodemographic characteristics, traffic safety perceptions) and school variables. Safety was the core concept of school travel policies, procedures and programmes. Significant differences in child variables, school socioeconomic status, and cycle lanes and traffic lights around school were found between children who actively travelled or used public transport to school and those driven to school. Overall, this study demonstrated the important role of school policy and procedures and the potential application of an intersectoral approach for interventions to support changes in school travel behaviour.

Different neighborhood walkability indexes for active commuting to school are necessary for urban and rural children and adolescents

BACKGROUND

Literature focusing on youth has reported limited evidence and non-conclusive associations between neighborhood walkability measures and active commuting to and from school (ACS). Moreover, there is a lack of studies evaluating both macro- and micro-scale environmental factors of the neighborhood when ACS is analyzed. Likewise, most studies on built environment attributes and ACS focus on urban areas, whereas there is a lack of studies analyzing rural residential locations. Moreover, the relationship between built environment attributes and ACS may differ in children and adolescents. Hence, this study aimed to develop walkability indexes in relation to ACS for urban and rural children and adolescents, including both macro- and micro-scale school-neighborhood factors.

METHODS

A cross-sectional study of 4593 participants from Spain with a mean age of 12.2 (SD 3.6) years was carried out. Macro-scale environmental factors were evaluated using geographic information system data, and micro-scale factors were measured using observational procedures. Socio-demographic characteristics and ACS were assessed with a questionnaire. Several linear regression models were conducted, including all the possible combinations of six or less built environment factors in order to find the best walkability index.

RESULTS

Analyses showed that intersection density, number of four-way intersections, and residential density were positively related to ACS in urban participants, but negatively in rural participants. In rural children, positive streetscape characteristics, number of regulated crossings, traffic calming features, traffic lanes, and parking street buffers were also negatively related to ACS. In urban participants, other different factors were positively related to ACS: number of regulated crossings, positive streetscape characteristics, or crossing quality. Land use mix acted as a positive predictor only in urban adolescents. Distance to the school was a negative predictor on all the walkability indexes. However, aesthetic and social characteristics were not included in any of the indexes.

CONCLUSIONS

Interventions focusing on improving built environments to increase ACS behavior need to have a better understanding of the walkability components that are specifically relevant to urban or rural samples.

School Walkability Index: Application of Environmental Audit Tool and GIS

INTRODUCTION

Active school travel is an important way to promote children's physical activity, but it requires supportive environments that can safely and comfortably accommodate children's walking and biking. Few existing indices explicitly consider school neighborhood environmental factors related to children's walking to school. In this study, we used a street audit tool and Geographic Information System (GIS) to evaluate walkability near low-income elementary schools in Seattle, WA.

METHODS

The audit-based school walkability index was developed based on all street segments (n=841) within a 0.4km network buffer from each study school (n=18). The GIS-based school walkability, a combination of road connectivity, vehicular traffic exposure, and residential density, was also measured in a 2km network buffer around each school. The participants were individuals aged 8-11 years (n=315) who participated in the Walking School Bus randomized controlled trial project. Mixed-effects logistic and linear models were used to examine the association of the index's representations of the built environment with children's school travel mode (walking or biking to school 1+ times per week) and with objectively measured moderate-to-vigorous physical activity (MVPA, average weekday minutes during the 90-min before-school period). These associations were tested with the total sample as well as the subsample of children living within 1.5km from their schools.

RESULTS

The audit-based school walkability index (WI) was positively associated with both active commuting to school among the subsample living within 1.5km from their schools and with children's before-school MVPA among the subsample and the total sample. The GIS-based school WI showed significant associations with children's before-school MVPA but no relationships with active school travel among the subsample and the total sample.

CONCLUSION

The audit-based school walkability index can be used as a complementary tool for measuring walkability near low-income elementary schools along with existing GIS-based school walkability index.

Walkability and Fitness Center Prices, Opening Hours, and Extra Services: The Case of Madrid, Spain

Walkability has been associated with urban development and political plans, contributing to more connected cities with improvements in communication, shopping, and pedestrian base. Among these services, fitness centers are becoming important elements for communities due to their impact on the health and welfare of citizens. The present study aims to examine how an area’s Walk Score^® affects fitness center services, specifically membership costs, opening hours, and aquatic services. Data from 193 fitness centers were retrieved, representing all the areas of the municipality of Madrid, Spain, including fitness centers in the 21 city districts. A nonlinear relationship between an area’s Walk Score^® and fitness centers’ monthly fees is observed. Only in premium fitness centers, a weak curvilinear model is observed, following a quadratic equation, showing that fitness centers with higher prices are in less walkable areas. Additionally, the association between Walk Score^® and a fitness center’s opening hours reveals that fitness centers with wider hours of operation tend to be in moderately to highly walkable locations. Lastly, the existence of a swimming pool is related to a lower Walk Score^®. Thus, fitness centers in less walkable areas try to offer additional services as differentiation from competitors, whereas centers in walkable locations use this advantage as a strength.

The relationship between living in urban and rural areas of Scotland and children's physical activity and sedentary levels: a country-wide cross-sectional analysis

Background

Living in urban or rural environments may influence children’s levels of physical activity and sedentary behaviours. We know little about variations in device-measured physical activity and sedentary levels of urban and rural children using nationally representative samples, or if these differences are moderated by socioeconomic factors or seasonal variation. Moreover, little is known about the influence of ‘walkability’ in the UK context. A greater understanding of these can better inform intervention strategies or policy initiatives at the population level.

Methods

Country-wide cross-sectional study in Scotland in which 774 children (427 girls, 357 boys), aged 10/11 years, wore an accelerometer on one occasion for at least four weekdays and one weekend day. Mean total physical activity, time spent in sedentary, light, and moderate-to-vigorous physical activity (MVPA), per day were extracted for weekdays, weekend days, and all days combined. Regression analyses explored associations between physical activity outcomes, urban/rural residence, and a modified walkability index (dwelling density and intersection density); with interactions fitted for household equivalised income and season of data collection. Sensitivity analyses assessed variation in findings by socioeconomic factors and urbanicity.

Results

Rural children spent an average of 14 min less sedentary (95% CI of difference: 2.23, 26.32) and 13 min more in light intensity activity (95% CI of difference, 2.81, 24.09) per day than those from urban settlements. No urban-rural differences were found for time spent in MVPA or in total levels of activity. Our walkability index was not associated with any outcome measure. We found no interactions with household equivalised income, but there were urban/rural differences in seasonal variation; urban children engaged in higher levels of MVPA in the spring months (difference: 10 mins, p = 0.06, n.s) and significantly lower levels in winter (difference: 8.7 mins, p = 0.036).

Conclusions

Extrapolated across one-year, rural children would accumulate approximately 79 h (or just over 3 days) less sedentary time than urban children, replacing this for light intensity activity. With both outcomes having known implications for health, this finding is particularly important. Future work should prioritise exploring the patterns and context in which these differences occur to allow for more targeted intervention/policy strategies.

Urban-level environmental factors related to pediatric asthma

During the 20th century, urbanization has increasing and represented a major demographic and environmental change in developed countries. This ever-changing urban environment has an impact on disease patterns and prevalence, namely on noncommunicable diseases, such as asthma and allergy, and poses many challenges to understand the relationship between the changing urban environment and the children health. The complex interaction between human beings and urbanization is dependent not only on individual determinants such as sex, age, social or economic resources, and lifestyles and behaviors, but also on environment, including air pollution, indoors and outdoors, land use, biodiversity, and handiness of green areas. Therefore, the assessment and identification of the impact of urban environment on children's health have become a priority and many recent studies have been conducted with the goal of better understanding the impacts related to urbanization, characterizing indoor air exposure, identifying types of neighborhoods, or characteristics of neighborhoods that promote health benefits. Thus, this review focuses on the role of urban environmental factors on pediatric asthma.

Active commute to school: does distance from school or walkability of the home neighbourhood matter? A national cross-sectional study of children aged 10-11 years, Scotland, UK

OBJECTIVES

To study the extent to which home-to-school distance and neighbourhood walkability were associated with self-reported active travel to school (ATS) (eg, walking, cycling), and to explore how distance moderates the effect of walkability on ATS, among 10-11 years old.

DESIGN

Cross-sectional study.

SETTING

Data were collected between May 2015 and May 2016 in partnership with the Growing Up in Scotland Study, a nationally representative longitudinal cohort study.

PARTICIPANTS

713 children (male (n=330) and female (n=383) 10-11 years old) from Studying Physical Activity in Children's Environments across Scotland.

PRIMARY AND SECONDARY OUTCOME MEASURES

Children who actively travelled to/from school categorised as active all (100% of ATS) and active 60%+ (at least 60% of ATS); home-to-school road/path network distance (<0.5 km, 0.5 to <1 km, 1 to <1.5 km, 1.5 to <2 km, 2 km+); home neighbourhood walkability (i.e., composite measure of road/path intersection density and dwelling density) (in quintiles).

RESULTS

Distance and walkability were both associated with ATS. The likelihood of ATS for all or most journeys decreased with increasing distance. Compared with 'most' walkable areas (Q1), the odds of active all were significantly lower within least walkable areas (Q5 OR 0.45, 95% CI 0.21 to 0.99), and odds of active 60%+ were significantly less in Q2-Q5 (lowest odds Q5 OR 0.20, 95% CI 0.07 to 0.47). Regarding walkability and distance interactions, for all distance categories, higher walkability increased the probability of ATS (for most school journeys).

CONCLUSION

Walkability was positively associated with ATS within all distance categories, with the relationship between walkability and ATS more complex than the clear-cut association between distance and ATS. A more walkable environment had a larger effect on the probability of reaching the 60% threshold of school journeys using ATS than the probability of always travelling in an active manner. Investment is needed in existing less walkable neighbourhoods to provide infrastructure to support opportunities for children's ATS.

Development, Validation, and Application of School Audit Tool (SAT): An Effective Instrument for Assessing Traffic Safety and Operation around Schools

There is a need for a reliable school audit tool with well-defined scales to convert qualitative evaluation of existing school sites into a quantitative assessment in order to help public agencies to improve schools’ safety and efficiency. In this study, a new, simple, and versatile School Audit Tool (SAT) was developed and tested. SAT was formed using a 30-item checklist categorized into four domains: school site assessment, road network assessment, parking/loading assessment, and active transport assessment. The tool was applied on a sample of 22 schools. Then, categorical and item-by-item Intraclass Correlation Coefficients (ICC) were calculated to validate the tool. The results showed acceptable overall test-retest (ICC = 0.919) and inter-rater reliability (ICC = 0.843) across all items and domains. SAT’s adaptable framework to assess and compare the safety and efficiency of schools is reliable, easy-to-use, and comprehensive. The tool is also effective in ranking schools and identifying items that may require upgrades or modifications.

School environment associates with lung function and autonomic nervous system activity in children: a cross-sectional study

Children are in contact with local environments, which may affect respiratory symptoms and allergic sensitization. We aimed to assess the effect of the environment and the walkability surrounding schools on lung function, airway inflammation and autonomic nervous system activity. Data on 701 children from 20 primary schools were analysed. Lung function, airway inflammation and pH from exhaled breath condensate were measured. Pupillometry was performed to evaluate autonomic activity. Land use composition and walkability index were quantified within a 500 m buffer zone around schools. The proportion of effects explained by the school environment was measured by mixed-effect models. We found that green school areas tended to be associated with higher lung volumes (FVC, FEV1 and FEF25-75%) compared with built areas. FVC was significantly lower in-built than in green areas. After adjustment, the school environment explained 23%, 34% and 99.9% of the school effect on FVC, FEV1, and FEF25-75%, respectively. The walkability of school neighbourhoods was negatively associated with both pupil constriction amplitude and redilatation time, explaining -16% to 18% of parasympathetic and 8% to 29% of sympathetic activity. Our findings suggest that the environment surrounding schools has an effect on the lung function of its students. This effect may be partially mediated by the autonomic nervous system.

The Importance of Pedestrian Network Connectivity for Adolescent Health: A Cross-sectional Examination of Associations between Neighbourhood Built Environments and Metabolic Health in the Pacific Islands Families Birth Cohort Study

The research aim was to investigate associations between objectively-assessed built environment attributes and metabolic risk in adolescents of Pacific Islands ethnicity, and to consider the possible mediating effect of physical activity and sedentary time. Youth (n = 204) undertook a suite of physical assessments including body composition, blood sampling, and blood pressure measurements, and seven day accelerometry. Objective measures of the neighbourhood built environment were generated around individual addresses. Logistic regression and linear modelling were used to assess associations between environment measures and metabolic health, accounting for physical activity behaviours. Higher pedestrian connectivity was associated with an increase in the chance of having any International Diabetes Federation metabolic risk factors for males only. Pedestrian connectivity was related to fat free mass in males in unadjusted analyses only. This study provides evidence for the importance of pedestrian network connectivity for health in adolescent males. Future research is required to expand the limited evidence in neighbourhood environments and adolescent metabolic health.

Travel-To-School Mode Choice Modelling Employing Artificial Intelligence Techniques: A Comparative Study

Many techniques including logistic regression and artificial intelligence have been employed to explain school-goers mode choice behavior. This paper aims to compare the effectiveness, robustness, and convergence of three different machine learning tools (MLT), namely the extreme learning machine (ELM), support vector machine (SVM), and multi-layer perceptron neural network (MLP-NN) to predict school-goers mode choice behavior in Al-Khobar and Dhahran cities of the Kingdom of Saudi Arabia (KSA). It uses the students’ information, including the school grade, the distance between home and school, travel time, family income and size, number of students in the family and education level of parents as input variables to the MLT. However, their outputs were binary, that is, either to choose the passenger car or walking to the school. The study examined a promising performance of the ELM and MLP-NN suggesting their significance as alternatives for school-goers mode choice modeling. The performances of the SVM was satisfactory but not to the same level of significance in comparison with the other two. Moreover, the SVM technique is computationally more expensive over the ELM and MLP-NN. Further, this research develops a majority voting ensemble method based on the outputs of the employed MLT to enhance the overall prediction performance. The presented results confirm the efficacy and superiority of the ensemble method over the others. The study results are likely to guide the transport engineers, planners, and decision-makers by providing them with a reliable way to model and predict the traffic demand for transport infrastructures on the basis of the prevailing mode choice behavior.

Children's Transport Built Environments: A Mixed Methods Study of Associations between Perceived and Objective Measures and Relationships with Parent Licence for Independent Mobility in Auckland, New Zealand

Children's independent mobility is declining internationally. Parents are the gatekeepers of children's independent mobility. This mixed methods study investigates whether parent perceptions of the neighbourhood environment align with objective measures of the neighbourhood built environment, and how perceived and objective measures relate to parental licence for children's independent mobility. Parents participating in the Neighbourhood for Active Kids study (n = 940) answered an open-ended question about what would make their neighbourhoods better for their child's independent mobility, and reported household and child demographics. Objective measures of the neighbourhood built environment were generated using geographic information systems. Content analysis was used to classify and group parent-reported changes required to improve their neigbourhood. Parent-reported needs were then compared with objective neighbourhood built environment measures. Linear mixed modelling examined associations between parental licence for independent mobility and (1) parent neighbourhood perceptions; and (2) objectively assessed neighbourhood built environment features. Parents identified the need for safer traffic environments. No significant differences in parent reported needs were found by objectively assessed characteristics. Differences in odds of reporting needs were observed for a range of socio-demographic characteristics. Parental licence for independent mobility was only associated with a need for safer places to cycle (positive) and objectively assessed cycling infrastructure (negative) in adjusted models. Overall, the study findings indicate the importance of safer traffic environments for children's independent mobility.

Assessment of direct and indirect associations between children active school travel and environmental, household and child factors using structural equation modelling

BACKGROUND

Active school travel (AST) is influenced by multiple factors including built and social environments, households and individual variables. A holistic theory such as Mitra's Behavioural Model of School Transportation (BMST) is vital to comprehensively understand these complex interrelationships. This study aimed to assess direct and indirect associations between children's AST and environmental, household and child factors based on the BMST using structural equation modelling (SEM).

METHODS

Data were drawn from Neighbourhoods for Active Kids (NfAK), a cross-sectional study of 1102 children aged 8-13 years (school years 5-8) and their parents from nine intermediate and 10 primary schools in Auckland, New Zealand between February 2015 and December 2016. Data were collected using an online participatory mapping survey (softGIS) with children, a computer-assisted telephone interviewing survey (CATI) with parents, and ArcGIS for built environment attributes. Based on the BMST a conceptual model of children's school travel behaviour was specified for SEM analyses ('hypothesised SEM'), and model modification was made to improve the model ('modified SEM'). SEM analyses using Mplus were performed to test the hypothesised/modified SEM and to assess direct and indirect relationships among variables.

RESULTS

The overall fit of the modified SEM was acceptable (N = 542; Root mean square error of approximation = 0.04, Comparative fit index = 0.94, Tucker-Lewis index = 0.92). AST was positively associated with child independent mobility, child-perceived neighbourhood safety, and parent-perceived importance of social interaction and neighbourhood social environment. Distance to school, and parental perceptions of convenience and concerns about traffic safety were negatively associated with AST. Parental fears of stranger danger were indirectly related to AST through those of traffic safety. Distance to school and child independent mobility mediated relationships between AST and child school year and sex.

CONCLUSIONS

Increasing children's AST requires action on multiple fronts including communities that support independent mobility by providing child friendly social and built environments, safety from traffic, and policies that promote local schools and safe vehicle-free zones around school.

Do Not Forget About Public Transportation: Analysis of the Association of Active Transportation to School Among Washington, DC Area Children With Parental Perceived Built Environment Measures

BACKGROUND

Although the active transportation (AT) indicator received an F grade on the 2016 US Report Card on Physical Activity for Children and Youth, this AT assessment excluded public transportation. An objective of the Built Environment and Active Play Study was to assess youth AT, including public transportation, among Washington, DC area children in relation to parental perceptions of neighborhood built environment (BE) variables.

METHODS

Questionnaires were mailed to 2000 parents of children aged 7-12 years. AT to school (ATS) was assessed with the question: "In an average school week, how many days does your child use each of the following ways to get to and from school? (a) Walk; (b) Bike; (c) Car; (d) Bus or Metro." Parental perceived BE data were obtained through questionnaire items, and logistic regression was conducted to determine if BE variables were associated with youth ATS.

RESULTS

The sample included 144 children (50% female; average age 9.7 years; 56.3% white; 23.7% African American; 10.4% Asian American). Over 30% used ATS-public transportation 5 days per week, and nearly 13% used ATS-walking daily. Parental perceived BE variables significantly predicted youth ATS-walking and ATS-public transportation.

CONCLUSIONS

ATS-public transportation is common among Washington, DC area youth, and parental perceptions of BE can significantly predict ATS.

The Built Environment and Child Health: An Overview of Current Evidence

Urbanization and the shaping of the built environment have provided a number of socioeconomic benefits, but they have also brought unwanted side effects on health. We aimed to review the current epidemiological evidence of the associations between the built environment, closely related exposures, and child health. We focused on growth and obesity, neuropsychological development, and respiratory and immune health. We used existing review articles and supplemented these with relevant work published and not included in existing reviews. The present review shows that there is good evidence for an association between air pollution and fetal growth restriction and respiratory health, whereas for other exposure and outcome combinations, further evidence is needed. Future studies should make efforts to integrate the different built environment features and to include the evaluation of environments other than home, as well as accessibility, qualitative and perception assessment of the built environment, and, if possible, with improved and standardized tools to facilitate comparability between studies. Efforts are also needed to conduct longitudinal and intervention studies and to understand potential mechanisms behind the associations observed. Finally, studies in low- and middle-income countries are needed.

Are Measures Derived From Land Use and Transport Policies Associated With Walking for Transport?

Background: There is growing urgency for higher quality evidence to inform policy. This study developed geographic information system spatial measures based on land use and transport policies currently used in selected Australian states to assess which, if any, of these measures were associated with walking for transport. Methods: Overall, 6901 participants from 570 neighborhoods in Brisbane, Australia, were included. Participants reported their minutes of walking for transport in the previous week. After a review of state-level land use and transport policies relevant to walking for transport across Australia, 7 geographic information system measures were developed and tested based on 9 relevant policies. Data were analyzed using multilevel multinomial logistic regression. Results: Greater levels of walking for transport were associated with more highly connected street networks, the presence of public transport stops, and having at least 2 public transport services per hour. Conversely, neighborhoods with shorter cul-de-sac lengths had lower levels of walking for transport. There was no evidence of associations between walking for transport and street block lengths less than 240 m or traffic volumes. Conclusions: These findings highlight the need for urban design and transport policies developed by governments to be assessed for their impact on transport-related physical activity.

Neighborhood Built Environment and Socioeconomic Status in Relation to Active Commuting to School in Children

Background:

The role of neighborhood type in active commuting to school (ACS) has not been extensively studied in children. The purpose of this study was to analyze the association between neighborhood built environment (walkability) and neighborhood socioeconomic status (SES) with ACS among children.

Methods:

A cross-sectional study of 310 Spanish children (aged 10–12 y; 51% male) was conducted in 2015. Walkability was defined as an index of 3 built environment characteristics (ie, residential density, land-use mix, and street connectivity) based on geographical information system data. Children’s home and school neighborhoods were evaluated. ACS was evaluated by questionnaire. Mixed model regression analyses evaluated ACS in relation to neighborhood walkability and SES.

Results:

There were no significant SES–walkability interactions for ACS. Children living in more walkable neighborhoods reported 2.5 more trips per week compared with those living in less walkable neighborhoods (P < .001). Children attending schools located in lower SES neighborhoods reported more ACS trips per week than those attending schools in higher SES neighborhoods (P < .05).

Conclusions:

Home-neighborhood walkability and school-neighborhood SES were associated with ACS. This study highlights the importance of assessing children’s home environment and school environment when ACS behavior is analyzed.